BACKGROUND: Lung ultrasonography (LUS) is a point-of-care imaging modality with growing potential in primary care. OBJECTIVES: While its use is well established in hospital settings, data on its accuracy when performed by general practitioners (GPs) remain limited. This study aimed to assess the diagnostic accuracy of LUS conducted by GPs following structured training. METHODS: We recruited 17 GPs from various regions of the Czech Republic. They completed a two-day educational course focused on LUS. Patients with current dyspnoea (NYHA II-IV) or a history of dyspnoea within the last four weeks were included and underwent LUS to assess the presence of pleural effusion and interstitial syndrome. An independent expert sonographer, blinded to clinical data, evaluated recorded LUS video loops as the reference standard. LUS findings were categorized into A profile (presence of A lines and intact lung sliding, indicating normal aeration), B profile (three or more B lines per intercostal space in at least two intercostal spaces per hemithorax, suggesting interstitial syndrome), pulmonary consolidation and pleural effusion. RESULTS: A total of 128 patients were enrolled in the study. A total of 768 thoracic segments were examined. A profile was identified in 642 (83.6%) segments, B profile in 108 (14.1%), pulmonary consolidation in 8 (1.0%), and pleural effusion in 12 (1.6%). For the identification of A profile, the sensitivity was 97.51% (95% CI 95.98-98.57), and the specificity was 88.10% (95% CI 81,13-93,18); for B profile, the sensitivity was 87.04% (95% CI 79,21-92,73), and the specificity was 97.73% (95% CI96,28-98,72); for pulmonary consolidation, the sensitivity was 100.0% (95% CI 63,06-100,00), and the specificity was 100.0% (95% CI 99,52-100,0); for pleural effusion, the sensitivity was 83.33% (95% CI 51,59-97,91), and the specificity was 99.87% (95% CI 99,27-100,00). CONCLUSION: Our findings provide important preliminary data, demonstrating that GPs can perform LUS accurately after a structured training program. THE TRIAL REGISTRATION IDENTIFIER: is NCT04905719.

• Klíčová slova
• Accuracy, COVID-19, Lung examination, Point-of-care ultrasound, Primary care,
• MeSH
• dospělí MeSH
• dyspnoe diagnostické zobrazování   MeSH
• intersticiální plicní nemoci diagnostické zobrazování   MeSH
• klinické kompetence MeSH
• lidé středního věku MeSH
• lidé MeSH
• pleurální výpotek diagnostické zobrazování   MeSH
• plíce * diagnostické zobrazování   MeSH
• plicní nemoci * diagnostické zobrazování   MeSH
• praktičtí lékaři * výchova   MeSH
• primární zdravotní péče MeSH
• průřezové studie MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• ultrasonografie MeSH
• vyšetření u lůžka * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: The knowledge and proficiency of primary care practitioners (PCPs) in diagnosing and managing irritable bowel syndrome (IBS) remain generally low and variable internationally. This variability is partly due to a lack of familiarity with the Rome Foundation diagnostic criteria and treatment guidelines for this condition. METHODS: We conducted an electronic survey of PCPs in the United States and nine European countries to assess their understanding of IBS pathophysiology; the use of Rome IV criteria in diagnosis, knowledge of and frequency in prescribing various recommended treatments; and the likelihood of referring patients with suspected IBS to subspecialists. RESULTS: Most PCPs in the United States and Europe perceive IBS as a diagnosis of exclusion rather than a definitive diagnosis. They also believe IBS is underdiagnosed in primary care and challenging to diagnose confidently. The majority of PCPs consider diet as a crucial component of IBS management. Notably, US PCPs reported greater confidence than their European counterparts in recommending dietary interventions such as increased dietary fiber, a low FODMAP diet, and gluten restriction. Conversely, both groups exhibited moderate to high confidence in recommending over-the-counter treatments. European PCPs showed greater confidence in treating IBS with antispasmodics and secretagogues, while US PCPs expressed greater confidence in prescribing neuromodulators. Additionally, US PCPs were more likely to refer patients with suspected IBS to a gastroenterologist, whereas both US and European PCPs showed similar referral patterns to dietitians and referred very few patients to mental health providers. Both US and European PCPs reported that IBS is moderately to extremely difficult to treat effectively and emphasized the importance of a strong and longitudinal doctor-patient relationship in managing the condition. CONCLUSION: Despite the Rome Foundation recommendations and criteria to support a positive diagnosis of IBS, most PCPs still rely on exclusionary investigations such as endoscopy and a serologic workup, while a significant percentage suggest referring patients to gastroenterologists.

