Exploring moral competence regression: a narrative approach in medical ethics education for medical students.

BACKGROUND: Studies from different countries report a stagnation or regression of moral competence in medical students between the first and the last year of their studies, and the value of various educational interventions remains uncertain. METHODS: We used Moral Competence Test (MCT) to measure C-scores of moral competence to determine the change in the MCT C-scores between the first- and the fifth-year medical students from two medical schools in the Czech Republic in the academic year 2022/2023 and to analyze factors associated with the C-scores (observational study). In addition, for the first-year students, we compared the results of the MCT before and after an intervention in medical ethics curriculum (interventional study). We used a cross-sectional and descriptive design for the observational study. Students completed the MCT, consisting of two moral dilemmas (Worker´s Dilemma and Doctor´s Dilemma), the results measured by the C-score, which represents moral competence. RESULTS: In total, 685 students participated in the observational study. Objective 1: based on the analysis of the C-score, we observed a decrease in moral competence between the first and the fifth-year medical students (p < .001). Objective 2: we did not observe a statistically significant effect of gender (p = .278), or self-rated religiosity (p = .163). Objective 3: in the interventional study, 440 students participated in the pretest and 422 students participated in the posttest. The test of statistical significance found no improvement in students' moral competence after the intervention (p = .253). CONCLUSION: Medical students show a regression in moral competence during medical education; it was lower in medical students in their fifth year, compared to the first-year medical students without the effect of gender, or self-rated religiosity. Although educational intervention consisting of multiple tools of medical ethics teaching (PBL, CBL, KMDD and StorED) did not lead to increase in moral competence, the longitudinal effect of such intervention remains to be seen.

High prevalence of burnout syndrome in Czech general practitioners: A cross-sectional survey.

Objective: A wide range in prevalence rates of burnout among general practitioners (GPs) has been reported in various regions, with an increasing trend. This nationwide cross-sectional study aimed to estimate the prevalence and associated determinants of burnout in Czech GPs. Methods: 1000 randomly selected physicians from the Czech Society of General Practitioners (through a pseudorandom number generator) were emailed an online survey based on the Maslach Burnout Inventory - Human Services Survey. Data collection was performed between January and February 2023. Results: 331 questionnaires were obtained (227 females and 104 males, mean age - 49.9 years, the mean number of registered patients - 1951). 21.8 % of GPs scored a high level of burnout in all three of its dimensions and 23.9 % in no dimension at all. The most prevalent dimension was reduced personal accomplishment (PA, 56.2 %) followed by emotional exhaustion (EE, 50.2 %) and depersonalization (DP, 40.5 %). Reaching burnout in all three dimensions was significantly more frequent in males and in GPs registering a number of patients above the median. Increasing age and years of practice were protective factors for DP but risk factors for reduced PA. Employed GPs had lower EE scores than GP practice owners. The respondents' basic characteristics reflected their presence among Czech GPs, which testifies against selection bias. Conclusions: The high rate of burnout (∼22 %) should be addressed by promoting personal resources along with the perception of the importance of GPs in society. A sufficiently dense network of GPs should allow them to register a lower number of patients.

Surveillance of chronic noninfectious diseases.

Surveillance is a comprehensive system of epidemiological work involving continuous collection, analysis and distribution of data on all characteristics of the disease. Among health professionals, surveillance in connection with noninfectious diseases is not as known as in infections where it has clearly proven successful. The principle of epidemiological surveillance may be applied in chronic noninfectious diseases but certain pitfalls and differences between this category and infectious diseases need to be borne in mind. These diseases have multifactorial etiology; their development is contributed to by several risk factors, mainly those associated with lifestyle; they have a long preclinical period with no apparent problems; data on their prevalence in populations may vary depending on the definition and diagnostic criteria used. Epidemiological surveillance as a continuous process aids in understanding the extent of the risk of a disease in a population, contributes to provision of early and effective care and control over their prevalence. The paper aims to describe the specific aspects of surveillance in chronic noninfectious diseases.

The unmet needs of family members of patients with progressive neurological disease in the Czech Republic.

