EMresearch.ch

Doulberis, M., Kotronis, G., Gialamprinou, D., Ozguler, O., Exadaktylos, A. K., Oikonomou, V., Katsinelos, P., et al. “Acute Liver Failure: From Textbook To Emergency Room And Intensive Care Unit With Concomitant Established And Modern Novel Therapies”. J Clin Gastroenterol 53, no. 2: 89-101. doi:10.1097/MCG.0000000000001162.

Abstract: Acute liver failure is a rare hepatic emergent situation that affects primarily young people and has often a catastrophic or even fatal outcome. Definition of acute liver failure has not reached a universal consensus and the interval between the appearance of jaundice and hepatic encephalopathy for the establishment of the acute failure is a matter of debate. Among the wide variety of causes, acetaminophen intoxication in western societies and viral hepatitis in the developing countries rank at the top of the etiology list. Identification of the clinical appearance and initial management for the stabilization of the patient are of vital significance. Further advanced therapies, that require intensive care unit, should be offered. The hallmark of treatment for selected patients can be orthotopic liver transplantation. Apart from well-established treatments, novel therapies like hepatocyte or stem cell transplantation, additional new therapeutic strategies targeting acetaminophen intoxication and/or hepatic encephalopathy are mainly experimental, and some of them do not belong, yet, to clinical practice. For clinicians, it is substantial to have the alertness to timely identify the patient and transfer them to a specialized center, where more treatment opportunities are available.

Tags: Emergency Service, Hospital/*statistics & numerical data, Humans, Intensive Care Units/*statistics & numerical data, Liver Failure, Acute/etiology/physiopathology/*therapy, Liver Transplantation, Patient Selection.

Sun, Q., Jankovic, M. V., Budzinski, J., Moore, B., Diem, P., Stettler, C., and Mougiakakou, S. G. “A Dual Mode Adaptive Basal-Bolus Advisor Based On Reinforcement Learning”. Ieee J Biomed Health Inform 23, no. 6: 2633-2641. doi:10.1109/JBHI.2018.2887067.

Abstract: Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) are commonly used by type 1 diabetes (T1D) patients to measure glucose concentrations. The proposed adaptive basal-bolus algorithm (ABBA) supports inputs from either SMBG or CGM devices to provide personalised suggestions for the daily basal rate and prandial insulin doses on the basis of the patients' glucose level on the previous day. The ABBA is based on reinforcement learning, a type of artificial intelligence, and was validated in silico with an FDA-accepted population of 100 adults under different realistic scenarios lasting three simulated months. The scenarios involve three main meals and one bedtime snack per day, along with different variabilities and uncertainties for insulin sensitivity, mealtime, carbohydrate amount, and glucose measurement time. The results indicate that the proposed approach achieves comparable performance with CGM or SMBG as input signals, without influencing the total daily insulin dose. The results are a promising indication that AI algorithmic approaches can provide personalised adaptive insulin optimization and achieve glucose control-independent of the type of glucose monitoring technology.

Tags: *Insulin Infusion Systems, *Insulin/administration & dosage/therapeutic use, *Machine Learning, Adult, Algorithms, Blood Glucose Self-Monitoring/*methods, Blood Glucose/analysis, Computer Simulation, Diabetes Mellitus, Type 1/blood/drug therapy, Female, Humans, Male, Precision Medicine/*methods.

Schnegg-Kaufmann, A., Calzavarini, S., Limacher, A., Mean, M., Righini, M., Staub, D., Beer, J. H., et al. “A High Gas6 Level In Plasma Predicts Venous Thromboembolism Recurrence, Major Bleeding And Mortality In The Elderly: A Prospective Multicenter Cohort Study”. J Thromb Haemost 17, no. 2: 306-318. doi:10.1111/jth.14365.

Abstract: Essentials Predictive ability of pro-hemostatic Gas6 for recurrent venous thromboembolism (VTE) is unknown. We measured Gas6 levels in 864 patients with VTE over 3 years. High Gas6 (> 157%) at diagnosis is associated with VTE recurrence, major bleeding and mortality. Gas6 plasma levels measured 12 months after the index VTE are discriminatory for VTE recurrence. SUMMARY: Background Growth arrest-specific gene 6 (Gas6) is a prohemostatic protein with an unknown predictive ability for recurrent venous thromboembolism (VTE). In the elderly, VTE results in higher mortality but does not have a higher rate of recurrence than in younger patients. Consequently, anticoagulation management in the elderly is challenging. Objective To prospectively investigate the performance of Gas6 in predicting VTE recurrence, major bleeding and mortality in the elderly. Methods Consecutive patients aged >/= 65 years with acute VTE were followed for a period of 3 years. Primary outcomes were symptomatic VTE recurrence, major bleeding, and mortality. Plasma Gas6 was measured with ELISA. Results Gas6 levels were measured in 864 patients at the time of the index VTE (T1) and, in 70% of them, also 12 months later (T2). The Gas6 level at T1 was discriminatory for VTE recurrence (C-statistic, 0.56; 95% confidence interval [CI] 0.51-0.62), major bleeding (0.60, 95% CI 0.55-0.65) and mortality (0.69, 95% CI 0.65-0.73) up to 36 months. VTE recurrence up to 24 months after T2 was discriminated by the Gas6 level at T2 (0.62, 95% CI 0.54-0.71). High Gas6 levels (> 157%) and continuous Gas6 levels at T1 were associated with VTE recurrence up to 6 months and 12 months, respectively. Conclusions In elderly patients, a high Gas6 level is associated with higher risks of VTE recurrence, major bleeding, and death. These findings support further studies to assess the performance of Gas6 in adjusting the length of anticoagulation.

Tags: Age Factors, Aged, Aged, 80 and over, and grants from MSD, Bayer,, Anticoagulants/*adverse effects, AstraZeneca, EliLilly, and Sanofi, and personal fees from MSD, AstraZeneca,, Biomarkers/blood, cohort studies, conduct of the study. The other authors state that they have no conflict of, Female, Foundation, during the conduct of the study, growth arrest-specific gene 6, Hemorrhage/*chemically induced/diagnosis/mortality, Humans, Incidence, Intercellular Signaling Peptides and Proteins/*blood, interest., Male, mortality, Prospective Studies, Recurrence, reports receiving grants from the Swiss National Science Foundation, during the, Risk Assessment, Risk Factors, Roche, Sanofi, Amgen, and Novartis, outside the submitted work. A. Limacher, Switzerland/epidemiology, Time Factors, Treatment Outcome, Up-Regulation, venous thromboembolism, Venous Thromboembolism/*blood/diagnosis/*drug therapy/mortality.

Pasquier, M., Paal, P., Blancher, M., and Darocha, T. “Higher Survival Chances Of Hypothermic Vs. Normothermic Cardiac Arrest Patients With Ecls Re-Warming”. Resuscitation 134: 161-162. doi:10.1016/j.resuscitation.2018.11.004.

