Článek se zabývá problematikou personalizované léčby akromegalie s důrazem na predikci terapeutické odpovědi. V kontextu rychle se rozvíjející oblasti personalizované medicíny zdůrazňuje variabilitu klinických, biochemických a radiologických rysů akromegalie a potřebu přesnější klasifikace a personalizovaných terapeutických přístupů. Chirurgie zůstává hlavním terapeutickým přístupem a v článku jsou analyzovány předoperační prediktory úspěšné operace, jako jsou vyšší koncentrace růstového hormonu před zákrokem a negativní vliv invaze kavernózního sinu. Při terapii somatostatinovými analogy jsou zkoumány faktory, včetně intenzity signálu na MRI a exprese receptorů SSTR2A a SSTR5. Dále je diskutován význam matematických analýz a modelů umělé inteligence při předpovědi terapeutické odpovědi. V současné době je nezbytné vyvinout nové algoritmy pro výběr terapie, aby bylo možné léčit pacienty s akromegalií efektivněji.

The article deals with the issue of personalized treatment of acromegaly with emphasis on prediction of therapeutic response. In the context of the rapidly developing field of personalized medicine, it emphasizes the variability of the clinical, biochemical and radiological features of acromegaly and the need for more accurate classification and personalized therapeutic approaches. Surgery remains the main therapeutic approach, and this article analyzes preoperative predictors of successful surgery, such as higher growth hormone concentrations before surgery and the negative impact of cavernous sinus invasion. Factors including signal intensity on MRI and SSTR2A and SSTR5 receptor expression are investigated during somatostatin analogue therapy. The importance of mathematical analyses and artificial intelligence models in predicting therapeutic response is also discussed. Currently, it is necessary to develop new algorithms for therapy selection in order to treat patients with acromegaly more effectively.

• MeSH
• Acromegaly * therapy   MeSH
• Precision Medicine MeSH
• Humans MeSH
• Neurosurgical Procedures MeSH
• Somatostatin analogs & derivatives   pharmacology   therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Timely initiation of effective therapy is crucial for preventing disability in multiple sclerosis; however, treatment response varies greatly among patients. Comprehensive predictive models of individual treatment response are lacking. Our aims were: (i) to develop predictive algorithms for individual treatment response using demographic, clinical and paraclinical predictors in patients with multiple sclerosis; and (ii) to evaluate accuracy, and internal and external validity of these algorithms. This study evaluated 27 demographic, clinical and paraclinical predictors of individual response to seven disease-modifying therapies in MSBase, a large global cohort study. Treatment response was analysed separately for disability progression, disability regression, relapse frequency, conversion to secondary progressive disease, change in the cumulative disease burden, and the probability of treatment discontinuation. Multivariable survival and generalized linear models were used, together with the principal component analysis to reduce model dimensionality and prevent overparameterization. Accuracy of the individual prediction was tested and its internal validity was evaluated in a separate, non-overlapping cohort. External validity was evaluated in a geographically distinct cohort, the Swedish Multiple Sclerosis Registry. In the training cohort (n = 8513), the most prominent modifiers of treatment response comprised age, disease duration, disease course, previous relapse activity, disability, predominant relapse phenotype and previous therapy. Importantly, the magnitude and direction of the associations varied among therapies and disease outcomes. Higher probability of disability progression during treatment with injectable therapies was predominantly associated with a greater disability at treatment start and the previous therapy. For fingolimod, natalizumab or mitoxantrone, it was mainly associated with lower pretreatment relapse activity. The probability of disability regression was predominantly associated with pre-baseline disability, therapy and relapse activity. Relapse incidence was associated with pretreatment relapse activity, age and relapsing disease course, with the strength of these associations varying among therapies. Accuracy and internal validity (n = 1196) of the resulting predictive models was high (>80%) for relapse incidence during the first year and for disability outcomes, moderate for relapse incidence in Years 2-4 and for the change in the cumulative disease burden, and low for conversion to secondary progressive disease and treatment discontinuation. External validation showed similar results, demonstrating high external validity for disability and relapse outcomes, moderate external validity for cumulative disease burden and low external validity for conversion to secondary progressive disease and treatment discontinuation. We conclude that demographic, clinical and paraclinical information helps predict individual response to disease-modifying therapies at the time of their commencement.