• Klíčová slova
• diagnosis, disorders of gut‐brain interaction (DGBI), epidemiology, functional gastrointestinal disorders (FGID), irritable bowel syndrome (IBS), primary care, treatment,
• MeSH
• dospělí MeSH
• lékaři primární péče * MeSH
• lékařská praxe - způsoby provádění * statistika a číselné údaje   MeSH
• lidé MeSH
• postoj zdravotnického personálu * MeSH
• primární zdravotní péče * MeSH
• průzkumy a dotazníky MeSH
• syndrom dráždivého tračníku * diagnóza   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH
• Spojené státy americké MeSH

BACKGROUND: The COVID-19 pandemic posed severe challenges to delivery of services at Primary Care level and for achieving follow-up of patients with chronic diseases. OBJECTIVES: We analysed data from the PRICOV-19 study to explore determinants of active follow-up for chronic disease patients in seven Central and Eastern European (CEE) countries during the pandemic. METHODS: Pricov-19 was a cross-sectional study conducted within PC (Primary Care) practices in 37 European countries. We analysed data from 7 CEE countries (Bulgaria, Czech Republic, Hungary, Poland, Moldova, Romania, Ukraine) collected between November 2020 and December 2021. Practices were recruited through random or convenience sampling and participation of practices was voluntary. We performed descriptive statistics to identify the level of follow-up of chronic disease and what health system and practice-specific factors were associated with better follow-up. We used logistic regression and meta-analysis techniques to explore associations and heterogeneity between countries. RESULTS: 67.8% out of 978 practices reported actively following up chronic patients. Positive associations were found between active follow-up and such as having more GPs (aOR = 1.18, p-value = 0.005), an above-average chronic patient population (aOR = 3.13, p-value = 0.006), adequate government support (aOR = 2.35, p-value = 0.001), and GPs having time for guideline reading (aOR = 0.008, p-value = 1.71). CONCLUSIONS: Patient follow-up, was influenced by different health system and practice-specific factors. The implications suggest the need for government support to enhance PC practice organisation during crises and solutions to decrease GP workload and provide tailored care for patients with chronic disease.

In 7 Central and Eastern European countries, 68% of PC practices effectively followed-up patients with chronic conditions during the pandemic.Key determinants for successful follow-up included government support, GP time availability, and staffing levels of GPs.Video consultations and payment mechanisms did not show significant associations with optimal patient follow-up.

• Klíčová slova
• COVID-19, Patient follow-up, multi-country, outreach, quality of care,
• MeSH
• chronická nemoc MeSH
• COVID-19 * epidemiologie   MeSH
• lidé MeSH
• primární zdravotní péče * organizace a řízení   statistika a číselné údaje   MeSH
• průřezové studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH
• východní Evropa MeSH

BACKGROUND: The escalating global prevalence of type 2 diabetes and prediabetes presents a major public health challenge. Physical activity plays a critical role in managing (pre)diabetes; however, adherence to physical activity recommendations remains low. The ENERGISED trial was designed to address these challenges by integrating mHealth tools into the routine practice of general practitioners, aiming for a significant, scalable impact in (pre)diabetes patient care through increased physical activity and reduced sedentary behaviour. METHODS: The mHealth intervention for the ENERGISED trial was developed according to the mHealth development and evaluation framework, which includes the active participation of (pre)diabetes patients. This iterative process encompasses four sequential phases: (a) conceptualisation to identify key aspects of the intervention; (b) formative research including two focus groups with (pre)diabetes patients (n = 14) to tailor the intervention to the needs and preferences of the target population; (c) pre-testing using think-aloud patient interviews (n = 7) to optimise the intervention components; and (d) piloting (n = 10) to refine the intervention to its final form. RESULTS: The final intervention comprises six types of text messages, each embodying different behaviour change techniques. Some of the messages, such as those providing interim reviews of the patients' weekly step goal or feedback on their weekly performance, are delivered at fixed times of the week. Others are triggered just in time by specific physical behaviour events as detected by the Fitbit activity tracker: for example, prompts to increase walking pace are triggered after 5 min of continuous walking; and prompts to interrupt sitting following 30 min of uninterrupted sitting. For patients without a smartphone or reliable internet connection, the intervention is adapted to ensure inclusivity. Patients receive on average three to six messages per week for 12 months. During the first six months, the text messaging is supplemented with monthly phone counselling to enable personalisation of the intervention, assistance with technical issues, and enhancement of adherence. CONCLUSIONS: The participatory development of the ENERGISED mHealth intervention, incorporating just-in-time prompts, has the potential to significantly enhance the capacity of general practitioners for personalised behavioural counselling on physical activity in (pre)diabetes patients, with implications for broader applications in primary care.

