BACKGROUND: Globally, most people with head and neck cancers (HNCs) are diagnosed with advanced-stage disease. HNC diagnostic stage has multifactorial explanations, with the role of health system factors not yet fully investigated. METHODS: HNC centres (n = 18) from the HEADSpAcE Consortium were surveyed via a bespoke health system questionnaire covering a range of factors. Centres were compared using the least square means for the presence/absence of each health system factor to their proportion of advanced-stage HNC. RESULTS: Health system factors associated with lower proportion in advanced-stage diagnosis were formal referral triaging (14%, 95% CI-0.26, -0.03), routine monitoring of time from referral to diagnosis (16%, 95% CI-0.27, -0.05), and fully publicly funded systems (17%, 95% CI-0.29, -0.06). Several health systems factors had no routinely available data. CONCLUSIONS: Through identifying and monitoring health systems factors associated with lower proportions of advanced stage HNC, interventions could be developed, and systems redesigned, to improve early diagnosis.

• Klíčová slova
• diagnostic pathway, head and neck cancer, health systems, stage at diagnosis,
• MeSH
• benchmarking * MeSH
• časná detekce nádoru MeSH
• konziliární vyšetření a konzultace statistika a číselné údaje   MeSH
• lidé MeSH
• nádory hlavy a krku * patologie   diagnóza   MeSH
• průzkumy a dotazníky MeSH
• staging nádorů MeSH
• třídění pacientů MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Although several studies have investigated temperature-related mortality and morbidity, only a little is known about the short-term effects of temperature on ambulance dispatches. We aimed to conduct the first nationwide analysis of the association between temperatures and ambulance dispatches in Europe, including, for the first time, a detailed description of age-specific risks for 10-year age groups. METHODS: We collected daily data on ambulance dispatches and climate (i.e. temperature and relative humidity) for each district of Czechia (n = 77) during 2010-19. We estimated the relationship for each district by using a quasi-Poisson regression with distributed lag non-linear models. We then applied a multilevel multivariate random-effects meta-analysis to derive regional and countrywide average associations and calculated the burden of ambulance dispatches that was attributable to non-optimum temperatures. RESULTS: The susceptibility to low (high) temperatures increased (decreased) with age, except for the youth (<20 years), for whom the risks for both heat and cold were the highest. High temperatures contributed slightly to the risk of ambulance dispatches due to respiratory and cardiovascular causes, while the contribution of low temperatures was substantial. The overall ambulance dispatches burden that was attributable to non-optimum temperatures (optimum temperature = 7.9°C) was 3.55% (95% eCI: 3.43 to 3.67), with a predominant contribution of heat [2.32% (95% eCI: 2.15 to 2.46)] compared with cold [1.23% (95% eCI: 1.16 to 1.30)]. CONCLUSION: This data can be used as an early-warning indicator for temperature impacts, especially among vulnerable population subgroups, such as children, adolescents, and young adults. This evidence has important implications for healthcare system preparedness and management, and for the projections of climate change health impacts.

• Klíčová slova
• ambulance, climate change, cold, emergency, heat, heat waves, temperature,
• MeSH
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nízká teplota * škodlivé účinky   MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• sanitky * statistika a číselné údaje   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• teplota * MeSH
• věkové faktory MeSH
• vysoká teplota * škodlivé účinky   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: The increasing complexity of mass casualty incidents (MCIs) necessitates highly effective training for emergency responders. Traditional training methods, while effective in teaching core skills, often fail to replicate the dynamic, high-pressure environments responders face in real-world crises. Virtual reality (VR) offers a novel approach to emergency training, providing an immersive, controlled setting that can simulate real-life scenarios. This study explores the effectiveness of VR in training paramedic students for MCIs and compares the outcomes to those from conventional training methods. METHODS: A comparative study was conducted with 37 paramedic students who underwent either VR-based training or conventional training using mannequins and real-world equipment. The VR application simulated a mass casualty car accident, focusing on triage and patient management. Both groups were assessed based on their performance in key areas, including the accuracy of situational reporting (METHANE), patient triage, heart rate monitoring, and perceived demand using the NASA Task Load Index (NASA-TLX). RESULTS: The VR group demonstrated significantly lower mental demand (p < 0.001) and frustration levels (p = 0.021) compared to traditional training. However, task completion times were slower in the VR setting (p < 0.001), likely due to the interface's unfamiliarity. Accuracy in situational reporting was higher in VR (p = 0.002), while heart rate monitoring did not reveal a significant difference between the groups (p = 0.516). Although VR did not reduce temporal demand (p = 0.057), it showed potential for improving focus and precision in training. Error rates in triage were similar across both training methods (p = 0.882), indicating comparable performance levels in patient classification. CONCLUSIONS: VR presents a promising tool for training emergency responders, particularly in situations that require rapid upskilling, such as crises or wars. The ability to simulate realistic, high-pressure scenarios in a controlled environment can enhance both cognitive and emotional preparedness. Further research is necessary to optimize VR systems and interfaces, making them more efficient for real-time decision-making. As VR technology advances, it holds potential as a key component in future emergency preparedness strategies.

