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Swiss Emergency Research collection

2021

  • Robert-Ebadi, H., Elias, A., Sanchez, O., Le Moigne, E., Schmidt, J., Le Gall, C., Aujesky, D., et al. “Assessing The Clinical Probability Of Pulmonary Embolism During Pregnancy: The Pregnancy-Adapted Geneva (Pag) Score”. J Thromb Haemost 19, no. 12: 3044-3050. doi:10.1111/jth.15521.
    Abstract: BACKGROUND: The diagnosis of pulmonary embolism (PE) in pregnant women represents an ongoing challenge. As in the general population, the first step in pregnant women with suspected PE consists of assessing clinical pre-test probability (PTP). However, no dedicated clinical decision rule has been developed in this population. OBJECTIVE: To propose a new version of the Geneva score adapted to pregnant women with suspected PE. METHODS: Data from a multicenter, prospective management outcome study including 395 women with suspected PE, in whom PTP was assessed using the Geneva score, were used. We first removed items which were present in none of the patients (cancer, age >65 years). Receiver operating characteristic (ROC) curve analysis was then performed for quantitative variables and the optimal threshold defined. The obtained Pregnancy-Adapted Geneva Score (PAG Score) comprised seven items, including an age 40 years or older and a heart rate >110 beats per minute. RESULTS: The PAG Score showed a high discriminative power to identify patients with a low, intermediate, or high PTP, associated with increasing prevalence of PE, 2.3%, 11.6%, and 61.5%, respectively. The ROC curves showed an area under the curve of 0.795 for the PAG Score compared to 0.684 for the Geneva score. CONCLUSION: In pregnant women with suspected PE, the PAG Score shows a high discriminative power to identify patients at low, intermediate, or high PTP. It has the strength of being a fully objective decision rule, is clinically relevant, easy to compute, and should now be tested in a prospective outcome study.
    Tags: *Pulmonary Embolism/diagnosis/epidemiology, Adult, author had full access to all the data in the study and takes responsibility for, diagnosis, Female, Fibrin Fibrinogen Degradation Products, Humans, Pregnancy, Pregnancy Complications/*epidemiology, Prevalence, Probability, Prospective Studies, pulmonary embolism, ROC Curve, the integrity of the data and the accuracy of the data analysis., venous thromboembolism.
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  • Minotti, B., Brenner, R., Desbiolles, L. M., Osterwalder, J., Schoch, O. D., and Ammann, P. “Electrocardiographic Alterations By Pneumothorax: A Case-Control Study With Review Of The Literature”. Swiss Med Wkly 151, no. 31: w30041. doi:10.4414/SMW.2021.w30041.
    Abstract: BACKGROUND: Numerous ECG alterations due to pneumothorax have been reported. The objective of the study was to establish the presence of ECG changes associated with pneumothorax in the literature, and in a cohort of patients with proven pneumothorax compared with age- and sex-matched healthy controls. METHODS: A systematic review for ECG alterations associated with pneumothorax was performed. We then reviewed our hospital database for patients with pneumothorax and identified all patients with an ECG available at this time. The retrieved ECG alterations in the systematic review were identified in our pneumothorax patients and compared with a healthy sex- and age-matched control group. Accordingly, we calculated sensitivity and specificity for all alterations. RESULTS: Seventeen ECG alterations were found and defined from the systematic review. Our pneumothorax cohort consisted of 82 pneumothorax patients and 82 control patients. Specificity was mostly more than 90%, but sensitivities were low. Phasic R voltage (pneumothorax group 25.6% vs control group 1.2%), T-wave inversion (31.7% vs 2.4%), prolonged QTc (11.0% vs 2.4%), right axis deviation (14.6% vs 3.6%) and QRS voltage ratio in aVF/I >2 (41.5% vs 22.0%) were significantly more frequent in pneumothorax patients compared with controls. CONCLUSION: The sensitivity of published ECG signs in predicting pneumothorax in our cohort was low, which means that ECG findings are an unsuitable tool for pneumothorax screening. However, presence of these ECG signs might raise a suspicion of pneumothorax in patients presenting with dyspnoea, or unclear chest discomfort.
    Tags: *Pneumothorax/diagnosis, Arrhythmias, Cardiac, Case-Control Studies, Dyspnea, Electrocardiography, Humans.
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  • Diserens, R. V., Marmy, C., Pasquier, M., Zingg, T., Joost, S., and Hugli, O. “Modelling Transport Time To Trauma Centres And 30-Day Mortality In Road Accidents In Switzerland: An Exploratory Study”. Swiss Med Wkly 151, no. 35-36. doi:10.4414/SMW.2021.w30007.
    Abstract: BACKGROUND: Rapid access to a trauma centre for severely injured road accident victims, conceptualised as the Golden Hour, links access time to definitive treatment within 1 hour of trauma with reduced risks of morbidity and mortality. Access times have not been studied in Switzerland. The aim of this work was to model the transport time by ambulance of seriously injured road traffic accident victims to one of the 12 trauma centres in Switzerland and to investigate whether this time influenced mortality. METHODS: Isochronous travel curves in 10-minute increments were modelled around each of the 12 Swiss trauma centres to assess travel times at the Swiss national level, based on the shortest travel time from the location of a serious road accident to the nearest trauma centre. We used the national database of the Federal Roads Office, which provided the geolocation of these accidents occurring between 2011 and 2017. The association between mortality and transport time to the nearest trauma centre was then analysed. RESULTS: The current distribution of trauma centres allowed access time within the Golden Hour for accidents occurring on the Swiss plateau, but the time was more prolonged in the Alps or the Jura. An association existed between mortality and prehospital transport time from the site of an accident to the nearest trauma centre. For each additional 10-minute isochrone, an average increase of 0.4% in mortality was observed. CONCLUSION: This work showed an adequate distribution of trauma centres in Switzerland and suggests a positive relationship between transport time to the nearest trauma centre and mortality. The numerous confounding factors not systematically collected in publicly available databases limit the robustness of our results. This study confirms the importance of having a national trauma registry to allow quality analyses to guide public health decisions.
    Tags: *Trauma Centers, *Wounds and Injuries, Accidents, Traffic, Databases, Factual, Humans, Registries, Switzerland/epidemiology.
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  • Anwander, H., Klingberg, K., Gerber, J., Bednarski, P., Exadaktylos, A., and Muller, M. “Major Trauma During Covid-19 In A Level 1 Trauma Centre In Switzerland - A Cohort Study Comparing The Years 2020 And 2019”. Swiss Med Wkly 151, no. 33-34. doi:10.4414/SMW.2021.w30010.
    Abstract: INTRODUCTION: The COVID-19 pandemic and the associated restrictions may have modified the activities of the Swiss population and thus altered trauma patterns. MATERIALS AND PATIENTS: All adult patients with major trauma admitted to our institution in 2019 and 2020 were assessed using the Injury Severity Score (ISS), by body region involved, type of injury, age, admission to an intensive care unit and 30-day mortality. RESULTS: In 2020, 454 patients with major trauma were admitted to our institution, 17% fewer than in the previous year. The drop in the number of major trauma patients proceeded with and overlapped both the first and second peaks in incidence of the pandemic and the associated restrictions. The median ISS was higher in 2020 (25, interquartile range [IQR] 17-26.5) than in 2019 (22, IQR 16-26, p = 0.04). There were no significant differences in body region involved, type of injury or age (p >0.05). In 2020, a higher percentage of patients were admitted to an intensive care unit (86.5% vs 77.7%, p <0.001) and died within 30 days (8.8% vs 5.0%, p = 0.015). The 30-day mortality was higher in 2020 than in 2019, with an odds ratio of 1.80 (95% confidence interval 1.04-3.10, p= 0.036) after adjustment for the following potential confounders: ISS, age, gender and type of injury. CONCLUSION: In the first year of the COVID-19 pandemic, fewer patients with major trauma were admitted to our institution. However, the patients admitted were more severely injured and more often died within 30 days. Understanding the differences in injury patterns and admissions in major trauma patients under special conditions - such as a pandemic - could help to allocate rare resources adequately.
    Tags: *covid-19, *Wounds and Injuries/epidemiology, Adult, Cohort Studies, Humans, Injury Severity Score, Pandemics, Retrospective Studies, SARS-CoV-2, Switzerland/epidemiology, Trauma Centers.
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  • Soares, S., Rocha, V., Kelly-Irving, M., Stringhini, S., and Fraga, S. “Adverse Childhood Events And Health Biomarkers: A Systematic Review”. Front Public Health 9: 649825. doi:10.3389/fpubh.2021.649825.
    Abstract: Background: This systematic review aimed to summarize evidence reporting epigenetic and/or neuro-immuno-endocrine embedding of adverse childhood events (ACEs) in children, with a particular focus on the short-term biological effect of those experiences. Methods: A search was conducted in PsycINFO(R), PubMed(R), Isi Web of Knowledge and Scopus, until July 2019, to identify papers reporting the short-term biological effects of exposure to ACEs. Results: The search identified 58 studies, that were included in the review. Regarding exposure, the type of ACE more frequently reported was sexual abuse (n = 26), followed by life stressors (n = 20) and physical abuse (n = 19). The majority (n = 17) of studies showed a positive association between ACEs and biomarkers of the immune system. Regarding DNA methylation 18 studies showed more methylation in participants exposed to ACEs. Two studies presented the effect of ACEs on telomere length and showed that exposure was associated with shorter telomere length. Conclusion: Overall the associations observed across studies followed the hypothesis that ACEs are associated with biological risk already at early ages. This is supporting evidence that ACEs appear to get "under the skin" and induce physiological changes and these alterations might be strongly associated with later development of disease.
    Tags: *DNA Methylation, *Physical Abuse, Aces, adverse childhood events, biology of social adversity, Biomarkers, Child, commercial or financial relationships that could be construed as a potential, conflict of interest., Humans, review-systematic.
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  • Gonzalez-Jaramillo, V., Guyer, J., Luethi, N., Sobanski, P., Zbinden, R., Rodriguez, E., Hunziker, L., Eychmuller, S., and Maessen, M. “Validation Of The German Version Of The Needs Assessment Tool: Progressive Disease-Heart Failure”. Health Qual Life Outcomes 19, no. 1: 214. doi:10.1186/s12955-021-01817-6.
    Abstract: BACKGROUND: The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) is a tool created to assess the needs of people living with heart failure and their informal caregivers to assist delivering care in a more comprehensive way that addresses actual needs that are unmet, and to improve quality of life. In this study, we aimed to (1) Translate the tool into German and culturally adapt it. (2) Assess internal consistency, inter-rater reliability, and test-retest reliability of the German NAT: PD-HF. (3) Evaluate whether and how patients and health care personnel understand the tool and its utility. (4) Assess the tool's face validity, applicability, relevance, and acceptability among health care personnel. METHODS: Single-center validation study. The tool was translated from English into German using a forward-backward translation. To assess internal consistency, we used Cronbach s alpha. To assess inter-rater reliability and test-retest reliability, we used Cohen s kappa, and to assess validity we used face validity. RESULTS: The translated tool showed good internal consistency. Raters were in substantial agreement on a majority of the questions, and agreement was almost perfect for all the questions in the test-retest analysis. Face validity was rated high by health care personnel. CONCLUSION: The German NAT: PD-HF is a reliable, valid, and internally consistent tool that is well accepted by both patients and health care personnel. However, it is important to keep in mind that effective use of the tool requires training of health care personnel.
    Tags: Aged, Disease Progression, Female, Germany, Heart failure, Heart Failure/*diagnosis/*therapy, Humans, Male, Middle Aged, Nat: Pd-hf, Needs assessment, Needs Assessment/*standards, Palliative Care, Patient-Centered Care, Quality of Life/*psychology, Reproducibility of Results, Stroke Volume, Surveys and Questionnaires/*standards, Translating.
