Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive cardiac electrophysiology procedures as well as surgical operations including minimally invasive aortic and mitral valve repair, coronary artery bypass procedures, and structural heart diseases. Furthermore, machines are used as staff-assisting tools to support nurses with repetitive clinical duties i.e., food delivery. High precision and resolution allow for excellent maneuverability, enabling the performance of medical procedures in challenging anatomies that are difficult or impossible using conventional approaches. Moreover, robot-assisted techniques protect operators from occupational hazards, reducing exposure to ionizing radiation, and limiting risk of orthopedic injuries. Novel automatic systems provide advantages for patients, ensuring device stability with optimized utilization of fluoroscopy. The acceptance of robotic technology among healthcare providers as well as patients paves the way for widespread clinical application in the field of cardiovascular medicine. However, incorporation of robotic systems is associated with some disadvantages including high costs of installation and expensive disposable instrumentations, the need for large operating room space, and the necessity of dedicated training for operators due to the challenging learning curve of robotic-assisted interventional systems.
- Publication type
- Journal Article MeSH
- Review MeSH
Aim: To present the current knowledge about possible applications, effectiveness, and other aspects of mirror therapy in adult stroke clients, with an emphasis on the performance of Activities of Daily Living (ADL), or on supporting independence and self-care, including limitations. Design: A descriptive mapping study. Methods: A systematic literature search and an interpretative content analysis (according to predetermined criteria) of 34 identified relevant studies (2000-2017) and conceptualization of findings in relation to ADL performance / limitation among adult stroke clients. Results: Mirror Therapy (MT) is a simple and undemanding approach which improves the function of extremities with respect to performance of ADL. However, due to smaller research samples, it is impossible to clearly confirm its effectiveness and extrapolate the conclusions. MT is also used to complement other therapeutic approaches, or various approaches can be combined with it (e.g., micro-sensory electrical stimulation or observation imitation). Assessment of ADL was primarily performed with the Barthel Index, Modified Barthel Index, and Functional Independence Measures, Functional Ambulation Categories, and Foot and Ankle Ability Measure tests. Conclusion: It seems desirable to apply task-oriented MT - an approach that includes functional tasks to prevent clients from becoming bored during therapy. The performance of MT tasks need not always be supervised by a physiotherapist. Good cooperation between nurses from clinical practice and physiotherapy is desirable. In order to be able to widen the conclusions and clearly confirm the effectiveness of MT in the context of ADL, other randomized controlled (pilot) studies are desirable.
- Keywords
- activities of daily living, adult stroke patients, mirror therapy, stroke, task-oriented mirror therapy,
- MeSH
- Stroke * therapy MeSH
- Adult MeSH
- Humans MeSH
- Neurological Rehabilitation MeSH
- Treatment Outcome MeSH
- Mirror Neurons MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
To elucidate the role of domestication, we used the impossible task paradigm to test Czechoslovakian Wolfdogs with a known proportion of 'wolfblood' in their DNA and, as a control group for our subjects, we used German shepherd dogs. We hypothesized that the difference between wolves and domestic dogs is based on genetics and modified by obedience; if so, the looking back performance of the subject should be linked to its proportion of wolf-genes. To prove that, we observed 73 Czechoslovakian Wolfdogs, and 27 German shepherd dogs, and analysed their human-directed gazing behaviour during our test. Our apparatus consisted of a glass container placed upside down over a small amount of food. The test proceeded with three solvable trials, in which the subject could obtain the food by manipulating the container, followed by an unsolvable one in which the container was fixed onto the board. Our results suggest that there is no significant correlation between the probability of looking back in Czechoslovakian Wolfdogs and their proportion of 'wolf blood'. However, the probability of looking back was higher in German Shepherd dogs than in Czechoslovakian Wolfdogs (odds ratio = 9.1). German Shepherd dogs showed not only a higher frequency of looking back, but also the duration of their looks was longer.
