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1.
Int J Med Inform ; 133: 104017, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31778885

RESUMO

BACKGROUND: Wearable devices with an ability to collect various type of physiological data are increasingly becoming seamlessly integrated into everyday life of people. In the area of electronic health (eHealth), many of these devices provide remote transfer of health data, as a result of the increasing need for ambulatory monitoring of patients. This has a potential to reduce the cost of care due to prevention and early detection. OBJECTIVE: The objective of this study was to provide an overview of available wearable sensor systems with data exchange possibilities. Due to the heterogeneous capabilities these systems possess today, we aimed to systematize this in terms of usage, where there is a need of, or users benefit from, transferring self-collected data to health care actors. METHODS: We searched for and reviewed relevant sensor systems (i.e., devices) and mapped these into 13 selected attributes related to data-exchange capabilities. We collected data from the Vandrico database of wearable devices, and complemented the information with an additional internet search. We classified the following attributes of devices: type, communication interfaces, data protocols, smartphone/PC integration, connection to smartphone health platforms, 3rd party integration with health platforms, connection to health care system/middleware, type of gathered health data, integrated sensors, medical device certification, access to user data, developer-access to device, and market status. Devices from the same manufacturer with similar functionalities/characteristics were identified under the same device family. Furthermore, we classified the systems in three subgroups of relevance for different actors in mobile health monitoring systems: EHR providers, software developers, and patient users. RESULTS: We identified 362 different mobile health monitoring devices belonging to 193 device families. Based on an analysis of these systems, we identified the following general challenges: CONCLUSIONS: Few of the identified mobile health monitoring systems use standardized, open communication protocols, which would allow the user to directly acquire sensor data. Use of open protocols can provide mobile health (mHealth) application developers an alternative to proprietary cloud services and communication tools, which are often closely integrated with the devices. Emerging new types of sensors, often intended for everyday use, have a potential to supplement health records systems with data that can enrich patient care.

2.
JMIR Mhealth Uhealth ; 7(7): e11527, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290400

RESUMO

BACKGROUND: Despite the fact there are many wearable and mobile medical devices that enable patients to better self-manage their diabetes, not many patients are aware of all the options they have. In addition, there are those who are not fully satisfied with the devices they use, and those who often do not use them effectively. OBJECTIVE: The study aimed to propose possible changes to the combination of devices used by 6 specific patients for diabetes self-management. We assessed the suitability of selected technical devices for diabetes control. METHODS: Data of 6 patients (3 men and 3 women) with type 1 diabetes mellitus, who had been using the Diani telemedicine system for at least 3 months, were analyzed. The suitability of selected technical devices for diabetes control was ascertained using the data obtained via the Diani telemedicine system, as well as the patients' subjective feelings and statements, their everyday life habits, and self-management of diabetes. Informed consent was signed and obtained from each of the patients included. RESULTS: Each of the presented case studies describes how a given patient handled the system and its specific components based on his or her lifestyle, level of education, habits related to diabetes management, personality type, and other factors. At the conclusion of each case study, the best composition of devices for patients with similar personal descriptions was suggested. CONCLUSIONS: We believe this study can provide relevant guidance on how to help particular patients choose the technology that is best suited for their needs, based on the specific patient information we are able to obtain from them. Furthermore, clinicians or educators should be aware of available technologies a given patient can choose from. In addition, there is a substantial need for proper patient education in order for them to effectively use devices for diabetes self-management.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Gerenciamento Clínico , Telemedicina/normas , Adulto , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Autogestão/métodos , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
3.
Int J Evid Based Healthc ; 17 Suppl 1: S3-S5, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283567

