{"id":17466,"date":"2022-02-18T09:00:50","date_gmt":"2022-02-18T08:00:50","guid":{"rendered":"https:\/\/lifelonghearing.com\/?p=17466"},"modified":"2025-04-17T04:54:06","modified_gmt":"2025-04-17T04:54:06","slug":"kvalita-zivota-jak-ji-lze-merit","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/cs\/kvalita-zivota-jak-ji-lze-merit\/","title":{"rendered":"Kvalita \u017eivota: jak ji lze m\u011b\u0159it?"},"content":{"rendered":"

Kochle\u00e1rn\u00ed implant\u00e1ty a kvalita \u017eivota<\/h1><\/div>

Dr. Ruth Z\u00f6hrerov\u00e1 vystudovala medic\u00ednu a m\u00e1 doktor\u00e1t z biologie. Dnes se pod\u00edl\u00ed na studi\u00edch, kter\u00e9 mimo jin\u00e9 m\u011b\u0159\u00ed, jak sluchov\u00e9 implant\u00e1ty ovliv\u0148uj\u00ed kvalitu \u017eivota u\u017eivatel\u016f CI.<\/strong><\/p>\n<\/div>

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Dr. Ruth Z\u00f6hrerov\u00e1 pracovala jako v\u011bdeck\u00e1 pracovnice v Institutu Ludwiga Boltzmanna a na renomovan\u00fdch univerzit\u00e1ch v Rakousku a USA, kde prov\u00e1d\u011bla l\u00e9ka\u0159sk\u00fd v\u00fdzkum kost\u00ed a kloub\u016f. Pot\u00e9 hledala l\u00e9ka\u0159sk\u00fd obor, v n\u011bm\u017e by se v\u011bdeck\u00e9 poznatky p\u0159\u00edmo odr\u00e1\u017eely na kvalit\u011b \u017eivota u\u017eivatel\u016f. Proto se rozhodla v\u011bnovat transla\u010dn\u00edmu v\u00fdzkumu v oblasti sluchov\u00fdch implant\u00e1t\u016f. Sv\u00fdmi znalostmi a zku\u0161enostmi v oboru podporuje v\u011bdce a l\u00e9ka\u0159ev jejich akademick\u00fdch studi\u00edch.<\/em><\/p>\n<\/div><\/div><\/div><\/div>

Pr\u00e1ce m\u011b velmi napl\u0148uje! Nejen\u017ee m\u016f\u017eeme lidem prodlou\u017eit \u017eivot jako v jin\u00fdch l\u00e9ka\u0159sk\u00fdch oborech, ale tato technologie jim umo\u017e\u0148uje \u017e\u00edt relativn\u011b norm\u00e1ln\u00ed \u017eivot. Tak jim zaji\u0161\u0165ujeme lep\u0161\u00ed kvalitu \u017eivota.<\/p>\n

Co je to kvalita \u017eivota? <\/strong><\/p>\n

To je dobr\u00e1 ot\u00e1zka! Z\u00e1le\u017e\u00ed na \u00fahlu pohledu. V m\u00e9m osobn\u00edm pojet\u00ed kvalita \u017eivota znamen\u00e1 d\u011blat to, co m\u011b bav\u00ed. P\u0159edpokladem je samoz\u0159ejm\u011b dobr\u00e9 zdrav\u00ed. Ke kvalitn\u00edmu \u017eivotu pat\u0159\u00ed i to, \u017ee se zab\u00fdv\u00e1m \u00fakoly, kter\u00e9 mi p\u0159in\u00e1\u0161ej\u00ed pot\u011b\u0161en\u00ed, a \u017ee nezanedb\u00e1v\u00e1m rovnov\u00e1hu mezi prac\u00ed a osobn\u00edm \u017eivotem. Tak\u00e9 to znamen\u00e1 udr\u017eovat dobr\u00e9 soci\u00e1ln\u00ed kontakty, a to jak v pr\u00e1ci, tak v soukrom\u00e9m \u017eivot\u011b. A to cht\u011bj\u00ed i na\u0161i u\u017eivatel\u00e9 \u2013 ale abychom toho v\u0161eho dos\u00e1hli, pot\u0159ebujeme neomezen\u00e9 komunika\u010dn\u00ed schopnosti.<\/p>\n

Pokud je zdrav\u00ed jen jedn\u00edm z aspekt\u016f, pro\u010d se v\u011bdeck\u00e9 studie v medic\u00edn\u011b st\u00e1le odvol\u00e1vaj\u00ed na kvalitu \u017eivota?<\/strong><\/p>\n