Tags: *Extracorporeal Membrane Oxygenation, *Heart Arrest, *Hypothermia, Emergency Service, Hospital, Humans.

Popovic, M., Blum, C. A., and Christ-Crain, M. “Copeptin Levels Upon Corticosteroid Treatment In Acute Community-Acquired Pneumonia”. J Investig Med 67, no. 2: e1. doi:10.1136/jim-2018-000886.

Tags: Acute Disease, Adrenal Cortex Hormones/*therapeutic use, Aged, arginine vasopressin, Community-Acquired Infections/*blood/*drug therapy, Female, glucocorticoids, Glycopeptides/*blood, Humans, inflammation, Male, pneumonia.

Keller, S. A., Klukowska-Rotzler, J., Schenk-Jaeger, K. M., Kupferschmidt, H., Exadaktylos, A. K., Lehmann, B., and Liakoni, E. “Mushroom Poisoning-A 17 Year Retrospective Study At A Level I University Emergency Department In Switzerland”. Int J Environ Res Public Health 15, no. 12. doi:10.3390/ijerph15122855.

Abstract: The consequences of mushroom poisoning range from mild, mostly gastrointestinal, disturbances to organ failure or even death. This retrospective study describes presentations related to mushroom poisoning at an emergency department in Bern (Switzerland) from January 2001 to October 2017. Gastrointestinal disturbances were reported in 86% of the 51 cases. The National Poisons Information Centre and mycologists were involved in 69% and 61% of the cases, respectively. Identification of the mushroom type/family was possible in 43% of the cases. The most common mushroom family was Boletaceae (n = 21) and the most common mushrooms Xerocomus chrysenteron (n = 7; four being part of a cluster), Clitocybe nebularis, Lepista nuda and Lactarius semisanguifluus (n = 5 each, four being part of a cluster). Poisonous mushrooms included Amanita phalloides (n = 3, all analytically confirmed), Boletus satanas (n = 3), Amanita muscaria (n = 2) and Amanita pantherina (n = 2). There were no fatalities and 80% of the patients were discharged within 24 h. Mushroom poisoning does not appear to be a common reason for emergency consultation and most presentations were of minor severity and related to edible species (e.g., due to incorrect processing). Nevertheless, poisonous mushrooms and severe complications were also recorded. Collaboration with a poison centre and/or mycologists is of great importance, especially in high risk cases.

Tags: Agaricales/*classification, data, emergency department, Emergency Service, Hospital/*statistics & numerical data, Female, Humans, Male, Middle Aged, mushroom poisoning, Mushroom Poisoning/*epidemiology/mortality/pathology, mushroom toxicity, Referral and Consultation/organization & administration/statistics & numerical, Retrospective Studies, Switzerland/epidemiology, Universities.

Keitel, K. “Biomarkers To Improve Rational Antibiotic Use In Low-Resource Settings”. Lancet Glob Health 7, no. 1: e14-e15. doi:10.1016/S2214-109X(18)30497-2.

Tags: *Anti-Bacterial Agents, *C-Reactive Protein, Biomarkers, Humans, Myanmar, Point-of-Care Systems, Primary Health Care, Thailand.

Papuc, S. M., Abela, L., Steindl, K., Begemann, A., Simmons, T. L., Schmitt, B., Zweier, M., et al. “The Role Of Recessive Inheritance In Early-Onset Epileptic Encephalopathies: A Combined Whole-Exome Sequencing And Copy Number Study”. Eur J Hum Genet 27, no. 3: 408-421. doi:10.1038/s41431-018-0299-8.

Abstract: Early-onset epileptic encephalopathy (EE) and combined developmental and epileptic encephalopathies (DEE) are clinically and genetically heterogeneous severely devastating conditions. Recent studies emphasized de novo variants as major underlying cause suggesting a generally low-recurrence risk. In order to better understand the full genetic landscape of EE and DEE, we performed high-resolution chromosomal microarray analysis in combination with whole-exome sequencing in 63 deeply phenotyped independent patients. After bioinformatic filtering for rare variants, diagnostic yield was improved for recessive disorders by manual data curation as well as molecular modeling of missense variants and untargeted plasma-metabolomics in selected patients. In total, we yielded a diagnosis in approximately 42% of cases with causative copy number variants in 6 patients ( approximately 10%) and causative sequence variants in 16 established disease genes in 20 patients ( approximately 32%), including compound heterozygosity for causative sequence and copy number variants in one patient. In total, 38% of diagnosed cases were caused by recessive genes, of which two cases escaped automatic calling due to one allele occurring de novo. Notably, we found the recessive gene SPATA5 causative in as much as 3% of our cohort, indicating that it may have been underdiagnosed in previous studies. We further support candidacy for neurodevelopmental disorders of four previously described genes (PIK3AP1, GTF3C3, UFC1, and WRAP53), three of which also followed a recessive inheritance pattern. Our results therefore confirm the importance of de novo causative gene variants in EE/DEE, but additionally illustrate the major role of mostly compound heterozygous or hemizygous recessive inheritance and consequently high-recurrence risk.

Tags: *DNA Copy Number Variations, *Mutation Rate, Adolescent, Adult, Child, Child, Preschool, Epilepsy/diagnosis/*genetics, Exome, Exome Sequencing/*methods, Female, Genes, Recessive, Humans, Infant, Male.

Dugas, S., Favrod-Coune, T., Poletti, P. A., Huwyler, T., Richard-Lepouriel, H., Simon, J., Sarasin, F. P., and Rutschmann, O. T. “Pitfalls In The Triage And Evaluation Of Patients With Suspected Acute Ethanol Intoxication In An Emergency Department”. Intern Emerg Med 14, no. 3: 467-473. doi:10.1007/s11739-018-2007-7.

Abstract: Acute ethanol intoxication (AEI) is frequent in emergency departments (EDs). These patients are at risk of mistriage, and to leave the ED without being seen. This study's objective was to describe the process and performance of triage and trajectory for patients with suspected AEI. Retrospective, observational study on adults admitted with a suspected AEI within 1 year at the ED of an urban teaching hospital. Data on the triage process, patients' characteristics, and their ED stay were extracted from electronic patient records. Predictors for leaving without being seen were identified using logistic regression analyzes. Of 60,488 ED patients within 1 year, 776 (1.3%) were triaged with suspected AEI. This population was young (mean age 38), primarily male (64%), and professionally inactive (56%). A large proportion were admitted on weekends (45%), at night (46%), and arrived by ambulance (85%). The recommendations of our triage scale were entirely respected in a minority of cases. In 22.7% of triage situations, a triage reason other than "alcohol abuse/intoxication" (such as suicidal ideation, head trauma or other substance abuse) should have been selected. Nearly, half of the patients (49%) left without being seen (LWBS). This risk was especially high amongst men (OR 1.56, 95% CI 1.12-2.19), younger patients (< 26 years of age; OR 1.97, 95% CI 1.16-3.35), night-time admissions (OR 1.97, 95% CI 1.16-3.35), and patients assigned a lower emergency level (OR 2.32, 95% CI 1.58-3.42). Despite a standardized triage protocol, patients admitted with suspected AEI are at risk of poor assessment, and of not receiving optimal care.

Tags: Adolescent, Adult, Aged, Alcoholic intoxication, Alcoholic Intoxication/*complications/psychology, data, Emergency service (Hospital), Emergency Service, Hospital/organization & administration/statistics & numerical, Female, Hospitalization/statistics & numerical data, Humans, Left without being seen, Logistic Models, Male, Middle Aged, Retrospective Studies, Triage, Triage/methods/*standards/trends.

Morais Oliveira, M., Marti, C., Ramlawi, M., Sarasin, F. P., Grosgurin, O., Poletti, P. A., Rouyer, F., and Rutschmann, O. T. “Impact Of A Patient-Flow Physician Coordinator On Waiting Times And Length Of Stay In An Emergency Department: A Before-After Cohort Study”. Plos One 13, no. 12: e0209035. doi:10.1371/journal.pone.0209035.

Abstract: OBJECTIVE: Overcrowding is common in most emergency departments (ED). Despite the use of validated triage systems, some patients are at risk of delayed medical evaluation. The objective of this study was to assess the impact of a patient-flow physician coordinator (PFPC) on the proportion of patients offered medical evaluation within time limits imposed by the Swiss Emergency Triage Scale (SETS) and on patient flow within the emergency department of a teaching urban hospital. METHODS: In this before-after retrospective cohort study, we compared the proportions of patients who received their first medical contact within SETS-imposed time limits, mean waiting times before first medical consultation, mean length of stay, and number of patients who left without being seen by a physician, between two periods before and after introducing a PFPC. The PFPC was a senior physician charged with quickly assessing in the waiting area patients who could not immediately be seen and managing patient flow within the department. RESULTS: Before introducing the PFPC position, 33,605 patients were admitted, versus 36,288 after. Introducing a PFPC enabled the department to increase the proportion of patients seen within the SETS-imposed time limits from 60.1% to 69.0% (p <0.0001). Waiting times until first medical consultation were reduced on average by 27.7 minutes (95% confidence interval [95% CI]: 25.9-29.5, p < .0001). No significant differences were observed as to length of stay or number of patients who left without being seen between the two study periods. CONCLUSIONS: Introducing a physician dedicated to managing patient flow enabled waiting times until first medical consultation to be reduced, yet had no significant benefit for patient flow within the ED, nor did it reduce the number of patients who left without being seen.

Tags: *Physician-Patient Relations, *Waiting Lists, Cohort Studies, Crowding, data, Efficiency, Organizational/*statistics & numerical data, Emergency Service, Hospital/*organization & administration/statistics & numerical, Female, Humans, Length of Stay/*statistics & numerical data, Male, Middle Aged, Retrospective Studies.

Wildi, K., Boeddinghaus, J., Nestelberger, T., Twerenbold, R., Badertscher, P., Wussler, D., Gimenez, M. R., et al. “Comparison Of Fourteen Rule-Out Strategies For Acute Myocardial Infarction”. Int J Cardiol 283: 41-47. doi:10.1016/j.ijcard.2018.11.140.

Abstract: BACKGROUND: The clinical availability of high-sensitivity cardiac troponin (hs-cTn) has enabled the development of several innovative strategies for the rapid rule-out of acute myocardial infarction (AMI). Due to the lack of direct comparisons, selection of the best strategy for clinical practice is challenging. METHODS: In a prospective international multicenter diagnostic study enrolling 3696 patients presenting with suspected AMI to the emergency department, we compared the safety and efficacy of 14 different hs-cTn-based strategies: hs-cTn concentrations below the limit of detection (LoD), dual-marker combining hs-cTn with copeptin, ESC 0 h/1 h-algorithm, 0 h/2 h-algorithm, 2 h-ADP-algorithm, NICE-algorithm, and ESC 0 h/3 h-algorithm, each using either hs-cTnT or hs-cTnI. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations. RESULTS: AMI was the final diagnosis in 16% of patients. Using hs-cTnT, safety quantified by the negative predictive value (NPV) and sensitivity was very high (99.8-100% and 99.5-100%) and comparable for all strategies, except the dual-marker approach (NPV 98.7%, sensitivity 96.7%). Similarly, using hs-cTnI, safety quantified by the NPV and sensitivity was very high (99.7-100% and 98.9-100%) and comparable for all strategies, except the dual-marker approach (NPV 96.9%, sensitivity 90.4%) and the NICE-algorithm (NPV 99.1%, sensitivity 94.7%). Efficacy, quantified by the percentage of patients eligible for rule-out, differed markedly, and was lowest for LoD-algorithm (15.7-26.8%). CONCLUSION: All rapid rule-out algorithms, except the dual-marker strategy and the NICE-algorithm using hs-cTnI, favorably combine safety and efficacy, and can be considered for routine clinical practice. CLINICAL TRIAL REGISTRATION: NCT00470587, http://clinicaltrials.gov/show/NCT00470587.

Tags: *Algorithms, *Practice Guidelines as Topic, Acute myocardial infarction, Aged, Aged, 80 and over, Biomarkers/blood, Coronary Angiography, Coronary Care Units, Diagnosis, Efficacy, Electrocardiography, Female, Follow-Up Studies, High-sensitivity cardiac troponin T and I, Humans, Male, Middle Aged, Myocardial Infarction/*diagnosis, Predictive Value of Tests, Prospective Studies, Rule-out, Rule-out algorithm, Time Factors, Triage/*standards, Troponin I/*blood, Troponin T/*blood.

Correia, J. C., Braillard, O., Combescure, C., Gerstel, E., and Spechbach, H. “Admission Rates In Emergency Departments In Geneva During Tennis Broadcasting: A Retrospective Study”. Bmc Emerg Med 18, no. 1: 56. doi:10.1186/s12873-018-0209-y.

Abstract: BACKGROUND: Literature provides mixed results regarding the influence of large-scale sporting events on emergency department attendance. To contribute to the research on the subject, we sought to evaluate whether the broadcasting of major tennis tournaments, one of the most popular sports in Switzerland, has an impact on patient admission rates in emergency units in Geneva including 1) type of match 2) the role of a Swiss player, 3) degree of triage, 4) reason of attendance and 5) age of patients. METHODS: Admission rates between periods with tennis matches regarding the semi-finals and finals of 3 major tennis tournaments were compared to equivalent periods without matches from May 2013 to August 2017. Patient admission data was retrieved retrospectively from administrative databases of two Outpatient Emergency Units in Geneva. Patients' admission rates in periods with and without a tennis match were investigated using a negative binomial regression model with mixed effects. RESULTS: We observed a statistically significant decrease (- 10%, 95% CI -17 to - 2, p = 0.015) in admission rates in periods with a tennis match compared to periods without a tennis match, more pronounced during finals (- 15%, 95% CI -26 to - 3, p = 0.017) than during semi-finals (- 7%, - 16 to 2, p = 0.13). In addition, this effect was more pronounced in patients aged between 26 to 64 years of age, a category representing professionnally active people. No modification in the admission rates was detected in the hours preceding and following the matches, nor in type of consultations (traumatology vs non traumatology related admissions). CONCLUSION: Although modest, the results support the hypothesis that the broadcasting of large-scale sporting events such as tennis matches decreases admission rates in emergency units. Further research is required to explore for a potential causal relationship.

Tags: *Emergency Service, Hospital, *Tennis, Adult, affiliations., Anniversaries and Special Events, Attendance rates, Emergency, Female, have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral, Humans, Male, Middle Aged, Patient Admission/*trends, PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they, Retrospective Studies, Sports tournament, stated that this research doesn't require ethical approval. CONSENT FOR, Switzerland, Tennis, with regard to jurisdictional claims in published maps and institutional, Workload, Young Adult.

Sauter, T. C., Exadaktylos, A., Krummrey, G., Lehmann, B., Brodmann-Maeder, M., and Hautz, W. E. “Development, Implementation And First Insights Of A Time- And Location-Independent Longitudinal Postgraduate Curriculum In Emergency Medicine”. Gms J Med Educ 35, no. 4: Doc44. doi:10.3205/zma001190.

Abstract: Introduction, background and context: There have been few reports on the implementation of a structured curriculum for emergency medicine, as emergency medicine is not yet an established medical specialty for training in many European countries, including Switzerland and Germany. Because of the non-plannable workload in the emergency setting, common training approaches are often difficult to implement. Need-assessments of emergency medicine trainees commonly identify a need for interactive, time-independent ways of learning that integrate modern forms of knowledge transfer. Methods: In the present study, we assess the local needs of emergency medicine specialists and trainees for a curriculum in emergency medicine and elaborate possible solutions for the implementation of this curriculum, taking into account the special needs in a highly dynamic, unplannable environment, such as an interdisciplinary emergency department. Results: We describe the development of the emergency medicine curriculum on the basis of the six steps proposed by Kern for curriculum development in medical education, as well as the implementation, lessons learned and interval evaluation. Conclusions: The combination of multiple teaching formats, ranging from time- and location-independent solutions such as podcasted lectures to simulation-based training sessions, as well as small-group workshops and skill training sessions, might be a valuable approach to implementing a state-of-the-art curriculum in a busy emergency department.

Tags: curriculum development, Curriculum/*trends, Education, Medical, Graduate/methods/standards, emergency medicine, Emergency Medicine/*education, Humans, medical education, Needs Assessment, Outcome and Process Assessment, Health Care/*methods/standards, Schools, Medical/organization & administration, Simulation Training/methods/standards, Surveys and Questionnaires, Switzerland.

Keller, J., Wolfensberger, A., Clack, L., Kuster, S. P., Dunic, M., Eis, D., Flammer, Y., Keller, D. I., and Sax, H. “Do Wearable Alcohol-Based Handrub Dispensers Increase Hand Hygiene Compliance? - A Mixed-Methods Study”. Antimicrob Resist Infect Control 7, no. 1: 143. doi:10.1186/s13756-018-0439-5.

Abstract: BACKGROUND: Hand Hygiene (HH) compliance was shown to be poor in several studies. Improving the availability of alcohol-based hand rub (ABHR) is a cornerstone for increasing HH compliance. METHODS: In this study, we introduced wearable dispensers for ABHR in an Emergency Department (ED) well equipped with mounted ABHR dispensers and accompanied this single-modal intervention by a quasi-experimental mixed-method study. The study was performed in the ED of the University Hospital Zurich, Switzerland, a 950-bed tertiary teaching hospital. During a five-week baseline period and a seven-week intervention period, we observed HH compliance according to the WHO 'Five Moments' concept, measured ABHR consumption, and investigated perceived ABHR availability, self-reported HH compliance and knowledge of HH indications by questionnaire. Multivariable logistic regression was used to identify independent determinants for HH compliance. In addition, semi-structured interviews were conducted and thematically analyzed to assess barriers and facilitators for the use of the newly introduced dispensers. RESULTS: Across 811 observed HH opportunities, the HH compliance for all moments was 56% (95% confidence interval (CI), 51-62%) during baseline and 64% (CI, 59-68%) during intervention period, respectively. In the multivariable analysis adjusted for sex, profession, and WHO HH moment, there was no difference in HH compliance between baseline and intervention (adjusted Odds ratio: 1.22 (0.89-1.66), p = 0.22), No significant changes were observed in consumption and perceived availability of ABHR. During intervention, 7.5% ABHR was consumed using wearable dispensers. HCP perceived wearable dispensers as unnecessary since mounted dispensers were readily accessible. Poor ergonomic design of the wearable dispenser emerged as a main barrier, especially its lid and fastening mechanism. Interviewees identified two ideal situations for wearable dispensers, HCP who accompany patients from ED to other wards, and HCP approaching a patient from a non-patient areas in the ED such as the central working station or the meeting room. CONCLUSION: The introduction of wearable dispensers did not increase observed hand hygiene compliance or ABHR consumption in an ED already well equipped with mounted dispensers. For broader acceptance and use, wearable dispensers might benefit from an optimized ergonomic design.

Tags: Anti-Infective Agents, Local/pharmacology, Availability, Clip on dispensers, Compliance, Cross Infection/prevention & control, Emergency room, Emergency Service, Hospital, Ethanol/*administration & dosage, Female, Hand Disinfection/*methods, Hand hygiene, Hand Hygiene/*methods, Hospitals, Teaching, Hospitals, University, Humans, Infection Control/*methods, interests.Springer Nature remains neutral with regard to jurisdictional claims in, Logistic Models, Male, Patients' Rooms, Personnel, Hospital/education, Pocket dispensers, Point of care, published maps and institutional affiliations., Risk Factors, Switzerland, Tertiary Care Centers, Wearable dispensers.

Getzmann, J. M., Slankamenac, K., Sprengel, K., Mannil, L., Giovanoli, P., and Plock, J. A. “The Impact Of Non-Thermal Injuries In Combined Burn Trauma: A Retrospective Analysis Over The Past 35 Years”. J Plast Reconstr Aesthet Surg 72, no. 3: 438-446. doi:10.1016/j.bjps.2018.10.022.

