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1.
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
2.
Int J Evid Based Healthc ; 17 Suppl 1: S9-S11, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283569

RESUMO

Despite a significant transformation of ischaemic stroke management, it remains one of the leading causes of death, disability, functional impairment and cognitive deficits. With the advent of intravenous thrombolysis and mechanical thrombectomy, stroke is not an untreatable disease, mostly occurring in older people, any more. The most common cause of cardioembolic strokes is atrial fibrillation or flutter and atrial fibrillation is the most prevalent arrhythmia.The aim of this short communication is to describe the methodology of the Czech stroke guidelines development.High-quality 2017 Australian Stroke Foundation stroke guideline was considered for adaptation and a new guideline was developed and disseminated.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controle , Anticoagulantes/administração & dosagem , Isquemia Encefálica/prevenção & controle , República Tcheca , Medicina Baseada em Evidências , Guias como Assunto , Humanos , Acidente Vascular Cerebral/tratamento farmacológico
3.
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
4.
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
5.
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
6.
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.
J Wound Care ; 27(5): 288-295, 2018 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-29738300

RESUMO

OBJECTIVE: Different types of multidisciplinary concepts for treating non-healing wounds have been developed. However, there is insufficient evidence on the quality of multidisciplinary wound centres, and a limited number of evaluation systems have so far been developed. The lack of an international wound centre evaluation/certification system is the basis for the European Wound Management Association (EWMA) Wound Centre Endorsement Project. The project aims to describe the minimum requirements for a wound management centre. These requirements have been defined as a basis for evaluation and endorsement of wound centres inside as well as outside a hospital setting (in- and outpatient clinics). METHOD: The endorsement programme focused on wound centre characteristics such as: target population; types of centres; and choice of model used. The method used to develop the EWMA wound centre endorsement programme was an evaluation of the quality of the different types of established wound centres across and outside Europe. Criteria and procedures for endorsement of wound centres were developed and pilot projects were performed outside Europe in two in-patient centres in China and one outpatient centre in Brazil. RESULTS: The EWMA endorsement procedure includes the following steps: initial application; review of centre data provided via the application form and follow-up dialogue; visit to the wound centre; final report and endorsement; and re-endorsement. A follow-up visit was arranged in connection with the re-endorsement. Experiences from the pilot studies have so far indicated that the endorsement process is not only a quality declaration, but may also result in positive developments, such as increased visibility, increased patient flow, increased healing rates, and decreased amputation rate. CONCLUSION: Development of endorsement systems focusing on the minimum requirements for a wound management centre is required to support the development of high-quality wound centres which provide health-care services according to recent evidence of current best practice. The EWMA Wound Centre Endorsement Project is the first international programme of its kind and this may, in the future, support the establishment of international collaboration and knowledge sharing about the development and maintenance of high-quality wound centres.


Assuntos
Certificação/normas , Competência Clínica/normas , Guias como Assunto , Instalações de Saúde/normas , Cicatrização , Ferimentos e Lesões/terapia , Europa (Continente) , Humanos , Projetos Piloto
9.
J Wound Care ; 26(Sup12): S1-S27, 2017 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29244959

RESUMO

The European Wound Management Association (EWMA) has just finalised the first curriculum in a series of several curricula intended for use in levels 5-7 of the European Qualifications Framework (EQF)1. The aim of these is to support a common approach to post-registration qualification in wound management for nurses across Europe. EWMA hopes and will work towards a close collaboration with European nurse organisations as well as educational institutions to implement these common curricula.


Assuntos
Currículo/normas , Educação Continuada em Enfermagem/normas , Sociedades de Enfermagem , Ferimentos e Lesões/enfermagem , Europa (Continente) , Humanos
10.
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
11.
Stud Health Technol Inform ; 235: 231-235, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28423788

RESUMO

In the recent years, medical and healthcare higher education institutions compile their curricula in different ways in order to cover all necessary topics and sections that the students will need to go through to success in their future clinical practice. A medical and healthcare curriculum consists of many descriptive parameters, which define statements of what, when, and how students will learn in the course of their studies. For the purpose of understanding a complicated medical and healthcare curriculum structure, we have developed a web-oriented platform for curriculum management covering in detail formal metadata specifications in accordance with the approved pedagogical background, namely outcome-based approach. Our platform provides a rich database that can be used for innovative detailed educational data analysis. In this contribution we would like to present how we used a proven process model as a way of increasing accuracy in solving individual analytical tasks with the available data. Moreover, we introduce an innovative approach on how to explore a dataset in accordance with the selected methodology. The achieved results from the selected analytical issues are presented here in clear visual interpretations in an attempt to visually describe the entire medical and healthcare curriculum.


Assuntos
Currículo , Bases de Dados Factuais , Educação Médica/organização & administração , Mineração de Dados , Humanos , Internet
12.
Neuro Endocrinol Lett ; 37(1): 12-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26994380

RESUMO

The etiology of skin integrity disorders of the lower extremities can be very diverse. In addition to common diagnoses such as venous ulcers with ischemic etiology, decubitus ulcers and diabetic foot syndrome, ulceration of a malignant etiology must also be considered. Malignant melanoma is one of the most dangerous forms of skin cancer and, although rare, may cause foot lesions. The most frequently encountered type of melanoma on acral parts of the limbs is the rare acral lentiginous variant, which only occurs in 2-10% of all melanoma types. Clinical manifestation ranges from cutaneous surface erosion to ulceration with surrounding hyperkeratosis, which can cause considerable differential diagnostic difficulties in the management of patients with non-healing foot wounds. This paper aims to present a clear case study of a Caucasian female with chronic leg ulceration that resulted in a final diagnosis of malignant acral lentiginous melanoma. Supplemental theoretical information regarding the diagnosis and treatment of malignant melanoma has also been included in the report. Malignant acral lentiginous melanoma is a rare cause of non-healing wounds, but it must be considered in cases with long-term healing complications. Precise diagnostic deliberation is crucial in the management and treatment of all chronic and long-term non-healing lesions, and appropriately performed biopsies are essential to determine whether malignancy is the primary cause.


