Home > Bibliographic references

Swiss Emergency Research collection

2018

  • Kamradt-Scott, A., Dolea, C., Ponce, C., Rodier, G., Lamunu, M., Drury, P., and Ioos, S. “Who Tracking Mechanism For Ihr Additional Health Measures”. Lancet 392, no. 10161: 2250-2251. doi:10.1016/S0140-6736(18)32068-3.
    Tags: Australia/epidemiology, Disease Outbreaks/*legislation & jurisprudence/prevention & control, Humans, International Cooperation/legislation & jurisprudence, International Health Regulations/*standards, Process Assessment, Health Care/*standards, Social Class, Social Control, Formal, World Health Organization/*organization & administration.
  • Tan, R., Hugli, O., Cavassini, M., and Darling, K. “Non-Targeted Hiv Testing In The Emergency Department: Not Just How But Where”. Expert Rev Anti Infect Ther 16, no. 12: 893-905. doi:10.1080/14787210.2018.1545575.
    Abstract: The emergency department (ED) has the potential to enhance early HIV diagnosis through HIV testing programs. How these are implemented is a subject of debate. Areas covered: We describe the main HIV testing approaches: diagnostic testing, targeted screening, and non-targeted screening, and review ED-based non-targeted HIV screening studies conducted after 2006 among >/=5000 patients. As well as examining how testing is offered, we focus on where it is offered, through the patient's journey from registration, via triage and the waiting room, to the bedside. Barriers to the testing offer, acceptance and performance were examined at each location. While testing offer rates were higher at registration and triage, compared to the waiting room and bedside, this was sometimes at the expense of testing acceptance and performance. Variables affecting testing rates included type of consent, employment of external staff and type of testing: fourth generation serological testing versus rapid testing. Expert commentary: These large studies shed light on the importance of where as well as how HIV testing is performed, and the ways in which the 'where' can influence non-targeted screening yields. This perspective enables testing approaches to be tailored to specific ED settings in order to maximize testing rates.
    Tags: *Emergency Service, Hospital, Early Diagnosis, emergency department, Hiv, HIV diagnosis, HIV Infections/*diagnosis, HIV testing, Humans, Mass Screening/*methods, non-targeted, opt-out, Patient Acceptance of Health Care, screening, Serologic Tests/methods.
  • Bahrmann, A., Benner, L., Christ, M., Bertsch, T., Sieber, C. C., Katus, H., and Bahrmann, P. “The Charlson Comorbidity And Barthel Index Predict Length Of Hospital Stay, Mortality, Cardiovascular Mortality And Rehospitalization In Unselected Older Patients Admitted To The Emergency Department”. Aging Clin Exp Res 31, no. 9: 1233-1242. doi:10.1007/s40520-018-1067-x.
    Abstract: BACKGROUND AND AIMS: The Charlson Comorbidity Index (CCI) is the most widely used assessment tool to report the presence of comorbid conditions. The Barthel index (BI) is used to measure performance in activities of daily living. We prospectively investigated the performance of CCI or BI to predict length of hospital stay (LOS), mortality, cardiovascular (CV) mortality and rehospitalization in unselected older patients on admission to the emergency department (ED). We also studied the association of CCI or BI with costs. METHODS: We consecutively enrolled 307 non-surgical patients >/= 68 years presenting to the ED with a wide range of comorbid conditions. Baseline characteristic, clinical presentation, laboratory data, echocardiographic parameters and hospital costs were compared among patients. All patients were followed up for mortality, CV mortality and rehospitalization within the following 12 months. A multivariate analysis was performed. RESULTS: Mortality was increased for patients having a higher CCI or BI with a hazard ratio around 1.17-1.26 or 0.75-0.81 (obtained for different models) for one or ten point increase in CCI or BI, respectively. The prognostic impact of a high CCI or BI on CV mortality and rehospitalization was also significant. In a multiple linear regression using the same independent variables, CCI and BI were identified as a predictor of LOS in days. Multiple linear regression analysis did not confirm an association between CCI and costs, but for BI after adjusting for multiple factors. CONCLUSION: CCI and BI independently predict LOS, mortality, CV mortality, and rehospitalization in unselected older patients admitted to ED.
    Tags: *Hospital Mortality, Activities of Daily Living, Aged, Aged, 80 and over, Cardiovascular Diseases/mortality, Comorbidity, Decision support techniques, Emergency department, Emergency Service, Hospital/statistics & numerical data, Female, Geriatric Assessment/*statistics & numerical data, Geriatric assessment/methods, Hospital mortality, Humans, Kaplan-Meier Estimate, Length of Stay/economics/*statistics & numerical data, Male, Middle Aged, Multivariate Analysis, Patient Readmission/economics/*statistics & numerical data, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Proportional hazards models: prospective studies, Prospective Studies, Risk assessment.
  • Klee, P., Bussien, C., Castellsague, M., Combescure, C., Dirlewanger, M., Girardin, C., Mando, J. L., et al. “An Intervention By A Patient-Designed Do-It-Yourself Mobile Device App Reduces Hba1C In Children And Adolescents With Type 1 Diabetes: A Randomized Double-Crossover Study”. Diabetes Technol Ther 20, no. 12: 797-805. doi:10.1089/dia.2018.0255.
    Abstract: BACKGROUND: Prevention of type 1 diabetes mellitus (T1DM)-related complications is dependent on metabolic control. The recommended glycated hemoglobin (HbA1c) values <7.5% (58.5 mmol/mol) are met only by a minority of diabetic children and especially adolescents. The aim of this study was to evaluate the impact of an intervention comprising the use of Webdia, a patient-designed app for smartphones, on metabolic control of T1DM in children. METHODS: Fifty-five patients with T1DM, 10-18 years of age, were included in this single-center, randomized double-crossover study. We tested an intervention consisting of using Webdia for 3 months with monthly feedback and adaptation of the treatment. Main outcome was modification of HbA1c. Secondary outcomes were the prevalence of hypoglycemia and quality of life (QoL). RESULTS: Of the 55 included patients, 33 completed the study, 9 dropped out, and 13 were excluded due to insufficient use of the app. The app was well accepted by the users who completed the study (46.4% rated the program as good and 39.3% as excellent). The intervention led to a reduction of HbA1c by 0.33%, compared to the control group in which HbA1c rose by 0.21% (P = 0.048) in patients with HbA1c values >8.0% (63.9 mmol/mol) at inclusion, without increasing the prevalence of hypoglycemia (8.52 +/- 9.45 hypoglycemic events during last 2 weeks of intervention vs. 7.62 +/- 6.37 observation, P = 0.680). QoL scores were not modified. CONCLUSIONS: The intervention resulted in a significant decrease in HbA1c, without increasing the prevalence of hypoglycemia in patients with initial HbA1c >8.0% (63.9 mmol/mol).
    Tags: *Mobile Applications, Adolescent, Blood Glucose Self-Monitoring/*instrumentation/methods, Blood Glucose/*analysis, Child, Cross-Over Studies, Diabetes Mellitus, Type 1/*blood/complications, Do-it-yourself applications, eHealth, Female, Glycated Hemoglobin/*analysis, Humans, Hypoglycemia/epidemiology/etiology, Male, mHealth app, Patient-designed applications, Prevalence, Quality of Life, Smartphone, Telemedicine.
  • Carreira, H., Williams, R., Muller, M., Harewood, R., Stanway, S., and Bhaskaran, K. “Associations Between Breast Cancer Survivorship And Adverse Mental Health Outcomes: A Systematic Review”. J Natl Cancer Inst 110, no. 12: 1311-1327. doi:10.1093/jnci/djy177.
    Abstract: BACKGROUND: We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (>/=1 year) compared with women with no history of cancer. METHODS: Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias. RESULTS: Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status. CONCLUSIONS: There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.
    Tags: *Cancer Survivors, *Mental Health, *Survivorship, Anxiety/etiology, Breast Neoplasms/*epidemiology/psychology, Cognitive Dysfunction/etiology, Depression/etiology, Humans, Outcome Assessment, Health Care, Publication Bias.
  • Nissen, S. K., Brabrand, M., Nickel, C. H., Kellett, J., and Cooksley, T. “Impaired Mobility Is Associated With Risk Of Icu Admission But Not Outcome After Icu Treatment”. Acta Anaesthesiol Scand 63, no. 3: 418. doi:10.1111/aas.13286.
    Tags: *Hospitalization, *Intensive Care Units, Humans.
  • Semik-Gurgul, E., Zabek, T., Fornal, A., Wnuk, M., Pawlina-Tyszko, K., Gurgul, A., Klukowska-Rotzler, J., Koch, C., Mahlmann, K., and Bugno-Poniewierska, M. “Corrigendum To 'Dna Methylation Patterns Of The S100A14, Pou2F3 And Sfn Genes In Equine Sarcoid Tissues' Research In Veterinary Science 119 (2018) 302-307”. Res Vet Sci 121: 116. doi:10.1016/j.rvsc.2018.10.012.
    Abstract: The authors regret that the original version of this Article contained error in the affiliation of some of the authors. The affiliation indicated as: a - National Research Institute of Animal Production, Department of Animal Genomics and Molecular Biology, Krakowska 1, 32–083 Balice, Poland. should be specified as: a - National Research Institute of Animal Production, Department of Animal Molecular Biology, Krakowska 1, 32–083 Balice, Poland. The authors would like to apologise for any inconvenience caused due to this error. © 2018 Elsevier Ltd
    Tags: erratum, error.
  • Poletti, P. A., Sahin, M., Peter, R., Boudabbous, S., Herpe, G., Rutschmann, O. T., and Platon, A. “Femoral Head Subchondral Impaction On Ct: What Does It Mean In Patients With Acetabular Fracture?”. Skeletal Radiol 48, no. 6: 939-948. doi:10.1007/s00256-018-3100-8.
    Abstract: OBJECTIVE: To evaluate the prevalence of isolated femoral head impactions associated with acetabular fractures and to assess whether impactions may be predictive of the development of delayed major complications requiring total hip arthroplasty. MATERIALS AND METHODS: A total of 128 consecutive adult patients with acetabular fracture and no femoral head fracture were included. Admission CTs were re-interpreted for the presence of hip dislocation and femoral head impactions. Radiological and clinical reports were reviewed in patients in whom conservative management of the femoral head was attempted, to determine if total hip arthroplasty was eventually required over a 48-month follow-up period. Univariate and multivariate analyses were performed to assess whether impaction is an independent predictor of failure of conservative management. RESULTS: Impaction was found in 40% of all patients (51 out of 128), in 58% of those with dislocation (19 out of 33), and in 34% of those without dislocation (32 out of 95; p < 0.05). One hundred and five patients underwent conservative management of the femoral head; 12.5% of them (13 out of 105) eventually required total hip arthroplasty. An impaction was present in 77% of the latter (10 out of 13) and in 33% of patients with successful conservative management (30 out of 92; p = 0.0042). At multivariate analysis, impaction and dislocation were significantly and independently associated with a higher risk for delayed total hip arthroplasty (odds ratio of 4.8 and 4.0 respectively). CONCLUSION: Femoral head impactions are frequently seen on CT of patients with acetabular fractures; they are independent predictive factors for the need for delayed total hip arthroplasty. They should be systematically mentioned in the CT report.
    Tags: *Tomography, X-Ray Computed, Acetabular fracture, Acetabulum/diagnostic imaging/*injuries, Adolescent, Adult, Aged, Aged, 80 and over, Conservative Treatment, Ct, Female, Femoral head, Femur Head/diagnostic imaging/*injuries, Hip Dislocation/*diagnostic imaging/therapy, Hip Fractures/*diagnostic imaging/*therapy, Humans, Impaction, Male, Middle Aged, Retrospective Studies.
  • Seiler, M., Massaro, S. L., Staubli, G., and Schiestl, C. “Tongue Lacerations In Children: To Suture Or Not?”. Swiss Med Wkly 148, no. 43-44: w14683. doi:10.4414/smw.2018.14683.