RESUMO

Currently in the Czech Republic, there does not exist such an institution as a 'National Centre for Clinical Practice Guidelines'. In 2017, there were about 123 professional medical organizations which developed about 1909 'guidelines' until 2017. However, the majority of these guidelines are 'expert opinion' or 'consensual' based 'guidance' or rather recommendations in the most cases missing a systematic approach that reflects evidence-based medicine principles and methods. The project is led by the Czech Health Research Council, the first partner is the Ministry of Health of the Czech Republic and the second partner is the Institute of Health Information and Statistics of the Czech Republic with support from policy makers, academics, clinicians and members of the Czech National Centre for Evidence-Based Healthcare and Knowledge Translations. This centre is an umbrella for three very important international collaborations which play a key role in Evidence-Based Healthcare, Evidence Synthesis, Evidence Implementation and trustworthy guidelines development. These are Cochrane Czech Republic, Masaryk University Grade Centre and the Czech Republic Centre for Evidence-Based Healthcare: The Joanna Briggs Institute Centre of Excellence.The main aim of this article is to present the Czech National Methodology of the Trustworthy Clinical Practice Guideline (CPG) development and the first results of the project 'Clinical Practice Guidelines'.A pilot phase of the project was realized during the first year of the project from January to December 2018. As the first step, there were established managing authorities including a Guarantee Committee and an Appraisal (Methodological) Committee. The Members of the Appraisal Committee developed a pilot version of the National Methodology of CPG development based on the best available approaches to Trustworthy CPGs development followed by testing on the first five pilot CPGs.


Assuntos
Medicina Baseada em Evidências/normas , Guias como Assunto/normas , República Tcheca , Medicina Baseada em Evidências/métodos , Humanos
4.
Int J Evid Based Healthc ; 17 Suppl 1: S43-S47, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283581

RESUMO

Coronary heart disease, sometimes also referred to as ischemic heart disease, remains the leading condition causing most deaths and disability-adjusted life years worldwide. Acute coronary syndrome (ACS) represents a subset that is defined by sudden reduction of blood supply in the coronary arteries. ACS consists of unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).The current short communication aims to provide current ACS prevalence and incidence data analysis to inform development of clinical practice guidelines in the Czech Republic.The Institute of Health Information and Statistics of the Czech Republic has provided the data that are collected by the National Health Information System with the National Register of Reimbursed Health Services as a primary source providing data for the period from 2015 to 2017.There has been a slight decrease in the number of hospitalized patients for ACS in the Czech Republic from 2015 to 2017. Sex difference remains large, with majority (two thirds) of those hospitalized for unstable angina, NSTEMI, or STEMI being men. Hospitalization with STEMI is reported in younger age with no sex difference compared with NSTEMI and unstable angina.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Angina Instável/epidemiologia , Infarto do Miocárdio/epidemiologia , Fatores Etários , República Tcheca/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Prevalência , Fatores Sexuais
5.
Int J Evid Based Healthc ; 17 Suppl 1: S48-S52, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283582

RESUMO

The prevalence of diabetes is on the rise worldwide especially in developed countries. The aim of glucose management in all types of diabetes is to minimize chronic and acute complications associated with diabetes. All patients with type 1 diabetes mellitus (T1DM) require insulin. Main areas of technology advances in diabetes are continuous subcutaneous insulin infusion (CSII) and also continuous glucose monitoring systems for the management of patients with both types of diabetes. It is very important to analyse the epidemiological situation within each country before and during the clinical practice guidelines (CPGs) development and implementation. The analyses will allow us to monitor the effect of the CPG after its implementation.The aim of this short communication is to analyse the epidemiology of prevalence and incidence of diabetes mellitus and use of CSII to inform development of CPGs in the Czech Republic.The analysis is developed based on the data managed by Institute of Health Information and Statistics of the Czech Republic. We used the National Register of Reimbursed Health Services 2015-2017 as primary source, and the annual report type A (Ministry of Health) 1-01: for Diabetology (A MH 004) 2007-2017 was used as validation source. The presented data are related to the year 2016 because we were able to validate them based on the data from 2015 to 2017 for this cohort of patients.The number of patients with T1DM is increasing in the Czech Republic with no significant sex difference. Life expectancy is about 11 years lower in the T1DM population. The majority of the patients are in older age; however, these are not treated with CSII compared with the younger population. From 61 533 patients with T1DM, 81% were reported with acute and chronic complications in 2016. Only 5011 of these patients were reported as using CSII.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/epidemiologia , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , República Tcheca/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Incidência , Insulina/uso terapêutico , Sistemas de Infusão de Insulina/estatística & dados numéricos , Expectativa de Vida , Masculino , Prevalência
6.
Int J Evid Based Healthc ; 17 Suppl 1: S53-S56, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283583

