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Prevention in Primary care with a focus on colorectal cancer screening
Král, Norbert ; Seifert, Bohumil (advisor) ; Lukáš, Milan (referee) ; Matějovská Kubešová, Hana (referee)
Prevention in Primary care with a focus on colorectal cancer screening Introduction: Preventive examinations and screening methods are an integral part of the work of a general practitioner. Primarily are focused on cardiometabolic and oncological diseases that share risk factors. The aim of this study was to evaluate the system of preventive examinations and screening programs for CRCa, and to propose modifications to preventive examinations-with regard to cardiometabolic diseases-that would be in line with current scientific knowledge. Furthermore, to determine the attitude of the Czech population towards preventive examinations and screenings for CRCa, and to analyse the current situation of CRCa screening and identify its major shortcomings. Materials and Methods: The thesis consists of a set of studies. The studies were aimed at the general population, general practitioners, and other primary care professionals. The research took the form of questionnaire surveys distributed among physicians and patients. The Rand/UCLA consensus method, which combines the best available scientific evidence with the collective judgement of a group of experts, was chosen in the search for an appropriate model of preventive examinations. Results: Selective prevention is an effective tool in the prevention of...
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The Importance of Self-Reported Medication Adherence in the Evaluation of the Effectiveness of Pharmacotherapy
Ládová, Kateřina ; Matoulková, Petra (advisor) ; Červený, Petr (referee) ; Lukáš, Milan (referee) ; Kolář, Jozef (referee)
Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Candidate: Mgr. Kateřina Ládová Supervisor: PharmDr. Petra Matoulková, Ph.D.; PharmDr. Magda Vytřísalová, Ph.D. (Consultant) Title of Doctoral Thesis: The Importance of Self-Reported Medication Adherence in the Evaluation of the Effectiveness of Pharmacotherapy Introduction and Objective: Medication adherence (MA) is a highly variable factor affecting the response to the therapy. Especially in chronic disease, non-adherence presents a problem that may have health, social, and even economic consequences. Measuring MA is the most often performed by self-reported surveys which enables, among others, their simple application in research as well as in every day clinical practices. Self-reported MA monitoring may contribute to maximizing the effectiveness of pharmacotherapy and minimizing the risk of therapy failure, however, standardization of measuring process is needed. Moreover, some factors such as healthy adherer effect (HAE), which reflect patient health seeking behaviour but cannot be easily monitored, can favourably affect health outcomes. Acquired results may then be incorrectly attributed to drug therapy examined in the study. Hence, the main aims of this doctoral thesis were: 1) to...
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The influence of enteral nutrition on the course of Crohn's disease
Homzová, Nikola ; Lukáš, Milan (advisor) ; Bortlík, Martin (referee)
Introduction: Crohn's disease is an illness of the digestive tract with an uncertain etiology which threatens the nutritional state of patients and in addition to other problems results in a worsening of the disease in reaction to primary treatment. The possibilities of optimizing the nutritional state are several: changing diet, enteral or parenteral nutrition or combination of both. It is necessary to arrange an entirely individual approach for ensuring the highest measure of attention and nutritional effectiveness. Methods: The influence of enteral nutrition was monitored during a course of Crohn's disease. 84 patients with malnutrition and with an active form of Crohn's disease were included in this study. They were divided into 2 groups according to the type and dosage of enteral nutrition. The first group included patients who used partial enteral nutrition in the form of sipping with an energy value of 1200 kcal daily. Patients covered the remaining energy needs with a low-residue diet enriched by soluble fiber. The second group included patients who were given exclusive oligomeric enteral nutrition with a nasojejunal tube for a period of eight weeks. The amount of enteral nutrition in both groups was individually adjusted and calculated, according to the Harris-Benedict equation. The...
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název v anglickém jazyce není uveden
Koubíková, Petra ; Lukáš, Milan (advisor) ; Zbořil, Vladimír (referee) ; Konečný, Michal (referee)
Background: Thioguanine derivatives, azathioprine (AZA) and 6-mercaptopurine (6-MP), have been used for many years in the treatment of inflammatory bowel disease (IBD). They represent major drugs in therapy of steroid-dependent and chronic active IBD. In 20-35% of the patients administration of AZA or 6-MP does not lead to improvement of the disease. Another limitation is the occurrence of adverse events of the therapy which can be observed in 10-15% of the patients. The metabolism of AZA/6-MP is influenced by thiopurine methyl transferase (TPMT). Since there is a significant variability in the activity of TPMP, there is an idea that monitoring the enzyme activity or the genotyping can significantly minimize the toxicity. Several studies have analysed correlation between the levels of AZA/6-MP and the efficacy or toxicity. The cut-off level corresponds to 230-250 pmol/8x108 RBC. High concentrations are linked with a risk of myelotoxicity. The occurrence of hepatotoxicity is dependent on the concentration of 6-methylmercaptopurine (6-MMP) in the erythrocytes. 6-thioguanine (6-TG) has been studied as an alternative therapy in patients with inflammatory bowel disease, who are resistant or intolerant to AZA/6-MP.The administration of 6-TG is effective in approximately 60% of patients. However, 6-TG...
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Clinical and genetic predictors of drug dependency in inflammatory bowel disease
Ďuricová, Dana ; Lukáš, Milan (advisor) ; Keil, Radan (referee) ; Špičák, Julius (referee)
IN ENGLISH Drug dependency in inflammatory bowel disease (IBD), Crohn's disease (CD) and ulcerative colitis (UC), is a specific disease phenotype which determines disease prognosis and hence may be used as a prognostic marker for treatment management. Drug dependency in IBD has been well described in corticosteroid treatment and recently also in infliximab (IFX) therapy. The aims of this thesis were: 1) to assess the occurrence of IFX dependency in paediatric and adult patients with CD; further to search for clinical and genetic predictors of IFX outcome and to evaluate the impact of IFX dependency on surgical rate; 2) to assess in CD patients the outcome of the first course of 5-ASA monotherapy with emphasis on 5-ASA dependency and to define clinical predictors of 5-ASA treatment outcome. We found that 66% of children and 29% of adults with CD became IFX dependent. The high frequency in paediatrics is in agreement with previously published studies, while the finding in adult patients indicates a lower rate of IFX dependency in the only study to date. Perianal disease and no bowel surgery prior to IFX start were predicative of IFX dependency in paediatric patients. In adult cohort, 2 genetic variants LTA c.207 A>G and CASP9 c.93 C>T were associated with IFX outcome, whereas no relevant clinical...
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The Importance of Self-Reported Medication Adherence in the Evaluation of the Effectiveness of Pharmacotherapy
Ládová, Kateřina ; Matoulková, Petra (advisor) ; Červený, Petr (referee) ; Lukáš, Milan (referee) ; Kolář, Jozef (referee)
Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Candidate: Mgr. Kateřina Ládová Supervisor: PharmDr. Petra Matoulková, Ph.D.; PharmDr. Magda Vytřísalová, Ph.D. (Consultant) Title of Doctoral Thesis: The Importance of Self-Reported Medication Adherence in the Evaluation of the Effectiveness of Pharmacotherapy Introduction and Objective: Medication adherence (MA) is a highly variable factor affecting the response to the therapy. Especially in chronic disease, non-adherence presents a problem that may have health, social, and even economic consequences. Measuring MA is the most often performed by self-reported surveys which enables, among others, their simple application in research as well as in every day clinical practices. Self-reported MA monitoring may contribute to maximizing the effectiveness of pharmacotherapy and minimizing the risk of therapy failure, however, standardization of measuring process is needed. Moreover, some factors such as healthy adherer effect (HAE), which reflect patient health seeking behaviour but cannot be easily monitored, can favourably affect health outcomes. Acquired results may then be incorrectly attributed to drug therapy examined in the study. Hence, the main aims of this doctoral thesis were: 1) to...
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The influence of enteral nutrition on the course of Crohn's disease
Homzová, Nikola ; Lukáš, Milan (advisor) ; Bortlík, Martin (referee)
Introduction: Crohn's disease is an illness of the digestive tract with an uncertain etiology which threatens the nutritional state of patients and in addition to other problems results in a worsening of the disease in reaction to primary treatment. The possibilities of optimizing the nutritional state are several: changing diet, enteral or parenteral nutrition or combination of both. It is necessary to arrange an entirely individual approach for ensuring the highest measure of attention and nutritional effectiveness. Methods: The influence of enteral nutrition was monitored during a course of Crohn's disease. 84 patients with malnutrition and with an active form of Crohn's disease were included in this study. They were divided into 2 groups according to the type and dosage of enteral nutrition. The first group included patients who used partial enteral nutrition in the form of sipping with an energy value of 1200 kcal daily. Patients covered the remaining energy needs with a low-residue diet enriched by soluble fiber. The second group included patients who were given exclusive oligomeric enteral nutrition with a nasojejunal tube for a period of eight weeks. The amount of enteral nutrition in both groups was individually adjusted and calculated, according to the Harris-Benedict equation. The...
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The Importance of Self-Reported Medication Adherence in the Evaluation of the Effectiveness of Pharmacotherapy
Ládová, Kateřina ; Matoulková, Petra (advisor) ; Červený, Petr (referee) ; Lukáš, Milan (referee) ; Kolář, Jozef (referee)
Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Candidate: Mgr. Kateřina Ládová Supervisor: PharmDr. Petra Matoulková, Ph.D.; PharmDr. Magda Vytřísalová, Ph.D. (Consultant) Title of Doctoral Thesis: The Importance of Self-Reported Medication Adherence in the Evaluation of the Effectiveness of Pharmacotherapy Introduction and Objective: Medication adherence (MA) is a highly variable factor affecting the response to the therapy. Especially in chronic disease, non-adherence presents a problem that may have health, social, and even economic consequences. Measuring MA is the most often performed by self-reported surveys which enables, among others, their simple application in research as well as in every day clinical practices. Self-reported MA monitoring may contribute to maximizing the effectiveness of pharmacotherapy and minimizing the risk of therapy failure, however, standardization of measuring process is needed. Moreover, some factors such as healthy adherer effect (HAE), which reflect patient health seeking behaviour but cannot be easily monitored, can favourably affect health outcomes. Acquired results may then be incorrectly attributed to drug therapy examined in the study. Hence, the main aims of this doctoral thesis were: 1) to...
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The Importance of Self-Reported Medication Adherence in the Evaluation of the Effectiveness of Pharmacotherapy
Ládová, Kateřina ; Matoulková, Petra (advisor) ; Červený, Petr (referee) ; Lukáš, Milan (referee) ; Kolář, Jozef (referee)
Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Candidate: Mgr. Kateřina Ládová Supervisor: PharmDr. Petra Matoulková, Ph.D.; PharmDr. Magda Vytřísalová, Ph.D. (Consultant) Title of Doctoral Thesis: The Importance of Self-Reported Medication Adherence in the Evaluation of the Effectiveness of Pharmacotherapy Introduction and Objective: Medication adherence (MA) is a highly variable factor affecting the response to the therapy. Especially in chronic disease, non-adherence presents a problem that may have health, social, and even economic consequences. Measuring MA is the most often performed by self-reported surveys which enables, among others, their simple application in research as well as in every day clinical practices. Self-reported MA monitoring may contribute to maximizing the effectiveness of pharmacotherapy and minimizing the risk of therapy failure, however, standardization of measuring process is needed. Moreover, some factors such as healthy adherer effect (HAE), which reflect patient health seeking behaviour but cannot be easily monitored, can favourably affect health outcomes. Acquired results may then be incorrectly attributed to drug therapy examined in the study. Hence, the main aims of this doctoral thesis were: 1) to...
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