This study sought to determine the diagnostic accuracy of 64-slice computed tomographic coronary angiography (CTCA) to detect or rule out significant coronary artery disease (CAD). BACKGROUND: CTCA is emerging as a noninvasive technique to detect coronary atherosclerosis. METHODS: We conducted a prospective, multicenter, multivendor study involving 360 symptomatic patients with acute and stable anginal syndromes who were between 50 and 70 years of age and were referred for diagnostic conventional coronary angiography (CCA) from September 2004 through June 2006. All patients underwent a nonenhanced calcium scan and a CTCA, which was compared with CCA. No patients or segments were excluded because of impaired image quality attributable to either coronary motion or calcifications. Patient-, vessel-, and segment-based sensitivities and specificities were calculated to detect or rule out significant CAD, defined as >or=50% lumen diameter reduction. RESULTS: The prevalence among patients of having at least 1 significant stenosis was 68%. In a patient-based analysis, the sensitivity for detecting patients with significant CAD was 99% (95% confidence interval [CI]: 98% to 100%), specificity was 64% (95% CI: 55% to 73%), positive predictive value was 86% (95% CI: 82% to 90%), and negative predictive value was 97% (95% CI: 94% to 100%). In a segment-based analysis, the sensitivity was 88% (95% CI: 85% to 91%), specificity was 90% (95% CI: 89% to 92%), positive predictive value was 47% (95% CI: 44% to 51%), and negative predictive value was 99% (95% CI: 98% to 99%). CONCLUSIONS: Among patients in whom a decision had already been made to obtain CCA, 64-slice CTCA was reliable for ruling out significant CAD in patients with stable and unstable anginal syndromes. A positive 64-slice CTCA scan often overestimates the severity of atherosclerotic obstructions and requires further testing to guide patient management.

• MeSH
• financování organizované MeSH
• interval spolehlivosti MeSH
• koronární angiografie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen patofyziologie   radiografie   MeSH
• počítačová rentgenová tomografie MeSH
• prediktivní hodnota testů MeSH
• prevalence MeSH
• prospektivní studie MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• multicentrická studie MeSH

Účinný selfmonitoring glykemií je kritickým prvkem při bezpečné léčbě pacientů s diabetem. Napomáhá jim při samostatném zvládání diabetu (self-managementu). Lékařům pak poskytuje podklady pro hodnocení kvality léčby, umožňuje její individualizaci a signalizuje včas nutnost její úpravy. Osobní glukometry určené pro běžný selfmonitoring glykemií mají tedy u všech pacientů velký význam pro dlouhodobou kompenzaci diabetu a pro snížení rizika rozvoje diabetických komplikací. Význam přesného měření glykemie však stoupá u pacientů léčených inzulinem, především v intenzifikovaných schématech. Pacienti s diabetem 1. typu a vysokou citlivostí k inzulinu jsou pak na přesném selfmonitoringu při určování dávek inzulinu doslova vitálně závislí. Hlavním rizikem je předávkování inzulinem, které může způsobit více či méně závažnou hypoglykemi. V případě nedostatečné dávky inzulinu se naopak rozvíjí hyperglykemie, která má dlouhodobý dopad po stránce rizika rozvoje pozdních komplikací diabetu. Je proto správné, že se v poslední době otevírá diskuze nad otázkou přesnosti měření glykemie pomocí osobních glukometrů a vůbec nad procedurami vedoucími ke schválení zdravotnických přístrojů pro používání v Evropské unii. Toto téma je nyní častěji zkoumáno, vychází nové srovnávací publikace a své stanovisko k celé problematice vydala i Evropská asociace pro studium diabetu (EASD). Cílem tohoto článku je přispět k diskuzi o přesnosti glukometrů v České republice.

