Úvod: Navzdory existenci mnoha doporučených postupů v managementu traumat jsou traumata stále vedoucí příčinou smrti u mladých věkových skupin a mortalita se v České republice za posledních 10 let nesnížila. Nadále není zcela jasně definovaná problematika oběhové stability, indikace podání plné krve, rutinní využití jednotlivých zobrazovacích metod a prioritizace jednotlivých kroků péče. Rozhodli jsme se prostřednictvím dotazníkové studie zmapovat podobu iniciální péče o traumatizované pacienty napříč Českou republikou v rámci 12 traumacenter a najít společnou definici oběhové stability pacienta, která je klíčová pro posloupnost jednotlivých diagnosticko‐terapeutických kroků. Metodika: Vytvořili jsme dotazníkovou multicentrickou studii a oslovili klinická pracoviště všech traumacenter v České republice. Otázky byly zaměřeny na postup při ošetření traumatizovaných pacientů. V květnu 2022 byl dotazník zaslán vedoucím lékařům všech 12 traumacenter v České republice stanovených dle aktuálního Věstníku Ministerstva zdravotnictví. Na základě odpovědí byly vytvořeny doplňující otázky. Vedoucí lékaři traumacenter odpovídali dle vlastního uvážení a aktuální situace na svém pracovišti. Získané odpovědi jsme zpracovali metodou popisné statistiky. Výsledky: V osmi centrech je vedoucím trauma týmu traumatolog. Nejčastěji (ve čtyřech centrech) tvoří trauma tým šest osob. Plnou krev podává pouze pět pracovišť, ačkoliv si sedm z 12 center myslí, že má indikaci k podávání u traumatizovaných pacientů. Oběhovou stabilitu lze definovat jako systolický tlak nad 80–90 mmHg bez vasopresorické podpory a srdeční frekvenci pod 120/min, hraniční stabilitu jako stav, kdy je k udržení systolického TK nad 80–90 mmHg potřeba vasopresorická podpora a srdeční frekvence je 120–130/min a nestabilitu, kdy ani použití vasopresorů nevede ke stabilnímu udržení systolického tlaku nad 80–90 mmHg a srdeční frekvence je nad 130/min. Osm pracovišť má CT vyšetření jako součást urgentního příjmu a rutinní vyšetření RTG hrudníku, pánve a E‐FAST (Extended Focused Assessment with Sonography in Trauma) provádí pouze tři pracoviště. Všech 12 pracovišť se kloní k využití CT vyšetření u FAST pozitivního oběhově stabilního pacienta a čtyři centra i u hraničně stabilního pacienta ke stanovení definitivní diagnózy. Všechna centra jsou schopna provést hrudní drenáž na urgentním příjmu, 10 center provádí urgentní torakotomii a čtyři centra laparotomii. Pouze tři centra využívají katétr REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) na urgentním příjmu. Závěr: Zjistili jsme, že navzdory určité variabilitě v postupu péče o traumata napříč Českou republikou je pojetí oběhové stability, hraniční stability a nestability společné všem traumacentrům. Toho lze využít v další odborné diskuzi směřující k optimalizaci managementu této skupiny pacientů.