• Klíčová slova
• Behaviour change techniques, Fitbit, Just-in-time adaptive intervention (JITAI), Participatory development, Phone counselling, Primary care, Self-regulation theory, Text messages, Walking, Wearables,
• MeSH
• cvičení MeSH
• diabetes mellitus 2. typu * prevence a kontrola   epidemiologie   MeSH
• lidé MeSH
• mobilní telefon * MeSH
• praktické lékařství * MeSH
• prediabetes * terapie   MeSH
• sedavý životní styl MeSH
• telemedicína * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Physicians who suffer from poor sleep quality are at an increased risk of mistakes and poor decision-making. We deemed it noteworthy to assess sleep quality in practicing physiatrists, previously reported to be at higher risk of physician burnout, which was documented associated with sleep deprivation. OBJECTIVE: The aim was to estimate the prevalence of sleep disturbance among practicing physiatrists and evaluate the association of sleep quality with their sleep hygiene habits and depression. METHODS: Of the 101 study participants (77 females) who met the inclusion criteria, the majority was between the age of 25 and 40 years (70.3%); 62 (61.4%) were specialists and 39 (38.6%) were in training. In this cross-sectional study, practicing physiatrists were invited to complete an anonymous and voluntary web-based survey. The survey consisted of questions covering demographic information, nicotine and caffeine consumption, exercise habits, and three questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the Beck Depression Inventory-II (BDI-II), and the Sleep Hygiene Index (SHI). RESULTS: Sixty-five (64.4%) respondents showed poor sleep quality (PSQI > 5), and 23 (22.8%) showed at least mild symptoms of depression (BDI-II>13). The mean PSQI, SHI, BDI-II scores were 6.85±3.09, 18.18±5.35, and 8.36±7.52, respectively. Poor sleep quality was significantly positively correlated with symptoms of depression and sleep hygiene misbehavior. CONCLUSION: We found that 64.4% of practicing physiatrists suffered from poor sleep quality, and 22.8% showed at least mild symptoms of depression. Considerable efforts should be directed toward sleep hygiene behavior and mental health improvement.

• Klíčová slova
• Rehabilitation, burnout, depression, sleep, sleep hygiene,
• MeSH
• deprese psychologie   MeSH
• dospělí MeSH
• internet MeSH
• lidé MeSH
• poruchy iniciace a udržování spánku * epidemiologie   MeSH
• poruchy spánku a bdění * etiologie   MeSH
• prevalence MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• rehabilitační lékaři * MeSH
• spánek MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: Coverage by examinations is a crucial indicator of the future impact on the burden of colorectal cancer (CRC). The study aimed to evaluate coverage by examinations associated with CRC screening and early cancer detection of CRC in the Czech Republic. The burden of CRC was also assessed. METHODS: The novel nationwide administrative registry with individual data (period 2010-19) was used to evaluate coverage by examinations for screening faecal occult blood test and colonoscopy. In the second step, additional examinations for early CRC detection were included in the coverage calculation (complete coverage). Age-specific trends in CRC incidence (period 1977-2018) were investigated using Joinpoint regression. RESULTS: Coverage by screening examinations within recommended interval was around 30%. Complete coverage reached >37% and >50% at the 3-year interval. The coverage by examinations for the non-screening population aged 40-49 years was almost 4% and 5% (most of them were colonoscopies) at the 3-year interval. In age groups aged ≥50 years, we observed a significant annual decline, especially in the 50-69 age group, with recent annual decreases reaching up to 5-7%. The change in trend and the recent decline were also observed in the age group 40-49. CONCLUSIONS: More than half of the target screening population was covered by examinations potentially associated with early detection and subsequent treatment of colorectal neoplasms. The substantial coverage by potentially prophylactic examinations might be an explanation for the considerable decrease in CRC incidence.

• MeSH
• časná detekce nádoru * MeSH
• kolorektální nádory * diagnóza   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• okultní krev MeSH
• plošný screening MeSH
• registrace MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: The growing number of patients with type 2 diabetes and prediabetes is a major public health concern. Physical activity is a cornerstone of diabetes management and may prevent its onset in prediabetes patients. Despite this, many patients with (pre)diabetes remain physically inactive. Primary care physicians are well-situated to deliver interventions to increase their patients' physical activity levels. However, effective and sustainable physical activity interventions for (pre)diabetes patients that can be translated into routine primary care are lacking. METHODS: We describe the rationale and protocol for a 12-month pragmatic, multicentre, randomised, controlled trial assessing the effectiveness of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). Twenty-one general practices will recruit 340 patients with (pre)diabetes during routine health check-ups. Patients allocated to the active control arm will receive a Fitbit activity tracker to self-monitor their daily steps and try to achieve the recommended step goal. Patients allocated to the intervention arm will additionally receive the mHealth intervention, including the delivery of several text messages per week, with some of them delivered just in time, based on data continuously collected by the Fitbit tracker. The trial consists of two phases, each lasting six months: the lead-in phase, when the mHealth intervention will be supported with human phone counselling, and the maintenance phase, when the intervention will be fully automated. The primary outcome, average ambulatory activity (steps/day) measured by a wrist-worn accelerometer, will be assessed at the end of the maintenance phase at 12 months. DISCUSSION: The trial has several strengths, such as the choice of active control to isolate the net effect of the intervention beyond simple self-monitoring with an activity tracker, broad eligibility criteria allowing for the inclusion of patients without a smartphone, procedures to minimise selection bias, and involvement of a relatively large number of general practices. These design choices contribute to the trial's pragmatic character and ensure that the intervention, if effective, can be translated into routine primary care practice, allowing important public health benefits. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05351359, 28/04/2022).