OBJECTIVES: Emotion regulation is one of the most prevalent objectives for real-time fMRI neurofeedback (rt-fMRI-NF) studies. The existing studies differ in a number of methodological parameters. This study provides a literature review of the main parameters and results of studies using rt-fMRI-NF for emotion regulation enhancement. METHOD: A search of the Web of Science database up through November 8, 2018, identified 144 articles written in English, 89 of which were excluded as irrelevant for this study. The remaining 51 original studies and four secondary analyses of previously published original studies were included in the literature review. The selection of target brain areas, target populations, emotion regulation protocols, NF presentation, control group types, and emotion regulation instructions were examined in relation to achieved brain regulation and changes in cognitive or clinical outcomes. Study results were evaluated in terms of their statistical robustness. RESULTS: The results show that healthy people are able to regulate their brain activity in the presence of rt-fMRI-NF from various brain regions related to emotion regulation, including the amygdala, anterior insula, and anterior cingulate cortex. The regulation of brain activity using rt-fMRI-NF from prefrontal-limbic connectivity or from individually navigated brain areas is feasible as well. Most studies that used a control group show that rt-fMRI-NF actually induces some effects on brain regulation, cognitive variables, and clinical variables. Generally, the success of ROI regulation during NF training is related to the combination of target brain region, the type of emotion regulation task, and the population undergoing the training. In terms of patient groups, the strongest support for the beneficial effects of rt-fMRI-NF has been shown in increased positive emotion experiencing in patients with depression and in decreased anxiety in patients with anxiety disorders. Symptom reduction following NF training has been also reported in patients with PTSD, BPD, and schizophrenia, but direct comparisons with control groups in these studies makes it impossible to evaluate the added value of NF. Studies often do not report all the relevant analyses for evaluating NF success and many studies lack statistical robustness. CONCLUSIONS: Overall, rt-fMRI-NF seems a promising tool for emotion regulation enhancement with the potential to induce long-term symptom reduction in patients with various mental disorders. Preplanning of statistical analyses, careful interpretations of the results, and evaluations of the NF effect on symptom reduction in patient groups is recommended.
- MeSH
- Mental Disorders therapy MeSH
- Emotions physiology MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Brain physiology MeSH
- Neurofeedback methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Cévní mozková příhoda (CMP) je velmi závažné a časté onemocnění s vysokou mortalitou, u kterého je zásadní zahájení včasné rehabilitace, a tím i maximální využití plasticity mozku, která je omezená časem. Brzké propuštění z nemocnice umožňuje rehabilitaci v domácím prostředí, ambulantní formou či v denním stacionáři, podle možností v místě bydliště, a v budoucnosti i podle volby pacienta a jeho rodiny. Cílem rehabilitace pacientů je brzký návrat do domácího prostředí, dosažení maximální možnosti soběstačnosti a v produktivním věku, pokud je to možné, návrat do práce. Propuštění z nemocnice je však především pro starší pacienty někdy až kritické z důvodu nižších funkčních schopností v oblasti aktivit a participací. Návrat může být spojen s úkoly, které pacient nezvládne, s riziky pádu, motorickými, kognitivními, fatickými problémy i strachem z neúspěchu. Pro pacienty je velice důležité zvýšení jejich informovanosti o dostupných službách, možnostech zajištění bezpečnosti domácího prostředí a dostupnosti potřebných služeb. Z časových a finančních důvodů je, bohužel, téměř nemožné zajistit u všech pacientů domácí návštěvu ergoterapeuta, který by společně s pacientem domácí prostředí zhodnotil, případně navrhl jeho úpravy a vybavení kompenzačními pomůckami. Tyto úkony nejsou v ČR hrazeny ani zdravotním ani sociálním pojištěním. Pacienti ani rodiny nemají dostatečné informace, a proto je vhodné zvýšit informovanost pacientů před propuštěním z nemocnice. Pro zvýšení informovanosti pacientů po CMP jsme zpracovali "Soubor doporučení pro pacienty a jejich rodiny", jehož cílem je poskytnout pacientům a jejich rodinám přehledný soubor informací, které jsou důležité pro zvýšení soběstačnosti pacientů v domácím prostředí.
