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Physical therapy in patients after transplantation of the heart
Náprstková, Alžběta ; Bartůňková, Staša (advisor) ; Kohlíková, Eva (referee)
Název práce: Pohybová léčba u osob po transplantaci srdce Exercise therapy ofheart transplant individuals Cíl práce: Práce podává základní přehled o transplantacích srdce. Samotný zákrok, byť zachrání život člověka v terminálním stadiu srdečního selhávání, by nemohl být úspěšný bez navazující péče, jejíž nedílnou součástí je rehabilitace. V této práci popisuji své zkušenosti s využitím programu zaměřeného na pohybovou léčbu u osob po transplantaci srdce s dotazníkem na kvalitu jejich života. Metoda: Potřebné informace o indikacích a vlastním průběhu transplantace jsem získala studiem dostupné literatury. Při sestavování plánu pohybových aktivit jsem vycházela ze zkušeností a praxe v IKEM (Institut Klinické a Experimentální Medicíny). Postupovala jsem následovně: po zpracování dostupných informací jsem získala rozhovorem a vyšetřením přehled o celkovém zdravotním stavu a kondici jednotlivých pacientů. Zaměřila jsem se především na minimalizaci komplikací, kterými trpí pacienti po transplantacích srdce. Jedním z důležitých úkolů bylo seznámit pacienty po transplantaci srdce s možnými pohybovými aktivitami. Výsledky: K porovnání zdravotního stavu jednotlivých účastníků projektu jsem přeložila z angličtiny dotazník COOP/WONCA, který jsem doplnila o otázky týkající se pohybových aktivit. Jako další...
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Preparedness of medical rescue service in South Bohemian coutry for solving emergency situacions
MAJSTR, Jiří
The frequency of emergency incidents and the expanding spectrum of all possible mass casualties require preventive and safety precautions and fast professional respond to their occurrence. Emergency prevailing medical complication requests from Medical Rescue Service providers a different attendance to intervention than is usually requested in their daily routine activities. Daily routines of Medical Rescue Service providers include medical treatments of one or two patients using urgent care medicine methods, which present a full medical treatment to a particular patient from the first contact to their handing over to other medical services providers. In emergencies with mass casualties? incidence, it is impossible to attend one particular patient at a time, but it is necessary to adjust priorities in medical attendance to patients in dispatch and as well to transfer all patients to other medical service provider facilities. Shall there be an emergency with mass casualties, there are few concomitant circumstances in their solving, and these are: lack of time for decision making and rescue works co-ordination, panic, delay in treatment and transport of patients to other medical facilities. Especially at the rescue work start of all integrated rescue system units, forces and equipments are insufficient, as for example lack of professional medical staff, rescuer and medical equipment including medicaments. The ration of rescue forces and medical equipment to a number of patients optimizes in following process, when a successful outcome is conditioned by the rescue work in the first thirty to sixty minutes. It is, thus, very important to paying attention to the organization and control of rescue works of all integrated rescue units right from the start. An intergrated rescue system is mentioned in theoretical part of the thesis. On the strenght of valid legislation, the provider of Medical Rescue Service is generally described, particularly focused on preparedness and solving of emergency incidents by the Medical Rescue Service of South Bohemia. Furthermore, the organisation trauma plan,the START asset classification of casualties with the follow-up method using identification and sorting cards (medical classification) are described. The theoretical part of thesis is closed up by an outlined exterior emergency plan of the nuclear power plant Temelin with focus on its trauma plan related to the Medical Rescue Service of South Bohemia activities solving emergency situation in the connection with an outflow of radioactive substance. The thesis was written on the ground of a qualitative research using the method of a semi-led interview of seven superintendant medical doctors of Medical Rescue Service from different areas in South Bohemia. The content of the research was an evaluation of possible development and potentional changes in preparing and also consequential activities of medical units at emergency situations with mass casulties. Research questionaire was focused on competence and funcion of medical dispatching centre, establishing work process of first paramedics attending at the place of an emergency situation, also co-operation of medical units with other units of an integrated rescue system and as well the tie-in system to other medical facilities. The aim of the research was establishing hypotheses in terms of Medical Rescue Service of South Bohemia preparadness to solution of emergency situations. Created hypotheses attached to a chapter ¨Discussion¨ may be verified, in the future, by a quantitative research. Other thesis aims are included in attachment part. It represents an interpretation of tactical and testing practise of Medical Rescue Service of South Bohemia from 2006 to 2012 and topics focused on emergency incidents and mapping incidence and solution of emergency incidents with mass casualties in South Bohemia region from 2003 to 2012.
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SOCIAL REHABILITATION OF CLIENTS KLADRUBY REHABILITATION CENTRE
STÖCKEL, Barbora
For my thesis I chose a topic of social rehabilitation of clients of Rehabilitation Center Kladruby. An aim of this work, was to find which opportunities of social rehabilition with a focus on vocational rehabilitation the clients of the Rehabilitation Center Kladruby have and what are their views ot this issue. I also wanted to determine whether the clients after social rehabilitation in RC Kladruby successfully involve to the labor market, or to point out the aspects that limit the clients to return to the labor market. To obtain the necessary data, I chose a qualitative form of application of questioning techniques. Data collection was by semi-controlled interviews with clients of RC Kladruby. Out of 175 clients with altered health status dignosed at RC Kladruby for the purpose of vacational rehabilitation, 9 is sucdessfully involved in the labor market.
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Physiotherapy for people with cerebral palsy from 15 to 30 years old
ŠKOPKOVÁ, Eva
For my bachelor thesis I chose topic Physiotherapy of Persons between fifteen and thirty Years of Age Suffering Cerebral Palsy. Number of patients with this disorder is still increasing, but since 50s of the 20th century neonatal care began to become better. Thanks to this improvement in medical care number of saved newborns, who would have earlier died because of the consequences of prematureness or diseases, is now higher. These children are often disabled by cerebral palsy. Cerebral palsy is an untreatable disease, whose displays can be influenced only by a well chosen therapy. Bachelor thesis has two basic parts. The first one is theoretical, which is divided into a general and special part. In the general part, I focused on the sum of theoretical knowledge about cerebral palsy, I paid attention to the characteristics of the disease, incidence, etiology, pathological anatomy and to the classification of cerebral palsy. Then I focused on the diseases associated with cerebral palsy. I describe physiotherapy of cerebral palsy patients with focus on reflexive locomotion in the special part of my bachelor thesis. The aim of my bachelor thesis is to summarize knowledge about cerebral palsy. Considering that one of the basic features of the treatment is physiotherapy, I devoted my attention to the most usually used methods in the treatment of cerebral palsy. The theoretical part is concerned with methods of reflex-locomotion (Vojtova metoda), of Redcord ? therapy and by the concept of Mr. and Mrs.Bobaths. In the practical part of my thesis I made a quality research, where I specified goals of my work, offered description of methodology, characteristics of a file, and I made three casuistries. A part of the casuistries were anamneistic data and making of preliminary and output exploration. These explorations included objective general assessment, establishing locomotive state according to professor Vojta, exploration of locomotive abilities and goniometric explorations too. All persons went through classification of spasticity according to Ashworth´s measures and exploration of shorten muscles was also done. Research was made in the ARPIDA centre in České Budějovice, it took three months (March, April and June/2013) ? investigation of one patient of all three took circa one month, in which 9 therapies were done. The aim of practical part is to bring physiotherapical plan for observed patients with cerebral palsy. Results show that short-termed treatment had positive effect on health state of all three observed patients. The most affected areas were stability, correction of axial organ, but hypertonus of muscles and empowerment of weakened muscles also became better. The bachelor thesis can be used as a source of information for orientation in the topic of cerebral palsy by students of physiotherapy, but can also serve as an educative material for patients between fifteen and thirty years of their age and by their parents. Thesis could also be an inspiration for physiotherapists, who could think about their own treatment therapies for patients with cerebral palsy with the usage of not so known method Redcord?.
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Boccia as an effective way to increase the quality of life of persons with severe disabilities(?)
AUSPERGEROVÁ, Vendula
Bachelor thesis "Boccia as an effective way to improve the quality of life of people with severe physical disabilities?" Discusses the possibility of positive impacts on the quality of life of individuals especially with severe disabilities through active participation in the game called "Boccia". Boccia is a game designed for people with severe physical or combined disabilities, in which special equipment is used in order to allow disabled people with arduous opportunities for participation in other sports because of severe disability to play in an independent way. In the Czech Republic, thanks to good playing conditions, an offshoot called "Integrated boccia", abbreviated "iBoccia" has been developed, which is based on the simplified rules allowing the practicing of the classical Boccia basically to anyone. The level or the type of disability does not play a significant role (except for visual impairment) because the special equipment reduces major differences caused by disability, and so the game can also be played by people without disabilities. In the game 3-6-membered teams participate, it is therefore a collective sport. The integrated Boccia may provide an opportunity for self-realisation based on physical activity and enables to establish or enhance social relationships, which appear to be a suitable mean of improving the quality of life of people with severe physical disabilities. The aim of this thesis is to determine whether and how integrated Boccia influences subjectively perceived quality of life of selected players with disabilities involved in students project "Boccia heading south" implemented in the Czech Budejovice. In order to achieve the targets of the research part a qualitative research was used, specifically the design of case studies. The opening chapter is devoted to the definition and characteristics of basic terms like disability, severe and physical, and classification of defects. Here is indicated working definition of severe disability, it is "a particularly severe form of disability, when a person is largely limited in his physical abilities due to damage support or the musculoskeletal system, or other physical damage, therefore, becomes dependent on the assistance of another person."(Gruber, Lendl, 1992 in Pipeková, 2006, p 168; Fröhlich, 1994, p 44 in Pipeková, 2006, pp. 329, MPSV.CZ: Zdravotní postižení. [online]. [cit. 2013-08-13]. Dostupné z: http://www.mpsv.cz/cs/8) The fifth part is consists of qualitative research, whose outputs consist three case studies. By the addressed respondents are players of integrated boccia from South Bohemia involvement in the project "Boccia heading south." These are two women of age 54 and 27 years and men of age 22 years. Dates required to process the case studies was obtained by interviews and participating observation. For each of the surveyed players iBoccia performs a different function and takes the different positions in the ranking of importance in the life of the respondents. For the respondent I. iBoccia means for example self-fulfillment, respondent II. iBoccii perceive like more free time to improvement of rehabilitation function, while for the respondent III. It brings the possibility of self-fulfillment and a sense of "necessity". The research results have brought confirmation that integrated Boccia has a positive effect on the quality of life of these respondents with severe physical disabilities, providing them the possibility self-realization, takes the social and rehabilitative function. These results are however applicable only as an individual, depending on many factors related to medical diagnosis, human personality, current psychological or physical condition, self-discipline and financial situation. It also depends on the organizers and employees of facilities how bring the game.
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Quality of life of patients with Crohn´s disease
RENDL, Lukáš
Theoretical foundation Crohn's disease is a chronical autoimmune disease categorized, together with ulcerative colitis, in the group of idiopatic intestinal inflammations. But in spite of this categorization, Crohn's disease may not be found only in the intestines but anywhere in the gastrointestinal tract. However, the intestinal localization is most frequent and is related with numerous manifestations like stomachake, diarrhoea, bloating, flatulence, belching, loss of weight, etc. The pathogenetic cause of those discomforts consists in disorder of autoimmunity, when the body starts producing antibodies against its own tissues. But the cause of start of that pathogenetic mechanism has not been clarified so far. Experts speak about influence of infections, food, psychosomatics, smoking, genetic perceptiveness, etc. The hope of the patients is pinned on the continuously improving treatment, culminating by biological preparations that have most influenced the health condition of those persons so far. But in spite of the modern therapy, all characteristics of the disease can have negative impact on the quality of life of the patients. Goal of the thesis The goal of this thesis consists in ascertaining the quality of life of Crohn's disease patients. Hypotheses H1: Crohn's disease patients have problems in physical area. H2: Crohn's disease patients have problems in psychic area. H3: Crohn's disease patients have problems in social area. Methodology The practical part of the thesis was implemented based on quantitative inquiry within the grant Project No. 120/2012/S ?Reflection of life quality in nursing?. Two standardized questionnaires were used for the inquiry: the WHOQOL-100 general questionnaire and the IBDQ specific questionnaire, distributed among Crohn's disease patients. Valid licence was bought for both questionnaires. The size of the research set was determined at 100 Crohn's disease patients, the Crohn's disease diagnosis being the only criterion for selection of the respondents. The distribution of the questionnaires among the respondents took place with the help of gastroenterological centres. Results All data obtained were statistically processed in the SASD (Statistical Analysis of Social Data) program. The results of the processing can be divided into three areas, by the three main hypotheses verified. The first area of results provided information on the problems confronted by Crohn's disease patients in physical area. Only one problem was confirmed here: the Crohn's disease patients feel fatigue. All the remaining problems under verification in this area were refused. The second area brought information on psychical problems of the patients. Similarly to the preceding case, only one problem troubling the Crohn's disease patients was found here: feeling of irritation. The occurrence of the remaining psychical problems under verification was not confirmed. The last area of results found out the problems of the patients in social area. The results were the most positive in this case, as none of the problems under verification in this area was confirmed. Based on all results stated above, the hypotheses were evaluated as follows: H1 Crohn's disease patients have problems in physical area - refused; H2 Crohn's disease patients have problems in psychic area - refused and H3 Crohn's disease patients have problems in social area - refused. Conclusion The thesis provides comprehensive view on the issue of quality of life of Crohn's disease patients. The results may be used particularly in the work of so called IBD nurses, endoscopic nurses, but also general nurses working with the patients. The thesis can be also used as study material or as foundation for further research.
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Examination of D-dimer in patients from the district Jindřichův Hradec
PROCHÁZKOVÁ, Veronika
Investigation of level (concentration) of d-dimer in the plasma is used to capture several pathological conditions. The most common is venous thrombosis and pulmonary embolism. Just thrombosis is diagnosed in 71 patients out of 100 000 inhabitants per year, pulmonary embolism in the same population in 69 inhabitants. Thanks to determine levels of d-dimer we can also determine the risk thrombophilia, a tendency to thrombosis. Thrombosis is the third most common pathological condition after myocardial infarction and stroke. Another states we can diagnose are undoubtedly disseminated intravascular coagulation, tumors, acute coronary syndromes, inflammatory disease. Increased level of d-dimer is found in pregnancy. My main objectives were to: 1. Acquisition of method for the examination of d-dimer, which is used in the Hospital Jindřichův Hradec, a.s. the Department of Haematology and Blood Transfusion, during one month. 2. Processing of at least 30 samples. D-dimer is one of the fission products of fibrin. It occurs in fibrinolysis, which was preceded by a sequence of reactions coagulation cascade. Its presence in the blood shows a fibrinolytic activity in the vascular system. Its level is increased after trauma or surgery. People taking hormonal therapy may suffer from increased coagulation and subsequently induced fibrinolysis. I deal in the tehoretical part of my thesis what is d-dimer, when arises. I mentioned also the coagulation cascade, which precedes the fibrinolysis. I focused on the main thrombotic condition in which the levels of d-dimer increased, from what causes these conditions arise, how they can be diagnosed. I was considering which diseases can develope because of thrombotic states and thrombophilia, what the symptoms are. In this section there is also the types of thrombotic conditions treatment, material, conditions of work with it, the types of hematological examination, the possibility of establishing d-dimer and preparation of antibodies. The practical part describes the receiption of material, its preparation for analysis, analysis, description of the apparatus, required reagents, the principle of work. I worked in the Department of Haematology and Blood Transfusion in the Hospital in Jindřichův Hradec. It was allowed to me to examine 100 patient samples, in most of the outpatient department of the hospital. I worked on the automatic coagulation analyzer ACL Elite Pro and I examined the levels of d-dimer. The latex-enhanced method is used to determine the d-dimer in routine practice in Jindřichův Hradec. D-dimer contained in the plasma forms a complex with the monoclonal antibody, which is bound to the latex particle. The principle of measurement is immunoturbidimetry, at 405 nm. The light beam is absorbed on the immune complexes and decrease of the transmitted light intensity, which passed through the reaction cell with a sample to be analyzed, is measured. I processed the measured values of d-dimer in tables and graphs using a computer program to separate part of the thesis. I divided the results according to gender, cut-off value of d-dimer used in hospital in Jindřichův Hradec, according to risk age of 45. I created graphs and tables and I evaluated the research. Increased level of d-dimer was showed in 56 patients, while the proportion of men and women was the same. I did not notice dependence on increased concentration with increasing age. Unconfirmed of two hypotheses may be due to the fact that I investigated samples from a small group of patients who were diagnosed with a pathological condition. Increased concentrations of d-dimer are most often caused by lifestyle and heredity. By working in the laboratory I have developed latex-agglutination d-dimer determination in plasma.
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The issue of evacuation of people with disabilities
KOVÁČ, David
The aim of social services is the creation of conditions for satisfying people's basic needs, through support and assistance in dealing with the care of disabled people. The feeling of home creates a personal relationship. It is not just about facilities or a roof over one's head, but especially about kind and friendly staff of social facilities. The theme of the thesis is focused on the issue of evacuation of disabled persons in selected facilities. For this purpose, the research part of the work is dedicated to facilities providing social services in the South Bohemian Region, where there are staying people with different kinds and degrees of disability for most of the day time. These facilities include: homes for the elderly, special regime homes, homes for people with disabilities, respite care, weekly care centers, sheltered housing and social rehabilitation. Disabled people, in case of evacuation, are dependent on the help of others, in particular nursing staff, and on the activities of the Integrated Rescue System (IRS). This places high demands on the readiness of social facilities and personnel itself in terms of evacuation. The thesis deals with the readiness of the aforementioned social facilities for emergencies, with special emphasis on the evacuation of users living in these facilities. In the theoretical part, the issues of evacuation and ways of its division are discussed in several respects, i.e. in terms of duration, the selected solution, the method of implementation, measure extent and in terms of choice of people and in terms of danger to people. Because attention of the thesis is focused on the buildings in which persons with disabilities are grouped, building evacuation as such was described in more detail in the thesis. A substantial, and even to a considerable extent extensive, chapter talks about a description of social care services, of which I chose only those that have the form of buildings where disabled people stay. Then I chose those devices that provide residential form, because there arises an obligation to care for the person entrusted, and therefore the need for a response to emergence of an extraordinary event, which is in many cases inherently linked with implementing evacuation. Defined criteria for the selection of providers of social services (residential form of social services and the type of social services) corresponded to a total of 66 social facilities in the South Bohemian Region. For the purposes of the subsequent questionnaire it was interviewed 33 of them, chosen randomly, while the survey itself was attended by 30 facilities. For the sake of compact perspective of the problem it was necessary to define disability according to the Act no. 108/2006 Coll., on social services. According to this act, a disability is divided into visual, auditory, physical, mental and combined disability. Specifically, but not exhaustively, they are described in chapter 2. The aim of the thesis was to evaluate the readiness of selected social services of the region for evacuation. For this purpose, an extensive survey was carried out in selected facilities in the region. For the actual investigation, two questionnaires were created. One was intended for managers or responsible leaders of these facilities and contained 16 questions. The second was intended for staff and included 26 questions. It was divided into three blocks. The first block contained five questions that provide information about the respondent. The second block contained 16 questions, which reported on the knowledge of personnel in the area of evacuation, health and safety at work, fire protection and emergencies that may arise in the structure of the facility or its surroundings. The third block contains five questions, which focus on self-evaluation of the one interviewed. Results of the survey were, for the purpose of clarity, evaluated as graphs including their interpretation.
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The use of the TL dosimeters for measuring inhomogeneities irradiation
CANDROVÁ, Daniela
Radiotherapy has commonly been utilised to cure cancer for more than a century. It is counted among the fundamental branches of medicine and represents an effective local or locally-regional method of curing both cancer and some non-cancerous conditions. It utilises ionising radiation which unfortunately eliminates tumour cells along with healthy ones. This is why a wide range of harmful effects of the radiation can be observed on humans. Patients treated with radiotherapy are in some cases monitored with dosimeters so that the intended dose can be compared with what is really absorbed. Nemocnice České Budějovice, a. s. monitors the dose in expected locations of non-homogeneous irradiation using the aforementioned TL dosimeters during the process of rotary irradiation of Mycosis fungoides. Before actually being used in an in vivo dosimetry, these dosimeters must be properly calibrated and have their sensitivity adjusted. Other than that, they are fairly easy to use, do not require much time or money invested and are able to constantly monitor the dose received by a patient treated with rotary irradiation. This diploma thesis discusses the usage of TL dosimeters to measure non-homogeneity of irradiation. It therefore compares the doses received by patients in various parts of the body during irradiation by the TSEI method. These 22 irradiated patients had thorough measurements taken of the doses they received in the so-called black hole region, their axillae and neck while holding their arms up and with arms loosely positioned close to the body. The thesis also suggests the possibility of the dosimeters being used by the integrated emergency service to assist during rescues and demolitions performed in emergency situations when a leak of ionising radiation occurs. Using TL dosimeters would mean more precise measurements of the dose received by the involved personnel in various parts of their body. If a patient is treated with the TSEI method, the dose received is monitored in a reference point, critical areas and areas with residual infiltrations or tumours. Doses measured in critical areas indicate that should the acral parts of limbs be left uncovered, they absorb larger doses than the rest of the body. They thus exceed the intended dose significantly. In the case of fingers, the dose tends to reach as much as 3 Gy. Depending on clinical picture, the attending physician determines whether special covering should be used. This covering reduces the doses received to merely a few tenths of a Gy. There also tends to be a large difference in absorbed doses in axillar areas and the neck, depending on whether the patient's arms are held up or close to the body respectively. Test results indicate that holding arms up or keeping them close to the body on a particular side have always had a profound effect on the dose absorbed by the patient in this particular area. This means that the position of the body greatly influences how much is absorbed in various parts of the body. TL dosimeters are also used in other areas than in vivo dosimetry in radiotherapy. An example of this could be determining the dose received in upper limbs of the workers monitored with thermoluminescent dosimeters in the form of bracelets or rings. They also serve to monitor the external irradiation of persons within the limits of the Czech Republic (TLD network). In radiation therapy, both the doses in skin and body are taken into account when conducting measurements. Depending on the data extracted, it is then possible to assess the course of treatment and ensure safe implementation of ionising radiation. Integrated emergency service teams deployed in cases of radiation emergencies are not considering using TL dosimeters so far, although they could most likely be used to ascertain the exact doses absorbed. Further research would however need to be conducted to either confirm or disprove the benefits of using TLD.
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The attitude and the role of siblings of children with strong handicaps in family
BERGEROVÁ, Denisa
Family, a basic and irreplaceable institution presents above all an emotional environment, a sense of security, love and safety not only for a child but also for other family members. A child creates close relationships within the family not only with their parents but also with siblings. A relationship between siblings offers an emotional support, an opportunity to share both joys and worries but also cooperation and conspiracy against parents. Siblings can offer help in difficult times in life, on the other hand conflicts may arise between siblings and rivalry and jealousy appears. The birth of a child with a severe disability presents an enormous challenge for the parents but the effects of this situation on siblings have not yet been sufficiently described. This sibling relationship can be more emotional, has its specifics and unmistakable quality. This bachelor thesis is divided into a theoretical and a practical part. The first chapter focuses on family its functions, educational styles and current family trends. The second chapter is focused on disabilities, which are further divided into basic types, such as bodily, sensory, mental and combined. In the third chapter we focus more on a family with a heavily disabled child and we devote the last chapter to siblings, especially to those with a disabled sibling. The practical part aims to describe the situation of siblings of children with a severe disability and to find positive aspects of the situation. I also tried to find out what demands does the family put on these siblings and if these siblings show tendencies to pro-social behavior , especially in the area of interests, education and career. The practical part was done using qualitative research, namely the method of questioning. The technique used was a semi-constructed interview. The experimental research was conducted in April 2015. The selective sample included two groups of respondents. In the first group there were siblings of people with severe health disability; in the second were siblings of people who were intact, meaning a sample of common population. The results of the experimental part follow after every round of respondents' answers. It is clear from the results that siblings of people with severe disability have the same duties in the household as the siblings of the intact ones. However, higher demands are put on them, when it comes to taking care of their sibling. None of the respondents thinks that they would have had less duties had their sibling been healthy. The results of the research showed that siblings of people with severe disability have higher predispositions for such personality traits that increase the tendency to pro-social behavior. They display empathy, a sense of social awareness, they also "feel protective" of their sibling and they feel selfless and patient. The interests and hobbies of siblings of children with a severe disability do not differ from interests of siblings of children without it. It is the siblings of children with a severe disability, however, who spend their free time with their sibling. They also more often work as volunteers. This thesis could be most useful for parents and siblings of people with a severe disability, because it can help them find a different perspective on the matter it will be a feedback of a sort. The thesis can also be used by students, who are preparing to work in helping professions, because it will help them orient in the matter. It could also be used by people who work in helping professions. Last but not least, it could be used to create material concerned with this matter.
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