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Producing evidence in civil proceedings with a special regard to disputes in the area of medical care
Holčapek, Tomáš ; Winterová, Alena (advisor) ; Salač, Josef (referee) ; Uhlíř, David (referee)
Holčapek, T., Evidence in Civil Litigation with Emphasis on Disputes Arising from Medical Care, doctoral thesis, Charles University in Prague, Law Faculty, 2010. The doctoral thesis focuses on the issues of fact-finding in general and evidence in particular, all within the framework of rules of civil proceedings and with regard to lawsuits that result from the providing of medical care. It analyses the factual prerequisites which need to be found (proven) in order to establish liability of the health care provider for personal injury or interference with personality rights of the patient, and discusses who bears the evidentiary burden in their respect, how persuasive the proof has to be and what techniques for the lightening of such burden (e. g. factual presumptions or utilisation of loss of chance or other concept of proportional liability) are employed by various legal systems. The thesis builds on the comparison between Czech law and rules used in other legal areas, including both continental law and common law countries. Keywords: health, medical care, civil liability, civil proceedings, evidence
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Chronic Patients' Depression
Pečinková, Jana ; Šivicová, Gabriela (advisor) ; Loneková, Katarína (referee)
This thesis "Chronic Patients' Depression" looks into Alzheimer's disease patients' depression. Theoretical part focuses on topics of old age, dementia syndrome, Alzheimer's disease and depression. These topics are described also in their associations. Current researches in the field of study are mentioned too. Practical part deals with presence of depression in Alzheimer's persons. Hypothesis that depression is more frequent in early stage of dementia is tested. In the research there is used standardised method - Yesevage's Geriatric Depression Scale. Other methods which can bring new information is also used (Geriatric Depression Scale filled in by caring persons and structured observation). The outcome is 9,7% Alzheimer's patients suffer from depression. More persons with depression we can find in a group of Alzheimer's early stage however difference between group of early and advanced stage is not significant. This study occupies with assets of other methods for diagnostic of depression.
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Monitoring of biochemici markers of septic states
Brodská, Helena ; Kazda, Antonín (advisor) ; Zazula, Roman (referee) ; Průša, Richard (referee)
The topic of systemic inflammatory response is lately often discussed across the whole field of medicine. Early diagnosis and the following adequate therapy minimize the risks of the development of systemic inflammatory response syndrome (SIRS). Therefore there is a general urge to find an appropriate marker for diagnosing and monitoring of the development of SIRS. Each year new markers appear, markers that fill up the mosaic of a pathophysiological picture, but we still do not have a marker, that would fulfill the demands of specificity, sensitivity and availability. In the recent ten years, one of the most promising markers seems to be the PCT. (...) In two studies with patients in end states renal diseases (ESRD) the non infectious elevations appear as marker of severity of clinical state. In the last study we confirm the relationship between PCT and severity of clinical state and the antioxidative defence, respectively the plasmatic selenium level. In the above mentioned studies I would like to present the wide range of this marker, which in the meantime is one of the most used markers of the SIRS. I would like to stress the importance of a correct indication and of an accurate interpretation in accordance with all the other parameters, but most of all with the clinical state. PCT, being almost ten...
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Resting energy expenditure by polytraumatic patients.
Tichá, Veronika ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
Critically ill patients are characterized by an increased catabolic response, a hypermetabolic state, higher nutritional requirements and a decreased capacity for utilization of parenteral substrate. Measurement of energetic expenditure in critically ill patients is necessery to determine the optimal nutritional support which is individual for everyone patient with the view of contribute to recovery, to prevent possible complications of overfeeding or underfeeding and reduce the hospitalization period. Energy expenditure was measured in two intervals by indirect calorimetry in 12 polytrauma patients (mean age 32 years ± 16 years) in the intensive care unit at FN HK. The hypermetabolic state of patients was evaluated from the ratio of REE/BEE (REE regarding basal energy expenditure calculated on the basis of the Harris-Benedict equation) and was also evaluated utilization of substrates. Resting energy expenditure during the first examination was on average 2195 kcal/d ± 665,8 kcal/d, at the second examination of 2031 kcal/d ± 590,9 kcal/d. Between measurements was no statistically significant difference. Mean REE/BEE was 122,3 % ± 27,44 %, 118,5 % ± 23,15 %, respectively. Respiratory quotient has an average around 0,81, which indicates a preferential utilization of proteins. The large loss of...
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Passive rehabilitation affecting on spasticity of multiplex sclerosis
Prášil, Jakub ; Bunc, Václav (advisor) ; Foubíková, Bohdana (referee)
Title: The influence of a passive rehabilitation on spasticity in multiple sclerosis Objectives: The main objective is to summarize the current knowledge about multiple sclerosis and the possibilities of influencing the spasticity as a serious symptom. Another objective is to verify the effectiveness of the antispastic passive rehabilitation of the lower limbs of selected patient in practice. Methods: Verification of the effectiveness of the system of antispastic passive rehabilitation of the lower limbs was through a qualitative research. For the work design is used the type of qualitative experiment. The research sample is a person with spasticity in the lower limbs. In the first two parts of the work was used an analysis of scientific literature and a content analysis. The strategy of data obtaining is also in the form of observation, interviewing, measuring, scale and variety. A medical documentation, anamnesis, casuistry and a secondary analysis were used. Results: Individual use of each method resulted in the influence of spasticity only for a short time. Mobility was affected in the sense of passive movement the most after the soft techniques and massage therapy. The most striking results were achieved after the use of all methods when the spasticity was positively influenced in accordance...
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Immunotherapy of ovarian carcinoma with dendritic cells
Partlová, Simona ; Rožková, Daniela (advisor) ; Froňková, Eva (referee)
V ANGLICKÉM JAZYCE Immunotherapy of ovarian carcinoma with dendritic cells Anticancer immunotherapy is a therapeutical strategy aimed at elicitation and maintenance of immune responses against cancer cells. In this study we have focused on immunotherapy of ovarian cancer, because it is one of the most common gynaecological tumors with poor prognosis and high mortality. Our immunotherapy protocol involves preparing dendritic cells (DC) from monocytes isolated from patient's peripheral blood, which are subsequently pulsed with irradiated cells of established ovarian cancer cell line. These immature pulsed DC are maturated and subsequently co-cultivated with autologous T lymphocytes. The aim of this study was to demonstrate, that DC are able to elicit specific immune response after addition of suitable mature agens in combination with apoptotic ovarian tumor cells. Our observations indicate that 24 hours are sufficient for induction of tumor cells apoptosis. Additionally, we have shown that DC successfully ingested most of the apoptotic tumor cells after 4 hours of co-incubation. Furthermore, we have found out that ingestion of apoptotic cells by dendritic cells, which are stimulated with polyI:C, inhibits maturation of DC and consequently also production of cytokines IL-12p70, IL-6 and TNF-α. Whereas...
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Psychological aspects of amniocentesis
Skutilová, Vladana ; Šulová, Lenka (referee) ; Hrachovinová, Tamara (advisor)
Genetical counselling represents complex activity with multidisciplinar overlap. Most of patients are pregnant women who usually pass amniotic fluid sampling. The aim of this diploma work is to describe these womens behaviour and feelings on the basis of chosen aspects. The text is divided into twelve chapters Theoretical part presents surveyed problems from two poits of view - psychological and medical. It describes indication to invasive prenatal nealth check, thereinafter it talks about most frequented chromosomal deficiency which can be exposed by karyotypisation. Further it talks about the doctor and patinet's realition and about aspects of genetical counselling as well as about ethical aspects of prenatal diagnostics. On the basis of questionaire results, empirical part presents feelings, behaviour and attitudes of women to prenatal health check within in process. Thereinafter it shows and verify which factors influence women's far of health check results.
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Comparison of sequence variations in genes of biotransfromation enzymes in some carcinoma
Turková, Lucie ; Tavandzis, Spiros (referee) ; Bóday, Arpád (advisor)
Xenobiotic biotransformation process and its capacity is crucial for xenobiotic chemicals elimination that may cause damage toward cell structures. The effectiveness of the enzymes included in this process depends on the gene variants that encodes them. The aim of this work was to compare certain polymorphisms of selected genes between cases and control groups. Studied polymorphisms were null genotypes of the glutathione S-transferase gene M1 and T1 and the insertion of TA dinucleotide in the promotor region of UDP-glucuronosyl transferase 1A1. The number of cases group was six included patients with colorectal, lung, prostate, breast, pancreatic and head and neck cancer. Total number of analysed individuals was 1 118 for cancer cases and 470 for healthy controls. The control group was divided into two groups, the first one was called general and the second one was called special included healthy individuals with no cancer history in their closest family members. Gilbert syndrome (GS) is caused by homozygous insertion of the TA dinucleotide in the TATA box of the gene UGT1A1 and it causes elevated bilirubin levels. Bilirubin is a potent antioxidant in human body, so the aim was to attest its protective effect toward cancer. We expected lower frequency of GS as a protective factor in the cases groups compared with controls. This hypothesis was confirmed in the breast cancer group (GS frequency 10,0 %) and pancreatic cancer group (GS frequency 11,1 %). In the general and special control groups the frequency of GS was 16,0 % and 15,4 % respectively. Although the other case groups show lower frequency of GS, the results weren´t statistically significant. Null GSTM1 genotype was observed with 50,4 % frequency in the general control groups and with 55,3 % frequency in the special control group. Neither the one of the cases groups hasn´t showed significantly lower percentage of null genotype. Despite expectation we observed statistically significant lower frequency of null genotype in the group of lung and pancreatic cancer group (37,4 % and 39,3 % respectively). According to this study, we can say that the lack of glutathione S-transferase M1 activity is not a risk factor for cancer development. Null genotype of GSTT1 wasn´t identified in both control groups at all. In case groups of breast and prostate cancer, there was only one individual carrying the null GSTT1 genotype. Statistically significant higher frequency of this polymorphism was observed in patients with colorectal cancer (9,7 %), lung cancer (17,2 %), pancreatic cancer (3,0 %) and head and neck cancer (15,9 %). In these groups the lack of glutathion S-transferase T1 activity might be considered as risk factor for cancer development. Nevertheless, for further verification it needs to take more investigation in this field, especially enlarge the number of patient in the case groups of head and neck, lung and pancreatic cancer.
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Risk factors at public health work: differences among professions in non-medical fields
LAŠTOVKOVÁ, Marie
The paper focuses on health risk factors for non-medical healthcare workers, namely general nurses and radiology assistants. Factors which may have negative impacts on healthcare workers{\crq} health affect both physical and mental health. Factors such as toxic substances, biological radiation, infectious diseases and spine and joints overloading caused by the incorrect manipulation with patients can have negative impact on physical health. Both physical and mental health is affected by stress, as well as by workers{\crq} lifestyle and education. Healthcare workers who take care of patients must be in a good physical and mental shape in order to provide quality care. Therefore, the goal of healthcare workers themselves, as well as of their employer, should be obtaining sufficient information on work safety and hygienic measures and being able to use the information in practice - they should actively participate in prevention of health damage related to the performance of their profession. The first hypothesis {--} non-medical healthcare workers are informed about risk factors associated with the performance of their profession - was confirmed. The second hypothesis - there are differences in the presence of risk factors among non-medical healthcare workers - was also confirmed; differences in the occurrence of some risk factors are clearly visible. Different healthcare professions should therefore be approached in a targeted way, with respect to the type of workplace and job description of healthcare workers. The third hypothesis {--} non-medical healthcare workers comply with preventive measures preventing health damage - was not confirmed. One of the reasons why hypotheses 1 and 2 were confirmed may be the fact that increased attention has been paid to this topic recently - standards have been made, and consequently also targeted audits. These measures have usually a positive impact - healthcare workers have gradually realized that safety measures are not useless, and by obeying them, healthcare workers protect not only patient and their surrounding, but especially themselves.
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