INTRODUCTION/AIMS: Prospective, randomized, controlled trials of intravenous immunoglobulin (IVIG) maintenance therapy in myasthenia gravis (MG) are lacking. In this trial, we evaluated the safety and efficacy of caprylate/chromatography-purified IVIG; (IGIV-C) in patients with generalized MG undergoing standard care. METHODS: Sixty-two patients enrolled in this phase 2, multicenter, international, randomized trial (1:1 IGIV-C [2 g/kg loading dose; 1 g/kg every 3 weeks through week 21] or placebo). Efficacy was assessed by changes in Quantitative MG (QMG) score at week 24 versus baseline (primary endpoint) and percentage of patients with clinical improvement in QMG, MG Composite (MGC), and MG-Activities of Daily Living (MG-ADL) scores (secondary endpoints). Safety assessments reported all adverse events (AEs). RESULTS: The change in QMG at 24 weeks was -5.1 for IGIV-C and -3.1 for placebo (p = .187). Seventy percent of patients in the IGIV-C group had improvement in MG-ADL (≥2-point decrease) versus 40.6% in the placebo group (p = .025). Patients showing clinical improvement in QMG and MGC (≥3-point decrease) were 70.0% for IGIV-C versus 59.4% for placebo (p = .442) and 60.0% for IGIV-C versus 53.1% for placebo (p = .610). IGIV-C was well tolerated; serious AEs were similar between arms. Three of four MG exacerbations requiring hospitalizations occurred in the IGIV-C arm with one death. DISCUSSION: Several efficacy parameters showed numerical results greater than those seen in the placebo group. This was a small study and may have been underpowered to see significant differences. Additional studies may be warranted to fully determine the efficacy of IVIG maintenance therapy in MG.
- MeSH
- autoprotilátky krev MeSH
- činnosti denního života MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- imunologické faktory terapeutické užití škodlivé účinky aplikace a dávkování MeSH
- intravenózní imunoglobuliny * terapeutické užití škodlivé účinky aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- myasthenia gravis * farmakoterapie MeSH
- prospektivní studie MeSH
- receptory cholinergní * imunologie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze II MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
Sexualita ženy je komplexním jevem, na kterém se podílí řada faktorů. Mezi nejdůležitější z nich patří věk a zdravotní stav, nicméně nezanedbatelný vliv mají i další aspekty. Vzhledem k tomu, že udávaná prevalence sestupu pánevních orgánů v ženské populaci přesahuje 50 %, nelze jeho dopad na sexuální funkce opomenout. Předložený článek prezentuje systematický přehled prací týkajících se problematiky vlivu sestupu pánevních orgánů na sexuální funkce žen. Poruchy sexuálních funkcí jsou u žen se sestupem časté, bez ohledu na jeho stadium či postižený kompartment. Terapie estrogeny nemá na sexualitu žen se sestupem žádný vliv, naopak rehabilitace může přinést určité zlepšení. Nebyl prokázán negativní vliv pesaroterapie na sexuální funkce. Chirurgická terapie s použitím nativní tkáně sexuální funkce obecně spíše zlepšuje. Výjimkou je však zadní poševní plastika, která je často spojována s dyspareunií. Nebyla nalezena korelace mezi pooperační délkou pochvy a změnou sexuálních funkcí. Dopad použití vaginálních implantátů v řešení sestupu na sexualitu žen zůstává nejednoznačný. Naopak sakrokolpopexe jednoznačně sexuální funkce zlepšuje.