Stroke is a very serious and common disease with a high mortality. It is important for patients to start rehabilitation as soon as possible to ensure the use of time-limited brain plasticity. Early discharge from the hospital allows stroke patients homecoming to continue rehabilitation in familiar surroundings according to the patient choice. The responsibility for continued rehabilitation is in the hands of patients and their families and the main aim is to adjust the everyday life, reach the maximum of self-sufficiency and return to work if it is possible. However, discharge from the hospital is sometimes critical for older patients because of lower functional abilities in activities and participations. Some tasks and activities should be difficult for these patients, sometimes appears higher risks, motor, cognitive and facial problems and fear of failure. It is very important for patients to increase their awareness of available services, the possibilities of ensuring the safety home environment and the availability of the necessary services. For the time and financial reasons, it is almost impossible to provide a home visit for all patients by an occupational therapist to evaluate the home environment, or even propose its treatments and equipment with compensatory aids. For this reason, occupational therapists in the Czech Republic try to increase the awareness of patients before their discharge from hospital. To raise awareness of patients, a Summary of Recommendations for patients and their families was written to provide stroke patients and their families with a clear set of information that is important for increasing self-sufficiency in the home environment.
INTRODUCTION: Taking microdoses (a mere fraction of normal doses) of psychedelic substances, such as truffles, recently gained popularity, as it allegedly has multiple beneficial effects including creativity and problem-solving performance, potentially through targeting serotonergic 5-HT2A receptors and promoting cognitive flexibility, crucial to creative thinking. Nevertheless, enhancing effects of microdosing remain anecdotal, and in the absence of quantitative research on microdosing psychedelics, it is impossible to draw definitive conclusions on that matter. Here, our main aim was to quantitatively explore the cognitive-enhancing potential of microdosing psychedelics in healthy adults. METHODS: During a microdosing event organized by the Dutch Psychedelic Society, we examined the effects of psychedelic truffles (which were later analyzed to quantify active psychedelic alkaloids) on two creativity-related problem-solving tasks: the Picture Concept Task assessing convergent thinking and the Alternative Uses Task assessing divergent thinking. A short version of the Ravens Progressive Matrices task assessed potential changes in fluid intelligence. We tested once before taking a microdose and once while the effects were expected to be manifested. RESULTS: We found that both convergent and divergent thinking performance was improved after a non-blinded microdose, whereas fluid intelligence was unaffected. CONCLUSION: While this study provides quantitative support for the cognitive-enhancing properties of microdosing psychedelics, future research has to confirm these preliminary findings in more rigorous placebo-controlled study designs. Based on these preliminary results, we speculate that psychedelics might affect cognitive metacontrol policies by optimizing the balance between cognitive persistence and flexibility. We hope this study will motivate future microdosing studies with more controlled designs to test this hypothesis.