• MeSH
• Algorithms * MeSH
• Databases, Factual MeSH
• Demography MeSH
• Adult MeSH
• Immunosuppressive Agents therapeutic use   MeSH
• Precision Medicine methods   MeSH
• Humans MeSH
• Young Adult MeSH
• Disability Evaluation MeSH
• Forecasting methods   MeSH
• Prognosis MeSH
• Disease Progression MeSH
• Recurrence MeSH
• Reproducibility of Results MeSH
• Risk Factors MeSH
• Multiple Sclerosis diagnosis   drug therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Multicenter Study MeSH

Úvod: Chronická obstrukční plicní nemoc (CHOPN) je celosvětovým problémem se závažným dopadem i na české pacienty. Současně se aktuálně poněkud změnil pohled na diagnostiku, monitoraci a optimální léčebná doporučení. Metodika: Česká pneumologická a ftizeologická společnost (ČPFS) prostřednictvím Sekce bronchiálních obstrukcí vypracovala nový doporučený postup péče o nemocné ve stabilní fázi onemocnění. Tento dokument byl prodiskutován na Národní konsenzuální konferenci a následně prezentován na sérii lokálních a celostátních seminářů. Finální verze byla odeslána k publikaci, česky v plné verzi, anglicky ve zkrácené podobě. Diagnóza: Elementární diagnostickou metodu představuje spirometrie provedená po aplikaci inhalačního bronchodilatancia. Dále je kladen důraz na anamnézu (výskyt projevů onemocnění včetně frekvence akutních exacerbací). Spektrum symptomů umožňuje rozpoznat jednotlivé klinické varianty CHOPN (tzv. fenotypy). ČPFS doporučení popisuje šest, pro praxi relevantních, fenotypů: emfyzematický a bronchitický fenotyp, fenotyp častých exacerbací, fenotyp plicní kachexie a dva překryvné fenotypy (CHOPN + astma respektive CHOPN + bronchietázie). Léčba: Léčebná doporučení rozdělujeme do čtyř kroků. Prvním je eliminace inhalačních rizik. Paušální terapie, zejména inhalační bronchodilatancia, pulmonální rehabilitace, vakcinace a léčba komorbidit, je určena pro všechny pacienty s prokázanou diagnózou CHOPN. Pokročilé onemocnění jeví tendenci vývoje do určitých fenotypů, cílená fenotypická léčba je tedy zaměřená právě na tyto specifické typy postižení. Posledním léčebným krokem je péče o respirační selhávání a o terminální CHOPN. Závěr: Moderní a efektivní léčba CHOPN vyžaduje personalizovaný přístup k nemocným.

Introduction: Chronic obstructive pulmonary disease (COPD) is a global problem with serious impacts on patients in the Czech Republic. The current view on COPD changes the diagnostic approach and optimal treatment recommendations. Methods: The Expert group of the Czech Pneumological and Phthisiological Society (CPPS) has drawn up draft guidelines on COPD. This document was discussed at the National Consensus Conference and subsequently presented at a series of local and national workshops. The final document was prepared for publication (full version in Czech, short version in English) in April and May 2013. Diagnosis: The basic diagnostic method is spirometry after inhaled bronchodilators. Detailed analysis of medical history (symptoms and exacerbations) provides additional important information. The wide spectrum of COPD symptoms can help with detection of the clinical subtypes of COPD (called phenotypes). CPPS describes six clinical phenotypes relevant for practical usage: emphysematic and bronchitic phenotypes, the phenotype of frequent exacerbations, phenotype of pulmonary cachexia and two overlapping phenotypes (COPD with asthma and COPD with bronchiectasis). Treatment: Treatment recommendations are divided into four steps. The first is to eliminate all risk of inhalation. Standard therapy, particularly inhaled bronchodilators, pulmonary rehabilitation, vaccination and treatment of comorbidities, is intended for all patients with confirmed diagnosis of COPD. Advanced diseases have a tendency to develop disease specific phenotypes, phenotypic targeted therapy is geared to specific types of disabilities. The final therapeutic step is to care for respiratory failure and terminal COPD. Conclusion: Effective treatment of COPD requires a personalized approach to the each patient.