• Klíčová slova
• Crisis simulation, Emergency preparedness, Mass casualty incidents, Paramedic training, Virtual reality training,
• MeSH
• dospělí MeSH
• first responder * výchova   psychologie   MeSH
• hromadné neštěstí * MeSH
• lidé MeSH
• plánování postupu v případě katastrof metody   MeSH
• třídění pacientů metody   MeSH
• virtuální realita * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Rationale: Early detection, standardized therapy, adequate infrastructure, and strategies for quality improvement should constitute essential components of every hospital's sepsis plan. Objectives: To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute-care hospitals. Methods: A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives (QIIs) in hospitals. Measurements and Main Results: A total of 1,023 hospitals in 69 countries were included. Most of them, 835 (81.6%), were in Europe. Sepsis screening was used in 54.2% of emergency departments (EDs), 47.9% of wards, and 61.7% of ICUs. Sepsis management was standardized in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. The implementation of comprehensive QIIs was associated with increased screening (EDs, +33.3%; wards, +44.4%; ICUs, +23.8% absolute difference) and increased standardized sepsis management (EDs, +33.6%; wards, +40.0%; ICUs, +17.7% absolute difference) compared with hospitals without QIIs. A total of 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. Conclusions: The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regard to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.

• Klíčová slova
• quality of care, sepsis management, sepsis programs, sepsis screening, standard of care,
• MeSH
• antibiotická politika MeSH
• dodržování směrnic * statistika a číselné údaje   MeSH
• jednotky intenzivní péče normy   MeSH
• lidé MeSH
• nemocnice * normy   statistika a číselné údaje   MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• sepse * terapie   diagnóza   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• urgentní služby nemocnice normy   MeSH
• zlepšení kvality * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

PURPOSE OF THE STUDY: Pelvic avulsion fractures in children are rare and usually associated with sports. The study aimed to evaluate the epidemiology, complications, and displacement cutoff value for surgical treatment. MATERIAL AND METHODS: In a retrospective study (2007-2022), we used a group of 201 boys and 20 girls (p < 0.0001). The mean age of boys was 14.9 ± 1.7, and 14.0 ± 1.9 years for girls (p = 0.0129). Injuries included 86 anterior superior iliac spine (ASIS), 83 anterior inferior iliac spine (AIIS), 28 ischial tuberosity (ITU), 13 iliac crest, nine reflected head of the rectus femoris avulsions, and two ipsilateral ASIS + AIIS avulsions. The displacement cutoff value was determined using logistic regression. Complications were assessed using Cox regression and Kaplan-Meier plots. RESULTS: The mean incidence of avulsions was 21 per 1,000,000 children per year. The highest prevalence of osteosynthesis was in ITU (10 out of 28, 35.71%); iliac crest and reflexed head avulsions were treated conservatively. Running was related to the highest risk of ASIS, football for AIIS, and gymnastics for ITU. Most avulsions occurred in September, the fewest in July. Displacement cutoff values were calculated as 10.5 mm for ASIS, 9.5 mm for AIIS, and 14.5 mm for ITU. The most common healing complication was distraction 31 (14.0%), refracture in 2 ITU and non-union in 1 ITU; ITU complications were treated with osteosynthesis. According to the Cox regression, the following items significantly affected outcomes: fracture type (p < 0.0001), early verticalization (p = 0.0062), and initial displacement (p < 0.0001). DISCUSSION: Our study had several limitations, such as it was retrospective, there was a loss of patients from follow-up, and a lack of functional evaluations, for example, using Majeed's score modified for pediatric patients. The positives of the study included a relatively large group of patients from multiple hospitals, the use of logistic regression to determine displacement values to help differentiate between OS and conservative treatment, the inclusion of fracture incidence data, and the inclusion of patients with both surgical and conservative treatment. CONCLUSIONS: In the case of ASIS and AIIS avulsions, osteosynthesis can be considered for displacements ≥ 1 cm and ≥ 1.5 cm for ITU avulsions. Early verticalization was associated with a lower risk of healing complications in distraction injuries.

