• MeSH
• gynekologie MeSH
• porodnictví MeSH
• Publikační typ
• periodika MeSH

• Konspekt
• Gynekologie. Porodnictví
• NLK Obory
• gynekologie a porodnictví
• gynekologie a porodnictví

To, co pacienta přivádí k lékaři nejčastěji, je bolest. V rehabilitační ambulanci je to nejčastěji bolest zad. Ta může mít tolik důvodů, že se v diagnostice někdy nedokážeme dobrat konce. Oproti tomu bolest u pacienta po úrazu nebo operaci struktur pohybového aparátu by mohla vypadat jednoduše jako prostá nocicepce. Tak tomu ale není, bolest nekoreluje se stavem poškození tkáně či aktivitou nociceptorů. Výrazné je to např. u komplexního regionálního bolestivého syndromu (KRBS, dříve Sudeckův syndrom, reflexní sympatická dystrofie, algoneurodystrofie), jehož příčiny stále nejsou zcela jasné, průběh může být velmi variabilní a stran léčby také není plný konsenzus. Etiologie je jistě multifaktoriální, zahrnuje dysfunkci nervového a imunitního systému, zřejmě faktory genetické a psychologické. O psychiatrických komorbiditách a psychologických faktorech přinášejí studie nekonzistentní údaje. Z mého pohledu je tedy na KRBS jistě potřeba nahlížet v biopsychosociálních souvislostech a takto vést terapii.

What brings the patient to the doctor most often is pain. In a rehabilitation clinic, it's most often back pain. It can have so many causes that sometimes we can't get to the bottom of the diagnosis. In contrast, pain in a patient after an injury or surgery to musculoskeletal structures might look like a simple nociception. However, this is not the case; pain does not correlate with the state of tissue damage or the activity of nociceptors. This is evident, for example, in complex regional pain syndrome (CRPS, formerly Sudeck's syndrome, reflex sympathetic dystrophy, algoneurodystrophy), the causes of which are still not entirely clear, the course can be highly variable and there is no full consensus on treatment. The aetiology is certainly multifactorial, involving dysfunction of the nervous and immune systems, probably genetic and psychological factors. Studies provide inconsistent data on psychiatric comorbidities and psychological factors. From my point of view, then, CRPS certainly needs to be viewed in a biopsychosocial context and therapy needs to be guided in this way.

The European Association of Urology Renal Cell Carcinoma (RCC) guidelines panel updated their recommendation on adjuvant therapy in unfavourable, clinically nonmetastatic RCC following the recently reported results of a second randomised controlled phase 3 trial comparing 1-yr sunitinib to placebo for high-risk RCC after nephrectomy (S-TRAC). On the basis of conflicting results from the two available studies, the panel rated the quality of the evidence, the harm-to-benefit ratio, patient preferences, and costs. Finally, the panel, including representatives from a patient advocate group (International Kidney Cancer Coalition) voted and reached a consensus to not recommend adjuvant therapy with sunitinib for patients with high-risk RCC after nephrectomy. PATIENT SUMMARY: In two studies, sunitinib was given for 1 yr and compared to no active treatment (placebo) in patients who had their kidney tumour removed and who had a high risk of cancer coming back after surgery. Although one study demonstrated that 1 yr of sunitinib therapy resulted in a 1.2-yr longer time before the disease recurred, the other study did not show a benefit and it has not been shown that patients live longer. Despite having been diagnosed with high-risk disease, many patients remain without recurrence, and the side effects of sunitinib are high. Therefore, the panel members, including patient representatives, do not recommend sunitinib after tumour removal in these patients.

• MeSH
• adjuvantní chemoterapie MeSH
• indoly terapeutické užití   MeSH
• karcinom z renálních buněk farmakoterapie   patologie   MeSH
• lidé MeSH
• nádory ledvin farmakoterapie   patologie   MeSH
• nefrektomie * MeSH
• protinádorové látky terapeutické užití   MeSH
• pyrroly terapeutické užití   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• společnosti lékařské MeSH
• urologie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

Skupina předních světových odborníků, vedená profesorem Pauwelsem, vydala v dubnu loňského roku moderní konsenzus, shrnující nejnovější doporučeni pro diagnostiku i léčbu CHOPN. Cílem článku je ukázat na nejvýznamnější novinky, která tato publikace přinesla. CHOPN je nově definována jako nemoc charakterizovaná omezením průtoku vzduchu v průduškách (bronchiální obstrukcíl, které není úplně reverzibilní. Bronchiální obstrukce progreduje a je spojena s abnormální zánětlivou odpovědí plic na škodlivé částice a plyny. Další změna je ve vztahu mezi CHOPN a astmatem. Mezinárodní konsensus opět připouští koexistenci CHOPN a astmatu. U nemocného může dojít ke kombinaci „astmatu podobného zánětu" a „CHOPN podobného zánětu". Významná je i změna v diagnostice obstrukční ventilační poruchy. Průkaz bronchiální obstrukce je vyžadován po bronchodflataci. Novinkou je i hodnocení bronchodflatačních testů. Za pozitivní test se považuje, jestliže se zvýší FEVl o 200 ml a současně nejméně o 12 % proti hodnotám před podélním bronchodflatačního léku. Při léčbě stabilní CHOPN se doporučuje vycházet z následujících zásad: stupňovité přidávání léků v závislosti na závažnosti nemoci; krok dolů není možný (léky tedy pouze přidávat, ne ubírat); pro symptomatickou léčbu CHOPN jsou hlavní bronchodflatačni léky; hlavními bronchodUatačními léky jsou beta2-mimetika, anticholinergika, teofyliny a jejich kombinace; inhalační dlouhodobě působící bronchodflatancia jsou pro léčbu „pohodlnější"; kombinace bronchodflatancií může zvyšovat jejich účinnost a snižovat riziko nežádoucích účinků ve srovnání se zvyšováním dávky jednoho bronchodflatancia; je třeba se vyhýbat chronickému podávání systémových kortikosteroidů pro nepříznivý poměr mezi jejich prospěchem a rizikem.

A group of outstanding specialists headed by professor Pauwelsen published in April of last year an up-to-date consensus summarizing the most recent recommendations for the diagnosis and treatment of COPD. The purpose of the paper is to present the most significant novelties found in the publication. COPD is now defmed as a disease whose most characteristic feature is a limited air-flow in the bronchi (bronchial obstruction), which is not fully reversible. Bronchial obstruction progresses and goes hand in hand with an abnormal inflammatory pulmonary response to noxious particles and gases. Another change concerns the relationship of COPD and asthma. The international consensus once more admits the coexistence of COPD and of asthma. Patients may present with a combination of an „asthma-like" and of a „COPD-like inflammation". Another significant change concerns the diagnosis of obstructive ventilation disorders. Bronchial obstruction should be demonstrated follovraigbronchodflatation. New is also the assessment of bronchodflatation tests. A test is considered positive when FEV rises by 200 ml and, simultaneously, by 12% as compared with the values measured prior to the administration of a bronchodilator. The following principle should gear the management of stable COPD: a step-wise increase of drugs depending on the severity of the disorder; a step back is not possible (we can increase the quantity of drugs, but not reduce it); bronchodilators are the chief drugs in the symptomatic management of COPD; among the main bronchodilators are beta2mimetics, anticholinergics, theophyllines and their combinations; slow-acting inhalation bronchodilators are „more comfortable" for treatment; combinations of bronchodilators may enhance their efficacy and reduce the risk of adverse side-effects as compared with increasing doses of a single bronchodilator; we should avoid all chronic administration of systemic corticosteroids because of the unfavourable benefit-risk ratio.

