Casopis lekaru ceskych最新文献

Vocational rehabilitation plays a key role in the overall improvement of the quality of life for patients with chronic illness or after injury. Physicians have an important role in identifying suitable patients and recommending vocational rehabilitation as part of a comprehensive rehabilitation treatment. This article provides an overview of the use of vocational rehabilitation in the treatment of various patients with different types of illnesses and suggests criteria for selecting appropriate patients for involvement in vocational rehabilitation. The review presents the current state of vocational rehabilitation, its possibilities, limitations, and challenges for further development. One of the main challenges is the potential use of vocational rehabilitation for patients on temporary disability leave. Although employment law has allowed this possibility for 20 years, in practice, the tool of vocational rehabilitation has not yet been used for this group of individuals. The article also brings new findings revealed by research conducted within an experimental project that pilot tested the concept of so-called "vocational rehabilitation centers." The research showed, among other things, that the early involvement of individuals with disabilities in vocational rehabilitation, combined with a multidisciplinary approach, more than triples their chances of obtaining or retaining employment.

Glycation plays a crucial role in the development of chronic vascular complications in diabetes. The total individual glycation is a result of interaction between proglycation and deglycation mechanisms and can be expressed by hemoglobin glycation index (HGI). There is increasing evidence that patients with higher glycation (and higher HGI) suffer from more frequent diabetic complications. In practice, it would therefore be advantageous to identify and treat such patients to stricter glycemic goals.

With the growing significance of artificial intelligence in healthcare, new perspectives are emerging in primary care. Diabetic retinopathy, a microvascular complication of diabetes mellitus, often remains unnoticed until patient is facing complications. Artificial intelligence presents a promising solution that can enhance the accessibility of diabetic retinopathy screening for a broader range of patients. The key challenge lies in successfully integrating the solution into clinical practice, a demanding process with multiple phases to ensure the resulting medical device is effective and safe for patient use. Aireen software uses artificial intelligence to perform diabetic retinopathy screening on retinal images captured by optical fundus cameras. The medical device complies with European Medical Device Regulation 2017/745 and was introduced to the market in 2023. Collaboration between physicians and the development team played a crucial role throughout the entire lifecycle of the medical device. Physicians were engaged in defining the intended use of the medical device, risk analysis, data annotation for training and software validation, as well as throughout a clinical trial. A clinical trial was conducted on 1,274 patients with type 1 and type 2 diabetes mellitus, where Aireen medical device achieved a sensitivity of 94.0% and a specificity of 90.7% compared to the reference evaluation. This clinical trial confirmed the potential of Aireen to enhance the availability of diabetic retinopathy screening and early disease detection.

Gene therapy is gradually becoming a mainstream treatment modality and is no longer the preserve of large university departments whose laboratories master nucleic acid analytical procedures and whose clinical teams manage its administration. It was originally designed for genetic diseases that, because of their prevalence, were a group known as rare diseases. Gene therapy has so far been applied in children to act before the disease development. These new treatments have also begun to be applied for common diseases such as metabolic disorders (e. g. diabetes) and even for those that are increasingly affecting us, such as various malignancies and diseases of the central nervous system (e. g. Alzheimer's disease). The targets targeted by GT are genes, where pathogenic alterations in the form of pathogenic variants (formerly mutations) induce phenotypic disorders, and our aim is either to knock them out of function (e. g. haemoglobinopathies) or to replace them with genes with normal function, which we introduce into the genome using one of the appropriate vectors, such as viruses or liposomes. The process of GT can take place directly inside the patient's body (in vivo) or outside the body on isolated cells (ex vivo), which are usually stem cells (iPSCs, induced pluripotent stem cell). After treatment, these cells are returned to the patient's body to fulfil their "destiny". In a broader sense, GT can target the product of gene transcription, which is the messenger RNA, or the end product of gene function, such as functional proteins (eg. cystic fibrosis). Any of these approaches have been used successfully in various diseases, depending on their availability, which is determined, among other things, by the costs associated with GT or the accessibility of the target tissue. Ultimately, it is not only the validation of the efficacy and safety of GT, but also economic reasons that determine why GT has been slow to develop and is mostly undertaken only by large and wealthy institutions. Another decisive factor is that from initial experimental work through clinical trials, the whole process of its development normally takes up to a decade.