• Klíčová slova
• Active control, Ecological Momentary Assessment (EMA), Fitbit, Just-in-time adaptive intervention (JITAI), Micro-randomisation, Phone counselling, Text messages, Primary care, Self-monitoring, Step-count,
• MeSH
• cvičení MeSH
• diabetes mellitus 2. typu * prevence a kontrola   MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• pragmatické klinické studie jako téma MeSH
• praktické lékařství * MeSH
• prediabetes * terapie   MeSH
• randomizované kontrolované studie jako téma MeSH
• sedavý životní styl MeSH
• telemedicína * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• protokol klinické studie MeSH

INTRODUCTION: Prevalence of insomnia is higher in females and increases with higher age. Besides primary insomnia, comorbid sleep disorders are also common, accompanying different conditions. Considering the possible adverse effects of commonly used drugs to promote sleep, a non-pharmacologic approach should be preferred in most cases. Although generally considered first-line treatment, the non-pharmacologic approach is often underestimated by both patients and physicians. OBJECTIVE: To provide primary care physicians an up-to-date approach to the non-pharmacologic treatment of insomnia. METHODS: PubMed, Web of Science, and Scopus databases were searched for relevant articles about the non-pharmacologic treatment of insomnia up to December 2020. We restricted our search only to articles written in English. MAIN MESSAGE: Most patients presenting with sleep disorder symptoms can be effectively managed in the primary care setting. Primary care physicians may use pharmacologic and non-pharmacologic approaches, while the latter should be generally considered first-line treatment. A primary care physician may opt to refer the patient to a subspecialist for refractory cases. CONCLUSIONS: This paper provides an overview of current recommendations and up-to-date evidence for the non-pharmacologic treatment of insomnia. This article emphasizes the importance of cognitive-behavioral therapy for insomnia, likewise, exercise and relaxation techniques. Complementary and alternative approaches are also covered, eg, light therapy, aromatherapy, music therapy, and herbal medicine.

• MeSH
• kognitivně behaviorální terapie * MeSH
• lidé MeSH
• poruchy iniciace a udržování spánku * terapie   MeSH
• primární zdravotní péče MeSH
• spánek MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• bolest MeSH
• lidé MeSH
• nemoci nohy (od hlezna dolů) * MeSH
• noha (od hlezna dolů) diagnostické zobrazování   MeSH
• ultrasonografie MeSH
• žilní trombóza * diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, people volunteered for sewing hand-made face masks. However, sewing-machine operating might be associated with high ergonomic risk and a negative impact on musculoskeletal health. OBJECTIVE AND METHODS: This paper describes an ultrasonographic diagnosis of a foot ganglion - after sewing 300 face masks within two months using a foot-operated sewing machine. RESULTS: The patient significantly improved after an ultrasound-guided aspiration and corticosteroid injection. CONCLUSION: In short, we highlight the importance of ultrasound examination in the management of work (overuse)-related disorders in occupational medicine practice.

• Klíčová slova
• Coronavirus, mask, seamstress, sewing machine, ultrasound,
• MeSH
• anestetika lokální aplikace a dávkování   MeSH
• antiflogistika aplikace a dávkování   MeSH
• COVID-19 * epidemiologie   prevence a kontrola   MeSH
• cystická ganglia diagnostické zobrazování   etiologie   MeSH
• dobrovolní pracovníci * MeSH
• drenáž metody   MeSH
• intervenční ultrasonografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• masky MeSH
• methylprednisolon acetát aplikace a dávkování   MeSH
• nemoci nohy (od hlezna dolů) diagnostické zobrazování   etiologie   MeSH
• nemoci z povolání diagnostické zobrazování   etiologie   MeSH
• pandemie MeSH
• poranění nohy (od hlezna dolů) komplikace   MeSH
• poranění z opakovaného přetěžování komplikace   MeSH
• SARS-CoV-2 MeSH
• textilní průmysl * MeSH
• trimekain aplikace a dávkování   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• anestetika lokální MeSH
• antiflogistika MeSH
• methylprednisolon acetát MeSH
• trimekain MeSH