• MeSH
• bronchiální astma MeSH
• bronchodilatancia aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• lidé MeSH
• obstrukční plicní nemoci diagnóza   klasifikace   terapie   MeSH
• plicní ventilace kontraindikace   metody   přístrojové vybavení   MeSH
• příznaky a symptomy diagnóza   terapie   MeSH
• respirační vzplanutí diagnóza   etiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

OBJECTIVE: To compare image quality of different reconstruction techniques in submillisievert ultralow-dose CT colonography (CTC) and to correlate colonic findings with subsequent optical colonoscopy. METHODS: 58 patients underwent ultralow-dose CTC. The images were reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR) or model-based iterative reconstruction (MBIR) techniques. In each segment, endoluminal noise (expressed as standard deviation of endoluminal density) was measured and image quality was rated on a five-point Likert scale by two independent readers. Colonic lesions were evaluated in consensus and correlated with subsequent optical colonoscopy where possible. RESULTS: The estimated radiation dose was 0.41 ± 0.05 mSv for the supine and 0.42 ± 0.04 mSv for the prone acquisitions. In the endoluminal view, the image quality was rated better in HIR, whereas better scores were obtained in MBIR in the cross-sectional view, where the endoluminal noise was the lowest (p < 0.0001). Five (26%) polyps were not identified using both computer-aided detection and endoluminal inspection in FBP images vs only one (5%) in MBIR and none in HIR images. CONCLUSION: This study showed that in submillisievert ultralow-dose CTC, the image quality for the endoluminal view is better when HIR is used, whereas MBIR yields superior images for the cross-sectional view. The inferior quality of images reconstructed with FBP may result in decreased detection of colonic lesions. ADVANCES IN KNOWLEDGE: Radiation dose from CTC can be safely reduced <1 mSv for both positions when iterative reconstruction is used. MBIR provides better image quality in the cross-sectional view and HIR in the endoluminal view.

• MeSH
• dávka záření MeSH
• kolonografie počítačovou tomografií metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• rentgenový obraz - interpretace počítačová metody   MeSH
• senioři MeSH
• teoretické modely MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

Introduction: Health and social care systems in Central and Eastern European (CEE) countries have undergone significant changes and are currently dealing with serious problems of system disintegration, coordination and a lack of control over the market environment. Description: The increased health needs related to the ageing society and epidemiological patterns in these countries also require funding needs to increase, rationing to be reformed, sectors to be integrated (the managed care approach), and an analytical information base to be developed if supervision of new technological approaches is to improve. The period of system transitions in CEE countries entailed significant changes in their health systems, including health care financing. Discussion: Large deficits in the public financing of health systems were just one of the challenges arising from the economic downturn of the 1990s, which was coupled with inflation, increasing unemployment, low salaries, a large informal sector and tax evasion in a number of CEE countries. During the communist period, there was universal access to a wide range of health services, proving it difficult to retain this coverage. As a result, many states sought to ration publicly funded health services - for example, through patient cost-sharing or decreasing the scope of basic benefits. Yet, not all of these reform plans were implemented, and in fact, some were rolled back or not implemented at all due to a lack of social or political consensus. Conclusion: CEE health systems had come to practice implicit rationing in the form of under-the-table payments from patients, quasi-formal payments to providers to compensate for lack of funding, and long waiting lists forcing patients to the private sector. All these difficulties pose a challenge to the implementation of integrated care.

• Publikační typ
• časopisecké články MeSH

Dotazníky jsou jednoduchým psychometrickým nástrojem k hodnocení subjektivních obtíží pacientů s chronickým revmatickým onemocněním. S ohledem na pozdní diagnostiku idiopatických střevních zánětů (IBD) u pacientů se spondyloartritidou (SpA) byl vytvořen dotazník v podobě screeningových kritérií hodnotící střevní a mimostřevní obtíže v čase. Cílem této práce byl český překlad a jeho lingvistická validace, která pozůstávala z několika fází. V první fázi probíhal nezávislý překlad originální anglické verze do českého jazyka a procesem konsenzuální syntézy byly tyto verze autorskou skupinou analyzovány a diskutovány. Ve druhé fázi probíhal zpětný překlad sjednocené české verze dotazníku. Takto byla vytvořená pre-finální verze dotazníku, kterou vyplnilo celkem 68 pacientů trpících axiální formou SpA, z toho 39 pacientů s neradiografickou axiální SpA (nr-AxSpA) a 29 pacientů s ankylozující spondylitidou (AS). Samostatnou část tvořil dotazník zpětné vazby ke zhodnocení obsahové, lingvistické a stylistické stránky. Vznesené připomínky byly zahrnuty ve finální české verzi dotazníku. V této práci prezentujeme českou verzi Screeningového dotazníku IBD určeného pro pacienty se SpA. Oficiální překlad tak umožní jeho běžné použití jak v klinické, tak výzkumné oblasti.

