BACKGROUND: Studies from different countries report a stagnation or regression of moral competence in medical students between the first and the last year of their studies, and the value of various educational interventions remains uncertain. METHODS: We used Moral Competence Test (MCT) to measure C-scores of moral competence to determine the change in the MCT C-scores between the first- and the fifth-year medical students from two medical schools in the Czech Republic in the academic year 2022/2023 and to analyze factors associated with the C-scores (observational study). In addition, for the first-year students, we compared the results of the MCT before and after an intervention in medical ethics curriculum (interventional study). We used a cross-sectional and descriptive design for the observational study. Students completed the MCT, consisting of two moral dilemmas (Worker´s Dilemma and Doctor´s Dilemma), the results measured by the C-score, which represents moral competence. RESULTS: In total, 685 students participated in the observational study. Objective 1: based on the analysis of the C-score, we observed a decrease in moral competence between the first and the fifth-year medical students (p < .001). Objective 2: we did not observe a statistically significant effect of gender (p = .278), or self-rated religiosity (p = .163). Objective 3: in the interventional study, 440 students participated in the pretest and 422 students participated in the posttest. The test of statistical significance found no improvement in students' moral competence after the intervention (p = .253). CONCLUSION: Medical students show a regression in moral competence during medical education; it was lower in medical students in their fifth year, compared to the first-year medical students without the effect of gender, or self-rated religiosity. Although educational intervention consisting of multiple tools of medical ethics teaching (PBL, CBL, KMDD and StorED) did not lead to increase in moral competence, the longitudinal effect of such intervention remains to be seen.

• Klíčová slova
• Case-based learning, Konstanz Method of Dilemma Discussion, Medical students, Moral competence, Narrative approach, Problem-based learnig,
• MeSH
• dospělí MeSH
• kurikulum * MeSH
• lékařská etika * výchova   MeSH
• lidé MeSH
• mladý dospělý MeSH
• mravy * MeSH
• průřezové studie MeSH
• studenti lékařství * psychologie   MeSH
• studium lékařství pregraduální metody   MeSH
• vyprávění MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

An integrated care model for people living with Parkinson's disease (PD) offers the promise of meeting complex care needs in a person-centered way that addresses fragmentation and improves quality of life. The purpose of our research was to co-design a care delivery model that supports both social and medical care from the perspective of patients and care partners. In the first step of our co-design approach, participants from five countries were invited to share their experiences of living with PD during a narrative interview. A qualitative analysis of these narrative interviews based on the Corbin and Strauss model was done to map out patients' trajectories. Three typical trajectories were identified: (a) the "unpredictable" trajectory, (b) the "situated" trajectory, and (c) the "demanding" trajectory. Based on the analysis of these trajectories, we were able to integrate various patient experiences into the design of an integrated care network.

• Klíčová slova
• Canada, Europe, Parkinson’s disease, co-design, integrated care, narrative interviews, patients’ experience, trajectory,
• MeSH
• integrované poskytování zdravotní péče * MeSH
• kvalita života MeSH
• lidé MeSH
• Parkinsonova nemoc * terapie   MeSH
• vyprávění MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVE: To investigate the effects of narrative group counseling combined with diet modification and exercise plans on weight loss in Iranian women with obesity. DESIGN: Parallel 2-arm clinical trial. PARTICIPANTS: Fifty-six Iranian women with obesity (aged 18-50 years). INTERVENTION: The intervention group included weekly diet, exercise, and narrative-focused group counseling, whereas the comparison group included dietary modification and exercise sessions for 8 months (32 sessions). MAIN OUTCOME MEASURE: Anthropometric and body composition parameters, blood biochemical parameters (high-density lipoproteins, low-density lipoproteins, triglycerides, fasting blood sugar, ghrelin, obestatin), physical activities, and appetite scores. ANALYSIS: McNemar test was used for the variables that were not normally distributed and for scaling. Furthermore, t tests were used to compare quantitative variables with normal distributions. The original P (0.05) was adjusted to P = 0.0031 using the Bonferroni correction. RESULTS: Weight, body mass index, body fat proportion, and hip circumference decreased significantly in the intervention vs comparison group. Serum low-density lipoproteins, triglycerides, total cholesterol, fasting blood sugar, appetite score, and ghrelin decreased, whereas obestatin increased significantly in the intervention vs comparison group. CONCLUSIONS AND IMPLICATIONS: Narrative-focused group counseling combined with traditional strategies was effective in achieving significant changes in weight, body mass index, and appetite. Future studies with a more diverse audience and a longer follow-up are warranted.