BACKGROUND: Caring for patients with a progressive neurological disease (PND) causes stress that may impact on the state of health as well as the quality of life of the caring family. OBJECTIVE: The aim of the study was to explore the unmet needs of the family members of patients with PND in advanced stages. METHODS: Grounded theory (constructivist approach) was used to conceptualize the patterns of unmet care needs. Data collection methodology involved focus groups (n = 4) and interviews, in which a total of 52 people participated (patients, family members, and professionals). RESULTS: Based on the data analysis, three domains (family situation, role of the caregiver, and professional help) were identified, which illustrate the unmet needs. In particular, lack of information about the disease and available support available resulted in a deterioration mutual understanding between the patient, family, and the medical staff; also increased stress for the caregiver, and lowered quality of life for the caring family. CONCLUSION: Family members expect health workers to provide them with support, which includes informing them about the possible help available from the health and social welfare systems.

The Unmet Needs of Patients With Progressive Neurological Diseases in the Czech Republic: A Qualitative Study.

AIM:: The aim of our research was to explore the unfulfilled needs of patients with a progressive neurological disease in advanced stage of the illness within the current system of health and social care in the Czech Republic. DESIGN AND SETTING:: Qualitative research (grounded theory) was used to conceptualize the patterns of unmet palliative care needs in Czech Republic. METHODS:: The data collection method comprised individual, in-depth interviews (n = 19) and focus groups (n = 4) where a total of 52 respondents participated (patients with progressive neurological diseases [PNDs], family members, and professionals). RESULTS:: Two main categories of unfulfilled needs were determined (life with the disease, professional help), and they were described in the context of the 3 crucial themes identified in the study-the symptoms of the advanced stage of the disease resulted in substantial reduction of physical self-sufficiency, loss of autonomy, and social isolation; the level of dependence on the support and help of others increased; the patients also highlighted several problems related to health-care services. CONCLUSION:: The unmet needs should be taken into consideration when creating the concept of the neuropalliative and rehabilitation care, including the mental health support plan, because of the emotional, behavioral, and cognitive disorders that frequently occur in the lives of a substantial amount of patients with PND.

Manner of Death of Older People with Regard to Blood Alcohol Concentration.

OBJECTIVE: Alcohol abuse is related to a wide variety of negative health outcomes including mortality in older people. Alcohol abuse in older people is characterised by certain specific features uncommon in general adult population. The main objective of this study was to analyse the autopsy protocols of deceased older people in relation to blood alcohol concentration (BAC), sex, age, and manner of death. As a positive BAC, >0.20 g/kg was accepted. METHODS: The sample consists of 1,012 deceased older people (i.e. aged 65 years and over) selected out of 2,377 autopsied subjects in the period from 2003­2013. Subjects included into the sample were chosen via the proportional sampling method. Data (BAC, sex, age, and manner of death) was recorded in a single structured protocol. Data was evaluated statistically (Kolmogorov-Smirnov two-sample test, Wilcoxon two-sample test, risk ratio). RESULTS: Among older people, there has been a statistically significant correlation of natural death with sex (men died earlier) and with increased BAC (people with positive BAC died earlier). In case of violent death there is a difference in the types of accidents in older people with positive BAC (>0.2 g/kg) and with negative BAC (≤0.2 g/kg). Drowning is more common in older people with positive BAC. CONCLUSIONS: Health campaigns in Europe and the Czech Republic aimed at reducing alcohol consumption mainly deal with young people. Alcohol abuse has an impact on premature mortality even in older people. As shown by this study, older people with positive BAC die significantly earlier.

Non-adherence in seniors with dementia - a serious problem of routine clinical practice.

BACKGROUND: Non-adherence to treatment in seniors with dementia is a frequent and potentially dangerous phenomenon in routine clinical practice which might lead to the inappropriate treatment of a patient, including the risk of intoxication. There might be different causes of non-adherence in patients with dementia: memory impairment, sensory disturbances, limitations in mobility, economical reasons limiting access to health care and medication. Non-adherence leads to serious clinical consequences as well as being a challenge for public health. AIM: to estimate prevalence of non-adherence in seniors with dementia and to study correlation between cognitive decline and non-adherence. SUBJECTS AND METHODS: Prospective study, analyzing medical records of seniors with dementia admitted to the inpatient psychogeriatric ward in the Kromeriz mental hospital from January 2010 to January 2011. Cognitive decline measured by MMSE, prevalence of Non-adherence to treatment and reasons for patient Non-adherence were studied. RESULTS: Non-adherence to any treatment was detected in 31.3% of seniors; memory impairment was the most common cause of non-adherence to treatment. CONCLUSION: In conclusion, non-adherence to treatment in the studied group of seniors with dementia correlates with the severity of cognitive impairment - a higher cognitive decline correlates with a higher risk of non-adherence to treatment.

Bad on the net, or bipolars' lives on the web: analyzing discussion web pages for individuals with bipolar affective disorder.

OBJECTIVE: The main therapeutic approach in the treatment of bipolar affective disorder is the administration of drugs. The effectiveness of this approach can be increased by specific psychotherapeutic interventions. There is not much knowledge about self-help initiatives in this field. Anonymous internet communication may be beneficial, regardless of the fact that it is non-professional. It offers a chance to confide and share symptoms with other patients, to open up for persons with feelings of shame, and to obtain relevant information without having a direct contact with an expert. METHODS: Qualitative analysis of web discussions used by patients with bipolar disorder in Czech language was performed. Using key words "diskuze" (discussion), "maniodeprese" (manic depression) and "bipolární porucha" (bipolar disorder), 8 discussions were found, but only 3 of them were anonymous and non-professional. Individual discussion entries were analyzed for basic categories or subcategories, and these were subsequently assessed so that their relationships could be better understood. RESULTS: A total of 436 entries from 3 discussion web pages were analyzed. Subsequently, six categories were identified (participant, diagnosis, relationships, communication, topic and treatment), each having 5-12 subcategories. These were analyzed in terms of relationships and patterns. CONCLUSIONS: Czech discussion web pages for people suffering from bipolar disorder are a lively community of users supporting each other, that may be characterized as a compact body open to newcomers. They seem to fulfill patients' needs that are not fully met by health care services. It also has a "self-cleaning" ability, effectively dealing with posts that are inappropriate, provocative, criticizing, aggressive or meaningless.

Prevalence of elder abuse and neglect in seniors with psychiatric morbidity - example from central moravia, czech republic.

BACKGROUND: Elder abuse and neglect (EAN) comprises emotional, financial, physical, and sexual abuse, neglect by other individuals, and self-neglect. Elder abuse and neglect in seniors with psychiatric morbidity was not monitored in the Czech Republic at all, despite the literature shows mental morbidity as one of the important risk factor for developing elder abuse and neglect. METHODS: We designed comparative cross sectional study comprising 305 seniors hospitalized in Mental Hospital Kromeriz in June 2011 - group of 202 seniors hospitalized due to mental disorder in psychogeriatric ward and group of 103 seniors hospitalized due to somatic disorder in internal ward. Content analysis of medical records was done in both groups of seniors, with regards to symptoms of elder abuse. Then, we discussed the topic of elder abuse with 30 nurses of psychogeriatric ward in focus group interview. RESULTS: Between two compared groups of seniors we detected statistically higher prevalence of elder abuse in seniors with psychiatric morbidity (48 cases, 23.8% prevalence of EAN), compared to somatically ill seniors (3 cases, 2.9%). As for nursing staff, 5 from 30 nurses (16.7%) have never heard about symptoms of elder abuse and neglect, 10 from 30 nurses (33.3%) had just a partial knowledge about elder abuse and neglect and its symptoms, the rest of nurses (15 from 30 nurses, 50.0%) had good knowledge about elder abuse and neglect and its symptoms. CONCLUSION: Elder abuse and neglect seems to be a relevant problem in senior population with mental disorders. Development of educational programs for nursing and medical staff about Elder abuse and neglect (symptoms of EAN, early detection of EAN, knowledge how to report cases of EAN) could improve the situation and help mentally ill seniors to better quality of life.