Questionnaires are a simple psychometric tool to assess the subjective ailments of patients with chronic rheumatic diseases. Concerning the late diagnosis of inflammatory bowel disease (IBD) in patients with spondyloarthritis (SpA), a questionnaire was created in the form of screening criteria evaluating intestinal and extraintestinal problems over time. The aim of this work was the Czech translation and its linguistic validation, which consisted of several phases. In the first phase, an independent translation of the original English version into the Czech language was performed, and these versions were analyzed and discussed by the author group through a process of consensus synthesis. In the second phase, the back translation of the unified Czech version of the questionnaire was carried out. In this way, a pre-final version of the questionnaire was created, which was completed by a total of 68 patients suffering from axial SpA, of which 39 patients with non-radiographic axial SpA (nr-AxSpA) and 29 patients with ankylosing spondylitis (AS). A separate part consisted of a feedback questionnaire to evaluate the content, linguistic and stylistic aspects. The comments raised were included in the final Czech version of the questionnaire. In this work, we present the Czech version of the IBD Screening Questionnaire intended for patients with SpA. An official translation will thus enable its common use in both clinical and research fields.

• Klíčová slova
• lingvistická validace,
• MeSH
• axiální spondyloartritida * komplikace   MeSH
• dospělí MeSH
• idiopatické střevní záněty * diagnóza   komplikace   MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• reprodukovatelnost výsledků MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND: Surgical factors and direct cytotoxicity of bile salts on cholangiocytes may play a role in the development of ischemic cholangiopathy (IC) after liver transplantation (LTx). There is no validated consensus on how to protect the bile ducts during procurement, static preservation, and LTx. Meanwhile, IC remains the most troublesome complication after LTx. AIM: To characterize bile duct management techniques during the LTx process among European transplant centers in cases of donation after brain death (DBD) and circulatory death (DCD). METHOD: An European Liver and Intestine Transplant Association-European Liver Transplant Registry web survey designed to conceal respondents' personal information was sent to surgeons procuring and/or transplanting livers in Europe. RESULTS: Sixty-five percent of responses came from large transplant centers (>50 procurements/y). In 8% of DBDs and 14% of DCDs the bile duct is not rinsed. In 46% of DBDs and 52% of DCDs surgeons prefer to remove the gallbladder after graft reperfusion. Protocols concerning preservation solutions (nature, pressure, volume) are extremely heterogeneous. In 54% of DBDs and 61% of DCDs an arterial back table pressure perfusion is performed. Steroids (20%-10%), heparin (72%-60%), prostacyclin (3%-7%), and fibrinolytics (4%-11%) are used as donor-protective interventions in DBD and DCD cases, respectively. In 2% of DBD and 6% of DCD cases a hepatic artery reperfusion is performed first. In 4% of DBD and 6% of DCD cases, fibrinolytics are administered through the hepatic artery during the bench and/or implantation. CONCLUSION: This European web survey shows for the first time the heterogeneity in the management of bile ducts during procurement, preservation, and transplantation in Europe. In the context of sharing more marginal liver grafts, an expert meeting must be organized to formulate guidelines to be applied to protect liver grafts against IC.

