Changes in gene expression in pressure ulcers debrided by different approaches - a pilot study.

Pressure ulcers (PUs), also known as pressure injuries, are chronic wounds that represent potential lifelong complications. Pressure ulcers of a deep category (III and IV) are often indicated for surgical treatment - debridement and surgical reconstruction. Sharp surgical debridement is widely used in the debridement of PUs; however, the Versajet® hydrosurgery system is becoming an increasingly popular tool for tangential excision in surgery due to its numerous advantages. This work focused on the expression of selected genes, especially those associated with oxidative stress, in PUs debrided by two approaches - sharp surgical debridement and debridement using Versajet® hydrosurgery system. Expression of following genes was evaluated: NFE2L2, ACTA2, NFKB1, VEGFA, MKI67, HMOX1, HMOX2, HIF1A, and SOD2. ACTB and PSMB were used as housekeeping genes. So far, five patients have been enrolled in the study. Preliminary results suggest no significant difference in gene expression with different pressure ulcer treatment approaches except NFE2L2, despite the macroscopic differences. However, the results revealed correlations between the expression of some genes, namely HIF1A and SOD2, VEGFA and SOD2 and VEGFA and HIF1A. These results may indicate a connection between hypoxia, oxidative stress, pressure ulcer healing processes and angiogenesis.

Exercise as a tool to improve the quality of life of patients after breast cancer treatment.

BACKGROUND: The increasing quality of cancer treatment and early detection of tumors have an impact on the number of patients who survive cancer treatment. Therefore, the attention of physicians as well as scientists is increasingly focused on the consequences of the treatment than just on the treatment itself. One of the ways to positively influence the side effects of oncological treatment seems to be physical activity. METHODS: In our research, there were involved 18 women after breast cancer treatment, 17 completed the research (average values of the tested group: 55.9 years, 165.1cm, 76.9kg, body mass index (BMI) 28.3). The patients who signed informed consent were divided into 3 groups (SAPA = supervised exercises 3times a week, HAPA = home exercises 3times a week, and a control group without exercises). The whole intervention lasted 12 weeks and the exercise unit itself contained an aerobic-resistant component and a yoga component. During the exercise, the patients heart rate was monitored using a chest belt and sports testers. We used spiroergometry (peak oxygen uptake - VO2peak), bio-electric impedance, and spectral analysis of the heart rate variability to evaluate changes in the quality of life. RESULTS: VO2peak increased in training groups by an average of 5ml/min/kg (P = 0.082). A similar tendency was evident in some body composition values (skeletal muscle: P = 0.005; fat free mass: P = 0.006). Statistical significance did not reach the values of BMI (P = 0.131) and autonomic nervous system (P = 0.513; P = 0.585). CONCLUSION: Although our results suggest a positive trend in affecting the quality of life of patients after breast cancer treatment by exercises, similar research needs to be repeated in a larger study to confirm our results.

Oncology wounds - recommendations for care based on multidisciplinary cooperation.

BACKGROUND: Oncology wounds and wounds of other etiology are rare but serious complications, which significantly impair patients quality of life. Preventive and curative interventions and education of healthcare personnel and patients reduce the risk of either their occurrence or their impact and consequences. A working group of authors from professional groups (the Supportive Care Group of the Czech Society for Oncology, the Czech Society for Wound Healing, the Society for Radiation Oncology, Biology and Physics, and the Czech Nurses Association) prepared recommendations for care. A comprehensive approach to the treatment of oncological wounds, including symptomatic treatment of associated healing complications, prevention, early detection, interdisciplinary cooperation and education are essential to deal with wounds related to chemotherapy administration, radiotherapy and oncological treatment in general. The proper choice of local care products and the eventuality of active oncological treatment are important elements of care in ulcerating tumors. PURPOSE: A basic summary of recommended interventions to prevent and treat oncology wounds in daily practice, defined based on expert societies guidelines, trials and literature data, proven practice and on the consensus opinions of the authors group members. The recommended procedures contribute to the reduction of the development, severity and consequences of oncological wounds and wounds of other etiology in oncological  patients.

Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries.

BACKGROUND: Skin tears are acute wounds that are frequently misdiagnosed and under-reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way. OBJECTIVES: To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally. METHODS: A multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two-round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter-rater reliability and intrarater reliability of the instrument. RESULTS: A definition for the concept of a 'skin flap' in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79-0·80] and sensitivity ranged from 0·74 (95% CI 0·73-0·75) to 0·88 (95% CI 0·87-0·88). The inter-rater reliability was 0·57 (95% CI 0·57-0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73-0·75). CONCLUSIONS: The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under-reported too often. A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries. Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.

[Changes in Cognitive Functions after Total Hip Arthroplasty]. / Zmeny kognitivních funkcí po totální náhrade kycelního kloubu.

PURPOSE OF THE STUDY The postoperative delirium is a frequent, oftentimes underestimated complication of total hip arthroplasty. Its occurrence is reported to be between 10% and 50%. The postoperative delirium increases mortality, the length of hospital stay and leads to worse functional results. Even though there is evidence of efficiency of preventive measures and effectiveness of treatment interventions, inadequate attention has been paid so far to this serious complication related to inpatient hospital care. This paper aimed to determine the incidence of cognitive function impairment in relation to the total hip replacement, to determine the influence of the defined parameters on changes in cognitive functions and to draft practice guidelines for the care of patients after a total hip replacement in the framework of prevention and early detection of changes in cognition of patients after total hip replacement. MATERIAL AND METHODS Prospective observational descriptive study, the evaluated parameters included: type of anaesthesia, duration of surgical procedure (operation), type of analgesia, O2 saturation, haemoglobin levels, changes in the ionogram, body temperature, presence of concomitant diseases, polypragmasia, abuse, level of self-sufficiency of patients evaluated by ADL. In order to obtain the data, the Mini Mental State Examination (MMSE), the Abbreviated Mental Test Score (AMTS), Recall and naming test, and the Activities of Daily Living Test (ADL) were used. The monitored group of patients included a total of 116 persons, of whom 68 men and 48 women. The mean age was 71.16 years; the range from 65 to 86 years; median - 72.36 years. RESULTS A statistically significant dependence was revealed between the change in cognitive functions and all the monitored parameters, except for the haemoglobin levels after 120 hours postoperatively, ion levels after 120 hours and sex by the 10-point Mini Mental Test score. A statistically significant dependence was revealed between the change in cognitive functions and 02 saturation, ion levels, elevated body temperature after 120 hours postoperatively, age, diabetes, polypragmasia and in correlation with the ADL 120 hours postoperatively by the MMSE test. A statistically significant dependence was revealed between the change in cognitive functions and all the monitored parameters, except for anaesthesia and analgesia, haemoglobin levels after 24 and 120 hours, ion levels after 120 hours, renal insufficiency and in correlation with the ADL after 24 hours by the "Recall and naming" test. DISCUSSION The correlation between delirium and long-term cognition impairment was described by several studies. Both the recent literature and our study clearly indicate a correlation between the postoperative cognitive impairment on the one hand and polypragmasia, age, presence of concomitant diseases on the other hand. In some parameters such as the sex of the patient its influence was not clearly established by the relevant literature or our study. The perioperative factors influencing the onset of delirium referred to in literature are anaesthesia and its duration. Our study reveals the correlation between the anaesthesia and the onset of cognitive impairment when evaluated by the Abbreviated Mental Test Score. As regards the monitored postoperative parameters, the influence of postoperative hyposaturation, decreased haemoglobin level, changes in ionogram, elevated body temperature, lower self-sufficiency of the patient was established. Also our study shows the correlation between the change in the aforementioned parameters and the cognitive impairment, even though not quite clearly in all the parameters. The most sensitive evaluation tool turned out to be the Abbreviated Mental Test Score. CONCLUSIONS Our study clearly showed that a highly sensitive test to detect the current changes in cognition in a short-term horizon is the Abbreviated Mental Test Score. Based on the statistically significant factors determining the onset of the change in cognition that we had revealed, we elaborated a clearly arranged scheme of identified risk factors and interventions for the prevention and early identification of the onset of changes in cognitive functions and potential delirium. Key words:total hip arthroplasty, cognitive impairment, delirium.

Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries.

BACKGROUND: Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research. OBJECTIVES: To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties. METHODS: The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed. RESULTS: The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62). CONCLUSIONS: The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.

[Intervention Exercise Program for Cancer Patients with Breast Cancer]. / Intervencní cvicební program pro onkologické pacientky s karcinomem prsu.

BACKGROUND: Movement is a sign of life and regular physical activity has an indisputable influence on each and every person. When applied selectively to patients after cancer therapy, physical activity, including rehabilitation, positively contributes to complete recuperation and improves quality of life. Our interventional exercise program for cancer patients was prepared and implemented on the basis of reports in the medical literature and on the lecturers own experience. The interventional exercise program was divided into two parts - body and mind and body fitness. AIM: Besides increasing self-confidence and improving quality of life, the aim of the exercise program was to improve cardiovascular function, basal metabolism, muscular strength and endurance, and joint flexibility and to strengthen phasic muscles and stretch tonic muscles, both of which are important for balance.Key words: breast cancer - exercise - quality of lifeThe authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 15. 9. 2016Accepted: 5. 10. 2016.

Evaluation of the assessment and documentation of chronic wounds in residential social care in the Czech Republic.

OBJECTIVE: Accurate evaluation of non-healing, chronic wounds followed by the selection of an appropriate therapeutic strategy is a must for the foundation of health-care management. Assessment of non-healing chronic wounds in clinical practice in the Czech Republic is not standardised in acute care settings or in residential social care facilities. The aim of the study was to analyse the methods being used to assess non-healing, chronic wounds in residential social services in the Czech Republic, where more patients with chronic wounds are present because of the increasing incidence of wounds in old age. METHOD: The research was carried out at 66 residential social care institutions across all regions of the Czech Republic. A mixed model was used for the research (participatory observation including creation of field notes and content analysis of documents for documentation and analysis of qualitative and quantitative data). The same methodology was used in previous work which has been done in acute care settings in 2013. RESULTS: The results of this research have corroborated the inconsistencies in procedures used by general nurses for assessment of non-healing, chronic wounds. However, the situation was found to be more positive with regard to the evaluation of basic/fundamental parameters of a wound (e.g. size, depth and location of the wound) compared with the evaluation of more specific parameters (e.g. exudate or signs of infection). This included not only the number of observed variables, but also the action taken. Both were improved when a consultant for wound healing was present. CONCLUSION: An effective strategy for wound management depends on the method and scope of the assessment of non-healing, chronic wounds in place in clinical practice in observed facilities; improvement may be expected following the general introduction of 'non-healing, chronic wound assessment' algorithm.

[Injury to the Scapholunate Ligament in Distal Radius Fractures: Peri-Operative Diagnosis and Treatment Results]. / Konkomitantné poranenia skafolunátneho väzu pri zlomeninách distálneho rádia ­ perioperacná diagnostika a výsledky liecby.

PURPOSE OF THE STUDY Injury to the scapholunate ligament is frequently associated with a fracture of the distal radius. At present neither a unified concept of treatment nor a standard method of diagnosis in these concomitant injuries is available. The aim of the study was to evaluate a group of surgically treated patients with distal radius fractures in order to assess a contribution of combined conventional X-ray and intra-operative fluoroscopic examinations to the diagnosis of associated lesions and to compare short-term functional outcomes of sugically treated patients with those of patients treated conservatively. MATERIAL AND METHODS A group of patients undergoiong surgery for distal radius fractures using plate osteosynthesis was evaluated retrospectively. The peri-operative diagnosis of associated injury to the scapholunate ligament was based on pre-operative standard X-ray views and intra-operative fluoroscopy. The latter consisted of images of maximum radial and ulnar deviation as well as an image of the forearm in traction exerted manually along the long axis. All views were in postero-anterior projection. Results were read directly on the monitor of a fluoroscopic device after its calibration or were obtained by comparing the thickness of an attached Kirschner wire with the distance to be measured. Subsequently, pixels were converted to millimetres. When a scapholunate ligament injury was found and confirmed by examination of the contralateral wrist, the finding was verified by open reduction or arthroscopy. Both static and dynamic instabilities were treated together with the distal radius fracture at one-stage surgery. After surgery, the patients without ligament injury had the wrist immobilised for 4 weeks, then rehabilitation followed. In the patients with a damaged ligament, immobilisation in a short brace lasted until transarticular wires were removed. All patients were followed up for a year at least. At follow-up, the injured wrist was examined for signs of clinical instability of the scapholunate joint, functional outcome was assessed using the Mayo Wrist Score (MWS) and pain intensity was evaluated on the Visual Analoque Scale (VAS). Restriction in daily activities was rated by the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score and plain X-ray was done. If any of the results was not satisfactory, MRI examination was indicated. RESULTS Of a total of 265 patients, 35 had injury to the scapholunate joint, 16 had static instability diagnosed by a standard fluoroscopic examination and nine patients with an acute phase of injury remained undiagnosed. For detection of associated scapholunate injuries, a standard X-ray examination had sensitivity of 46%, specificity of 99%, accuracy of 92%, positive predictive value of 84%, negative predictive value of 92%, positive likelihood ratio = 35.05 and negative likelihood ratio = 0.55. Dynamic fluoroscopic examination showed sensitivity of 53%, specificity of 99%, accuracy of 95%, positive predictive value of 77%, negative predictive value of 96%, positive likelihood ratio = 36.49 and negative likelihood ratio = 0.48. Using the MWS system, no differences in the outcome of scapholunate instability treatment were found between the patients undergoing surgery and those treated conservatively (p=0.35). Statistically significant differences were detected in the evaluation of subjective parameters - both VAS and QDASH scores were better in the treated than non-treated patients (p=0.02 and p=0.04, respectively). DISCUSSION The high negative predictive values of both standard X-ray and intra-operative fluoroscopy showed that combined use of the two method is more relevant for excluding than for confirming an injury to the scapholunate ligament concomitant with distal radius fracture. Similarly, the low negative likelihood ratio showed that a negative result decreases the pre-test probability of concomitant injury. CONCLUSIONS Negative findings of scapholunate ligament injury on standard X-ray views and intra-operative fluoroscopic images make it unnecessary to perform any further intra-operative examination to detect injury to the scapholunate ligament. Positive findings require verification of the degree of injury by another intra-operative modality, most ideally by arthroscopy. Patients with untreated instability associated with distal radius fracture have, at short-term follow-up, no statistically significant differences in functioning of the injured extremity in comparison with treated patients. Subjectively, however, they feel more pain and more restriction in performing daily activities. Therefore, the treatment of an injured scapholunate ligament together with distal radius fracture at one-stage surgery seems to be a good alternative for the patient. Key words: distal radius fractures, scapholunate ligament, radiographic, diagnosis, outcome distal radius fracture.

[Compliance of senior /  elderly patients with cognitive impairment]. / Compliance starsích nemocných s kognitivní poruchou.

The contribution presents the results of investigation conducted at a department of the Longterm Care and Rehabilitation Centre of The Merciful Brothers Hospital in Brno. Altogether, 100 seniors were examined, 20 men and 80 women, with an average age of 81.6 ± 6.88 years and an age range of 70 to 98 years. The wellknown and repeatedly demonstrated errors in the therapeutic regime of the patients, especially older seniors, compel us to focus our attention on consistent prevention of these situations. The present work summarises the knowledge about the diminished compliance of geriatric patients. It compares the mutual relationship of cognitive functions and the subjective and objective rates of the patients compliance regarding the taking of medicaments and observation of therapeutic recommendations. Key words: geriatric patient -  compliance -  testing of cognitive functions -  dementia -  pharmacotherapy in elderly.