BACKGROUND: Although cystic fibrosis (CF) standards of care have been produced and regularly updated, they are not specifically targeting at the adult population. The ECFS Standards of Care Project established an international task force of experts to identify quality standards for adults with CF and assess their adherence. METHODS: This study was composed of two phases. In the first one, a task force of international experts derived from published guidelines and graded ten quality standards for adult CF care using a modified Delphi methodology. In the second phase, an international audit was conducted among adult CF centers to retrospectively validate the quality statements and monitor adherence. RESULTS: The task force identified 10 quality standards specific to the care of adults with CF, mainly based on the 2018 ECFS standards of care. 14 adult CF centers participated in the audit, which showed that most quality standards for the management of CF in adults are met across Europe. Heterogeneity in adherence to standards was found across centers according to geographical setting and centers' characteristics. CONCLUSIONS: The identification of quality standards is a valuable resource for the standardization and monitoring of care delivery across centers taking care of adults with CF.
- MeSH
- cystická fibróza * terapie MeSH
- delfská metoda MeSH
- dodržování směrnic MeSH
- dospělí MeSH
- lidé MeSH
- management nemoci MeSH
- poradní výbory MeSH
- retrospektivní studie MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- standardní péče MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
There are limited data on referral rates and the number of patients with idiopathic pulmonary fibrosis (IPF) who are eligible for lung transplantation. The aim of the present study was to assess adherence to the consensus of the International Society for Heart and Lung Transplantation (ISHLT) for the referral of patients with IPF among Czech interstitial lung disease (ILD) centers. Czech patients who were diagnosed with IPF between 1999 and 2021 (n = 1584) and who were less than 65 years old at the time of diagnosis were retrospectively selected from the Czech Republic of the European Multipartner Idiopathic Pulmonary Fibrosis Registry (EMPIRE). Nonsmokers and ex-smokers with a body mass index (BMI) of <32 kg/m2 (n = 404) were included for further analyses. Patients with a history of cancer <5 years from the time of IPF diagnosis, patients with alcohol abuse, and patients with an accumulation of vascular comorbidities were excluded. The trajectory of individual patients was verified at the relevant ILD center. From the database of transplant patients (1999-12/2021, n = 541), all patients who underwent transplantation for pulmonary fibrosis (n = 186) were selected, and the diagnosis of IPF was subsequently verified from the patient's medical records (n = 67). A total of 304 IPF patients were eligible for lung transplantation. Ninety-six patients were referred to the transplant center, 50% (n = 49) of whom were referred for lung transplantation. Thirty percent of potentially eligible patients not referred to the transplant center were considered to have too many comorbidities by the reporting physician, 19% of IPF patients denied lung transplantation, and 17% were not referred due to age. Among Czech patients with IPF, there may be a larger pool of potential lung transplant candidates than has been reported to the transplant center to date.
- MeSH
- dodržování směrnic statistika a číselné údaje MeSH
- dospělí MeSH
- idiopatická plicní fibróza * chirurgie MeSH
- intersticiální plicní nemoci chirurgie MeSH
- konziliární vyšetření a konzultace * statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- registrace MeSH
- retrospektivní studie MeSH
- senioři MeSH
- transplantace plic * statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Assessing parent-child relationship in sleep behaviours is important for facilitating changes in the sleep guideline compliance in preschool age children. The aim of this study was to examine accelerometer-measured sleep quantity and quality in families with children aged 3-8 years and investigate the parents' influence on the child's sleep. The data were obtained from the Czech cross-sectional FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study, with a final sample of 374 families. Families were recruited through the enrolment of their children in kindergartens/primary schools between March 2022 and May 2023. The sleep time window and total sleep time were assessed using a wrist-worn ActiGraph accelerometer. Participants wore this device continuously for 24 h/day over a period of 7 consecutive days. Demographic data and potential correlates were obtained via questionnaires completed by parents. Statistical analyses were completed using logistic regression and independent-samples Mann-Whitney U test. In all, 65.5% of children (60% boys, 70.9% girls) and 58.3% of parents (52.4% fathers, 64.3% mothers) achieved the recommended sleep duration. Greater sleep quantity and duration in good-quality sleep were significantly higher in girls/mothers, compared to boys/fathers. Preschoolers were more likely to comply with sleep guidelines if their mother (but not father) met the sleep recommendation and their mothers did not have a higher education level. Adhering to sleep guidelines in children was also associated with children's female gender, absence of screen device in the bedroom, and being more active. Given the high concurrence in mother-child sleep quantity, it is important to promote healthy sleep behaviours in the whole family.