Self-monitoring of blood glucose is an essential component of a safe diabetes treatment and helps patients with diabetes to manage their diabetes efficiently. It also provides valuable data about the diabetes control for both patients and healthcare professionals. Analysis of glucose profiles can support decision making and choosing appropriate treatment strategies. Personal blood glucose meters opened a way for reaching and keeping good diabetes control effectively and for cutting down the risk of late diabetes complications. In patients with type 1 diabetes, the precision of blood glucose meters is critical. These patients are usually very sensitive to insulin and need precise insuling dosing that is based on accurate glucose measurements. Inaccurate blood glucose readings may lead to insuling overdosing, resulting in hypoglycemia, or insufficient insulin dosing, which in turn causes hyperglycemia and increases the risk of late diabetes complications. A debate emerged recently on the accuracy of blood glucose meters and the procedures leading to the approval of medical devices for use in European Union. This topic is now frequently discussed and researched. Papers comparing many different meters were published and statement has been issued also by European Association for the Study of Diabetes (EASD). The aim of this paper is to contribute to the discussion about the precision of blood glucose meters in Czech Republic.

• MeSH
• diabetes mellitus prevence a kontrola   MeSH
• krevní glukóza analýza   MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• selfmonitoring glykemie metody   přístrojové vybavení   trendy   MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Cílem studie bylo srovnat přesnost predikce přežití skórovacích systémů APACHE II (Acute Physiology and Chronic Health Evaluation), ISS (Injury Severity Score) a TRISS (Trauma and Injury Severity Scoring) u traumatologických nemocných hospitalizovaných na ARK FN v Plzni od 1. 1. 1995 do 31. 12. 1997. Nemocní byli rozděleni podle typu diagnózy do třech skupin. První skupinu tvořili nemocní s polytraumatem bez poranění hlavy (P, n = 165), ve druhé skupině byli nemocní s polytraumatem, jehož součástí bylo poranění hlavy (P+H, n = 109), do třetí skupiny byli řazeni nemocní s izolovaným kraniocerebrálním poraněním (H, n = 147). U všech nemocných byl sledován věk, doba hospitalizace, doba umělé plicní ventilace (UPV), hodnoty skóre, predikce přežití a skutečné přežití. Kalibrace každého skórovacího systému na hodnocenou populaci byla vyjádřena kalibrační křivkou. Diskriminační schopnost skórovacích systémů byla posuzována pomocí ROC (Receiver Operating Characteristic) křivek. Hodnocení přesnosti predikce užitých skórovacích systémů pomocí velikosti plochy pod ROC křivkou ukazuje, že APACHE II je nespolehlivý v predikci prognózy u traumatologických nemocných, ISS má dobrou diskriminační schopnost u nemocných s polytraumatem bez poranění hlavy a TRISS je vhodný pro predikci prognózy ve všech testovaných diagnostických skupinách.

The target of the study was to compare the accuracy of survival probability according to scoring systems APACHE II (Acute Physiologic and Chronic Health Evaluation), ISS (Injury Severity score) and TRISS (Trauma and Injury Severity Scoring) in trauma patients hospitalized in Department of Anaesthesiology and Intensive Care, University Hospital Pilsen from January 1, 1995 to December 31, 1997. The patients were divided into three groups according to the type of diagnosis. First group of patients consisted of polytrauma patients without head injury (P, n = 165), the second group consisted of polytrauma patients with head injury (P+H, n = 109), the third group consisted of patients with isolated head-brain injury (H, n = 147). In all patients we recorded age, length of hospitalization, duration of mechanical ventilation, score points, survival prediction and actual survival. Calibration of each scoring system on evaluated population was evaluated with the use of ROC (Receiver Operating Characteristic) curves. The evaluation of prediction accuracy of scoring systems used according to the area below ROC curve shows that APACHE II is unreliable in prognosis prediction in trauma patients, ISS has good discrimination capability in polytrauma patients without head injury, while TRISS is feasible for prognosis prediction in all evaluated diagnostic groups.

