Tento příspěvek je druhým příspěvkem v sérii článků zaměřených na vývoj etického pojetí eutanazie. Problém eutanazie řeší na pozadí slavné Rachelsovy publikace The End of Life. Rachels je autor zastávající novodobou koncepci utilitaristické morálky. Ve své publikaci The End of Life velmi podrobně probírá všechny důležité momenty filosofické a etické diskuse o eutanazii a vytyčuje tak kontury území, na němž se jak zastánci jeho závěrů, tak i jejich odpůrci, musí pohybovat. Hovoří o posvátnosti lidského života, rozebírá různé formy eutanazie, kriticky hodnotí některé důležité distinkce, široce a někdy nekriticky užívané v lékařské etice: rozdíl mezi usmrcením (killing) a ponecháním zemřít (letting die), mezi řádnými a mimořádnými léčebnými prostředky, mezi aktivní a pasivní eutanazií. Důležitým prvkem Rachelsovy reflexe je i diskuse o důležitosti úmyslu (intence) v etickém vyhodnocování lidských skutků., This contribution is the second of a series of articles devoted to the ethical evaluation of euthanasia. It discusses the problems of euthanasia on the background of Rachel´s famous book The End of Life. Rachels as an author is holding a modern concept of utilitarian morality. In his publication The End of Life he discusses in detail all the important moments of philosophical and ethical debate about euthanasia. In this way he also outlines the contours of the territory for his proponents as well as their opponents for recent discussion on euthanasia and end of life decisions. He talks about the problems of conception of the sanctity of human life, discusses the various forms of euthanasia, critically evaluates some important distinctions between terminology in medical ethics: the difference between killing (killing) and allowing to die (letting die), between ordinary and extraordinary means of treatment, the active and passive euthanasia. One of the most important element of Rachels´ reflection is also the importance of intention in the ethical evaluation of human acts., David Černý, and Literatura
Tento příspěvek je první z řady článků věnovaných etického zhodnocení euthanasie. Pojednává o preferenčním utilitarismu Petera Singera a ukazuje, jakým způsobem se v rámci tohoto etického systému euthanasie ukazuje jako eticky oprávněná volba. Článek je rozdělený do dvou hlavních částí. V první části jsou předloženy základní principy utilitarismu a uvádí se důležité rozlišení mezi lidskými živočichy a osobami (založené na schopnosti vyšších kognitivních funkcí). Druhá hlavní část článku se podrobně věnuje vyjasnění základních forem euthanasie (vyžádaná, nevyžádaná, nedobrovolná) a argumentuje, že mezi pasivní a aktivní euthanasií neexistuje žádný morálně významný rozdíl. Článek končí konstatováním, že aktivní euthanasie je morálně lepší volbou než pasivní euthanasie., This contribution is the first of a series of articles devoted to the ethical evaluation of euthanasia. It discusses the preference utilitarianism of Peter Singer and shows that euthanasia can be a morally permissible choice. The article is divided into two main parts. In the first part the basic tenets of utilitarianism are set forth, the important distinction between human animals and persons is made (based on the capacity for higher cognitive functions). The second main part of the article is devoted in detail to the clarification of basic forms of euthanasia (voluntary, involuntary and non-voluntary), it is argued that there in no morally significant difference between passive and active euthanasia end, finally, the article concludes by noting that active euthanasia is morally more preferable then passive euthanasia., David Černý, and Literatura