Pojem kvalita \u017eivota se v politice pou\u017e\u00edv\u00e1 od 20. let 20. stolet\u00ed, ale v medic\u00edn\u011b se s n\u00edm setk\u00e1v\u00e1me a\u017e v posledn\u00edch 50-60 letech. Bylo zji\u0161t\u011bno, \u017ee konven\u010dn\u00ed m\u011b\u0159en\u00ed (nap\u0159. v na\u0161\u00ed oblasti audiogramy) ne v\u017edy odr\u00e1\u017eej\u00ed, jak se pacient\u016fm skute\u010dn\u011b da\u0159\u00ed. Navzdory dobr\u00fdm v\u00fdsledk\u016fm mohou m\u00edt pocit, \u017ee jejich sluch nebo porozum\u011bn\u00ed nesta\u010d\u00ed k dobr\u00e9 komunikaci. Proto je d\u016fle\u017eit\u00e9 tato m\u011b\u0159en\u00ed v\u017edy d\u00e1le up\u0159esnit.<\/p>\n

Pokud jde o kvalitu \u017eivota, je d\u016fle\u017eit\u00e9 nesoust\u0159edit se na nemoc nebo stav, kter\u00fd je t\u0159eba zlep\u0161it. Na kvalitu \u017eivota je t\u0159eba se v\u017edy d\u00edvat \u0161\u00ed\u0159eji a diferencovan\u011b. Pokud n\u011bkdo trp\u011bl ztr\u00e1toou sluchu a pot\u00e9 za\u010dal op\u011bt sly\u0161et, jist\u011b odpov\u00ed, \u017ee se kvalita jeho \u017eivota zlep\u0161ila. Chceme v\u0161ak vid\u011bt \u00fa\u010dinek intervence na v\u0161echny dimenze kvality \u017eivota. Ta je v\u0161ak u ka\u017ed\u00e9ho jin\u00e1: sportovec by byl velmi ne\u0161\u0165astn\u00fd, kdyby p\u0159estal b\u00fdt aktivn\u00ed, musel p\u0159estat sportovat, p\u0159eru\u0161it \u010dinnost nebo ji v\u00fdrazn\u011b omezit. Pro m\u011b osobn\u011b by nepohyblivost byla velmi \u0161patn\u00e1, proto\u017ee bych nemohla tak snadno tr\u00e1vit \u010das v p\u0159\u00edrod\u011b.<\/p>\n

Je kvalita \u017eivota d\u016fle\u017eit\u00e1 z l\u00e9ka\u0159sk\u00e9ho hlediska?<\/strong><\/p>\n

Jist\u011b! Nejd\u016fle\u017eit\u011bj\u0161\u00ed je p\u0159ece to, jak se pacient celkov\u011b c\u00edt\u00ed, a to i emocion\u00e1ln\u011b. St\u00e1v\u00e1 se, \u017ee si pacient st\u011b\u017euje, ale l\u00e9ka\u0159 nedok\u00e1te ihned naj\u00edt p\u0159\u00ed\u010dinu. Dobr\u00fd l\u00e9ka\u0159 si v\u017edy bude kl\u00e1st ot\u00e1zku, pro\u010d jeho objektivn\u00ed m\u011b\u0159en\u00ed neodpov\u00eddaj\u00ed subjektivn\u00edmu pocitu pacienta.<\/p>\n

Na kvalitu \u017eivota se lze pod\u00edvat i z ekonomick\u00e9ho hlediska. Pokud je n\u011bkdo spokojen\u00fd, se subjektivn\u011b vysokou kvalitou \u017eivota, pravd\u011bpodobn\u011b tak\u00e9 bude utr\u00e1cet v\u00edce pen\u011bz a bude st\u00e1t zdravotnick\u00fd syst\u00e9m m\u00e9n\u011b. Existuje cel\u00e1 \u0159ada r\u016fzn\u00fdch m\u011b\u0159\u00edc\u00edch faktor\u016f, kter\u00e9 lze p\u0159ev\u00e9st do ekonomick\u00fdch model\u016f a poskytnout tak kalkulaci n\u00e1klad\u016f a p\u0159\u00ednos\u016f.<\/p>\n

Do jak\u00e9 m\u00edry maj\u00ed tyto ekonomick\u00e9 \u00favahy vliv na n\u00e1\u0161 syst\u00e9m zdravotn\u00ed p\u00e9\u010de?<\/strong><\/p>\n

Na z\u00e1klad\u011b kvality \u017eivota lze prov\u00e9st jak\u00fdsi v\u00fdpo\u010det n\u00e1klad\u016f a p\u0159\u00ednos\u016f pro ur\u010ditou l\u00e9ka\u0159skou l\u00e9\u010dbu. Ka\u017ed\u00fd rok z\u00edskan\u00fd p\u0159i ur\u010dit\u00e9 \u00farovni kvality \u017eivota lze vyj\u00e1d\u0159it \u010d\u00edselnou hodnotou.<\/p>\n

P\u0159\u00edkladem m\u016f\u017ee b\u00fdt QALY. Zkratka znamen\u00e1 \u201equality-adjusted life-year\u201c, tedy \u201erok \u017eivota v pln\u00e9 kvalit\u011b\u201c. Po\u010det let \u017eivota, kter\u00e9 lze o\u010dek\u00e1vat po z\u00e1sahu, se vyn\u00e1sob\u00ed kvalitou t\u011bchto let \u017eivota (kvalita se ud\u00e1v\u00e1 v rozmez\u00ed nula a\u017e jedna). Pokud pacient s n\u00e1dorem z\u00edsk\u00e1 t\u0159i m\u011bs\u00edce \u017eivota, je QALY men\u0161\u00ed, ne\u017e kdy\u017e m\u00e1 \u0161estim\u011bs\u00ed\u010dn\u00ed d\u00edt\u011b p\u0159ed sebou cel\u00fd \u017eivot. V\u00fdpo\u010det n\u00e1klad\u016f a p\u0159\u00ednos\u016f n\u00e1kladn\u00e9 l\u00e9\u010dby rakoviny je ni\u017e\u0161\u00ed ne\u017e jednor\u00e1zov\u00e9 n\u00e1klady na kochle\u00e1rn\u00ed implantaci kojence.<\/p>\n

Je tedy v\u016fbec mo\u017en\u00e9 m\u011b\u0159it kvalitu \u017eivota? <\/strong><\/p>\n

Stru\u010dn\u011b \u0159e\u010deno ano, ale mus\u00edme b\u00fdt opatrn\u00ed. Zejm\u00e9na pokud jde o studie v oblasti sluchov\u00fdch implant\u00e1t\u016f, mus\u00edme p\u0159edem definovat, co chceme zjistit.<\/p>\n

Existuj\u00ed nap\u0159\u00edklad dotazn\u00edky, kter\u00e9 se specificky zam\u011b\u0159uj\u00ed na z\u00e1kladn\u00ed stav pacienta, a obsahuj\u00ed tedy mnoho konkr\u00e9tn\u00edch ot\u00e1zek t\u00fdkaj\u00edc\u00edch se sluchu. P\u0159edpokl\u00e1d\u00e1m, \u017ee u 99,9 procenta pacient\u016f p\u0159in\u00e1\u0161\u00ed kochle\u00e1rn\u00ed nebo jin\u00fd sluchov\u00fd implant\u00e1t zlep\u0161en\u00ed sluchu. Proto si mysl\u00edm, \u017ee tyto dotazn\u00edky nemaj\u00ed valn\u00fd smysl! Proto doporu\u010duji v\u017edy se pacienta pt\u00e1t na kvalitu jeho \u017eivota obecn\u011b. A vedle toho bych pou\u017eila i ot\u00e1zky t\u00fdkaj\u00edc\u00ed se sluchu.<\/p>\n

Bohu\u017eel mnoho dotazn\u00edk\u016f nen\u00ed p\u0159elo\u017eeno do r\u016fzn\u00fdch jazyk\u016f. Abychom mohli porovn\u00e1vat \u00fadaje na mezin\u00e1rodn\u00ed \u00farovni, pot\u0159ebovali bychom jeden dotazn\u00edk p\u0159elo\u017een\u00fd do co nejv\u00edce jazyk\u016f!<\/p>\n

Existuje dotazn\u00edk, kter\u00fd by m\u011b\u0159il kvalitu \u017eivota komplexn\u011b a s mo\u017enost\u00ed mezin\u00e1rodn\u00edho srovn\u00e1n\u00ed? <\/strong><\/p>\n

Existuje jich n\u011bkolik, ale m\u00fdm nejobl\u00edben\u011bj\u0161\u00edm je australsk\u00fd dotazn\u00edk AqoL (zkratka pro Assessment of Quality of Life, tj. Hodnocen\u00ed kvality \u017eivota). Podle m\u00e9ho n\u00e1zoru pokr\u00fdv\u00e1 v\u0161echny dimenze \u017eivota: od sluchu a dal\u0161\u00edch smyslov\u00fdch vjem\u016f, p\u0159es ot\u00e1zky t\u00fdkaj\u00edc\u00ed se bolesti a mobility a\u017e po soci\u00e1ln\u00ed interakce.<\/p>\n

Soci\u00e1ln\u00ed interakce zahrnuj\u00ed nejen p\u0159\u00e1tele, ale tak\u00e9 sexu\u00e1ln\u00ed interakce. Na klinice maj\u00ed lid\u00e9 \u010dasto z\u00e1brany se na to pt\u00e1t\u2026 Ale celkov\u011b je to d\u016fle\u017eit\u00e1 oblast. Dotazn\u00edk se skl\u00e1d\u00e1 z 34 ot\u00e1zek a odr\u00e1\u017e\u00ed kvalitu \u017eivota bez ohledu na nemoci nebo posti\u017een\u00ed. To znamen\u00e1, \u017ee umo\u017e\u0148uje porovn\u00e1vat kvalitu \u017eivota lid\u00ed, kte\u0159\u00ed maj\u00ed r\u016fzn\u00e1 onemocn\u011bn\u00ed.
\nT\u00edm, \u017ee se \u010dlov\u011bk pt\u00e1 na situaci p\u0159ed a po z\u00e1kroku, nap\u0159. kochle\u00e1rn\u00ed implantaci, m\u016f\u017ee zjistit jej\u00ed skute\u010dn\u00fd dopad. Hodnocen\u00ed je od 0 do 1, ale nula se rovn\u00e1 smrti, a tak \u0161patn\u011b na tom nen\u00ed nikdy nikdo! \u201eJedni\u010dka\u201c znamen\u00e1 zcela zdrav\u00fd a \u0161\u0165astn\u00fd \u010dlov\u011bk, ale toho je t\u011b\u017ek\u00e9 dos\u00e1hnout i u zcela zdrav\u00fdch respondent\u016f.<\/p>\n

Lze tedy srovn\u00e1vat v\u00fdsledky lid\u00ed se sluchov\u00fdm posti\u017een\u00edm a hluchotou s t\u011bmi, kte\u0159\u00ed pou\u017e\u00edvaj\u00ed naslouch\u00e1tko, ale tak\u00e9 je srovn\u00e1vat se zcela zdrav\u00fdmi lidmi. Pot\u00e9 lze v\u00fdsledky d\u00e1le rozd\u011blit do v\u011bkov\u00fdch skupin, skupin podle pohlav\u00ed atd.<\/p>\n

Jak se vyv\u00edj\u00ed kvalita \u017eivota v pr\u016fb\u011bhu \u017eivota? <\/strong><\/p>\n

Mlad\u0161\u00ed lid\u00e9 od \u017eivota hodn\u011b o\u010dek\u00e1vaj\u00ed, ale jsou tak\u00e9 pom\u011brn\u011b spokojeni. Vysokou kvalitu \u017eivota maj\u00ed tak\u00e9 lid\u00e9 ve v\u011bkov\u00e9 skupin\u011b 40-60 let. S v\u011bkem se v\u0161ak probl\u00e9my kumuluj\u00ed. Pat\u0159\u00ed sem zdravotn\u00ed probl\u00e9my, ale tak\u00e9 omezen\u00e1 pohyblivost a omezen\u00e9 soci\u00e1ln\u00ed kontakty, co\u017e souvis\u00ed tak\u00e9 s nar\u016fstaj\u00edc\u00edmi probl\u00e9my se sluchem.<\/p>\n

Kdy\u017e hovo\u0159\u00edme s u\u017eivateli CI, obvykle hodnot\u00ed oblasti komunikace a soci\u00e1ln\u00edch interakc\u00ed velmi \u0161patn\u011b pro obdob\u00ed p\u0159ed operac\u00ed. Po operaci toto hodnocen\u00ed vysko\u010d\u00ed a \u010dasto je vy\u0161\u0161\u00ed ne\u017e u lid\u00ed s norm\u00e1ln\u00edm sluchem. To znamen\u00e1, \u017ee obdob\u00ed bez sluchu m\u011blo na jejich \u017eivot tak siln\u00fd dopad, \u017ee kvalitu \u017eivota po aktivaci hodnot\u00ed je\u0161t\u011b l\u00e9pe. V del\u0161\u00edm \u010dasov\u00e9m obdob\u00ed si v\u0161ak lze v\u0161imnout, \u017ee spokojenost op\u011bt m\u00edrn\u011b kles\u00e1. Na sluch si zvyknou a mnoz\u00ed u\u017eivatel\u00e9 z\u0159ejm\u011b zapomenou, jak \u0161patn\u00e9 to bez sluchu bylo.<\/p>\n

Tento typick\u00fd vzorec chov\u00e1n\u00ed se naz\u00fdv\u00e1 Kano model neboli efekt mobiln\u00edho telefonu. Kdy\u017e je spln\u011bno vysok\u00e9 o\u010dek\u00e1v\u00e1n\u00ed, spokojenost vysko\u010d\u00ed, ale pak zase postupn\u011b klesne do norm\u00e1lu. Nap\u0159\u00edklad kdy\u017e si koup\u00edte nov\u00fd chytr\u00fd telefon, jste na za\u010d\u00e1tku nad\u0161eni v\u0161emi nov\u00fdmi funkcemi. B\u011bhem kr\u00e1tk\u00e9 doby si v\u0161ak na n\u011bj zvyknete.<\/p>\n

Jak smyslupln\u00e9 pak mohou takov\u00e9 subjektivn\u00ed dotazn\u00edky v\u016fbec b\u00fdt?<\/strong><\/p>\n

No, smyslupln\u00e9 jsou dost, proto\u017ee kvalita \u017eivota je dnes pova\u017eov\u00e1na za nez\u00e1visl\u00fd zdravotn\u00ed c\u00edl a je d\u016fle\u017eit\u00fdm parametrem pro hodnocen\u00ed \u00fa\u010dinnosti terapeutick\u00e9 intervence. Je d\u016fle\u017eit\u00e9 si uv\u011bdomit, \u017ee v\u00fdstup dotazn\u00edku z\u00e1vis\u00ed na p\u0159\u00edslu\u0161n\u00e9m du\u0161evn\u00edm rozpolo\u017een\u00ed a stavu v dan\u00fd den. Samoz\u0159ejm\u011b, \u017ee \u010dlov\u011bk bude odpov\u00eddat jinak, pokud t\u011bsn\u011b unikl nehod\u011b nebo p\u0159i\u0161el od zuba\u0159e je\u0161t\u011b s bolest\u00ed, nebo pokud t\u011bsn\u011b p\u0159ed odpov\u011bd\u00ed vyhr\u00e1l v loterii. M\u016f\u017eeme v\u0161ak \u0159\u00edci, \u017ee kvalita \u017eivota se st\u00e1le v\u00edce prosazuje jako dal\u0161\u00ed krit\u00e9rium \u00fasp\u011b\u0161n\u00e9 terapie.<\/p>\n

Osobn\u011b se domn\u00edv\u00e1m, \u017ee \u017eivotn\u00ed o\u010dek\u00e1v\u00e1n\u00ed kvalitu \u017eivota siln\u011b ovliv\u0148uj\u00ed. Moje motto zn\u00ed: vd\u011b\u010dnost a pozornost za v\u011bci, kter\u00e9 m\u00e1m, a za to, jak se chov\u00e1m k ostatn\u00edm lidem, abych zv\u00fd\u0161ila svou spokojenost, a t\u00edm i kvalitu \u017eivota.<\/p>\n<\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"

Dr. Ruth Z\u00f6hrerov\u00e1 vystudovala medic\u00ednu a m\u00e1 doktor\u00e1t z biologie. Dnes se pod\u00edl\u00ed na studi\u00edch, kter\u00e9 mimo jin\u00e9 m\u011b\u0159\u00ed, jak sluchov\u00e9 implant\u00e1ty ovliv\u0148uj\u00ed kvalitu \u017eivota u\u017eivatel\u016f<\/p>\n","protected":false},"author":4,"featured_media":31945,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[470],"tags":[423,539,412],"class_list":["post-17466","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-veda","tag-ci-users","tag-hearing-implant-user","tag-hearing-implants"],"yoast_head":"\nKvalita \u017eivota: jak ji lze m\u011b\u0159it? - Czech<\/title>\n<meta name=\"description\" content=\"Dr. Ruth Z\u00f6hrerov\u00e1 vystudovala medic\u00ednu a m\u00e1 doktor\u00e1t z biologie. 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