• MeSH
• analýza přežití MeSH
• lidé MeSH
• ukazatel závažnosti úrazu MeSH
• Check Tag
• lidé MeSH

Knowledge about the cause of differential structural damages following the occurrence of hazardous hydro-meteorological events can inform more effective risk management and spatial planning solutions. While studies have been previously conducted to describe relationships between physical vulnerability and features about building properties, the immediate environment and event intensity proxies, several key challenges remain. In particular, observations, especially those associated with high magnitude events, and studies designed to evaluate a comprehensive range of predictive features are both limited. To build upon previous developments, we described a workflow to support the continued development and assessment of empirical, multivariate physical vulnerability functions based on predictive accuracy. Within this workflow, we evaluated several statistical approaches, namely generalized linear models and their more complex alternatives. A series of models were built 1) to explicitly consider the effects of dimension reduction, 2) to evaluate the inclusion of interaction effects between and among predictors, 3) to evaluate an ensemble prediction method for applications where data observations are sparse, 4) to describe how model results can inform about the relative importance of predictors to explain variance in expected damages and 5) to assess the predictive accuracy of the models based on prescribed metrics. The utility of the workflow was demonstrated on data with characteristics of what is commonly acquired in ex-post field assessments. The workflow and recommendations from this study aim to provide guidance to researchers and practitioners in the natural hazards community.

• MeSH
• meteorologie * MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: To prospectively assess the concordance of examination under anesthesia (EUA)-based clinical T stage with pathological T stage and diagnostic accuracy of EUA in patients with bladder cancer undergoing cystectomy. METHODS: Consecutive patients with bladder cancer undergoing cystectomy between June 2017 and October 2020 in a single academic center were included in a prospective study. Two urologists performed EUA (one blinded to imaging) before patients underwent cystectomy. We assessed the concordance between clinical T stage in bimanual palpation (index test) and pathological T stage in cystectomy specimens (reference test). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with 95% confidence intervals (CIs) to detect or exclude locally advanced bladder cancer (pT3b-T4b) in EUA. RESULTS: The data of 134 patients were analyzed. Given that stage pT3a cannot be palpated, for the nonblinded examiner, T staging in EUA was concordant with pT in 107 (79.9%) patients, 20 (14.9%) cases being understaged in EUA and 7 (5.2%) overstaged. For the blinded examiner, staging was correct in 106 (79.1%) patients, 20 (14.9%) cases being understaged and 8 (6%) overstaged. For the nonblinded examiner, sensitivity, specificity, PPV, and NPV of EUA were 55.9% (95% CI 39.2%-72.6%), 93% (88%-98%), 73.1% (56%-90.1%), and 86.1% (79.6%-92.6%), respectively; for the blinded examiner, they were 52.9% (36.2%-69.7%), 93% (88%-98%), 72% (54.4%-89.6%) and 85.3% (78.7%-92%), respectively. Awareness of imaging results did not have a major impact on EUA results. CONCLUSION: Bimanual palpation should still be used for clinical staging, given its specificity, NPV, and that it could correctly determine bladder cancer T stage in 80% of cases.

• MeSH
• cystektomie * metody   MeSH
• lidé MeSH
• nádory močového měchýře * diagnóza   chirurgie   patologie   MeSH
• palpace MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• acidóza diagnóza   MeSH
• financování organizované MeSH
• hypoxie plodu diagnóza   MeSH
• kardiotokografie MeSH
• komplikace porodu diagnóza   prevence a kontrola   MeSH
• lidé MeSH
• oxymetrie MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• senzitivita a specificita MeSH
• statistika jako téma MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH

The study was aimed at (1) the determination of the incidence of abnormalities of the urinary tract in newborn infants detected by postnatal ultrasound screening, and (2) the evaluation of the diagnostic accuracy of postnatal ultrasound screening for detecting surgical urinary tract abnormalities. The prospective study was of full-term neonates born in the University Hospital of Olomouc in 2005-2008 who underwent renal ultrasound screening after 72 h of life. Significant findings were recorded. Subsequent diagnostic and therapeutic procedures were recorded and evaluated in a group of children with detected renal pelvic dilatation (RPD). (1) A total of 6,088 newborn infants was examined. The absolute and relative RPD incidence rates (anteroposterior diameter, APD) were as follows: 5-7 mm, 146 (2.4%); 7-10 mm, 70 (1.15%); 10-15 mm, 13 (0.21%), and 15 mm or more, 5 (0.08%). Of those, 16 children were operated on for abnormalities of the urinary tract, of which nine (56%) had been detected by prenatal screening. Other findings: six cases of unilateral renal agenesis, four cases of multicystic renal dysplasia, four of renal dystopia, one of polycystic kidney disease and one of renal hypoplasia. (2) A group of 224 children with postnatally detected RPD was examined, of whom 40 (17.9%) underwent voiding cystourethrography and/or scintigraphy and 16 (7.1%) were treated surgically. The receiver operating characteristic curves were analyzed, and the areas under the curves were calculated. Postnatal renal ultrasound screening is probably a suitable test for detecting significant urinary tract abnormalities.