    Abstract: AIMS OF THE STUDY: Tongue lacerations are common in children, occurring mostly from falls or sports injuries. Optimal treatment of tongue lacerations is a challenge for paediatricians due to contradictory recommendations and a lack of current guidelines. It remains unclear which tongue lacerations should be sutured and which would benefit from spontaneous healing, which is a promising alternative. In recent years, the treatment of choice in our paediatric emergency department (ED) has shifted from generally suturing the wounds to more frequently advising secondary wound healing. The aim of this study was to analyse tongue lacerations treated at our ED in order to develop guidance for the optimal management of tongue lacerations in children. METHODS: This retrospective study was conducted to assess tongue lacerations at the ED of a University Children's Hospital Zurich from January 2010 to August 2015. All families were contacted for informed consent and photo documentation of the healed tongue. Clinical records of all the patients included were reviewed and different variables were defined and analysed. RESULTS: A total of 73 children with tongue lacerations were included (75.3% boys, mean age +/- standard deviation 4.0 +/- 2.6 years). The mean size of the lacerations was 12.4 +/- 8.3 mm, with affected tongue borders in 51 cases (69.9%) and a through-and-through laceration in 23 patients (31.5%). A primary wound closure was performed in 12 children (16.4%). These wounds were significantly larger than those of the secondary wound healing group (21 +/- 10 mm compared to 10.8 +/- 6.8 mm), presented gaping wound edges with the tongue at rest more frequently (91.7% compared to 32.8%), and showed through-and-through lacerations more often (91.7% compared to 19.7%). The group with wound suturing needed longer to recover (median 13 days compared to 6.2 days) and had a higher rate of complications (25 vs 3.3%). CONCLUSIONS: Suturing is not required in gaping tongue lacerations less than 2 cm long that do not involve the tip of the tongue. The Zurich Tongue Scheme was developed as a guide for clinicians when deciding which tongue lacerations need suturing.
    Tags: *Sutures, Child, Preschool, Emergency Service, Hospital, Female, Hospitals, Pediatric, Humans, Lacerations/*therapy, Male, Retrospective Studies, Switzerland, Tongue/*injuries, Treatment Outcome, Wound Healing.
  • Sandoval, J. L., Himsl, R., Theler, J. M., Gaspoz, J. M., Joost, S., and Guessous, I. “Spatial Distribution Of Mammography Adherence In A Swiss Urban Population And Its Association With Socioeconomic Status”. Cancer Med 7, no. 12: 6299-6307. doi:10.1002/cam4.1829.
    Abstract: PURPOSE: Local physical and social environment has a defining influence on individual behavior and health-related outcomes. However, it remains undetermined if its impact is independent of individual socioeconomic status. In this study, we evaluated the spatial distribution of mammography adherence in the state of Geneva (Switzerland) using individual-level data and assessed its independence from socioeconomic status (SES). METHODS: Georeferenced individual-level data from the population-based cross-sectional Bus Sante study (n = 5002) were used to calculate local indicators of spatial association (LISA) and investigate the spatial dependence of mammography adherence. Spatial clusters are reported without adjustment; adjusted for neighborhood income and individual educational attainment; and demographic factors (age and Swiss nationality). The association between adjusted clusters and the proximity to the nearest screening center was also evaluated. RESULTS: Mammography adherence was not randomly distributed throughout Geneva with clusters geographically coinciding with known SES distributions. After adjustment for SES indicators, clusters were reduced to 56.2% of their original size (n = 1033). Adjustment for age and nationality further reduced the number of individuals exhibiting spatially dependent behavior (36.5% of the initial size). The identified SES-independent hot spots and cold spots of mammography adherence were not explained by proximity to the nearest screening center. CONCLUSIONS: SES and demographic factors play an important role in shaping the spatial distribution of mammography adherence. However, the spatial clusters persisted after confounder adjustment indicating that additional neighborhood-level determinants could influence mammography adherence and be the object of targeted public health interventions.
    Tags: *Patient Compliance, Adult, Aged, breast neoplasm, Cities, early detection of cancer, Female, geography, health services, Humans, mammography, Mammography/*statistics & numerical data, Middle Aged, Social Class, socioeconomic factors, Spatial Analysis, Switzerland, Urban Population/*statistics & numerical data.
  • Mebert, R. V., Klukowska-Roetzler, J., Ziegenhorn, S., and Exadaktylos, A. K. “Push Scooter-Related Injuries In Adults: An Underestimated Threat? Two Decades Analysed By An Emergency Department In The Capital Of Switzerland”. Bmj Open Sport Exerc Med 4, no. 1: e000428. doi:10.1136/bmjsem-2018-000428.
    Abstract: BACKGROUND: The number of people conducting cycling and skating sports in Switzerland is rising; likewise, we notice an increase in patients visiting our emergency department for adults due to push scooter accidents. In 2001, our emergency department published the first article worldwide on push scooter-related injuries. Nearly two decades later, we want to review the interim period-collect data, compare it with other studies and evaluate the current impact of push scooter accidents in our adult patient population. OBJECTIVE: To investigate data on the incidence, severity, treatment and approximate costs of push scooter-related injuries in adults who presented to our emergency department from 2000 to 2017. MATERIALS AND METHODS: For this descriptive retrospective study, data were collected in the Department of Emergency Medicine at Inselspital (University Hospital), Berne, Switzerland, from October 2000 to September 2017. We used two clinical reporting systems during that period: Qualicare from 2000 to April 2012 and Ecare from May 2012 to 2017. RESULTS: 165 patients were included, aged 16-80 years. The accidents were mainly classified as unspecified falls in 139 cases (84.24%). 21 patients (12.73%) were wearing a helmet at the time of the accident, while the remaining 144 (87.27%) were not. The most common injuries suffered were fractures in 73 patients (44.24%). 92 patients (55.76%) sustained an impact to the head. The most common treatment was surgery in the operating theatre (59 patients, 35.76%). The mean total cost per case was SFr7566.65 (emergency room visit, hospital stay and outpatient controls for the initial case). CONCLUSION: The incidence of push scooter-related injuries in adults in our patient population is small but rising. Nevertheless, the resulting injuries are potentially life-threatening and can lead to persistent medical impairment.
    Tags: injury, push scooter, trauma.
  • van de Voort, E. M. F., Mintegi, S., Gervaix, A., Moll, H. A., and Oostenbrink, R. “Antibiotic Use In Febrile Children Presenting To The Emergency Department: A Systematic Review”. Front Pediatr 6: 260. doi:10.3389/fped.2018.00260.
    Abstract: Introduction: While fever is the main complaint among pediatric emergency services and high antibiotic prescription are observed, only a few studies have been published addressing this subject. Therefore this systematic review aims to summarize antibiotic prescriptions in febrile children at the ED and assess its determinants. Methods: We extracted studies published from 2000 to 2017 on antibiotic use in febrile children at the ED from different databases. Author, year, and country of publishing, study design, inclusion criteria, primary outcome, age, and number of children included in the study was extracted. To compare the risk-of-bias all articles were assessed using the MINORS criteria. For the final quality assessment we additionally used the sample size and the primary outcome. Results: We included 26 studies reporting on antibiotic prescription and 28 intervention studies on the effect on antibiotic prescription. In all 54 studies antibiotic prescriptions in the ED varied from 15 to 90.5%, pending on study populations and diagnosis. Respiratory tract infections were mostly studied. Pediatric emergency physicians prescribed significantly less antibiotics then general emergency physicians. Most frequent reported interventions to reduce antibiotics are delayed antibiotic prescription in acute otitis media, viral testing and guidelines. Conclusion: Evidence on antibiotic prescriptions in children with fever presenting to the ED remains inconclusive. Delayed antibiotic prescription in acute otitis media and guidelines for fever and respiratory infections can effectively reduce antibiotic prescription in the ED. The large heterogeneity of type of studies and included populations limits strict conclusions, such a gap in knowledge on the determining factors that influence antibiotic prescription in febrile children presenting to the ED remains.
    Tags: antibiotic prescription, children, fever, management, pediatric emergency care.
  • Simma, L., and Neuhaus, T. J. “Common Diagnosis At An Unusual Age - Pulmonary Oedema In A Toddler”. Bmj Case Rep 2018. doi:10.1136/bcr-2018-225389.
    Tags: acute renal failure, Diagnosis, Differential, Humans, Infant, Lung/diagnostic imaging/physiopathology, Male, paediatrics, primary care, Pulmonary Edema/*diagnostic imaging/*etiology/physiopathology, Radiography, Renal Insufficiency/*complications.
  • Piccand, E., Vollenweider, P., Guessous, I., and Marques-Vidal, P. “Association Between Dietary Intake And Inflammatory Markers: Results From The Colaus Study”. Public Health Nutr 22, no. 3: 498-505. doi:10.1017/S1368980018002355.
    Abstract: OBJECTIVE: To assess the associations between single foods, nutrients, dietary patterns and dietary scores, and inflammatory markers (C-reactive protein (CRP), IL-6, TNF-alpha and leucocyte count). DESIGN: Cross-sectional, population-based study. SETTING: City of Lausanne, Switzerland, years 2009-2012. SUBJECTS: Adults (n 4027; 46.5 % men), mean age 57.2 (sd 10.2) years. Dietary intake was collected using a semi-quantitative FFQ. Single foods and nutrients, three dietary patterns ('Meat &amp; fries'; 'Fruits &amp; vegetables'; 'Fatty &amp; sugary') and three dietary scores (two Mediterranean; Alternative Healthy Eating Index (AHEI)) were used. Associations were assessed using correlation and multivariable linear regression. RESULTS: After adjusting for total energy intake, gender and other sociodemographic factors, no individual macro- or micronutrient was associated with inflammatory markers. Among single foods, only fruit intake was negatively associated with CRP levels (standardized regression score=-0.043, P&lt;0.01). The 'Fruits &amp; vegetables' pattern, the Mediterranean and the AHEI scores were negatively associated with CRP levels (standardized regression score=-0.079, -0.043 and -0.067, respectively, all P&lt;0.01). When entered simultaneously with fruit intake, the 'Fruits &amp; vegetables' pattern, the Mediterranean and the AHEI scores tended to remain significantly and negatively associated with CRP levels, while the association with fruit intake was no longer significant. No association between all dietary markers and IL-6, TNF-alpha or leucocyte count was found. CONCLUSIONS: Dietary scores, but not individual foods, are associated with inflammatory markers in the general population.
    Tags: Aged, Biomarkers/blood, C-Reactive Protein/analysis, Cross-Sectional Studies, Cytokines/blood, Diet Surveys, Diet/*statistics & numerical data, Dietary patterns, Dietary scores, Epidemiology, Feeding Behavior/*physiology, Female, Humans, Inflammation, Inflammation/*blood/epidemiology, Leukocyte Count, Male, Middle Aged, Nutrients, Nutritive Value/physiology, Switzerland/epidemiology.
  • Farpour-Lambert, N. J., Ells, L. J., Martinez de Tejada, B., and Scott, C. “Obesity And Weight Gain In Pregnancy And Postpartum: An Evidence Review Of Lifestyle Interventions To Inform Maternal And Child Health Policies”. Front Endocrinol (Lausanne) 9: 546. doi:10.3389/fendo.2018.00546.
    Abstract: Background: Maternal obesity, excessive gestational weight gain (GWG) and post-partum weight retention (PPWR) constitute new public health challenges, due to the association with negative short- and long-term maternal and neonatal outcomes. The aim of this evidence review was to identify effective lifestyle interventions to manage weight and improve maternal and infant outcomes during pregnancy and postpartum. Methods: A review of systematic reviews and meta-analyses investigating the effects of lifestyle interventions on GWG or PPWR was conducted (Jan 2009-2018) via electronic searches in the databases Medline, Pubmed, Web of Science and Cochrane Library using all keywords related to obesity/weight gain/loss, pregnancy or postpartum and lifestyle interventions;15 relevant reviews were selected. Results: In healthy women from all BMI classes, diet and physical activity interventions can decrease: GWG (mean difference -1.8 to -0.7 kg, high to moderate-quality evidence); the risks of GWG above the IOM guidelines (risk ratio [RR] 0.72 to 0.80, high to low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low to very low-quality evidence); cesarean section (RR 0.91 to 0.95; high to moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.56, high-quality evidence); without any maternal/fetal/neonatal adverse effects. In women with overweight/obesity, multi-component interventions can decrease: GWG (-0.91 to -0.63 kg, moderate to very low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low-quality evidence); macrosomia (RR 0.85, 0.73 to 1.0, moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.47, 0.26 to 0.85, moderate-quality evidence). Diet is associated with greater reduction of the risks of GDM, pregnancy-induced hypertension and preterm birth, compared with any other intervention. After delivery, combined diet and physical activity interventions reduce PPWR in women of any BMI (-2.57 to -2.3 kg, very low quality evidence) or with overweight/obesity (-3.6 to -1.22, moderate to very low-quality-evidence), but no other effects were reported. Conclusions: Multi-component approaches including a balanced diet with low glycaemic load and light to moderate intensity physical activity, 30-60 min per day 3-5 days per week, should be recommended from the first trimester of pregnancy and maintained during the postpartum period. This evidence review should help inform recommendations for health care professionals and women of child-bearing age.