- MeSH
- Adult MeSH
- Hallucinogens administration & dosage MeSH
- Intelligence drug effects physiology MeSH
- Intelligence Tests MeSH
- Clinical Trials, Phase I as Topic MeSH
- Creativity * MeSH
- Humans MeSH
- Young Adult MeSH
- Motivation drug effects physiology MeSH
- Thinking drug effects physiology MeSH
- Nootropic Agents administration & dosage MeSH
- Problem Solving drug effects physiology MeSH
- Photic Stimulation methods MeSH
- Dose-Response Relationship, Drug MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase I MeSH
- Pragmatic Clinical Trial MeSH
Ultrazvuk hraje důležitou roli v diagnostice pánevních tumorů a významně se podílí na jejich následném managementu. Ultrazvukové vyšetření pánevního tumoru lze rozdělit na základní a expertní. Nejdůležitějším úkolem základního ultrazvukového vyšetření je rozlišení mezi normálním a suspektním nálezem. Nález podezřelý ze závažné adnexální patologie je referován k expertnímu ultrazvukovému vyšetření, které s využitím IOTA terminologie rozliší, zda se jedná o nález benigní či maligní. V případě suspektního ovariálního karcinomu pak určí stádium onemocnění. Popis rozsahu nádorového postižení v jednotlivých kompartmentech pánve a dutiny břišní dále selektuje pacientky se známkami suboptimální operability. Mezi známky pokročilého primárně suboptimálně operabilního tumoru (tzn. postižení dutiny břišní, které nám neumožní dosáhnout nulového pooperačního rezidua) patří suprarenální lymfadenopatie, mnohočetné intraparenchymatozní metastázy, velkouzlové postižení mezenteria a difuzní viscerální karcinomatóza. Ve srovnání s CT či MR dosahuje expertní ultrazvukové vyšetření obdobné diagnostické přesnosti, přitom má ale nejvyšší specificitu jak ve stanovení šíření pánevního tumoru v dutině břišní, tak v predikci metastáz v jaterním parenchymu či postižení retroperitoneálních lymfatických uzlin. Asi 30 % pacientek s karcinomem vaječníku má v době diagnózy některou ze známek inoperability. U této skupiny pacientek zahajujeme neoadjuvatní chemoterapii a v případě dobré odpovědi následně indikujeme k intervalové operaci. Podmínkou této alternativy léčby je histologická verifikace tumoru. Spolehlivou, minimálně invazivní a bezpečnou metodou k získání validního histologického vzorku je ultrazvukem naváděná biopsie silnou jehlou (tru-cut biopsie). Mezi základní indikace transvaginálně či transabdominálně prováděné biopsie patří primárně inoperabilní nález, určení origa tumoru, rozlišení mezi benigním a maligním tumorem. Nejčastěji provádíme transvaginálně biopsii z pánevního tumoru či pánevní karcinomatózy, transabdominálně z infiltrovaného omenta.
Ultrasound plays an important role in diagnostics of pelvic tumors and significantly contributes to their subsequent management. Ultrasound of pelvic tumors can be divided into basic and expert. The most important task of basic ultrasound is a distinction between normal and suspicious finding. A finding, which is suspicious of a severe adnexal pathology, is referred to an expert sonography. Using the IOTA criteria, this examination differentiates between benign or malignant findings. In case of a suspicion of an ovarian carcinoma, stage of the disease is determined. A detailed description of the extent of tumor affection in individual compartments of the pelvis and abdominal cavity further identifies patients with signs of suboptimal operability. Signs of suboptimal operability (impossibility to achieve no residual disease after surgery) include suprarenal lymphadenopathy, multiple intraparenchymatous metastases, numerous metastatic nodules in the mesentery and diffuse visceral carcinomatosis. Ultrasound in hands of experienced examiner reaches similar overall accuracy as CT or MRI in staging of advanced cancer, while it has the highest specificity compared to CT or MRI in assesment of the tumor spread in the abdominal cavity and in the prediction of metastases in the liver parenchyma or retroperitoneal lymph node involvement. Approximately 30% of patients with ovarian carcinoma have any of the signs of inoperability at the time of diagnosis. Neoadjuvant chemotherapy is then initiated and followed by interval debulking surgery in case of a good effect of the treatment. However, histological verification of the tumor is necessary before initiation of this kind of therapy. Ultrasound-guided needle biopsy (tru-cut biopsy) is a reliable, minimally invasive and safe method to obtain a valid histological specimen. The basic indications for transvaginally or transabdominally conducted biopsies include primarily inoperable finding, identification of the tumor origin and differentiation between benign and malignant tumor. Biopsy is most often performed transvaginally from pelvic tumor or pelvic carcinomatosis, transabdominally from infiltrated omentum.