• MeSH
• Algorithms MeSH
• Pulmonary Disease, Chronic Obstructive * diagnosis   therapy   MeSH
• Phenotype MeSH
• Humans MeSH
• Practice Guidelines as Topic MeSH
• Severity of Illness Index MeSH
• Check Tag
• Humans MeSH

Pulmonary fibrosis is one of the most severe long-term consequences of COVID-19. Corticosteroid treatment increases the chances of recovery; unfortunately, it can also have side effects. Therefore, we aimed to develop prediction models for a personalized selection of patients benefiting from corticotherapy. The experiment utilized various algorithms, including Logistic Regression, k-NN, Decision Tree, XGBoost, Random Forest, SVM, MLP, AdaBoost, and LGBM. In addition easily human-interpretable model is presented. All algorithms were trained on a dataset consisting of a total of 281 patients. Every patient conducted an examination at the start and three months after the post-COVID treatment. The examination comprised a physical examination, blood tests, functional lung tests, and an assessment of health state based on X-ray and HRCT. The Decision tree algorithm achieved balanced accuracy (BA) of 73.52%, ROC-AUC of 74.69%, and 71.70% F1 score. Other algorithms achieving high accuracy included Random Forest (BA 70.00%, ROC-AUC 70.62%, 67.92% F1 score) and AdaBoost (BA 70.37%, ROC-AUC 63.58%, 70.18% F1 score). The experiments prove that information obtained during the initiation of the post-COVID-19 treatment can be used to predict whether the patient will benefit from corticotherapy. The presented predictive models can be used by clinicians to make personalized treatment decisions.

• Publication type
• Journal Article MeSH

Onychomykóza je mykotická infekce nehtu projevující se změnou barvy, ztluštěním nehtové ploténky a jejím odloučením od nehtového lůžka. Onychomykóza se vyskytuje u 10 % obecné populace, u 20 % populace starší 60 let, a dokonce u 50 % jedinců starších 70 let. Onemocnění je vyvoláváno řadou původců, ale nejběžněji dermatofyty. Správná diagnostika zahrnuje fyzikální vyšetření, mikroskopii a kultivační průkaz. Histologické vyšetření za použití metody PAS (kyselina jodistá – Schiffovo reagens) může zvýšit diagnostickou citlivost. Léčba se zaměřuje na eradikaci původce a následnou rekonstituci struktury nehtu. Systémová léčba je nejúčinnějším přístupem, metaanalytické studie udávají vyléčení u 76 % při použití terbinafinu, 63 % u pulsní léčby itraconazolem, u 59 % při kontinuální terapii itraconazolem, u 48 % případů léčených fluconazolem. Doprovodné snesení (débridement) poškozené části nehtové ploténky dále zvyšuje úspěšnost léčby. Lokální léčba ciclopiroxem je méně účinná; procento selhání převyšuje 60 %. Porovnávána byla i některá volně dostupná léčiva. Laser a fotodynamická terapie vykazují slibné výsledky v in vitro studiích, ale je třeba vyčkat na výsledky dalších klinických studií. Navzdory léčbě je rekurence onychomykózy častá, objevuje se u 10–50 % pacientů jako následek reinfekce nebo v případech nedostatečné léčby.

