BACKGROUND: Emergency medicine practice in the UK and Ireland offers a junior and middle grade doctor great learning opportunities that force engagement with multiple specialties, life-saving procedures, exposure to a myriad of patient presentations, and opportunities for best practices in medicine. MAIN BODY: The emergency department (ED) can be a hectic and dynamic environment; communication from the ED to specialists is essential to ensure best clinical outcomes for patients. The "per rectal" (PR) or "digital rectal exam" (DRE) can be a very difficult diagnostic test for even the most skilled operator to discern pathological versus normal; we propose this is especially the case in the emergency department patient population. Some specialists require this exam performed by an unskilled junior doctor with varying results prior to reviewing a referred and sick patient. The PR/DRE benefits may be limited in the ED setting for some pathologies, and the result of the exam may have limited impact in the overall treatment plan in the ED. CONCLUSION: This short paper reviews the indications, benefits, shortfalls, and limitations of the PR/DRE in the emergency department setting and offers novel alternatives to maximize best practice, ensure best clinical outcomes for patients, and, to first, do no harm.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVE: Public health status of populations is multifactorial and besides other factors it is linked to war and conflict. Public health crisis can erupt when states go to war or are invaded; health security may be reduced for affected populations. METHODS: This study reviews in aggregate multiple indices of human security, human development and legitimacy of the state in order to describe a predictable global health portrait. RESULTS: Paradigm shift of large global powers to that non-state actors and proxies impact regional influence through scaled conflict and present major global health challenges for policy makers. Small scale conflict with large scale violence threatens health security for at-risk populations. CONCLUSIONS: The paper concludes that health security is directly proportional to state security.
- MeSH
- bezpečnostní opatření * MeSH
- celosvětové zdraví * MeSH
- epidemický výskyt choroby MeSH
- lidé MeSH
- mezinárodní spolupráce MeSH
- rizikové faktory MeSH
- sociální prostředí MeSH
- vedení války * MeSH
- veřejná politika MeSH
- veřejné zdravotnictví * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high risk of disease progression led to a search for risk factors in CSI NSGCTT. The aim of this study was to analyze a 25-year single-center experience with risk-adapted therapeutic approaches-active surveillance (AS) versus adjuvant chemotherapy (ACT). PATIENTS AND METHODS: From January 1992 to January 2017, a total of 485 patients with CSI NSGCTT were stratified into the AS group (low-risk patients) and the ACT group (high-risk patients). Differences between relapse rates and overall survival rates in these groups were statistically analyzed. RESULTS: In the AS group, relapse occurred in 52 (17.3%) of 301 patients with a median follow-up of 7.2 months (range, 2-86 months). Six (2.0%) patients of this group died, with a median follow-up of 34.3 months (range, 11-102 months). In the ACT group, relapse occurred in 2 (1.1%) of 184 patients with a median follow-up of 56.2 months (range, 42-70 months). One (0.54%) patient died at 139.4 months following orchiectomy. The relapse rate for the AS group was 16.7 times higher than that for the ACT group. The groups did not differ in overall survival. The 3-year overall survival of all patients with CSI NSGCTT was 99.1% (95% confidence interval, 97.7%-99.7%). Three of a total of 7 deaths occurred thereafter. CONCLUSIONS: The policy of AS is recommended only in patients with low-risk CSI NSGCTT.
- MeSH
- adjuvantní chemoterapie metody mortalita MeSH
- analýza přežití MeSH
- dospělí MeSH
- germinální a embryonální nádory farmakoterapie mortalita chirurgie MeSH
- lidé MeSH
- management nemoci MeSH
- mladý dospělý MeSH
- pozorné vyčkávání metody MeSH
- recidiva MeSH
- staging nádorů MeSH
- testikulární nádory farmakoterapie mortalita chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: A new 'normal' in global affairs may be erupting from large global powers to that of non-state actors and proxies committing violence through scaled conflict in a post-Westphalian world generating significant global health policy challenges. Health security of populations are multifactorial and indirectly proportional to war, conflict and disaster. Preventing conflict and avoiding the health vacuum that occurs in war and violence may be best practices for policy makers. This paper considers an approach of applying clinical primary prevention principles to global health policy. METHODS: Brief policy review of current standards and practices in health security in fragile and failed states and prevention; and definitions discussion. A short case study series are presented with best practices, with risk and outcome review. RESULTS: The global balance of power and order may be shifting through geopolitical transference and inadequate action by major global power brokers. Health security in at risk nation-states may be decreasing as a result. CONCLUSION: Small scale conflict with large-scale violence threatens health security and may experience increased incidence and prevalence in fragile and failed states. Preventative policy to resuscitate fragile and failed states and prevent further external and internal shocks may support health and promote a positive feedback loop of further state stability and increased health security. Public health policy shift to mitigate state failure and public health crisis in war and conflict through the basis of primary prevention may provide best practices and maximize health security for at risk populations.
- MeSH
- celosvětové zdraví * MeSH
- lidé MeSH
- mezinárodní spolupráce * MeSH
- primární prevence metody MeSH
- veřejné zdravotnictví metody MeSH
- zdravotní politika * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Sýrie MeSH
- Ukrajina MeSH
The objective of this paper is an analysis of two main attributes of healthcare systems. First of the main attributes is the trend of ever growing expenditures of healthcare systems all across the world. Second attribute is the efficiency of chosen mixed healthcare systems, where mixed system is one which features involvement of both private and public sector. Countries chosen for analysis are USA as the country with high private sector influence on healthcare, France with its mediocre influence and Japan, where the private companies participate in health care but are very strictly regulated by a zero profit rule, and the Czech Republic, where public sector dominates the health care. The result is that the systems with higher influence of the private sector tend to have lesser occupancy, not significantly better performance and higher expenditures. This raise doubts whether the private sector brings anything of value for the patients within the healthcare system. However, more detailed analysis should be carried out to confirm or refuse this hypothesis.
- Klíčová slova
- soukromý vs veřejný sektor, trend růstu nákladů, neziskový princip financování zdravotnictví,
- MeSH
- financování organizované ekonomika trendy využití MeSH
- lidé MeSH
- náklady na zdravotní péči trendy MeSH
- soukromý sektor ekonomika trendy využití MeSH
- statistika jako téma MeSH
- veřejné zdravotnictví ekonomika trendy MeSH
- veřejný sektor ekonomika trendy využití MeSH
- výkonnost MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
- Francie MeSH
- Japonsko MeSH
- Spojené státy americké MeSH
On-the-fly surface hopping nonadiabatic photodynamical simulations using hybrid quantum mechanical/molecular mechanical approach of 4-aminopyrimidine were performed to model the relaxation mechanism of adenine within DNA double strand. The surrounding bases do not affect the overall ring-puckering relaxation mechanisms significantly, however, interesting hydrogen-bond dynamics is observed. First, formation of intra-strand hydrogen bonds is found. It is shown that this effect speeds up the decay process. In addition, the Watson–Crick structure is altered by breaking one of the inter-strand hydrogen bonds also leading to a decrease of the life time.
Tento článek se zabývá dvěma atributy zdravotnických systémů. Zaprvé jsou to neustále rostoucí výdaje na zdravotnictví, které jsou pozorovatelné všude v západním světě. Druhým bodem je výkonnost kombinovaného systému zdravotnictví ve vybraných zemích, přičemž kombinovaný systém financování je takový, kde hrají jak soukromý, tak veřejný sektor nezanedbatelnou roli. Vybranými zeměmi jsou – USA, jakožto země s nejvýznamnější rolí soukromého sektoru ve zdravotnictví, – Francie, kde je tento vliv soukromého sektoru slabší, a – Japonsko, kde je sice soukromý sektor vpuštěn do zdravotnictví, ale pod přísnou regulací pravidla nulového zisku. Výsledky jsou, že systémy s vlivnějším soukromým sektorem mají menší vytíženost, horší faktory kvality a vyšší výdaje. To nabízí hypotézu, že vliv soukromého sektoru na zdravotnictví je negativně korelován s jeho výkonností. Potvrzení či vyvrácení této hypotézy je přenecháno další podrobnější analýze.
This article analyses two attributes of health care systems. The first is the continual growth of health expenditure seen right across the western world; and the second is the efficiency of mixed health care systems in select countries, of which combined healthcare financing is one, with significant private and public sector involvement. The countries that have been selected are the – USA (as the country with the highest influence of the private sector in health care), – France (with its middling influence), and – Japan, where the private sector is allowed input into health care but is very strictly regulated by a zero profit rule. The result is that the systems with greater private sector influence tend to have lesser occupancy, worse quality factors and significantly higher expenditure. This suggests the hypothesis that the influence of the private sector on health care is negatively correlated to its efficiency. The confirmation or refutal of this hypothesis is left for further more detailed analysis.
- Klíčová slova
- trend růstu nákladů,
- MeSH
- ekonomika a organizace zdravotní péče MeSH
- financování organizované MeSH
- lidé MeSH
- náklady na zdravotní péči MeSH
- partnerství veřejného a soukromého sektoru ekonomika organizace a řízení MeSH
- řízení veřejného zdraví MeSH
- soukromý sektor MeSH
- veřejné zdravotnictví ekonomika MeSH
- veřejný sektor MeSH
- výkonnost MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Francie MeSH
- Japonsko MeSH
- Spojené státy americké MeSH