Abstract: INTRODUCTION: Combined burn trauma is rather uncommon and frequently difficult to manage. Historically combined burn trauma contributed to high mortality rates in severely injured patients. The purpose of this study was to determine the incidence, mechanisms and impact of non-thermal injuries in patients with severe burns. METHODS: The charts of 2536 patients admitted to the Burn Center of the University Hospital Zurich between 1977 and 2013 were reviewed and retrospectively analyzed. Patients with additional injuries were identified and analyzed statistically. RESULTS: Over 35 years from 1977 to 2013 a total of 100 burn patients (3.9%) with additional trauma were identified. Motor vehicle crash was the most common mechanism of injury (44%) from 1977 to 1995, compared to electrical injury (33%) from 1996 to 2013. Skeletal trauma including spinal and pelvic injury was the most common form (71%). Additional thoracic or abdominal trauma represented the highest risk factor for in-hospital mortality (adjusted RR 2.2, 95% CI 0.6-7.6). However, after 1995 the presence of any form of additional injury did not have a significant impact on in-hospital mortality (unadjusted RR 0.97, 95% CI 0.5-1.7, p = 0.914). CONCLUSIONS: Concomitant trauma did not reveal a significant impact on in-hospital mortality in our burn center recently. Retrospectively, trauma mechanisms shifted from motor vehicle crashes to electrical injuries in our population. Safety measures for motor vehicles and adequate emergency room algorithms seem to have contributed to a reduction of severity of injury and mortality.

Tags: Abdominal Injuries/complications/epidemiology, Abdominal injury, Accidents, Traffic/statistics & numerical data, Adult, Burn Units/statistics & numerical data, Burns/*complications/epidemiology/mortality, Electric Injuries/epidemiology, Electric injury, Fracture, Hospital Mortality, Humans, Male, Middle Aged, Mortality, Retrospective Studies, Switzerland/epidemiology, Thoracic Injuries/complications/epidemiology, Trauma severity index, Wounds and Injuries/*complications/epidemiology/mortality, Young Adult.

Brodmann Maeder, M., Saghir, R., Pun, M., Stawinoga, A. E., Turner, R., Strapazzon, G., Exadaktylos, A. K., and Brugger, H. “Intercultural Competence Of Western Teachers For Nepalese Rescuers”. High Alt Med Biol 20, no. 1: 22-27. doi:10.1089/ham.2018.0102.

Abstract: INTRODUCTION: Educational projects in mountain rescue in Nepal have a long tradition. They are usually led by Western experts who train their Nepalese colleagues using teams of people with diverse cultural background. To better understand the challenges of these encounters, we conducted a prospective cohort study during the first mountain rescue instructor course in Nepal. METHODS: Western instructors (WIs) and Nepalese instructor candidates (NICs) were asked to self-assess their intercultural competence with the help of questionnaires. The responses were compared and analyzed for differences between WIs and NICs and differences in a pre-post assessment of the WIs. In addition, semistructured interviews were conducted with randomly selected NICs. RESULTS: We found significant differences in communication styles between NICs and WIs: NICs showed a preference to establish relationships before discussing business and not to speak openly in conflict situations. WIs were much more direct and preferred dispassionate exchanges. In an assessment after the course, WIs had changed their attitude toward the host culture. CONCLUSIONS: We found differences in communication styles between WIs and NICs that are relevant to globalized medical education. Faculty members should be prepared before implementing medical training abroad and should have time to experience the host culture.

Tags: *Rescue Work, Adult, Cultural Competency/*psychology, Disaster Medicine/*education, education, Emergency Responders/*psychology, faculty development, Female, Germany/ethnology, Himalayas, Humans, intercultural competence, Italy/ethnology, Male, Middle Aged, mountain rescue, Nepal/ethnology, Prospective Studies, report., Slovenia/ethnology.

Zurcher, E., Richoz, B., Faouzi, M., and Michel, P. “Differences In Ischemic Anterior And Posterior Circulation Strokes: A Clinico-Radiological And Outcome Analysis”. J Stroke Cerebrovasc Dis 28, no. 3: 710-718. doi:10.1016/j.jstrokecerebrovasdis.2018.11.016.

Abstract: BACKGROUND: There are limited data comparing posterior (PC) and anterior (AC) circulation acute ischemic strokes (AIS). We aimed to identify specific features of PC and AC strokes regarding clinical, etiological, radiological, and outcome factors. METHODS: Patients from the Acute STroke Registry and Analysis of Lausanne, a prospective cohort of consecutive AIS, from years 2003 to 2008 were included. The stroke territory was determined by a combination of neuroimaging and clinical symptoms. Patients with uncertain localization or with simultaneous AC and PC strokes were excluded. Multivariate associations between territory and multiple variables were investigated. RESULTS: A total of 1449 patients were included, 466 (32.2%) had a PC territory stroke and 983 (67.8%) an AC. On multivariate analysis, those with PC AIS had lower National Institutes of Health Stroke Scale at admission, more often showed decreased consciousness, visual field defects, and vestibulo-cerebellar signs, but less hemisyndromes, dysarthria, and cognitive symptoms compared to AC AIS patients. Male sex, arterial dissection, lacunar mechanisms, and endovascular recanalization were more frequent in PC strokes, whereas cardioembolic strokes and IV-thrombolysis rates were lower. Less early ischemic signs on admission CT, overall arterial pathology, and 24-hour recanalization were present in PC strokes but intracranial arterial pathology was more prevalent than in AC. The adjusted clinical outcome at 3 months was similar in both groups. CONCLUSIONS: In this large retrospective consecutive AIS series, there were specific differences in clinical presentation, etiology, and arterial pathology between PC and AC strokes which did not influence clinical outcome. These findings could lead to a tailored diagnostic work-up, acute treatment strategies, and secondary prevention.

Tags: Aged, Aged, 80 and over, anterior circulation, Clinical neurology, Disability Evaluation, Female, Humans, Infarction, Anterior Cerebral Artery/*diagnostic imaging/drug, Infarction, Posterior Cerebral Artery/*diagnostic imaging/drug, Male, Middle Aged, Neuroimaging/*methods, outcome, posterior circulation, Predictive Value of Tests, Recovery of Function, Registries, Retrospective Studies, Risk Factors, Switzerland, therapy/physiopathology/psychology, Thrombolytic Therapy, Time Factors, Treatment Outcome.

Zurfluh, S., Nickler, M., Ottiger, M., Steuer, C., Kutz, A., Christ-Crain, M., Zimmerli, W., et al. “Dihydrotestosterone Is A Predictor For Mortality In Males With Community-Acquired Pneumonia: Results Of A 6-Year Follow-Up Study”. Respir Res 19, no. 1: 240. doi:10.1186/s12931-018-0947-0.

Abstract: BACKGROUND: Adrenal hormone metabolite levels are altered in acute illnesses such as community-acquired pneumonia (CAP). Our aim was to investigate associations of sex and mineralocorticoid hormone metabolites with short- and long-term mortality and severity of CAP in male and female patients. METHODS: We prospectively followed 285 patients (60.4% male, mean age 71 years) with CAP from a previous multicenter trial. At baseline, levels of different metabolites of sex hormones and mineralocorticoids were measured by liquid chromatography coupled to tandem mass spectrometry. We calculated Cox regression models adjusted for age and comorbidities. RESULTS: All-cause mortality was 5.3% after 30 days and increased to 47.4% after 6 years. In males, high levels of dihydrotestosterone were associated with higher 6-year mortality (adjusted HR 2.84, 95%CI 1.15-6.99, p = 0.023), whereas high levels of 17-OH-progesterone were associated with lower 6-year mortality (adjusted HR 0.72, 95%CI 0.54-0.97, p = 0.029). Testosterone levels in males correlated inversely with inflammatory markers (CRP rho = - 0.39, p < 0.001; PCT rho = - 0.34, p < 0.001) and disease severity as assessed by the Pneumonia severity index (PSI) (rho = - 0.23, p = 0.003). No similar association was found for female patients. CONCLUSION: Whereas in males with CAP, sex and mineralocorticoid hormone metabolite levels correlated with inflammation, disease severity and long-term survival, no similar association was found for females. Further study of sex and mineralocorticoid hormones in acute illness could generate predictive signatures with implementation in clinical practice.

Tags: *Sex Characteristics, Adrenal hormones, Adult, affiliations., Aged, Aged, 80 and over, anonymized in secondary analyses. CONSENT FOR PUBLICATION: Not applicable., associated with this manuscript. PUBLISHER'S NOTE: Springer Nature remains, Biomarkers/blood, committees of Aarau, Muensterlingen, Solothurn and Luzern, all with the same, Community-Acquired Infections/blood/diagnosis/mortality, Community-acquired pneumonia, COMPETING INTERESTS: All authors declare that they have no competing interests, Dihydrotestosterone, Dihydrotestosterone/*blood, ethical study number 87/06. Written informed consent was provided by all, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mortality prediction, Mortality/trends, neutral with regard to jurisdictional claims in published maps and institutional, participants for the initial trial, including agreement to use their data, Pneumonia/*blood/diagnosis/*mortality, Predictive Value of Tests, Prospective Studies, the ethics committee of the University of Basel as well as by the local ethics, Time Factors.

Schlagenhauf, P., Grobusch, M. P., Hamer, D. H., Asgeirsson, H., Jensenius, M., Eperon, G., Rothe, C., et al. “Area Of Exposure And Treatment Challenges Of Malaria In Eritrean Migrants: A Geosentinel Analysis”. Malar J 17, no. 1: 443. doi:10.1186/s12936-018-2586-9.

Abstract: BACKGROUND: Recent reports highlight malaria as a frequent diagnosis in migrants who originate from Eritrea. A descriptive analysis of GeoSentinel cases of malaria in Eritrean migrants was done together with a literature review to elucidate key attributes of malaria in this group with a focus on possible areas of acquisition of malaria and treatment challenges. RESULTS: A total of 146 cases were identified from the GeoSentinel database from 1999 through September 2017, with a marked increase in 2014 and 2015. All patients originated from Eritrea and the main reporting GeoSentinel sites were in Norway, Switzerland, Sweden, Israel and Germany. The majority of patients (young adult males) were diagnosed with malaria following arrival in the host country. All patients had a possible exposure in Eritrea, but may have been exposed in documented transit countries including Ethiopia, Sudan and possibly Libya in detention centres. Most infections were due to Plasmodium vivax (84.2%), followed by Plasmodium falciparum (8.2%). Two patients were pregnant, and both had P. vivax malaria. Some 31% of the migrants reported having had malaria while in transit. The median time to onset of malaria symptoms post arrival in the host country was 39 days. Some 66% of patients were hospitalized and nine patients had severe malaria (according to WHO criteria), including five due to P. vivax. CONCLUSIONS: The 146 cases of mainly late onset, sometimes severe, P. vivax malaria in Eritrean migrants described in this multi-site, global analysis reflect the findings of single-centre analyses identified in the literature search. Host countries receiving asylum-seekers from Eritrea need to be prepared for large surges in vivax and, to a lesser extent, falciparum malaria, and need to be aware and prepared for glucose-6-phosphate dehydrogenase deficiency testing and primaquine treatment, which is difficult to procure and mainly unlicensed in Europe. There is an urgent need to explore the molecular epidemiology of P. vivax in Eritrean asylum-seekers, to investigate the area of acquisition of P. vivax along common transit routes and to determine whether there has been re-introduction of malaria in areas, such as Libya, where malaria is considered eliminated, but where capable vectors and Plasmodium co-circulate.

Tags: *Transients and Migrants, Adolescent, Adult, Child, Child, Preschool, Eritrea, Europe, Female, Humans, Malaria, Falciparum/*epidemiology/pathology, Malaria, Vivax/*epidemiology/pathology, Male, Middle Aged, Young Adult.

Lagger, Grégoire, Correia, Jorge Cesar, Fernandes, Peter, Sittarame, Frédéric, and Golay, Alain. “A 5-Dimension Patient Education Program Targeting Type 2 Diabetes Remission”. Education Thérapeutique Du Patient - Therapeutic Patient Education 10, no. 2. doi:10.1051/tpe/2018018.

Abstract: Introduction: Type 2 diabetes (T2D) reversal has been demonstrated in patients undergoing bariatric surgery or low caloric diets. Objective: To investigate the effects of therapeutic patient education alone on T2D reversal in early diagnosed patients. Methods: Seventeen T2D patients underwent a one-week therapeutic education program, followed by 12 months of 1 hour sessions every month, targeting diabetes reversal. This reversal was determined using the DiaRem score which integrates glycated hemoglobin levels and antidiabetic drug treatment. Patient's conceptions, perceptions and motivation were assessed using a 5-dimensional psychopedagogic score. Results: After 1 year, the mean HbA1C fell from 7.2% (± 1.9) to 6.2% (± 0.8) (p < 0.05), antidiabetic drug doses decreased by 25% (p < 0.05), and the DiaRem score increased by 15% (p < 0.01), indicating a reversal of the disease, not correlated to weight loss. At the end of the study, 15 out of 17 patients had excellent glycemic control (HbA1C < 7.0%) and 4 patients had parameters compatible with partial diabetes remission. A significant improvement in glycemic control coupled with a lowering of antidiabetic drug treatment was observed. Conclusions: Following an initial therapeutic education program and regular consultation sessions thereafter, early diagnosed patients may reverse their type 2 diabetes. © 2018 EDP Sciences, SETE.

Junod Perron, N., Klockner Cronauer, C., Hautz, S. C., Schnabel, K. P., Breckwoldt, J., Monti, M., Huwendiek, S., and Feller, S. “How Do Swiss Medical Schools Prepare Their Students To Become Good Communicators In Their Future Professional Careers: A Questionnaire And Interview Study Involving Medical Graduates, Teachers And Curriculum Coordinators”. Bmc Med Educ 18, no. 1: 285. doi:10.1186/s12909-018-1376-y.

Abstract: BACKGROUND: Since 2011, the Swiss Catalogue of Learning Objectives (SCLO) has provided the framework for assessing communication skills in the Swiss Medical Federal Licensing Examination (FLE). This study evaluates how far the communication curricula of five Swiss medical schools match the SCLO and international recommendations. It also explores their strengths, weaknesses, opportunities and threats (SWOT). METHODS: A mixed method approach was used. In a first step, curriculum coordinators/key communication skills teachers and medical graduates were asked to fill out a questionnaire based on communication related objectives from the SCLO and a review of European consensus statements on communication training. Second, information was collected from all Swiss medical schools to identify which communication skills were taught in which formats and at what time points within the 6-year curricula. Finally, 3-4 curriculum coordinators/key communication skills teachers from each medical school were interviewed about their communication curriculum, using SWOT analysis. RESULTS: Sixteen teachers/coordinators (response rate 100%) and 389 medical graduates (response rate 43%) filled out the questionnaire. Both the teachers/coordinators and the graduates considered that two thirds of the communication items listed in the questionnaire were covered in their curricula. Between sixty and two hundred structured hours were dedicated to communication, predominantly in small group and experiential formats. Assessment relied on both MCQs and OSCEs. Most of the training occurred during the first three years of medical school. Teachers felt that the need for communication skills training was now well-recognized by their institution and was taught with appropriate teaching methods. However, recruitment and training of teachers, continuity of communication skills training during clinical years, and the adoption of a common frame of reference among the five medical schools, remained a challenge. CONCLUSION: Although the Swiss medical schools all offered a partly longitudinal communication skills training, with appropriate teaching methods, this study indicates that the communication skills actually taught do not fully match the SCLO or international recommendations. There was less training for complex communication skills training during the clinical years, and ensuring quality and coherence in the teaching remained a challenge.

Tags: *Communication, *Curriculum/standards, *Education, Medical, Undergraduate, *Schools, Medical/organization & administration/standards, *Students, Medical, affiliations., ask for an informed consent for publication from candidates who answered an, assessment among many other questions. COMPETING INTERESTS: The authors declare, Clinical Competence, Communication, coordinators signed a written consent form for publication. Students involved in, Curriculum, Educational Measurement, Educational Personnel, Health Services Research, Humans, informed that the data would be analysed and reported (after being anonymized, in, Medical students, neutral with regard to jurisdictional claims in published maps and institutional, not involve the collection of any personal health information (article 2 of the, online survey immediately after the exam. They were however free to answer or not, part of a quality improvement project of the Federal Licensing Exam, we did not, Professionalism/*standards, Surveys and Questionnaires, Swiss, Swiss Federal Act on Research involving Human Beings) [29]. The participants were, Switzerland, that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains, the case of the teachers and coordinators). CONSENT FOR PUBLICATION: Teachers and, the need for approval by the Ethical Committee of the Canton of Geneva, as it did, the survey which included questions on communication skills' training and, the think aloud process also signed a written consent form for publication. As, Training.

Doulberis, M., Papaefthymiou, A., Kountouras, J., Polyzos, S. A., Srivastava, D. S., Perrig, M., Katsinelos, P., et al. “Hookworms In Emergency Department: The ＂Vampire＂ Within”. J Acute Med 8, no. 4: 135-148. doi:10.6705/j.jacme.201812_8(4).0001.

Abstract: Hookworms infection is a soil-transmitted helminthic disease particularly endemic in developing counties of tropical regions. It is attributed mainly to two human pathogens nematodes namely Necator americanus and Ancylostoma duodenale. Although the disease has been characterized as "neglected" is very diffi cult to be eliminated and the economic consequences are great. Worms are fed with blood of hosts in small intestine and cause typically iron deficiency anemia with relevant symptoms as well as eosinophilia. Patients admitted in emergency department claim often diffuse general symptoms, whereas cases with obscure gastrointestinal bleeding can be seen. Within this brief review, after introducing some basic elements of hookworms' epidemiology, taxonomy and socioeconomic problem is emphasized, pathogenesis, and life cycle of parasite are concisely explained. Furthermore, clinical manifestations often or rarely seen in emergency department are described. Therapeutic options are also enclosed. Awareness of the problem and critical thinking of patients coming from endemic regions could result to identifying more hookworm cases and their therapy will efficiently alleviate not only the patients per se but health system and societies as well.

Tags: Ancylostoma, anemia, emergency department, hookworm, Necator.

Blum, C. A., Schuetz, P., Nigro, N., Winzeler, B., Arici, B., Refardt, J., Urwyler, S. A., et al. “Cosyntropin Testing Does Not Predict Response To Glucocorticoids In Community-Acquired Pneumonia In A Randomized Controlled Trial”. Clin Endocrinol (Oxf) 91, no. 3: 374-382. doi:10.1111/cen.13907.

Abstract: OBJECTIVE: Glucocorticoids have been shown to improve outcome in community-acquired pneumonia (CAP). However, glucocorticoids have potential side-effects, and treatment response may vary. It is thus crucial to select patients with high likelihood to respond favourably. In critical illness, cosyntropin testing is recommended to identify patients in need for glucocorticoids. We investigated whether cosyntropin testing predicts treatment response to glucocorticoids in CAP. DESIGN: Predefined secondary analysis of a randomized controlled trial. PATIENTS: Hospitalized patients with CAP. MEASUREMENTS: We performed 1 microg cosyntropin tests in a randomized trial comparing prednisone 50 mg for 7 days to placebo. We investigated whether subgroups based on baseline and stimulated cortisol levels responded differently to glucocorticoids with regard to time to clinical stability (TTCS) and other outcomes by inclusion of interaction terms into statistical models. RESULTS: A total of 326 patients in the prednisone and 309 patients in the placebo group were evaluated. Neither basal cortisol nor a Deltacortisol <250 nmol/L after stimulation nor the combination of basal cortisol and Deltacortisol predicted treatment response as measured by TTCS (all P for interaction >0.05). Similarly, we found no effect modification with respect to mortality, rehospitalization, antibiotic treatment duration or CAP-related complications (all P for interaction >0.05). However, glucocorticoids had a stronger effect on shortening length of hospital stay in patients with a baseline cortisol of >/=938 nmol/L (P for interaction = 0.015). CONCLUSIONS: Neither baseline nor stimulated cortisol after low-dose cosyntropin testing at a dose of 1 microg predicted glucocorticoid responsiveness in mild to moderate CAP. A treatment decision for or against adjunct glucocorticoids in CAP should not be made depending on cortisol values or cosyntropin testing results.

Tags: *Predictive Value of Tests, ACTH test, adrenal function, Adult, Community-Acquired Infections, community-acquired pneumonia, cosyntropin test, Cosyntropin/*analysis, critical illness-related corticosteroid insufficiency, Decision Making, Female, glucocorticoids, Glucocorticoids/*pharmacology/therapeutic use, Humans, Male, Middle Aged, Pneumonia/*drug therapy, Prednisone/therapeutic use.

Delacretaz, A., Vandenberghe, F., Glatard, A., Levier, A., Dubath, C., Ansermot, N., Crettol, S., et al. “Association Between Plasma Caffeine And Other Methylxanthines And Metabolic Parameters In A Psychiatric Population Treated With Psychotropic Drugs Inducing Metabolic Disturbances”. Front Psychiatry 9: 573. doi:10.3389/fpsyt.2018.00573.

Abstract: Importance: Multiple studies conducted in the general population identified an association between self-reported coffee consumption and plasma lipid levels. To date, no study assessed whether and which plasma methylxanthines (caffeine and/or its metabolites, i.e., paraxanthine, theophylline, and theobromine) are associated with plasma lipids. In psychiatric patients, an important coffee consumption is often reported and many psychotropic drugs can induce a rapid and substantial increase of plasma lipid levels. Objective: To determine whether plasma methylxanthines are associated with metabolic parameters in psychiatric patients receiving treatments known to induce metabolic disturbances. Design, Setting, and Participants: Data were obtained from a prospective study including 630 patients with metabolic parameters [i.e., body mass index (BMI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and fasting triglycerides (TG)] monitored routinely during psychotropic treatment. Exposures: Plasma methylxanthines levels. Main Outcomes and Measures: Metabolic variables including BMI and plasma lipid levels. Results: Multivariate analyses indicated that BMI, TC, HDL-C, and non-HDL-C increased significantly with increasing total methylxanthines (p (corrected) </= 0.05). In addition, compared to patients with plasma caffeine concentration in the lowest quartile, those with caffeine concentration in the highest quartile were twice more prone to suffer from non-HDL hypercholesterolemia (p (corrected) = 0.05), five times more likely to suffer from hypertriglyceridemia (p (corrected) = 0.01) and four times more susceptible to be overweight (p (corrected) = 0.01). Conclusions and Relevance: This study showed that plasma caffeine and other methylxanthines are associated with worsening of metabolic parameters in patients receiving psychotropic treatments known to induce metabolic disturbances. It emphasizes that important caffeine consumption could be considered as an additional environmental risk factor for metabolic worsening in patients receiving such treatments.

Tags: lipids, metabolic parameters, plasma caffeine level, plasma methylxanthines, psychotropic drugs, secondary effects.

Bangeas, P., Drevelegas, K., Agorastou, C., Tzounis, L., Chorti, A., Paramythiotis, D., Michalopoulos, A., et al. “Three-Dimensional Printing As An Educational Tool In Colorectal Surgery”. Front Biosci (Elite Ed) 11, no. 1: 29-37. doi:10.2741/E844.

Abstract: 3D printing is a rapidly advancing technology which represents a significant technological achievement that could be useful in a variety of biomedical applications. In the field of surgery, 3D printing is envisioned as a significant step in the areas of surgical planning, education and training. The 3D printed models are considered as high quality and efficient educational tools. In this paper A randomized controlled trial was performed to compare the educational role of 3D printed models with that of the conventional MRI films in the training of surgical residents. Statistical analysis revealed that Resident surgeons who studied only the anal fistula printed models, (Group B) achieved a higher overall score in the fistula assessment test (87,2 (82,6-91,6)) compared to resident surgeons (Group A) who studied only MRI images (74,85 (66,8-73,5)). 3D printing technology can lead to improvement in preoperative planning accuracy, followed by efficient optimization of the treatment strategy. It is believed that 3D printing technology could be used in the case of various other surgical applications, thus representing a novel tool for surgical education.

Tags: *Models, Anatomic, *Printing, Three-Dimensional, Digestive System Surgical Procedures/*education, Humans, Magnetic Resonance Imaging, Rectal Diseases/*pathology/surgery.

Bingisser, R., and Nickel, C. H. “Comment To: Non-Specific Complaints At Emergencydepartment Presentation Result In Uncleardiagnoses And Lengthened Hospitalization: A Prospective Observational Study”. Scand J Trauma Resusc Emerg Med 26, no. 1: 99. doi:10.1186/s13049-018-0553-7.

Tags: *Emergency Service, Hospital, *Hospitalization, claims in published maps and institutional affiliations., Emergency department, Geriatric emergency medicine, Humans, Mortality, Non-specific, Nonspecific complaints, Prospective Studies, PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional.

Sebo, P., Vaucher, P., Haller, D., Huber, P., Mueller, Y., and Favrat, B. “What Is The Profile Of Older Drivers Considered Medically Unfit To Drive? A Cross-Sectional Survey In Western Switzerland”. Swiss Med Wkly 148, no. 45-46: w14684. doi:10.4414/smw.2018.14684.

Abstract: OBJECTIVE: We aimed to assess how often and for what reasons general practitioners (GPs) consider older drivers medically unfit to drive. METHODS: All GPs certified to carry out fitness-to-drive assessments in Geneva (medical assessors, n = 69), as well as a random sample of 500 GPs practising in Vaud, Neuchatel and Jura, were asked to complete a questionnaire about the mean number of assessments per week, the number of negative decisions in the previous year and the main reason for the most recent negative decision. RESULTS: Completed questionnaires were returned by 268 respondents (45 medical assessors and 223 other GPs, participation rate: 47%). The mean proportion of drivers with a negative decision was 2.2% (standard deviation [SD] 3.3). The proportion was slightly lower among medical assessors (1.1%, SD 1.3) compared to other GPs (2.3%, SD 3.3, p <0.001). The main reasons for being considered medically unfit to drive were cognitive (64%) and visual acuity impairments (18%). CONCLUSIONS: GPs in this survey reported considering approximately 2% of older drivers as medically unfit to drive, mainly because of cognitive and visual acuity impairments. Further research should identify how GPs decide if older drivers are fit or unfit, and assess the effectiveness of medical screening in reducing car crashes involving older drivers.

Tags: Adult, Aged, Aging, Attitude of Health Personnel, Automobile Driving/*standards, Cognitive Dysfunction, Cross-Sectional Studies, Female, General Practitioners/*statistics & numerical data, Guideline Adherence/*standards/statistics & numerical data, Humans, Male, Middle Aged, Surveys and Questionnaires, Switzerland.

Swiss Emergency Research collection

2019

2018