Fakultni nemocnice Plzen

Plzeň, Czech Republic

Fakultni nemocnice Plzen

Plzeň, Czech Republic

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Rusinova K.,Charles University | Kukal J.,Czech Technical University | Simek J.,University of South Bohemia | Cerny V.,Dalhousie University | And 23 more authors.
BMC Psychiatry | Year: 2014

Background: Symptoms of anxiety and depression are common among family members of ICU patients and are culturally dependent. The aim of the study was to assess the prevalence of symptoms of anxiety and depression and associated factors in family members of ICU patients in two Central European countries.Methods: We conducted a prospective multicenter study involving 22 ICUs (250 beds) in the Czech and Slovak Republics. The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety and depression in family members of ICU patients. Family member understanding of the patient's condition was assessed using a structured interview and a questionnaire was used to assess satisfaction with family member/ICU staff communication.Results: Twenty two intensive care units (both adult and pediatric) in academic medical centers and community hospitals participated in the study. During a 6 month period, 405 family members of 293 patients were enrolled. We found a high prevalence of anxiety and depression symptoms - 78% and 54%, respectively. Information leaflets distributed to family members did not lower incidences of anxiety/depression. Family members with symptoms of depression reported higher levels of satisfaction according to the modified Critical Care Family Needs Inventory. Extended contact between staff and family members was the only related factor associated with anxiety reduction (p = 0.001).Conclusion: Family members of ICU patients in East European countries suffer from symptoms of anxiety and depression. We identified limited family member/ICU staff communication as an important health care professional-related factor associated with a higher incidence of symptoms of anxiety. This factor is potentially amenable to improvement and may serve as a target for proactive intervention proactive intervention. © 2014 Rusinová et al.; licensee BioMed Central Ltd.


Kubackova K.,Fakultni Nemocnice V Motole | Finek J.,Fakultni Nemocnice Plzen | Vyzula R.,Masarykuv Onkologicky Ustav | Zvarikova M.,Masarykuv Onkologicky Ustav | And 9 more authors.
Klinicka Onkologie | Year: 2011

Backgrounds: The Yondelis® (trabectedin) project was initiated in January 2011 with the aim to obtain basic epidemiological information on patients with soft tissue sarcomas, standard treatment procedures, and results of trabectedin therapy in routine clinical practice. Expert patronage is provided by the Czech Society for Oncology, CzMA JEP. The project covers a representative sample of Comprehensive Cancer Care centres established to provide systematic treatment to patients with soft tissue sarcoma. Patients and Methods: 45 patients diagnosed with soft tissue sarcoma were retrospectively included in the database. Median age at the initiation of trabectedin therapy was 51 years (23-72 years). Leiomyosarcoma was the most frequent tumour (35.6%), synovial sarcoma occurred in 13.3% of patients; liposarcoma, peripheral nerve sheath tumours and unspecified sarcomas contributed 6.7% each. 62.2% of sarcomas were larger than 5 cm. Trabectedin was administered in a dose of 1.5 mg/m 2 once in 3 weeks. 40% of patients received trabectedin as the 2nd line treatment, 35.6% as the 3rd line, and 34.4% as the 4th line. Results: Median number of administered cycles was 4(1-10 cycles). Neutropenia (28.9% of patients) and elevated liver enzymes (26.7% of patients) were the most frequent adverse affects. 73.8% of patients terminated the therapy due to disease progression. Treatment response was recorded in 6.6% of patients (complete and partial remission), stable disease in 26.7%, and progression in 53.3%. Median overall survival (95% CI) was 11.7 months (9.6; 13.8), median progression-free survival (95% CI) was 3 months (2.4; 3.6). Conclusion: Expert cancer societies have recently recommended trabectedin as the 2nd line palliative treatment for soft tissue sarcomas with documented effectiveness, particularly in liposarcomas and leiomyosarcomas, and good safety profile.