Onychomycosis is a fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed. Onychomycosis occurs in 10% of the general population, 20% of persons older than 60 years, and 50% of those older than 70 years. It is caused by a variety of organisms, but most cases are caused by dermatophytes. Accurate diagnosis involves physical and microscopic examination and culture. Histologic evaluation using periodic acid–Schiff staining increases sensitivity for detecting infection. Treatment is aimed at eradication of the causative organism and return to a normal appearance of the nail. Systemic antifungals are the most effective treatment, with meta-analyses showing mycotic cure rates of 76% for terbinafine, 63% for itraconazole with pulse dosing, 59% for itraconazole with continuous dosing, and 48% for fluconazole. Concomitant nail debridement further increases cure rates. Topical therapy with ciclopirox is less effective; it has a failure rate exceeding 60%. Several nonprescription treatments have also been evaluated. Laser and photodynamic therapies show promise based on in-vitro evaluation, but more clinical studies are needed. Despite treatment, the recurrence rate of onychomycosis is 10% to 50% as a result of reinfection or lack of mycotic cure.

• MeSH
• Algorithms MeSH
• Antifungal Agents therapeutic use   MeSH
• Administration, Topical MeSH
• Debridement MeSH
• Photochemotherapy MeSH
• Combined Modality Therapy MeSH
• Lasers, Solid-State therapeutic use   MeSH
• Nonprescription Drugs MeSH
• Humans MeSH
• Decision Support Techniques MeSH
• Treatment Failure MeSH
• Onychomycosis diagnosis   classification   microbiology   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

PURPOSE: Computational models of microwave ablation (MWA) are widely used during the design optimization of novel devices and are under consideration for patient-specific treatment planning. The objective of this study was to assess the sensitivity of computational models of MWA to tissue biophysical properties. METHODS: The Morris method was employed to assess the global sensitivity of the coupled electromagnetic-thermal model, which was implemented with the finite element method (FEM). The FEM model incorporated temperature dependencies of tissue physical properties. The variability of the model was studied using six different outputs to characterize the size and shape of the ablation zone, as well as impedance matching of the ablation antenna. Furthermore, the sensitivity results were statistically analyzed and absolute influence of each input parameter was quantified. A framework for systematically incorporating model uncertainties for treatment planning was suggested. RESULTS: A total of 1221 simulations, incorporating 111 randomly sampled starting points, were performed. Tissue dielectric parameters, specifically relative permittivity, effective conductivity, and the threshold temperature at which they transitioned to lower values (i.e., signifying desiccation), were identified as the most influential parameters for the shape of the ablation zone and antenna impedance matching. Of the thermal parameters considered in this study, the nominal blood perfusion rate and the temperature interval across which the tissue changes phase were identified as the most influential. The latent heat of tissue water vaporization and the volumetric heat capacity of the vaporized tissue were recognized as the least influential parameters. Based on the evaluation of absolute changes, the most important parameter (perfusion) had approximately 40.23 times greater influence on ablation area than the least important parameter (volumetric heat capacity of vaporized tissue). Another significant input parameter (permittivity) had 22.26 times higher influence on the deviation of ablation edge shape from a sphere than one of the less important parameters (latent heat of liver tissue vaporization). CONCLUSIONS: Dielectric parameters, blood perfusion rate, and the temperature interval across which the tissue changes phase were found to have the most significant impact on MWA model outputs. The latent heat of tissue water vaporization and the volumetric heat capacity of the vaporized tissue were recognized as the least influential parameters. Uncertainties in model outputs identified in this study can be incorporated to provide probabilistic maps of expected ablation outcome for patient-specific treatment planning.

• MeSH
• Ablation Techniques methods   MeSH
• Algorithms MeSH
• Finite Element Analysis MeSH
• Biomechanical Phenomena MeSH
• Electromagnetic Phenomena MeSH
• Precision Medicine methods   MeSH
• Liver physiology   MeSH
• Humans MeSH
• Microwaves * MeSH
• Computer Simulation * MeSH
• Regional Blood Flow MeSH
• Models, Theoretical * MeSH
• Temperature MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

