Background: Adverse drug reactions (ADRs), particularly in the context of polypharmacy, remain a persistent, unresolved problem for patients and healthcare professionals. The ADRe Profile identifies medicine-related harms, and supports their resolution, thereby improving care quality and preventing future problems. Objective: The objective of this study was to assess the validity and reliability of the ADRe Profile (https://www.swansea.ac.uk/adre/) in U.K. primary care general practices, building on assessments in other settings. Methods: The ADRe Profile's validity and reliability were investigated using complementary mixed methods: content validity index, contrast group construct validity, cognitive interviewing, and inter-rater reliability. Results: Cognitive interviews (n = 5) confirmed that the ADRe Profile needed only minor adjustments. The scale-level content validity index was 0.67 (n = 14), items ranging from 0.08 to 1. Significant differences in signs and symptoms associated with ADRs between service users taking different numbers of regular prescribed medicines confirmed construct validity (n = 68, U = 870.50, p < 0.001). Inter-rater reliability testing showed substantial agreement between service users and research nurse: 10 items had 100% agreement. Overall kappa mean was 0.71 (range: 0.31-1), (n = 42). Conclusions and Relevance: The ADRe Profile is suitable for use with older service users in primary care who live at home. Users understood the questions and provided meaningful answers. ADRe Profile responses were sufficiently reliable to be used as a basis for further investigations, prescriber referral and clinical actions. However, clinician judgement of content validity may depend on knowledge and experience, highlighting the importance of training. Clinicians acknowledged that the ADRe Profile was comprehensive but identified practical difficulties. Instruments to reduce ADRs should be validated before testing in feasibility studies and randomised controlled trials. Implications for Nursing Management: Managers need to optimise patient safety by introducing patient-centred symptom monitoring, with decision support. Before instruments are adopted, managers should check the reliability and validity data. Trial Registration: ClinicalTrials.gov identifier: NCT04663360.
- MeSH
- Middle Aged MeSH
- Humans MeSH
- Drug-Related Side Effects and Adverse Reactions * prevention & control MeSH
- Polypharmacy MeSH
- Surveys and Questionnaires MeSH
- Psychometrics * instrumentation methods standards MeSH
- Reproducibility of Results MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Validation Study MeSH
- Geographicals
- United Kingdom MeSH
BACKGROUND: Effectiveness of disease-modifying treatment (DMT) in people affected by primary progressive multiple sclerosis (PPMS) is limited. Whether specific subgroups may benefit more from DMT in a real-world setting remains unclear. Our aim was to investigate the potential effect of DMT on disability worsening among patients with PPMS stratified by different disability trajectories. METHODS: Within the framework of the Big MS Data network, we merged data from the Observatoire Français de la Sclérose en Plaques, the Swedish and Italian MS registries, and MSBase. We identified patients with PPMS that started DMT or were never treated during the observed period. Subpopulations with comparable baseline characteristics were selected by propensity score matching. Disability outcomes were analysed in time-to-recurrent event analyses, which were repeated in subclasses with different disability trajectories determined by latent class mixed models. RESULTS: Of the 3243 included patients, we matched 739 treated and 1330 untreated patients with a median follow-up of 3 years after pairwise censoring. No difference in the risk of confirmed disability worsening (CDW) was observed between the groups in the fully matched dataset (HR 1.11, 95% CI 0.97 to 1.23, p=0.127). However, we found a lower risk for CDW among the class of treated patients with an aggressive disability trajectory (n=360, HR 0.68, 95% CI 0.50 to 0.92, p=0.014). CONCLUSIONS: In line with previous studies, our data suggest that DMT does not ameliorate disability worsening in PPMS, in general. However, we observed a beneficial effect of DMT on disability worsening in patients with aggressive predicted disability trajectories.
- MeSH
- Multiple Sclerosis, Chronic Progressive * drug therapy physiopathology MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Disability Evaluation MeSH
- Disease Progression MeSH
- Registries MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Bolesti brucha u detí môžu mať rôzne príčiny, od banálnych problémov po závažnejšie život ohrozujúce stavy. Nevyhnutné je precízne vyšetrenie, anamnestika, dôkladné sledovanie symptómov a obozretnosť, monitorovanie, liečba a starostlivosť. Zdravotnícki pracovníci ako lekári, sestry, záchranári a ďalší sú nenahraditeľní, zohrávajú kľúčovú úlohu pri poskytovaní bezpečnej a kvalitnej zdravotnej starostlivosti. Mnohokrát sú prví, ktorí identifikujú zdravotné problémy, poskytujú život zachraňujúcu starostlivosť a podporujú pacientov na ich ceste k zotaveniu. Kľúčová je odbornosť, empatia a odhodlanie pre poskytovanie kvalitnej starostlivosti, ktorá zachraňuje životy a zlepšuje kvalitu života pacientov.
Abdominalpain in children can have various causes, ranging from trivial problems to more serious life-threatening conditions. Thorough examination, patient history, careful monitoring of symptoms, vigilance, treatment, and care are essential. Health care professionals such as doctors, nurses, paramedics, and others are irreplaceable, playing a key role in providing safe and high-quality health care. They are of ten the first to identify health problems, provide life-saving care, and support patients on their road to recovery. Expertise, empathy, and commitment to delivering quality care that saves lives and improves patients' quality of life are crucial
- MeSH
- Abdominal Pain diagnostic imaging diagnosis MeSH
- Diagnosis, Differential MeSH
- Child MeSH
- Check Tag
- Child MeSH
Detské úrazy predstavujú významný medicínsky a spoločenský problém, pričom závažné úrazy môžu viesť k dlhodobým zdravotným následkom, či úmrtiu. Efektívna prednemocničná zdravotná starostlivosť zohráva kľúčovú úlohu pri stabilizácii pacienta a minimalizácii komplikácií. Tento článok analyzuje najčastejšie príčiny detských úrazov, ako sú dopravné nehody, pády a popáleniny, a poukazuje na zásady poskytovania neodkladnej starostlivosti v prednemocničnej fáze. Cieľom článku je zvýšiť povedomie o správnych postupoch v prednemocničnej fáze s cieľom zlepšiť prognózu detských pacientov so závažnými úrazmi.