    Tags: intervention, nutrition, obesity, physical activity, postpartum, pregnancy, systematic review, weight gain.
  • Kuchen, N., Gmuer, C., and Schoeb, O. “Complete Jejunal Transection After Blunt Abdominal Trauma: A Case Report”. Surg Laparosc Endosc Percutan Tech 29, no. 1: e7-e8. doi:10.1097/SLE.0000000000000583.
    Abstract: INTRODUCTION: Isolated complete transection of the small bowel is extremely rare in blunt abdominal trauma. If it occurs, it is often associated with high-energy impact, as seen in motor vehicle accidents and falls from heights. In this case, a trivial trauma due to a handlebar injury caused a complete transection of the middle jejunum. CASE PRESENTATION: A 47-year-old man walked into the emergency department with moderate abdominal pain approximately 10 hours after a fall on to a bicycle's handlebar from a standing position. A bedside ultrasound showed minimal amount of free fluid and a following performed computed tomographic scan indicated an edematous loop of small bowel with diminutive amount of extraluminal air, suggesting small bowel perforation. Because of the absence of abdominal peritonism in a hemodynamically stable patient, a conservative treatment and surveillance was established. In the follow-up, the patient suddenly developed severe abdominal pain with now clear signs of peritonism. An emergency laparoscopy showed a complete transection of the middle jejunum. A primary anastomosis was performed. The patient had an uneventful recovery and was discharged after 7 days. CONCLUSIONS: Even seemingly trivial blunt abdominal traumas can cause complete transection of the small bowel, as shown in this case. Patients with blunt abdominal trauma need to be reviewed frequently by an experienced clinician. Diagnostic laparoscopy attaches a great importance to early detection and treatment of small bowel injuries. The mechanical pattern of the injury seems to be more important than the energy of the impact itself.
    Tags: Abdominal Injuries/*etiology, Abdominal Pain/etiology, Accidental Falls, Anastomosis, Surgical, Bicycling/injuries, Humans, Intestinal Perforation/*etiology/surgery, Jejunal Diseases/*etiology/surgery, Jejunum/*injuries/surgery, Laparoscopy/methods, Male, Middle Aged, Wounds, Nonpenetrating/*etiology.
  • Muller, M., Schlittler, F., Schaller, B., Nagler, M., Exadaktylos, A. K., and Sauter, T. C. “Characteristics, Treatment And Outcome Of Bleeding After Tooth Extraction In Patients On Doac And Phenprocoumon Compared To Non-Anticoagulated Patients-A Retrospective Study Of Emergency Department Consultations”. Clin Oral Investig 23, no. 5: 2273-2278. doi:10.1007/s00784-018-2676-7.
    Abstract: OBJECTIVES: Bleeding after tooth extraction range from minor bleeding to life-threating haemorrhagic shock and are among the leading complications in patients under oral anticoagulation with direct oral anticoagulants (DOACs) or phenprocoumon. Little is known about how anticoagulation in patients under DOAC or phenprocoumon alters the characteristics, treatment or outcome of bleeding events, in comparison to non-anticoagulated patients. METHODS: Patients admitted to a tertiary ED in Bern, Switzerland, from June 1st 2012 to 31st May 2016 with bleeding related to tooth extraction under DOAC, phenprocoumon or without anticoagulation, were compared. RESULTS: Out of 161,458 emergency consultations, 64 patients with bleeding from tooth extraction were included in our study. In anticoagulation groups, we found significantly more delayed bleeding events than in patients without anticoagulation (9 (81.3%) DOAC, 19 (86.4%) phenprocoumon, 8 (30.8%) no anticoagulation, p < 0.001). Anticoagulated patients had to stay longer in the ED than non-anticoagulated patients, with no significant difference between DOAC or phenprocoumon (hours: 4.8 (3.2-7.6 IQR) DOAC, 3.0 (2.0-5.5 IQR) phenprocoumon, p = 0.133; 2.7 (1.6-4.6) no anticoagulation; p = 0.039). More patients with anticoagulation therapy needed surgery than patients without anticoagulant therapy (11 (68.8%) DOAC, 12 (54.6%) VKA, p = 0.506; 7(26.9%) no anticoagulation; p = 0.020). CONCLUSIONS: Delayed bleeding occur more often in anticoagulated patients with both DOAC and phenprocoumon compared to patients without anticoagulation. Bleeding events in anticoagulated patients with DOAC and phenprocoumon equally need longer ED treatment and more frequent surgical intervention. CLINICAL RELEVANCE: Caution with delayed bleeding in anticoagulated patients with DOACs and phenprocoumon is necessary and treatment of bleeding is resource-demanding.
    Tags: Administration, Oral, Adult, Aged, Aged, 80 and over, Anticoagulants/*administration & dosage, Anticoagulation, Apixaban, Direct oral anticoagulant, Emergency Service, Hospital, Female, Hemorrhage/*etiology, Humans, Male, Middle Aged, Phenprocoumon, Phenprocoumon/*administration & dosage, Retrospective Studies, Rivaroxaban, Switzerland, Tooth extraction bleeding, Tooth Extraction/*adverse effects, Treatment Outcome, Young Adult.
  • Lazzarino, T., Martenet, S., Mamin, R., Du Pasquier, R. A., Peters, S., Perreau, M., Muller, O., Hugli, O., Cavassini, M., and Darling, K. E. A. “Effect Of National Hiv Testing Recommendations And Local Interventions On Hiv Testing Practices In A Swiss University Hospital: A Retrospective Analysis Between 2012 And 2015”. Bmj Open 8, no. 10: e021203. doi:10.1136/bmjopen-2017-021203.
    Abstract: OBJECTIVES: Despite HIV testing recommendations published by the Federal Office of Public Health (FOPH) since 2007, many individuals living with HIV are diagnosed late in Switzerland. The aim of this study is to examine the effect of the 2013 FOPH HIV testing recommendations on HIV testing rates. SETTING: Ten clinical services at Lausanne University Hospital, Lausanne, Switzerland. PARTICIPANTS: Patients attending between 1 January 2012 and 31 December 2015. DESIGN: Retrospective analysis using two existing hospital databases. HIV testing rates calculated as the percentage of tests performed (from the Immunology Service database) per number of patients seen (from the central hospital database). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was testing rate change following the 2013 FOPH testing recommendations, comparing testing rates 2 years before and 2 years after their publication. Secondary outcomes were demographic factors of patients tested or not tested for HIV. RESULTS: 147 884 patients were seen during the study period of whom 9653 (6.5%) were tested for HIV, with 34 new HIV diagnoses. Mean testing rate increased from 5.6% to 7.8% after the recommendations (p=0.001). Testing rate increases were most marked in services involved in clinical trials on HIV testing, whose staff had attended training seminars on testing indications and practice. Testing rates were lower among older (aged >50 years), female and Swiss patients compared with younger, male and non-Swiss patients, both globally (p=0.001) and in specific clinical services. CONCLUSIONS: This simple two-database tool demonstrates clinical services in which HIV testing practice can be optimised. Improved testing rates in services involved in clinical trials on testing suggest that local engagement complements the effect of national recommendations. While, overall, HIV testing rates increased significantly over time, testing rates were lower among patients with similar demographic profiles to individuals diagnosed late in Switzerland.
    Tags: Adult, Databases, Factual, Female, health policy, HIV Infections/*diagnosis/*epidemiology, HIV Seropositivity/diagnosis, Hospitals, University, Humans, Male, Mass Screening/*statistics & numerical data, Middle Aged, public health, Retrospective Studies, Switzerland/epidemiology.
  • Strebel, I., Twerenbold, R., Wussler, D., Boeddinghaus, J., Nestelberger, T., du Fay de Lavallaz, J., Abacherli, R., et al. “Incremental Diagnostic And Prognostic Value Of The Qrs-T Angle, A 12-Lead Ecg Marker Quantifying Heterogeneity Of Depolarization And Repolarization, In Patients With Suspected Non-St-Elevation Myocardial Infarction”. Int J Cardiol 277: 8-15. doi:10.1016/j.ijcard.2018.09.040.
    Abstract: BACKGROUND: The value of the 12-lead ECG in the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is limited due to insufficient sensitivity and specificity of standard ECG criteria. The QRS-T angle reflects depolarization-repolarization heterogeneity and might assist in detecting patients with a NSTEMI (diagnosis) as well as predicting patients with an increased mortality risk (prognosis). METHODS: We prospectively enrolled 2705 consecutive patients with symptoms suggestive of NSTEMI. The QRS-T angle was automatically derived from the standard 10 s 12-lead ECG recorded at presentation to the ED. Patients were followed up for all-cause mortality for 2 years. RESULTS: NSTEMI was the final diagnosis in 15% (n = 412) of patients. QRS-T angles were significantly greater in patients with NSTEMI compared to those without (p < 0.001). The use of the QRS-T angle in addition to standard ECG criteria indicative of ischemia improved the diagnostic accuracy for NSTEMI as quantified by the area under the ROC curve from 0.68 to 0.72 (p < 0.001). An algorithm for the combined use of standard ECG criteria and the QRS-T angle improved the sensitivity of the ECG for NSTEMI from 45% to 78% and the specificity from 86% to 91% (p < 0.001 for both comparisons). The 2-year survival rates were 98%, 97% and 87% according to QRS-T angle tertiles (p < 0.001). CONCLUSION: In patients with suspected NSTEMI, the QRS-T angle derived from the standard 12-lead ECG provides incremental diagnostic accuracy on top of standard ECG criteria indicative of ischemia, and independently predicts all-cause mortality during 2 years of follow-up.
    Tags: *Internationality, Adult, Aged, Cohort Studies, Electrocardiography/instrumentation/*methods/mortality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mortality/trends, Non-ST Elevated Myocardial Infarction/*diagnosis/mortality/*physiopathology, Prognosis, Prospective Studies.
  • Veron, C., Pautex, S., Weber, C., Janssens, J. P., and Cedraschi, C. “Recollection Of Participating In A Trial: A Qualitative Study Of Patients With Severe And Very Severe Chronic Obstructive Pulmonary Disease”. Plos One 13, no. 9: e0204701. doi:10.1371/journal.pone.0204701.
    Abstract: BACKGROUND: Despite having similar palliative needs to patients with lung cancer, advanced chronic obstructive pulmonary disease (COPD) patients are less likely to receive palliative care. To evaluate the effect of introducing specialized palliative care with severe to very severe COPD patients, a randomized controlled trial (RCT) was conducted in Switzerland. AIM: To explore COPD patients' recollection of the trial, their needs and the usefulness of the palliative care interventions. DESIGN AND SETTING: Qualitative study with advanced COPD patients who participated in a specialized palliative care intervention, conducted in a general hospital. METHOD: Eighteen patients with severe to very severe COPD were interviewed about their experiences. Interviews were transcribed and thematic content analysis was performed. RESULTS: Patients had poor recollection of the trial and difficulties understanding the palliative care intervention. No major differences were observed between patients who received the specialized intervention and those who did not. Content analysis emphasized that although they experienced disabling symptoms, participants tended to attribute their limitations to problems other than COPD and some declared that they were not sick. Patients reported restrictions due to oxygen therapy, and the burden of becoming dependent on it. This dependence resulted in intense anxiety, leading participants to focus on the present only. A strong feeling of perceived helplessness emerged from the patients' interviews. CONCLUSIONS: Our findings suggest that poor recollection and understanding of the palliative care intervention act as barriers to the conduct of clinical trials with severe and very severe COPD patients. Their cognitive difficulties, perception of COPD, functional limitations, overwhelming anxiety, focus on the present and perceived helplessness also seem to hinder the implementation of such care.
