The aim of this study was to evaluate the influence of nutritional support on energy expenditure and nutritional substrates oxidation, focused on proteins and nitrogen balance, in ventilated polytraumatized patients hospitalized in the intensive care unit. The study was performed on 15 critically ill patients (12 men and 3 women), their average age was 43,6 ± 17,5 years. 7 patients were examinated without nutritional support, 8 patients were examinated after administration of hypocaloric nutritional support. The examination of fasting patients was conducted after at least 4 hours of fasting. The examination of patients with nutritional support were conducted after at least 4 hours of nutritional support administration. Energy expenditure, resting energy expenditure and nutritional substrates oxidation were measured by indirect calorimetry. After statistical analysis of measured data was found, that administration of hypocaloric nutritional support did not significantly influence nutritional substrates oxidation. Protein intake correlated with total nitrogen balance (p = 0,0133) and muscular condition. Results suggest, that administered proteins were partly used as source of energy instead of muscle protein and partly used a different way, e.g. for tissue reparation. Therefore, nutritional support...

This diploma thesis analyses non-compliance phenomenon incidence rate of patients diagnosed for diabetes mellitus. Theoretical part studies non-compliance phenomenon and characteristics of diabetes mellitus disease. Practical part evaluates information resulting from questionnairing.

The aim of this study was to determine energy expenditure and to find relations between resting energy expenditure (REE) and selected parameters in 14 polytraumatic patients in the ICU of University Hospital in Hradec Kralove, which were easily measurable and usable for REE prediction. In this study 7 men (age 36 ± 18 years) and 7 women (age 58 ± 28 years) with polytrauma were examined. The assessment of REE was measured via indirect calorimetry (IC) method. The examination also included bioimpedance analysis (BIA). BIA was useful especially for obtaining values of overhydration (OH), lean tissue mass (LTM) and metabolically active body cell mass (BCM). Average REE-IC (measured by IC) was 2116 ± 516 kcal·day-1 in men and 1450 ± 407 kcal·day-1 in women (P = 0.018). Statistically significant difference between men's and women's population was also found in these relations: calculation of basal energy expenditure according to Harris-Bennedict equation without (P = 0.001) and with deduction of OH from body weight (P = 0.001), at "breathing energy expenditure" (REE related to respiratory rate) (P = 0.018) and at (REE related to heart rate) "heart rate energy expenditure" (P = 0.038). REE-IC related to kilogram of BCM with and without deduction of overhydration was shown as statistically significant...

This thesis investigates the influence of nutrition support on a set of critically ill patients after the administration of parenteral nutrition by measuring their energy expenditure and substrate oxidation. The study was performed on 8 spontaneously breathing patients during the 2nd-5th day of polytrauma and the variables were obtained by Indirect calorimetry. The mean age of the patients was 42 ± 16 years. Four patients were obese, three were overweight and one had normal weight in the examined group. The measurement was conducted on 7 patients after hypocaloric nutrition administration (1323 ± 281 kcal/day) and 1 patient after hypercaloric nutrition administration (3400 kcal/day). Statistical analysis revealed that the administered nutritional support had no significant effect on energy expenditure and the substrate oxidation preference. However, correlations between the values of energy expenditure, nutrients oxidation, and values of some of the laboratory parameters were observed. The energy expenditure of polytraumatic patients measured at least 4 hours after nutritional administration was 2139 ± 518 kcal/day and 24.6 ± 3.5 kcal/kg/day. This energy expenditure was covered by oxidation of proteins (31%), by lipids (46%) and by carbohydrates (23%). Large variability was found among the results...

The work focuses on consumer's problems in medicine, pacients's compensation and malpractice in practices. First part of this diploma work content theoretical part which shows the law system of compensation, fault and non -- fault liability in the Czech Republic. Health compensation is being huge and very expencive these days specially in the states of western Europe and USA. That is why the part of the work compares the law rules and system between Czech Republic, Germany and France. Because New Zealand has very unusual non -- fault system and the burden of proof doesn't bear the pacient but the hospital the comparision was made also with this country. This issue is also very interesting from the economic point of view. The whole analyses agrees on hypothesis: Consumers'law protection in medicin is comparable with EU and satisfactory.

The aim of this study was to evaluate the fluid balance of polytrauma patients hospitalized in the intensive care unit at the University Hospital in Hradec Kralove. Very little knowledge about this issue can be found; therefore we tried to clarify how the body responds to trauma and whether it is possible to influence the further course of the disease by controlling the amount of administered fluid. The study included 13 patients, 12 men and 1 woman with different length of hospitalization. The examination of the patients was carried out by the bioelectrical impedance analysis of the body composition which is able to determine the proportion of individual body components (water, muscle mass, fat). All the patients were examined twice, each after a different time period. Other data were collected from medical documentation related to fluid balance and laboratory results. After assessing the results we discovered differences in the measured values in the first and second test. While during the first examination no statistical correlation between the distribution of the fluids in the body and the intake and output was found, the second examination showed a statistically significant relationship between the fluid intake and subsequent body composition (fluid overload, total body water, extra and...