Podávanie inzulínu pomocou inzulínovej pumy umožňuje prostredníctvom vopred naprogramovaných opakovaných minidávok individualizáciu bazálnej substitúcie inzulínu pre jednotlivé časové obdobia dňa v hodinových intervaloch, s možnosťou diferenciácie o 0,05 až 0,01 U/hodinu. Umožňuje tak zohľadniť a prispôsobiť terapeutickú substitúciu inzulínu požiadavkám fyziologického diurnálneho rytmu ako aj dlhodobo či aktuálne sa meniacim denným potrebám vyplývajúcim z pracovných požiadaviek alebo požiadaviek životného štýlu. Predkladaný text predstavuje v súlade s aktuálnym znením indikačných obmedzení konsenzuálny terapeutický algoritmus pre liečbu pomocou inzulínovej pumpy a kontinuálne meranie glykémie, ktorý formuloval výbor Slovenskej diabetologickej spoločnosti.

Administering of insulin by means of an insulin pump allows through pre-programmed repeated mini doses for individualization of insulin basal substitution for individual time periods of the day in hourly intervals, with a possible differentiation of U-Hour by 0.05 through to 0.01 U-Hour. This makes it possible to take into account and adjust therapeutic substitution of insulin to the requirements of physiological diurnal rhythm as well as to the changing daily needs, instantly or over the long-term, following from work or lifestyle related demands. The presented text describes a consensual therapeutic algorithm for treatment with an insulin pump and continuous monitoring of glucose levels in compliance with the indicative limitations as amended, formulated by the Committee of the Slovak Diabetes Society.

• MeSH
• Diabetes Mellitus drug therapy   MeSH
• Drug Therapy standards   MeSH
• Precision Medicine MeSH
• Syringes MeSH
• Insulin Infusion Systems * MeSH
• Insulins administration & dosage   MeSH
• Drug Chronotherapy MeSH
• Humans MeSH
• Drug Administration Schedule MeSH
• Blood Glucose Self-Monitoring * standards   MeSH
• Infusions, Subcutaneous standards   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Practice Guideline MeSH

Východiska: Hepatocelulární karcinom (hepatocellular carcinoma – HCC) je celosvětově šestý nejčastější solidní nádor u dospělých a třetí nejčastější příčinou úmrtí na zhoubný novotvar s narůstající incidencí. Potenciálně kurativní chirurgická léčba je zatížena vysokou rekurencí. Paliativní postupy pak mají společnou nízkou účinnost. S rozšiřujícím se spektrem léčebných postupů je důležité identifikovat prediktivní faktory určující jejich efektivitu. Článek ilustruje současný stav diagnostiky a léčby hepatocelulárního karcinomu s možnými dopady prediktivní onkologie do budoucnosti. Materiál a metodika: Byl proveden rozbor dostupné literatury ve vztahu k etiologii, epidemiologii, diagnostice a individualizované léčbě hepatocelulárního karcinomu spolu s analýzou vlastního souboru 22 pacientů operovaných pro HCC ve FN Brno v letech 2017–2020, vč. vyšetření exprese izoforem cytochromu P450. Výsledky: V centru diagnosticko-terapeutického algoritmu stojí screening transabdominální ultrasonografií u rizikové populace definované cirhózou. Diagnostika je postavena na zobrazovacích metodách bez požadavku biopsie. Jen některé parametry nádoru jako počet a velikost ložisek a hladinu alfa-fetoproteinu (AFP) lze získat bez ní. U pacientů s pokročilým onemocněním v dobrém klinickém stavu lze k prodloužení kvalitního života využít molekulárně cílenou léčbu. Zvýšená exprese MET a AXL je negativní prognostický faktor především ve vztahu k léčbě protilátkami proti vaskulárnímu endoteliálnímu růstovému faktoru (anti-VEGF léčba). Vysoký AFP je prediktorem dobré účinnosti regorafenibu, ale časného relapsu po chirurgické léčbě. Na vlastním souboru pacientů jsme prokázali souvislost exprese izoforem cytochromu P450 v nádorové tkáni se stupněm dediferenciace nádoru, který souvisí s velikostí a počtem ložisek. U malých molekul v léčbě HCC (typicky tyrozinkinázové inhibitory) by měla být tato léčba tím účinnější, čím je nádor méně diferencovaný. Závěr: Podíl hepatocelulárního karcinomu na morbiditě a mortalitě nádorových onemocnění narůstá. Lze dobře definovat rizikovou populaci i jednoduchou screeningovou metodu. Léčba na základě stagingového systému Barcelona Clinic Liver Cancer (BCLC) dává nejlepší léčebné výsledky. V tomto systému ale nejsou zahrnuty sérové a tkáňové prediktivní parametry. Dokud nebude možné získat tyto informace ze séra, bude nejspíše nutné obměnit diagnostické schéma ve smyslu nutnosti biopsie co možná nejméně invazivním způsobem, ale v nezbytných případech i chirurgicky alespoň u stadií B a C dle BCLC. Tím se otevírají možnosti pro tekuté biopsie, při kterých bude možné využít některé ze specifických mi-RNA.

