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Emergency preparedness and protection of the inhabitans in the national company Budějovický Budvar in the release of hazardous substances
JIRKA, Martin
The thesis describes the issue of emergency preparedness and protection of the inhabitants in the National Corporation Budweiser Budvar during the release of hazardous substances. The thesis is focused on important aspects that determine the drafting of emergency documentation. One of aspects is the amount of hazardous chemical - ammonia. The total ammonia content in the object is 22 tons. This amount is according to the Act No. 59/2006 Coll., concerning prevention of major accidents as a sub-limit amount and not as an object into group A or B. On these not-classified resources are not subject to some duties under this Act, especially the obligation to prepare an emergency documentation (except where the regional authority include in the emergency plan then must provide and update the required documents). This paper doesn´t discuss by the massive leakage of 22 tons of ammonia. On the basis of analyzes were identified two sources of the risk. The first is a reservoir about the content of 10 tons which is located on the roof of the engine room. Maximum real filling is around 6 tons. The second source of risk is an expansion tank about the content of 14 tons, which is located in the building with cylinderconicals tanks (CKT). Considered fulfillment of the expansion vessel is about 7 tons. Although in this case is not about buildings and facility in which is treated with such a amount of dangerous chemical substances, which would belonged to the relevant group, I will perform available analysis according to a regulations issued or supportively used to analysis and risk assessment in according to the Act No. 59/2006 Coll., concerning prevention of major accidents. Harmful effects of ammonia are another important aspect. According to the Notice of the Ministry of Interior No. 103/2006 Coll., concerning establish principles defining the emergency planning zone and the extent and method of preparation of an external emergency plan, ammonia is taken as moderately toxic substance that irritates the eyes, mucous membranes, and in high concentrations can cause death. The great advantage from the point of view of the protection inhabitants are the warning properties. Characteristic pungency is already known in very weak concentrations. Also disposal of hazardous concentrations isn't technologically challenging, due to its solubility in the water. Another dangerous effect, except the toxicity is its explosiveness (explosive limit from 15 to 28 %) and flammability. Fortunately controlled condensing pressure prevents ignition and explosion of ammonia. Risk of the explosion and ignition of ammonia isn´t analyzed in this thesis, because the range of effects caused by leakage of several tons, is from a toxicological point of view more threatening. Impacts of hazardous concentrations aren´t threat only for people but also for animals and the environment. The thesis focuses on the analysis and evaluation of risks. The results of this research are an important element of the draft of emergency documentation. During the processing is calculated with methods IAEA-TECDOC-727, Dow's Chemical Exposure Index, Estimation of toxicity and software modeling program ALOHA. Further research is being done by brainstorming and semi-standardized interviews with employees of the company. In conclusion of the thesis is appropriate the drafting of emergency cards and emergency documentation (although not in range under the Act of concerning prevention of major accidents), according to which the reaction proceeded for any leakage of dangerous chemicals (ammonia) into the environment and the protection of workers which occur at the public premises or in the premises of the zone of impact of ammonia spilled outside the area Budweiser Budvar, NC. The use of the draft of emergency documentation is also conditioned by the location of the object in relatively densely populated areas of the county town of České Budějovice.
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Detection of extended-spectrum beta-lactamase (ESBL) producers in community and in a hospital
POLENOVÁ, Lucie
The incidence of bacteria resistant to available antibiotics has become an important problem. Statistics show the rising number of resistant bacteria worldwide. Bacteria have ability to be resistant naturally or they develop from point mutation of genes and relay it between species or kinds. The study was made because of significance and relevance of this problem. In theoretical part the study is focused on the functional parts of bacterial cell, which participate in mechanisms of resistance. Beta - lactam antibiotics are described in more detail. The research took place in Hospital České Budějovice, a. s. during 2013. The study aimed to determine the frequency of ESBL positive producers in this hospital and to compare with frequency in community, and to identify units with highest frequency of ESBL producers. Pathogens are isolated from clinical material, being delivered to bacteriology lab in Hospital České Budějovice, a. s. Resistant samples were examined with double disc synergy test (DDST) and quantitative method based on principle of minimal inhibition concentration in combination with chromogenic agar. The prevalence rate of ESBL producers is average to low in Hospital České Budějovice, a. s. During 2013, 12, 347 isolates were identified, ESBL production was identified in 226 isolates. Escherichia coli (183 isolates), Klebsiella pneumoniae (16 isolates), and Enterobacter cloacae (15 isolates) were the most prevalent species. The number of ESBL producers was lower compared to 2012, 2011, and 2010.
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Therapeutic hypotermia after cardiac arrest
JIRCOVÁ, Danuše
The bachelor thesis deals with the influence of a mild therapeutic hypothermia as a hospital post-resuscitation care of patients after cardiopulmonary resuscitation for non-traumatic cardiac arrest. Therapeutic hypothermia is a relatively new method. It is part of the European Guidelines for resuscitation since 2005. It was reported its positive effects on the neurological status of the patients. Using the method reduces the damage to the brain and cardiac muscle. The theoretical part of the thesis deals with the effect of mild hypothermia on the human body. Specifies the indication and contraindication criteria for initiation of therapeutic hypothermia, describes cooling methods of the patient and ways to terminate the therapeutic hypothermia. Describes the monitoring of physiological functions and nursing care of patients. The practical part of bachelor thesis mapped the procedures used in the administration of therapeutic hypothermia in patients treated in two large hospitals. These were Fakultní nemocnice Kralovske Vinohrady in Prague and Nemocnice Ceske Budejovice, a.s. The applied strategy of the research was qualitative. Content analysis of 10 case reports were carried out, 5 case reports from each hospital. Case reports concerning patients after cardiopulmonary resuscitation, who were treated using the therapeutic hypothermia as a part of hospital care. The aim of this thesis was to map the procedures used in the therapeutic hypothermia administration in patients after cardiopulmonary resuscitation. It was made available by hospitals after approval by ethics committees on the basis of applications submitted. The information was subsequently created into case studies that were analysed in the categorization tables. In the discussion, the results were compared with the published knowledge provided in the theoretical part of the thesis, and were commented. Analysed were: the composition of the group of patients by age and gender, provide the basic life support by witnesses prior to arrival of crew of the emergency medical service on scene, initial ECG rhythm after emergency medical service arrival, the time elapsed since the cardiac arrest appeared to restore of spontaneous circulation, initiation of therapeutic hypothermia in pre-hospital care, time elapsed since the therapeutic hypothermia start up to reaching the target body temperature, duration of the therapeutic hypothermia, the methods used for cooling the patients, the methods used for measuring the body temperature and neurological status at the time of discharge or transfer from the hospital. The results of the research surprisingly showed that general public are well-informed. Witnesses were able to recognize cardiac arrest, early called in professional help and were willing to give heart massage. This shows also the success in implementing the method of medical dispatcher-assisted basic life support in practice, because the witnesses were in many cases instructed by the medical dispatchers to resuscitate the patient. The majority of patient's initial ECG rhythm were diagnosed as ventricular fibrillation. Time to restoration of spontaneous circulation in most cases ranged within 29 minutes. To achieve the target body temperature at the recommended time limit has managed to half of patients. Target body temperature was always kept within the recommended timeframe and core body temperature was monitored. Concerns raised by an absence of the method start up in pre-hospital emergency care. The thesis highlighted the seriousness of sudden cardiac arrest and the high incidence of patients dismissed from the department with severe neurological deficit. Therefore, it is necessary to continue in research of this method, improve it and try to incorporate it already to pre-hospital care.
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The position of municipalities in the frame of the public administration in the Republic of Austria
STAŇKOVÁ, Lucie
The aim of the bachelor thesis is to introduce the system of public administration in the Republic of Austria. The bachelor thesis is focused on the position of municipalities in the frame of the public administration in the Republic of Austria, on their rights, position and role of the lowest municipalities in the Austrian administrative system. The bachelor work is complemented by the case study that is the sociological survey with the local representatives of the local administration and self-government.
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Profile of visitors of the Toulava touristic region
PLZÁKOVÁ, Aneta
This bachelor thesis focuses on tourist area Toulava which arose three years ago. It mentions the history of Toulava which was created as a combination of beautiful nature and interesting tourist sites. It analyses what visitors always do here and popular tourist sites. The first part focuses on literature. The practical part of the work introduces two researches which were done during the summer season in 2013 and through the summer in 2015. The goal was to get a general visitor profile of Toulava. Tourist from this region filled in the questionnaires relating to this area, which were placed at various tourist spots. The work concludes that the visitors profile is still the same and tries to suggest a new product for gaining the interest of potential tourist.
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Product Innovation of the selected tourism company
JUNGVIRTOVÁ, Kateřina
This bachelor thesis deals with innovations in a company which expands its business for activities of travel agency. The aim of this work is to analyze present product of the company and needs and wishes of potential customers. Moreover to recommend the product for the travel agency, eg. water theme tours. The theoretical part is dedicated to the characteristics of legal and other facts related with the issue of travel agency founding and informations about product and its innovations, sport and recreation tourism and water tourism as a part of it. The application part consists of the company description and the research. The method of directquestioning was used for this research. The questioning was realized face to face directly in the company. For the research was chosen people who at least once used its services. For comparison of acquired results Chi-squaretest was applied. In the conclusion of the thesis was compiled three water theme tours, each one of them for specific customer segment. Bachelor thesis shows the extension ofthe company in practice, especially establishing the travel agency. It explains the specific steps important for achieving successful results.
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Specifics of nursing care in patients after transapical aortic valve implantation.
VOTRUBOVÁ, Nataliya
Transcatheter aortic valve implantation (TAVI) is a new and an attractive method in cardiology and as well as in cardiac surgery. It is constantly evolving method which has been developed as an alternative to standard open surgery, especially in patients with severe symptomatic aortic stenosis with unacceptably high perioperative risk or patients who are not suitable for conventional open heart surgery because of age and comorbidities.A teamwork is very importantfor this new method and approach. The choice for TAVI is discussed by the institutional multidisciplinary heart team, typically consisting of interventional cardiologists, imaging-specialists, cardiac surgeons and anaesthesiologists. The first implant in a human being was performed by Cribierin 2002. In Czech Republic this method was first used in 2008. Transcatheter aortic valve implantation (TAVI) was accepted as a minimally invasive alternative to open surgery. This method does not require the use of cardiopulmonary bypass, and cardiac arrest. Other several benefits includinglower risks of bleeding and stroke events, better wound healing, less pain, as well as more rapid early recovery due to preservation of continuity of the sternumthat result in shorter durations of stay in the hospital, earlier rehabilitation and faster returns to normal life. In the presented work was used a combination of qualitative-quantitative methods of investigation. The data was obtained by using the quantitative research. The main technique was using the questionnaires designed for nurses working at the Department of Cardiac Surgery, Hospital Czech Budejovice, a. s. These results were backed up by the implementation of qualitative research, which investigated the patients and physicians view on monitored issues. Questioning method using a semi structured interview technique was used for qualitative research. The results of the survey were processed using descriptive statistics charts in LibreOffice Calc and using diagrams created in LibreOffice Writer. Qualitative results of the research were transcribed from audio recordings and coded, and the base code was created nine categories of interviews with clients/patients and three categories of interviews with doctors. The aim of this work was to explore the specific problem of nursing care about the clients / patients after transapical aortic valve implantation. On the base of our obtained data it is evident, that the client/patient after TAVI may be positioned sideways, the use of surgical drains are less frequently, so the care about the surgical wounds is simpler, patients report less pain in the surgical wound and postoperative rehabilitation and recovery is shorter. H1 - The nurses take care about the clients/patients after transapical aortic valve implantation in the same way as about the clients/patients after open aortic valve replacement, without realizing the differences between the patients treated with different approaches, was not confirmed. The nurses'sees/reported major differences in invasiveness and extent of providing care, rehabilitation, convalescent, in the duration of the hospitalization and better cosmetic effect. The results of the research can serve as a basis for creating the standards of nursing care or educational material for clients/patients. It is also possible to present the results of this work at a specialized seminar for non medical healthcare workers and results can also increase the quality of nursing care about the clients/patients after transapical aortic valve implantation.
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Nutritional care of children at pediatric clinics and hospitals
METELCOVÁ, Jana
The main goal of this work called Nutritional Care in Children's Hospital and Hospital facilities is to verify whether the nutritional standards created for older child patients meet the needs and are checked and if their physiological needs are fulfilled in chosen hospitals. The next objective is to evaluate the satisfaction of the hospitalised patients with the meals given to them by hospitals. The theoretical part of this work deals with nutritional care, therapeutic care and nutritional needs of adolescents. It further deals with nutritional risks and marginally mentions technological processes regarding meal preparation. The method of qualitative research was used by using questionnaires filled in by chosen children patients who were then interviewed. Children aged 10 to 14 were supposed to be on diet number 13, half of them were boys and the other half were girls. The research was conducted in the children's ward in the hospital in Jindřichův Hradec in December 2015 and in the same type of ward in the hospital in České Budějovice in February 2016. The initial number of respondents was five patients in each ward, then using snow ball sampling method their number increased into ten in each ward. The weekly menu according to which the meals were distributed was obtained from the catering facilities of the hospitals. By using the program "Nutriservis Profi" the contents of nutrients in the meals were obtained. The results gathered from the program "Nutriservis Profi" were compared with recommended values for particular age group defined by The Czech Society for Nutrition, so meeting the physiological needs of the patients could be evaluated. From the results it was found that both hospitals have problems with supplying enough fibre content, phosphorus and calcium in meals for children's patients. There is also sodium, potassium, cholesterol and vitamin C surplus in the menus. Thanks to the internship in both hospitals in Jindřichův Hradec and České Budějovice meeting the physiological needs of the children could be evaluated. Considering the fact that the previous evaluation revealed some imperfections, therapists from both hospitals should concentrate more on checking nutritional values in meals, consequently it was recommended to focus more on the variety of the menus and their improvement. There were also inadequacies in attendance at the children's ward. There was a comparison of the results from both hospitals, based on questionnaires and interviews from the children's point of view. Based on the data, children hospitalized in Jindřichův Hradec were more satisfied with the meals. In the conclusion there is a summary of the research and suggested suitable improvements for hospitals. There is a model menu for diet number 13 in the attachment which could be used by hospitals.
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