According to surveys conducted over the last 10 years, more than 80 % of our population want to live with their loved ones at the end of life. With the ageing of the population and the success of medicine in the early stages of terminal illness, the trajectory and needs at the end of life are gradually changing. The need for health care support is increasing, and for most patients this means the need for 24/7 availability of health care, in this context in the home environment of the terminally ill patient. The question of how palliative care should be organised in an appropriate, meaningful and effective way, the role of specialised health care teams (mobile specialised palliative care), the role of general practitioners, and if, when and how the medical rescue service should/could/should effectively intervene in care, is becoming increasingly urgent. The article combines the experiences and views of an emergency physician and a doctor specialising in geriatrics and palliative medicine.

Telemedicine, defined as the practice of delivering healthcare services remotely using information and communications technologies, raises a plethora of ethical considerations. As telemedicine evolves, its ethical dimensions play an increasingly pivotal role in balancing the benefits of advanced technologies, ensuring responsible healthcare practices within telemedicine environments, and safeguarding patient rights. Healthcare providers, patients, policymakers, and technology developers involved in telemedicine encounter numerous ethical challenges that need to be addressed. Key ethical topics include prioritizing the protection of patient rights and privacy, which entails ensuring equitable access to remote healthcare services and maintaining the doctor-patient relationship in virtual settings. Additional areas of focus encompass data security concerns and the quality of healthcare delivery, underscoring the importance of upholding ethical standards in the digital realm. A critical examination of these ethical dimensions highlights the necessity of establishing binding ethical guidelines and legal regulations. These measures could assist stakeholders in formulating effective strategies and methodologies to navigate the complex telemedicine landscape, ensuring adherence to the highest ethical standards and promoting patient welfare. A balanced approach to telemedicine ethics should integrate the benefits of telemedicine with proactive measures to address emerging ethical challenges and should be grounded in a well-prepared and respected ethical framework.

The increasing prevalence of diabetes mellitus (DM) leads to the differentiation of the registration of diabetics in individual specialties. Objective of this paper was the evaluation of changes in the representation of expertise providing care for patients with DM (pDM) in the Czech Republic, based on data analysis from the National Register of Paid Health Services (NRHZS) 2010-2021. In the entire pDM group, the number of patients treated by a diabetologist (DIA) increased from 491,490 (57.0 %) to 537,430 (50.4 %), with a general practitioner (GP) from 27,719 (3.2 %) to 181,330 (17.0 %) and by internist (INT) from 172,918 (20.0 %) to 161,291 (15.1 %). In 2021, 57.9 % DIA, 17 % GP, 12.2 % INT were treated from the group treated with antidiabetics (813,873). In 2021, 84,345 were treated with insulin alone (87.2 % DIA), 129,127 were treated with a combination of insulin and non-insulin antidiabetics; 115,604 (91.6 %) in DIA, 322 (0.3 %) in GP and 7,983 (6.3 %) in INT. 603,331 treated only with non-insulin antidiabetic drugs, of which 281,929 (46.7 %) DIA, 137,744 (22.8 %) GP and 85,273 (14.1 %) INT. For other specialties, 98,385 (16.3 %) persons. 185,838 patients without reported DIA/GP/INT control, of which 80,144 without therapy. The increasing prevalence of DM and changes in reimbursement conditions are reflected in the dynamic development of the distribution of diabetes care by individual specialties.

In the age of advanced modern medicine, prolonging the lives of patients is becoming easier and easier. Science is even going so far that some authors are beginning to see the need to advocate for the patient's right to die. The authors of the recommended resuscitation procedures themselves state that prolonging the inevitable dying process should be considered a harm (dysthanasia). The issue of not initiating urgent resuscitation is part of not only clinical practice, but also the study of physicians and other health professionals. The various criteria, indications, and contraindications for this action are repeatedly discussed in the course of study and practice, but rarely does this discussion go into significant detail. The teaching is limited to their enumeration or description of some of the more clearly understood ones, which are, for example, certain signs of death and their presence. The terminal stage of an incurable chronic disease is only marginally mentioned as a contraindication to urgent resuscitation, perhaps due to its ethical and legal overlap. The article includes an analysis of the sources of regulation of this issue, focusing mainly on legal and professional sources and their relationship. It also describes the actual process of decision making about the initiation of palliative care, decision making about end-of-life care, including the issue of not initiating urgent resuscitation.

Globally increasing ethnic diversity of patients brings new challenges for physicians regarding the provision of medical care to patients with different ethnic backgrounds. The starting point is the postulate that it is above all a certain culture that shapes the environment in which the patient meets and communicates with medical professionals, and this is reflected in the relationship between doctors and patients and their mutual communication. The article describes the cultural specifics of Roma patients and defines the most important principles of providing culturally sensitive health care to this unique group, which differs from the major population in many respects. The described principles and recommendations can also be used within the framework of health care for migrants and refugees, whose representation among our patients is increasing.