Motivation Until recently it was considered that 65 years is cutoff for defining patients as elderly, but newer reports indicate that this age limit shift to 70 years of age. Elderly patients with advanced non small cell lung cancer, associated comorbidities and poor performance status represent a specific population and a challenge for use of chemotherapy. Primary aim was to evaluate the impact of mono therapy with oral etoposide on overall survival in elderly patients (≥ 70 years of age) with advanced non small cell lung cancer and poor performance status (PS) ≥ 2 (clinical stage IIIb and IV ), and as well to evaluate tolerability of this therapy. Secondary aim was to evaluate response rate. Methods Retrospectively, medical records of 79 female and male patients with advanced non small cell lung cancer and poor performance status treated with oral etoposide (2x25 mg 20 days/10 days pause) in period from 2007 till 2010 were checked for relevant data. Data regarding demographics, performance status, overall survival, response rates and drug toxicity were collected. For statistical analysis we used Pearson chi-square test, T-test, Kaplan-Meier product limited method and Cox regression. Results Median overall survival (OS) was 31 weeks, in patients with PS 2 overall survival was 34 weeks, and in group with PS 3 was only 24 weeks. Partial response was registered in 20.2% of patients, stable disease in 41.85 % and disease progression in 38% of patients. Treatment was well tolerated, febrile neutropenia and toxic deaths were not registered. Toxic effects didn't have statistically significant influence on OS. Conclusion Oral etoposide used as mono therapy has been shown as moderate effective and very safe in treating elderly patients with advanced non small cell lung cancer and poor performance status so it represents a good therapy option for treating this specific population., Zoran Andrić, Vladimir Kovčin, Slobodanka Crevar, Zafir Murtezani, Sanja Kostić, and Literatura
The aim of this review is to summarize main aspects of the book Evropská úmluva o lidských právech written by Kmec, J., Kosař, D., Kratochvíl, J., Bobek, M., published in 2012 in Prague. As the title suggests the book itself is focused on Convention for the protection of human rights and fundamental freedom and relating questions, e.g. application to the European court of human rights, case proceeding and case - law. This review briefly informs about the authors, however it ́s mainly concentrated on th e publication ́s content. Paper itself describes component parts in the same order as it is written in the book and Jan Kotula
Introduction: Oral Lichen planus (OLP) is chronic inflammatory oral mucosal disease of unknown etiology. Basement membrane damage and T‑cell migration in OLP may be mediated by matrix metalloproteinases (MMPs). We examined the expression of matrix metalloproteinase 9 to support this hypothesis. Materials and methods: The study population consisted of 71 patients with OLP and 10 control patients with oral fibromas. Indirect immunohistochemistry was used for detection of MMP 9 expression (polyclonal rabbit anti‑human MMP antibody). Results: In all cases of OLP, the MMP‑9 expression was seen mainly in the area of lymphocytic inflammatory infiltrate in the lamina propria including lymphocytes within the overlying epithelium. In addition, it was observed in the epithelial keratinocytes, particularly in the stratum basale and stratum spinosum with occasional positivity in the superficial layer. Fibroblasts and endothelium of small vessels in the lamina propria showed MMP9 expression as well. In all cases of oral mucosal fibromas, the MMP‑9 expression was seen only in fibroblasts and in endothelium of small vessels with occasional positivity within the overlying epithelium. It remains unclear, whether MMP‑9 is directly connected to OLP pathogenesis., Vladimíra Paulusová, Jan Laco, Ivo Dřízhal, Radovan Slezák, and Literatura 24
Cíl práce: Analýza výsledků extrakčních vaginálních operací ve FN Motol v období let 2007 – 2011. Typ studie: Retrospektivní analýza Soubor a metodika: Analýza 341 vaginálních extrakčních porodů – frekvence využití jednotlivých instrumentů, indikace k jednotlivým extrakčním operacím, mateřské a neonatologické komplikace. Výsledky: V daném období stouplo využití extrakčních metod z 0,81 % na 3,55 %. Tento stoupající trend byl dán zejména zvyšující se frekvencí využití vakuumextraktoru (VEX). Na našem pracovišti se VEX do roku 2007 nepoužíval vůbec, v roce 2011 již tvořil 92 % všech extrakčních operací (nárůst z 0 % na 3,27 %, forceps pokles z 0,81 % na 0,28 %). Indikační schéma k využití jednotlivých instrumentů se v průběhu let také změnilo, dominantou k využití forcepsu byla hypoxie, v roce 2011 při vzrůstající oblibě vakuumextraktoru tvořila právě hypoxie již 50 % indikací k jeho