• MeSH
• dilatace patologická patologie   ultrasonografie   MeSH
• ledvinná pánvička embryologie   patologie   ultrasonografie   MeSH
• lidé MeSH
• močové ústrojí abnormality   ultrasonografie   MeSH
• nemocnice univerzitní MeSH
• novorozenec MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• reprodukovatelnost výsledků MeSH
• ROC křivka MeSH
• ultrasonografie MeSH
• urogenitální abnormality diagnóza   embryologie   epidemiologie   MeSH
• urologické nemoci diagnóza   embryologie   epidemiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: The Berlin Questionnaire (BQ) has been used to identify patients at high risk for sleep-disordered breathing (SDB) in a variety of populations. However, there are no data regarding the validity of the BQ in detecting the presence of SDB in patients after myocardial infarction (MI). The aim of this study was to determine the performance of the BQ in patients after MI. METHODS: We conducted a cross-sectional study of 99 patients who had an MI 1 to 3 months previously. The BQ was administered, scored using the published methods, and followed by completed overnight polysomnography as the "gold standard." SDB was defined as an apnea-hypopnea index of ≥ 5 events/h. The sensitivity, specificity, and positive and negative predictive values of the BQ were calculated. RESULTS: Of the 99 patients, the BQ identified 64 (65%) as being at high-risk for having SDB. Overnight polysomnography showed that 73 (73%) had SDB. The BQ sensitivity and specificity was 0.68 and 0.34, respectively, with a positive predictive value of 0.68 and a negative predictive value of 0.50. Positive and negative likelihood ratios were 1.27 and 0.68, respectively, and the BQ overall diagnostic accuracy was 63%. Using different apnea-hypopnea index cutoff values did not meaningfully alter these results. CONCLUSION: The BQ performed with modest sensitivity, but the specificity was poor, suggesting that the BQ is not ideal in identifying SDB in patients with a recent MI.

• MeSH
• infarkt myokardu komplikace   MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• neparametrická statistika MeSH
• plocha pod křivkou MeSH
• polysomnografie MeSH
• prediktivní hodnota testů MeSH
• průřezové studie MeSH
• průzkumy a dotazníky * MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• syndromy spánkové apnoe diagnóza   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

BACKGROUND: Although invasively measured blood pressure (invBP) is regarded as a "gold standard" in critically ill cardiac patients, the non-invasive BP is still widely used, at least at the initiation of medical care. The erroneous interpretation of BP can lead to clinical errors. We therefore investigated the agreement of both methods with respect to some common clinical situation. METHODS: We included 85 patients hospitalized for cardiogenic shock. We measured BP every 6 h for the first 72 h of hospitalization, in all patients. Each set of BP measurements included two invasive (invBP), two auscultatory (auscBP), and two oscillometric (oscBP) BP measurements. InvBP was considered as a gold standard. Mean non-invasive arterial pressure (MAP) was calculated as (diastolic pressure + (pulse pressure ÷ 3)). We used Bland-Altman analysis and we calculated concordance correlation coefficients to assess agreement between different BP methods. RESULTS: We obtained 967 sets of BP measurements. AuscMAP and oscMAP were on average only 0.4 ± 8.2 and 1.8 ± 8.5 mmHg higher than invMAP, respectively. On the other hand, auscSBP and oscSBP were on average - 6.1 ± 11.4 and - 4.1 ± 9.8 mmHg lower than invSBP, respectively. However, the mean differences and variability for systolic and diastolic BP variability were large; the 2 standard deviation differences were ± 24 and 18 mmHg. In hypotension, non-invasive BP tended to be higher than invBP while the opposite was true for high BP values. Clinical conditions associated with hypotension generally worsened the accuracy of non-invasive MAP. CONCLUSIONS: Mean arterial pressure measured non-invasively appears to be in good agreement with invasive MAP in patients admitted for cardiogenic shock. Several clinical associated with hypotension can affect accuracy of non-invasive measurement. Auscultatory and oscillometric measurements had similar accuracy even in patients with arrhythmia.

• MeSH
• arteriální tlak * MeSH
• časové faktory MeSH
• kardiogenní šok diagnóza   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření krevního tlaku metody   MeSH
• oscilometrie MeSH
• poslech MeSH
• prediktivní hodnota testů MeSH
• příjem pacientů * MeSH
• prospektivní studie MeSH
• reprodukovatelnost výsledků MeSH
• senioři 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

Cíl: U nemocných s ischemickou chorobou dolních končetin ověřit přesnost barevné duplexní ultrasonografie (BDU) v určení morfologie okluzivního arteriálního postižení. Zhodnotit význam metody při rozhodování o způsobu léčby. Materiál a metodika: Do studie byli zařazeni pacienti s ischemickou chorobou dolních končetin ve stadiu II. až IV. podle Fontainea. Stenóza byla kvantifikována pomocí parametru peak systolic velocity ratio. Hlavním sonografickým kritériem pro obliteracibyla absence dopplerovského signálu. Obliterace femoropopliteálního segmentu byly rozděleny na krátké (< 10 cm) a dlouhé ( >10 cm). Jako referenční metoda byla zvolena konvenční angiografie. Výsledky: Ultrasonografie byla provedena u 174 pacientů, u nichž bylo hodnoceno 220 dolních končetin a 1413 tepenných segmentů. Bylo diagnostikováno 389 závažných postižení. Celková přesnost metody pro určení stenózy > 50 % a obliterace byla 95 %, senzitivita 90 % a specificita 97 %. Shoda při určení délky obliterace femoropopliteálního úseku byla 94 %. Závěr: BDU je přesná neinvazivní metoda v určení morfologie a hemodynamické významnosti obstrukční leze tepen dolních končetin. Na základě znalosti morfologie arteriálního postižení stanovené duplexní ultrasonografií lze určit vhodný způsob léčby nemocných s ischemickou chorobou dolních končetin.

Objective: To determine the accuracy of information about the peripheral arterial obliteration character gained by colour duplex ultrasound (CDU) in patients with peripheral arterial occlusive disease. To assess the value of this method in decision making about type of treatment. Angiography was chosen as a comparative method. Materiál and method: Patients with claudications and critical limb ischaemia were included in the study. Arterial system was imaged from subrenal aorta to the level of the ankle. The stenosis was quantified by peak systolic velocity ratio. Absence of the signal in colour and spectral Doppler record is the main diagnostic criterion of obliteration. Obliterations in the femoropopliteal segments were divided into short ones (< 10 cm) and long ones (> 10 cm). Results: 174 patients (220 lower extremities and 1413 arterial segments) were examined ultrasonographically and compared with angiography. 389 pathological affections were found. Total accuracy of CDU for prediction of stenosis greater than 50 % and obliteration was 95 %, sensitivity 90 % and specificity 97 %. Total agreement in the evaluation of the occlusion was 94 %. Conclusion: CDU is an accurate non-invasive method for determination of haemodynamicaUy significant affections of arterial system in aortoiliac, femoropopliteal as well as crural area. High agreement between CDU and AG enables to choose patients suitable for PTA only in the basis of CDU results.

• MeSH
• angiografie metody   přístrojové vybavení   MeSH
• arteriální okluzní nemoci diagnóza   ultrasonografie   MeSH
• dolní končetina MeSH
• finanční podpora výzkumu jako téma MeSH
• hemodynamika MeSH
• ischemie diagnóza   ultrasonografie   MeSH
• lidé MeSH
• prospektivní studie MeSH
• ultrasonografie dopplerovská barevná metody   přístrojové vybavení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH
• srovnávací studie MeSH