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Swiss Emergency Research collection

2018

  • Walder, A., Muller, M., Dahdal, S., Sidler, D., Devetzis, V., Leichtle, A. B., Fiedler, M. G., et al. “The Effect Of A Previous Created Distal Arteriovenous-Fistula On Radial Bone Dxa Measurements In Prevalent Renal Transplant Recipients”. Plos One 13, no. 7: e0200708. doi:10.1371/journal.pone.0200708.
    Abstract: BACKGROUND: Accelerated bone loss occurs rapidly following renal transplantation due to intensive immunosuppression and persistent hyperparathyroidism. In renal transplant recipients (RTRs) due to the hyperparathyroidism the non-dominant forearm is often utilized as a peripheral measurement site for dual-energy x-ray absorptiometry (DXA) measurements. The forearm is also the site of previous created distal arteriovenous fistulas (AVF). Although AVF remain patent long after successful transplantation, there are no data available concerning their impact on radial bone DXA measurements. METHODS: In this cross-sectional study we performed DXA in 40 RTRs with preexisting distal AVF (RTRs-AVF) to assess areal bone mineral density (aBMD) differences between both forearms (three areas) and compared our findings to patients with chronic kidney disease (CKD, n = 40), pre-emptive RTRs (RTRs-pre, n = 15) and healthy volunteers (n = 20). In addition, we assessed relevant demographic, biochemical and clinical aspects. RESULTS: We found a marked radial asymmetry between the forearms in RTRs with preexisting AVF. The radial aBMD at the distal AVF forearm was lower compared to the contralateral forearm, resulting in significant differences for all three areas analyzed: the Rad-1/3: median (interquartile range) in g/cm2, Rad-1/3: 0.760 (0.641-0.804) vs. 0.742 (0.642, 0.794), p = 0.016; ultradistal radius, Rad-UD: 0.433 (0.392-0.507) vs. 0.420 (0.356, 0.475), p = 0.004; and total radius, Rad-total: 0.603 (0.518, 0.655) vs. 0.599 (0.504, 0.642), p = 0.001). No such asymmetries were observed in any other groups. Lower aBMD in AVF forearm subregions resulted in misclassification of osteoporosis. CONCLUSIONS: In renal transplant recipients, a previously created distal fistula may exert a negative impact on the radial bone leading to significant site-to-site aBMD differences, which can result in diagnostic misclassifications.
    Tags: *Bone Density, Absorptiometry, Photon, Aged, Arteriovenous Shunt, Surgical/*adverse effects, Cross-Sectional Studies, Diagnostic Errors, Female, Forearm, Humans, Hyperparathyroidism/etiology, Kidney Transplantation/*adverse effects, Male, Middle Aged, Osteoporosis/*diagnostic imaging/etiology, Radius/*diagnostic imaging/physiology.
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  • Isenschmid, C., Kalt, J., Gamp, M., Tondorf, T., Becker, C., Tisljar, K., Locher, S., Schuetz, P., Marsch, S., and Hunziker, S. “Routine Blood Markers From Different Biological Pathways Improve Early Risk Stratification In Cardiac Arrest Patients: Results From The Prospective, Observational Communicate Study”. Resuscitation 130: 138-145. doi:10.1016/j.resuscitation.2018.07.021.
    Abstract: INTRODUCTION: Prognostication of cardiac arrest patients admitted to the intensive care unit (ICU) may influence treatment decision, but remains challenging. We evaluated the incremental usefulness of routine blood markers from different biological pathways for predicting fatal outcome and neurological deficits in cardiac arrest patients. METHODS: We prospectively included consecutive, adult cardiac arrest patients upon ICU admission. We recorded initial clinical parameters and measured blood markers of cardiac injury/stress (troponin, BNP, CK), inflammation/infection (WBC, CRP, procalcitonin) and shock (lactate, creatinine, urea). The primary and secondary endpoints were all-cause in-hospital mortality and bad neurological outcome defined by the Cerebral Performance Category (CPC) score. RESULTS: Mortality in the 321 included patients was 49% (n = 156). Procalcitonin (adjusted odds ratio 1.84, 95%CI 1.34 to 2.53, p < 0.001; AUC 0.73) and lactate (adjusted odds ratio 7.29, 95%CI 3.05 to 17.42, p < 0.001; AUC 0.70) were identified as independent prognostic factors for mortality and significantly improved discrimination of a parsimonious clinical model including resuscitation measures (no-flow time, shockable rhythm) and initial vital signs (Glasgow coma scale, respiratory rate) from an AUC of 0.79 to 0.84 (p < 0.001). Cardiac markers did not further improve the model. Results for neurological outcome were similar with model improvements by procalcitonin and lactate from AUC 0.83 to 0.87 (p = 0.004). CONCLUSION: Assessment of routine markers of inflammation/infection and shock provide significant improvements for prognostication of cardiac arrest patients, while cardiac markers did not further improve statistical models. Combination of blood markers and clinical parameters may help to improve initial management decisions in this vulnerable patient population.