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  • Caspar, M., Dutilh, G., Achermann, S., Bingisser, R., and Nickel, C. H. “Contact-Free Monitoring Of Pulse Rate For Triage Of Patients Presenting To The Emergency Department”. J Emerg Med 61, no. 6: 649-657. doi:10.1016/j.jemermed.2021.07.005.
    Abstract: BACKGROUND: The evaluation of a patient's pulse rate (PR) plays a key role in emergency triage and is commonly measured in a contact-dependent way. OBJECTIVE: Our aims were to evaluate a camera-based prototype application (CBPA) measuring PR in an emergency department (ED) as an alternative to the current contact-dependent method of pulse oximetry and to determine the correlation between CBPA and pulse oximetry in measuring PR. METHODS: We simultaneously measured PR with CBPA and pulse oximetry as a reference method on a large group of ED walk-in patients. We then estimated correlation and agreement between the two methods, as well as the corresponding 95% confidence intervals. RESULTS: In a convenience sample of 446 patients, the correlation between CBPA and pulse oximetry in measuring PR was 0.939 (95% confidence interval [CI] 0.927-0.949) and the intraclass correlation was 0.939 (95% CI 0.927-0.949). CONCLUSIONS: Our study found that CBPA seems to be a viable alternative to the current method of measuring PR at triage. ClinicalTrials.gov identifier: NCT03393585.
    Tags: *Oximetry, *Triage, contact-free monitoring, Emergency Service, Hospital, Heart Rate, Humans, pulse rate, vital sign.
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  • Boeddinghaus, J., Lopez-Ayala, P., Nestelberger, T., Koechlin, L., Munch, T., Miro, O., Gimenez, M. R., Mueller, C., and Investigators, Apace. “Prospective Validation Of The Esc 0/1H-Algorithm Using High-Sensitivity Cardiac Troponin I”. Am J Cardiol 158: 152-153. doi:10.1016/j.amjcard.2021.08.007.
    Tags: *Algorithms, Aged, Biomarkers/blood, Female, Humans, Male, Middle Aged, Non-ST Elevated Myocardial Infarction/*blood/*diagnosis, Predictive Value of Tests, Troponin I/*blood.
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  • Siebert, J. N., Bloudeau, L., Combescure, C., Haddad, K., Hugon, F., Suppan, L., Rodieux, F., et al. “Effect Of A Mobile App On Prehospital Medication Errors During Simulated Pediatric Resuscitation: A Randomized Clinical Trial”. Jama Netw Open 4, no. 8: e2123007. doi:10.1001/jamanetworkopen.2021.23007.
    Abstract: IMPORTANCE: Medication errors are a leading cause of injury and avoidable harm, affecting millions of people worldwide each year. Children are particularly susceptible to medication errors, but innovative interventions for the prevention of these errors in prehospital emergency care are lacking. OBJECTIVE: To assess the efficacy of an evidence-based mobile app in reducing the occurrence of medication errors compared with conventional preparation methods during simulated pediatric out-of-hospital cardiac arrest scenarios. DESIGN, SETTING, AND PARTICIPANTS: This nationwide, open-label, multicenter, randomized clinical trial was conducted at 14 emergency medical services centers in Switzerland from September 3, 2019, to January 21, 2020. The participants were 150 advanced paramedics with drug preparation autonomy. Each participant was exposed to a 20-minute, standardized, fully video-recorded, realistic pediatric out-of-hospital cardiac arrest cardiopulmonary resuscitation scenario concerning an 18-month-old child. Participants were tested on sequential preparations of 4 intravenous emergency drugs of varying degrees of preparation difficulty (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate). INTERVENTION: Participants were randomized (1:1 ratio) to the support of an app designed to assist with pediatric drug preparation (intervention; n = 74) or to follow conventional drug preparation methods without assistance (control; n = 76). MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of medication errors, defined as a failure in drug preparation according to predefined, expert consensus-based criteria. Logistic regression models with mixed effects were used to assess the effect of the app on binary outcomes. Secondary outcomes included times to drug preparation and delivery, assessed with linear regression models with mixed effects. RESULTS: In total, 150 advanced paramedics (mean [SD] age, 35.6 [7.2] years; 101 men [67.3%]; mean [SD] time since paramedic certification, 8.0 [6.2] years) participated in the study and completed 600 drug preparations. Of 304 preparations delivered using the conventional method, 191 (62.8%; 95% CI, 57.1%-68.3%) were associated with medication errors compared with 17 of 296 preparations delivered using the app (5.7%; 95% CI, 3.4%-9.0%). When accounting for repeated measures, with the app, the proportion of medication errors decreased in absolute terms by 66.5% (95% CI, 32.6%-83.8%; P < .001), the mean time to drug preparation decreased by 40 seconds (95% CI, 23-57 seconds; P < .001), and the mean time to drug delivery decreased by 47 seconds (95% CI, 27-66 seconds; P < .001). The risk of medication errors varied across drugs with conventional methods (19.7%-100%) when compared with the app (4.1%-6.8%). CONCLUSIONS AND RELEVANCE: Compared with conventional methods, the use of a mobile app significantly decreased the rate of medication errors and time to drug delivery for emergency drug preparation in a prehospital setting. Dedicated mobile apps have the potential to improve medication safety and change practices in pediatric emergency medicine. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03921346.
    Tags: *Mobile Applications, Adult, Cardiopulmonary Resuscitation/*education/*standards, Emergency Medical Services/*standards/statistics & numerical data, Emergency Medical Technicians/*education, Female, Humans, Male, Medication Errors/*prevention & control/statistics & numerical data, Middle Aged, Out-of-Hospital Cardiac Arrest/*therapy, Practice Guidelines as Topic, Simulation Training/methods, Switzerland, Young Adult.
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  • van Veelen, M. J., and Brodmann Maeder, M. “Hypothermia In Trauma”. Int J Environ Res Public Health 18, no. 16. doi:10.3390/ijerph18168719.
    Abstract: Hypothermia in trauma patients is a common condition. It is aggravated by traumatic hemorrhage, which leads to hypovolemic shock. This hypovolemic shock results in a lethal triad of hypothermia, coagulopathy, and acidosis, leading to ongoing bleeding. Additionally, hypothermia in trauma patients can deepen through environmental exposure on the scene or during transport and medical procedures such as infusions and airway management. This vicious circle has a detrimental effect on the outcome of major trauma patients. This narrative review describes the main factors to consider in the co-existing condition of trauma and hypothermia from a prehospital and emergency medical perspective. Early prehospital recognition and staging of hypothermia are crucial to triage to proper care to improve survival. Treatment of hypothermia should start in an early stage, especially the prevention of further cooling in the prehospital setting and during the primary assessment. On the one hand, active rewarming is the treatment of choice of hypothermia-induced coagulation disorder in trauma patients; on the other hand, accidental or clinically induced hypothermia might improve outcomes by protecting against the effects of hypoperfusion and hypoxic injury in selected cases such as patients suffering from traumatic brain injury (TBI) or traumatic cardiac arrest.
    Tags: *Blood Coagulation Disorders/etiology/therapy, *Hypothermia/complications/therapy, *Wounds and Injuries/complications/therapy, cardiac arrest, coagulation, Ecls, emergency preservation resuscitation, extracorporeal life support, Heart Arrest/therapy, Hemorrhage, Humans, hypothermia, lethal triad, Rewarming, trauma, traumatic brain injury.
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  • Audige, A., Boni, J., Schreiber, P. W., Scheier, T., Buonomano, R., Rudiger, A., Braun, D. L., et al. “Reduced Relative Sensitivity Of The Elecsys Sars-Cov-2 Antigen Assay In Saliva Compared To Nasopharyngeal Swabs”. Microorganisms 9, no. 8. doi:10.3390/microorganisms9081700.
    Abstract: Early identification and isolation of SARS-CoV-2-infected individuals is central to contain the COVID-19 pandemic. Nasopharyngeal swabs (NPS) serve as a specimen for detection by RT-PCR and rapid antigen screening tests. Saliva has been confirmed as a reliable alternative specimen for RT-PCR and has been shown to be valuable for diagnosing children and in repetitive mass testing due to its non-invasive collection. Combining the advantages of saliva with those of antigen tests would be highly attractive to further increase test capacities. Here, we evaluated the performance of the Elecsys SARS-CoV-2 Antigen assay (Roche) in RT-PCR-positive paired NPS and saliva samples (N = 87) and unpaired NPS (N = 100) with confirmed SARS-CoV-2 infection (Roche cobas SARS-CoV-2 IVD test). We observed a high positive percent agreement (PPA) of the antigen assay with RT-PCR in NPS, reaching 87.2% across the entire cohort, whereas the overall PPA for saliva was insufficient (40.2%). At Ct values </= 28, PPA were 100% and 91.2% for NPS and saliva, respectively. At lower viral loads, the sensitivity loss of the antigen assay in saliva was striking. At Ct values </= 35, the PPA for NPS remained satisfactory (91.5%), whereas the PPA for saliva dropped to 46.6%. In conclusion, saliva cannot be recommended as a reliable alternative to NPS for testing with the Elecsys Anti-SARS-CoV-2 Antigen assay. As saliva is successfully used broadly in combination with RT-PCR testing, it is critical to create awareness that suitability for RT-PCR cannot be translated to implementation in antigen assays without thorough evaluation of each individual test system.
    Tags: antigen assay, Rt-pcr, saliva, SARS-CoV-2.
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  • Bargetzi, L., Bargetzi, M., Laviano, A., Stanga, Z., and Schuetz, P. “Inflammation Reduces The Effect Of Nutritional Therapy On Clinical Outcomes In Cancer Patients”. Ann Oncol 32, no. 11: 1451-1452. doi:10.1016/j.annonc.2021.08.1989.
    Tags: *Neoplasms/therapy, *Nutritional Support, declared no conflicts of interest., Health Science, Abbott Nutrition and Fresenius Kabi. All other authors have, Humans, Inflammation, institution of ZS received speaking honoraria and research support from Nestle, unrelated to this project from Nestle Health Science and Abbott Nutrition. The.
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  • Walpoth, B. H., Maeder, M. B., Courvoisier, D. S., Meyer, M., Cools, E., Darocha, T., Blancher, M., et al. “Hypothermic Cardiac Arrest - Retrospective Cohort Study From The International Hypothermia Registry”. Resuscitation 167: 58-65. doi:10.1016/j.resuscitation.2021.08.016.
    Abstract: AIM: The International Hypothermia Registry (IHR) was created to increase knowledge of accidental hypothermia, particularly to develop evidence-based guidelines and find reliable outcome predictors. The present study compares hypothermic patients with and without cardiac arrest included in the IHR. METHODS: Demographic, pre-hospital and in-hospital data, method of rewarming and outcome data were collected anonymously in the IHR between 2010 and 2020. RESULTS: Two hundred and one non-consecutive cases were included. The major causeof hypothermia was mountain accidents, predominantly in young men. Hypothermic Cardiac Arrest (HCA) occurred in 73 of 201 patients. Core temperature was significantly lower in the patients in cardiac arrest (25.0 vs. 30.0 degrees C, p < 0.001). One hundred and fifteen patients were rewarmed externally (93% with ROSC), 53 by extra-corporeal life support (ECLS) (40% with ROSC) and 21 with invasive internal techniques (71% with ROSC). The overall survival rate was 95% for patients with preserved circulation and 36% for those in cardiac arrest. Witnessed cardiac arrest and ROSC before rewarming were positive outcome predictors, asphyxia, coagulopathy, high potassium and lactate negative outcome predictors. CONCLUSIONS: This first analysis of 201 IHR patients with moderate to severe accidental hypothermia shows an excellent 95% survival rate for patients with preserved circulation and 36% for HCA patients. Witnessed cardiac arrest, restoration of spontaneous circulation, low potassium and lactate and absence of asphyxia were positive survival predictors despite hypothermia in young, healthy adults after mountaineering accidents. However, accidental hypothermia is a heterogenous entity that should be considered in both treatment strategies and prognostication.