A woman's sexuality is a complex phenomenon involving several factors, among which age and health are the most important. However, other aspects are not negligible. The impact of pelvic organ prolapse on sexual function cannot be ignored, as the reported prevalence of pelvic organ prolapse in female population exceeds 50%. This article presents a systematic review of articles dealing with the impact of pelvic organ prolapse on female sexual function. Sexual dysfunction is common in women with pelvic organ prolapse, regardless of prolapse stage or the compartment affected. Estrogen therapy has no effect on sexuality in women with prolapse, while pelvic floor muscle training may provide some improvement. There is no evidence that conservative therapy using a pessary is associated with negative impact on sexual function. Native tissue repair tends to improve sexual function in general, except for posterior colporrhaphy, which was frequently associated with dyspareunia. No correlation between postoperative vaginal length and change in sexual function was identified. The impact of transvaginal mesh repair on sexuality remains unclear. In contrast, there is enough evidence proving that sacrocolpopexy significantly improves sexual function in women.
- Klíčová slova
- sakrokolpopexe, vaginální implantát, sexuální funkce,
- MeSH
- gynekologické chirurgické výkony MeSH
- lidé MeSH
- představa o vlastním těle MeSH
- prolaps pánevních orgánů * MeSH
- rehabilitace MeSH
- sexualita * MeSH
- vagina chirurgie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- kongresy jako téma MeSH
- ortopedie * MeSH
- rehabilitace MeSH
- traumatologie MeSH
- Publikační typ
- zprávy MeSH
Cíl: Vyhledat a popsat intervence koordinované sestrou a jejich vliv na skóre kvality života pacientů se stabilní ischemickou chorobou srdeční (ICHS) včetně popisu koncepčního rámce intervence a nejdůležitějších aspektů poskytované ošetřovatelské péče. Metodika: Přehledová studie. Byly prozkoumány databáze PubMed, Scopus, Web of Science, ProQuest, Google Scholar. Pro stanovení základních komponent byla položena klinická otázka pomocí akronymu PICO (Patient/Problem, Intervention, Comparison and Outcome). Populaci tvořili pacienti se stabilní ICHS (P), edukace/intervence koordinovaná sestrou byla určena jako intervence (I), studie zahrnovaly kontrolní skupinu s rutinní péčí pro porovnání (C), sledovaným výsledkem bylo skóre kvality života pacientů (O). Výsledkem rešerše bylo celkem 448 studií publikovaných v letech 2013–2023. Výsledky: Do závěrečného přehledu bylo zahrnuto 24 studií, které jednoznačně vycházely ze sestrou koordinovaných intervencí ve vztahu ke kvalitě života pacientů se stabilní ICHS. Pro měření kvality života před a po intervenci byly využity různé nástroje, případně jejich kombinace. Koncepční rámce intervencí vycházely z ošetřovatelských modelů a z managementu péče o chronicky nemocné. Všechny studie uvedly zlepšení skóre kvality života pacientů u intervenční skupiny po provedení intervence. Závěr: Ve vybraných studiích bylo prokázáno, že intervenční programy kardiovaskulární rehabilitace vedené sestrou vedly ke zlepšení skóre kvality života pacientů se stabilní ICHS. Za důležité aspekty těchto intervencí považujeme péči o psychický stav pacienta, jeho aktivní zapojení do péče a také komplexnost, kontinuitu a personalizaci poskytované péče.
Aim: To find and describe nurse-coordinated interventions and their effect on quality of life scores of patients with stable coronary artery disease (CAD), including a description of the conceptual framework of the intervention and the most important aspects of the nursing care provided. Methodology: A review study. PubMed, Scopus, Web of Science, ProQuest, Google Scholar databases were studied. To determine the basic components, a clinical question was asked using the acronym PICO (Patient/Problem, Intervention, Comparison and Outcome). The population consisted of patients with stable CAD (P), the nurse-coordinated education/intervention was designated as the intervention (I), the studies included a control group with routine care for comparison (C), and the observed outcome was the patient quality of life score (O). The result of the search was a total of 448 studies published in the years 2013-2023. Results: The final review included 24 studies that were clearly based on nurse-coordinated interventions in relation to the quality of life of patients with stable CAD. Various instruments, or combinations thereof, were used to measure the quality of life before and after the intervention. The conceptual frameworks of the interventions were based on nursing models and chronic disease management. All studies reported an improvement in patient quality of life scores in the intervention group after the intervention. Conclusion: In selected studies, nurse-led cardiovascular rehabilitation intervention programs have been shown to improve quality of life scores in patients with stable CAD. The care of the patient's mental state, patient engagement, as well as the comprehensiveness, continuity and personalization of the care provided are considered to be important aspects of these interventions.