využití. Četnost poranění matky i novorozence byla nižší při použití vakuumextraktoru, kefalhematom novorozence v 7 % u VEXu a 13 % u forcepsu. Závěr: V daném období došlo na našem pracovišti k celkovému zvýšení četnosti extrakčních porodů, a to zejména vlivem použití vakuumextraktoru. Vakuumextraktor je dle našich dat spojen s nižší mateřskou a novorozeneckou morbiditou. Neonatologické výsledky obou metod jsou srovnatelné, mírně však ve prospěch vakuumextraktoru. Výjimkou je jeho neúspěšné použití., Objective: To analyze the results of assisted vaginal deliveries at the Motol University Hospital for the period 2007–2011. Type of study: A retrospective analysis Material and Methods: Analysis of 341 vaginal assisted deliveries - frequency of individual instrument use, indications for assisted vaginal deliveries, maternal and neonatal complications. Results: During the given time period the frequency of assisted vaginal deliveries increased from 0,81 % to 3,55 %. This increasing trend was mainly due to the increasing frequency of vacuum extractor (VEX) use. The first vacuum assisted vaginal delivery at our hospital was recorded in 2007. In 2011 this method already accounted for 92 % of all assisted vaginal deliveries (an increase from 0 % to 3,27 %; the frequency of forceps deliveries decreased from 0,81 % to 0,28 %). Over the years, indications for the use of instruments have also changed. Main indication for forceps delivery used to be hypoxia, but in 2011, with increasing popularity of vacuum extractions, it accounted only for 50 % of indications for its use. Frequency of maternal and neonatal injuries was lower when using vacuum extractor, newborn cephalhaematoma was recorded in 7 % when vacuum extractor was used and 13 % when forceps was used. Conclusion: During the given time period there was an overall increase of assisted vaginal deliveries at our department, mainly because of the vacuum extractor use. According to our data, vacuum extraction is associated with lower maternal and neonatal morbidity. Neonatal results of both methods are comparable, but slightly in favour of vacuum extraction, except cases of its unsuccessful application., P. Hanulíková, H. Hrubantová, R. Vlk, T. Binder, and Literatura 10
Cíl: Hlavním cílem výzkumného šetření bylo zjistit, které faktory ovlivňují pouţívání ošetřovatelských diagnóz v klinické praxi. Dalším cílem bylo zjistit rozdíly v hodnocení faktorů ovlivňujících pouţívání ošetřovatelských diagnóz v praxi podle věku, vzdělání a typu pracoviště. Metodika: Pro získání dat byl sestaven nestandardizovaný dotazník zaměřený na zjištění faktorů ovlivňujících pouţívání ošetřovatelských diagnóz. Výzkumný soubor tvořilo 253 registrovaných všeobecných sester z 9 zdravotnických zařízení v České republice. Sestry hodnotili na Likertově škále od 1 do 5, jak jednotlivé faktory ovlivňují pouţívání ošetřovatelské diagnostiky v praxi. Výzkumné šetření probíhalo od června 2011 do listopadu 2011. Výsledky: Podle našeho výzkumného souboru nejvíce ovlivňují pouţívání ošetřovatelských diagnóz v praxi následující faktory: počet pacientů na 1 sestru, administrativní zátěţ, syndrom vyhoření, nedostatek času, rozdíly v teorii a praxi a nedostatek personálu. Statisticky významné rozdíly v hodnocení faktorů podle věku byly zjištěny v hodnocení 2 faktorů: rozdíly v teorii a praxi, nedostatek motivace. Podle dosaţeného vzdělání byly statisticky významné rozdíly zjištěny v hodnocení 4 faktorů: nejednotnost ošetřovatelských diagnóz, terminologie diagnóz, rozdíly v teorii a praxi, rutinní práce. V závislosti na typu pracoviště byly statisticky významné rozdíly nalezeny v hodnocení 5 faktorů: terminologie diagnóz, rozdíly v teorii a praxi, nedostatek praktických zkušeností s ošetřovatelskou diagnostikou, rutinní práce, syndrom vyhoření. Závěr: Rozeznání faktorů ovlivňujících pouţívání ošetřovatelských diagnóz v praxi a zlepšení institucionální podpory můţe ulehčit implementaci ošetřovatelské diagnostiky v klinické praxi, Aim: The main aim of the study was to identify which factors influenced the use of nursing diagnoses in clinical practice. Another aim was to ascertain whether age, education and type of workplace affected the relative importance accorded to these factors. Methods: A