Introduction. Therapy of high risk myelodysplastic syndromes (MDS) remains unsatisfactory. The only treatment that alters the natural history of the disease is allogeneic stem-cell transplantation, which can be offered to a limited number of young patients. Modern therapy predominantly focuses on prolonging survival, postponing potential acute myeloid leukaemia (AML) transformation and improving quality of life (QoL). New epigenetic therapy, especially methyltransferase inhibitors, has achieved these goals. Here, we present the experience of the Czech MDS Cooperative Group with 5-azacitidine treatment of patients with intermediate II and high risk MDS patients (IPSS), chronic myelomonocytic leukaemia II (CMML II) and AML with less than 30% myeloblasts in the bone marrow. Patients and results. Between October 2008 and June 2012, we used azacitidine treatment in 111 patients (66 M, 45 F), median age 68 years (range 48-85) with the diagnosis: 44 RAEB II, 13 RAEB I, 9 CMML II, 6 RCMD, 28 AML < 30% MB, 7 AML > 30% MB and 4 MDS/MPS. Median follow-up was 8.8 month (range 1-32), median number of cycles of azacitidine was 5 (range 1-28). The most common adverse events included haematological toxicity with neutropenia grade (Gr) 3/4 in 54.9% and thrombocytopenia Gr 3/4 in 70.3%. Non-haematological side effects, mostly only Gr1/2, were gastrointestinal in 21.6% and local reactions and fatigue in 31.5%. Response. The overall response rate (ORR) was 42.4% (CR 19.6%, CRi 6.5%, PR 16.3%), stable disease (SD) was achieved in 19.6% and haematological improvement (HI) in 57.4%. After one year, based on Kaplan-Meier estimates, 67.8% of patients were alive and the median overall survival (OS) was 16.4 months. We also analysed several clinical parameters collected at the start of azacitidine treatment as prognostic factors for OS (age, sex, ECOG performance status (PS), transfusion dependency, peripheral blast percentage, neutrophil count, platelet count, bone marrow blast percentage, fibrosis, percentage of erythroid precursors in bone marrow, cytogenetic data, WHO classification, IPSS, primary and secondary aetiology of MDS). Conclusion. Our results correlate very well with other published data (AZA 001, CALGB 9221). OS data are comparable with other "real life" studies. It is also important to take into consideration that our group also included very high risk patients (relapsed, refractory to previous treatment, post-transplant patients and AML with more than 30% myeloblasts). Nevertheless, our results are very promising and support the positive effect of azacitidine compared to standard therapy in high risk MDS patients. The analysis performed so far shows that from the aspect of OS, best response correlates with: cytogenetic aberration, peripheral blast count, neutrophil count and ECOG PS.


Geryk E.,Fakultni Nemocnice Brno Bohunice | Dite P.,Fakultni Nemocnice Brno Bohunice | Kozel J.,Masaryk University | Kubicek P.,Masaryk University | And 3 more authors.
Casopis Lekaru Ceskych | Year: 2010

During 1976-2005 the Czech Cancer Registry registered 1.486, 984 neoplasms of categories ICD-10: C00-D48, of which were notified 290, 312 (19.5%) multiple cases. There were 65, 292 primary diseases in men and 59, 970 in women, 89, 796 subsequent neoplasms in men and 75, 254 in women. The duplicities were higher in men and multiplicities higher in women. The multiple cases there were 19.5% of total new diagnosed neoplasms in men and 18.5% in women, without the skin cancers there were 13.7% in men and 13.6% in women. The most frequent were primary cancers of skin 46%, digestive tract 13.5%, urinary tract 9.6%, genital organs 8.1%, respiratory and intrathoracic organs 7.8% in men and cancers of skin 39.4%, breast 17.3%, genital organs 14.6%, and digestive tract 9.8% in women. The highest percentage of multiplicities in new diagnosed cases were cancers of skin 56.4%, melanoma 22.7%, urinary tract 19.9%, oral cavity 17.8%, genital organs 16.4%, endocrine glands 15.8% and haemopoietic tissues 13.9% in men, the cancers of skin 43.6%, oral cavity 19.8%, melanoma 18.6%, breast 17.7%, urinary tract 17.7%, genital organs 13.5% and endocrine glands 13% in women. The most multiplicities were registered in region Northern Moravia 38, 547 (13.3%), Southern Moravia 34, 219 (11.8%) and in Prague 34, 218 (11.8%). From 125, 262 patients, 18, 887 (15.1%) men and 22, 274 (17.8%) women survived, number of deceased persons was 46, 405 (37%) men and 37, 696 (30.1%) women. In the view of multiple cancers the broad education of lifestyle appears not to be sufficient for both the healthy population and for patients with 595 thousand cancers, expected in 2010.


A questionary survey among 474 cancer patients treated with strong opioids on regular basis for background pain in Czech oncological, pain- and palliative services. The prevalence of any form of breakthrough pain (BtP) was 75%. The medication used for management of BtP was oral morpine, non-opioids, oral tramadol, parenteral morphine, combination of opioids and non-opioids and transmucosal fentanyl in 35%, 20%, 15%, 11%, 17% and 1% respectively. The time to pain relief for oral morpine, non-opioids, oral tramadol, parenteral morphine, and transmucosal fentanyl was 21-30 min, 15-40 min, 30-40 min, 6-10 min and 16-20 min respectively. 72% patients were satisfied with the management of their BtP. Lower satisfaction (only 50%) was found among patients with 3-4 episodes of BtP per day and among those treated with non-opioids a tramadol (satisfaction rate 64% and 58% respectively). To assess the relation between background pain management and prevalence and clinical characteristics of BtP as well as the optimal strategy of BtP management of different types of BtP on longitudinal prospective design of the survey would be needed.