Background: Though the sixth most frequent malignancy, hepatocellular carcinoma (HCC) is the third most common cause of death amongst solid tumours. Only surgery in the early stages may provide the cure; however, HCC still has a high recurrence rate. Non-surgical treatment lacks comparable efficacy. It was not sooner than in 2017 that the therapy galore started to extend. Thus prognostic factors driving the therapy have been gaining importance. Material and methods: All relevant literature was checked for aetiology, epidemiology, diagnostic means, and individualised treatment of HCC. Cytochrome P-450 expression data from 22 patients operated in the University Hospital Brno in the period 2017–2020 were included. Results: Screening the population at risk (presence of cirrhosis) with the transabdominal ultrasound lies at the centre of the diagnostic algorithm. Making the diagnosis does not require a biopsy in most cases. Only a few parameters are thus known before the treatment – a size and number of lesions, and AFP level. These drive the indication to surgery. Relapses after surgery and response to palliative treatment depend on the expression of MET and AXL that directly affect anti-VEGF therapy. High AFP predicts a good response to regorafenib but early relapse after surgery. The pattern of P450 expression was found linked with tumour differentiation. The differentiation correlates with the size and number of lesions. We also found a link between the P450 expression and some mi-RNAs possibly detectable using liquid biopsy techniques. Conclusion: The share of deaths from HCC overweighs its incidence. The risk population to screen is well-defined (cirrhosis). The BCLC staging system probably gives the best complication/efficacy results. This system does not require any biopsy and does not comprise all predictive factors important in the expanding targeted molecular therapy. According to our results, small molecules to treat HCC should work better in poorly differentiated tumours. Surgery is more effective in those well-differentiated. It isn‘t easy to get all relevant information before therapy. Some factors need macrobiopsy (surgical). The pretreatment workup will probably require a mandatory biopsy in BCLC B and C stages to get the information. This opens up a way for the liquid biopsy that could use some specific mi RNAs.

• MeSH
• Carcinoma, Hepatocellular * pathology   therapy   MeSH
• Precision Medicine MeSH
• Humans MeSH
• Neoplasm Recurrence, Local pathology   MeSH
• Liver Neoplasms pathology   therapy   MeSH
• Prognosis MeSH
• Neoplasm Staging MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Diabetes mellitus (DM) je v posledních letech narůstajícím celospolečenským problémem jak ve vyspělých, tak i rozvojových státech světa. Může to působit již jako klišé. ČR má v péči o diabetického pacienta co dohánět. Od začátku letošního roku mohou tedy VPL (všeobecný praktický lékař) léčit ve svých praxích nekomplikované diabetiky 2. typu. Dosud za tuto práci nebyli honorováni a navíc toto nebylo zohledněno zdravotními pojišťovnami v rámci regulací. Někdy spíše paradoxně byli penalizováni vyššími náklady na laboratoře a léky. V celkovém efektu to bylo pro praktické lékaře spíše demotivující. Od 1. 1. 2010 se všeobecným praktickým lékařům konečně nabízí možnost léčit nekomplikovaného diabetika. V Evropském kontextu při hodnocení Evropského spotřebitelského indexu týkajícího se kvality péče o diabetiky skončila ČR 23 mezi 28 Evropskými státy (Euro Diabetes Consumer Index (EDCI)). Je to opravdu jen o glykemii ? Není kromě glykemie zapotřebí léčit i hypertenzi a dyslipidemii ? Jak mnoho sníží následná rizika pacientů důsledná léčba těchto rizik ? Jak drahá bude náprava těchto škod, pokud nejsou adekvátně léčeni ? Není léčba hypertenze stejně důležitá jako léčba hypoglykemická ? Stoupá počet diabetiků v populaci, ale počet diabetologických ambulancí nikoliv. Došlo proto po sérii jednání s MZ o prosazení zlepšení dostupnosti a zkvalitnění péče o zejména nově zachycené diabetiky v ordinacích VPL.