Despite the existence of many guidelines in the management of trauma, trauma is still the leading cause of death in young age groups, and mortality has not decreased in the Czech Republic over the past 10 years. The issues of circulatory stability, indications for the administration of whole blood, routine use of imaging methods, and prioritization of individual care steps are still not clearly defined. We decided to use a questionnaire study to map what the initial care of traumatized patients looks like across our country in 12 trauma centers and to define the circulatory stability of the patient, on which the sequence of individual diagnostic and therapeutic steps is built. Methodology: We created a questionnaire-based multicenter study and addressed the clinical workplaces of all trauma centers in the Czech Republic. The questions were focused on the procedure for treating traumatized patients. In May 2022, the questionnaire was sent to the leading physicians of all 12 trauma centers in the Czech Republic, according to the current Bulletin of the Ministry of Health. Additional questions were created based on the answers. The leading physicians of the trauma centers answered at their discretion regarding the current situation at their workplace. We processed the answers obtained using descriptive statistics. Results: In eight centers, the head of the trauma team is a traumatologist. Most often (in four centers), a trauma team comprises six people. Only five centers administer whole blood, although seven of the 12 centers believe it has an indication for administration in traumatized patients. Circulatory stability can be defined as a systolic pressure above 80-90 mmHg without vasopressors and a heart rate below 120/min; borderline stability as a condition where vasopressor support is needed to maintain the systolic blood pressure above 80-90 mmHg, and heart rate is 120-130/min and instability when even the use of vasopressors does not lead to maintain stable systolic pressure above 80-90 mmHg, and heart rate is above 130/min. Eight workplaces have CT scans as part of the emergency department, and routine X-rays of the chest, pelvis, and E-FAST (Extended Focused Assessment with Sonography in Trauma) are performed by only three sites. All 12 centers are inclined to use a CT scan at FAST positive circulatory stable patients, and four centers even in borderline stable patients to establish a definitive diagnosis. All centers can perform chest drainage in the emergency department; ten centers perform emergency thoracotomy, and four centers perform laparotomy. Only three centers use the REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) catheter in the emergency room. Conclusion: Despite certain variability in trauma care management across the Czech Republic, the concepts of circulating stability, boundary stability, and instability are common to all trauma centers. These concepts can be used in further professional discussions to optimize the management of this group of patients.

• MeSH
• balónková okluze metody   MeSH
• lidé MeSH
• neodkladná péče o pacienty s traumatem metody   MeSH
• počítačová rentgenová tomografie metody   MeSH
• průzkumy a dotazníky MeSH
• rány a poranění * terapie   MeSH
• resuscitace metody   MeSH
• traumatologická centra MeSH
• urgentní lékařství * metody   organizace a řízení   MeSH
• Check Tag
• lidé MeSH

Polypragmazie v souvislosti s léčivy znamená předepisování, vydávání nebo užívání více léčiv současně. Správné charakterizování preskripce či užívání léčiva konkrétním pacientem umožňuje volbu vhodné změny. Cílem racionální farmakoterapie je minimalizace lékové zátěže, což vyžaduje řízený a mnohdy déle trvající zásah a postupně realizované změny v terapii pacienta v návaznosti na individuálně vyhodnocené a identifikované lékové problémy. K omezení nevhodné polypragmazie lze využít například možnosti depreskripce zacílením na léčiva uplatňovaná v preskripčních kaskádách a komplexně zaměřené postupy a koncepty. Práce představuje problematiku preskripčních kaskád a možnosti jejich řešení v rámci optimalizace farmakoterapie. Charakterizuje koncepty a kampaně "Méně je více", "Vybírejte rozumně" a "Cesta pacienta". Doporučení a upozornění formulovaná v rámci těchto konceptů a kampaní mají za cíl soustředit pozornost zdravotnických pracovníků na důležitost zhodnocení a zvážení nutnosti jimi aplikovaných postupů. Měli by upřednostňovat péči založenou na hodnotách a vyvarovat se nadbytečnému zatížení pacientů diagnostickými a terapeutickými intervencemi.

Polypharmacy in the context of medicines means the prescription, dispensing, or use of multiple medications simultaneously. The correct characterization of a particular patient's prescription or use of a medicine allows the appropriate change to be chosen. Rational pharmacotherapy aims to minimize the medication-rela­ted burden, which requires controlled and often longer-lasting intervention and gradually implemented changes in the therapy of a particular patient based on individually assessed and identified drug-related problems. For example, deprescribing options can reduce inappropriate polypharmacy by targeting medicines that occur in prescribing cascades and using comprehensive approaches and concepts. The paper presents the prescribing cascades and the possibilities of their solution within the framework of pharmacotherapy optimization, characterizing the concepts and campaigns "Less is More", "Choose Wisely", and "Patient pathway". The recommendations and warnings formulated within these concepts and campaigns aim to focus the attention of healthcare professionals on the importance of evaluating and considering the necessity of their interventions. They should prioritize value-based care and avoid overloading patients with diagnostic and therapeutic interventions.

• Klíčová slova
• preskripční kaskáda,
• MeSH
• depreskripce MeSH
• lidé MeSH
• management farmakoterapie MeSH
• polypharmacy * prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

In the last decade, the regeneration of derelict or underused sites, fully or partly located in urban areas (or so called "brownfields"), has become more common, since free developable land (or so called "greenfields") has more and more become a scare and, hence, more expensive resource, especially in densely populated areas. Although the regeneration of brownfield sites can offer development potentials, the complexity of these sites requires considerable efforts to successfully complete their revitalization projects and the proper selection of promising sites is a pre-requisite to efficiently allocate the limited financial resources. The identification and analysis of success factors for brownfield sites regeneration can support investors and decision makers in selecting those sites which are the most advantageous for successful regeneration. The objective of this paper is to present the Timbre Brownfield Prioritization Tool (TBPT), developed as a web-based solution to assist stakeholders responsible for wider territories or clusters of brownfield sites (portfolios) to identify which brownfield sites should be preferably considered for redevelopment or further investigation. The prioritization approach is based on a set of success factors properly identified through a systematic stakeholder engagement procedure. Within the TBPT these success factors are integrated by means of a Multi Criteria Decision Analysis (MCDA) methodology, which includes stakeholders' requalification objectives and perspectives related to the brownfield regeneration process and takes into account the three pillars of sustainability (economic, social and environmental dimensions). The tool has been applied to the South Moravia case study (Czech Republic), considering two different requalification objectives identified by local stakeholders, namely the selection of suitable locations for the development of a shopping centre and a solar power plant, respectively. The application of the TBPT to the case study showed that it is flexible and easy to adapt to different local contexts, allowing the assessors to introduce locally relevant parameters identified according to their expertise and considering the availability of local data.

• MeSH
• internet MeSH
• metody pro podporu rozhodování * MeSH
• regenerace a remediace životního prostředí ekonomika   metody   MeSH
• rozhodování * MeSH
• vytváření politiky * MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

Prioritizing brownfields for redevelopment in real estate portfolios can contribute to more sustainable regeneration and land management. Owners of large real estate and brownfield portfolios are challenged to allocate their limited resources to the development of the most critical or promising sites, in terms of time and cost efficiency. Authorities worried about the negative impacts of brownfields - in particular in the case of potential contamination - on the environment and society also need to prioritize their resources to those brownfields that most urgently deserve attention and intervention. Yet, numerous factors have to be considered for prioritizing actions, in particular when adhering to sustainability principles. Several multiple-criteria decision analysis (MCDA) approaches and tools have been suggested in order to support these actors in managing their brownfield portfolios. Based on lessons learned from the literature on success factors, sustainability assessment and MCDA approaches, researchers from a recent EU project have developed the web-based Timbre Brownfield Prioritization Tool (TBPT). It facilitates assessment and prioritization of a portfolio of sites on the basis of the probability of successful and sustainable regeneration or according to individually specified objectives. This paper introduces the challenges of brownfield portfolio management in general and reports about the application of the TBPT in five cases: practical test-uses by two large institutional land owners from Germany, a local and a regional administrative body from the Czech Republic, and an expert from a national environmental authority from Romania. Based on literature requirements for sustainability assessment tools and on the end-users' feedbacks from the practical tests, we discuss the TBPT's strengths and weaknesses in order to inform and give recommendations for future development of prioritization tools.

• MeSH
• lidé MeSH
• metody pro podporu rozhodování MeSH
• regenerace a remediace životního prostředí metody   MeSH
• zachování přírodních zdrojů metody   MeSH
• znečištění životního prostředí MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Německo MeSH
• Rumunsko MeSH

• MeSH
• bezpečnost MeSH
• celosvětové zdraví MeSH
• dopravní nehody statistika a číselné údaje   trendy   MeSH
• hodnocení programu MeSH
• sběr dat MeSH
• úrazy a nehody MeSH

• Konspekt
• Veřejné zdraví a hygiena
• NLK Obory
• veřejné zdravotnictví
• NLK Publikační typ
• publikace WHO

Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.