- Keywords
- tru-cut,
- MeSH
- Biopsy methods instrumentation MeSH
- Diagnosis, Differential MeSH
- Humans MeSH
- Pelvic Neoplasms * diagnostic imaging diagnosis MeSH
- Ovarian Neoplasms diagnosis MeSH
- Sensitivity and Specificity MeSH
- Ultrasonography classification methods MeSH
- Image-Guided Biopsy * methods MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
Tématem článku je hodnocení dostupnosti zdravotní péče v České republice v kontextu aktuálního znění příslušných legislativních nařízení. Dostupnost zdravotní péče jako taková je jednou z často diskutovaných otázek, avšak její kvantitativní podchycení je poměrně problematické. V rámci ČR neexistují oficiální normativy, které by určovaly, jaká kapacita pracovníků ve zdravotnictví, s ohledem na jejich kategorii a typ poskytované péče, má být pro určité obyvatelstvo bydlící v daném regionu dostupná. Nicméně s účinností od roku 2013 vešlo v platnost nařízení vlády o místní a časové dostupnosti zdravotních služeb. Ačkoliv se jedná o první nařízení tohoto druhu na našem území (nebo právě proto), v jeho znění lze najít hned několik nejasností, bez jejichž bližší specifikace jej nelze řádně aplikovat do praxe a vyžadovat jeho dodržování. Cílem článku je pokusit se jednak identifikovat tyto nejasnosti a dále v širším pohledu identifikovat hlavní faktory, které mohou mít na problematiku dostupnosti zdravotní péče vliv. K těmto cílům je přistoupeno nejen pomocí základní analýzy dat za poskytovatele zdravotních služeb, ale také pomocí pokročilejších prostorových analýz v rámci geografických informačních systémů (GIS). S ohledem na široké spektrum poskytovaných zdravotních služeb jsou veškeré příklady ukázány na segmentu primární zdravotní péče, konkrétně odbornosti praktického lékařství pro děti a dorost.
The article looks at the accessibility of health care in the Czech republic in relation to the relevant legislation. Health care access is a frequently debated issue, but quantifying it is a difficult task. There are no official regulations in our country for determining the capacity of health care workers by category and type of health care provision that could be used to ensure health care is accessible to the inhabitants of a given region. Nonetheless, a government regulation came into force in 2013 regulating local health care access and travel time. This regulation is the first of its kind in the Czech rep., but (perhaps because of this) it contains a number of ambiguities, and this lack of detail makes it impossible to ensure the regulation is fully implemented and adhered to. The aim of this article is to attempt to identify these ambiguities and to broadly pinpoint the main factors potentially affecting health care access. To achieve this, an analysis is performed on the data on health care providers and methods using advanced GIS (geographic information systems) are utilized. Given the wide range of health care services on offer, the examples relate to primary health care, specifically practical medicine for children and adolescents.
- Keywords
- GIS,
- MeSH
- Health Services Accessibility * trends legislation & jurisprudence MeSH
- Process Assessment, Health Care methods MeSH
- Physicians trends MeSH
- Humans MeSH
- Delivery of Health Care legislation & jurisprudence MeSH
- Vital Statistics MeSH
- Age Distribution MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Geographicals
- Czech Republic MeSH
Studies of the capillary bed characterized by its length or length density are relevant in many biomedical studies. A reliable assessment of capillary length from two-dimensional (2D), thin histological sections is a rather difficult task as it requires physical cutting of such sections in randomized directions. This is often technically demanding, inefficient, or outright impossible. However, if 3D image data of the microscopic structure under investigation are available, methods of length estimation that do not require randomized physical cutting of sections may be applied. Two different rat brain regions were optically sliced by confocal microscopy and resulting 3D images processed by three types of capillary length estimation methods: (1) stereological methods based on a computer generation of isotropic uniform random virtual test probes in 3D, either in the form of spatial grids of virtual "slicer" planes or spherical probes; (2) automatic method employing a digital version of the Crofton relations using the Euler characteristic of planar sections of the binary image; and (3) interactive "tracer" method for length measurement based on a manual delineation in 3D of the axes of capillary segments. The presented methods were compared in terms of their practical applicability, efficiency, and precision.