• Klíčová slova
• ghrelin, metabolic biomarkers, obestatin, weight loss, narrative-focused group counseling,
• MeSH
• cholesterol MeSH
• ghrelin * MeSH
• index tělesné hmotnosti MeSH
• krevní glukóza * MeSH
• lidé MeSH
• lipoproteiny HDL MeSH
• lipoproteiny LDL MeSH
• obezita terapie   MeSH
• poradenství MeSH
• triglyceridy MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Írán MeSH
• Názvy látek
• cholesterol MeSH
• ghrelin * MeSH
• krevní glukóza * MeSH
• lipoproteiny HDL MeSH
• lipoproteiny LDL MeSH
• triglyceridy MeSH

Several theories describe the development of the retraction pocket of the tympanic membrane (RP). Many authors suggest that the negative middle ear pressure is the main reason responsible for developing this condition. A narrative review has been undertaken, and conclusions are drawn reflecting a current knowledge with our new observations in the histological and immunohistochemical study. Recent studies show the important role of inflammation in the development and progression of RP. A review of the available literature shows that the inflammation plays a key role in pathogenesis of the RP and its progression to the cholesteatoma. We support this statement with our new results from histological and immunohistochemical analysis of the RPs.

• Klíčová slova
• cholesteatoma, chronic otitis media, pathogenesis, pathology, retraction pocket, tympanic membrane,
• MeSH
• cholesteatom středního ucha * MeSH
• lidé MeSH
• membrana tympani * MeSH
• zánět MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

"Novichok" refers to a new group of nerve agents called the A-series agents. Their existence came to light in 2018 after incidents in the UK and again in 2020 in Russia. They are unique organophosphorus-based compounds developed during the Cold War in a program called Foliant in the USSR. This review is based on original chemical entities from Mirzayanov's memoirs published in 2008. Due to classified research, a considerable debate arose about their structures, and hence, various structural moieties were speculated. For this reason, the scientific literature is highly incomplete and, in some cases, contradictory. This review critically assesses the information published to date on this class of compounds. The scope of this work is to summarize all the available and relevant information, including the physicochemical properties, chemical synthesis, mechanism of action, toxicity, pharmacokinetics, and medical countermeasures used to date. The environmental stability of A-series agents, the lack of environmentally safe decontamination, their high toxicity, and the scarcity of information on post-contamination treatment pose a challenge for managing possible incidents.

• Klíčová slova
• A-series agents, Analysis, Environmental stability, Physicochemical properties, Therapy, Toxicity,
• MeSH
• kontaminace léku * MeSH
• nervová bojová látka * toxicita   MeSH
• organofosforové sloučeniny MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• nervová bojová látka * MeSH
• organofosforové sloučeniny MeSH

INTRODUCTION: To date, our knowledge on antihypertensive pharmacological treatment in children and adolescents is still limited because there are few randomized clinical trials (CTs), hampering appropriate management. The objective was to perform a narrative review of the most relevant aspects of clinical trials carried out in primary and secondary hypertension. METHODS: Studies published in PubMed with the following descriptors: clinical trial, antihypertensive drug, children, adolescents were selected. A previous Cochrane review of 21 randomized CTs pointed out the difficulty that statistical analysis could not assess heterogeneity because there were not enough data. A more recent meta-analysis, that applied more stringent inclusion criteria and selected 13 CTs, also concluded that heterogeneity, small sample size, and short follow-up time, as well as the absence of studies comparing drugs of different classes, limit the utility. RESULTS: In the presented narrative review, including 30 studies, there is a paucity of CTs focusing only on children with primary or secondary, mainly renoparenchymal, hypertension. In trials on angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs) and diuretics, a significant reduction of both SBP and DBP in mixed cohorts of children with primary and secondary hypertension was achieved. However, few studies assessed the effect of antihypertensive drugs on hypertensive organ damage. CONCLUSIONS: Given the increasing prevalence and undertreatment of hypertension in this age group, innovative solutions including new design, such as 'n-of-1', and optimizing the use of digital health technologies could provide more precise and faster information about the efficacy of each antihypertensive drug class and the potential benefits according to patient characteristics.

• Klíčová slova
• adolescents, antihypertensive drug, children, clinical trial (2.172), pharmacological treatment,
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

Extended high-frequency audiometry (HFA) is considered an important tool in the detection of hearing loss. However, the values at extended high frequencies (EHF) in older adults (in both men and women) are associated with considerable uncertainty due to limited reference data. The presented review aimed to analyze hearing thresholds at EHF in adults older than 60 years. A literature search for HFA-related keyword combinations was conducted using the electronic databases PubMed, Scopus, and Web of Science. A total of 1654 records, published in the last 22 years, were identified through this search, of which only 7 articles were ultimately included in the analysis. Multiple studies have shown that significant hearing loss can be observed at EHF in older adults. Hearing thresholds in the frequency range of 9-20 kHz in the elderly varied widely across the studies. Therefore, further research in this field is needed to complete the normative data.