non-standardized questionnaire on factors influencing the use of nursing diagnoses was administered to a sample consisting of 243 registered general nurses from 9 healthcare facilities in the Czech Republic. Using Likert´s 5-point scale, the nurses rated the importance of several factors in influencing their use of nursing diagnoses in practice. The research was conducted between June 2011 and November 2011. Results: Based on our sample, there are several factors which influence the use of nursing diagnoses in practice. Some of them are: number of patients per nurse, administrative strain, burnout syndrome, lack of time, discrepancies between theory and practice, lack of staff. Statistically significant age-related differences in rating factors were found for the following: discrepancies between theory and practice, lack of motivation. Statistically significant differences in ratings relative to education were found for four factors: disunity of nursing diagnoses, diagnostic terminology, discrepancies between theory and practice, workplace routine. Based on type of workplace, statistically significant differences in ratings were found for five factors: diagnostic terminology, discrepancies between theory and practice, lack of practical experience in nursing diagnostics, workplace routine, burnout syndrome. Conclusion: Recognizing the factors which influence the use of nursing diagnoses and enhancing institutional support can facilitiate the implementation of nursing diagnostics in practice., Helena Macková, Renáta Zeleníková, and Literatura 14
Cieľ: Cieľom štúdie bolo analyzovať faktory ovplyvňujúce dentálnu hygienu, medzi ktoré patrí konzumácia sladkostí a sladených nápojov u školskej mládeže z hľadiska veku a pohlavia a zároveň analyzovať výskyt dentálnej hygieny počas dňa. Metodika: Súbor respondentov tvorilo 1187 žiakov (620 dievčat a 567 chlapcov) vo veku 11, 13 a 15 rokov v oblasti stredného Slovenska. Zber údajov prebiehal v období máj 2010 až jún 2010. Na zber údajov bol použitý štandardizovaný dotazník vytvorený pre potreby HBSC štúdie (Health Behaviour in School – aged Children). Výsledky boli vyhodnotené Chí-kvadrát testom. Výsledky: Sladkosti a kolu v jednotlivých vekových kategóriách konzumuje každý deň alebo viac krát za deň približne tretina respondentov. Výskyt umývania zubov viac ako raz denne je približne rovnaký vo všetkých vekových kategóriách od 53% u 11 ročných chlapcov do 64% u 15 ročných dievčat. Vo všetkých vekových kategóriách dievčatá udávajú častejšie umývanie zubov v porovnaní s chlapcami. Záver: Výsledky poukazujú na zvýšenú konzumáciu sladkostí a koly počas dňa u školskej mládež stredného Slovenska, čo môže spôsobovať zvýšenú kazivosť zubov. Dentálna hygiena je v našom súbore respondentov nedostačujúca. Na základe získaných výsledkov je možné konštatovať, že potreba zvyšovania úrovne vedomostí nielen detí, ale aj rodičov o zásadách správneho stravovania a o zásadách dentálnej hygieny je neodmysliteľnou súčasťou výchovy k zdraviu a preventívnych opatrení v školskom veku., Aim: The aim of the study was to analyse the factors affecting dental hygiene such as consumption of sweets and sweet soft drinks in school-aged pupils in terms of their age and gender and at the same time to analyse the occurrence of dental hygiene during the day. Methods: The set of respondents consisted of 1187 pupils (620 girls and 567 boys) at the age of 11, 13 and 15 years in the area of central Slovakia. The data collection was conducted in the period of May 2010 to June 2010. For data collection was used standardized questionnaire for HBSC studies (Health Behaviour in School–aged Children). The results were analysed by Chi-square test. Results: Approximately one third of respondents in each category consumes sweets and Coca-cola every day or several times a day. The occurrence of cleaning the teeth more than once a day was equally proved in all age groups ranging from 53% in 11 years old boys to 64% in 15 years old girls. The girls of all age groups indicate more frequent cleaning of teeth in comparison with boys. Conclusion: The results show increased consumption of sweets and Cocacola during the day in the school youth from central Slovakia, which may cause an increase in tooth decay. Dental hygiene in our set of respondents is insufficient. Based on the obtained results is possible to state that the need for higher level of knowledge, not only in children but also in parents about the principles of proper diet and proper dental hygiene is the integral part of the preventive measures and health education at school age., Mária Kožuchová, Martina Bašková, and Literatura 18