Assuntos
Traumatismos do Pé/patologia , Úlcera da Perna/patologia , Lentigo/patologia , Melanoma/patologia , Idoso , Feminino , Humanos , Neoplasias Cutâneas , Cicatrização
13.
Nurse Educ Today ; 38: 74-81, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26763210

RESUMO

BACKGROUND: In the European context regulated by the Bologna Process principles, there is little evidence to date on the different profiles, if any, of nursing students enrolled in the 1st academic year and their academic outcomes. AIMS: To describe and compare the nursing student profiles and their academic outcomes at the end of the 1st year across European Bachelor of Nursing Science (BNS) courses. DESIGN: An exploratory multicentre cohort study involving five countries: Nursing students who were enrolled in nursing programmes for the academic year 2011/2012 in the participating BNS courses, willing to participate and regularly admitted to the 2nd academic year, were included in this study undertaken in 2013. Individual and faculty level variables were collected after having ensured the validity of the tools developed in English and then appropriately translated into the language of each participating country. FINDINGS: A total of 378/710 (53.2%) students participated in the study. They attended from 390 to 810h of lessons, while clinical experience ranged from 162 to 536h. The students reported a mean average age of 21.4 (Confidence of Interval [CI] 95%, 21.0-22.3) and foreign students were limited in number (on average 3.7%). The students reported adopting mainly individual learning strategies (92.9%), duplicating notes or lecture notes prepared by professors (74.4%), and concentrating their study before exams (74.6%). The majority reported experiencing learning difficulties (49.7%) and a lack of academic support (84.9%). Around 33.2% reported economic difficulties and the need to work while studying nursing on average for 24h/week. Personal expectations regarding the nursing role were different (45.6%) than the role encountered during the 1st year, as learning workloads were higher (57.2%) with regard to expectations. Around one-third of students reported the intention to leave nursing education while the proportion of those reporting early academic failure was on average 5.6%. CONCLUSIONS: More strategies aimed at harmonising nursing education across Europe, at supporting nursing students' learning processes during 1st year, and identifying factors influencing their intention to leave and their academic failure, are recommended.


Assuntos
Avaliação Educacional , Evasão Escolar/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Adolescente , Adulto , Atitude do Pessoal de Saúde , Estudos de Coortes , Bacharelado em Enfermagem , Europa (Continente) , Feminino , Humanos , Masculino , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Adulto Jovem
14.
PLoS One ; 10(12): e0143748, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26624281

RESUMO

BACKGROUND: No universal solution, based on an approved pedagogical approach, exists to parametrically describe, effectively manage, and clearly visualize a higher education institution's curriculum, including tools for unveiling relationships inside curricular datasets. OBJECTIVE: We aim to solve the issue of medical curriculum mapping to improve understanding of the complex structure and content of medical education programs. Our effort is based on the long-term development and implementation of an original web-based platform, which supports an outcomes-based approach to medical and healthcare education and is suitable for repeated updates and adoption to curriculum innovations. METHODS: We adopted data exploration and visualization approaches in the context of medical curriculum innovations in higher education institutions domain. We have developed a robust platform, covering detailed formal metadata specifications down to the level of learning units, interconnections, and learning outcomes, in accordance with Bloom's taxonomy and direct links to a particular biomedical nomenclature. Furthermore, we used selected modeling techniques and data mining methods to generate academic analytics reports from medical curriculum mapping datasets. RESULTS: We present a solution that allows users to effectively optimize a curriculum structure that is described with appropriate metadata, such as course attributes, learning units and outcomes, a standardized vocabulary nomenclature, and a tree structure of essential terms. We present a case study implementation that includes effective support for curriculum reengineering efforts of academics through a comprehensive overview of the General Medicine study program. Moreover, we introduce deep content analysis of a dataset that was captured with the use of the curriculum mapping platform; this may assist in detecting any potentially problematic areas, and hence it may help to construct a comprehensive overview for the subsequent global in-depth medical curriculum inspection. CONCLUSIONS: We have proposed, developed, and implemented an original framework for medical and healthcare curriculum innovations and harmonization, including: planning model, mapping model, and selected academic analytics extracted with the use of data mining.


Assuntos
Currículo , Educação Médica , Modelos Estatísticos , Humanos
15.
Int Wound J ; 12(2): 224-31, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25224308

RESUMO

The foundation of health care management of patients with non-healing, chronic wounds needs accurate evaluation followed by the selection of an appropriate therapeutic strategy. Assessment of non-healing, chronic wounds in clinical practice in the Czech Republic is not standardised. The aim of this study was to analyse the methods being used to assess non-healing, chronic wounds in inpatient facilities in the Czech Republic. The research was carried out at 77 inpatient medical facilities (8 university/faculty hospitals, 63 hospitals and 6 long- term hospitals) 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 results of this research have corroborated the suspicion of 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 evaluation of basic/fundamental parameters of a wound (e.g. size, depth and location of a 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 significantly improved when a consultant for wound healing was present (P = 0·047). The same applied to facilities possessing a certificate of quality issued by the Czech Wound Management Association (P = 0·010). In 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 a 'non-healing, chronic wound assessment' algorithm.


Assuntos
Hospitais , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/terapia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Doença Crônica , Protocolos Clínicos , República Tcheca , Controle de Formulários e Registros , Humanos , Registros Médicos , Papel do Profissional de Enfermagem , Úlcera Cutânea/etiologia , Cicatrização , Ferimentos e Lesões/etiologia
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