This editorial discusses the recent study conducted by Macias et al., revealing that anesthesiologists' case volume history has only a marginal impact on improving operating room efficiency, resulting in minimal clinical significance. The idea that a specific anesthesia team or type of anesthesia could enhance productivity has been previously investigated, yielding similar conclusions. Although the study primarily focuses on the time from patient arrival to the completion of anesthesia induction, excluding the latter part of anesthesia-controlled time, Macias et al. have made a valuable contribution by challenging the prevalent notion that less experienced anesthesiologists adversely affect operating room efficiency.
- MeSH
- anesteziologie * MeSH
- anesteziologové * MeSH
- celková anestezie MeSH
- lidé MeSH
- operační sály MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
The primary medication non-adherence occurs when a patient does not collect his or her newly prescribed medication. Various studies give estimates that this occurs between 0.2 percent and 74 percent. Recently, this topic has been researched by analyzing data in national electronic prescription systems. The database of the Czech electronic prescription system was used to obtain the number of all prescriptions issued and collected in 2021 for fifty particular substances (associated with six medication groups). Additionally, a similar query was performed with an additional criterion that the same substance had not been prescribed within the last 365 days. The data were obtained separately in five age categories. The total number of prescriptions analyzed in this study was over 21 million, which represents almost 30 percent of all prescriptions issued in the Czech Republic in 2021. The primary medication non-adherence in the selected substances was 4.56 percent, which negatively correlates (rxy = 0.707) with the age of a patient. There is a higher primary non-adherence in the Psychoanaleptics and Lipid modifying medication groups than in the whole studied sample (p < 0.05). Lipid-modifying medication group and several other particular substances showed a larger difference between primary non-adherence and overall non-adherence, indicating issues in the initiation of these drugs. The results of our study are following earlier studies with similar methodologies from other countries. However, the difference between primary non-adherence and overall non-adherence had not been observed in other studies before. The electronic prescription system proved to be a valuable tool for conducting this type of research.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: European Union intends to enable cross-border health services through a program referred to as "MyHealth@EU". The first main service is the dispensation of medicine by interlinking national electronic prescription systems. The second one is the Patient Summary, which enables providing the basic set of patients' medical data. METHODS: The contemporary technical documentation of the project was studied and selected published Key Performance Indicators of the project were analyzed. Where necessary, data were acquired directly from the European Commission. RESULTS: Data from the start of the project (fourth quarter of 2019) until the second quarter of 2022 were analyzed. During this time both the overall number of EU countries with operational cross-border healthcare and their particular abilities in both services have risen. At present, there are eleven countries with capabilities in at least one of the services, of which nine have reported transactions. More countries are in the test phase now and will join the operational phase of the project shortly. DISCUSSION AND CONCLUSION: Nevertheless, the program is still used mostly for testing purposes. It seems that only electronic prescription and dispensation are commonly and widely used so far and only Estonian and Finnish patients usually get their medication dispensed abroad. The rest of the operational countries is still at present missing country pairs with a strong cross-border use case.
- MeSH
- elektronické předepisování * MeSH
- Evropská unie MeSH
- lidé MeSH
- poskytování zdravotní péče * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Studie EURASPIRE V, která bude pobíhat v letech 2017-2019, bude v cca 25 evropských zemích zjišťovat u pacientů původně hospitalizovaných s prokázanou ICHS, u jejich příbuzných I. stupně a u osob s vysokým kardiovaskulárním (KV) rizikem prevalenci rizikových faktorů ICHS a kontrolu KV rizika intervencí životního stylu a medikamentózní léčbou. Česká část studie EUROASPIRE V porovná úroveň prevence v ČR s požadavky evropských doporučení KV prevence z roku 2012 a 2016, se stavem prevence v dalších evropských zemích a časové trendy od roku 1995. Studie se věnuje také diagnostice a léčbě DM, fibrilace síní a srdečního selhání a některým dalším klinickým stavům a faktorům KV rizika. Aktuální analýza sekundární prevence ICHS, časové trendy a porovnání s dalšími evropskými zeměmi, analýza souboru vysokého KV rizika a substudie v definovaném souboru pacientů s prokázanou a intervenovanou ICHS, zaměřené na nové KV rizikové faktory, budou publikovány v časopisech s IF, recenzovaných časopisech bez IF a aplikovány při přípravě nových doporučení KV prevence.; The EUROASPIRE V Study will be carried out in 2017 -2019 in about 25 European countries. In patients treated previously in hospitals with established CHD, in their Ist-degree relatives and in persons at high cardiovascular (CV) risk, it will assess the prevalence of CHD risk factors and CHD risk control by lifestyle interventions and medication. The Czech EUROASPIRE V, as integral part of an international project, will compare the level of CV prevention in the Czech Republic with requirements of the European CV prevention guidelines, with the standard of prevention in other European countries and time trends since 1995. Diagnosis and treatment of diabetes mellitus, atrial fibrillation, heart failure and some other CV risk factors will be analysed in particular. In a sample of patients with confirmed CHD, substudies of new CV (CHD) risk factors will be carried out. Study results will be published in journals with IF and will be used in the preparation of the next CV prevention guidelines.