Surveys conducted in different countries and settings have described cancer breakthrough pain (CBTP) prevalence from 19% to 95%. Aim: To describe the CBTP in different clinical settings in Czech Republic as for prevalence, clinical characteristics, treatment strategies used and patient satisfaction. Method: A survey among cancer patients treated by oncologists and palliative care and pain specialists. Cooperating physicians distributed the questionary to unselected consecutive cancer patients in their office, who have been using for their pain strong opioids. Results: 474 patients completed the questionary. The "average" intensity of background pain was 0-4/10 in 74% (group A) and 5-10/10 in 26% (group B). The prevalence of CBTP was 71% in group A, 86% in group B. The duration of the episode of CBTP was 30-60 minutes in more than 50% of patiens. The number of CBTP episodes was 1-4 per day in 64% (median 3). More than 30% of patiens reported less than 1 episode per day. The intensity of CBTP in group A was severe and moderate in 56% and 46% respectively and severe in 96% in group B. The intensity of BCTP was in average 2 points higher than the reported background pain intensity Conclusion: CBTP is a very prevalent but heterogenous clinical phenomenon which should be assessed and managed in context with the background pain management. Longitudinal design of the study would be necessary to capture the impact of CBTP on patiens quality of life as well as the effectiveness of different therapeutic strategies.


Akinwande O.K.,University of Louisville | Akinwande O.K.,University of Pittsburgh | Philips P.,University of Louisville | Duras P.,Fakultni nemocnice Plzen | And 3 more authors.
CardioVascular and Interventional Radiology | Year: 2015

Purpose: To compare the feasibility, safety, and efficacy with small and large irinotecan drug-eluting beads (DEBIRI) for treating hepatic colorectal metastases.Methods: Using our prospectively maintained, multi-center, intra-arterial therapy registry, we identified 196 patients treated with a combination of large beads (100–300 to 500–700 μm) and patients treated with a combination of small beads (70–150 to 100–300 μm). To minimize selection bias, a propensity score analysis was performed to compare both groups.Results: Unadjusted analysis consisted of 196 and 30 patients treated with large and small beads, respectively. The adjusted analysis consisted of 19 patients each. Unadjusted analysis showed decreased all-grade (p = <0.001) and high-grade adverse effects (p = 0.02) in the small bead group, with a persisting trend toward decreased overall side effects in the adjusted analysis favoring small beads (p = 0.09) The adjusted analysis showed the percentage dose delivered (delivered dose/intended dose) was significantly greater in the small bead group compared to the large bead group (96 vs 79 %; p = 0.005). There were also a lower percentage of treatments terminating in complete stasis in the adjusted analysis (0.0035). Adjusted analysis also showed increased objective response rate (ORR) at 12 months (p = 0.04), with a corresponding trend also seen in the unadjusted analysis (0.09).Conclusion: Smaller beads result in increased dose delivery probably due to less propensity to reach complete stasis. It may also lead to more durable long-term efficacy. Smaller beads also demonstrate similarly low toxicity compared to large-sized beads with a trend toward less toxicity. © 2014, Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).


Machart S.,Fakultni Nemocnice Plzen | Lejcko J.,Fakultni Nemocnice Plzen | Kozak J.,Fakultni Nemocnice Motol
Bolest | Year: 2013

The aim of this study was to evaluate costs of pharmacotherapy before implantation of neuromodulation system in comparison with that six months after the implantation. The highest costs are represented by opioids and antineuropathic agents. Executive and subsequently management of hospitals exert on pain centres sustained pressure to decrease prescription these costly drugs. Pharmacotherapy expenses might among other things be reduced by early application of pain interventional and neuromodulation methods. Neuromodulation approaches are cost effective in the long-term despite the initial high costs of the implantable devices. These methods contribute to global reduction of health care consumption.


Cesak V.,Fakultni Nemocnice Plzen | Cesakova H.,Fakultni Nemocnice Plzen | Zourek M.,Fakultni Nemocnice Plzen | Kovarova K.,Fakultni Nemocnice Plzen | Rusavy Z.,Fakultni Nemocnice Plzen
Diabetologie Metabolismus Endokrinologie Vyziva | Year: 2015

Acute pancreatitis can present as a mild or a severe life-threatening disease. The critically ill patients should be admitted to an intensive care unit. utritional support. It is an integral part of the treatment. In mild acute pancreatitis it is not always necessary to use special types of nutrition. P intake is possible in most cases, however, acute pancreatitis can lead to systemic inflammatory response or multiorgan failure and thus patients are not eat. The metabolism and proteolysis are high. The aim of nutritional support is to cover the energy requirements of the organism, to sustain intestinal integrity and to accelerate recovery of patients. In the last years, the opinion on nutritional strategy has changed due to new data from clinical trials. Enteral nutrition is now superior to parenteral nutrition, polymeric formulas via nasogastric tube have the same effectivity as semielemental formulas via nasojejunal tube. Howerver, many questions remain unanswered, e.g. the role of nutrition supplements (glutamine, omega 3 fatty acids) or probiotics. These supplements are being discussed again.

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