RESUMO

Stroke is one of the leading causes of mortality and the leading cause of functional impairment and cognitive deficits worldwide. It is important that clinical practice guidelines development is based on robust statistical and epidemiological data and their analysis throughout the whole process of guidelines development and implementation. The aim of this short communication is to analyse epidemiology of prevalence and incidence of ischaemic stroke, its main causes, brain imaging using MRI, recanalization therapies, secondary prevention with antiplatelet and anticoagulants, mortality data and to inform development of stroke clinical practice guidelines in the Czech Republic. The main analysed diagnosis was I63 (cerebral infarction) and secondary diagnoses were: I48 (atrial fibrillation and flutter), I35.9 (nonspecified aortic valve disease), Q21.1 (atrial septal defect) or I33.0 (acute and subacute endocarditis). We have also analysed use of brain imaging with MRI, recanalization treatment using intravenous thrombolysis and mechanical thrombectomy, stroke secondary prevention with antiplatelet drugs and anticoagulation as well as hospital admissions and mortality. In total, 159 344 patients were diagnosed with an ischaemic stroke from 2015 to 2017. Average prevalence of ischaemic stroke in the Czech Republic is 54.9 patients per 100 000. 22.2% of patients with stroke received intravenous thrombolysis or mechanical thrombectomy in 2017.


Assuntos
Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Anticoagulantes/administração & dosagem , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , República Tcheca/epidemiologia , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Inibidores da Agregação de Plaquetas/administração & dosagem , Prevalência , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Trombectomia/estatística & dados numéricos , Terapia Trombolítica/estatística & dados numéricos
7.
Int J Evid Based Healthc ; 17 Suppl 1: S57-S61, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283584

RESUMO

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the fourth most common cause of cancer death worldwide. Crucial in CRC as well as for other effective diagnostics and treatment is the knowledge translation and implementation of the current best available evidence into clinical practice and public health. Clinical practice guidelines are one of the useful tools to be able to improve diagnostics and increase survival rate.The epidemiological analysis was performed based on the data of the Czech National Cancer Registry from 1977 to 2017. We have analysed incidence, prevalence, mortality and primary treatment of CRC in the Czech Republic.The incidence of CRC increased significantly from 1982 to 2002 and is higher in men compared with women based on the data from the National Health Information System in the Czech Republic. The majority of the patients with CRC were diagnosed in early stages. Women were diagnosed at slightly higher age than men. An increase in surgical therapy performed in primary treatment of early CRC was reported from 2006 to 2016. Relative time of survival increased in reported patients with CRC.This analysis reported significant changes in incidence of CRC in the last 40 years as well as in diagnostics and primary therapy in early stages of CRC in the last 12 years. The first ever evidence-based clinical practice guideline on diagnostics and therapy of early CRC in the Czech Republic was developed and disseminated.


Assuntos
Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/terapia , Neoplasias Colorretais/mortalidade , República Tcheca/epidemiologia , Feminino , Guias como Assunto , Humanos , Incidência , Masculino , Prevalência , Fatores Sexuais , Análise de Sobrevida
8.
Cas Lek Cesk ; 158(2): 52-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31109163

RESUMO

Overview of epidemiology focused on tumors of the bile ducts and gallbladder is based on data of the National Cancer Registry and its newly validated and published data from 2016. In most recent period 2012-2016, 1013 patients were annually (in average) diagnosed with tumors of the bile ducts and gallbladder in the Czech Republic. In the same time, average annual mortality of this disease reached value 836. Prevalence of bile ducts and gallbladder cancer reached 1723 in 2016 and in comparison, with the value measured in 2006, it increased by 28 %. More than 50 % of bile ducts and gallbladder cancers are diagnosed in advanced clinical stages (stage III+) which makes prognosis of patients worse and limits reachable results of therapy.