    Tags: *Heart Arrest/therapy, *Hypothermia/complications/epidemiology/therapy, Accidental, Adult, Cardiac Arrest, Ecls, Humans, Hypothermia, Male, Registries, Registry, Retrospective Studies, Rewarming.
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  • Prader, S., Ritz, N., Baleydier, F., Andre, M. C., Stahli, N., Schmid, K., Schmid, H., et al. “X-Linked Lymphoproliferative Disease Mimicking Multisystem Inflammatory Syndrome In Children-A Case Report”. Front Pediatr 9: 691024. doi:10.3389/fped.2021.691024.
    Abstract: Most children with a SARS-CoV-2 infection are asymptomatic or exhibit mild symptoms. However, a small number of children develop features of substantial inflammation temporarily related to the COVID-19 also called multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), clinically similar to Kawasaki disease, toxic shock syndrome and hemophagocytic lymphohistiocytosis (HLH). It is well-known that genetic pre-disposition plays an important role in virally-triggered diseases such as Epstein-Barr virus (EBV)-associated HLH, while this has not yet been established for patients with MIS-C. Here we describe a male patient fulfilling the diagnostic criteria of MIS-C, who was initially treated according to current consensus guidelines. Presence of hypofibrinogenemia, normal lymphocyte counts and C-reactive protein, but substantial hyperferritinemia distinguish this patient from others with MIS-C. The clinical course following initial presentation with acute respiratory distress syndrome was marked by fatal liver failure in the context of EBV-associated HLH despite treatment with steroids, intravenous immunoglobulins, interleukin (IL)-1 receptor blockade and eventually HLH-directed treatment. X-linked lymphoproliferative disease type 1 (XLP1), a subtype of primary HLH was diagnosed in this patient post-mortem. This case report highlights the importance of including HLH in the differential diagnosis in MIS-C with severe disease course to allow specific, risk-adapted treatment and genetic counseling.
    Tags: advisory board for Emapalumab for SOBI. The remaining authors declare that the, case report, fatal, Hlh, Mis-c, pediatric, Pims-ts, relationships that could be construed as a potential conflict of interest., research was conducted in the absence of any commercial or financial, SARS-CoV-2, Xlp1.
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  • Klocker, E., Meuli, L., Rauch, S., Kottmann, A., Mosimann, U., Pasquier, M., Metrailler, P., Doppman, P., Albrecht, R., and Pietsch, U. “Crevasse Accidents In The Swiss Alps Epidemiology And Mortality Of 405 Victims Of Crevasse Accidents From 2010 To 2020”. Injury 53, no. 1: 183-189. doi:10.1016/j.injury.2021.08.010.
    Abstract: INTRODUCTION: The clinical spectrum of injuries in crevasse accidents can range from benign to life-threatening, even including death. To date, little is known about incidence and causes. METHODS: We retrospectively analyzed mountain rescue missions that included crevasse accidents and took place in Switzerland from 2010 to 2020. Demographic and epidemiological data were collected. Injury severity was graded according to the National Advisory Committee for Aeronautics (NACA) score. Winter season was defined as December to May, and summer season as June to November. RESULTS: A total of 321 victims of crevasse falls were included in the study. The median age of victims was 41.2 years (interqauartile range [IQR] 31.3 to 51.6), with 82% (n=260) being male and 59% (n=186) foreigners. The typical altitude range at which rescue missions were performed was between 3000 and 3499m (44% of all cases). The median depth of the fall was 15 meters (IQR 8 to 20) during the winter season compared to 8 meters (IQR 5 to 10) during the summer, p<0.001. Overall mortality was 6.5%. The NACA score was >/=4 for 9.4% (n=30) of the victims. 55% (n=177) had a NACA score of 0 or 1. There was a significant positive correlation between the depth of fall and the injury severity (Pearson;s correlation r=0.35, 95%- confidence interval: 0.18 to 0.51), p<0.001. CONCLUSION: More than half of victims fallen into a crevasse are uninjured or sustain mild injury. Life-threathening injuries were found in about 10% of victims and the crevasse fall was fatal in 6.5% of cases. Injury severity positively correlates with the depth of fall, which is higher during winter season.
    Tags: *Accidental Falls, *Accidents, Adult, Crevasse, Ethnicity, Glacial Sports, Hems, Humans, Male, Mountain Medicine, Retrospective Studies, Seasons, Swiss Alps, Switzerland/epidemiology.
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  • Storz, M. A., Lederer, A. K., and Heymann, E. P. “German-Speaking Medical Students On International Electives: An Analysis Of Popular Elective Destinations And Disciplines”. Global Health 17, no. 1: 90. doi:10.1186/s12992-021-00742-z.
    Abstract: BACKGROUND: International medical electives are a well-established part of the curriculum of many western medical schools. It is widely accepted that these electives contribute to improved clinical examination and communication skills. Overseas electives also exert a strong influence over future career decisions and often pave the way for later international work. Whilst the positive outcomes are known, little information exists regarding elective preferences and destinations overall, information that could help optimise a safe learning experience and maximise the potential for one of the highlights of medical education. In order to obtain analytical data that could assist medical elective framework development, we systematically reviewed the two largest German online databases cataloguing abroad elective testimonies. RESULTS: We identified 856 overseas elective reports uploaded within the last five years. European destinations were the most sought-after choice among German-speaking medical students. Interest in abroad electives in the United States (U.S.), a traditionally popular destination, was much lower than expected. U.S. elective reports accounted for only 3 % of long-term electives. Electives in low- and middle-income countries were generally less popular than electives in high-income countries. General surgery was the most popular elective discipline, followed by Emergency Medicine and Gynaecology and Obstetrics. CONCLUSIONS: We observed a large inhomogeneity in German-speaking medical students' elective choices, potentially influenced by financial and organizational aspects as well as geopolitical developments. This highlights a crucial challenge for medical schools and other organizations involved in elective planning. In light of regional differences, our data suggest that a "one size fits all" preparation is not pertinent to optimize students' elective experience. Country- or region-specific pre-departure trainings and more individualized elective frameworks might be necessary to address these differences and to ensure a safe learning experience for students.
    Tags: *Education, Medical, *Education, Medical, Undergraduate, *Students, Medical, Abroad elective, Curriculum, Global Health, Humans, International elective, International health care, Internationalization, Medical education, Medical elective, Medical training, Schools, Medical, Travel Medicine, United States.
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  • Davis, A. L., Sunderji, A., Marneni, S. R., Seiler, M., Hall, J. E., Cotanda, C. P., Klein, E. J., et al. “Caregiver-Reported Delay In Presentation To Pediatric Emergency Departments For Fear Of Contracting Covid-19: A Multi-National Cross-Sectional Study”. Cjem 23, no. 6: 778-786. doi:10.1007/s43678-021-00174-z.
    Abstract: OBJECTIVE: To determine if caregivers of children presenting to pediatric emergency departments (EDs) during the COVID-19 pandemic are delaying presenting to care for fear of contracting COVID-19. METHODS: This was a pre-planned secondary analysis of a cross-sectional survey study of caregivers accompanying their children aged 0-19 years to 16 pediatric EDs in 5 countries from May to June 2020. An anonymous online survey, completed by caregivers via RedCAP, included caregiver and child demographics, presenting complaints, if they delayed presentation and whether symptoms worsened during this interval, as well as caregiver concern about the child or caregiver having COVID-19 at the time of ED visit. RESULTS: Of 1543 caregivers completing the survey, 287 (18.6%) reported a delay in seeking ED care due to concerns of contracting COVID-19 in the hospital. Of those, 124 (43.2%) stated their child's symptoms worsened during the waiting interval. Caregiver relationship to child [mother] (OR 1.85, 95% CI 1.27-2.76), presence of chronic illness in child (OR 1.78. 95% CI 1.14-2.79), younger age of caregiver (OR 0.965, 95% CI 0.943-0.986), and caregiver concerns about lost work during the pandemic (OR 1.08, 95% CI 1.04-1.12) were independently associated with a COVID-19-related delayed presentation in multivariable regression analysis. CONCLUSIONS: Almost one in five caregivers reported delaying ED presentation for their ill or injured child specifically due to fear of contracting COVID-19 while in hospital, with mothers, younger caregivers, caregivers of children with chronic illness, and those concerned about lost work more likely to report delaying ED presentation.
    Tags: *Caregivers, *covid-19, Caregivers, Child, Children, Covid-19, Cross-Sectional Studies, Emergency department, Emergency Service, Hospital, Fear, Humans, Pandemics, Presentation delay, SARS-CoV-2.
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  • Schreiner, P., Greuter, T., Tatu, A., Keller, D. I., Straumann, A., and Biedermann, L. “Is There A Role For Topical Swallowed Steroids Upon Emergency Room Admission For Suspected Food Bolus Obstruction In Eosinophilic Esophagitis?”. Dysphagia 37, no. 4: 933-936. doi:10.1007/s00455-021-10354-9.
    Abstract: Since most pharmacological treatments in case of esophageal food impaction (EFI) are unsuccessful, an endoscopy is usually required to resolve EFI. We present the first results of a budesonide orodispersible tablet (BOT) as a medical treatment option before endoscopy. We evaluated all patients with a suspected EFI to receive BOT before emergent endoscopy at a tertiary hospital between March 2019 and June 2020. A total of eight patients received BOT before endoscopy. Mean age was 50.1 years and 87.5% were male. In 38% (3/8) of patients the EFI resolved without endoscopic intervention. No adverse events occurred. After endoscopy, a diagnosis of EoE was established in 75%. This case series demonstrate the potential of BOT as medical rescue therapy in case of EFI.
    Tags: *Deglutition Disorders/diagnosis/drug therapy/etiology, *Eosinophilic Esophagitis/complications/diagnosis/drug therapy, AG, Switzerland, Esocap AG, Switzerland, Sanofi-Aventis AG, Switzerland and, Budesonide orodispersible tablet, Calypso Biotech SA., conflict of interest. DIK has no conflict of interest. AS reports receiving, consulting fees from Allakos, AstraZeneca, EsoCap, Dr. Falk Pharma, Gossamer,, Deglutition, Deglutition disorders, Emergency Service, Hospital, Enteritis, Eosinophilia, Esophageal food impaction, Female, Gastritis, GmbH and Vifor, and an unrestricted research grant from Novartis. AT has no, GSK, Receptos-Celgene and Regeneron-Sanofi. LB received consulting fees and/or, Humans, Male, Middle Aged, Sanofi-Regeneron and Falk Pharma GmbH, received travel grants from Falk Pharma, speaker fees and/or research grants from Dr. Falk Pharma, GmbH, Germany, Vifor, Steroids/therapeutic use, support from Falk, UCB and Pfizer. TG has consulting contracts with.
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  • Meszaros, E. P., Stancu, C., Costanza, A., Besson, M., Sarasin, F., Bondolfi, G., and Ambrosetti, J. “Antibiomania: A Case Report Of Clarithromycin And Amoxicillin-Clavulanic Acid Induced Manic Episodes Separately”. Bmc Psychiatry 21, no. 1: 399. doi:10.1186/s12888-021-03397-7.