• MeSH
• adrenalin MeSH
• anafylaxe * etiologie   prevence a kontrola   MeSH
• COVID-19 * MeSH
• lidé MeSH
• SARS-CoV-2 MeSH
• senioři MeSH
• vakcíny proti COVID-19 MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• regionální zdravotnické plánování MeSH
• řízení rizik metody   MeSH
• sladká voda MeSH
• studie případů a kontrol MeSH
• zásobování vodou normy   MeSH
• zdravotní inženýrství výchova   MeSH
• znečištění vody prevence a kontrola   MeSH
• Publikační typ
• příručky MeSH

• Konspekt
• Životní prostředí a jeho ochrana
• NLK Obory
• environmentální vědy
• NLK Publikační typ
• publikace WHO

The European Academy of Allergy and Clinical Immunology (EAACI) organized the first European Strategic Forum on Allergic Diseases and Asthma. The main aim was to bring together all relevant stakeholders and decision-makers in the field of allergy, asthma and clinical Immunology around an open debate on contemporary challenges and potential solutions for the next decade. The Strategic Forum was an upscaling of the EAACI White Paper aiming to integrate the Academy's output with the perspective offered by EAACI's partners. This collaboration is fundamental for adapting and integrating allergy and asthma care into the context of real-world problems. The Strategic Forum on Allergic Diseases brought together all partners who have the drive and the influence to make positive change: national and international societies, patients' organizations, regulatory bodies and industry representatives. An open debate with a special focus on drug development and biomedical engineering, big data and information technology and allergic diseases and asthma in the context of environmental health concluded that connecting science with the transformation of care and a joint agreement between all partners on priorities and needs are essential to ensure a better management of allergic diseases and asthma in the advent of precision medicine together with global access to innovative and affordable diagnostics and therapeutics.

• MeSH
• alergie diagnóza   epidemiologie   etiologie   terapie   MeSH
• big data MeSH
• bioinženýrství MeSH
• bronchiální astma diagnóza   epidemiologie   terapie   MeSH
• environmentální zdraví MeSH
• implementační věda MeSH
• informační technologie MeSH
• kapitálové financování * MeSH
• lidé MeSH
• management nemoci MeSH
• translační biomedicínský výzkum * ekonomika   zákonodárství a právo   metody   organizace a řízení   MeSH
• vyvíjení léků MeSH
• výzkum * MeSH
• zapojení pacienta MeSH
• zdravotní politika MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Evropa MeSH

COVID-19 has depleted healthcare systems around the world. Extreme conditions must be defined as soon as possible so that services and treatment can be deployed and intensified. Many biomarkers are being investigated in order to track the patient's condition. Unfortunately, this may interfere with the symptoms of other diseases, making it more difficult for a specialist to diagnose or predict the severity level of the case. This research develops a Smart Healthcare System for Severity Prediction and Critical Tasks Management (SHSSP-CTM) for COVID-19 patients. On the one hand, a machine learning (ML) model is projected to predict the severity of COVID-19 disease. On the other hand, a multi-agent system is proposed to prioritize patients according to the seriousness of the COVID-19 condition and then provide complete network management from the edge to the cloud. Clinical data, including Internet of Medical Things (IoMT) sensors and Electronic Health Record (EHR) data of 78 patients from one hospital in the Wasit Governorate, Iraq, were used in this study. Different data sources are fused to generate new feature pattern. Also, data mining techniques such as normalization and feature selection are applied. Two models, specifically logistic regression (LR) and random forest (RF), are used as baseline severity predictive models. A multi-agent algorithm (MAA), consisting of a personal agent (PA) and fog node agent (FNA), is used to control the prioritization process of COVID-19 patients. The highest prediction result is achieved based on data fusion and selected features, where all examined classifiers observe a significant increase in accuracy. Furthermore, compared with state-of-the-art methods, the RF model showed a high and balanced prediction performance with 86% accuracy, 85.7% F-score, 87.2% precision, and 86% recall. In addition, as compared to the cloud, the MAA showed very significant performance where the resource usage was 66% in the proposed model and 34% in the traditional cloud, the delay was 19% in the proposed model and 81% in the cloud, and the consumed energy was 31% in proposed model and 69% in the cloud. The findings of this study will allow for the early detection of three severity cases, lowering mortality rates.

• MeSH
• algoritmy MeSH
• COVID-19 * MeSH
• internet věcí * MeSH
• lidé MeSH
• poskytování zdravotní péče MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• antibiotická rezistence účinky léků   MeSH
• antiinfekční látky klasifikace   škodlivé účinky   MeSH
• řízení rizik MeSH

• Konspekt
• Farmacie. Farmakologie
• NLK Obory
• farmacie a farmakologie
• farmakoterapie
• NLK Publikační typ
• publikace WHO