- MeSH
- akcelerometrie * přístrojové vybavení MeSH
- cvičení * MeSH
- dítě MeSH
- dodržování směrnic * statistika a číselné údaje MeSH
- dospělí MeSH
- kvalita spánku MeSH
- lidé MeSH
- předškolní dítě MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- rodiče MeSH
- sedavý životní styl * MeSH
- spánek * fyziologie MeSH
- vztahy mezi rodiči a dětmi * MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Cíl: Jednou z potenciálních překážek pro implementaci vysoce kvalitní péče o jedince s bolestí zad je nenásledování klinických doporučených postupů. Cílem této práce bylo zmapování adherence ke klinickým doporučeným postupům u kliniků/ček léčících jedince s nespecifickou bolestí zad v ČR. Soubor a metodika: Fyzioterapeuté/ky a lékaři/ky, kteří v ČR aktivně léči dospělé jedince s bolestí zad, vyplnili sebe-reportující dotazník ohledně preferovaného výběru intervencí a edukačních výroků na základě doporučení pro klinickou praxi a kazuistiky reprezentující jedince s nespecifickou bolestí zad společně s e sběrem demografických údajů a kulturně adaptovaným dotazníkem Fear-Avoidance Beliefs Tool. Výsledky: Do analýzy bylo zahrnuto 344 účastníků. Celková adherence ke klinickým doporučeným postupům byla pouze 52 % a byla negativně asociována s ženským pohlavím (b = –1,04; p = 0,006), fyzioterapeutickou profesí a nižším stupněm vzdělání (b = –2,51; p = 0,006), více lety praxe (b = –0.04; p = 0,02) a vyšším skórem v dotazníku Fear-Avoidance Beliefs Tool-CZ (b = –0,2; p < 0,001). Model vysvětlil 25 % z celkové variance (R2 = 0,25). Závěr: Naše zjištění naznačují, že adherence ke klinickým doporučeným postupům s ohledem na výběr léčebných intervencí a edukačních výroků je v ČR nízká. Pro podporu vysoce hodnotné péče o jedince s bolestí zad v ČR by měly být v budoucnu vytvořeny vysoce kvalitní lokální doporučené postupy a dále by měly být zkoumány v rámci kvantitativního i kvalitativního výzkumu různé překážky a podpůrné mechanizmy k jejich adherenci tak, aby bylo možné se účinně zaměřit na nejdůležitější faktory.
Aim: One of the potentially important barriers to the implementation of high-value care for individuals with low back pain is non-adherence to clinical practice guidelines. The aim of this study was to explore adherence to clinical guidelines in clinicians treating individuals with non-specific low back pain in the Czech Republic. Subjects and methods: Physiotherapists and physicians actively treating adult individuals with low back pain in the Czech Republic completed a self- -reported clinical behavior questionnaire regarding intervention recommendations and educational statements selection based on clinical practice guidelines following a vignette representing an individual with non-specific low back pain together with demographic data collection and cross-culturally adapted Fear-Avoidance Beliefs Tool. Results: 344 participants were included in the analysis. Overall self-reported adherence to clinical guidelines was only 52% and was negatively associated with female sex (b = –1.04; P = 0.006), physiotherapy profession and lower education level (b = –2.51; P = 0.006), more years of practice (b = –0.04; P = 0.02) and higher Fear-Avoidance Beliefs Tool-CZ score (b = –0.2; P < 0.001). Our model explained 25% of the variance (R2 = 0.25). Conclusion: Our findings suggest that adherence to clinical guidelines regarding recommendations against inappropriate interventions and the promotion of unhelpful narratives is low in the Czech Republic. To facilitate high-value care for individuals with low back pain in the Czech Republic, local high-quality clinical practice guidelines should be developed in the future and different barriers and facilitators to its adaption and adherence should be further examined in quantitative as well as qualitative research so that the most important factors could be effectively targeted.
- Klíčová slova
- pracovní právo,
- MeSH
- adherence pacienta MeSH
- dodržování směrnic MeSH
- formální sociální kontrola MeSH
- lidé MeSH
- personální management MeSH
- pracovní neschopnost * zákonodárství a právo MeSH
- zákonodárství jako téma * MeSH
- zákonodárství lékařské MeSH
- zdravotní pojištění zákonodárství a právo MeSH
- Check Tag
- lidé MeSH
OBJECTIVES: The study aims to examine the extent to which the updated ACC/AHA management of blood cholesterol guideline (2018) is implemented in practice and to assess the value of the clinical pharmacist interventions in improving physicians' adherence the guidelines recommendations. METHODS: We utilized in this study an interventional before-after design. The study was conducted on 272 adult patients who visited the study site internal medicine clinics and were candidates for statin therapy based on the 2018 ACC/AHA guidelines for cholesterol management. Adherence to guideline recommendations was measured before and after clinical pharmacists' interventions by calculating the percentage of patients receiving statin therapy as per guideline recommendation, the type and intensity (moderate or high intensity) of statin therapy used, and the need for additional non-statin therapy. RESULTS: Adherence with guideline recommendations was significantly improved from 60.3% to 92.6% (X2 = 79.1, p = 0.0001) after clinical pharmacist interventions. Among patients who were on statin therapy, the percentage of those who were on proper statin intensity increased significantly from 47.6% to 94.4% (X2 = 72.5, p = 0.0001). The combination of statins with non-statin therapies such as ezetimibe and PCSK9 inhibitors increased from 8.5% to 30.6% (X2 = 95, p<0.0001) and from 0.0% to 1.6% (X2 = 6, p = 0.014), respectively. The use of other lipid-lowering agents was diminished from 14.6% to 3.2% (X2 = 19.2, p<0.0001). CONCLUSION: Collaboration between physicians and clinical pharmacists is a crucial strategy to improve patients' treatment and hence, achieve better health outcomes among patients suffering from dyslipidemia.
- MeSH
- cholesterol MeSH
- dodržování směrnic MeSH
- dospělí MeSH
- farmaceuti MeSH
- hypercholesterolemie * farmakoterapie chemicky indukované MeSH
- kardiologie * MeSH
- kardiovaskulární nemoci * MeSH
- lidé MeSH
- proproteinkonvertasa subtilisin/kexin typu 9 MeSH
- statiny * terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Spojené státy americké MeSH
Aim: The aim of the research was to determine the fulfilment of the standard operating procedure - "Care of patients with increased risk levelˮ incorporating the JCI AOP 1.7 standard "Patients and their loved ones are investigated and reinvestigated due to their individualized needsˮ by healthcare professionals of the selected healthcare facility. Design: A cross-sectional study. Methods: A quantitative survey was selected for data collection. The data were obtained through structured interviews with selected healthcare professionals from the designated facilities conducted by hospital management and recorded in writing in a pre-prepared record sheet. The research sample consisted of 78 respondents, of whom 36 were physicians and 42 were nurses, from 14 facilities. The research was conducted from 15. 1. - 31. 12. 2018. Results: From the interviews, we found that respondents regarded terminal patients and their loved ones holistically, but failed to record the information obtained. We also found that there was no difference in the evaluation of the patient and his / her loved ones according to the profession of the respondents, the length of their medical practice, or their workplace. In terms of the respondentsʼ workplace, there was no difference in perceptions of the quality of palliative care provided in the selected hospital. Conclusion: Respondents perceive patients holistically and they are assessed as a bio-psycho-socio-spiritual unit, and their loved ones are included in the assessment. However, the information obtained is not fully documented in written form.
- MeSH
- dodržování směrnic MeSH
- kvalita zdravotní péče statistika a číselné údaje MeSH
- lidé MeSH
- paliativní péče * metody normy psychologie statistika a číselné údaje MeSH
- péče o umírající metody normy psychologie statistika a číselné údaje MeSH
- rozhovory jako téma MeSH
- zdravotnický personál psychologie MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes. METHODS: In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines. FINDINGS: 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04-1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05-1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4-30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals. INTERPRETATION: Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay. FUNDING: Scynexis.
- MeSH
- antifungální látky terapeutické užití MeSH
- Candida * MeSH
- dodržování směrnic MeSH
- dospělí MeSH
- kandidemie * farmakoterapie epidemiologie mikrobiologie MeSH
- kohortové studie MeSH
- lidé MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