• MeSH
• cholangitida etiologie   MeSH
• ischemie etiologie   MeSH
• lidé MeSH
• odběr tkání a orgánů škodlivé účinky   metody   MeSH
• perfuze škodlivé účinky   metody   MeSH
• pooperační komplikace etiologie   MeSH
• přežívání štěpu MeSH
• průzkumy a dotazníky MeSH
• reperfuze škodlivé účinky   metody   MeSH
• transplantace jater škodlivé účinky   MeSH
• uchovávání orgánů škodlivé účinky   metody   MeSH
• žlučové cesty krevní zásobení   transplantace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: The Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT; www.coh-fit.com) is an anonymous and global online survey measuring health and functioning during the COVID-19 pandemic. The aim of this study was to test concurrently the validity of COH-FIT items and the internal validity of the co-primary outcome, a composite psychopathology "P-score". METHODS: The COH-FIT survey has been translated into 30 languages (two blind forward-translations, consensus, one independent English back-translation, final harmonization). To measure mental health, 1-4 items ("COH-FIT items") were extracted from validated questionnaires (e.g. Patient Health Questionnaire 9). COH-FIT items measured anxiety, depressive, post-traumatic, obsessive-compulsive, bipolar and psychotic symptoms, as well as stress, sleep and concentration. COH-FIT Items which correlated r ≥ 0.5 with validated companion questionnaires, were initially retained. A P-score factor structure was then identified from these items using exploratory factor analysis (EFA) and confirmatory factor analyses (CFA) on data split into training and validation sets. Consistency of results across languages, gender and age was assessed. RESULTS: From >150,000 adult responses by May 6th, 2022, a subset of 22,456 completed both COH-FIT items and validated questionnaires. Concurrent validity was consistently demonstrated across different languages for COH-FIT items. CFA confirmed EFA results of five first-order factors (anxiety, depression, post-traumatic, psychotic, psychophysiologic symptoms) and revealed a single second-order factor P-score, with high internal reliability (ω = 0.95). Factor structure was consistent across age and sex. CONCLUSIONS: COH-FIT is a valid instrument to globally measure mental health during infection times. The P-score is a valid measure of multidimensional mental health.

• MeSH
• COVID-19 * MeSH
• dospělí MeSH
• faktorová analýza statistická MeSH
• hodnocení výsledků zdravotní péče MeSH
• lidé MeSH
• pandemie * MeSH
• průzkumy a dotazníky MeSH
• psychometrie MeSH
• reprodukovatelnost výsledků MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Grade of non-muscle-invasive bladder cancer (NMIBC) is an important prognostic factor for progression. Currently, two World Health Organization (WHO) classification systems (WHO1973, categories: grade 1-3, and WHO2004 categories: papillary urothelial neoplasm of low malignant potential [PUNLMP], low-grade [LG], high-grade [HG] carcinoma) are used. OBJECTIVE: To ask the European Association of Urology (EAU) and International Society of Urological Pathology (ISUP) members regarding their current practice and preferences of grading systems. DESIGN SETTING AND PARTICIPANTS: A web-based, anonymous questionnaire with ten questions on grading of NMIBC was created. The members of EAU and ISUP were invited to complete an online survey by the end of 2021. Thirteen experts had previously answered the same questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The submitted answers from 214 ISUP members, 191 EAU members, and 13 experts were analyzed. RESULTS AND LIMITATIONS: Currently, 53% use only the WHO2004 system and 40% use both systems. According to most respondents, PUNLMP is a rare diagnosis with management similar to Ta-LG carcinoma. The majority (72%) would consider reverting back to WHO1973 if grading criteria were more detailed. Separate reporting of WHO1973-G3 within WHO2004-HG would influence clinical decisions for Ta and/or T1 tumors according the majority (55%). Most respondents preferred a two-tier (41%) or a three-tier (41%) grading system. The current WHO2004 grading system is supported by a minority (20%), whereas nearly half (48%) supported a hybrid three- or four-tier grading system composed of both WHO1973 and WHO2004. The survey results of the experts were comparable with ISUP and EAU respondents. CONCLUSIONS: Both the WHO1973 and the WHO2004 grading system are still widely used. Even though opinions on the future of bladder cancer grading were strongly divided, there was limited support for WHO1973 and WHO2004 in their current formats, while the hybrid (three-tier) grading system with LG, HG-G2, and HG-G3 as categories could be considered the most promising alternative. PATIENT SUMMARY: Grading of non-muscle-invasive bladder cancer (NMIBC) is a matter of ongoing debate and lacks international consensus. We surveyed urologists and pathologists of European Association of Urology and International Society of Urological Pathology on their preferences regarding NMIBC grading to generate a multidisciplinary dialogue. Both the "old" World Health Organization (WHO) 1973 and the "new" WHO2004 grading schemes are still used widely. However, continuation of both the WHO1973 and the WHO2004 system showed limited support, while a hybrid grading system composed of both the WHO1973 and the WHO2004 classification system may be considered a promising alternative.

• Publikační typ
• časopisecké články MeSH