• Klíčová slova
• avulsion injury, complication., epidemiology, multicentric study, pediatric pelvic fracture,
• MeSH
• avulzní fraktury * epidemiologie   chirurgie   MeSH
• dítě MeSH
• incidence MeSH
• lidé MeSH
• mladiství MeSH
• pánevní kosti * zranění   chirurgie   MeSH
• retrospektivní studie MeSH
• sportovní úrazy * epidemiologie   MeSH
• traumatologická centra statistika a číselné údaje   MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• multicentrická studie MeSH

INTRODUCTION: The conflict in Ukraine, ongoing since 2014 and escalating with the Russian invasion in 2022, has unveiled profound challenges in prehospital care essential for the survival and recovery of warfighters and civilians alike, necessitating a detailed examination of the current medical response mechanisms and their effectiveness. MATERIALS AND METHODS: This study provides an overview of these challenges and examines how these critical vulnerabilities have impacted the delivery of medical care in war-torn regions. It also explores the role of NATO and its member states in addressing these challenges, focusing on the efforts to standardize prehospital care, enhance training, and foster interoperability among medical services. Furthermore, it explores the role of global heath engagement through NGOs in addressing these prehospital care gaps within the Ukrainian conflict zone, drawing from direct observations, expert testimonials, and secondary data. RESULTS: Findings reveal significant enhancements in prehospital care through improved training, interoperability, and logistics management, despite ongoing challenges in medical infrastructure and extended evacuation times, which continue to impact the quality of care. CONCLUSIONS: The study underscores the critical role of international collaboration and standardized protocols in bolstering prehospital medical responses in conflict settings, highlighting the need for continuous adaptation and support to mitigate the complexities of modern warfare. The insights gained from the Ukraine conflict offer valuable lessons for future military and humanitarian medical responses in similar conflict settings.

• MeSH
• celosvětové zdraví MeSH
• lidé MeSH
• ozbrojené konflikty MeSH
• urgentní zdravotnické služby * metody   normy   trendy   MeSH
• vedení války MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Ukrajina MeSH

Massive bleeding causes approximately 50% of deaths in patients with major trauma. Most patients die within 6 h of injury, which is preventable in at least 10% of cases. For these patients, early activation of the massive transfusion protocol (MTP) is a critical survival factor. With severe trauma, high-mobility group box 1 (HMGB-1, i.e., amphoterin) is released into the blood, and its levels correlate with the development of a systemic inflammatory response, traumatic coagulopathy, and fibrinolysis. Previous work has shown that higher levels of HMGB-1 are associated with a higher use of red blood cell transfusions. We conducted a retrospective analysis of previous prospective single-center study to assess the value of admission HMGB-1 levels in predicting activation of MTP in the emergency department. From July 11, 2019, to April 23, 2022, a total of 104 consecutive adult patients with severe trauma (injury severity score > 16) were enrolled. A blood sample was taken at admission, and HMGB-1 was measured. MTP activation in the emergency department was recorded in the study documentation. The total amount of blood products and fibrinogen administered to patients within 6 h of admission was monitored. Among those patients with massive bleeding requiring MTP activation, we found significantly higher levels of HMGB-1 compared to patients without MTP activation (median [interquartile range]: 84.3 µg/L [34.2-145.9] vs. 21.1 µg/L [15.7-30.4]; p < 0.001). HMGB-1 level showed good performance in predicting MTP activation, with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.75-0.93) and a cut-off value of 30.55 µg/L. HMGB-1 levels correlated significantly with the number of red blood cell units (rs [95% CI] 0.46 [0.28-0.61]; p < 0.001), units of fresh frozen plasma (rs 0.46 [0.27-0.61]; p < 0.001), platelets (rs 0.48 [0.30-0.62]; p < 0.001), and fibrinogen (rs 0.48 [0.32-0.62]; p < 0.001) administered in the first 6 h after hospital admission. Admission HMGB-1 levels reliably predict severe bleeding requiring MTP activation in the emergency department and correlate with the amount of blood products and fibrinogen administered during the first 6 h of hemorrhagic shock resuscitation.Trial registration: NCT03986736. Registration date: June 4, 2019.

• Klíčová slova
• Bleeding, HMGB-1, Major trauma, Massive transfusion protocol,
• MeSH
• biologické markery krev   MeSH
• dospělí MeSH
• krevní transfuze * metody   MeSH
• krvácení * terapie   krev   etiologie   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• protein HMGB1 * krev   MeSH
• rány a poranění * komplikace   krev   terapie   MeSH
• retrospektivní studie MeSH
• ROC křivka MeSH
• senioři MeSH
• skóre závažnosti úrazu MeSH
• urgentní služby nemocnice 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
• Názvy látek
• biologické markery MeSH
• HMGB1 protein, human MeSH Prohlížeč
• protein HMGB1 * MeSH

In a febrile patient admitted to the Adult Emergency Department, the haematology analyser detected the presence of erythrocytes infected with plasmodia. The finding was confirmed by thin smear and thick drop microscopy. A 43-year-old male patient was admitted to the Emergency Department with fever, vomiting, diarrhoea and pain in the upper abdomen. He reported a history of travel to Ethiopia and a short stay in Tanzania. The Sysmex XN series haematology analyser showed the activation of the iRBC flag signalling the presence of Plasmodium-infected erythrocytes. Thin smear and thick drop microscopy confirmed the presence of malaria plasmodia in erythrocytes.