Child hood injuries are a significant medical and societal problem, and serious injuries can lead to long-term health consequences or death. Effective prehospital medical careplays a key role in stabilising the patient and mini mising complications. This article reviews the most common causes of child hood injuries, such as car accidents, falls and burns, and high lights the principles of providing emergency care in the prehospital phase. The aim of the articleis to raise awareness of the correct procedures in the prehospital phase in order to improve the prognosis of pediatric patients with serious injuries.
- MeSH
- Child MeSH
- Multiple Trauma MeSH
- Accidents MeSH
- Emergency Medical Services MeSH
- Paramedics MeSH
- Check Tag
- Child MeSH
První vydání 212 stran : barevné ilustrace ; 24 cm
Studijní příručka, která se zaměřuje na psaní studentských závěrečných prací. Určeno pro studující středních a vysokých škol.; Publikace obsahuje šest kapitol zaměřených na jednotlivé fáze práce. První kapitola uvádí počáteční kroky v rámci příprav. Druhá se věnuje procesu studia zdrojů a zpracování teoretické části práce. Třetí kapitola se soustředí na návrh a realizaci výzkumné strategie popsané v metodické části. Čtvrtá kapitola popisuje postup při sběru a rozboru získaných dat, jehož výsledky budou předloženy v analytické části práce. Pátá kapitola představuje způsoby vyhodnocení výsledků v závěrečné části práce. Šestá kapitola nabízí přehled posledních kroků, jimž musí být věnována pozornost v rámci konečných úprav textu a kompletace svazku.
- MeSH
- Academic Dissertations as Topic standards MeSH
- Writing standards MeSH
- Schools MeSH
- Publication type
- Study Guide MeSH
- Conspectus
- Organizace výuky a vzdělávání
- Učební osnovy. Vyučovací předměty. Učebnice
- NML Fields
- pedagogika
V kazuistice prezentujeme případ patnáctiletého chlapce se vzácnou primární imunodeficiencí, tzv. syndromem XMEN. Tento syndrom je charakterizován zvýšenou náchylností k chronické EBV infekci a lymfoproliferacím asociovaným s EBV, dalšími klinickými znaky bývají sinopulmonární infekce, otitidy, lymfadenopatie, dysgamaglobulinemie a autoimunitní cytopenie. XMEN syndrom je způsoben mutacemi genu MAGT1, který kóduje přenašeč hořečnatých kationtů magnesium transporter protein 1. Klíčovým bodem kazuistiky je strastiplná diagnostická cesta pacienta, jemuž přes postupné návštěvy celé řady specialistů chybělo komplexní zhodnocení stavu a zachycení souvislostí různých klinických symptomů, které přinesla až návštěva v ambulanci alergologa/klinického imunologa
In this case report, we present a case of a 15 year old boy with a rare primary immunodeficiency called XMEN syndrome. XMEN syndrom is characterized by increased susceptibility to chronic EBV infection and EBV-associated lymphoproliferation, sinopulmonary and ear infections, lymphadenopathy, dysgammaglobulinemia, and autoimmune cytopenias. XMEN disease is caused by loss of function mutations in the gene MAGT1, which codes magnesium transporter protein 1.The critical point of the case report is the difficult diagnostic journey of the patient, who, despite a series of visits to several specialists, lacked a comprehensive assessment of his condition. A visit to an allergist/ clinical immunologist only gave a grasp of the context of various clinical symptoms.
Díky novým technologiím a vyššímu důrazu kladenému na bezpečnostní profil léčiv dochází k postupnému zlepšování lékových forem, což je také případ inhalačního kortikosteroidu beklometason dipropionátu, kdy jeho extra-fine formulace vede vklinické praxi ke snížení jeho nominální dávky až 2,5krát. Článek podrobněji popisuje dopady této transformace vefixních kombinovaných přípravcích, tj. depozici extra-fine částic vcentrální i periferní části plic, nižší systémovou expozici a v neposlední řadě taky pozitivní vliv u skupiny pacientů s astmatem, CHOPN a snížení rizika výskytu pneumonie.
Thanks to advancements and increased emphasis on the safety profile of medications, there is a gradual improvement in the development of pharmaceutical forms. One such change has been implemented in the inhaled corticosteroid beclomethasone dipropionate, resulting in a 2.5× reduction in its nominal clinical dose. The article provides a detailed description of the effects of this transformation in fixed combination preparations, i.e., the deposition of extra-fine particles in both the central and peripheral parts of the lungs, lower systemic exposure, and, last but not least, the positive impact on patients with asthma, COPD, and a reduced risk of pneumonia.
- MeSH
- Administration, Inhalation MeSH
- Beclomethasone * administration & dosage pharmacology therapeutic use MeSH
- Asthma * drug therapy MeSH
- Pulmonary Disease, Chronic Obstructive * drug therapy MeSH
- Drug Combinations MeSH
- Formoterol Fumarate administration & dosage pharmacology therapeutic use MeSH
- Humans MeSH
- Pneumonia prevention & control MeSH
- Randomized Controlled Trials as Topic MeSH
- Check Tag
- Humans MeSH