• MeSH
• audiometrie čistými tóny metody   MeSH
• audiometrie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nedoslýchavost diagnóza   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sluchový práh * fyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Blood loss in major abdominal surgery is an essential parameter in the evaluation of strategies aimed at reducing perioperative bleeding. It is also an important parameter of quality of the surgical procedure, along with postoperative morbidity and mortality, radicality of the surgical resection, etc. However, blood loss quantification remains unreliable and inaccurate. The methods used to measure blood loss can be categorized as visual estimation, gravimetric method, direct measurement, spectrophotometry, calculation methods, colorimetric analysis, and miscellaneous. The aim of this work is to review up-to-date knowledge about the various methods of blood loss quantification and then to introduce study, which should compare more methods of blood loss quantification in a real surgical setting.

• Klíčová slova
• abdominal surgery, blood loss quantification,
• MeSH
• krvácení * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: A cross-sectional survey GENERATE (GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe) initiated on behalf of the European chapter of the Extracorporeal Life Support Organization (EuroELSO), aims to provide a systematic, detailed description of contemporary Extracorporeal Life Support (ECLS) provision in Europe, map the spatial distribution of ECLS centers, and the accessibility of ECLS. METHODS: Structured data collection forms were used to create a narrative description of ECLS provision in EuroELSO affiliated countries. This consisted of both center-specific data and relevant national infrastructure. Data was provided by a network of local and national representatives. Spatial accessibility analysis was conducted where appropriate geographical data were available. RESULTS: 281 centers from 37 countries affiliated to EuroELSO were included in the geospatial analysis and demonstrate heterogeneous patterns of ECLS provision. Accessibility of ECLS services within 1 hour of drive-time is available for 50% of the adult population in 8 of 37 countries (21.6%). This proportion is reached within 2 hours in 21 of 37 countries (56.8%) and within 3 hours in 24 of 37 countries (64.9%). For pediatric centers, accessibility is similar with 9 of 37 countries (24.3%) reached the covering of 50% of the population aged 0-14 within 1 hour and 23 of 37 countries (62.2%) within 2 hours and 3 hours. CONCLUSIONS: ECLS services are accessible in most of the European countries, but their provision differs across the continent. There is still no solid evidence given regarding the optimal ECLS provision model. The spatial disparity in ECLS provision demonstrated in our analysis requires governments, healthcare professionals and policy makers to consider how to develop existing provision to accommodate the anticipated increase in need for time critical access to this advanced support modality.

• Klíčová slova
• ECLS, ECMO, extracorporeal life support, extracorporeal membrane oxygenation, geospatial analysis, regionalization,
• MeSH
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mimotělní membránová oxygenace * MeSH
• průřezové studie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Narrative medical reports do not use standardized terminology and often bring insufficient information for statistical processing and medical decision making. Objectives of the paper are to propose a method for measuring diversity in medical reports written in any language, to compare diversities in narrative and structured medical reports and to map attributes and terms to selected classification systems. METHODS: A new method based on a general concept of f-diversity is proposed for measuring diversity of medical reports in any language. The method is based on categorized attributes recorded in narrative or structured medical reports and on international classification systems. Values of categories are expressed by terms. Using SNOMED CT and ICD 10 we are mapping attributes and terms to predefined codes. We use f-diversities of Gini-Simpson and Number of Categories types to compare diversities of narrative and structured medical reports. The comparison is based on attributes selected from the Minimal Data Model for Cardiology (MDMC). RESULTS: We compared diversities of 110 Czech narrative medical reports and 1119 Czech structured medical reports. Selected categorized attributes of MDMC had mostly different numbers of categories and used different terms in narrative and structured reports. We found more than 60% of MDMC attributes in SNOMED CT. We showed that attributes in narrative medical reports had greater diversity than the same attributes in structured medical reports. Further, we replaced each value of category (term) used for attributes in narrative medical reports by the closest term and the category used in MDMC for structured medical reports. We found that relative Gini-Simpson diversities in structured medical reports were significantly smaller than those in narrative medical reports except the "Allergy" attribute. CONCLUSIONS: Terminology in narrative medical reports is not standardized. Therefore it is nearly impossible to map values of attributes (terms) to codes of known classification systems. A high diversity in narrative medical reports terminology leads to more difficult computer processing than in structured medical reports and some information may be lost during this process. Setting a standardized terminology would help healthcare providers to have complete and easily accessible information about patients that would result in better healthcare.

• MeSH
• chorobopisy * MeSH
• klinické kódování metody   MeSH
• lidé MeSH
• metody pro podporu rozhodování * MeSH
• mezinárodní klasifikace nemocí * MeSH
• SNOMED * MeSH
• terminologie jako téma * MeSH
• vyprávění * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH