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Pharmacogenetic prediction of tamoxifen efficiacy and adverse effects in hormonal dependent breast karcinoma patients.
Argalácsová, Soňa ; Slanař, Ondřej (advisor) ; Vrána, David (referee) ; Paluch, Zoltán (referee)
ABSTRACT/SUMMARY Background: The clinical efficacy of tamoxifen therapy may be modified by the drug-metabolizing enzymes and transporting molecules involved into the pharmacokinetics of tamoxifen. The aim of this study was to evaluate the association of CYP2D6, ABCB1 polymorhisms and comedication with efficacy and safety of tamoxifen treatment. Methods: Totally 258 women with hormonal positive breast carcinoma were retrospectively evaluated in relation to CYP2D6, ABCB1 polymorphisms and comedication. Results: CYP2D6 polymorphisms or co-medication affecting CYP2D6 activity demonstrated no statistically significant effect on the efficacy of tamoxifen therapy or adverse event incidence; there was only a trend towards shortening the time to event (TTE) in CYP2D6 poor metabolizers. ABCB1 polymorphism rs2032582 was not associated with clinical outcomes, while a trend towards an increase of TTE in variant allele carriers was noted. The ABCB1 polymorphism rs1045642 demonstrated statistical significance in premenopausal patients (p = 0.0012, HR 0.69 (95% CI 0.21 to 2.31), and its significant association was noted with gynaecological /vasomotor adverse events (p = 0.0221, HR = 1.0588), with no evidence of the influence on the incidence and onset of venous complications. Conclusions: Although this work did not show...
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Analysis of Spontaneous Adverse Events Reports of InfanrixHexa vaccine
Kovaříková, Klára ; Zimčíková, Eva (advisor) ; Rejmanová, Anna (referee)
Analysis of spontaneous adverse events reports of Infanrix hexa vaccine Author: Klára Kovaříková Supervisor: PharmDr. Eva Zimčíková, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction: Infanrix hexa vaccine is used for vaccination of infants and toddlers against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and disease caused by Haemophilus influenzae type b. Analysis of spontaneous adverse drug reactions (ADRs) reports is one of the most important sources of information to evaluate drug-related risks. Objective: The aim of this study was to analyse spontaneous ADRs reports of Infanrix hexa vaccine, which were sent to the State Institute for Drug Control (SÚKL) database in the period from 2004 to 2017. Methods: The data was analysed using descriptive statistic in MS Excel. ADRs were classified according to the MedDRA. Seriousness and expectedness of ADRs were evaluated. Results: Overall 1288 reports were obtained containing 4334 ADRs, approximately 3.4 ADRs per report. Infanrix hexa vaccine was the only suspected drug in most of the reports (75.9%). Physicians were the most frequent reporters (70.2%). Serious ADRs were found in 84.3% of reports. The most frequent ADRs were general disorders and administration site...
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Pharmacogenetic prediction of tamoxifen efficiacy and adverse effects in hormonal dependent breast karcinoma patients.
Argalácsová, Soňa ; Slanař, Ondřej (advisor) ; Vrána, David (referee) ; Paluch, Zoltán (referee)
ABSTRACT/SUMMARY Background: The clinical efficacy of tamoxifen therapy may be modified by the drug-metabolizing enzymes and transporting molecules involved into the pharmacokinetics of tamoxifen. The aim of this study was to evaluate the association of CYP2D6, ABCB1 polymorhisms and comedication with efficacy and safety of tamoxifen treatment. Methods: Totally 258 women with hormonal positive breast carcinoma were retrospectively evaluated in relation to CYP2D6, ABCB1 polymorphisms and comedication. Results: CYP2D6 polymorphisms or co-medication affecting CYP2D6 activity demonstrated no statistically significant effect on the efficacy of tamoxifen therapy or adverse event incidence; there was only a trend towards shortening the time to event (TTE) in CYP2D6 poor metabolizers. ABCB1 polymorphism rs2032582 was not associated with clinical outcomes, while a trend towards an increase of TTE in variant allele carriers was noted. The ABCB1 polymorphism rs1045642 demonstrated statistical significance in premenopausal patients (p = 0.0012, HR 0.69 (95% CI 0.21 to 2.31), and its significant association was noted with gynaecological /vasomotor adverse events (p = 0.0221, HR = 1.0588), with no evidence of the influence on the incidence and onset of venous complications. Conclusions: Although this work did not show...
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The quality of nursing care at selected department subsequent care
KRATOCHVÍLOVÁ, Eva
Current state: The goal of nursing is a quality of nursing healthcare. Each department has its own specific features and therefore has its own quality indicator. This work focuses on two quality indicators related to healthcare, specifically on patients with MRSA infection and their falls. Methodology: In the research were applied three methods of data collection: 1) statistical data from the hospital system; 2) intentional structured observation; 3) structured interviews. Research file: In order to evaluate the incidence of falls and cause of falls, were examined a total of 85 patients and a total of 98 patients for evaluation of decolonized patients with MRSA infection. The investigated group of people for observation and in-depth interviews were ONP nurses from the 6th floor of České Budějovice Hospital, plc. Results: The hypothesis that the most common cause of the fall is leaving the bed without any accompaniment has not been confirmed and the incidence of falls at the patients throughtout the observation period of the year 2015 dropped down significantly in comparison with the year 2014. The most common source of MRSA infection was a wound. Also, has not been confirmed the hypothesis that the number of decolonized patients with MRSA infection who were observing in the year 2015 will be statistically higher than in the year 2014. Most nurses know the cause of MRSA infection, but the problems they have are the precise definitions. By observing the practical activities and skills of nurses during the treatment of patients with MRSA infection were revealed certain shortages, especially the improper use of protective equipment and the improper disinfection of aids after their use. Conclusion: The results of the research show the need for more nursing education in this subject. Adverse events are a serious complication of the nursing process. The number of falls as well as the number of decolonized patients with MRSA infection is not successful significantly decrease in comparison year-on-year. The research also found inadequate theoretical preparedness of the nurses in the area of infectious diseases and a certain discrepancy between verbally presented experiences and the results of observation real activities.
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Patient safety in the operating theatre
Fejglová, Pavla ; Holečková, Zuzana (advisor) ; Milfaitová, Vlasta (referee)
Author: Pavla Fejglová Institution: Department of Social Medicine, Charles University, Faculty of Medicine in Hradec Králové, Department of Nursing Care Title of the thesis: Patient safety in the operating theatre Supervisor: Ing. Zuzana Holečková Number of pages: 133 Number of attachments : 8 Year of defence: 2014 Key words: perioperative care, safety, quality of care, adverse events This bachelor thesis deals with one of the crucial roles of the medical staff in the operating theater - the issue of ensuring patient safety and quality of nursing care during the perioperative period on central operating theaters of the University Hospital in Hradec Králové and Liberec Regional Hospital from the perioperative nurses point of view. The core of the empirical part consists of quantitative research in the area of compliance with the measures to ensure the safety of patients during their stay in the operating room. Research data were obtained thanks to the understanding of perioperative nurses from operating theatres of the above mentioned hospitals. Based on the data, analysis was conducted with interpretation of results and several measures aimed mainly to improve the safety of patients during the perioperative period and the prevention of adverse events are proposed.
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Ensuring Patient Safety in Healthcare Facility.
MICHÁLKOVÁ, Dominika
The thesis contains a summary of issues relating the quality and safety of services and healthcare environment. The theoretical part is a cross section of the whole topic of quality and safety from a culture of quality and safety, ensuring and creating safe care at European and global level, through causes and prevention of adverse events, the influence of the European Union on this issue, the national legislation, the accreditation investigation and evaluation of the quality and safety. The research is focused towards deeper investigation the issue, clarification of concepts, causes and contexts. The pur-pose is not to draw conclusions directly, but to explore how some facilities are in comparison with the theory and in comparison with each other. The purpose and goal of this work is to determine whether the currently implemented measures and changes lead to improving of services and greater safety. The main goal of the thesis is: To determine whether the introduction of DSO (Departmental security objectives) has a positive effect on patient safety in health facilities in Pilsen and South Bohemia regions and compare the differences. As a tool to clarify the quality and safety I chose a descriptive qualitative research and quantitative analysis of adverse events in observed group. Quality was assessed by using questionnaire consisting of the main and most important parts of the theoretical concept. From data obtained by questionnaire was subsequently compiled a description of the culture of quality and safety of each facility and then compared. A numeric data was used to compare the incidence of adverse events before and after the implementation of a program of continuous improving quality and safety as well as between members of the research group.
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Risk Management in Selected Health Facilities
JÍNOVÁ, Jana
Healthcare risk management consists of continuous consideration of potential adverse situations and their prevention. In this sense, healthcare facilities consider any source of uncertainty to be a risk which must be eliminated or, at least, reduced. International studies show that up to 70% of adverse events could be prevented. Reasons for observing various types of adverse events may differ in individual healthcare facilities. However, most adverse events are observed in an effort to prevent their consequences upon patients' health.
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Assessment of safety culture in selected hospitals in the Ústí nad Labem and Liberec regions
VOLENÍKOVÁ, Kateřina
Current status: The issue of medical errors has recently gotten considerable attention among organizations at the global and national levels. In its report the Institute of Medicine recommended the development of a safety culture where employees want to provide the safest health care. Assessing the current culture of safety is the first stage in the development of patient safety. Subject: The main purpose of the research was "to evaluate the safety culture in select hospitals." Method: A standardized method was chosen for the research: The AHRQ Hospital Survey on Patient Safety Culture. A quantitative method was implemented using polling. Obtained data were tested in SPSS version 16.0. For statistical testing Person's chi-square and sign scheme was elected. Research group: The research survey addressed 301 non-medical staff of Krajské zdravotní a.s. Masarykova nemocnice, o. z. (Regional Health a.s. Masaryk Hospital) in Ústí nad Labem and Krajské nemocnici Liberec, a.s. (Liberec Regional Hospital) Results: The survey results showed that the surveyed health care professionals assess the organizational culture as friendly. The respondents indicated that they are praised by the manager for conducting their work safely and that they can suggest changes in management practices. The results showed that addressed health care professionals support each other (58.1%) and cooperate better (72.4%). According to the respondents, better teamwork leads to better patient safety. An analysis of the results shows that health professionals have an active approach to safe care (82.7%) and in their opinion, errors and mistakes lead to improved patient safety (40.9%). Paramedics have confirmed that they receive feedback on reported incidents (37.9%). Based on team discussion about errors the respondents' evaluation of patient safety has significantly improved. An analysis of respondents' answers revealed a lack of reporting of adverse events. Most respondents consider the number of staff in the workplace deficient (42.5%). Conclusion: Hospital management should be involved in changing the detection of individual errors from individual to systemic. In order to improve the safety culture there should be regular supervision or teambuilding activities that support the development of teamwork. Feedback on the results of reporting errors must be given in an appropriate way to motivate staff to continue to report future errors. The results require a change in how medical staff report errors and greater consistency among management when checking reports. Complaints of work overload by medical personnel must be taken seriously. Improvements can be brought about by changes to work organization or the use of temporary workers.
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Undesirable effects in nursing care
MARKOVÁ, Ladislava
Adverse events in nursing care are currently much discussed topic. In providing of nursing care we meet with some kind of adverse events every day. But not always we come to realize that it is an adverse event. The number of adverse events grows up every year and this topic becomes more current. The target of this bachelor thesis titled Adverse events in nursing care was to obtain enough information about the discussed topic of adverse events. Practical part of bachelor thesis was prepared by form of quantitative research carried out by using questionnaire survey. Based in the results from questionnaire survey were confirmed or unconfirmed given hypotheses. Ascertained results were summarized in the graphs of which analysis confirmed the hypothesis no.2 The average age of clients who suffer most with the adverse events is from 65 to 75 years. Hypothesis no. 3 The most common adverse events are falls. Hypothesis no. 4 The most commonly used methods of prevention are barriers and warning devices. Hypothesis no. 5 Adverse events occurring more in internal wards. Hypothesis no. 1 The frequency of adverse events increased in 2011, compared to other years based on the processed research results, was not confirmed. As emerged from the research, to the topic of adverse events is not attached such seriousness as it should and sometimes are adverse events underestimated by medical staff. The results of the research will be presented and consulted with the hospital´s main nurse, who could works with it within the meaning of the organizing various seminars, information meetings with my contribution and participation.
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