Assuntos
Neoplasias dos Ductos Biliares , Neoplasias da Vesícula Biliar , Neoplasias dos Ductos Biliares/epidemiologia , República Tcheca/epidemiologia , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Prognóstico
10.
Artigo em Inglês | MEDLINE | ID: mdl-29795545

RESUMO

AIMS: The main aim of this study was to provide an estimate of the incidence and prevalence of spasticity following stroke in the internal carotid artery territory for Regional Stroke Centers in the Czech Republic. A secondary goal was to identify predictors for the development of spasticity. METHODS: In a prospective cohort study, 256 consecutive patients with clinical signs of central paresis due to a first-ever stroke were examined in the acute stage. All patients had primary stroke of carotid origin and paresis of the upper and/or lower limb for longer than 7 days after stroke onset. All were examined between 7-10 days after the stroke. We evaluated the degree and pattern of paresis, spasticity using the Modified Ashworth scale and the Barthel Index, baseline characteristics and demographic data. RESULTS: Of 256 patients (157 males; mean age 69.9±12.4 years), 115 (44.9%) patients developed spasticity during the first 10 days after stroke onset. Eighty-three (32.5%) patients presented with mild neurological deficit (modified Rankin Scale 0 - 2) and 69 (27.0%) patients were bedridden. CONCLUSION: Spasticity was noted in 44.9% patients with neurological deficit due to first-ever stroke in the carotid territory in the first 10 days after stroke onset. Severe spasticity was rare.

11.
Vnitr Lek ; 63(11): 876-883, 2018.
Artigo em Tcheco | MEDLINE | ID: mdl-29303289

RESUMO

Authors present actual overview of information on diagnostic and therapeutic procedures in small-cell lung cancer (SCLC). This highly aggressive type of lung cancer is diagnosed in 14.8 % of Czech lung cancer patients. Vast majority of those patients (87 %) suffer from advanced and metastatic disease in the time of diagnosis. In this issue are presented prognostic factors, staging diagnostic procedures and therapeutic recommendations. The backbone of actual SCLC treatment is combined chemotherapy and radiotherapy and less frequently, carefully in selected cases, surgical procedures. SCLC should be have as chemosensitive, chemoresistent or chemorefractory disease. Actual cytostatic combinations used in 1st line treatment, different schedules of chemoradiotherapy, drugs used in second line treatment and schedules and timing of prophylactic brain irradiation are presented. In near future, perspectively, there are some promissible data on antitumour immunotherapy based on anti CTLA-4 and anti PD-1/PE-L1 antibodies also in SCLC patients.Key words: cancer immunotherapy - concomitant chemoradiotherapy - chemotherapy - chest radiotherapy - lung resections - prophylactic brain irradiation - small cell lung cancer.


Assuntos
Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada/métodos , Humanos , Imunoterapia/métodos , Neoplasias Pulmonares/terapia , Radioterapia/métodos , Carcinoma de Pequenas Células do Pulmão/terapia
12.
J Stroke Cerebrovasc Dis ; 27(1): 240-245, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28919314

RESUMO

BACKGROUND: Neuroanatomic substrates responsible for development of post-stroke spasticity are still poorly understood. The study is focused on identification of brain regions within the territory of the middle cerebral artery associated with spasticity development. METHODS: This is a single-center prospective cohort study of first documented anterior circulation ischemic strokes with a neurologic deficit lasting >7 days (from March 2014 to September 2016, all patients are involved in a registry). Ischemic cerebral lesions within the territory of middle cerebral artery were evaluated using the Alberta Stroke Program Early CT Score (ASPECTS) on control 24-hour computed tomography or magnetic resonance imaging. Spasticity was assessed with modified Ashworth scale. RESULTS: Seventy-six patients (mean age 72 years, 45% females; 30% treated with IV tissue plasminogen activator, 6.5% mechanical thrombectomy) fulfilled the study inclusion criteria. Forty-nine (64%) developed early elbow or wrist flexor spasticity defined as modified Ashworth scale >1 (at day 7-10), in 44 (58%) the spasticity remained present at 6 months. There were no differences between the patients who developed spasticity and those who did not when comparing admission stroke severity (National Institutes of Health Stroke Scale 5 [interquartile range {IQR} 4-8] versus 6 [IQR 4-10]) and vascular risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, coronary artery disease). Nor was there a difference in 24-hour ASPECTS score (9 [IQR 8-10] versus 9 [IQR 7-10]). No differences were found between the groups with and without the early upper limb flexor spasticity of particular regions (M1, M2, M3, M4, M5, M6, lentiform, insula, caudate, internal capsule) and precentral-postcentral gyrus, premotor cortex, supplementary motor area, posterior limb of internal capsule, and thalamus were compared. CONCLUSIONS: We did not find any middle cerebral artery territory associated with post-stroke spasticity development by detailed evaluation of ASPECTS.


Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Técnicas de Apoio para a Decisão , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Espasticidade Muscular/etiologia , Extremidade Superior/inervação , Idoso , Idoso de 80 Anos ou mais , Circulação Cerebrovascular , República Tcheca , Imagem de Difusão por Ressonância Magnética , Diagnóstico Precoce , Feminino , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , Pessoa de Meia-Idade , Atividade Motora , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
13.
Comput Math Methods Med ; 2018: 4091497, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30693047

RESUMO

Background: Type-1 diabetes is a condition caused by the lack of insulin hormone, which leads to an excessive increase in blood glucose level. The glucose kinetics process is difficult to control due to its complex and nonlinear nature and with state variables that are difficult to measure. Methods: This paper proposes a method for automatically calculating the basal and bolus insulin doses for patients with type-1 diabetes using reinforcement learning with feedforward controller. The algorithm is designed to keep the blood glucose stable and directly compensate for the external events such as food intake. Its performance was assessed using simulation on a blood glucose model. The usage of the Kalman filter with the controller was demonstrated to estimate unmeasurable state variables. Results: Comparison simulations between the proposed controller with the optimal reinforcement learning and the proportional-integral-derivative controller show that the proposed methodology has the best performance in regulating the fluctuation of the blood glucose. The proposed controller also improved the blood glucose responses and prevented hypoglycemia condition. Simulation of the control system in different uncertain conditions provided insights on how the inaccuracies of carbohydrate counting and meal-time reporting affect the performance of the control system. Conclusion: The proposed controller is an effective tool for reducing postmeal blood glucose rise and for countering the effects of external known events such as meal intake and maintaining blood glucose at a healthy level under uncertainties.


Assuntos
Algoritmos , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Simulação por Computador , Humanos , Insulina/administração & dosagem , Cinética , Modelos Biológicos , Terapia Assistida por Computador/estatística & dados numéricos
14.
J Wound Ostomy Continence Nurs ; 44(4): 331-335, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28549051