Aim: Advances in intensive care have reduced mortality rates but increased the number of survivors who face medium to long-term physical, cognitive, and psychological deficits. Nurses play a crucial role in aiding these individuals during their health transition process. The aim of this study was to examine the health consequences and nursing care needs of patients post-ICU. Design: Retrospective observational study. Methods: Data were collected between December 2017 and October 2020 through a retrospective analysis of 215 clinical processes. Descriptive and inferential statistical analyses were performed using SPSS, version 24. Results: While physical sequelae, such as respiratory and digestive issues, decrease over time, mental health issues persist. Quality of life, especially regarding mobility and daily activities, remains affected. Survivors face various self-care needs, including compromised ventilation, impaired swallowing, hallucinations, depressive mood, and anxiety, but also have potential for improving self-efficacy and daily task performance. Nursing interventions should focus on neuromuscular, gastrointestinal, psychological, and cardiorespiratory health. Conclusion: Survivors of critical illness experience significant changes that impact on their quality of life. Identifying their needs allows for more personalized nursing care and the development of a follow-up model that effectively addresses these challenges and highlights the benefits of nursing interventions on health outcomes.
Aim: The aim of the review was to identify, analyse and synthesise the results of qualitative studies focusing on patients' experiences of self-management after stroke. The research question according to the Participants, Phenomenon of Interest, Context format was as follows: What are patients' experiences of self-management after stroke? Design: A literature review aimed at synthesising the findings of qualitative studies was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. Methods: Qualitative studies were searched in the EBSCO, PubMed and Web of Science databases in November 2023. Searching and sorting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The methodological quality of the included studies was assessed using the Critical Appraisal Skills Programme. According to these criteria, 1072 studies were retrieved. Eight studies were included in the review. Results: The analysis of the eight qualitative studies revealed four themes: understanding the meaning of self-management; individual capacity and readiness; needs; and resources and supports in this area. The fourth theme includes five subthemes: family, healthcare professionals, peers, environment, and technology. Conclusion: Findings can inform routine practice to develop self-management support after stroke. Self-management support can enable stroke survivors and their families to take control of their long-term condition, from diagnosis to living with the disease.
Vydání první 199 stran, 16 nečíslovaných stran obrazových příloh : ilustrace ; 23 cm
Příručka, která se zaměřuje na metody terapie uměním a na vedení a etické aspekty terapie. Určeno odborné veřejnosti.
- MeSH
- arteterapie MeSH
- profesionální etika MeSH
- vztahy mezi lékařem a pacientem MeSH
- Publikační typ
- příručky MeSH
- Konspekt
- Fyzioterapie. Psychoterapie. Alternativní lékařství
- NLK Obory
- psychoterapie
BACKGROUND: The study aimed to analyze the effect of respiratory muscle endurance training (RMT) on performance and respiratory function in professional road cyclists during the off-season period. METHODS: Twenty professional road cyclists from the Czech Republic were divided into the control (CON) (N.=10) and the RMT (N.=10) groups. Cyclists from the RMT group accomplished 30 sessions over 10 weeks. Performance in the incremental cycling test and respiratory capacity via test were assessed before and after 10 weeks in both groups. The comparison between and within the groups was performed, together with effect size and delta % (P<0.05). RESULTS: Significant effects on respiratory function during the exercise, on lung volume utilization at 90% of VO
- MeSH
- cyklistika fyziologie MeSH
- dechová cvičení metody MeSH
- dýchací svaly fyziologie MeSH
- dýchání MeSH
- fyzická vytrvalost * fyziologie MeSH
- lidé MeSH
- roční období MeSH
- vytrvalostní trénink * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Limited empirical evidence is available regarding the effect of technology-assisted cardiac rehabilitation (TACR) among coronary heart disease (CHD) patients with central obesity. AIM: To determine the effects of 12-week TACR on health outcomes of patients with CHD. DESIGN: Two-arm randomized controlled trial. SETTING: Cardiovascular department of a regional hospital. POPULATION: Coronary heart disease patients with central obesity. METHODS: The study randomized 78 hospitalized CHD patients to receive either the 12-week TACR intervention or usual care. Guided by social cognitive theory, the intervention began with an in-person assessment and orientation session to assess and identify individual risks and familiarize with the e-platform/device before discharge. After discharge, patients were encouraged to visit the interactive CR website for knowledge and skills acquisition, data uploading, use the pedometer for daily step tracking, and interact with peers and professionals via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). RESULTS: Participants in the intervention group showed significant improvement in daily steps at six weeks but not 12 weeks (T1: β=2713.48, P=0.03; T2:β=2450.70, P=0.08), weekly sitting minutes (T1: β=-665.17, P=0.002; T2: β=-722.29, P=0.02), and total (vigorous, moderate, and walking) exercise at 12-week (β=-2445.99, P=0.008). Improvement in health-promoting lifestyle profile (T1: β=24.9, P<0.001; T2: β=15.50, P<0.001), smoking cessation (T2: β=-2.28, P<0.04), self-efficacy (T2: β=0.63, P=0.02), body mass index (T1:β =-0.97, P=0.03; T2: β=-0.73, P=0.04) and waist circumferences (T1: β =-1.97, P=0.003; T2: β =-3.14, P=0.002) were identified. CONCLUSIONS: Results indicated the effectiveness of the TACR intervention in improving healthy behaviors and anthropometric parameters for CHD patients with central obesity. Individual assessment, collaborative action planning, and ongoing obesity management support should be highlighted in TACR programs for CHD patients. CLINICAL REHABILITATION IMPACT: Central obesity should be assessed and highlighted in TACR intervention as an independent risk factor that requires corresponding behavior change and body fat management.
Léze lícního nervu vede ve všech fázích onemocnění k celé řadě funkčních, motorických i psychických omezení. Akutní terapie má v neurologii a neurochirurgii již dlouhou dobu definované postupy na základech evidence based medicine. V navazující rehabilitační terapii jsou však postupy nekonzistentní, terapie jsou aplikovány dle empirických zkušeností, s malou oporou v evidenci. V současné době jsou již některé postupy ověřovány, ale stále buď na malém vzorku pacientů, nebo pouze v jednotlivých oblastech. Např. v oblasti elektroterapie jsou metodiky nejednotné, bez jednoznačně definovaných doporučení. K účinku relaxačních metod, masáží a manuální lymfatické drenáže neexistují rovněž žádná přesvědčivá data. Pozitivně se jeví využití zrcadlové terapie a virtuální terapie s biofeedbackem, ale i zde je potřebné sjednotit postup a doplnit evidenci.
Facial nerve lesions lead to a variety of functional, motor, and psychological limitations in all stages of the disease. Acute therapy in neurology and neurosurgery has long defined procedures based on evidence-based medicine. However, in follow-up, rehabilitation therapy procedures are inconsistent, with therapies applied according to empirical experience with little support from the evidence. Currently, some procedures are already being validated, but still either in a small sample of patients or only in individual areas. For example, in the field of electrotherapy, methodologies are inconsistent, without clearly defined recommendations. There are also no conclusive data on the effect of relaxation methods, massage, and manual lymphatic drainage. The use of mirror therapy and virtual therapy with biofeedback is positive, but here too, there appears a need for standardization of practice and the addition of evidence.