    Tags: Aged, Aged, 80 and over, Anxiety, Female, Humans, Interview, Psychological, Male, Mental Recall, Middle Aged, Oxygen Inhalation Therapy, Palliative Care/*psychology, Pulmonary Disease, Chronic Obstructive/*psychology/*therapy, Qualitative Research, Randomized Controlled Trials as Topic/*psychology, Switzerland.
  • Abbas, M., Aloudat, T., Bartolomei, J., Carballo, M., Durieux-Paillard, S., Gabus, L., Jablonka, A., et al. “Migrant And Refugee Populations: A Public Health And Policy Perspective On A Continuing Global Crisis”. Antimicrob Resist Infect Control 7, no. 1: 113. doi:10.1186/s13756-018-0403-4.
    Abstract: The 2015-2017 global migratory crisis saw unprecedented numbers of people on the move and tremendous diversity in terms of age, gender and medical requirements. This article focuses on key emerging public health issues around migrant populations and their interactions with host populations. Basic needs and rights of migrants and refugees are not always respected in regard to article 25 of the Universal Declaration of Human Rights and article 23 of the Refugee Convention. These are populations with varying degrees of vulnerability and needs in terms of protection, security, rights, and access to healthcare. Their health status, initially conditioned by the situation at the point of origin, is often jeopardised by adverse conditions along migratory paths and in intermediate and final destination countries. Due to their condition, forcibly displaced migrants and refugees face a triple burden of non-communicable diseases, infectious diseases, and mental health issues. There are specific challenges regarding chronic infectious and neglected tropical diseases, for which awareness in host countries is imperative. Health risks in terms of susceptibility to, and dissemination of, infectious diseases are not unidirectional. The response, including the humanitarian effort, whose aim is to guarantee access to basic needs (food, water and sanitation, healthcare), is gripped with numerous challenges. Evaluation of current policy shows insufficiency regarding the provision of basic needs to migrant populations, even in the countries that do the most. Governments around the world need to rise to the occasion and adopt policies that guarantee universal health coverage, for migrants and refugees, as well as host populations, in accordance with the UN Sustainable Development Goals. An expert consultation was carried out in the form of a pre-conference workshop during the 4th International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland, on 20 June 2017, the United Nations World Refugee Day.
    Tags: *Population Dynamics, *Refugees, *Transients and Migrants, affiliations., Communicable Disease Control, Communicable Diseases/epidemiology/transmission, Cost of Illness, Crisis, declare that they have no competing interests.Springer Nature remains neutral, Global Health, Health Policy, Humans, Infectious diseases, Migrant populations, Models, Theoretical, on the internet and may be seen by the general public. Oral consent was provided, Public health policy, Public Health Surveillance, Refugees, the photographed persons for the purposes of signing a consent form.The authors, the photographs taken of them will may be published, and may be freely available, to the photographer, and a form was not signed. It was not possible to contact, United Nations, with regard to jurisdictional claims in published maps and institutional.
  • Studerus-Germann, A. M., Gautschi, O. P., Bontempi, P., Thiran, J. P., Daducci, A., Romascano, D., von Ow, D., Hildebrandt, G., von Hessling, A., and Engel, D. C. “Central Nervous System Microbleeds In The Acute Phase Are Associated With Structural Integrity By Dti One Year After Mild Traumatic Brain Injury: A Longitudinal Study”. Neurol Neurochir Pol 52, no. 6: 710-719. doi:10.1016/j.pjnns.2018.08.011.
    Abstract: INTRODUCTION: Several imaging modalities are under investigation to unravel the pathophysiological mystery of delayed performance deficits in patients after mild traumatic brain injury (mTBI). Although both imaging and neuropsychological studies have been conducted, only few data on longitudinal correlations of diffusion tensor imaging (DTI), susceptibility weighted imaging (SWI) and extensive neuropsychological testing exist. METHODS: MRI with T1- and T2-weighted, SWI and DTI sequences at baseline and 12 months of 30 mTBI patients were compared with 20 healthy controls. Multiparametric assessment included neuropsychological testing of cognitive performance and post-concussion syndrome (PCS) at baseline, 3 and 12 months post-injury. Data analysis encompassed assessment of cerebral microbleeds (Mb) in SWI, tract-based spatial statistics (TBSS) and voxel-based morphometry (VBM) of DTI (VBM-DTI). Imaging markers were correlated with neuropsychological testing to evaluate sensitivity to cognitive performance and post-concussive symptoms. RESULTS: Patients with Mb in SWI in the acute phase showed worse performance in several cognitive tests at baseline and in the follow-ups during the chronic phase and higher symptom severity in the post concussion symptom scale (PCSS) at twelve months post-injury. In the acute phase there was no statistical difference in structural integrity as measured with DTI between mTBI patients and healthy controls. At twelve months post-injury, loss of structural integrity in mTBI patients was found in nearly all DTI indices compared to healthy controls. CONCLUSIONS: Presence of Mb detected by SWI was associated with worse cognitive outcome and persistent PCS in mTBI patients, while DTI did not prove to predict neuropsychological outcome in the acute phase.
    Tags: *Brain Concussion, *Cerebral Hemorrhage/diagnostic imaging, Cognitive assessment, Diffuse axonal injury, Diffusion Tensor Imaging, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Mild traumatic brain injury, Neuropsychological Tests, Susceptibility-weighted imaging.
  • Moschetti, K., Iglesias, K., Baggio, S., Velonaki, V., Hugli, O., Burnand, B., Daeppen, J. B., Wasserfallen, J. B., and Bodenmann, P. “Health Care Costs Of Case Management For Frequent Users Of The Emergency Department: Hospital And Insurance Perspectives”. Plos One 13, no. 9: e0199691. doi:10.1371/journal.pone.0199691.
    Abstract: BACKGROUND: In most emergency departments (EDs), few patients account for a relatively high number of ED visits. To improve the management of these patients, the university hospital of Lausanne, Switzerland, implemented an interdisciplinary case management (CM) intervention. This study examined whether the CM intervention-compared with standard care (SC) in the ED-reduced costs generated by frequent ED users, not only from the hospital perspective, but also from the third-party payer perspective, that is, from a broader perspective that takes into account the costs of health care services used outside the hospital offering the intervention. METHODS: In this randomized controlled trial, 250 frequent ED users (>5 visits during the previous 12 months) were allocated to either the CM or the SC group and followed up for 12 months. Cost data were obtained from the hospital's analytical accounting system for the entire sample and from health insurance companies for a subgroup (n = 140). Descriptive statistics and multivariate regressions were used to make comparisons between groups and assess the contribution of patient characteristics to the main cost components. RESULTS: At the end of the 12-month follow-up, 115 patients were in the CM group and 115 in the SC group (20 had died). Despite differences in economic costs between patients in the CM intervention and the SC groups, our results do not show any statistically significant reduction in costs associated with the intervention, either for the hospital that housed the intervention or for the third-party payer. Frequent ED users were big users of health services provided by both the hospital and community-based services, with 40% of costs generated outside the hospital that housed the intervention. Higher age, Swiss citizenship, and having social difficulty increased costs significantly. CONCLUSIONS: As the role of the CM team is to guide patients through the entire care process, the intervention location is not limited to the hospital but often extends into the community.
    Tags: Adult, Costs and Cost Analysis, Emergency Service, Hospital/*economics, Female, Follow-Up Studies, Humans, Insurance, Health/*economics, Male, Middle Aged.
  • Larribau, R., Deham, H., Niquille, M., and Sarasin, F. P. “Improvement Of Out-Of-Hospital Cardiac Arrest Survival Rate After Implementation Of The 2010 Resuscitation Guidelines”. Plos One 13, no. 9: e0204169. doi:10.1371/journal.pone.0204169.
    Abstract: OBJECTIVE: The implementation of cardiopulmonary resuscitation guidelines, updated every five years, appears to improve patient survival rates after Out-Of-Hospital Cardiac Arrest (OHCA). The aim of this study is: 1) to measure the level of improvement in the prognosis of OHCA patient survival rates for the years 2009 and 2010 and the following two years 2011 and 2012; and 2) correlate the improvement in prognosis with the updated 2010 Advanced Cardiovascular Life Support (ACLS) Guidelines. METHOD: We performed a retrospective observational study based on Geneva's OHCA register that includes data from January 1, 2009 to December 31, 2012. We compared the evolution of prognostic factors that influenced survival at hospital discharge between the periods before and after the implementation of the 2010 guidelines. We then compared the survival rates between each period. Finally, we adjusted the effects on survival in the second period to prognostic factors not linked with the care provided by Emergency Medical Services (EMS) teams, using a multivariable logistic regression model. Changes in advanced resuscitation treatment provided by EMS personnel were also examined. RESULTS: 795 OHCA were resuscitated between 1st January, 2009 and 31st December, 2012. The prognosis of patient survival at the time of hospital discharge rose from 10.33% in 2009-2010 to 17.01% in 2011-2012 (p = 0.007). After making adjustments for the effect of improved survival rates on the second period with factors not related to care provided by EMS teams, the odds ratio (OR) remains comparable (OR = 1.87, 95% CI [1.08-3.22]). Measured changes in treatment provided by EMS personnel were minor. CONCLUSIONS: Survival rate for OHCA patients improved significantly in 2011-2012. This study suggests that it was probably the improvement in the quality of care provided during CPR and post-cardiac arrest care that have contributed to the increase in survival rates at the time of hospital discharge.
    Tags: *Cardiopulmonary Resuscitation, *Practice Guidelines as Topic, Aged, Female, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Out-of-Hospital Cardiac Arrest/*mortality, Patient Discharge, Prognosis, Survival Rate.
  • Keidar, O., Jegerlehner, S. N., Ziegenhorn, S., Brown, A. D., Muller, M., Exadaktylos, A. K., and Srivastava, D. S. “Emergency Department Discharge Outcome And Psychiatric Consultation In North African Patients”. Int J Environ Res Public Health 15, no. 9. doi:10.3390/ijerph15092033.
    Abstract: Studies in Europe have found that immigrants, compared to the local population, are more likely to seek out medical care in Emergency Departments (EDs). In addition, studies show that immigrants utilize medical services provided by EDs for less acute issues. Despite these observed differences, little is known about the characteristics of ED use by North African (NA) immigrants. The main objective of this study was to examine whether there were differences in ED discharge outcomes and psychiatric referrals between NA immigrants and Swiss nationals. A retrospective analysis was conducted using patient records from NA and Swiss adults who were admitted to the ED of the University Hospital in Bern (Switzerland) from 2013(-)2016. Measures included demographic information as well as data on types of admission. Outcome variables included discharge type and psychiatric referral. A total of 77,619 patients generated 116,859 consultations to the ED, of which 1.1 per cent (n = 1338) were consultations by NA patients. Compared to Swiss national patients, NA patients were younger, with a median age of 38.0 (IQR 28(-)51 years vs. 52.0 (IQR 32(-)52) for Swiss and predominantly male (74.4% vs. 55.6% in the Swiss). NA patient admission type was more likely to be "walk-in" or legal admission (7.5% vs 0.8 in Swiss,). Logistic regressions indicated that NA patients had 1.2 times higher odds (95% CI 1.07(-)1.40, p < 0.003) of receiving ambulatory care. An effect modification by age group and sex was observed for the primary outcome "seen by a psychiatrist", especially for men in the 16(-)25 years age group, whereby male NA patients had 3.45 times higher odds (95% CI: 2.22(-)5.38) of having being seen by a psychiatrist. In conclusion differences were observed between NA and Swiss national patients in ED consultations referrals and outcomes, in which NA had more ambulatory discharges and NA males, especially young, were more likely to have been seen by psychiatrist. Future studies would benefit from identifying those factors underlying these differences in ED utilization.
    Tags: Adolescent, Adult, Africa, Northern/ethnology, Aged, Aged, 80 and over, Ambulatory Care/*statistics & numerical data, Child, Child, Preschool, disparities, emergency department, Emergency Service, Hospital/*statistics & numerical data, Emigrants and Immigrants/*statistics & numerical data, Female, health care, Hospitals, University/statistics & numerical data, Humans, immigration, Infant, Infant, Newborn, Male, Middle Aged, North African, Patient Admission/*statistics & numerical data, Patient Discharge/*statistics & numerical data, Psychiatry/*statistics & numerical data, Referral and Consultation/classification/*statistics & numerical data, Retrospective Studies, Switzerland, Young Adult.
  • du Fay de Lavallaz, J., Badertscher, P., Nestelberger, T., Isenrich, R., Miro, O., Salgado, E., Geigy, N., et al. “Prospective Validation Of Prognostic And Diagnostic Syncope Scores In The Emergency Department”. Int J Cardiol 269: 114-121. doi:10.1016/j.ijcard.2018.06.088.
    Abstract: BACKGROUND: Various scores have been derived for the assessment of syncope patients in the emergency department (ED) but stay inconsistently validated. We aim to compare their performance to the one of a common, easy-to-use CHADS(2) score. METHODS: We prospectively enrolled patients >/= 40 years old presenting with syncope to the ED in a multicenter study. Early clinical judgment (ECJ) of the treating ED-physician regarding the probability of cardiac syncope was quantified. Two independent physicians adjudicated the final diagnosis after 1-year follow-up. Major cardiovascular events (MACE) and death were recorded during 2 years of follow-up. Nine scores were compared by their area under the receiver-operator characteristics curve (AUC) for death, MACE or the diagnosis of cardiac syncope. RESULTS: 1490 patients were available for score validation. The CHADS(2)-score presented a higher or equally high accuracy for death in the long- and short-term follow-up than other syncope-specific risk scores. This score also performed well for the prediction of MACE in the long- and short-term evaluation and stratified patients with accuracy comparative to OESIL, one of the best performing syncope-specific risk score. All scores performed poorly for diagnosing cardiac syncope when compared to the ECJ. CONCLUSIONS: The CHADS(2)-score performed comparably to more complicated syncope-specific risk scores in the prediction of death and MACE in ED syncope patients. While better tools incorporating biochemical and electrocardiographic markers are needed, this study suggests that the CHADS(2)-score is currently a good option to stratify risk in syncope patients in the ED. TRIAL REGISTRATION: NCT01548352.
    Tags: Aged, Aged, 80 and over, Diagnosis, Electrocardiography/methods/*standards, Emergency department, Emergency Service, Hospital/*standards, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Scores, Syncope, Syncope/*diagnosis/*physiopathology.
  • Doulberis, M., Kountouras, J., Polyzos, S. A., Tzivras, D., Vardaka, E., Kountouras, C., Tzilves, D., et al. “Impact Of Helicobacter Pylori And/Or Helicobacter Pylori-Related Metabolic Syndrome On Gastroesophageal Reflux Disease- Barrett's Esophagus- Esophageal Adenocarcinoma Sequence”. Helicobacter 23, no. 6: e12534. doi:10.1111/hel.12534.
    Tags: *Adenocarcinoma, *Barrett Esophagus, *Gastroesophageal Reflux, *Helicobacter Infections, *Helicobacter pylori, *Metabolic Syndrome, Humans.
  • Braillard, O., Slama-Chaudhry, A., Joly, C., Perone, N., and Beran, D. “The Impact Of Chronic Disease Management On Primary Care Doctors In Switzerland: A Qualitative Study”. Bmc Fam Pract 19, no. 1: 159. doi:10.1186/s12875-018-0833-3.
    Abstract: BACKGROUND: Patient-centeredness and therapeutic relationship are widely explored as a means to address the challenge of chronic disease and multi-morbidity management, however research focusing on the perspective of doctors is still rare. In this study, we aimed to explore the impact of the patient's chronic disease(s) on their healthcare provider. METHODS: A qualitative approach was taken using semi-structured interviews with general practitioners working in outpatient clinics either in individual practices or in a hospital setting in Geneva, Switzerland. Codes were developed through an iterative process and using grounded theory an inductive coding scheme was performed to identify the key themes. Throughout the analysis process the research team reviewed the analysis and refined the coding scheme. RESULTS: Twenty interviews, 10 in each practice type, allowed for saturation to be reached. The following themes relevant to the impact of managing chronic diseases emerge around the issue of feeling powerless as a doctor; facing the patient's socio-economic context; guidelines versus the reality of the patient; time; and taking on the patient's burden. Primary care practitioners face an emotional burden linked with their powerlessness and work conditions, but also with the empathetic bond with their patients and their circumstances. Doctors seem poorly prepared for this emotional strain. The health system is also not facilitating this with time constraints and guidelines unsuitable for the patient's reality. CONCLUSIONS: Chronic disease and multi-morbidity management is a challenge for healthcare providers. This has its roots in patient characteristics, the overall health system and healthcare providers themselves. Structural changes need to be implemented at different levels: medical education; health systems; adapted guidelines; leading to an overall environment that favors the development of the therapeutic relationship.
    Tags: (available on request from the corresponding author) and declare no support from, *Attitude of Health Personnel, *Patient-Centered Care, *Physician-Patient Relations, Adult, Aged, any organisation for the submitted work, Chronic disease, Female, General practice, Geneva Research Ethics Committee, reference number 14-022. Each participant, Humans, INTERESTS: All authors have completed the Unified Competing Interest form, Male, maps and institutional affiliations., material is published and therefore no consent to publish is required. COMPETING, Middle Aged, Multimorbidity, Multiple Chronic Conditions/*therapy, no financial relationships with any, organisations that might have an interest in the submitted work in the previous, Physicians, Primary Care/*psychology, Practice Guidelines as Topic, Primary health care, Qualitative Research, signed a written informed consent form. CONSENT FOR PUBLICATION: No identifiable, Springer Nature remains neutral with regard to jurisdictional claims in published, Switzerland, that could appear to have influenced the submitted work. PUBLISHER'S NOTE:, three years, as well as during this study, no other relationships or activities, Time management.
  • Luginbuhl, M., Junker, T., and Keller, D. I. “A Patient Full Of Surprises: A Body Packer With Cocaine Intoxication, Pneumococcal Pneumonia And Hiv Infection”. Bmc Emerg Med 18, no. 1: 29. doi:10.1186/s12873-018-0180-7.
    Abstract: BACKGROUND: Smuggling of illegal drugs by hiding them inside one's own body, also called body packing, is a worldwide phenomenon. Cocaine is the most frequently transported drug. Body packing is a potentially lethal practice. The most serious complications of body packing are gastrointestinal obstruction or perforation and drug toxicity due to packet leakage or rupture. CASE PRESENTATION: A 30-year-old confirmed body packer was brought to our emergency department from jail because of agitation and mydriasis. He presented with a high respiratory rate of 40/min but normal oxygen saturation on ambient air, a heart rate of 116 bpm, a blood pressure of 116/68 mmHg and a temperature of 38.0 degrees Celsius. Blood tests were suggestive of infection, urine analysis was positive for cocaine. Abdominal and thoracic computed tomography scans showed pulmonary infiltrates as a possible focus of infection; signs of bowel obstruction or perforation were absent. Given his clinical presentation, we suspected severe infection rather than massive cocaine intoxication to be the main problem. We therefore withheld immediate surgical decontamination. Instead, we started broad-spectrum antibiotic treatment with piperacillin/tazobactam plus clarithromycin for suspected severe community-acquired pneumonia or abdominal sepsis and treated the patient with intravenous midazolam for symptomatic cocaine intoxication. After detection of urinary pneumococcal antigen, the antibacterial regimen was changed to ceftriaxone and vancomycin for pneumococcal pneumonia. In addition, we found human immunodeficiency virus (HIV) type 1 infection as underlying disease. The patient recovered from his acute illness and was discharged after 7 days of treatment with ceftriaxone plus vancomycin. Antiretroviral therapy was started in an outpatient setting. CONCLUSIONS: With this case report, we emphasize the need to look for alternative diagnoses to intoxication and gastrointestinal obstruction in acutely ill body packers with atypical presentation. Special risks, such as underlying HIV infection and potential antimicrobial resistance according to the individual's geographical origin, should be taken into account while treating these patients.
    Tags: *Body Packing, Adult, Anti-Bacterial Agents/therapeutic use, Body packer, claims in published maps and institutional affiliations., Cocaine, Cocaine-Related Disorders/complications/drug therapy, Cocaine/*blood, COMPETING INTERESTS: The authors declare that they have no competing interests., HIV Infections/*complications/diagnosis, Human immunodeficiency virus, Humans, Hypnotics and Sedatives/therapeutic use, Male, Pneumococcal pneumonia, Pneumonia, Pneumococcal/*complications/diagnosis/drug therapy, publication of this case report and any accompanying images. A copy of the, PUBLICATION: Written informed consent was obtained from the patient for, PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional, Sepsis, written consent is available for review by the Editor-in-Chief of this journal..
  • Kountouras, J., Doulberis, M., Polyzos, S. A., Zeglinas, C., Vardaka, E., Kountouras, C., Tzivras, D., Dardiotis, E., Exadaktylos, A., and Katsinelos, P. “Helicobacter Pylori Infection And Gastroesophageal Reflux Disease-Barrett's Esophagus-Esophageal Adenocarcinoma Sequence”. Am J Gastroenterol 113, no. 11: 1723-1724. doi:10.1038/s41395-018-0214-5.
    Tags: *Adenocarcinoma, *Barrett Esophagus, *Esophageal Neoplasms, *Gastroesophageal Reflux, *Helicobacter Infections, *Helicobacter pylori, Humans.
  • Abolhassani, N., Santos-Eggimann, B., Bula, C., Goy, R., Guessous, I., and Henchoz, Y. “Temporal Changes In Importance Of Quality Of Life Domains: A Longitudinal Study In Community-Dwelling Swiss Older People”. Qual Life Res 28, no. 2: 421-428. doi:10.1007/s11136-018-1983-4.
    Abstract: PURPOSE: Population aging is a global phenomenon requiring interventions to improve quality of life (QoL), a subjective and dynamic concept. Such interventions should be based on QoL domains considered as important from older people's viewpoint. It is unclear whether and how much these domains may vary over time as people age. This study aims to assess the importance of QoL domains, their pattern and determinants of change among the non-institutionalized older population over a 5-year period. METHODS: This longitudinal study included community-dwelling older adults (N = 1947, aged 68-77 years at baseline) from the Lausanne cohort 65+. In 2011 and 2016, participants rated the importance of 28 QoL items in seven domains. The difference between scores (0-100) of importance attributed to each QoL domain between two assessments was calculated and used as a dependent variable to assess the associations with covariates in multivariable analysis for each domain. RESULTS: Importance scores slightly but significantly decreased in five of the seven QoL domains. Despite the majority of participants did not modify their ranking of importance for each QoL domain between the two time points, the proportion of change was still substantial. Bivariate and multivariable analyses showed that education and to a lesser extent age, living arrangement and morbidity, were associated with decrease in the importance of specific QoL domains; characteristics indicating vulnerability (e.g., low education or morbidity) were associated with a decline in the importance. CONCLUSION: Although aging individuals modified the importance they give to the seven QoL domains, at population level, changes in opposite directions overall resulted in only small decline; importance seems less stable over time among individuals with vulnerable sociodemographic and health profiles.
    Tags: Aged, Aged, 80 and over, Aging/*psychology, Cohort Studies, Ethnicity, Female, Humans, Importance, Independent Living, Longitudinal Studies, Longitudinal study, Male, Older people, Quality of life, Quality of Life/*psychology, Sweden.
  • Hunziker, S., O'Connell, K. J., Ranniger, C., Su, L., Hochstrasser, S., Becker, C., Naef, D., et al. “Effects Of Designated Leadership And Team-Size On Cardiopulmonary Resuscitation: The Basel-Washington Simulation (Bawasim) Trial”. J Crit Care 48: 72-77. doi:10.1016/j.jcrc.2018.08.001.
    Abstract: OBJECTIVE: During cardiopulmonary resuscitation (CPR), it remains unclear whether designating an individual person as team leader compared with emergent leadership results in better team performance. Also, the effect of CPR team size on team performance remains understudied. METHODS: This randomized-controlled trial compared designated versus emergent leadership and size of rescue team (3 vs 6 rescuers) on resuscitation performance. RESULTS: We included 90 teams with a total of 408 students. No difference in mean (+/-SD) hands-on time (seconds) were observed between emergent leadership (106 +/- 30) compared to designated leadership (103 +/- 27) groups (adjusted difference - 2.97 (95%CI -15.75 to 9.80, p = 0.645), or between smaller (103 +/- 30) and larger teams (106 +/- 26, adjusted difference 3.53, 95%CI -8.47 to 15.53, p = 0.56). Emergent leadership groups had a shorter time to circulation check and first defibrillation, but the quality of CPR based on arm and shoulder position was lower. No differences in CPR quality measures were observed between smaller and larger teams. CONCLUSIONS: Within this international US/Swiss trial, leadership designation and larger team size did not improve hands-on time, but emergent leadership teams initiated defibrillation earlier. Improvements in performance may be more likely to be achieved by optimization of emergent leadership than increasing the size of cardiac arrest teams.
    Tags: *Leadership, Cardiopulmonary resuscitation, Cardiopulmonary Resuscitation/*methods, Clinical Competence/*standards, Female, Humans, Leadership, Male, Manikins, Patient Care Team/*organization & administration, Simulation Training/*organization & administration, Team behaviour.
  • Laribi, S., Keijzers, G., van Meer, O., Klim, S., Motiejunaite, J., Kuan, W. S., Body, R., et al. “Epidemiology Of Patients Presenting With Dyspnea To Emergency Departments In Europe And The Asia-Pacific Region”. Eur J Emerg Med 26, no. 5: 345-349. doi:10.1097/MEJ.0000000000000571.
    Abstract: OBJECTIVE: The primary objective of this study was to describe the epidemiology and management of dyspneic patients presenting to emergency departments (EDs) in an international patient population. Our secondary objective was to compare the EURODEM and AANZDEM patient populations. PATIENTS AND METHODS: An observational prospective cohort study was carried out in Europe and the Asia-Pacific region. The study included consecutive patients presenting to EDs with dyspnea as the main complaint. Data were collected on demographics, comorbidities, chronic treatment, clinical signs and investigations, treatment in the ED, diagnosis, and disposition from ED. RESULTS: A total of 5569 patients were included in the study. The most common ED diagnoses were lower respiratory tract infection (LRTI) (24.9%), heart failure (HF) (17.3%), chronic obstructive pulmonary disease (COPD) exacerbation (15.8%), and asthma (10.5%) in the overall population. There were more LRTI, HF, and COPD exacerbations in the EURODEM population, whereas asthma was more frequent in the AANZDEM population. ICU admission rates were 5.5%. ED mortality was 0.6%. The overall in-hospital mortality was 5.0%. In-hospital mortality rates were 8.7% for LRTI, 7.6% for HF, and 5.6% for COPD patients. CONCLUSION: Dyspnea as a symptom in the ED has high ward and ICU admission rates. A variety of causes of dyspnea were observed in this study, with chronic diseases accounting for a major proportion.
    Tags: Age Distribution, Aged, Aged, 80 and over, Asia/epidemiology, Asthma/diagnosis/*epidemiology, Cohort Studies, Comorbidity, Dyspnea/diagnosis/*epidemiology, Emergency Service, Hospital/*statistics & numerical data, Europe/epidemiology, Female, Heart Failure/diagnosis/*epidemiology, Hospital Mortality/trends, Humans, Internationality, Male, Middle Aged, Pacific Islands/epidemiology, Pneumonia/diagnosis/*epidemiology, Prevalence, Prospective Studies, Pulmonary Disease, Chronic Obstructive/diagnosis/epidemiology, Severity of Illness Index, Sex Distribution.
  • Boeddinghaus, J., Nestelberger, T., Twerenbold, R., Neumann, J. T., Lindahl, B., Giannitsis, E., Sorensen, N. A., et al. “Impact Of Age On The Performance Of The Esc 0/1H-Algorithms For Early Diagnosis Of Myocardial Infarction”. Eur Heart J 39, no. 42: 3780-3794. doi:10.1093/eurheartj/ehy514.
    Abstract: AIMS: We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients. METHODS AND RESULTS: We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction in three large diagnostic studies. Final diagnoses were adjudicated by two independent cardiologists. High-sensitivity cardiac troponin (hs-cTn) T and I concentrations were measured at presentation and after 1 h. Patients were stratified according to age [<55 years (young), >/=55 to <70 years (middle-age), >/=70 years (old)]. Rule-out safety of the ESC hs-cTnT 0/1h-algorithm was very high in all age-strata: sensitivity 100% [95% confidence interval (95% CI) 94.9-100] in young, 99.3% (95% CI 96.0-99.9) in middle-age, and 99.3% (95% CI 97.5-99.8) in old patients. Accuracy of rule-in decreased with age: specificity 97.0% (95% CI 95.8-97.9) in young, 96.1% (95% CI 94.5-97.2) in middle-age, and 92.7% (95% CI 90.7-94.3) in older patients. Triage efficacy decreased with increasing age (young 93%, middle-age 80%, old 55%, P < 0.001). Similar results were found for the ESC hs-cTnT 0/1h-algorithm. Alternative, slightly higher cut-off concentrations optimized for older patients maintained very high safety of rule-out, increased specificity of rule-in (P < 0.01), reduced overall efficacy for hs-cTnT (P < 0.01), while maintaining efficacy for hs-cTnI. Findings were confirmed in two validation cohorts (n = 2767). CONCLUSION: While safety of the ESC 0/1h-algorithms remained very high, increasing age significantly reduced overall efficacy and the accuracy of rule-in. Alternative slightly higher cut-off concentrations may be considered for older patients, particularly if using hs-cTnI. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587 and NCT02355457 (BACC).
    Tags: Adult, Age Factors, Aged, Algorithms, Early Diagnosis, Female, Humans, Male, Middle Aged, Myocardial Infarction/*diagnosis/*epidemiology, Practice Guidelines as Topic, Prospective Studies, Sensitivity and Specificity, Troponin/blood.
  • Klukowska-Roetzler, J., Eracleous, M., Muller, M., Srivastava, D. S., Krummrey, G., Keidar, O., and Exadaktylos, A. K. “Increased Urgent Care Center Visits By Southeast European Migrants: A Retrospective, Controlled Trial From Switzerland”. Int J Environ Res Public Health 15, no. 9. doi:10.3390/ijerph15091857.
    Abstract: We investigated whether immigrants from Southeast Europe (SE) and Swiss patients have different reasons for visiting the emergency department (ED). Our retrospective data analysis for the years 2013(-)2017 describes the pattern of ED consultations for immigrants from SE living in Switzerland (Canton Bern), in comparison with Swiss nationals, with a focus on type of referral and reason for admission. A total of 153,320 Swiss citizens and 12,852 immigrants from SE were included in the study. The mean age was 51.30 (SD = 21.13) years for the Swiss patients and 39.70 (SD = 15.87) years for the SE patients. For some countries of origin (Albania, Bosnia and Herzegovina, and Turkey), there were highly statistically significant differences in sex distribution, with a predominance of males. SE immigrants had a greater proportion of patients in the lower triage level (level 3: SE: 67.3% vs. Swiss: 56.0%) and a greater proportion of patients in the high triage level than the Swiss population (level 1: SE: 3.4% vs. Swiss: 8.8%). SE patients of working age (16(-)65 years) were six times more often admitted by ambulance than older (>/=65 years) SE patients, whereas this ratio was similar in the Swiss population. In both groups, the fast track service was primarily used for patients of working age (<65) and more than three times more often in the SE than the Swiss group (SE: 39.1%, Swiss: 12.6%). We identified some indications for access to primary care in emergency departments for immigrants and highlighted the need for attention to the role of organizational characteristics of primary health care in Switzerland. We highlighted the need for professional support to improve the quality of healthcare for immigrants. In the future, we will need more primary care services and general practitioners with a migrant background.
    Tags: *Ambulatory Care Facilities, *Transients and Migrants, Adult, Aged, Emergency Service, Hospital, Emigrants and Immigrants, Ethnicity, Female, healthcare, Hospitalization, Humans, immigrant, Male, Middle Aged, Retrospective Studies, Southeast Europe, Switzerland/epidemiology, Young Adult.
  • Cullati, S., von Arx, M., Courvoisier, D. S., Sandoval, J. L., Manor, O., Burton-Jeangros, C., Bouchardy, C., and Guessous, I. “Organised Population-Based Programmes And Change In Socioeconomic Inequalities In Mammography Screening: A 1992-2012 Nationwide Quasi-Experimental Study”. Prev Med 116: 19-26. doi:10.1016/j.ypmed.2018.08.012.
    Abstract: Organised mammography screening programmes may reduce socioeconomic inequalities in breast cancer screening, but evidence is contradictory. Switzerland has no national organised mammography screening programme, but regional programmes were progressively introduced since 1999, giving the opportunity to conduct a nationwide quasi-experimental study. We examined the evolution of socioeconomic inequalities in mammography screening in Switzerland and if exposure to regional organised programmes reduced socioeconomic inequalities. Data of 10,927 women aged 50 to 70 years old were collected from the Swiss Health Interview Survey, a nationally representative cross-sectional survey repeated 5 times (1992-2012). Socioeconomic characteristics were assessed using education, income, employment status, and occupational class. Adjusted prevalence ratios of up-to-date mammography screening were estimated with Poisson regressions and weighted for sampling strategy and non-participation bias. In the absence of organised screening programmes (1992-1997), prevalence of mammography screening increased by 23% and was associated with tertiary education and working part time. During the period of progressive introduction of regionally organised programmes (2002-2012), prevalence of mammography screening increased by 19% every 5 years and was associated with exposure to regional programmes and with independent/artisan occupations. Tertiary education and working part time were no longer associated. Exposure to organised programmes did not modify socioeconomic inequalities except for employment status: not employed women benefitted more from organised programmes compared to women working full time. In conclusion, socioeconomic inequalities in mammography screening decreased over time but organised programmes did not greatly modify them, except women not employed whose prevalence passed employed women.
    Tags: *Socioeconomic Factors, Adult, Aged, Breast Neoplasms/*diagnosis, Breast screening, Early Detection of Cancer/*statistics & numerical data, Employment, Female, Health Surveys, Humans, Mammography screening programmes, Mammography/*statistics & numerical data, Middle Aged, Occupations, Opportunistic screening, Organised screening, Prevalence, Socioeconomic inequalities, Switzerland.
  • Muller, M., Jurgens, J., Redaelli, M., Klingberg, K., Hautz, W. E., and Stock, S. “Impact Of The Communication And Patient Hand-Off Tool Sbar On Patient Safety: A Systematic Review”. Bmj Open 8, no. 8: e022202. doi:10.1136/bmjopen-2018-022202.
    Abstract: OBJECTIVES: Communication breakdown is one of the main causes of adverse events in clinical routine, particularly in handover situations. The communication tool SBAR (situation, background, assessment and recommendation) was developed to increase handover quality and is widely assumed to increase patient safety. The objective of this review is to summarise the impact of the implementation of SBAR on patient safety. DESIGN: A systematic review of articles published on SBAR was performed in PUBMED, EMBASE, CINAHL, Cochrane Library and PsycINFO in January 2017. All original research articles on SBAR fulfilling the following eligibility criteria were included: (1) SBAR was implemented into clinical routine, (2) the investigation of SBAR was the primary objective and (3) at least one patient outcome was reported. SETTING: A wide range of settings within primary and secondary care and nursing homes. PARTICIPANTS: A variety of heath professionals including nurses and physicians. PRIMARY AND SECONDARY OUTCOME MEASURES: Aspects of patient safety (patient outcomes) defined as the occurrence or incidence of adverse events. RESULTS: Eight studies with a before-after design and three controlled clinical trials performed in different clinical settings met the inclusion criteria. The objectives of the studies were to improve team communication, patient hand-offs and communication in telephone calls from nurses to physicians. The studies were heterogeneous with regard to study characteristics, especially patient outcomes. In total, 26 different patient outcomes were measured, of which eight were reported to be significantly improved. Eleven were described as improved but no further statistical tests were reported, and six outcomes did not change significantly. Only one study reported a descriptive reduction in patient outcomes. CONCLUSIONS: This review found moderate evidence for improved patient safety through SBAR implementation, especially when used to structure communication over the phone. However, there is a lack of high-quality research on this widely used communication tool. TRIAL REGISTRATION: none.
    Tags: *Communication, *Patient Handoff, *Patient Safety, adverse event, educational consultations and congress invitations from Mundipharma Basel., hand-off situation, Humans, interprofessional communication, Medical Errors/prevention & control, patient safety, Sbar.
  • du Fay de Lavallaz, J., Badertscher, P., Nestelberger, T., Flores, D., Miro, O., Salgado, E., Geigy, N., et al. “Circadian, Weekly, Seasonal, And Temperature-Dependent Patterns Of Syncope Aetiology In Patients At Increased Risk Of Cardiac Syncope”. Europace 21, no. 3: 511-521. doi:10.1093/europace/euy186.
    Abstract: AIMS: It is unknown whether cardiac syncope, and possibly also other syncope aetiologies exhibit circadian, weekly, seasonal, and temperature-dependent patterns. METHODS AND RESULTS: We prospectively recorded the exact time, date, and outside temperature of syncope of patients >40 years old presenting with syncope to the emergency department in a diagnostic multicentre study. Two independent cardiologists/emergency physicians adjudicated the final diagnosis based on all information becoming available during clinical work-up including 1-year follow-up. Among 1230 patients, the adjudicated aetiology was cardiac in 14.6%, reflex in 39.2%, orthostatic in 25.7%, other non-cardiac in 9.7%, and unknown in 10.8% of patients. All syncope aetiologies occurred much more frequently during the day when compared with the night (P < 0.01). While reflex and orthostatic syncope showed a broad peak of prevalence with 80.9% of these events occurring between 4 am and 4 pm, cardiac syncope showed a narrow peak of prevalence with 70.1% of all events occurring between 8 am and 2 pm. A weekly pattern was present for most syncope aetiologies, with events occurring mainly from Monday to Friday (P < 0.01). Reflex syncope displayed a seasonal rhythm and was more common in winter (P < 0.01), while cardiac syncope stayed constant over the year. Syncope occurred most often when the outside temperature was coldest. Overall the patterns observed for cardiac syncope were similar to the patterns observed for its differential diagnosis. CONCLUSION: Syncope aetiologies in patients >40 years old display circadian, weekly, seasonal, and temperature-dependent patterns. Unfortunately, these patterns do not allow to reliably differentiate cardiac syncope from other aetiologies.
    Tags: *Circadian Rhythm, *Seasons, *Temperature, Adult, Aged, Aged, 80 and over, Australia/epidemiology, Cardiac syncope, Circadian pattern, Diagnosis, Europe/epidemiology, Female, Humans, Male, Middle Aged, New Zealand/epidemiology, Prevalence, Prospective Studies, Risk Factors, Seasonal, Syncope/diagnosis/*epidemiology/physiopathology, Temperature, Time Factors, United States/epidemiology, Weekly.
  • Muller, M., Schefold, J. C., Leichtle, A. B., Srivastava, D., Lindner, G., Exadaktylos, A. K., and Pfortmueller, C. A. “Qsofa Score Not Predictive Of In-Hospital Mortality In Emergency Patients With Decompensated Liver Cirrhosis”. Med Klin Intensivmed Notfmed 114, no. 8: 724-732. doi:10.1007/s00063-018-0477-z.
    Abstract: BACKGROUND: Quick sequential organ failure assessement (qSOFA) has been validated for patients with presumed sepsis and the general emergency department (ED) population. However, it has not been validated in specific subgroups of ED patients with a high mortality. We aimed to investigate the prognostic performance of qSOFA with respect to in-hospital mortality, intensive care unit (ICU) admission, and length of hospitalisation in patients with decompensated liver cirrhosis. Furthermore, we compared qSOFA to systemic inflammatory response syndrome (SIRS), model of end stage liver disease score (MELD), and Child-Pugh criteria and evaluated whether addition of sodium (Na(+)) levels to qSOFA increases its prognostic performance. METHODS: This observational study included patients admitted with the diagnosis of decompensated liver cirrhosis. All patients with a complete set of vital parameters were included in this study. RESULTS: A total of 186 patients were included. A positive qSOFA score was not associated with in-hospital mortality, ICU admission, or length of hospitalisation (all p > 0.15). MELD scores reliably predicted need for ICU admission and in-hospital mortality (both p < 0.01), but not the length of hospitalisation. qSOFA-Na+ only moderately increased the diagnostic performance of qSOFA with regard to need for ICU admission (AUC(ICU)[qSOFA] = 0.504 vs. AUC(ICU)[qSOFA-Na+] = 0.609, p = 0.03), but not for in-hospital mortality (AUC(death)[qSOFA] = 0.513 vs. AUC(death)[qSOFA-Na+] = 0.592, p = 0.054). CONCLUSION: qSOFA does not predict in-hospital mortality, ICU admission or length of hospitalisation in patients with decompensated liver cirrhosis. Extension of qSOFA with a disease-specific component, the qSOFA-Na+, moderately increased the diagnostic ability of qSOFA.
    Tags: *Hospital Mortality, *Liver Cirrhosis/mortality, *Organ Dysfunction Scores, *Sepsis, Critical illness, Electrolyte disorder, Emergency admissions, Humans, Mortality prediction, Prognosis, QSOFA extended, Retrospective Studies, Sodium, Systemic Inflammatory Response Syndrome.
  • Schneid Schuh, D., Guessous, I., Gaspoz, J. M., Theler, J. M., and Marques-Vidal, P. “Twenty-Four-Year Trends And Determinants Of Change In Compliance With Swiss Dietary Guidelines”. Eur J Clin Nutr 73, no. 6: 859-868. doi:10.1038/s41430-018-0273-0.
    Abstract: BACKGROUND AND AIMS: A healthy diet is the cornerstone of disease prevention, and dietary guidelines have been issued in most countries. We aimed to assess trends in compliance with dietary guidelines in the population of Geneva, Switzerland. METHODS: Multiple cross-sectional, population-based surveys conducted between 1993 and 2016 in the canton of Geneva, Switzerland [20,310 participants (52.3% women, mean age 51.9 +/- 10.7 years)]. Trends in compliance with the Swiss dietary guidelines regarding food intake were assessed using logistic regression (a) for each guideline and (b) for at least three guidelines. Compliance before and after the first and second issuing of the guidelines was assessed. RESULTS: After multivariable adjustment, compliance with fruits increased overall [odds ratio and (95% confidence interval) for 1-year increase: 1.007 (1.003-1.012), p < 0.001], in men, participants aged over 45 and with low educational level. Compliance with vegetables increased overall [1.015 (1.008-1.022), p < 0.001], in both genders, age groups [45-54 and 55-64] and participants with low educational level. Compliance with meat increased in women [1.007 (1.001-1.013), p = 0.021] and participants with a university degree. Compliance with fresh fish increased in age group [55-64] [1.009 (1.000-1.018), p = 0.041]. Compliance with dairy products decreased overall [0.979 (0.972-0.986), p < 0.001] and in all groups studied, except for age group [65-74]. Compliance with at least three guidelines increased in age group [55-64] only [1.013 (1.002-1.024), p = 0.019]. No effect of the issuing of the guidelines was found. CONCLUSION: In the Geneva adult population, compliance with the Swiss dietary guidelines improved little. Issuing of dietary guidelines did not impact trends.
    Tags: *Guideline Adherence, Cross-Sectional Studies, Diet Surveys, Humans, Nutrition Policy/*trends, Switzerland.
  • Ahmad, S. J. S., Ahmed, A. R., Exadaktylos, A. K., McWhinnie, D., Nickel, F., Hakky, S. M., Ramdin, A., and Muller, P. C. “Systematic Review On Citation Classics In Minimally Invasive Gastrointestinal Surgery”. J Minim Access Surg 14, no. 4: 265-272. doi:10.4103/jmas.JMAS_149_18.
    Abstract: BACKGROUND: The impact an article has on a specific field is manifested by its number of citations. The aim of this systematic review was to perform a citation analysis and identify the 100 most-cited articles in the field of minimally invasive (MI) gastrointestinal (GI) surgery. METHODS: The Institute for Scientific Information Web of Knowledge (1945-2017) was utilised to identify the top 100 most-cited articles in the field of MI GI surgery, using 19 distinct keywords. The data extracted were number of citations, time of publication, research topic, level of evidence, authorship and country of origin. RESULTS: Of the 100 most-cited articles, the number of citations ranged from 3331 to 317 citations. Most publications reported on bariatric surgery (n = 36), followed by oncology (n = 26) and hepatobiliary surgery (n = 15). The studies were published in 26 different journals with the top three journals being Annals of Surgery (n = 30), New England Journal of Medicine (n = 10) and Obesity Surgery (n = 9). The studies were conducted in 17 different countries led by the USA (n = 51), the UK (n = 9) and France (n = 6). Articles were published on all levels of evidence: level I (n = 20), Level II (n = 29), Level III (n = 8), Level IV (n = 29) and Level V (n = 14). CONCLUSION: The study revealed citation classics in the field of MI surgery. Interestingly, a high level of evidence was not significantly associated with an increased citation number.
    Tags: Bibliometric analysis, citation classics, laparoscopic surgery, minimally invasive surgery, most-cited articles.
  • Chargui, M., Dhouib, A., Esposito, F., Spyropoulou, V., Steiger, C., Dayer, R., and Ceroni, D. “Osteonecrosis After Contralateral In Situ Prophylactic Pinning For A Slipped Capital Femoral Epiphysis: A Case Report”. Jbjs Case Connect 8, no. 3: e60. doi:10.2106/JBJS.CC.17.00200.
    Abstract: CASE: We report the case of an 11-year-old girl who developed osteonecrosis of the femoral head in the radiographically normal, asymptomatic left hip that had been fixed prophylactically in the context of a slipped capital femoral epiphysis (SCFE) that had been detected on the contralateral hip. The etiology of the osteonecrosis remains unknown. CONCLUSION: This case report demonstrates that prophylactic fixation of a radiographically normal, asymptomatic hip in the context of an SCFE on the contralateral side has the potential for substantial complications. Therefore, the risk of osteonecrosis in the prophylactically pinned hip should be carefully considered because this complication may have devastating functional consequences.
    Tags: Child, Female, Femur Head Necrosis/diagnostic imaging/*etiology, Humans, Iatrogenic Disease, Orthopedic Procedures/*adverse effects, Slipped Capital Femoral Epiphyses/diagnostic imaging/*prevention & control.
  • Muller, M., Nett, P. C., Borbely, Y. M., Buri, C., Stirnimann, G., Laederach, K., and Kroll, D. “Mental Illness Has A Negative Impact On Weight Loss In Bariatric Patients: A 4-Year Follow-Up”. J Gastrointest Surg 23, no. 2: 232-238. doi:10.1007/s11605-018-3903-x.
    Abstract: BACKGROUND: Mental health disorders are highly prevalent among bariatric surgery patients. Bariatric surgery induces weight loss with continuous health improvements. However, long-term follow-up data on weight loss and quality of life data of patients who have a mental illness after bariatric surgery are scarce, and it is not clear whether mental illness is associated with more pronounced weight regain. The aim was to investigate the impact of preoperative mental illness on the course of long-term weight changes after bariatric surgery. METHODS: Patients with sleeve gastrectomy (SG) or Roux-en-Y gastric bypass surgery (RYGB) between 2005 and 2013 with a follow-up of at least 3 years were included. The study population was divided into two groups: patients with mental illness (MI) and patients without (No-MI). Weight loss outcomes over time were compared using mixed models up to 4 years after surgery. RESULTS: In total, 254 patients (RYGB 61.0%, SG 39%) were included. The distribution of baseline characteristics was similar between the MI (n = 108) and No-MI groups (n = 146). The most prevalent mental illness was depressive disorder (63.9%). In the MI group, the percent of total weight loss (%TWL) was significantly smaller over the study period. After 36 months, the predicted mean group-difference of %TWL was 4.6% (95% CI 1.9, 7.2; p = 0.001), and the predicted odds ratio for weight regain was 4.9 (95% CI 1.6, 15.1) for patients in the MI group. CONCLUSION: Preoperative mental illness leads to lower long-term weight loss and an increased risk of weight regain after bariatric surgery.
    Tags: *Bariatric Surgery, *Quality of Life, *Weight Loss, Adult, Bariatric surgery, Comorbidity, Depression, Female, Follow-Up Studies, Humans, Long-term, Male, Mental Disorders/*epidemiology, Mental illness, Obesity, Morbid/epidemiology/physiopathology/*surgery, Retrospective Studies, Switzerland/epidemiology, Time Factors, Weight change, Weight loss outcomes.
  • Cullati, S., Hudelson, P., Ricou, B., Nendaz, M., Perneger, T. V., and Escher, M. “Internists' And Intensivists' Roles In Intensive Care Admission Decisions: A Qualitative Study”. Bmc Health Serv Res 18, no. 1: 620. doi:10.1186/s12913-018-3438-6.
    Abstract: BACKGROUND: Intensive care Unit (ICU) admission decisions involve collaboration between internists and intensivists. Clear perception of each other's roles is a prerequisite for good collaboration. The objective was to explore how internists and intensivists perceive their roles during admission decisions. METHODS: Individual in-depth interviews with 12 intensivists and 12 internists working at a Swiss teaching hospital. Interviews were analyzed using a thematic approach. RESULTS: Roles could be divided into practical roles and identity roles. Internist and intensivists had the same perception of each other's practical roles. Internists' practical roles were: recognizing signs of severity when the patient becomes acutely ill, calling the intensivist at the right moment, having the relevant information about the patient and having determined the goals of care. Intensivists' practical roles were: assessing the patient on the ward, giving expert advice, making quick decisions, managing access to the ICU, having the final decision power and, sometimes, deciding whether or not to limit treatment. In complex situations, perceived flaws in performing practical roles could create tensions between the doctors. Intensivists' identity roles included those of leader, gatekeeper, life-death decision maker, and supporting colleague doctors (consultant, senior and helper). These roles could be perceived as emotionally burdensome. Internists' identity roles were those of leader and partner. CONCLUSIONS: Despite a common perception of each other's practical roles, tensions can arise between internists and intensivists in complex situations of ICU admission decisions. Training in communication skills and interprofessional education interventions aimed at a better understanding of each other roles would improve collaboration.
    Tags: *Clinical Decision-Making, *Professional Role, Academic Medical Centers/statistics & numerical data, applicable. The authors declare that they have no competing interests. Springer, Collaboration, Critical Care/*statistics & numerical data, Female, Humans, institutional affiliations., Intensive care, Intensive Care Units/statistics & numerical data, Internal medicine, Internship and Residency/statistics & numerical data, Interprofessional Relations, Leadership, Male, Medical decision making, Middle Aged, Nature remains neutral with regard to jurisdictional claims in published maps and, Participants of this study gave their written consent to participate. Not, Patient Admission/*statistics & numerical data, Physicians/*standards, Practice Patterns, Physicians'/standards, Qualitative Research, Roles.
  • Semik-Gurgul, E., Zabek, T., Fornal, A., Wnuk, M., Pawlina-Tyszko, K., Gurgul, A., Klukowska-Rotzler, J., Koch, C., Mahlmann, K., and Bugno-Poniewierska, M. “Dna Methylation Patterns Of The S100A14, Pou2F3 And Sfn Genes In Equine Sarcoid Tissues”. Res Vet Sci 119: 302-307. doi:10.1016/j.rvsc.2018.07.006.
    Abstract: Genetic and epigenetic alterations in the equine sarcoid, a locally invasive skin tumour of equids, are still poorly characterized. Numerous studies have provided reliable evidence for the relationship between the development of cancer and the loss of function of a number of tumour suppressor genes. In the present study, we assessed methylation levels in the promoter region of SFN, S100A14 and POU2F3 genes in sarcoid samples to clarify whether DNA methylation may be associated with previously identified changes in the expression level of these genes during the course of tumour progression. Using bisulfite sequencing and clone sequencing, we detected that lesional samples had a significantly higher rate of DNA methylation in the analyzed S100A14A region than the corresponding normal skin tissue. A frequent methylation of the SFN and POU2F3 promoter sequences were observed in both the tumour samples and the control skin tissues. Further studies are needed to evaluate the role of aberrant methylation in sarcoid progression and to understand the mechanisms involved in reduced expression of SFN, S100A14 and POU2F3 genes in the lesional tissues.
    Tags: *DNA Methylation, Animals, DNA methylation, Epigenomics, Equine sarcoids, Gene Expression Regulation, Neoplastic/*physiology, Horse Diseases/*metabolism, Horses, Pou2f3, Promoter Regions, Genetic, S100a14, Sfn, Skin, Skin Neoplasms, Tumorigenesis.
  • Guessous, I., and Ponte, B. “In Reply-Caffeine Effects On Arterial Stiffness: To Drink Or Not To Drink”. Mayo Clin Proc 93, no. 8: 1150-1151. doi:10.1016/j.mayocp.2018.06.007.
    Tags: *Caffeine, *Vascular Stiffness, Blood Pressure, Heart Rate.
  • Hua, X., Shen, M., Reddy, U. M., Buck Louis, G., Souza, J. P., Gulmezoglu, A. M., and Zhang, J. “Comparison Of The Intergrowth-21St, National Institute Of Child Health And Human Development, And Who Fetal Growth Standards”. Int J Gynaecol Obstet 143, no. 2: 156-163. doi:10.1002/ijgo.12637.
    Abstract: OBJECTIVE: To compare the ability of the INTERGROWTH-21st, National Institute of Child Health and Human Development, and WHO fetal growth standards to identify fetuses at risk of adverse perinatal outcomes. METHODS: A retrospective analysis was performed among women enrolled in a multicenter randomized controlled trial (Routine Antenatal Diagnostic Imaging with Ultrasound) that was conducted in six states in the USA between November 1987 and May 1991. The predictive capability of various biometric indicators (biparietal diameter, femur length, abdominal circumference, head circumference, estimated fetal weight, and birthweight) was evaluated. Adverse outcomes included severe morbidity and perinatal death. RESULTS: There were 9409 women included. Biometric indicators measured at a gestational age of 18-24 weeks had insufficient predictive sensitivity (range, 4%-47%). By contrast, measurements taken at 28-34 weeks predicted statistically significant relative risk (range 1.5-10.2; P<0.05 for 27/30 relative risk values) and area under the receiver operating characteristic curve (range, 0.50-0.59; P<0.05 for 8/15 curves). Nonetheless, differences in accuracy between standards for predicting adverse perinatal outcomes were subtle (P>0.05 for differences in area under the curve values). CONCLUSION: Although useful to monitor fetal growth trajectory and the level of risk, all three fetal growth standards provided limited accuracy for identifying fetuses at risk of adverse perinatal outcomes.
    Tags: Adult, Biometry, Birth Weight/*physiology, Female, Fetal Development/*physiology, Fetal growth standard, Fetal Weight/*physiology, Gestational Age, Humans, Infant, Newborn, INTERGROWTH 21st, National Institute of Child Health and Human Development, National Institute of Child Health and Human Development (U.S.), Predictive Value of Tests, Pregnancy, Pregnancy Trimester, Second/physiology, Pregnancy Trimester, Third/physiology, Reference Standards, Retrospective Studies, Ultrasonography, Prenatal/standards, United States, Who, World Health Organization.
  • Strohle, M., Rauch, S., Lastei, P., Brodmann Maeder, M., Brugger, H., and Paal, P. “Frostbite Injuries In The Austrian Alps: A Retrospective 11-Year National Registry Study”. High Alt Med Biol 19, no. 4: 316-320. doi:10.1089/ham.2018.0060.
    Abstract: OBJECTIVES: Frostbite is a cold injury mostly affecting the extremities. The objective of this study was to reveal the incidence of frostbite injuries in the Austrian Alps, to search for frostbite risk factors, and thereby optimize prevention and treatment. METHODS: Out-of-hospital data in the National Registry of Alpine Accidents from January 1, 2005, to December 31, 2015, were screened for frostbite injuries. Cases in the registry were merged with clinical data from the major trauma center in western Austria, Innsbruck Medical University Hospital, and statistically analyzed. RESULTS: Documented in the National Registry are 114,595 injured persons in the 11-year study period. Thirty-one frostbite cases were documented nationwide, 18 (58%) of which occurred in the western states of Austria and were therefore potentially referred to the Innsbruck Medical University Hospital. Six (19.6%) patients were female. Frostbite was almost exclusively related to fingers and toes (90% of cases). CONCLUSIONS: Frostbite injuries in the Austrian Alps are rare. With an incidence of 0.07/100,000, three to four clinically relevant frostbite injuries occur annually. Men are at greater risk for frostbite injuries than women. Fingers and toes are at greatest risk. Proper preparation of outdoor activities and cold-protective gear can help prevent frostbite injuries.
    Tags: Adult, Altitude, Austria/epidemiology, cold injury, emergency treatment, Female, Finger Injuries/*epidemiology/etiology, frostbite, Frostbite/*epidemiology/etiology, Humans, Incidence, Male, Middle Aged, Mountaineering/*injuries, Registries, Retrospective Studies, Risk Factors, Toes/*injuries.
  • Lazarevic, V., Gaia, N., Girard, M., Leo, S., Cherkaoui, A., Renzi, G., Emonet, S., et al. “When Bacterial Culture Fails, Metagenomics Can Help: A Case Of Chronic Hepatic Brucelloma Assessed By Next-Generation Sequencing”. Front Microbiol 9, no. JUL: 1566. doi:10.3389/fmicb.2018.01566.
    Abstract: Here, we sequenced DNA extracted from a necrotic hepatic lesion from a patient with suspected chronic hepatic brucelloma but negative culture results. Although most of the taxonomically classified sequencing reads corresponded to human genome sequences, our data suggest that whole-metagenome shotgun sequencing may be used together with other tests to strengthen the diagnosis of hepatic brucelloma.
    Tags: Brucella, clinical metagenomics, liver abscess, molecular diagnosis of infectious diseases, next-generation sequencing.
  • Peyrony, O., Legay, L., Morra, I., Verrat, A., Milacic, H., Franchitti, J., Amami, J., et al. “Monitoring Personalized Learning Curves For Emergency Ultrasound With Risk-Adjusted Learning-Curve Cumulative Summation Method”. Aem Educ Train 2, no. 1: 10-14. doi:10.1002/aet2.10073.
    Abstract: BACKGROUND: Ultrasound (US) has been a regular practice in emergency departments for several decades. Thus, train our students to US is of prime interest. Because US image acquisition ability can be very different from a patient to another (depending on image quality), it seems relevant to adapt US learning curves (LCs) to patient image quality using tools based on cumulative summation (CUSUM) as the risk-adjusted LC CUSUM (RLC). OBJECTIVES: The aim of this study was to monitor LC of medical students for the acquisition of abdominal emergency US views and to adapt these curves to patient image quality using RLC. METHODS: We asked medical students to perform abdominal US examinations with the acquisition of 11 views of interest on emergency patients after a learning session. Emergency physicians reviewed the student examinations for validation. LCs were plotted and the student was said proficient for a specific view if his LC reached a predetermined limit fixed by simulation. RESULTS: Seven students with no previous experience in US were enrolled. They performed 19 to 50 examinations of 11 views each. They achieve proficiency for a median of 9 (6-10) views. Aorta and right pleura views were validated by seven students; inferior vena cava, right kidney, and bladder by six; gallbladder and left kidney by five; portal veins and portal hilum by four; and subxyphoid and left pleura by three. The number of US examinations required to reach proficiency ranged from five to 41 depending on the student and on the type of view. LC showed that students reached proficiency with different learning speeds. CONCLUSIONS: This study suggests that, when monitoring LCs for abdominal emergency US, there is some heterogeneity in the learning process depending on the student skills and the type of view. Therefore, rules based on a predetermined number of examinations to reach proficiency are not satisfactory.
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