In recent years, diabetes mellitus (DM) has been an increasing public health problem in both developed and developing countries. More often than not, it feels like a cliché to me. The Czech Republic is way behind in the care of the diabetic patient. Beginning this year, GPs (general practitioners) can treat uncomplicated type 2 diabetic patients in their practice. Up to now, they have not been paid for this work and, what is more, it has not been considered by health insurance companies in terms of regulations. Paradoxically enough, sometimes GPs were even penalized by higher costs for laboratories and drugs. In an overall effect, it was rather demotivating for general practitioners. Since 1st January 2010, general practitioners have finally been provided with an opportunity to treat an uncomplicated diabetic patient. In the European context, when the Euro Diabetes Consumer Index (EDCI) concerning the quality of diabetes care was assessed, the Czech Republic ranked 23rd among 28 European countries. Is it really only a matter of glycaemia ? In addition to glycaemia, is it not necessary to manage hypertension and dyslipidaemia ? How much can the subsequent risks in patients be reduced by a consistent treatment of these risks ? How expensive will the reversal of damage be if they are not treated adequately ? Is treatment of hypertension not as important as hypoglycaemic treatment ? The number of diabetics in the population is increasing but the number of diabetologist services is not. Therefore, following a series of negotiations with the ministry of health, better availability and improved quality of care, particularly of newly detected diabetics in GP surgeries have been advocated.

• MeSH
• Algorithms MeSH
• Diabetes Mellitus, Type 2 diagnosis   prevention & control   therapy   MeSH
• Hypoglycemic Agents therapeutic use   MeSH
• Diabetes Complications diagnosis   therapy   MeSH
• Humans MeSH
• Patient-Centered Care MeSH
• Primary Health Care methods   organization & administration   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Among medical specialties, laboratory medicine is the largest producer of structured data and must play a crucial role for the efficient and safe implementation of big data and artificial intelligence in healthcare. The area of personalized therapies and precision medicine has now arrived, with huge data sets not only used for experimental and research approaches, but also in the "real world". Analysis of real world data requires development of legal, procedural and technical infrastructure. The integration of all clinical data sets for any given patient is important and necessary in order to develop a patient-centered treatment approach. Data-driven research comes with its own challenges and solutions. The Findability, Accessibility, Interoperability, and Reusability (FAIR) Guiding Principles provide guidelines to make data findable, accessible, interoperable and reusable to the research community. Federated learning, standards and ontologies are useful to improve robustness of artificial intelligence algorithms working on big data and to increase trust in these algorithms. When dealing with big data, the univariate statistical approach changes to multivariate statistical methods significantly shifting the potential of big data. Combining multiple omics gives previously unsuspected information and provides understanding of scientific questions, an approach which is also called the systems biology approach. Big data and artificial intelligence also offer opportunities for laboratories and the In Vitro Diagnostic industry to optimize the productivity of the laboratory, the quality of laboratory results and ultimately patient outcomes, through tools such as predictive maintenance and "moving average" based on the aggregate of patient results.

• MeSH
• Algorithms MeSH
• Big Data * MeSH
• Precision Medicine methods   MeSH
• Humans MeSH
• Delivery of Health Care MeSH
• Artificial Intelligence * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH