Purpose: Dysphagia may occur in all critically ill patients, and large-scale clinical data show that post-extubation dysphagia (PED) is commonly observed in intensive care unit (ICU) patients. The study aimed to determine how dysphagia is diagnosed after extubation, and what factors influence the incidence of dysphagia after invasive airway support in selected ICUs. Methods: A prospective observational study was conducted for five months (07/2023 to 11/ 2023), in the acute ICU and long-term ICU of the Teaching hospital in the Czech Republic. Results: Of the 101 extubated patients in the study, only 27.7% (n = 28) were examined by a physician, and PED was confirmed in 26.7% (n = 27), representing 99% of all extubated patients. Age, gender, and ICU type were not significantly related to PED occurrence. However, the type of airway management (p < 0.001), duration of mechanical ventilation (p = 0.017), and main diagnosis (p < 0.001) were significantly associated with PED occurrence. Conclusion: The study confirmed the underdiagnosis of PED in ICU patients post-extubation. Higher PED incidence was linked to tracheostomy + endotracheal cannula use, mechanical ventilation longer than 9 days, and neurological diagnoses. Training health professionals to identify PED symptoms is essential to establish uniform procedures for diagnosing and preventing PED-related complications.
Cíle: V roce 2022 byl připraven adaptovaný Klinický doporučený postup (KDP) zahrnující diagnos- ticko-terapeutické postupy u pacientů s Parkinsonovou nemocí. Doporučení mají pomoci odborníkům z klinické praxe v rozhodovacích schopnostech a cílem KDP je zkvalitnění poskytovaných služeb na národní úrovni a zefektivnění nákladovosti. Metodika: Retrospektivní dotazníkový průzkum s cílem ověřit využití KDP odborníky z klinické praxe (lékaři a nelékařští zdravotničtí pracovníci). Sběr dat byl realizován od začátku června do konce července v roce 2023 sdílením na webovém portále České neurologické společnosti (ČNS) a Extrapyramidovou sekcí ČNS v elektronické podobě. Využit byl dotazník vlastní konstrukce a data byla analyzována pomocí deskriptivní analýzy. Výsledky: Průzkumu se zúčastnilo celkem 51 respondentů (30 žen a 21 mužů) průměrného věku 43,3 roku. V souboru bylo zastoupeno 31 lékařů, tj. 61 % (12 ambulantní péče a 19 lůžková péče), a 20 sester, tj. 39 % (11 ambulantní péče a 9 lůžková péče), s průměrnou délkou klinické praxe 15,2 roku. Využívání KDP v plném znění neuvedla ani jedna všeobecná sestra ve srovnání s lékaři, kde jich šest uvedlo využívání KDP (p = 0,036) a ohodnotilo jej ve vysoké kvalitě. V souvislosti s dalšími návrhy na aktualizaci KDP bylo doporučeno doplnění nových léčivých přípravků (n = 5) a komplexní rozpracování informací pro pacienty (n = 2). Závěr: Parkinsonova nemoc představuje významnou ekonomickou zátěž pro zdravotnické systémy a snížení kvality života pro pacienty v rámci postupné progrese onemocnění. KDP na národní úrovni má za cíl snižovat geografické, demografické a další rozdíly v přístupu k pacientům. Bude realizována pravidelná aktualizace KDP diagnostiky a léčby Parkinsonovy nemoci dle potřeb Extrapyramidové sekce. Doplněna budou doporučení s posledními registrovanými léčivy a diagnosticko- -terapeutickými postupy a také budou v rámci aktualizace připravena komplexní doporučení pro pacienty v laickém jazyce.
Aims: Adapted Clinical Practice Guidelines (CPG) covering diagnostic and therapeutic procedures for patients with Parkinson‘s disease were developed in 2022. The recommendations are intended to assist clinical practitioners in their decision-making abilities, and the CPG aims to improve the quality of services provided nationally including cost-effectiveness. Methodology: A retrospective questionnaire survey to examine the use of CPG by clinical practitioners (physicians and non-physician health professionals). Data collection was conducted from early June to late July in 2023 by sharing it electronically on the Czech Neurological Society (CNS) web portal and the Extrapyramidal Section of the CNS. A self-constructed questionnaire was used and data were analyzed using descriptive analysis. Results: A total of 51 respondents (30 women and 21 men) took part in the survey with an average age of 43.3 years. There were 31 physicians, i.e. 61% (12 ambulatory care and 19 inpatient care) and 20 nurses, i.e. 39% (11 ambulatory care and 9 inpatient care) with an average length of clinical experience of 15.2 years. None of the general nurses reported full use of CPG compared to physicians, where 6 of them reported using CPG (P = 0.036) and rated it as high quality. Other suggestions for updating the CPG included the addition of new medicines (N = 5) and comprehensive development of patient information (N = 2). Conclusion: Parkinson‘s disease represents a significant economic burden on healthcare systems and a reduction in quality of life for patients as the disease progresses. The national CPG aims to reduce geographic, demographic, and other disparities in patient access. Regular updates to the CPG on the diagnosis and treatment of Parkinson‘s disease will be implemented as required by the Extrapyramidal Section. Recommendations will be updated with the latest registered drugs and diagnostic and therapeutic procedures, and comprehensive recommendations for patients in lay language will be prepared as part of the update.
Burns are a major global healthcare concern, often complicated by the presence of bacteria such as Pseudomonas aeruginosa in the wounds. Silver-based dressings are commonly used in the treatment of burns but can cause skin irritation and delay healing time. Medical-grade honey (MGH) provides an interesting alternative. This study investigated the antimicrobial effects and possible cytotoxicity of L-Mesitran Soft (MGH-gel) and its individual components, Medihoney (Manuka), Flammazine (silver sulphadiazine), and silver nitrate (AgNO3) in an ex vivo human burn wound model. Bacterial survival and wound healing parameters, including re-epithelialization and keratinocyte proliferation were assessed. L-Mesitran, Flammazine, and AgNO3 reduced P. aeruginosa numbers below detection levels. L-Mesitran Soft exhibited a significantly stronger antimicrobial effect compared to Medihoney. The individual components of L-Mesitran contributed significantly to its antibacterial efficacy, thus suggesting synergistic activities. Moreover, L-Mesitran, Flammazine, and AgNO3 slightly inhibited re-epithelialization while Medihoney treatment resulted in a complete lack of re-epithelialization and keratinocyte proliferation. Furthermore, clinical cases illustrated the effectiveness of MGH therapy in infected burns. Overall, L-Mesitran Soft had similar effects as silver-based products on bacterial load and epidermal regeneration, but outperformed Medihoney. Therefore, supplemented MGH could be used as an effective alternative to silver-based dressings for P. aeruginosa-infected burns.
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
The essence and main focus of the project is the preparation and validation of the methodology for monitoring the cost of pressure ulcers (cost analyses) in hospitalized patients. The standard data on the occurrence and treatment of pressure ulcers during hospitalization will be collected and evaluated, followed by the creation of a special dataset to assess the cost of care for pressure ulcers (both curative/treatment and nursing interventions). The basis for data analysis will be existing registers, the hospital information system and the identification of benefits and limitations of data obtained from hospitalization records. The main applied output of the project will be a detailed methodology for monitoring the cost of pressure ulcers (comprehensive economical model) in hospitalized patients that can be used in clinical practice for inpatient providers of healthcare services.
Podstatou řešení projektu je příprava a ověření metodiky pro sledování nákladovosti dekubitů u hospitalizovaných pacientů. V projektu budou sbírána a vyhodnocována standardní data o výskytu a léčbě dekubitů, následně bude vytvořen speciální dataset umožňující posouzení nákladovosti péče o dekubity (léčebné i ošetřovatelské intervence). Východiskem pro analýzu dat budou stávající registry, nemocniční informační systém a identifikace benefitů a limitů údajů získaných z hospitalizačních záznamů. Hlavním aplikovaným výstupem projektu bude detailní metodika (ekonomický model) pro komplexní sledování nákladovosti dekubitů u hospitalizovaných pacientů využitelný v klinické praxi pro lůžkové poskytovatele zdravotních služeb.
- Klíčová slova
- analýza, dekubitus, nákladovost, nákladnost, pressure ulcer, cost, expensiveness, hospitalizační záznam, medical record, analyses,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
- MeSH
- časové faktory MeSH
- dekubity * terapie MeSH
- kvalita zdravotní péče MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- úvodníky MeSH
AIM: This study aimed to analyse cross-cultural differences in the prevalence of low back pain (LBP) and other back pain of general nurses in direct inpatient care in the Czech Republic (CZ) and Great Britain (GB). METHODS: The survey was used using an extended standardized Nordic Musculoskeletal Questionnaire and self-created additional questions. The data were analysed with Stata 15 using a significance level of 0.05. RESULTS: The data analysis was based on 1043 questionnaires. We identified statistically significant differences in the LBP prevalence between the respondents (CZ 93% and GB 85%) over a period of 12 months. Nurses in both countries stated a higher prevalence of LBP compared to pain in the neck, shoulders or upper back. LBP increases in relation to age, length of work experience, body mass index (BMI) and university education (BSc). Age, length of work experience, BMI and education (nursing college and master's degree) were confirmed as significant risks contributing to the increased prevalence of other back pain as well. Respondents reported a reduction in work performance, leisure activities and the need to change profession in relation to LBP. CONCLUSION: The results of the study confirm that LBP is a frequent occupational health issue in the general nurses working in direct inpatient care in both countries.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie * epidemiologie MeSH
- nemoci z povolání epidemiologie MeSH
- pilotní projekty MeSH
- prevalence MeSH
- průzkumy a dotazníky MeSH
- srovnání kultur * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
- Spojené království MeSH
BACKGROUND AND OBJECTIVE: The Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT methodology has been widely used to adopt, adapt, or de novo develop recommendations from existing or new guideline and evidence synthesis efforts. The objective of this guidance is to refine the operationalization for applying GRADE-ADOLOPMENT. METHODS: Through iterative discussions, online meetings, and email communications, the GRADE-ADOLOPMENT project group drafted the updated guidance. We then conducted a review of handbooks of guideline-producing organizations, and a scoping review of published and planned adolopment guideline projects. The lead authors refined the existing approach based on the scoping review findings and feedback from members of the GRADE working group. We presented the revised approach to the group in November 2022 (approximately 115 people), in May 2023 (approximately 100 people), and twice in September 2023 (approximately 60 and 90 people) for approval. RESULTS: This GRADE guidance shows how to effectively and efficiently contextualize recommendations using the GRADE-ADOLOPMENT approach by doing the following: (1) showcasing alternative pathways for starting an adolopment effort; (2) elaborating on the different essential steps of this approach, such as building on existing evidence-to-decision (EtDs), when available or developing new EtDs, if necessary; and (3) providing examples from adolopment case studies to facilitate the application of the approach. We demonstrate how to use contextual evidence to make judgments about EtD criteria, and highlight the importance of making the resulting EtDs available to facilitate adolopment efforts by others. CONCLUSION: This updated GRADE guidance further operationalizes the application of GRADE-ADOLOPMENT based on over 6 years of experience. It serves to support uptake and application by end users interested in contextualizing recommendations to a local setting or specific reality in a short period of time or with limited resources.
- MeSH
- lidé MeSH
- medicína založená na důkazech normy MeSH
- směrnice pro lékařskou praxi jako téma * normy MeSH
- systém GRADE normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