The important biological role of saliva in maintaining of the homeostasis of the oral cavity environment, preventing infection and tooth decay is widely accepted. Salivary glands insufficiency may violate the balance between health and disease. Clinical data indicated that the destruction, agenesis and aplasia of salivary gland commonly followed with hypo salivation, low salivary flow, which resulted in severe caries and periodontal disease. Salivary gland dysfunction also frequently found in preterm and low birth weight newborns. But the information about structural background of abnormal salivation in early childhood is still limited. A presence of any correlation between salivary glands structural development and intrauterine restrictions of fetal growth (IUGR) is unclear. The aim of present study was to determine morphological and morphometric peculiarities of human parotid gland in case of IUGR at late gestation. Material and methods: Parotid glands of twenty human fetuses 2022 weeks of gestation with diagnosed IUGR from late abortions material were compared with ten fetal glands in cases of induced abortions due to psychological reasons (control group). Tissue samples were immersionfixed in 10% buffered formalin solution, embedded in paraffin wax. Histological slides were stained routinely with hematoxylin & eosin, with Van Gieson's Stain. Microscopical examination was performed on magnification x 40 and x 100. Stereometric study by point count method at magnification x 40 allowed finding out volume fractions (VF) of glands parenchyma and stroma. VF of lobules components (glands wall, glands lumen, ducts wall, ducts lumen, vessels, intralobular connective tissue) were registered at magnification x100. Morphometry of the secretory portion of the parotid gland was conducted on the Zeiss microscope with the help of the AxioVision Rel.4.8 program. The mature (differentiated) end pieces were measured, including their area (in mkm2), width, height, perimeter (all in mkm). Similar measurements were done in the foci of immature secretory ends of a gland. Additionally the mean height of the epithelial cells layer within the mature secretory end pieces was measured. The differences were analyzed by methods of mathematical statistics using the software Microsoft Excel; data was compared with control measurements by Students ttest. Results: The results of present research have shown the delayed differentiation of fetal parotid glands parenchymal components in case of IUGR. The parenchymal VF did not reach control values. Furthermore, VF of lobules components was also decreased. Ducts lumens appeared to be significantly narrower than at physiological gestation. Interlobular and intralobular connective tissue stroma, in contrast to the controls, occupied vast areas, and their volume fraction was increased. Deficit of the parenchymal components of the gland was enhanced by slower maturation of glands. In cases with IUGR, differentiated glands occupied smaller area, with reduced width, height and perimeter. Epithelium lining the differentiated glands is characterized by significantly lower height compared to the control group. Delayed differentiation resulted in higher proportion of immature glands. Their area, width, height and perimeter increased. IUGR was also accompanied with a variety of pathological changes. Conclusion: Present evidences suggest that IUGR leads to impaired growth and maturation of the parotid gland. Structural immaturity and lack of differentiated parenchymal elements of the organ may form the basis of its secretory functions lesion. The finding tends to support the hypothesis that the mechanism behind the increased risk of dental pathology in preterm, low birth weight and retarded children is centred at structural and functional immaturity of salivary gland., Sergiy Morozov, Olga Reshetnikova, and Literatura