The aim of this work were examinations of septic patiens to determinate energy expenditure and the utilization of nutritional substrates and to compare results of examinations to standart recommendations of ESPEN for patient's nutrition. For investigations was used indirect calorimetry. Our group of septic patients consisted of three men and three women from 58 to 73 years old. The lenght of the hospital stay was different, so the group was heterogenous and each patient was in different phase of sepsis. Five of six patients were in hypermetabolism. The value of energy expenditure was from 87,3 % to 176,2 %. Average energy expenditure was 1790,3 ± 414,9 kcal/ kg/ day and average energy of nutrition was 2080,2 ± 754,7kcal/ kg/ day. As for nutritional substrates, average income of carbohydrates was 257,9 ± 109,9 g/ den. Average utilization of carbohydrates was 83,9 ± 62,1 g/ day. So the intake of carbohydrates were significantly higher, than the utilization. Average income of lipids was 63,6 ± 15,7 g/ day and average utilization was 102,1 ± 61,8 g/ day. There was also significant diference between lipid utilization and lipid intake. Average income of proteins was 127,4 ± 61,7 g/ day. Average utilization of proteins was 132,5 ± 53,6 g/ day. To conclusion, the results of examinations, measured by...

The purpose of my thesis is to analyse criminal aspects of the relationship between a doctor and an patient. The reason for my research is that I think this topic does not recive enough attention in Czech republic as it deserves. The thesis is composed of five chapters, each of them dealing with different aspects of doctors criminal lability. I dedicated m attention only to doctors criminal lability, not to the criminal liability of patient. Chapter One is introductory and defines basic terminology used in the thesis as types of lability, basic aspects of relatinship between doctor and patient, medical experiment, specific aspects of criminal lability in medicine and another terminology which is often used in medical law. The chapter is devided in nine parts. Chapter Two is dedicated to crimes which are usually committed by doctors practising their profession. The chapter is divided five parts, using the same system and order as in czech Penal Code. Chapter Three is subdivided in two parts. Part one is dedicated to euthanasia and legal problems which are united with euthanasia. Chapter three examines relevant czech legislation and problems in czech legislation united with euthanasia. This part of chapter also deals with advantages and disadvantages of euthanasia. Part two is dedicated to assisted...

The aim of this study was to determine and evaluate resting energy expenditure (REE) and the utilization of nutritional substrates in 14 polytrauma patients in the ICU. Was also assessed level of impact Overhydration (OH) on the accuracy of the determination. Diagnostic investigations using indirect calorimetry (IC) was performed in 9 men and 5 women (age 30 ± 15 years, BMI 27.5 ± 9.4 kg·m-2) with polytrauma (ISS 41 ± 16). For more accurate sizing of REE and extent of utilization of nutritional substrates were used equations derived from the equation of Weir, not Softwear calorimeter. Using IC volumes were determined only inspired an expired oxygen and carbon dioxide. To determine the rate of OH was used bioimpedance analysis methods using BCM. Almost 86% (8 men and 4 women) examined patients showed hypermetabolism. Average REE value was 2241.38 ± 854.27 kcal·day-1, which represented an average increase of prediction of 38.09 ± 49.09% due to the physiological condition. A statistically significant relationship was demonstrated between REE determined using the Weir equation according and the Harris-Bennedict equation without (P = 0,01) with deduction of OH (P = 0,007) only in men. In clinical practice, significant correlations were established between the REE-IC and BSA (P < 0,01), LTM (P < 0,05),...

This thesis deals with the criminal aspects of the patient's status as an injured party in the provision of health care. Author especially characterizes the criminal relationships between patients and health care facilities, their contents and background. In the first part of the thesis the author provides a legal framework for the health law, especially in the area of national and international law. It deals with crucial laws directly governing the healthcare law, and laws that are related to health law and greatly affect it. In the field of international law, the author deals mainly with the European Convention on Human Rights and the Convention on Biomedicine. At the level of the national rights of the author touches the area of constitutional order, in particular the Charter of Fundamental Rights and Freedoms as well as the partition law, which describes the particular treatment of health law, criminal law and civil law. In the second part of the thesis the author first defines the basic concepts and fundamental institutes occurring in health care. Eventually, the author of the second part focuses on the actual relationship between the patient and the medical facility where the first for the understanding of the issues dealing with the historical evolution of this relationship and later...