- MeSH
- farmakoterapie MeSH
- hodnocení rizik MeSH
- ischemická choroba srdeční epidemiologie prevence a kontrola MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- sekundární prevence metody MeSH
- životní styl MeSH
- Geografické názvy
- Československo MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- kardiologie
- angiologie
- preventivní medicína
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
Aterosklerózu a její klinické projevy charakterizuje pokračující zánět cévní stěny. Vrozené (inátní) a adaptivní imunitní mechanismy se uplatňují ve všech fázích aterosklerózy. Tíže zánětu, respektive pokročilejší proaterogenní imunitní aktivita zhoršují průběh kardiovaskulárních (KV) onemocnění. Snahy potlačit zánět a imunitní proaterogenní mechanismy se potýkají s řadou problémů, ale několik klinických studií již dosáhlo pozitivních výsledků. Podávání statinů má protizánětlivý efekt, naopak PCSK9 monoklonální protilátky protizánětlivý efekt nemají. Také SGLT2 inhibitory (glifloziny) mají prokázaný protizánětlivý účinek, což by částečně vysvětlovalo jejich protektivní KV efekt. Recentní studie COLCOT s kolchicinem a CANTOS s canakinumabem (monoklonální protilátka proti interleukinu 1beta) snížily zánětlivou aktivitu a KV mortalitu i incidenci jednotlivých KV endpointů. Jsou zvažovány i další cesty ovlivnění zánětu u aterosklerózy, např. blokace proaterogenních chemokinů specifickými protilátkami nebo intervence metabolismu zánětlivých buněk. Je vyvíjena vakcína proti PCSK9. Další studie se zřejmě zaměří na blokaci osy aktivní IL-1beta - IL-6, blokaci proaterogenních cytokinů a bude preferováno zařazení pacientů se známkami perzistujícího zánětu, s určením zánětlivé fáze a s přesným popisem aterosklerotické léze.
Atherosclerosis and its clinical manifestations are characterised by ongoing arterial wall inflammation. Innate and adaptive imunity patterns are involved in all stages of atherosclerosis. Intensity of inflammation, more advanced proatherogenic imunity activity enhance development of cardiovascular (CV) disease. Efforts to control inflammation and imune proatherogenic patterns face considerable problems, but recent clinical studies offer promissing results. Statins have antiinflammatory effect, but PCSK9 monoclonal antibodies not. SGLT2 inhibitors (gliflozins) have a proven antiinflammatory effect and this might partly explain their protective CV effect. Recent clinical studies, COLCOT with colchicine and CANTOS with cinakinumab decreased inflammatory activity, CV mortality and incidence of defined CV endpoints. Other approaches to control inflammation in atherosclerosis are considered, namely blocation of proatherogenic cytokins by specific antibodies and intervention of metabolism of inflammatory cells. Vaccination against PCSK9 is being developed. Further studies may aim on active IL-1beta - IL-6 axis blocation nad on blocation of proatherogenic cytosins. Patients with signs of persistent inflammation, with specified inflammatory stage and with atherosclerotic leasion more precisely defined will be included.
- MeSH
- antiflogistika nesteroidní terapeutické užití MeSH
- Aspirin terapeutické užití MeSH
- aterosklerotický plát * imunologie patofyziologie MeSH
- ateroskleróza * farmakoterapie imunologie patofyziologie MeSH
- chemokiny antagonisté a inhibitory MeSH
- hypolipidemika terapeutické užití MeSH
- kolchicin terapeutické užití MeSH
- LDL-cholesterol škodlivé účinky MeSH
- lidé MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- zánět diagnóza patofyziologie MeSH
- Check Tag
- lidé MeSH
The simple definition of Electronic prescription (EP) can be met by different approaches as encoding the whole data of a prescription to a QR-code or a memory card. Also, the data can be sent directly to a particular pharmacy. Still, a unified national system with central storage is the only way how to guarantee wide benefits - not only the basic ones but also the advanced such as exploiting the gathered data and using automated clinical decision support. The Czech Republic at present features a widely used national EP system for its development state-of -the art method of process modeling has been used. Most other EU countries are endowed with a similar system, although few exceptions (e.g., Germany with only a pilot phase) exist. Also, the interoperability of EP in the EU is still not widely developed with only four countries with this feature.
- MeSH
- COVID-19 MeSH
- elektronické zdravotní záznamy * MeSH
- Evropská unie MeSH
- lékové předpisy * MeSH
- lidé MeSH
- telemedicína MeSH
- výměna zdravotnických informací MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
AIMS: Studies on the incidence, acute and subsequent mortality from myocardial infarction are limited mostly to selected clinical cohorts and populations and cover relatively short periods. Our aim was to describe and analyse long-term trends on a national scale. METHODS: Acute myocardial infarction (AMI) was defined by the International Classification of Diseases (ICD)10; codes I21 and I22. Our natiowide 1994-2016 data on AMI mortality were obtained from the official mortality statistics (Czech Bureau of Statistics), data on morbidity (hospitalizations) from the National Register of Hospitalizations (Institute for Health Information and Statistics). For further analyses, data from the Czech EUROASPIRE I-V and Czech IMPACT studies were used. RESULTS: Over the 1994-2016 period the total number of AMI cases per year decreased from 34,084 to 19,015, that of patients hospitalized for AMI from 22,373 to 15,419, the total number of deaths due to AMI from 14,834 to 4,673, in those treated because of AMI from 3,794 to 1,137, and hospital fatality in patients treated for AMI decreased from 17% to 7.5%. Over the years 1997-2016, the one-year all-cause mortality rate after AMI declined from 25.1 to 17.9%, cardiovascular (CV) mortality from 22.3 to 14.2%, five-year all-cause mortality from 41.7 to 34%, and CV mortality from 34.1 to 23.6%. CONCLUSION: The Czech Republic has witnessed a pronounced decrease in AMI incidence and fatality and, consequently, long-term mortality. The decreasing incidence and improving course of AMI are due to progress in primary prevention, in acute coronary care and interventional cardiology, and in secondary coronary heart disease (CHD) prevention.
- MeSH
- incidence MeSH
- infarkt myokardu * epidemiologie MeSH
- lidé MeSH
- morbidita MeSH
- mortalita v nemocnicích MeSH
- nemocnice MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