RESUMO

PURPOSE: The purpose of this study was to analyze pressure injury (PI) occurrence upon admission and at any time during the hospital course inpatients care facilities in the Czech Republic. Secondary aims were to evaluate demographic and clinical data of patients with PI and the impact of a PI on length of stay (LOS) in the hospital. DESIGN: Retrospective, cross-sectional analysis. SETTING AND SUBJECTS: The sample comprised data of hospitalized patients entered into the National Register of Hospitalized Patients (NRHOSP) database of the Czech Republic between 2007 and 2014 with a diagnosis L89 (pressure ulcer of unspecified site based on the International Classification of Diseases, Tenth Revision, ICD-10). Electronic records of 17,762,854 hospitalizations were reviewed. METHOD: Data from the NRHOSP from all acute and non-acute care hospitals in the Czech Republic were analyzed. Specifically, we analyzed patients admitted to acute and non-acute care facilities with a primary or secondary diagnosis of PI. RESULTS: The NRHOSP database included 17,762,854 cases, of which 46,224 cases (33,342 cases in acute care hospitals; 12,882 in non-acute care hospitals) had the L89 diagnosis (0.3%). The mean age of patients admitted with a PI was 73.8 ± 15.3 years (mean ± SD), and their average LOS was 33.2 ± 76.9 days. The mean LOS of patients hospitalized with L89 code as a primary diagnosis (n = 6877) was significantly longer compared to those patients for whom L89 code was a secondary diagnosis (25.8 vs 20.2 days, P < .001) in acute care facilities. In contrast, we found no difference in the mean LOS for patients hospitalized in non-acute care facility (58.7 days vs 65.1 days; P = .146) with ICD code L89. CONCLUSION: Pressure injuries were associated with significant LOS in both acute and non-acute care settings in the Czech Republic. Despite the valuable insights we obtained from the analysis of NRHOSP data, we advocate creation of a more valid and reliable electronic reporting system that enables policy makers to evaluate the quality and safety concerning PI and its impact on patients and the healthcare system.


Assuntos
Bases de Dados Factuais/normas , Pacientes Internados/estatística & dados numéricos , Lesão por Pressão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , República Tcheca , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/classificação , Lesão por Pressão/enfermagem , Estudos Retrospectivos , Estatísticas não Paramétricas
15.
Biochem Med (Zagreb) ; 25(3): 460-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26526166

RESUMO

INTRODUCTION: Women with previous gestational diabetes mellitus (GDM) have increased risk of developing glucose abnormality, but current diagnostic criteria are evidence-based for adverse pregnancy outcome. THE AIMS OF OUR STUDY WERE: (i) to ascertain a frequency of early conversion of GDM into permanent glucose abnormality, (ii) to determine predictive potential of current GDM diagnostic criteria for prediction of postpartum glucose abnormality and (iii) to find optimal cut-off values of oral glucose tolerance test (oGTT) to stratify GDM population according to postpartum risk. MATERIALS AND METHODS: Electronic medical records of an ethnically homogenous cohort of women diagnosed and treated for GDM in a single medical centre during the period 2005-2011 who completed postpartum oGTT up to 1 year after the index delivery were retrospectively analysed (N=305). RESULTS: Postpartum glucose abnormality was detected in 16.7% subjects. Mid-trimester oGTT values, respective area under the curve and HbA1c were significantly associated with early postpartum glucose abnormality (P<0.05, Mann-Whitney) and exhibited significant predictive potential for postpartum glucose abnormality risk assessment. Optimal cut-off values for discrimination of at-risk sub-population were identified using ROC analysis and their comparison with WHO and IADPSG criteria exhibited superiority of IADPSG for risk-stratification of GDM population. CONCLUSION: Risk-based stratification at the time of GDM diagnosis could improve efficiency of the post-gestational screening for diabetes. IADPSG criteria seem to optimally capture both perinatal and maternal metabolic risks and are therefore medically and economically justified.


Assuntos
Diabetes Gestacional/diagnóstico , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose , Testes para Triagem do Soro Materno , Segundo Trimestre da Gravidez/sangue , Transtornos Puerperais/diagnóstico , Adulto , Área Sob a Curva , República Tcheca/epidemiologia , Diabetes Gestacional/epidemiologia , Suscetibilidade a Doenças , Jejum/sangue , Feminino , Intolerância à Glucose/epidemiologia , Hemoglobina A Glicada/análise , Humanos , Gravidez , Prognóstico , Transtornos Puerperais/epidemiologia , Curva ROC , Estudos Retrospectivos , Medição de Risco
16.
Anticancer Res ; 35(11): 6303-10, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26504067

RESUMO

AIM: Evaluation of efficacy and safety of ipilimumab in patients with advanced, refractory melanoma enrolled into a national ipilimumab Expanded Access Program. PATIENTS AND METHODS: Adult patients with advanced/metastatic refractory melanoma were eligible for study inclusion. Ipilimumab was administered up to a total of four doses. RESULTS: One hundred and ninety-six patients were analyzed. Full ipilimumab induction was administered to 66.8% of patients. Median overall survival (OS) in the entire cohort was 7.5 months. Median OS for patients after four doses of ipilimumab was significantly longer than for patients with fewer doses (12.3 months vs. 2.0 months respectively; p<0.001). Median OS for patients with objective tumor response was 42.3 months. Normal baseline serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) levels, and the number of affected organs correlated with improved OS. CONCLUSION: The number of affected organs and combination of baseline LDH and CRP levels could potentially serve as predictors for both treatment response and OS.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Melanoma/mortalidade , Recidiva Local de Neoplasia/mortalidade , Terapia de Salvação , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Feminino , Seguimentos , Humanos , Ipilimumab , L-Lactato Desidrogenase/metabolismo , Masculino , Melanoma/tratamento farmacológico , Melanoma/patologia , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Segurança , Taxa de Sobrevida , Fatores de Tempo , Adulto Jovem
17.
J Diabetes Sci Technol ; 9(3): 556-63, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25591859

RESUMO

BACKGROUND: Wearable computing has long been described as the solution to many health challenges. However, the use of this technology as a diabetes patient self-management tool has not been fully explored. A promising platform for this use is the smartwatch-a wrist-worn device that not only tells time but also provides internet connection and ability to communicate information to and from a mobile phone. METHOD: Over 9 months, the design of a diabetes diary application for a smartwatch was completed using agile development methods. The system, including a two-way communication between the applications on the smartwatch and mobile phone, was tested with 6 people with type 1 diabetes. A small number of participants was deliberately chosen due to ensure an efficient use of resources on a novel system. RESULTS: The designed smartwatch system displays the time, day, date, and remaining battery time. It also allows for the entry of carbohydrates, insulin, and blood glucose (BG), with the option to view previously recorded data. Users were able to record specific physical activities, program reminders, and automatically record and transfer data, including step counts, to the mobile phone version of the diabetes diary. The smartwatch system can also be used as a stand-alone tool. Users reported usefulness, responded positively toward its functionalities, and also provided specific suggestions for further development. Suggestions were implemented after the feasibility study. CONCLUSIONS: The presented system and study demonstrate that smartwatches have opened up new possibilities within the diabetes self-management field by providing easier ways of monitoring BG, insulin injections, physical activity and dietary information directly from the wrist.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Registros de Dieta , Smartphone , Adulto , Glicemia , Monitorização Ambulatorial da Pressão Arterial , Carboidratos da Dieta , Estudos de Viabilidade , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Insulina/administração & dosagem , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Autocuidado , Inquéritos e Questionários , Adulto Jovem
18.
Rep Pract Oncol Radiother ; 19(3): 182-90, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24944819

RESUMO

AIM: To compare radiotherapy plans made according to CT and PET/CT and to investigate the impact of changes in target volumes on tumour control probability (TCP), normal tissue complication probability (NTCP) and the impact of PET/CT on the staging and treatment strategy. BACKGROUND: Contemporary studies have proven that PET/CT attains higher sensitivity and specificity in the diagnosis of lung cancer and also leads to higher accuracy than CT alone in the process of target volume delineation in NSCLC. MATERIALS AND METHODS: Between October 2009 and March 2012, 31 patients with locally advanced NSCLC, who had been referred to radical radiotherapy were involved in our study. They all underwent planning PET/CT examination. Then we carried out two separate delineations of target volumes and two radiotherapy plans and we compared the following parameters of those plans: staging, treatment purpose, the size of GTV and PTV and the exposure of organs at risk (OAR). TCP and NTCP were also compared. RESULTS: PET/CT information led to a significant decrease in the sizes of target volumes, which had the impact on the radiation exposure of OARs. The reduction of target volume sizes was not reflected in the significant increase of the TCP value. We found that there is a very strong direct linear relationship between all evaluated dosimetric parameters and NTCP values of all evaluated OARs. CONCLUSIONS: Our study found that the use of planning PET/CT in the radiotherapy planning of NSCLC has a crucial impact on the precise determination of target volumes, more precise staging of the disease and thus also on possible changes of treatment strategy.

19.
Leuk Lymphoma ; 55(4): 802-10, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23772666

RESUMO

Although a prognostic model (MIPI, Mantle Cell Lymphoma International Prognostic Index) for patients with mantle cell lymphoma (MCL) has been established, its clinical significance for daily practice in the rituximab era remains controversial. Data of 235 unselected patients with MCL from the Czech Lymphoma Project Database were analyzed. MIPI, simplified MIPI (s-MIPI) and Ki-67 proliferation index were assessed for all patients and for a subgroup of 155 rituximab-treated (RT) patients. MIPI divided all patients into subgroups of low-risk (22%), intermediate-risk (29%) and high-risk (49%), with median overall survival 105.8 vs. 54.1 vs. 24.6 months, respectively (p < 0.001). s-MIPI revealed similar results. The validity of both indexes was confirmed in RT patients. We confirmed the Ki-67 index to be a powerful single prognostic factor for overall survival (64.4 vs. 20.1 months, p < 0.001) for all patients and for the RT subset. Our results confirm the clinical relevance of MIPI, s-MIPI and Ki-67 for risk stratification in MCL also in the rituximab era.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Antígeno Ki-67/metabolismo , Linfoma de Célula do Manto/diagnóstico , Linfoma de Célula do Manto/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Murinos/administração & dosagem , Biomarcadores/metabolismo , República Tcheca , Bases de Dados Factuais , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Imuno-Histoquímica , Linfoma de Célula do Manto/mortalidade , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Rituximab , Transplante Autólogo , Resultado do Tratamento
20.
Cancer Epidemiol ; 38(1): 28-34, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24315848

RESUMO

BACKGROUND: The objective of this study was to assess trends in overall and in stage-specific 5-year relative survival rates of the Czech cancer patients between periods 2000-2004 and 2005-2008. METHODS: All Czech cancer patients diagnosed between 1995 and 2008 were included in the analysis. Period analysis was employed to calculate 5-year relative survival for 21 cancers. RESULTS: Significant improvements in crude 5-year relative survival for 14 of 21 assessed types of cancer, including the most frequent diagnoses, such as, colorectal, prostate, breast, lung, kidney, pancreatic, and bladder cancer and melanoma, were identified. Moreover, in case of colorectal, lung, and prostate cancer, improvement in stage-specific 5-year relative survival was confirmed as statistically significant for all clinical stages. No diagnosis showed significant decrease in the 5-year relative survival. However, the 5-year relative survival remained poor in patients with metastatic cancers at diagnosis, particularly in case of liver, pancreatic, lung, and oesophageal cancer. CONCLUSIONS: The cancer-specific outcomes in the Czech Republic are improving. Nevertheless, despite the overall significant improvement in 5-year relative survival of most of the cancer diagnoses, the high proportion of patients primarily diagnosed with metastatic cancer still represents a substantial challenge for prevention and early detection.


Assuntos
Neoplasias/epidemiologia , Adolescente , Adulto , Idoso , República Tcheca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias/patologia , Sistema de Registros , Taxa de Sobrevida , Adulto Jovem
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