• Klíčová slova
• Malaria, Plasmodium, Sysmex XN series, erythrocyte, haematology analyser, red cells,
• MeSH
• dospělí MeSH
• erytrocyty parazitologie   MeSH
• lidé MeSH
• malárie diagnóza   MeSH
• nemocnice univerzitní MeSH
• urgentní služby nemocnice * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Geografické názvy
• Etiopie MeSH
• Tanzanie MeSH

BACKGROUND: If carried out correctly and without delay, activation of emergency services by stroke bystanders could improve mortality and disability from stroke. This paper describes the development of a school-based intervention using the Intervention Mapping approach. It aims to improve the appropriate activation of emergency medical services for suspected stroke by 12-15-year-old children. METHODS: The development of the intervention was guided by Intervention Mapping approach. The logic model of the problem was created through analysis of the existing literature and semi-structured interviews with stakeholders. Based on these findings, performance objectives and their determinants were determined and matched to create a model for changing emergency medical services activation behavior. Behavior change methods and their practical applications were then determined. Based on them, intervention messages and materials were designed, the intervention was drafted, pretested, and finalized. RESULTS: It was found that the main performance objectives for the activation of emergency medical services were (1) recognizing symptoms, (2) communicating with the victim, and (3) calling an ambulance immediately. Their main determinants were knowledge, social influence, risk perception, self-efficacy, outcome expectations, and skills. Determinants were then matched with performance objectives to create the matrices of requested behavior changes. The following change methods were chosen: modeling, elaboration, belief selection, providing cues, scenario-based risk information, and cultural similarity. Methods were translated into practical applications in the form of a short educational film. The production company created, pretested, and finalized the film. As a result, a 5-minute entertainment-education video was created modeling an acute stroke with a child as the main bystander. CONCLUSION: The Intervention Mapping approach guided the development of a school-based program to improve Emergency medical services activation in stroke by 12-15 year old children. Our process and approach can serve as a model for researchers and health promotion professionals aiming to improve help-seeking behavior for stroke to improve stroke help-seeking behavior as well as other acute diseases.

• Klíčová slova
• Educational intervention, Emergency medical services activation, Entertainment-education, Intervention mapping, School-based, Stroke,
• MeSH
• cévní mozková příhoda * terapie   MeSH
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• rozvoj plánování MeSH
• školní zdravotnické služby MeSH
• školy MeSH
• urgentní zdravotnické služby * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Patients are the most common source of violence against EMS personnel. This study aims at elucidating specific clinical features in patients with mental alteration and aggressive behaviour increasing risk of violence. MATERIAL AND METHODS: This consecutive cross-sectional retrospective study analysed consecutive patients treated for prespecified list of primary diagnoses by one EMS provider in the Czech Republic between 1 January 2021 and 31 December 2023. The effect of individual features of medical history and present symptoms on the occurrence of violence, need for the Police assistance and use of restraints was evaluated, using linear regression model. RESULTS: 410 patients were evaluated. Verbal and brachial violence was present in 21.5 and 12.9 %, respectively. Police assistance was needed in 48.3 %, restraints were used in 4.6 %. The most significant predictor for violence, need for Police or restraints was agitation (OR 7.02, CI 4.14 - 11.90; OR 2.60, CI 1.60 - 4.24, OR 11.02, CI 3.49 - 34.80 respectively). Other predictors of violence included history of acute psychotic attacks and psychotic disorders, or outpatient psychiatry care. Among other predictors for Police assistance was presence of delusions, paranoia and history of outpatient psychiatry care. CONCLUSION: Prehospital care for patients with mental status alteration and aggressive behaviour is complex. Some clinical features seem to increase the risk of violence. Future research in the evaluation of agitated and violent patients is warranted to find strategies of risk mitigation for EMS personnel.

• MeSH
• agrese * psychologie   MeSH
• dospělí MeSH
• duševní poruchy epidemiologie   terapie   MeSH
• fyzické omezení statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• násilí statistika a číselné údaje   psychologie   MeSH
• policie MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• urgentní zdravotnické služby * statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH