Bohumil Seifert - Academia.edu (original) (raw)
Papers by Bohumil Seifert
The Lancet, 2019
Background Antivirals are infrequently prescribed in European primary care for influenza-like ill... more Background Antivirals are infrequently prescribed in European primary care for influenza-like illness, mostly because of perceived ineffectiveness in real world primary care and because individuals who will especially benefit have not been identified in independent trials. We aimed to determine whether adding antiviral treatment to usual primary care for patients with influenza-like illness reduces time to recovery overall and in key subgroups. Methods We did an open-label, pragmatic, adaptive, randomised controlled trial of adding oseltamivir to usual care in patients aged 1 year and older presenting with influenza-like illness in primary care. The primary endpoint was time to recovery, defined as return to usual activities, with fever, headache, and muscle ache minor or absent. The trial was designed and powered to assess oseltamivir benefit overall and in 36 prespecified subgroups defined by age, comorbidity, previous symptom duration, and symptom severity, using a Bayesian piece-wise exponential primary analysis model. The trial is registered with the ISRCTN Registry, number ISRCTN 27908921.
Clinical Drug Investigation
Background and Objective Influenza-like illness (ILI) leads to a substantial disease burden every... more Background and Objective Influenza-like illness (ILI) leads to a substantial disease burden every winter in Europe; however, oseltamivir is not frequently prescribed to ILI patients in the primary-care setting. An open-label, multi-country, multi-season, randomised controlled trial investigated the effectiveness of oseltamivir for treating ILI in 15 European countries. We aimed to evaluate whether patients presenting with ILI in primary care and being managed with the addition of oseltamivir to usual care had lower average direct and indirect costs compared to patients with usual care alone. Methods Resource use data were extracted from participants' daily diaries. Itemised country-specific unit costs were collected through official tariffs, pharmacies or literature. Costs were converted to 2018 values. The null hypothesis was tested based on one-sided credible intervals (CrIs) obtained by bootstrapping. Base-case analysis estimated direct cost and productivity losses using itemised costed resource use and the human capital approach. Scenario analyses with self-reported spending rather than itemised costing were also performed. Results Patients receiving oseltamivir (N = 1306) reported fewer healthcare visits, medication uses, hospital attendances and paid-work hours lost than the other patients (N = 1298). Excluding the oseltamivir cost, the average direct costs were lower in patients treated with oseltamivir from all perspectives, but these differences were not statistically significant (perspective of patient: €17 [0-95% Crl: 16-19] vs. €24 [5-100% Crl: 18-29]; healthcare provider: €37 [28-67] vs. €44 [25-55]; healthcare payers: €54 [45-85] vs. €68 [45-81]; and society: €423 [399-478] vs. €451 [390-478]). Scenario and age-group analyses confirmed these findings, but with some between-country differences. Conclusion The average direct and indirect costs were consistently lower in patients treated with oseltamivir than in patients without from four perspectives (excluding the oseltamivir cost). However, these differences were not statistically significant.
Kolorektalni karcinom (KRK) je druhou nejcastějsi přicinou umrti na maligni onemocněni ve světě. ... more Kolorektalni karcinom (KRK) je druhou nejcastějsi přicinou umrti na maligni onemocněni ve světě. Rocně je v Ceske republice (CR) nově diagnostikovano přibližně 8000 pacientů s timto karcinomem a kolem 4000 nemocných na něj zemře. Vzhledem k povaze onemocněni lze jeho vzniku ucinně předchazet pomoci screeningových vysetřeni. Narodni screeningový program KRK v CR probiha již od roku 2000 a je zaměřen na asymptomaticke jedince ve věku nad 50 let. V roce 2014 bylo zavedeno adresne zvani cilove populace na screeningu KRK. Mezi zakladni screeningove metody patři testy na okultni krvaceni a kolonoskopie. I když je kolonoskopie považovana za zlatý standard vysetřeni tlusteho střeva, compliance asymptomatických jedinců k tomuto vysetřeni je nižsi než doporucovaných 50 %. Jednou z přicin může být invazivita tohoto vysetřeni. Z toho důvodu jsou s výhodou využivany neinvazivni testy na okultni krvaceni (TOKS). V soucasnosti jsou dale hledany dalsi alternativni screeningove metody - meně invaz...
Screening sporadickeho kolorektalniho karcinomu byl zahajen v Cesku již v 80. letech 20. stoleti.... more Screening sporadickeho kolorektalniho karcinomu byl zahajen v Cesku již v 80. letech 20. stoleti. Narodni program jako soucast preventivni prohlidky zacal v roce 2000. Program zahrnuje bezpřiznakove jedince od 50. let věku bez rodinne a osobni anamnezy kolorektalniho karcinomu a prekancerozy (adenom, idiopatický střevni zanět). V soucasnosti je naplni programu u jedinců ve věku 50–54 let vysetřeni stolice na okultni krvaceni do stolice v jednoletem intervalu. Od 55 let věku může proband volit mezi timto testem v intervalu 2 roků s naslednou kolonoskopii při jeho pozitivitě a primarni screeningovou kolonoskopii v intervalu 10 let. Pokryti cilove populace dosahlo 25 % v roce 2011. Od roku 2009 se do programu zapojili take ambulantni gynekologove. Screening umožňuje diagnozu v casnějsim stadiu, lepsi prognozu a přinasi usporu nakladů na zdravotni a socialni peci.
Východiska: Ceska populace je výrazně zatižena zhoubnými nadory, důležitou roli proto maji dlouho... more Východiska: Ceska populace je výrazně zatižena zhoubnými nadory, důležitou roli proto maji dlouhodobě zavedene screeningove programy. V lednu 2014 bylo zahajeno adresne zvani ceských obcanů do těchto programů ke zvýseni jejich pokryti. Cilem sděleni je prezentovat aktualni výsledky adresneho zvani. Material a metody: K hodnoceni byla využita data zdravotnich pojisťoven, na zakladě kterých byl vyhodnocen v obdobi 2014–2017 objem zaslaných pozvanek k jednotlivým screeningovým programům a zejmena mira ucasti po pozvani. Výsledky: Od ledna 2014 do prosince 2017 bylo rozeslano vice než 6 milionů pozvanek na screeningova vysetřeni a tak byly osloveny přibližně 3 miliony osob. Mira ucasti po prvnim pozvani dosahovala u screeningu karcinomu prsu, kolorekta a děložniho hrdla 22,3 %, 21,7 %, respektive 15,5 %. Efekt adresných výzev vsak výrazně klesa s opakujici se pozvankou ke screeningu u osob, ktere nereagovaly na předchozi výzvy. Zavěr: Projekt adresneho zvani přispěl k vysetřeni statisic...
Hepatoprotektiva jsou ĹĄirokou skupinou pĹĂrodnĂch lĂĄtek s pĹedpoklĂĄdanĂ˝m pozitivnĂm, och... more Hepatoprotektiva jsou ĹĄirokou skupinou pĹĂrodnĂch lĂĄtek s pĹedpoklĂĄdanĂ˝m pozitivnĂm, ochrannĂ˝m a regeneraAnĂm ĂsAinkemna jaternĂ buĹku. VyznaAujĂ se s velmi dobrou tolerancĂ a bezpeAnostnĂm profilem, osvAdAenĂ˝m tisĂciletĂ˝m uĹžĂvĂĄnĂm. ĂAinnostnAkterĂ˝ch hepatoprotektiv, napĹ. silymarinu nebo vitaminu E, je dobĹe literĂĄrnA podloĹžena. ĂAinnost a role dalĹĄĂch potenciĂĄlnAhepatoprotektivnĂch lĂĄtek je pĹedmAtem lĂSkaĹskĂ˝ch vĂ˝zkumĹŻ na celĂSm svAtA. V modernĂ hepatologii, kterĂĄ je zamAĹena pĹedevĹĄĂmna ĂsAinnou kauzĂĄlnĂ lĂSAbu chronickĂ˝ch hepatitid a dalĹĄĂch klinickĂ˝ch jednotek, je postavenĂ hepatoprotektiv oslabenĂS. JinĂĄje situace ve vĹĄeobecnĂS praxi, kde se praktickĂ˝ lĂSkaĹ setkĂĄvĂĄ s pacienty v rĹŻznĂ˝ch fĂĄzĂch jaternĂch onemocnAnĂ. PeAuje o osobys rĹŻznou ĹživotosprĂĄvou, chronickou medikacĂ, metabolickĂ˝m syndromem, nadvĂĄhou nebo diabetem 2. typu. Mezi tAmito pacientyje vysokĂĄ prevalence jaternĂch poruch...
Casopis lekaru ceskych, 2021
There is insufficient evidence from medical studies for clinical approaches to patients with COVI... more There is insufficient evidence from medical studies for clinical approaches to patients with COVID-19 in primary care. Patients often urge the therapeutic use and preventive administration of various medicines, often controlled by studies insufficiently or completely unverified. The aim of the project, commissioned by the Committee of the Society of General Practice of the Czech Medical Association JEP, was to compensate for this deficiency by interdisciplinary consensus and thus provide general practitioners (GPs) with a basic support in accessing patients with COVID-19. Representatives of GPs identified the most common questionable diagnostic or therapeutic approaches and formulated 17 theses, taking into account their own experience, existing Czech and foreign professional recommendations. The RAND/UCLA Appropriateness Method, modified for the needs of pandemic situation, was chosen to seek consensus. Representatives of 7 medical specialties accepted the participation in the 20-m...
Introduction. In the last decade of the 20th century, the countries of Central and Eastern Europe... more Introduction. In the last decade of the 20th century, the countries of Central and Eastern Europe (CEE) have experienced rapid changes in health policies. This process was largely supported by international grants. After this support has ended, it is important to keep up with the development, developing its own strategies and priorities. Aims and methods. The aim of the paper is to make a proposal for the future development of the discipline in CEE countries. The proposal is based on reports on an invitational conference that was organized for the key representatives of family medicine from CEE countries. For the purpose of this paper, additional information about the situation was gathered from literature reviews, country visits and personal interviews. Results. Information shows that although family medicine has been formally recognized and introduced in university curricula, there is a very big difference in its academic position. Postgraduate training has been established in all CEE countries, according to the European Directive. Quality measures such as the development and implementation of guidelines and the recertification procedure have also been formally introduced, but its quality varies. The key areas of concern are atomization of practices, unsatisfactory payment systems, lack of academic infrastructure and unsatisfactory continuous professional development. On the other hand, examples of good practice exist and need to be promoted. Conclusion. There is a need for continuous exchange of expertise within the countries. The paper will serve as a discussion paper for the next meeting of experts from CEE countries.
Prague medical report, 2008
BACKGROUND An informed patient is a better partner for the physician than an uninformed one. Such... more BACKGROUND An informed patient is a better partner for the physician than an uninformed one. Such a patient will be more likely to practice effective selfcare, appropriately utilize the health care system, and be prepared to seek and obtain health care services that meet his needs. Objectives. To develop a system of presenting standardized medical information for the general population based on guidelines developed for general practitioners (GPs). METHODS Guidelines are instruments to be used by GPs to assure comprehensive and consistent enhancement of the quality of care. At the same time, guidelines describe the actions which could be expected by patients in various clinical situations. These materials establish a good basis for the patient's understanding of health care procedures and when and how to utilize health services. These materials will have to be adapted in form, content, and nomenclature in order to be understandable with the background knowledge of the average &qu...
Clinical Drug Investigation, 2021
Influenza-like illness (ILI) leads to a substantial disease burden every winter in Europe; howeve... more Influenza-like illness (ILI) leads to a substantial disease burden every winter in Europe; however, oseltamivir is not frequently prescribed to ILI patients in the primary-care setting. An open-label, multi-country, multi-season, randomised controlled trial investigated the effectiveness of oseltamivir for treating ILI in 15 European countries. We aimed to evaluate whether patients presenting with ILI in primary care and being managed with the addition of oseltamivir to usual care had lower average direct and indirect costs compared to patients with usual care alone. Resource use data were extracted from participants’ daily diaries. Itemised country-specific unit costs were collected through official tariffs, pharmacies or literature. Costs were converted to 2018 values. The null hypothesis was tested based on one-sided credible intervals (CrIs) obtained by bootstrapping. Base-case analysis estimated direct cost and productivity losses using itemised costed resource use and the huma...
INTRODUCTION/OBJECTIVES: Although a substantial proportion of the population experiences dyspepsi... more INTRODUCTION/OBJECTIVES: Although a substantial proportion of the population experiences dyspepsia, only a minority of them seek medical care.AIMS & METHODS: The aim of this prospective multi-centre study was to determine the prevalence of investigated and uninvestigated dyspepsia in a representative sample of general non-selected population of the Czech Republic. A total of 1,837 subjects (aged 5-98 years) from 22 centres corresponding well to the geographical distribution entered the study. Two-step random selection was performed centrally out of 38,147 people from the registered general population. Helicobacter pylori (Hp) infection was investigated by means of 13C-UBT (INFAI, Koln, Germany). There were no preliminary exclusion criteria. Symptoms of dyspepsia, with severity measured on a scale from zero (no problems) to 10 (the worst problems), social and demographic characteristics were obtained from self-completed questionnaires from particular subjects and other health-related...
Obcanům CR jsou dostupne vsechny mezinarodně doporucene programy screeningu zhoubných nadorů. Vsi... more Obcanům CR jsou dostupne vsechny mezinarodně doporucene programy screeningu zhoubných nadorů. Vsichni obcane od 50 let mohou využit screeningu nadorů tlusteho střeva a konecniku, ženy od 45 let mohou podstoupit mamograficke vysetřeni pro screening nadorů prsu a vsechny dospěle ženy se mohou zucastnit screeningu nadorů děložniho hrdla. Dle doporuceni Rady Evropske unie by měla být screeningova vysetřeni nabizena prostřednictvim organizovaných programů, s jasně definovanými postupy a zajistěnou kontrolou kvality. Proto jsou vybrana zdravotnicka zařizeni provadějici screening (mamograficka centra, centra pro screeningovou kolonoskopii a cytologicke laboratoře) průběžně kontrolovana tak, aby poskytovala vysetřeni ve vysoke kvalitě. Předkladana publikace shrnuje důkazy o ucinnosti organizovaneho screeningu zhoubných nadorů, epidemiologii uvedených nadorových onemocněni a principy monitoringu a hodnoceni organizovaneho screeningu v CR. Publikace taktež přinasi aktualni výsledky jednotlivý...
Travici obtiže patři mezi nejcastějsi důvody navstěvy lekaře a na jejich diagnostiku a lecbu jsou... more Travici obtiže patři mezi nejcastějsi důvody navstěvy lekaře a na jejich diagnostiku a lecbu jsou vynakladany nemale prostředky. Odbornou peci o nemocne s gastrointestinalnimi obtižemi nelze zjednodusit v tom smyslu, že na travici obtiže mame specialisty gastroenterology. Vzhledem k prevalenci obtiži, a zejmena dominanci funkcnich poruch je role praktických lekařů a jejich kompetence v teto oblasti významna a nalehava, stejně jako potřeba optimalizace mezioborove spoluprace. Během minulých let bylo věnovano hodně usili tvorbě doporuceni a algoritmů pro pacienty s těmito obtižemi ve snaze racionalizovat přistupy. Pro letosni rok zadala Spolecnost vseobecneho praktickeho lekařstvi CLS JEP již druhou aktualizaci doporucených postupů pro prakticke lekaře na tema horni a dolni dyspeptický syndrom a autorský tým zahajil praci. Předkladane sděleni poskytuje přehled namětů k aktualizaci ve ctyřech klicových oblastech: funkcni dyspepsie, peptický vřed, refluxni choroba jicnu a gastropatie z ...
UNLABELLED Colorectal cancer (CRC) is the third most common malignant disease in developed countr... more UNLABELLED Colorectal cancer (CRC) is the third most common malignant disease in developed countries and its incidence is steadily growing. This trend has a stable character despite the fact that CRC is among the best prevention influenced malignancies. National CRC screening program in the Czech Republic, which was established in year 2000, follows the world trends resulting from evidence based medicine. Currently, the basic tools of screening program are immunochemical fecal occult blood tests and colonoscopy in case of their positivity or screening colonoscopy. Stagnation of participating population resulted to initiation of address invitation of the target population in January 2014, in which citizens are regularly invited to attend the screening program and their response is subsequently evaluated. Screening that impacts whole target group is called population screening. KEY WORDS colorectal cancer, population screening program, colonoscopy, fecal occult blood tests, address in...
V Ceske republice byly zahajeny programy screeningu karcinomu prsu, kolorektalniho karcinomu a ka... more V Ceske republice byly zahajeny programy screeningu karcinomu prsu, kolorektalniho karcinomu a karcinomu děložniho hrdla. Tyto programy umožňuji na populacni urovni snižovat incidenci a mortalitu zhoubných nadorových onemocněni. Pilotni projekt informacni podpory těchto programů v CR umožnil monitoring nabizených vysetřeni a poskytl zakladni udaje o pokryti těmito programy a zachytu nadorových onemocněni a prekanceroz. V roce 2009 dosahl program screeningu karcinomu prsu pokryti 50 % populace žen ve věku 45–69 let. Stejne hodnoty pokryti populace žen ve věku 25–59 let dosahuje program screeningu karcinomu děložniho hrdla. Screening kolorektalniho karcinomu prostřednictvim testu na okultni krvaceni do stolice bohužel v soucasnosti dosahuje pokryti pouhých 20 % populace mužů a žen starsich 50 let. Bez snižovani rizika nadorových onemocněni lze v budoucnu v důsledku starnuti populace ocekavat významný narůst incidence, což bylo ukazano pravě na přikladu kolorektalniho karcinomu. Kvalit...
The Lancet, 2019
Background Antivirals are infrequently prescribed in European primary care for influenza-like ill... more Background Antivirals are infrequently prescribed in European primary care for influenza-like illness, mostly because of perceived ineffectiveness in real world primary care and because individuals who will especially benefit have not been identified in independent trials. We aimed to determine whether adding antiviral treatment to usual primary care for patients with influenza-like illness reduces time to recovery overall and in key subgroups. Methods We did an open-label, pragmatic, adaptive, randomised controlled trial of adding oseltamivir to usual care in patients aged 1 year and older presenting with influenza-like illness in primary care. The primary endpoint was time to recovery, defined as return to usual activities, with fever, headache, and muscle ache minor or absent. The trial was designed and powered to assess oseltamivir benefit overall and in 36 prespecified subgroups defined by age, comorbidity, previous symptom duration, and symptom severity, using a Bayesian piece-wise exponential primary analysis model. The trial is registered with the ISRCTN Registry, number ISRCTN 27908921.
Clinical Drug Investigation
Background and Objective Influenza-like illness (ILI) leads to a substantial disease burden every... more Background and Objective Influenza-like illness (ILI) leads to a substantial disease burden every winter in Europe; however, oseltamivir is not frequently prescribed to ILI patients in the primary-care setting. An open-label, multi-country, multi-season, randomised controlled trial investigated the effectiveness of oseltamivir for treating ILI in 15 European countries. We aimed to evaluate whether patients presenting with ILI in primary care and being managed with the addition of oseltamivir to usual care had lower average direct and indirect costs compared to patients with usual care alone. Methods Resource use data were extracted from participants' daily diaries. Itemised country-specific unit costs were collected through official tariffs, pharmacies or literature. Costs were converted to 2018 values. The null hypothesis was tested based on one-sided credible intervals (CrIs) obtained by bootstrapping. Base-case analysis estimated direct cost and productivity losses using itemised costed resource use and the human capital approach. Scenario analyses with self-reported spending rather than itemised costing were also performed. Results Patients receiving oseltamivir (N = 1306) reported fewer healthcare visits, medication uses, hospital attendances and paid-work hours lost than the other patients (N = 1298). Excluding the oseltamivir cost, the average direct costs were lower in patients treated with oseltamivir from all perspectives, but these differences were not statistically significant (perspective of patient: €17 [0-95% Crl: 16-19] vs. €24 [5-100% Crl: 18-29]; healthcare provider: €37 [28-67] vs. €44 [25-55]; healthcare payers: €54 [45-85] vs. €68 [45-81]; and society: €423 [399-478] vs. €451 [390-478]). Scenario and age-group analyses confirmed these findings, but with some between-country differences. Conclusion The average direct and indirect costs were consistently lower in patients treated with oseltamivir than in patients without from four perspectives (excluding the oseltamivir cost). However, these differences were not statistically significant.
Kolorektalni karcinom (KRK) je druhou nejcastějsi přicinou umrti na maligni onemocněni ve světě. ... more Kolorektalni karcinom (KRK) je druhou nejcastějsi přicinou umrti na maligni onemocněni ve světě. Rocně je v Ceske republice (CR) nově diagnostikovano přibližně 8000 pacientů s timto karcinomem a kolem 4000 nemocných na něj zemře. Vzhledem k povaze onemocněni lze jeho vzniku ucinně předchazet pomoci screeningových vysetřeni. Narodni screeningový program KRK v CR probiha již od roku 2000 a je zaměřen na asymptomaticke jedince ve věku nad 50 let. V roce 2014 bylo zavedeno adresne zvani cilove populace na screeningu KRK. Mezi zakladni screeningove metody patři testy na okultni krvaceni a kolonoskopie. I když je kolonoskopie považovana za zlatý standard vysetřeni tlusteho střeva, compliance asymptomatických jedinců k tomuto vysetřeni je nižsi než doporucovaných 50 %. Jednou z přicin může být invazivita tohoto vysetřeni. Z toho důvodu jsou s výhodou využivany neinvazivni testy na okultni krvaceni (TOKS). V soucasnosti jsou dale hledany dalsi alternativni screeningove metody - meně invaz...
Screening sporadickeho kolorektalniho karcinomu byl zahajen v Cesku již v 80. letech 20. stoleti.... more Screening sporadickeho kolorektalniho karcinomu byl zahajen v Cesku již v 80. letech 20. stoleti. Narodni program jako soucast preventivni prohlidky zacal v roce 2000. Program zahrnuje bezpřiznakove jedince od 50. let věku bez rodinne a osobni anamnezy kolorektalniho karcinomu a prekancerozy (adenom, idiopatický střevni zanět). V soucasnosti je naplni programu u jedinců ve věku 50–54 let vysetřeni stolice na okultni krvaceni do stolice v jednoletem intervalu. Od 55 let věku může proband volit mezi timto testem v intervalu 2 roků s naslednou kolonoskopii při jeho pozitivitě a primarni screeningovou kolonoskopii v intervalu 10 let. Pokryti cilove populace dosahlo 25 % v roce 2011. Od roku 2009 se do programu zapojili take ambulantni gynekologove. Screening umožňuje diagnozu v casnějsim stadiu, lepsi prognozu a přinasi usporu nakladů na zdravotni a socialni peci.
Východiska: Ceska populace je výrazně zatižena zhoubnými nadory, důležitou roli proto maji dlouho... more Východiska: Ceska populace je výrazně zatižena zhoubnými nadory, důležitou roli proto maji dlouhodobě zavedene screeningove programy. V lednu 2014 bylo zahajeno adresne zvani ceských obcanů do těchto programů ke zvýseni jejich pokryti. Cilem sděleni je prezentovat aktualni výsledky adresneho zvani. Material a metody: K hodnoceni byla využita data zdravotnich pojisťoven, na zakladě kterých byl vyhodnocen v obdobi 2014–2017 objem zaslaných pozvanek k jednotlivým screeningovým programům a zejmena mira ucasti po pozvani. Výsledky: Od ledna 2014 do prosince 2017 bylo rozeslano vice než 6 milionů pozvanek na screeningova vysetřeni a tak byly osloveny přibližně 3 miliony osob. Mira ucasti po prvnim pozvani dosahovala u screeningu karcinomu prsu, kolorekta a děložniho hrdla 22,3 %, 21,7 %, respektive 15,5 %. Efekt adresných výzev vsak výrazně klesa s opakujici se pozvankou ke screeningu u osob, ktere nereagovaly na předchozi výzvy. Zavěr: Projekt adresneho zvani přispěl k vysetřeni statisic...
Hepatoprotektiva jsou ĹĄirokou skupinou pĹĂrodnĂch lĂĄtek s pĹedpoklĂĄdanĂ˝m pozitivnĂm, och... more Hepatoprotektiva jsou ĹĄirokou skupinou pĹĂrodnĂch lĂĄtek s pĹedpoklĂĄdanĂ˝m pozitivnĂm, ochrannĂ˝m a regeneraAnĂm ĂsAinkemna jaternĂ buĹku. VyznaAujĂ se s velmi dobrou tolerancĂ a bezpeAnostnĂm profilem, osvAdAenĂ˝m tisĂciletĂ˝m uĹžĂvĂĄnĂm. ĂAinnostnAkterĂ˝ch hepatoprotektiv, napĹ. silymarinu nebo vitaminu E, je dobĹe literĂĄrnA podloĹžena. ĂAinnost a role dalĹĄĂch potenciĂĄlnAhepatoprotektivnĂch lĂĄtek je pĹedmAtem lĂSkaĹskĂ˝ch vĂ˝zkumĹŻ na celĂSm svAtA. V modernĂ hepatologii, kterĂĄ je zamAĹena pĹedevĹĄĂmna ĂsAinnou kauzĂĄlnĂ lĂSAbu chronickĂ˝ch hepatitid a dalĹĄĂch klinickĂ˝ch jednotek, je postavenĂ hepatoprotektiv oslabenĂS. JinĂĄje situace ve vĹĄeobecnĂS praxi, kde se praktickĂ˝ lĂSkaĹ setkĂĄvĂĄ s pacienty v rĹŻznĂ˝ch fĂĄzĂch jaternĂch onemocnAnĂ. PeAuje o osobys rĹŻznou ĹživotosprĂĄvou, chronickou medikacĂ, metabolickĂ˝m syndromem, nadvĂĄhou nebo diabetem 2. typu. Mezi tAmito pacientyje vysokĂĄ prevalence jaternĂch poruch...
Casopis lekaru ceskych, 2021
There is insufficient evidence from medical studies for clinical approaches to patients with COVI... more There is insufficient evidence from medical studies for clinical approaches to patients with COVID-19 in primary care. Patients often urge the therapeutic use and preventive administration of various medicines, often controlled by studies insufficiently or completely unverified. The aim of the project, commissioned by the Committee of the Society of General Practice of the Czech Medical Association JEP, was to compensate for this deficiency by interdisciplinary consensus and thus provide general practitioners (GPs) with a basic support in accessing patients with COVID-19. Representatives of GPs identified the most common questionable diagnostic or therapeutic approaches and formulated 17 theses, taking into account their own experience, existing Czech and foreign professional recommendations. The RAND/UCLA Appropriateness Method, modified for the needs of pandemic situation, was chosen to seek consensus. Representatives of 7 medical specialties accepted the participation in the 20-m...
Introduction. In the last decade of the 20th century, the countries of Central and Eastern Europe... more Introduction. In the last decade of the 20th century, the countries of Central and Eastern Europe (CEE) have experienced rapid changes in health policies. This process was largely supported by international grants. After this support has ended, it is important to keep up with the development, developing its own strategies and priorities. Aims and methods. The aim of the paper is to make a proposal for the future development of the discipline in CEE countries. The proposal is based on reports on an invitational conference that was organized for the key representatives of family medicine from CEE countries. For the purpose of this paper, additional information about the situation was gathered from literature reviews, country visits and personal interviews. Results. Information shows that although family medicine has been formally recognized and introduced in university curricula, there is a very big difference in its academic position. Postgraduate training has been established in all CEE countries, according to the European Directive. Quality measures such as the development and implementation of guidelines and the recertification procedure have also been formally introduced, but its quality varies. The key areas of concern are atomization of practices, unsatisfactory payment systems, lack of academic infrastructure and unsatisfactory continuous professional development. On the other hand, examples of good practice exist and need to be promoted. Conclusion. There is a need for continuous exchange of expertise within the countries. The paper will serve as a discussion paper for the next meeting of experts from CEE countries.
Prague medical report, 2008
BACKGROUND An informed patient is a better partner for the physician than an uninformed one. Such... more BACKGROUND An informed patient is a better partner for the physician than an uninformed one. Such a patient will be more likely to practice effective selfcare, appropriately utilize the health care system, and be prepared to seek and obtain health care services that meet his needs. Objectives. To develop a system of presenting standardized medical information for the general population based on guidelines developed for general practitioners (GPs). METHODS Guidelines are instruments to be used by GPs to assure comprehensive and consistent enhancement of the quality of care. At the same time, guidelines describe the actions which could be expected by patients in various clinical situations. These materials establish a good basis for the patient's understanding of health care procedures and when and how to utilize health services. These materials will have to be adapted in form, content, and nomenclature in order to be understandable with the background knowledge of the average &qu...
Clinical Drug Investigation, 2021
Influenza-like illness (ILI) leads to a substantial disease burden every winter in Europe; howeve... more Influenza-like illness (ILI) leads to a substantial disease burden every winter in Europe; however, oseltamivir is not frequently prescribed to ILI patients in the primary-care setting. An open-label, multi-country, multi-season, randomised controlled trial investigated the effectiveness of oseltamivir for treating ILI in 15 European countries. We aimed to evaluate whether patients presenting with ILI in primary care and being managed with the addition of oseltamivir to usual care had lower average direct and indirect costs compared to patients with usual care alone. Resource use data were extracted from participants’ daily diaries. Itemised country-specific unit costs were collected through official tariffs, pharmacies or literature. Costs were converted to 2018 values. The null hypothesis was tested based on one-sided credible intervals (CrIs) obtained by bootstrapping. Base-case analysis estimated direct cost and productivity losses using itemised costed resource use and the huma...
INTRODUCTION/OBJECTIVES: Although a substantial proportion of the population experiences dyspepsi... more INTRODUCTION/OBJECTIVES: Although a substantial proportion of the population experiences dyspepsia, only a minority of them seek medical care.AIMS & METHODS: The aim of this prospective multi-centre study was to determine the prevalence of investigated and uninvestigated dyspepsia in a representative sample of general non-selected population of the Czech Republic. A total of 1,837 subjects (aged 5-98 years) from 22 centres corresponding well to the geographical distribution entered the study. Two-step random selection was performed centrally out of 38,147 people from the registered general population. Helicobacter pylori (Hp) infection was investigated by means of 13C-UBT (INFAI, Koln, Germany). There were no preliminary exclusion criteria. Symptoms of dyspepsia, with severity measured on a scale from zero (no problems) to 10 (the worst problems), social and demographic characteristics were obtained from self-completed questionnaires from particular subjects and other health-related...