    Abstract: BACKGROUND: Antibiomania is a rare but recognized side effect with yet unclear definite pathogenesis although multiple hypotheses have been proposed. The novelty of this case is the suspected pharmacodynamic drug-drug interaction between clarithromycin and amoxicillin-clavulanic acid. CASE PRESENTATION: We present the occurrence of a brief manic episode concerning a 50-year-old man with no psychiatric history, first started on amoxicillin-clavulanic acid therapy and then switched to clarithromycin for left basal pneumonia. Shortly after the antibiotic prescription, he presented psychiatric symptomatology (logorrhea, elevated mood, irritability, increase in physical activity and delusions). The antibiotic was stopped and the patient received lorazepam (2.5 mg p.o.) to treat psychomotor agitation. Approximately 12 h after clarithromycin cessation, amelioration was already observed, supporting the diagnosis of a clarithromycin-induced manic episode. Amoxicillin-clavulanic acid was then reintroduced because of the pneumonia and psychiatric symptoms reemerged. This second antibiotic was also stopped, and 1 week later, the patient was symptom-free. CONCLUSION: The emergence of psychiatric side effects related to antibiotherapy, which is a common treatment, can greatly impact a patient's quality of life. Early recognition and intervention could substantially influence the administered medical care and recovery. Moreover, given the widespread use of antibiotics including in combination, we thought our case report might be clinically useful as a clinical reminder relevant to the use of antibiotic combinations.
    Tags: *Amoxicillin-Potassium Clavulanate Combination/adverse effects, *Clarithromycin/adverse effects, Adverse effects, Amoxicillin-clavulanic acid, Anti-Bacterial Agents/adverse effects, Antibiomania, Antibiotics, Case report, Clarithromycin, Humans, Male, Mania, Middle Aged, Quality of Life.
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  • Lopez-Ayala, P., Nestelberger, T., Boeddinghaus, J., Koechlin, L., Ratmann, P. D., Strebel, I., Gehrke, J., et al. “Novel Criteria For The Observe-Zone Of The Esc 0/1H-Hs-Ctnt Algorithm”. Circulation 144, no. 10: 773-787. doi:10.1161/CIRCULATIONAHA.120.052982.
    Abstract: BACKGROUND: The non-ST-segment-elevation myocardial infarction (NSTEMI) guidelines of the European Society of Cardiology (ESC) recommend a 3h cardiac troponin determination in patients triaged to the observe-zone of the ESC 0/1h-algorithm; however, no specific cutoff for further triage is endorsed. Recently, a specific cutoff for 0/3h high-sensitivity cardiac troponin T (hs-cTnT) change (7 ng/L) was proposed, warranting external validation. METHODS: Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. Final diagnoses were centrally adjudicated by 2 independent cardiologists applying the fourth universal definition of myocardial infarction, on the basis of complete cardiac workup, cardiac imaging, and serial hs-cTnT. Hs-cTnT concentrations were measured at presentation, after 1 hour, and after 3 hours. The objective was to externally validate the proposed cutoff, and if necessary, derive and internally as well as externally validate novel 0/3h-criteria for the observe-zone of the ESC 0/1h-hs-cTnT-algorithm in an independent multicenter cohort. RESULTS: Among 2076 eligible patients, application of the ESC 0/1h-hs-cTnT-algorithm triaged 1512 patients (72.8%) to either rule out or rule in NSTEMI, leaving 564 patients (27.2%) in the observe-zone (adjudicated NSTEMI prevalence, 120/564 patients, 21.3%). The suggested 0/3h-hs-cTnT-change of <7 ng/L triaged 517 patients (91.7%) toward rule-out, resulting in a sensitivity of 33.3% (95% CI, 25.5-42.2), missing 80 patients with NSTEMI, and >/=7 ng/L triaged 47 patients toward rule-in (8.3%), resulting in a specificity of 98.4% (95% CI, 96.8-99.2). Novel derived 0/3h-criteria for the observe-zone patients ruled out NSTEMI with a 3h hs-cTnT concentration <15 ng/L and a 0/3h-hs-cTnT absolute change <4 ng/L, triaging 138 patients (25%) toward rule-out, resulting in a sensitivity of 99.2% (95% CI, 96.0-99.9), missing 1 patient with NSTEMI. A 0/3h-hs-cTnT absolute change >/=6 ng/L triaged 63 patients (11.2%) toward rule-in, resulting in a specificity of 98% (95% CI, 96.2-98.9) Thereby, the novel 0/3h-criteria reduced the number of patients in the observe zone by 36%s and the number of type 1 myocardial infarction by 50%. Findings were confirmed in both internal and external validation. CONCLUSIONS: A combination of a 3h-hs-cTnT concentration (<15 ng/L) and a 0/3h absolute change (<4 ng/L) is necessary to safely rule out NSTEMI in patients remaining in the observe-zone of the ESC 0/1h-hs-cTnT-algorithm. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT00470587.
    Tags: *Algorithms, algorithms, biomarkers, Cardiac Imaging Techniques/methods, Cardiology/methods, Cardiovascular System/*physiopathology, Data Collection, Diagnostic Tests, Routine/adverse effects, Heart/physiopathology, Humans, myocardial infarction, Myocardial Infarction/physiopathology/*therapy, Nstemi, ST Elevation Myocardial Infarction/*therapy, triage, troponin, troponin T.
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  • Sava, M., Sommer, G., Daikeler, T., Woischnig, A. K., Martinez, A. E., Leuzinger, K., Hirsch, H. H., et al. “Ninety-Day Outcome Of Patients With Severe Covid-19 Treated With Tocilizumab - A Single Centre Cohort Study”. Swiss Med Wkly 151: w20550. doi:10.4414/smw.2021.20550.
    Abstract: OBJECTIVES: Patients with severe COVID-19 may be at risk of longer term sequelae. Long-term clinical, immunological, pulmonary and radiological outcomes of patients treated with anti-inflammatory drugs are lacking. METHODS: In this single-centre prospective cohort study, we assessed 90-day clinical, immunological, pulmonary and radiological outcomes of hospitalised patients with severe COVID-19 treated with tocilizumab from March 2020 to May 2020. Criteria for tocilizumab administration were oxygen saturation &lt;93%, respiratory rate &gt;30/min, C-reactive protein levels &gt;75 mg/l, extensive area of ground-glass opacities or progression on computed tomography (CT). Descriptive analyses were performed using StataIC 16. RESULTS: Between March 2020 and May 2020, 50 (27%) of 186 hospitalised patients had severe COVID-19 and were treated with tocilizumab. Of these, 52% were hospitalised on the intensive care unit (ICU) and 12% died. Eleven (22%) patients developed at least one microbiologically confirmed super-infection, of which 91% occurred on ICU. Median duration of hospitalisation was 15 days (interquartile range [IQR] 10&ndash;24) with 24 days (IQR 14&ndash;32) in ICU patients and 10 days (IQR 7&ndash;15) in non-ICU patients. At day 90, 41 of 44 survivors (93%) were outpatients. No long-term adverse events or late-onset infections were identified after acute hospital care. High SARS-CoV-2 antibody titres were found in all but one patient, who was pretreated with rituximab. Pulmonary function tests showed no obstructive patterns, but restrictive patterns in two (5.7%) and impaired diffusion capacities for carbon monoxide in 11 (31%) of 35 patients, which predominated in prior ICU patients. Twenty-one of 35 (60%) CT-scans at day 90 showed residual abnormalities, with similar distributions between prior ICU and non-ICU patients. CONCLUSIONS: In this cohort of severe COVID-19 patients, no tocilizumab-related long-term adverse events or late-onset infections were identified. Although chest CT abnormalities were highly prevalent at day 90, the majority of patients showed normal lung function. TRIAL REGISTRATION: ClinicalTrials.gov NCT04351503.
    Tags: *COVID-19 Drug Treatment, Antibodies, Monoclonal, Humanized, Cohort Studies, Humans, Prospective Studies, SARS-CoV-2.
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  • Roy, P. M., Penaloza, A., Hugli, O., Klok, F. A., Arnoux, A., Elias, A., Couturaud, F., et al. “Triaging Acute Pulmonary Embolism For Home Treatment By Hestia Or Simplified Pesi Criteria: The Home-Pe Randomized Trial”. Eur Heart J 42, no. 33: 3146-3157. doi:10.1093/eurheartj/ehab373.
    Abstract: AIMS: The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. METHODS AND RESULTS: Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient's opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. CONCLUSIONS: For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.
    Tags: *Pulmonary Embolism/drug therapy, Acute Disease, Clinical decision-making, Emergency department, Home treatment, Humans, Patient Discharge, Prognosis, Pulmonary embolism, Randomized controlled trial, Risk Assessment, Severity of Illness Index.
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  • von Allmen, M., Grazioli, V. S., Kasztura, M., Chastonay, O., Moullin, J. C., Hugli, O., Daeppen, J. B., and Bodenmann, P. “Does Case Management Provide Support For Staff Facing Frequent Users Of Emergency Departments? A Comparative Mixed-Method Evaluation Of Ed Staff Perception”. Bmc Emerg Med 21, no. 1: 92. doi:10.1186/s12873-021-00481-9.
    Abstract: OBJECTIVE: Frequent users of emergency departments (FUED) account for a disproportionate number of emergency department (ED) visits and contribute to a wide range of challenges for ED staff. While several research has documented that case management (CM) tailored to FUED leads to a reduction in ED visits and a better quality of life (QoL) among FUED, whether there is added value for ED staff remains to be explored. This study aimed to compare, among staff in two academic EDs in Switzerland (one with and one without CM), the FUED-related knowledge, perceptions of the extent of the FUED issue, FUED-related work challenges and FUEDs' legitimacy to use ED. METHOD: Mixed methods were employed. First, ED physicians and nurses (N = 253) of the two EDs completed an online survey assessing their knowledge and perceptions of FUEDs. Results between healthcare providers working in an ED with CM to those working in an ED without CM were compared using independent two-sided T-tests. Next, a sample of participants (n = 16) took part in a qualitative assessment via one-to-one interviews (n = 6) or focus groups (n = 10). RESULTS: Both quantitative and qualitative results documented that the FUED-related knowledge, the extent FUED were perceived as an issue and perceived FUEDs' legitimacy to use ED were not different between groups. The level of perceived FUED-related challenges was also similar between groups. Quantitative results showed that nurses with CM experienced more challenges related to FUED. Qualitative exploration revealed that lack of psychiatric staff within the emergency team and lack of communication between ED staff and CM team were some of the explanations behind these counterintuitive findings. CONCLUSION: Despite promising results on FUEDs' QoL and frequency of ED visits, these preliminary findings suggest that CM may provide limited support to ED staff in its current form. Given the high burden of FUED-related challenges encountered by ED staff, improved communication and FUED-related knowledge transfer between ED staff and the CM team should be prioritized to increase the value of a FUED CM intervention for ED staff.
    Tags: *Case Management, *Emergency Service, Hospital, *Medical Overuse, Case management, Emergency service, Female, Focus Groups, Frequent users of emergency departments, Humans, Male, Quality of Life, Staff, Switzerland.
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  • Vasiloglou, M. F., Christodoulidis, S., Reber, E., Stathopoulou, T., Lu, Y., Stanga, Z., and Mougiakakou, S. “Perspectives And Preferences Of Adult Smartphone Users Regarding Nutrition And Diet Apps: Web-Based Survey Study”. Jmir Mhealth Uhealth 9, no. 7: e27885. doi:10.2196/27885.
    Abstract: BACKGROUND: Digital technologies have evolved dramatically in recent years, finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are being used for a steadily increasing number of tasks, including health monitoring. A large number of nutrition and diet apps are available, and some of them are very popular in terms of user downloads, highlighting a trend toward diet monitoring and assessment. OBJECTIVE: We sought to explore the perspectives of end users on the features, current use, and acceptance of nutrition and diet mHealth apps with a survey. We expect that this study can provide user insights to assist researchers and developers in achieving innovative dietary assessments. METHODS: A multidisciplinary team designed and compiled the survey. Before its release, it was pilot-tested by 18 end users. A 19-question survey was finally developed and was translated into six languages: English, German, French, Spanish, Italian, and Greek. The participants were mainly recruited via social media platforms and mailing lists of universities, university hospitals, and patient associations. RESULTS: A total of 2382 respondents (1891 female, 79.4%; 474 male, 19.9%; and 17 neither, 0.7%) with a mean age of 27.2 years (SD 8.5) completed the survey. Approximately half of the participants (1227/2382, 51.5%) had used a nutrition and diet app. The primary criteria for selecting such an app were ease of use (1570/2382, 65.9%), free cost (1413/2382, 59.3%), and ability to produce automatic readings of caloric content (1231/2382, 51.7%) and macronutrient content (1117/2382, 46.9%) (ie, food type and portion size are estimated by the system without any contribution from the user). An app was less likely to be selected if it incorrectly estimated portion size, calories, or nutrient content (798/2382, 33.5%). Other important limitations included the use of a database that does not include local foods (655/2382, 27.5%) or that may omit major foods (977/2382, 41%). CONCLUSIONS: This comprehensive study in a mostly European population assessed the preferences and perspectives of potential nutrition and diet app users. Understanding user needs will benefit researchers who develop tools for innovative dietary assessment as well as those who assist research on behavioral changes related to nutrition.
    Tags: *Mobile Applications, *Smartphone, Adult, apps, behavior, behavior change, Diet, dietary assessment, end-users, Female, Humans, Internet, Male, mHealth, mobile apps, mobile health, nutrition, smartphone, survey, Surveys and Questionnaires, users.
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  • Van Singer, M., Brahier, T., Brochu Vez, M. J., Gerhard Donnet, H., Hugli, O., and Boillat-Blanco, N. “Pancreatic Stone Protein For Early Mortality Prediction In Covid-19 Patients”. Crit Care 25, no. 1: 267. doi:10.1186/s13054-021-03704-4.
    Tags: Aged, Aged, 80 and over, Biomarkers/blood, C-Reactive Protein, COVID-19/diagnosis/*mortality, Emergency Service, Hospital, Female, Hospitals, Teaching, Humans, Lithostathine/*blood, Male, Middle Aged, Prospective Studies, Switzerland.
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  • Bodenmann, P., Kasztura, M., Graells, M., Schmutz, E., Chastonay, O., Canepa-Allen, M., Moullin, J., et al. “Healthcare Providers' Perceptions Of Challenges With Frequent Users Of Emergency Department Care In Switzerland: A Qualitative Study”. Inquiry 58: 469580211028173. doi:10.1177/00469580211028173.
    Abstract: Frequent users of emergency departments (FUED; >/= 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED. This study aimed to explore ED healthcare providers' challenges related to FUED care to gain insight into the support and resources required to address FUED complex needs. An online survey was sent to all general adult emergency services within Switzerland (N = 106). Participants were asked to indicate the extent to which they perceived that FUED represented a problem and to describe the main challenges encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed the survey. Among the 208 participants, 134 (64%) reported that FUED represented a challenge and 133 described 1 to 5 challenges encountered. A conventional content analysis yielded 4 main categories of perceived challenges. Negative consequences in the ED secondary to FUED's presence (eg, ED overcrowding, staff helplessness, and fatigue) was the most frequently reported challenge, followed by challenges related to FUEDs' characteristics (eg, mental health and social problems) leading to healthcare complexity. The third most frequently encountered challenge was related to the ED inappropriateness and inefficiency to address FUEDs' needs. Finally, challenges related to the lack of FUED healthcare network were the least often mentioned. ED healthcare providers experience a wide range of challenges related to FUED care. These findings suggest that currently EDs nor their staff are equipped to address FUEDs' complex needs.
    Tags: *Emergency Service, Hospital, *Health Personnel, Adult, conflicts of interest with respect to the research, authorship, and/or, ED healthcare providers' challenges, frequent users of emergency department, Humans, Perception, publication of this article., Qualitative Research, Switzerland.
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  • Hufner, K., Caramazza, F., Stawinoga, A. E., Pircher Nockler, E. R., Fusar-Poli, P., Bhandari, S. S., Basnyat, B., et al. “Assessment Of Psychotic Symptoms In Individuals Exposed To Very High Or Extreme Altitude: A Field Study”. High Alt Med Biol 22, no. 4: 369-378. doi:10.1089/ham.2020.0210.
    Abstract: Hufner, Katharina, Fabio Caramazza, Agnieszka E. Stawinoga, Evelyn R. Pircher Nockler, Paolo Fusar-Poli, Sanjeeb S. Bhandari, Buddha Basnyat, Monika Brodmann Maeder, Giacomo Strapazzon, Iztok Tomazin, Barbara Sperner-Unterweger, and Hermann Brugger. Assessment of psychotic symptoms in individuals exposed to very high or extreme altitude: A field study. High Alt Med Biol. 22:369-378, 2021. Background: Symptoms of psychosis such as hallucinations can occur at high or extreme altitude and have been linked to accidents on the mountain. No data are available on how to assess such symptoms in the field and what their prevalence or predisposing factors might be. Methods: In this field study at Everest Base Camp (5,365 m) in Nepal, 99 participants of organized expeditions underwent 279 assessments: The High Altitude Psychosis Questionnaire (HAPSY-Q), the Prodromal Questionnaire, 16-items (PQ-16), and the Mini International Neuropsychiatric Interview (M.I.N.I., psychosis section) were collected together with further clinical data. Statistical analysis was done for each phase, that is, altitude range of the climb, and overall data. Results: One of 97 climbers fulfilled the M.I.N.I. diagnostic criteria for psychosis during one acclimatization climb. At least one endorsed item on the HAPSY-Q and the PQ-16, indicating the presence of symptoms of psychosis in the absence of a psychotic disorders, were identified in 10/97 (10.3%) and 18/87 (20.7%) participants respectively. The scores of the HAPSY-Q and the PQ-16 were correlated (r = 0.268, p < 0.001). Odds ratio analysis identified an increased risk for accidents in individuals with endorsed items on the HAPSY-Q. Conclusions: The diagnosis of high altitude psychosis is rare in climbers during organized expeditions. Nevertheless, subdiagnostic symptoms of psychosis occurred in a significant proportion of climbers. Future research is needed to validate these pilot findings.
    Tags: *Altitude Sickness/diagnosis, *Expeditions, *Mountaineering, *Psychotic Disorders/etiology, Acclimatization, Altitude, from EURAC research, Bolzano, Italy. The remaining authors have no disclosures., Hapsy-q, high altitude, high altitude cerebral edema, Humans, M.I.N.I Interview, Pq-16, psychosis.
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  • Mettler, A. C., Piazza, L., Michel, J., Muller, M., Exadaktylos, A. K., Hautz, W. E., and Sauter, T. C. “Use Of Telehealth And Outcomes Before A Visit To The Emergency Department: A Cross-Sectional Study On Walk-In Patients In Switzerland”. Swiss Med Wkly 151, no. 29-30: w20543. doi:10.4414/smw.2021.20543.
    Abstract: AIMS OF THE STUDY: An increasing number of patients are using telehealth before contacting the healthcare system. If we are to optimise future telehealth strategies and adequately respond to patient needs, we need to know more about the frequency and characteristics of telehealth use. Our objectives were (i) to investigate whether patients use telehealth before consulting the emergency department (ED), (ii) to compare patients with and without use of telehealth, and (iii) to investigate adherence, confidence and satisfaction. MATERIALS AND METHODS: A survey was conducted among ED walk-in patients at a tertiary university hospital in Switzerland. Eligible patients were questioned about their use of telehealth before current presentation, during 30 shifts from 23 October to 15 December 2019. RESULTS: A total of 183 (43.9%) of 417 surveyed patients used telehealth, with the telephone being the most commonly used modality, especially among elderly patients. Patients using telehealth were more likely to be male (53.5%, p = 0.001) and were similar in age to non-users. Telehealth users tended to be better educated. Telehealth was predominantly used for semi-urgent non-traumatic diseases that did not lead to hospitalisation. All age groups expressed satisfaction with telehealth, trusted the recommendations and adhered to them. The main reason for &quot;non-use&quot; of telehealth was lack of knowledge. CONCLUSIONS: Lack of knowledge about telehealth opportunities and barriers in specific patient groups should be addressed to include all patients, and thus to exploit telehealth&rsquo;s many advantages.
    Tags: *Telemedicine, Aged, Cross-Sectional Studies, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Switzerland.
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  • Wipplinger, F., Holthof, N., Lienert, J., Maeder, M. B., and Moens, D. “In Reply To Vitiello, De Bernardo, Capasso, And Rosa”. Wilderness Environ Med 32, no. 3: 408-409. doi:10.1016/j.wem.2021.05.002.
  • Ravioli, S., Gygli, R., and Lindner, G. “The Possibility Of Heart Failure In Patients With "Pneumonia" -Author's Reply”. Eur J Intern Med 91: 84. doi:10.1016/j.ejim.2021.06.024.
    Tags: *Community-Acquired Infections, *Heart Failure, *Pneumonia, Community-acquired pneumonia, Electrolyte disorders, Heart failure, Humans, Hyponatremia.
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  • Kammer, J. E., Schauber, S. K., Hautz, S. C., Stroben, F., and Hautz, W. E. “Differential Diagnosis Checklists Reduce Diagnostic Error Differentially: A Randomised Experiment”. Med Educ 55, no. 10: 1172-1182. doi:10.1111/medu.14596.
    Abstract: INTRODUCTION: Wrong and missed diagnoses contribute substantially to medical error. Can a prompt to generate alternative diagnoses (prompt) or a differential diagnosis checklist (DDXC) increase diagnostic accuracy? How do these interventions affect the diagnostic process and self-monitoring? METHODS: Advanced medical students (N = 90) were randomly assigned to one of four conditions to complete six computer-based patient cases: group 1 (prompt) was instructed to write down all diagnoses they considered while acquiring diagnostic test results and to finally rank them. Groups 2 and 3 received the same instruction plus a list of 17 differential diagnoses for the chief complaint of the patient. For half of the cases, the DDXC contained the correct diagnosis (DDXC+), and for the other half, it did not (DDXC-; counterbalanced). Group 4 (control) was only instructed to indicate their final diagnosis. Mixed-effects models were used to analyse results. RESULTS: Students using a DDXC that contained the correct diagnosis had better diagnostic accuracy, mean (standard deviation), 0.75 (0.44), compared to controls without a checklist, 0.49 (0.50), P < 0.001, but those using a DDXC that did not contain the correct diagnosis did slightly worse, 0.43 (0.50), P = 0.602. The number and relevance of diagnostic tests acquired were not affected by condition, nor was self-monitoring. However, participants spent more time on a case in the DDXC-, 4:20 min (2:36), P </= 0.001, and DDXC+ condition, 3:52 min (2:09), than in the control condition, 2:59 min (1:44), P </= 0.001. DISCUSSION: Being provided a list of possible diagnoses improves diagnostic accuracy compared with a prompt to create a differential diagnosis list, if the provided list contains the correct diagnosis. However, being provided a diagnosis list without the correct diagnosis did not improve and might have slightly reduced diagnostic accuracy. Interventions neither affected information gathering nor self-monitoring.
    Tags: *Checklist, *Students, Medical, Diagnosis, Differential, Diagnostic Errors, Humans.
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  • Freytag, J., Stroben, F., Hautz, W. E., Penders, D., and Kammer, J. E. “Effects Of Using A Cognitive Aid On Content And Feasibility Of Debriefings Of Simulated Emergencies”. Gms J Med Educ 38, no. 5: Doc95. doi:10.3205/zma001491.
    Abstract: Background: Adverse events in patient care are often caused by failures in teamwork. Simulation training and its debriefing can contribute to improving teamwork and thus patient care. When conducting debriefings, there are several design factors that can potentially influence learning outcomes. This study examines the use of a cognitive aid to help structure the content of debriefings and compares it with debriefings that are merely roughly structured. In addition, the feasibility of the debriefing, the satisfaction of the participants and their teamwork during the training are investigated. Methods: In a simulated night shift, seven teams of four to five medical students (n=32) took part in six cases that simulated common situations in an emergency medicine environment and received a debriefing on their teamwork after each case, either in the intervention condition with the help of the TeamTAG tool - a cognitive aid focusing on selected teamwork principles from Crisis Resource Management (CRM) - or in the control condition without it. The facilitators noted the topics of the debriefings and rated their experience of conducting them; the participants indicated their satisfaction with the debriefings, as well as their assessment of the importance of CRM principles. In addition, the quality of teamwork was assessed using the Team Emergency Assessment Measure (TEAM). Results: The analysis showed no difference in the number of teamwork principles discussed between the control and intervention conditions, but topics were repeated more frequently in the control group. The TeamTAG guideline was focused on and implemented by the tutors, who discussed the CRM principles included in the TeamTAG more consistently than in the control condition. The tutors in both conditions were satisfied with the implementation, and the use of TeamTAG facilitated time management. There were no differences in participants' satisfaction, their assessment of the importance of the teamwork principles, or the quality of teamwork between conditions. Conclusion: The use of a cognitive aid can help to direct the focus on certain topics or learning objectives and facilitate time management through pre-structuring; however, a difference in learning outcomes (in terms of the quality of teamwork) could not be identified. Besides the influence of a certain structure or script, a strong influence from the individual guiding the debriefing is likely.
    Tags: *Emergencies, *Simulation Training, Clinical Competence, Cognition, cognitive aid, Feasibility Studies, Humans, non-technical skills, Patient Care Team, simulation-based education, structured debriefing, teamwork.
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  • Lanier, C., Muller-Juge, V., Dominice Dao, M., Gaspoz, J. M., Junod Perron, N., and Audetat, M. C. “Management Of Residents In Difficulty In A Swiss General Internal Medicine Outpatient Clinic: Change Is Necessary!”. Plos One 16, no. 7: e0254336. doi:10.1371/journal.pone.0254336.
    Abstract: AIMS OF THE STUDY: Residents in difficulty are a major cause for concern in medical education, with a prevalence of 7-15%. They are often detected late in their training and cannot make use of remediation plans. Nowadays, most training hospitals in Switzerland do not have a specific program to identify and manage residents in difficulty. The aim of the study was to explore the challenges perceived by physicians regarding the process of identifying, diagnosing, and supporting residents in difficulty in a structured and programmatic way. We explored perceptions of physicians at different hierarchical levels (residents (R), Chief residents (CR), attending physicians (A), Chief Physician (CP)) in order to better understand these challenges. METHODS: We conducted an exploratory qualitative study between December 2015 and July 2016. We asked volunteers from the Primary Care Division of the Geneva University Hospitals to partake to three focus groups (with CR, A, R) and one interview with the division's CP. We transcribed, coded, and qualitatively analyzed the three focus groups and the interview, using a content thematic approach and Fishbein's conceptual framework. RESULTS: We identified similarities and differences in the challenges of the management of residents in difficulty on a programmatic way amongst physicians of different hierarchical levels. Our main findings: Supervisors (CR, A, CP) have good identification skills of residents in difficulty, but they did not put in place systematic remediation strategies.Supervisors (CR, A) were concerned about managing residents in difficulty. They were aware of the possible adverse effects on patient care, but "feared to harm" resident's career by documenting a poor institutional assessment.Residents "feared to share" their own difficulties with their supervisors. They thought that it would impact their career negatively.The four physician's hierarchical level reported environmental constraints (lack of funding, time constraint, lack of time and resources...). CONCLUSION: Our results add two perspectives to specialized recommendations regarding the implementation of remediation programs for residents in difficulty. The first revolves around the need to identify and fully understand not only the beliefs but also the implicit norms and the feeling of self-efficacy that are shared by teachers and that are likely to motivate them to engage in the management of residents in difficulty. The second emphasizes the importance of analyzing these elements that constitute the context for a change and of identifying, in close contact with the heads of the institutions, which factors may favor or hinder it. This research action process has fostered awareness and discussions at different levels. Since then, various actions and processes have been put in place at the Faculty of Medicine in Geneva.
    Tags: *Quality Assurance, Health Care, Adult, Aged, Ambulatory Care Facilities/*standards, Education, Medical/*standards, Female, Focus Groups, Humans, Internal Medicine/standards, Internship and Residency, Male, Medical Staff, Hospital, Middle Aged, Physicians/*psychology, Surveys and Questionnaires, Switzerland/epidemiology.
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  • Sebo, P., Haller, D. M., Kaiser, C., Zaim, A., Heimer, O., Chauveau, N., and Maisonneuve, H. “Health-Related Quality Of Life Associated With Nocturnal Leg Cramps In Primary Care: A Mixed Methods Study”. Fam Pract 39, no. 1: 85-91. doi:10.1093/fampra/cmab082.
    Abstract: BACKGROUND: Although nocturnal leg cramps are common, little research is available about their impact on quality of life. This mixed-methods study explored the impact of nocturnal leg cramps on health-related quality of life (HRQoL). METHODS: The study included primary care patients (>50 years) who reported suffering from nocturnal leg cramps (2016-2017). In the quantitative phase, patients completed a questionnaire about their HRQoL (SF-36) and the frequency of their cramps, and we computed the SF-36 scores. Then, we conducted a qualitative study using semi-structured interviews with patients with various levels of HRQol to explore their perception of the impact of cramps on their lives. RESULTS: A total of 114 patients (49%) agreed to participate in the quantitative study (mean age: 71, women: 62%) and 15 patients were included in the qualitative study (mean age: 69, women: 67%). The number of cramps in the previous week was low (mean: 1.6 (SD 1.5)). The SF-36 mean physical and mental summary scores were 43 and 50, respectively, and the domain scores were similar to a comparative general population. Whilst some patients reported little interference with their daily lives, others reported a major decrease in their HRQoL. SF-36 scores were not sufficient to describe the cramp-related impairment, as patients from all levels of SF-36 scores reported major impacts of NLC in the interviews. CONCLUSIONS: Some patients describe a specific impact of cramps on their lives, regardless of their HRQoL. These patients should be the target of future intervention trials.
    Tags: *Quality of Life, *Sleep-Wake Transition Disorders, Aged, Female, Health-related quality of life, HRQol, Humans, Leg, mixed-methods study, Muscle Cramp/etiology, nocturnal leg cramps, primary care, Primary Health Care, Sf-36, Surveys and Questionnaires.
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  • Swol, J., Darocha, T., Paal, P., Brugger, H., Podsiadlo, P., Kosinski, S., Puslecki, M., Ligowski, M., and Pasquier, M. “Extracorporeal Life Support In Accidental Hypothermia With Cardiac Arrest-A Narrative Review”. Asaio J 68, no. 2: 153-162. doi:10.1097/MAT.0000000000001518.
    Abstract: Severely hypothermic patients, especially suffering cardiac arrest, require highly specialized treatment. The most common problems affecting the recognition and treatment seem to be awareness, logistics, and proper planning. In severe hypothermia, pathophysiologic changes occur in the cardiovascular system leading to dysrhythmias, decreased cardiac output, decreased central nervous system electrical activity, cold diuresis, and noncardiogenic pulmonary edema. Cardiac arrest, multiple organ dysfunction, and refractory vasoplegia are indicative of profound hypothermia. The aim of these narrative reviews is to describe the peculiar pathophysiology of patients suffering cardiac arrest from accidental hypothermia. We describe the good chances of neurologic recovery in certain circumstances, even in patients presenting with unwitnessed cardiac arrest, asystole, and the absence of bystander cardiopulmonary resuscitation. Guidance on patient selection, prognostication, and treatment, including extracorporeal life support, is given.
    Tags: *Cardiopulmonary Resuscitation, *Extracorporeal Membrane Oxygenation/adverse effects, *Heart Arrest/etiology/therapy, *Hypothermia/complications/therapy, Humans, Rewarming.
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  • Pietsch, U., Knapp, J., Mann, M., Meuli, L., Lischke, V., Tissi, M., Sollid, S., et al. “Incidence And Challenges Of Helicopter Emergency Medical Service (Hems) Rescue Missions With Helicopter Hoist Operations: Analysis Of 11,228 Daytime And Nighttime Missions In Switzerland”. Scand J Trauma Resusc Emerg Med 29, no. 1: 92. doi:10.1186/s13049-021-00898-y.
    Abstract: OBJECTIVE: We aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions. METHODS: We designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019. RESULTS: During the study period, 9,963 (88.7 %) HEMS missions with HHO and HEC were conducted during the day, and 1,265 (11.3 %) at night. Of the victims with time-critical injuries (NACA >/= 4), 21.1 % (n = 400) reached the hospital within 60 min during the day, and 9.1 % (n = 18) at night. Nighttime missions, a trauma diagnosis, intubation on-site, and NACA Score >/= 4 were independently and highly significantly associated with longer mission times (p < 0.001). The greatest proportion of patients who needed hoist or HEC operations in the course of the HEMS mission during the daytime sustained moderate injuries (NACA 3, n = 3,731, 37.5 %) while practicing recreational activities (n = 5,492, 55.1 %). In daytime HHO missions, the most common medical interventions performed were insertion of a peripheral intravenous access (n = 3,857, 38.7 %) and administration of analgesia (n = 3,121, 31.3 %). CONCLUSIONS: Nearly 20 % of patients who needed to be evacuated by a hoist were severely injured, and complex and lifesaving medical interventions were necessary before the HHO procedure. Therefore, only adequately trained and experienced medical crew members should accompany HHO missions.
    Tags: Adolescent, Adult, Aged, Aged, 80 and over, Air Ambulances/*statistics & numerical data, Aircraft/statistics & numerical data, Analgesia/methods, Child, Child, Preschool, Emergency Medical Services/*statistics & numerical data, Humans, Incidence, Infant, Infant, Newborn, Middle Aged, Rescue Work/*statistics & numerical data, Retrospective Studies, Shift Work Schedule, Switzerland/epidemiology, Time Factors, Wounds and Injuries/therapy, Young Adult.
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  • Vossen, M. G., Pferschy, S., Milacek, C., Haidinger, M., Karolyi, M., Vass, Z., Burgmann, H., et al. “In Vivo / In Vitro Correlation Of Pharmacokinetics Of Gentamicin, Vancomycin, Teicoplanin And Doripenem In A Bovine Blood Hemodialysis Model”. Front Pharmacol 12: 702455. doi:10.3389/fphar.2021.702455.
    Abstract: Background: Elimination of a drug during renal replacement therapy is not only dependent on flow rates, molecular size and protein binding, but is often influenced by difficult to predict drug membrane interactions. In vitro models allow for extensive profiling of drug clearance using a wide array of hemofilters and flow rates. We present a bovine blood based in vitro pharmacokinetic model for intermittent renal replacement therapy. Methods: Four different drugs were analyzed: gentamicin, doripenem, vancomicin and teicoplanin. The investigated drug was added to a bovine blood reservoir connected to a hemodialysis circuit. In total seven hemofilter models were analyzed using commonly employed flow rates. Pre-filter, post-filter and dialysate samples were drawn, plasmaseparated and analyzed using turbidimetric assays or HPLC. Protein binding of doripenem and vancomycin was measured in bovine plasma and compared to previously published values for human plasma. Results: Clearance values were heavily impacted by choice of membrane material and surface as well as by dialysis parameters such as blood flow rate. Gentamicin clearance ranged from a minimum of 90.12 ml/min in a Baxter CAHP-170 diacetate hemofilter up to a maximum of 187.90 ml/min in a Fresenius medical company Fx80 polysulfone model (blood flow rate 400 ml/min, dialysate flow rate 800 ml/min). Clearance of Gentamicin vs Vancomicin over the F80s hemofilter model using the same flow rates was 137.62 mL vs 103.25 ml/min. Doripenem clearance with the Fx80 was 141.25 ml/min. Conclusion: Clearance values corresponded very well to previously published data from clinical pharmacokinetic trials. In conjunction with in silico pharmacometric models. This model will allow precise dosing recommendations without the need of large scale clinical trials.
    Tags: antimicrobial agent, bovine blood, chronic hemodialysis, clearance, commercial or financial relationships that could be construed as a potential, conflict of interest., pharmacokinetics.
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  • Korda, A., Zamaro, E., Wagner, F., Morrison, M., Caversaccio, M. D., Sauter, T. C., Schneider, E., and Mantokoudis, G. “Acute Vestibular Syndrome: Is Skew Deviation A Central Sign?”. J Neurol 269, no. 3: 1396-1403. doi:10.1007/s00415-021-10692-6.
    Abstract: OBJECTIVE: Skew deviation results from a dysfunction of the graviceptive pathways in patients with an acute vestibular syndrome (AVS) leading to vertical diplopia due to vertical ocular misalignment. It is considered as a central sign, however, the prevalence of skew and the accuracy of its test is not well known . METHODS: We performed a prospective study from February 2015 until September 2020 of all patients presenting at our emergency department (ED) with signs of AVS. All patients underwent clinical HINTS and video test of skew (vTS) followed by a delayed MRI, which served as a gold standard for vestibular stroke confirmation. RESULTS: We assessed 58 healthy subjects, 53 acute unilateral vestibulopathy patients (AUVP) and 24 stroke patients. Skew deviation prevalence was 24% in AUVP and 29% in strokes. For a positive clinical test of skew, the cut-off of vertical misalignment was 3 deg with a very low sensitivity of 15% and specificity of 98.2%. The sensitivity of vTS was 29.2% with a specificity of 75.5%. CONCLUSIONS: Contrary to prior knowledge, skew deviation proved to be more prevalent in patients with AVS and occurred in every forth patient with AUVP. Large skew deviations (> 3.3 deg), were pointing toward a central lesion. Clinical and video test of skew offered little additional diagnostic value compared to other diagnostic tests such as the head impulse test and nystagmus test. Video test of skew could aid to quantify skew in the ED setting in which neurotological expertise is not always readily available.
    Tags: *Ocular Motility Disorders, *Vertigo/diagnosis, Acute stroke, Acute unilateral vestibulopathy, affiliations that represent a relevant financial conflict of interest with, Head Impulse Test, Humans, investigators has any relevant financial interests, activities, relationships, or, Nausea, on the direction and content of the research conducted., professorship sponsored by Touring Club Switzerland. The sponsor has no influence, Prospective Studies, respect to the conduct or analysis of this study. TCS holds an endowed, Test of skew, Vertigo, Video-oculography, Vog.
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  • Diaz, T., Strong, K. L., Cao, B., Guthold, R., Moran, A. C., Moller, A. B., Requejo, J., et al. “A Call For Standardised Age-Disaggregated Health Data”. Lancet Healthy Longev 2, no. 7: e436-e443. doi:10.1016/S2666-7568(21)00115-X.
    Abstract: The 2030 Sustainable Development Goals agenda calls for health data to be disaggregated by age. However, age groupings used to record and report health data vary greatly, hindering the harmonisation, comparability, and usefulness of these data, within and across countries. This variability has become especially evident during the COVID-19 pandemic, when there was an urgent need for rapid cross-country analyses of epidemiological patterns by age to direct public health action, but such analyses were limited by the lack of standard age categories. In this Personal View, we propose a recommended set of age groupings to address this issue. These groupings are informed by age-specific patterns of morbidity, mortality, and health risks, and by opportunities for prevention and disease intervention. We recommend age groupings of 5 years for all health data, except for those younger than 5 years, during which time there are rapid biological and physiological changes that justify a finer disaggregation. Although the focus of this Personal View is on the standardisation of the analysis and display of age groups, we also outline the challenges faced in collecting data on exact age, especially for health facilities and surveillance data. The proposed age disaggregation should facilitate targeted, age-specific policies and actions for health care and disease management.
    Tags: *covid-19, *Pandemics, Child, Preschool, Humans, Morbidity, Sustainable Development.
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  • Rousson, V., Ackermann, D., Ponte, B., Pruijm, M., Guessous, I., d'Uscio, C. H., Ehret, G., et al. “Sex- And Age-Specific Reference Intervals For Diagnostic Ratios Reflecting Relative Activity Of Steroidogenic Enzymes And Pathways In Adults”. Plos One 16, no. 7: e0253975. doi:10.1371/journal.pone.0253975.
    Abstract: OBJECTIVE: Diagnostic ratios calculated from urinary steroid hormone metabolites are used as a measure for the relative activity of steroidogenic enzymes or pathways in the clinical investigation of steroid metabolism disorders. However, population-based sex- and age-specific reference intervals and day-night differences in adults are lacking. METHODS: Sixty-five diagnostic ratios were calculated from steroid metabolites measured by GC-MS in day- and night-time and in 24-hour urine from 1128 adults recruited within the Swiss Kidney Project on Genes in Hypertension (SKIPOGH), a population-based, multicenter cohort study. Differences related to sex, age and day- and night-time were evaluated and reference curves in function of age and sex were modelled by multivariable linear mixed regression for diagnostic ratios and were compared to values from the literature. RESULTS: Most ratios had sex- and age-specific relationships. For each ratio, percentiles were plotted in function of age and sex in order to create reference curves and sex- and age-specific reference intervals derived from 2.5th and 97.5th percentiles were obtained. Most ratios reflected a higher enzyme activity during the day compared to the night. CONCLUSIONS: Sex- and age-specific references for 24 hours, day and night urine steroid metabolite ratios may help distinguishing between health and disease when investigating human disorders affecting steroid synthesis and metabolism. The day-night differences observed for most of the diagnostic ratios suggest a circadian rhythm for enzymes involved in human steroid hormones metabolism.
    Tags: *Metabolic Networks and Pathways, *Sex Characteristics, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Enzymes/*metabolism, Female, Humans, Male, Metabolome, Middle Aged, Reference Values, Steroids/*metabolism/urine, Young Adult.
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  • Bingisser, R., and Burstein, B. “Time To Study Time: Informing The Future Of Anaphylaxis Observation Duration”. Cjem 23, no. 4: 423-424. doi:10.1007/s43678-021-00166-z.
    Tags: *Anaphylaxis/diagnosis/drug therapy, Allergic reaction, Anaphylaxis, Epinephrine, Humans, Observation time, Time Factors.
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  • Mendrala, K., Kosinski, S., Podsiadlo, P., Pasquier, M., Mazur, P., Paal, P., Gajniak, D., and Darocha, T. “The Efficiency Of Continuous Renal Replacement Therapy For Rewarming Of Patients In Accidental Hypothermia--An Experimental Study”. Artif Organs 45, no. 11: 1360-1367. doi:10.1111/aor.14032.
    Abstract: Severe accidental hypothermia carries high mortality and morbidity and is often treated with invasive extracorporeal methods. Continuous veno-venous hemodiafiltration (CVVHDF) is widely available in intensive care units. We sought to provide theoretical basis for CVVHDF use in rewarming of hypothermic patients. CVVHDF system was used in the laboratory setting. Heat balance and transferred heat units were evaluated for the system without using blood. We used 5L of crystalloid solution at the temperature of approximately 25 degrees C, placed in a thermally insulated tank (representing the "central compartment" of a hypothermic patient). Time of warming the central compartment from 24.9 to 30.0 degrees C was assessed with different flow combinations: "blood" (central compartment fluid) 50 or 100 or 150 mL/min, dialysate solution 100 or 1500 mL/h, and substitution fluid 0 or 500 mL/h. The total circulation time was 1535 minutes. There were no differences between heat gain values on the filter depending on blood flow (P = .53) or dialysate flow (P = .2). The mean heating time for "blood" flow rates 50, 100, and 150 mL/min was 113.7 minutes (95% CI, 104.9-122.6 minutes), 83.3 minutes (95% CI, 76.2-90.3 minutes), and 74.7 minutes (95% CI, 62.6-86.9 minutes), respectively (P < .01). The respective median rewarming rate for different "blood" flows was 3.6 degrees C/h (IQR, 3.0-4.2 degrees C/h), 4.8 (IQR, 4.2-5.4 degrees C/h), and 5.4 (IQR, 4.8-6.0 degrees C/h), respectively (P < .01). The dialysate flow did not affect the warming rate. Based on our experimental model, CVVHDF may be used for extracorporeal rewarming, with the rewarming rates increasing achieved with higher blood flow rates.
    Tags: continuous renal replacement therapy, Continuous Renal Replacement Therapy/*methods, continuous veno-venous hemodiafiltration, dialysis, extracorporeal, hemodiafiltration, Hemodynamics, Humans, hypothermia, Hypothermia/*therapy, rewarming, Rewarming/*methods.
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  • Darocha, T., Hugli, O., Kosinski, S., Podsiadlo, P., Caillet-Bois, D., and Pasquier, M. “Clinician Miscalibration Of Survival Estimate In Hypothermic Cardiac Arrest: Hope-Estimated Survival Probabilities In Extreme Cases”. Resusc Plus 7: 100139. doi:10.1016/j.resplu.2021.100139.
    Abstract: AIM: Patients with hypothermic cardiac arrest may survive with an excellent outcome after extracorporeal life support rewarming (ECLSR). The HOPE (Hypothermia Outcome Prediction after ECLS) score is recommended to guide the in-hospital decision on whether or not to initiate ECLSR in patients in cardiac arrest following accidental hypothermia. We aimed to assess the HOPE-estimated survival probabilities for a set of survivors of hypothermic cardiac arrest who had extreme values for the variables included in the HOPE score. METHODS: Survivors were identified and selected through a systematic literature review including case reports. We calculated the HOPE score for each patient who presented extraordinary clinical parameters. RESULTS: We identified 12 such survivors. The HOPE-estimated survival probability was >/=10% for all (n = 11) patients for whom we were able to calculate the HOPE score. CONCLUSION: Our study confirms the robustness of the HOPE score for outliers and thus further confirms its external validity. These cases also confirm that hypothermic cardiac arrest is a fundamentally different entity than normothermic cardiac arrest. Using HOPE for extreme cases may support the proper calibration of a clinician's prognosis and therapeutic decision based on the survival chances of patients with accidental hypothermic cardiac arrest.
    Tags: Cardiac arrest, Extracorporeal life support rewarming, Hypothermia, Triage.
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  • Bingisser, R., Simon, N. R., and Nickel, C. H. “Comment To: Non-Specific Clinical Presentations Are Not Prognostic And Do Not Anticipate Hospital Length Of Stay Or Resource Utilization”. Eur J Intern Med 91: 85-86. doi:10.1016/j.ejim.2021.06.011.
    Tags: *Hospitals, Humans, Length of Stay, Prognosis, Retrospective Studies.
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  • Bargetzi, L., Laviano, A., Stanga, Z., and Schuetz, P. “What Is Optimal Nutritional Support In Acutely Ill Cancer Patients? More May Not Be Better”. Ann Oncol 32, no. 10: 1305-1306. doi:10.1016/j.annonc.2021.06.025.
    Tags: *Neoplasms/therapy, *Nutritional Support, declared no conflicts of interest., Health Science, Abbott Nutrition and Fresenius Kabi. All other authors have, Humans, institution of ZS received speaking honoraria and research support from Nestle, unrelated to this project from Nestle Health Science and Abbott Nutrition. The.
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  • Theodosopoulou, P., Tsiamis, C., Pikoulis, A., Pikouli, A., Aristomenis, E., and Pikoulis, E. “Rescue Medical Activities Among Sea Migrants And Refugees In The Mediterranean Region: Lessons To Be Learned From The 2014-2020 Period”. Int Marit Health 72, no. 2: 99-109. doi:10.5603/IMH.2021.0018.
    Abstract: BACKGROUND: Since 2014, the number of migrants and refugees crossing the Mediterranean towards Europe has risen significantly due to various reasons. Both state agencies and non-governmental organizations (NGOs) have launched rescue missions in the Central Mediterranean in accordance with international legal obligations for search and rescue (SAR) operations for those under distress at sea. Our aim is to summarise the specific qualifications needed for maritime SAR in the Mediterranean both in terms of the population at risk, the equipment and the medical support required, especially during the coronavirus disease 2019 (COVID-19) pandemic and the operational legal framework. MATERIALS AND METHODS: This article aims to summarise the key points of SAR efforts from a medical perspective as depicted in the relevant literature during a specific timeline period (2014-2020) in a specific part of the Mediterranean Sea (Central Mediterranean route). Only papers published in English and whose full text was available were included in this study. The inclusion criteria were: a) articles referring to sea rescue operations between 2014 and 2020, b) research that focused on medical preparedness and assistance during rescue operations in the Central Mediterranean route, c) studies concerning demographic and clinical features of the rescue population, d) guidelines on the rule of conduct of persons and states participating in rescue activities. The exclusion criteria were: a) studies describing SAR operations in different regions of the world and b) studies focusing on routes, demographics and medical support of migrants/refugees on land. RESULTS: Three major themes were identified: a) characteristics of the population in distress at sea: country of origin, age groups, presence of communicable and non-communicable diseases were identified in the relevant literature. Our research shows that dermatological and respiratory issues were the major concerns among sea migrants, coming from different countries of both Africa and Asia, being relatively young and mostly males; b) medical preparedness and equipment needed for rescue: according to current guidelines, revised during the COVID-19 pandemic, infrastructure needed during SAR operations includes both equipment for resuscitation, personal protective equipment, deck adjustments, medical personnel trained to function in an austere setting and able to handle vulnerable patient groups such as children and pregnant women; c) medico-legal implications of SAR operations: knowledge of the legal framework encompassing SAR operations seems necessary, as European Union and state led initiatives seem to withdraw from proactive SAR, while criminalising NGO led rescue efforts. Operating with the imperative to save lives seems to be the only way of respecting international law and human values, thus, a summary of what the law dictates was made in an effort to keep medical workers participating in such operations updated. CONCLUSIONS: Investigation aims to shed light on the special clinical features of sea migrants, the skills, equipment and organizational structure needed by medical workers participating in SAR operations as well as the legal framework under which they will be asked to operate. Special consideration will be given to the difficulties that emerged due to the COVD-19 pandemic.
    Tags: Covid-19, Emergency Medical Services/*statistics & numerical data, Female, Humans, initial assessment, Male, Mediterranean route, Mediterranean Sea, Refugees/*statistics & numerical data, Relief Work/*organization & administration, sea migrants, search and rescue (SAR), Security Measures/organization & administration, Socioeconomic Factors, Transients and Migrants/*statistics & numerical data.
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  • Radtke, S., Trepp, G. L., Muller, M., Exadaktylos, A. K., and Klukowska-Rotzler, J. “Floorball Injuries Presenting To A Swiss Adult Emergency Department: A Retrospective Study (2013-2019)”. Int J Environ Res Public Health 18, no. 12. doi:10.3390/ijerph18126208.
    Abstract: BACKGROUND: The popularity of floorball has surged throughout Switzerland in the last 20 years. However, epidemiological studies are still scarce. OBJECTIVE: To collect information on floorball-related injuries, their severity and approximate cost in adults who presented to our emergency department from 2013-2019. Moreover, to use this information to suggest possible strategies to prevent injuries. MATERIALS AND METHODS: The study population includes all patients who suffered injuries related to floorball and were then seen at the University Hospital in Bern during a 7-year period. Bern University Hospital, Switzerland, has a comprehensive management system (Ecare) that was used to generate the data for this study. The data were then used to create an injury profile of all cases presented during the said period. RESULTS: A total of 263 injures were recorded from 2013 to 2019. The most common locations for injuries were to the eyes (43.73%), followed by the lower extremities (25.48%). The mean cost per case was CHF 1191.43. However, the vast majority of admissions could be sent home (93.16%) and did not cost more than 500 CHF/case (57.41%). Of the 22 cases that cost more than CHF 2000, 10 were located around the torso and 6 affected one or both eyes. Significant differences were observed between the age groups and treatment area (p =0.008), costs (p =0.008), route of discharge (p =0.023) and type of trauma (p =0.020). CONCLUSION: Although floorball is still a relatively minor sport, its impact on sport-related injuries must not be underestimated. Injuries to the eyes are particularly common. In our opinion, our findings provide strong evidence that all floorball players (not only children and adolescents) should wear protective eyewear. We conclude that the Swiss Floorball Association (Swiss Unihockey) should mandate the use of protective eyewear.
    Tags: *Athletic Injuries, *Eye Injuries/epidemiology, Adolescent, Adult, Child, Emergency Service, Hospital, floorball, Humans, injuries, mechanism of injury, Retrospective Studies, Switzerland/epidemiology, type of injury, Unihockey.
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  • Lampart, M., Ruegg, M., Jauslin, A. S., Simon, N. R., Zellweger, N., Eken, C., Tschudin-Sutter, S., et al. “Direct Comparison Of Clinical Characteristics, Outcomes, And Risk Prediction In Patients With Covid-19 And Controls-A Prospective Cohort Study”. J Clin Med 10, no. 12. doi:10.3390/jcm10122672.
    Abstract: Most studies investigating early risk predictors in coronavirus disease 19 (COVID-19) lacked comparison with controls. We aimed to assess and directly compare outcomes and risk predictors at time of emergency department (ED) presentation in COVID-19 and controls. Consecutive patients presenting to the ED with suspected COVID-19 were prospectively enrolled. COVID-19-patients were compared with (i) patients tested negative (overall controls) and (ii) patients tested negative, who had a respiratory infection (respiratory controls). Primary outcome was the composite of intensive care unit (ICU) admission and death at 30 days. Among 1081 consecutive cases, 191 (18%) were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 890 (82%) were tested negative (overall controls), of which 323 (30%) had a respiratory infection (respiratory controls). Incidence of the composite outcome was significantly higher in COVID-19 (23%) as compared with the overall control group (10%, adjusted-HR 2.45 (95%CI, 1.61-3.74), p < 0.001) or the respiratory control group (10%, adjusted-HR 2.93 (95%CI, 1.66-5.17), p < 0.001). Blood oxygen saturation, age, high-sensitivity troponin, c-reactive protein, and lactate dehydrogenase were identified as the strongest predictors of poor outcome available at time of ED presentation in COVID-19 with highly comparable prognostic utility in overall and respiratory controls. In conclusion, patients presenting to the ED with COVID-19 have a worse outcome than controls, even after adjustment for differences in baseline characteristics. Most predictors of poor outcome in COVID-19 were not restricted to COVID-19, but of comparable prognostic utility in controls and therefore generalizable to unselected patients with suspected COVID-19.
    Tags: (Grant No P300PB_167803), the Swiss Heart Foundation, the Swiss Society of, Abbott, Amgen, Astra Zeneca, Roche, Siemens, Singulex, and Thermo Scientific, and the University Hospital Basel and speaker honoraria/consulting honoraria from, Basel, that are unrelated to this work, and consultant fees from Janssen. S., BRAHMS. Kuster reports research support from the Swiss National Science, Cardiology, the Cardiovascular Research Foundation Basel, the University of Basel, characteristics, comparison, conflict of interest., controls, Covid-19, difficile, of the Pfizer Anti-infective Advisory Board, the Menarini and Shionogi, Forschung der Freiwilligen Akademischen Gesellschaft Basel, and the, Foundation (Grant No IZCOZ0_189877) and the Cardiovascular Research Foundation, Foundation (NRP 72 167060) and (197901), NCCR AntiResist (180541), the Gottfried, Jubilaumsstiftung from Swiss Life. Authors not named here have disclosed no, outcome, risk prediction, SARS-CoV-2, Scientific Advisory Boards. She reports grants from the Swiss National Science, Tschudin-Sutter is a member of the Astellas and MSD Advisory Boards for C., und Julia Bangerter-Rhyner Stiftung, the Fonds zur Forderung von Lehre und.
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  • Doulberis, M., Pierre, N. T., Manzini, G., Papaefthymiou, A., Kountouras, J., Klukowska-Rotzler, J., Polyzos, S. A., et al. “Helicobacter Pylori-Related Metabolic Parameters And Premalignant Gastric Mucosa Histological Lesions In Swiss Bariatric Patients”. Microorganisms 9, no. 7. doi:10.3390/microorganisms9071361.
    Abstract: Obesity, as a major risk factor of metabolic syndrome (MetS), represents a pandemic, especially in Western societies, and is considered a risk factor for malignancies. Helicobacter pylori (Hp), is a definite carcinogen with global distribution. We aimed to investigate, for the first time in Switzerland, the main gastric mucosa premalignant histological lesions of bariatric patients in correlation with MetS components and Hp Infection (Hp-I). By reviewing retrospectively 94304 patient cases, a total of 116 eligible patients having undergone bariatric surgery were identified. The mean patient age was 48.66 years. Hp(+) patients were 24% (28/116). Presence of gastric mucosa atrophy was documented in 8/28 Hp(+) patients (29%) and (2/88) Hp(-) ones (2%) (p = 0.006). Gastric mucosa intestinal metaplasia was observed in 14/28 (50%) Hp(+) patients versus 3/88 (3.4%) of Hp(-) group (p < 0.0001). Hp(+) patients exhibited statistically higher arterial hypertension (p = 0.033). The homeostatic model of assessment insulin resistance was also statistically significantly higher for the Hp(+) group (p < 0.001). In a multivariate analysis, including arterial hypertension, gastric mucosa atrophy, and intestinal metaplasia as variables, statistical significance remained only for intestinal metaplasia (p = 0.001). In conclusion, Hp-I is associated with premalignant gastric mucosa histologic lesions and MetS components, including arterial hypertension and IR. Further large-scale prospective studies are required to confirm these findings.
    Tags: and Amgen, and Research grants from the Novartis Stiftung fur klinische, bariatric, Forschung, and Merck, Sharp & Dohme. All other authors declare no conflict of, Ga, gastric atrophy, Helicobacter pylori, Hp, Ime, interest., intestinal metaplasia, metabolic syndrome, MetS, received travel grants from Gilead Sciences, Vifor, Roche, Merck, Sharp & Dohme.
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  • Seiler, M., Staubli, G., Hoeffe, J., Gualco, G., Manzano, S., and Goldman, R. D. “A Tale Of Two Parts Of Switzerland: Regional Differences In The Impact Of The Covid-19 Pandemic On Parents”. Bmc Public Health 21, no. 1: 1275. doi:10.1186/s12889-021-11315-5.
    Abstract: BACKGROUND: We aimed to document the impact of the coronavirus disease 2019 (COVID-19) pandemic on regions within a European country. METHODS: Parents arriving at two pediatric emergency departments (EDs) in North of Switzerland and two in South of Switzerland completed an online survey during the first peak of the pandemic (April-June 2020). They were asked to rate their concern about their children or themselves having COVID-19. RESULTS: A total of 662 respondents completed the survey. Parents in the South were significantly more exposed to someone tested positive for COVID-19 than in the North (13.9 and 4.7%, respectively; P < 0.001). Parents in the South were much more concerned than in the North that they (mean 4.61 and 3.32, respectively; P < 0.001) or their child (mean 4.79 and 3.17, respectively; P < 0.001) had COVID-19. Parents reported their children wore facemasks significantly more often in the South than in the North (71.5 and 23.5%, respectively; P < 0.001). CONCLUSION: The COVID-19 pandemic resulted in significant regional differences among families arriving at EDs in Switzerland. Public health agencies should consider regional strategies, rather than country-wide guidelines, in future pandemics and for vaccination against COVID-19 for children.
    Tags: *covid-19, *Pandemics, Child, Covid-19, Emergency department, Europe, Humans, Parental concern, Parents, SARS-CoV-2, Switzerland, Switzerland/epidemiology.
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