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Independent predictors of prognosis in patients after out-of-hospital cardiac arrest
Kroupa, Josef ; Moťovská, Zuzana (advisor) ; Ošťádal, Petr (referee) ; Duška, František (referee)
The dissertation refers to the up to date topic of Out-of-Hospital Cardiac Arrest (OHCA). The clinical research is divided into two parts. 1. Characteristics and Survival Determinants in Patients After Out-of-Hospital Cardiac Arrest in The Era of 24/7 Coronary Intervention Facilities Background. Survival rates and outcomes after out-of-hospital cardiac arrest (OHCA) remain low despite investments of time and money. The goal of this analysis was to identify variables related to survival of patients transferred to our coronary care unit (CCU) after an OHCA. Methods. 102 consecutive OHCA patients, mean age 64.6 (SD 13.3), 70.6 % men, between January, 2011 and December, 2013, who were transferred to our tertiary care CCU, were studied. Results. Cardiac-cause OHCA was present in 84 patients (82.4 %). Of these 60.7 % had an acute coronary syndrome (ACS) - STEMI 35.7 %; NSTEMI 23.8 %. Coronary angiography was performed in 73 (71.6 %) patients - 81.0 % with cardiac- and 31.3 % (5/16) with a non-cardiac cause. Percutaneous coronary intervention (PCI) was performed in 50 patients (68.5 %), 49 with cardiac-cause, and succeeded in 92.0 %. In-hospital mortality was 38.2 %, one-year mortality was 51.5 %. In-hospital and one-year mortality were related to age (p = 0.002 resp. p = 0.001), first ECG rhythm (p =...
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Czech Republic Police Activities in the Event of Reoccurring Floods in the Třeboň Region.
KROUPA, Josef
While writing this diploma thesis, I realized that the issue of the Czech Police{\crq}s activities in the context of potentially reoccurring floods is a considerably complex matter. Moreover, it is subject to a multitude of mutually intertwined and interlinked laws and regulations. In the theoretical part, I studied the relevant laws concerning high-water crises, e.g., floods, and the work of the police in such emergency situations. Also, I focused on floods as such, their types, the factors leading to high-water scenarios, and the different levels of activities during floods. Thereupon I compiled an overview of the authorities of competence during floods, and examined the laws dealing with high-water crises. The second part of my thesis details the events that occurred during the flood in the Třeboň region in 2002. Finally, my thesis presents a detailed description of the current organizational structure of the PCR, as one of the fundamental elements of the country{\crq}s Integrated Rescue System (IZS). In the practical part of my thesis, I present an evaluation of a questionnaire that was taken with the aim of analyzing the level of preparedness of the PCR for maintaining public order in the event of a flood. My research indicates that the level of the PCR{\crq}s preparedness is not adequate enough, primarily in terms of existing material provisions and communication amongst the individual units of the IZS. This problem cannot be solved on the level of the Třeboň District Police (OOP) alone, for it has to be approached centrally in the context of potential flooding in the given locality. Another drawback appears to be, apart from shortage of PCR{\crq}s material provisions, also communication amongst the IZS units, particularly on the level of field watches (ground surveillance). A survey focused on to-date experience of the PCR{\crq}s members in the area of assuring public order in flooded territories revealed that the main problems the policemen had to deal with was disobedience and obstinacy on the part of the public when asked to evacuate a place, as well as inadequate provisions for effective communication. Moreover, the survey revealed inadequate knowledge of the scope of competence on the part of the PCR when ordered to evacuate a flooded area. Clearly, the Police Code should be applied consistently and better knowledge thereof pursued through periodical training, upgrading, and independent study. Despite the above shortcomings and the many problems arising therefrom, it should be noted that the organization of rescue activities was handled well, thanks to maximum effort of all the participating persons, so that the population suffered no major casualties or significant material losses.
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