Obcanům CR jsou dostupne vsechny mezinarodně doporucene programy screeningu zhoubných nadorů. Vsi... more Obcanům CR jsou dostupne vsechny mezinarodně doporucene programy screeningu zhoubných nadorů. Vsichni obcane od 50 let mohou využit screeningu nadorů tlusteho střeva a konecniku, ženy od 45 let mohou podstoupit mamograficke vysetřeni pro screening nadorů prsu a vsechny dospěle ženy se mohou zucastnit screeningu nadorů děložniho hrdla. Dle doporuceni Rady Evropske unie by měla být screeningova vysetřeni nabizena prostřednictvim organizovaných programů, s jasně definovanými postupy a zajistěnou kontrolou kvality. Proto jsou vybrana zdravotnicka zařizeni provadějici screening (mamograficka centra, centra pro screeningovou kolonoskopii a cytologicke laboratoře) průběžně kontrolovana tak, aby poskytovala vysetřeni ve vysoke kvalitě. Předkladana publikace shrnuje důkazy o ucinnosti organizovaneho screeningu zhoubných nadorů, epidemiologii uvedených nadorových onemocněni a principy monitoringu a hodnoceni organizovaneho screeningu v CR. Publikace taktež přinasi aktualni výsledky jednotlivý...
Travici obtiže patři mezi nejcastějsi důvody navstěvy lekaře a na jejich diagnostiku a lecbu jsou... more Travici obtiže patři mezi nejcastějsi důvody navstěvy lekaře a na jejich diagnostiku a lecbu jsou vynakladany nemale prostředky. Odbornou peci o nemocne s gastrointestinalnimi obtižemi nelze zjednodusit v tom smyslu, že na travici obtiže mame specialisty gastroenterology. Vzhledem k prevalenci obtiži, a zejmena dominanci funkcnich poruch je role praktických lekařů a jejich kompetence v teto oblasti významna a nalehava, stejně jako potřeba optimalizace mezioborove spoluprace. Během minulých let bylo věnovano hodně usili tvorbě doporuceni a algoritmů pro pacienty s těmito obtižemi ve snaze racionalizovat přistupy. Pro letosni rok zadala Spolecnost vseobecneho praktickeho lekařstvi CLS JEP již druhou aktualizaci doporucených postupů pro prakticke lekaře na tema horni a dolni dyspeptický syndrom a autorský tým zahajil praci. Předkladane sděleni poskytuje přehled namětů k aktualizaci ve ctyřech klicových oblastech: funkcni dyspepsie, peptický vřed, refluxni choroba jicnu a gastropatie z ...
UNLABELLED Colorectal cancer (CRC) is the third most common malignant disease in developed countr... more UNLABELLED Colorectal cancer (CRC) is the third most common malignant disease in developed countries and its incidence is steadily growing. This trend has a stable character despite the fact that CRC is among the best prevention influenced malignancies. National CRC screening program in the Czech Republic, which was established in year 2000, follows the world trends resulting from evidence based medicine. Currently, the basic tools of screening program are immunochemical fecal occult blood tests and colonoscopy in case of their positivity or screening colonoscopy. Stagnation of participating population resulted to initiation of address invitation of the target population in January 2014, in which citizens are regularly invited to attend the screening program and their response is subsequently evaluated. Screening that impacts whole target group is called population screening. KEY WORDS colorectal cancer, population screening program, colonoscopy, fecal occult blood tests, address in...
V Ceske republice byly zahajeny programy screeningu karcinomu prsu, kolorektalniho karcinomu a ka... more V Ceske republice byly zahajeny programy screeningu karcinomu prsu, kolorektalniho karcinomu a karcinomu děložniho hrdla. Tyto programy umožňuji na populacni urovni snižovat incidenci a mortalitu zhoubných nadorových onemocněni. Pilotni projekt informacni podpory těchto programů v CR umožnil monitoring nabizených vysetřeni a poskytl zakladni udaje o pokryti těmito programy a zachytu nadorových onemocněni a prekanceroz. V roce 2009 dosahl program screeningu karcinomu prsu pokryti 50 % populace žen ve věku 45–69 let. Stejne hodnoty pokryti populace žen ve věku 25–59 let dosahuje program screeningu karcinomu děložniho hrdla. Screening kolorektalniho karcinomu prostřednictvim testu na okultni krvaceni do stolice bohužel v soucasnosti dosahuje pokryti pouhých 20 % populace mužů a žen starsich 50 let. Bez snižovani rizika nadorových onemocněni lze v budoucnu v důsledku starnuti populace ocekavat významný narůst incidence, což bylo ukazano pravě na přikladu kolorektalniho karcinomu. Kvalit...