- MeSH
- Biometry methods MeSH
- Capillaries anatomy & histology MeSH
- Microscopy, Confocal methods MeSH
- Rats MeSH
- Automation, Laboratory methods MeSH
- Brain anatomy & histology MeSH
- Imaging, Three-Dimensional methods MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Obsahem prezentace je seznámení s novým vydáním Akreditačních standardů SAK pro nemocnice, a to v oblasti řízení prostředí. V této oblasti došlo v novém vydání akreditačních standardů k zásadním změnám, a to nejen z hlediska požadavků samotných, ale zejména z hlediska organizace kapitoly XI. Bezpečí prostředí a obecně přístupu k řízení rizik. Bezpečí prostředí nemocnice, v novém vydání Akreditačních standardů pro nemocnice upraveno zejména standardy v kapitole 11, činilo v minulosti nemocnicím určité interpretační potíže. Hlavním důvodem byla velká heterogenita oblastí, které pod ni spadají a také velký objem legislativy, nejrůznějších nařízení a norem, které upravují vše od stavebních požadavků, přes hygienické až po například požadavky na provoz zdrojů ionizujícího záření. Je pochopitelné, že není možné prověřit vše, takové akreditační šetření, respektive jeho „technická” část, by trvalo měsíce a logicky bylo neúměrně drahé. Každá organizace, která provádí externí hodnocení kvality a bezpečí, tedy stojí před úkolem vybrat ty prioritní oblasti, jejichž hladké a bezpečné fungování je bezpodmínečně nutné pro bezpečí pacientů, personálu a návštěv v nemocnici, a ty následně upravit akreditačními standardy. Výsledkem tohoto přístupu v SAK je zcela přepracovaná kapitola 11, která obsahuje srozumitelně formulované standardy a též odkazy na související legislativu, které dohromady představují konečný výčet požadavků, které je nutné pro získání akreditace splnit. To vše s cílem odstranit interpretační nejistotu a jasně vymezit tuto oblast z hlediska akreditace SAK . Existují také rizika, jejichž prevenci nelze požadovat paušálně (například činnost v případě povodně), neboť jsou specifická pouze pro některá zařízení, a to vzhledem k jejich zeměpisné poloze, stavu budov a pozemků, charakteru služeb, které poskytují, a dalším faktorům. Z toho důvodu SAK do svých standardů zavedla novou povinnost (upravenou standardem č. 11.7.): systematicky identifikovat a řídit rizika, která jinak nejsou upravena standardy a legislativou, která ale mohou mít zásadní vliv na chod nemocnice, případně představují vysokou hrozbu ztráty na životech či majetku.
The presentation introduces SAK 's new approach to facility management and environmental safety as pursued in the new edition of accreditation standards for hospitals. This area has undergone significant change of both the content and general context of the risk management requirements, specifically listed in chapter XI. Facility safety. The facility safety, now mainly covered by chapter XI. of the standards, has been causing some interpretation problems to the organizations undergoing the accreditation process. The heterogeneity of the topic was the primary reason for such misinterpretations, others being voluminous legislation coverage of the area, including building requirements and norms, hygiene control, radiation safety and many others. Naturally, it is impossible to survey all aspects of facility safety in a single survey. Such survey would be extremely expensive and take months to complete. Every external quality evaluator thus stands before the task of selecting those priority areas which have the most significant impact on patient, staff and visitors safety and formulating the requirements for management of such areas through the accreditation standards. As a result of such process in SAK , completely rewritten chapter XI is now part of the new edition of standards. These standards now mark the complete facility management territory by offering clear and well-defined standards and legal references, all with the goal to prevent misinterpretation in the scope and content of the requirements. Apart from described and well known risks, there are others which cannot be applied equally to all hospitals (such as flood, for example) because they are specific to the individual settings due to differences in geographic location, building and land condition, scope and characteristics of provided services and other factors. Based on this fact, SAK has introduced a new requirement (described by standard no. 11.7.): systematically identify and manage risks which are not covered by legislation and other standards but which could significantly alter the functioning of the organization or could lead to loss of life or property.