    Tags: *Out-of-Hospital Cardiac Arrest/blood/diagnosis/mortality/therapy, Aged, Biomarker, Biomarkers/*blood, Cardiac arrest, Cardiopulmonary resuscitation, Cardiopulmonary Resuscitation/adverse effects/methods, Early Diagnosis, Female, Hospital Mortality, Humans, Inflammation/*blood, Intensive Care Units/statistics & numerical data, Male, Middle Aged, Nervous System Diseases/diagnosis/etiology, Neurological outcome, Predictive value, Predictive Value of Tests, Prognosis, Risk Assessment/methods, Risk stratification, Shock/*blood, Switzerland/epidemiology.
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  • Pasquier, M., Hugli, O., and Rousson, V. “Reply To: Combining Individual Patient Data From Multiple Trials Require Specific Modelling Techniques In Order To Provide Accurate Predictions”. Resuscitation 129: e2. doi:10.1016/j.resuscitation.2018.06.011.
    Tags: *Models, Statistical, Humans, Statistics as Topic.
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  • Schoretsanitis, G., Bhugra, D., Eisenhardt, S., Ricklin, M. E., Srivastava, D. S., Exadaktylos, A., and Walther, S. “Upon Rejection: Psychiatric Emergencies Of Failed Asylum Seekers”. Int J Environ Res Public Health 15, no. 7. doi:10.3390/ijerph15071498.
    Abstract: Background: The status of a refugee or asylum seeker is only recognised after legal processes. The uncertainty of these procedures or the rejection itself may severely impact mental well-being. Methods: We surveyed the patterns of psychiatric services used by patients whose applications for asylum had been rejected. In a retrospective investigation of admissions to the University Emergency Department in Bern, Switzerland between 1 March 2012 and 28 February 2017, we studied patients receiving a psychiatric consultation after their applications had been rejected. The primary endpoint was based on the comparison of these individuals with controls who were asylum seekers with pending asylum applications using the Mann-Whitney U test and the chi-square test (chi(2)) with a significance level of 0.05. Results: Thirty-eight cases were identified. There were more men than women and the mean age was 30.08 +/- 9.62 years. Patients predominantly presented as walk-in patients (n = 16, 42.1%), most frequently due to suicidal ideation (n = 16, 42.1%). Stress-related disorders were the most common diagnosis (n = 29, 76.3%) and patients were mainly referred to inpatient treatment (n = 28, 73.7%). Patients with rejected applications were less likely to be living in reception centres than patients with a pending application (chi(2) = 17.98, p < 0.001). Conclusion: The profile of asylum seekers whose applications had been rejected reflects individuals with high-stress levels, potentially aggravated by the negative asylum decision.
    Tags: acute stress, Adult, Age Factors, Emergency Service, Hospital/*statistics & numerical data, failed asylum seekers, Female, Humans, Male, Mental Health Services/*statistics & numerical data, Middle Aged, psychiatric emergency services, psychiatric hospitalisation, Refugees/*psychology, Retrospective Studies, Sex Factors, Stress, Psychological/epidemiology, Suicidal Ideation, Switzerland, Young Adult.
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  • Sauter, T. C., Capaldo, G., Hoffmann, M., Birrenbach, T., Hautz, S. C., Kammer, J. E., Exadaktylos, A. K., and Hautz, W. E. “Non-Specific Complaints At Emergency Department Presentation Result In Unclear Diagnoses And Lengthened Hospitalization: A Prospective Observational Study”. Scand J Trauma Resusc Emerg Med 26, no. 1: 60. doi:10.1186/s13049-018-0526-x.
    Abstract: BACKGROUND: Up to 20% of patients admitted to an emergency department present with non-specific complaints. Retrospective studies suggest an increased risk of misdiagnosis and hospital admission for these patients, but prospective comparisons of the outcomes of emergency patients with non-specific complaints versus specific complaints are lacking. METHODS: All consecutive patients >/=18 years of age admitted to any internal medicine ward at Bern University Hospital via the emergency department from August 15th 2015 to December 7th 2015 were prospectively included and followed up upon. Patients with non-specific complaints were compared against those with specific complaints regarding the quality of their emergency department diagnosis, length of hospital stay and in-hospital mortality. RESULTS: Seven hundred and-eleven patients, 165 (23.21%) with non-specific complaints and 546 with specific complaints, were included in this study. No differences between patient groups regarding age, gender or initial severity of the medical problem (deducted from triage category and treatment in a resuscitation bay) were found. Patients with non-specific complaints received more unspecific diagnoses (30.3% vs. 23.1%, p = 0.001, OR = 1.82 [95% CI 1.159-2.899]), were hospitalized significantly longer (Median = 6.51 (IQR = 5.85) vs. 5.22 (5.83) days, p = 0.025, d = 0.2) but did not have a higher mortality than patients with specific complaints (7.3% vs. 3.7%, p = 0.087, OR 1.922 [95% CI 0.909-4.065]). CONCLUSIONS: Non-specific complaints in patients admitted to an emergency department result in low-quality diagnoses and lengthened hospitalization, despite the patients being comparable to patients with specific complaints at admission.
    Tags: *Diagnostic Errors, *Diagnostic Self Evaluation, *Guideline Adherence, 197/15) as a quality evaluation study. According to Swiss law, the need to obtain, Aged, applicable COMPETING INTERESTS: TCS received research grants from the, approved by the responsible ethics committee of the Canton Bern, Switzerland (Nr., Bangerter-Rhyner Foundation as well as research grants and lecture fees from, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo and Bistol-Myers Squibb. WEH received, claims in published maps and institutional affiliations., Critical Illness/epidemiology/*therapy, Emergency department, Emergency Service, Hospital/*standards, Female, Foundation Zuerich. GC, MH, TB, SCH, JEK, AKE report no conflict of interest., Hospital Mortality/trends, Humans, Incidence, informed consent was waived by the ethics committee. CONSENT FOR PUBLICATION: Not, Length of stay, Length of Stay/*trends, Male, Middle Aged, Non-specific complaints, Prospective Studies, PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional, Reproducibility of Results, research grants from Mundipharma Basel and paid educational consultancies from AO, Switzerland/epidemiology, Triage/*methods.
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  • Marti-Soler, H., Guessous, I., Gaspoz, J. M., Metcalf, P., Deschamps, V., Castetbon, K., Malyutina, S., et al. “Seasonality Of Nutrient Intake - An Analysis Including Over 44,000 Participants In 4 Countries”. Clin Nutr Espen 21: 66-71. doi:10.1016/j.clnesp.2017.05.003.
    Abstract: BACKGROUND AND AIMS: Dietary intake is believed to follow a seasonal pattern, so adjusting for seasonality in nutritional epidemiology is usually requested. The aim of this study was to assess the seasonality of energy and macronutrients intake (expressed as % of total caloric intake) using a large set of population-based studies. METHODS: Cross-sectional data from 9 population-based studies from 4 countries (3 in the Northern Hemisphere and 1 in Southern Hemisphere), with a total sample size of 44,611 subjects. Data were derived from FFQ or repeated 24 h-recalls. Dietary markers included total energy intake, protein, carbohydrates, fat, alcohol, sugars and fatty acids (saturated, mono and poly-unsaturated). Seasonality was assessed using the cosinor method stratifying on hemisphere and gender. RESULTS: Most nutrients did not show a significant seasonal variation. When individual studies were considered, the number of nutrients showing significant seasonal variations varied from 5 to none in men and from 6 to none in women. Jointly, in the Northern hemisphere, significant seasonal variations were found for sugar intake in both genders and for alcohol consumption in men only; in the Southern Hemisphere, significant seasonal variations were found for fat and monounsaturated fatty acids in women. Analysis of the three consecutive periods of the Bus Sante study in Switzerland showed that the number of significant seasonal variations decreased from 5 in 1993-1999 to 1 in 2006-2012 in men, and from 6 in 1993-1999 to none in 2006-2012 in women. Seasonal variation decreased over time for most nutrients, with the exception of monounsaturated fatty acids in men. CONCLUSIONS: Seasonality of energy and macronutrients intake varies considerably according to study, with no common pattern and small magnitude of variation. Its amplitude appears to be declining over time. Systematic adjustment for season might not be necessary when assessing the effects of total energy and macronutrient intake on disease.
    Tags: *Diet, *Nutrition Assessment, *Seasons, Cosinor regression, Cross-Sectional Studies, Dietary Carbohydrates/administration & dosage, Dietary Fats/administration & dosage, Dietary Proteins/administration & dosage, Fatty Acids, Monounsaturated/administration & dosage, Fatty Acids, Unsaturated/administration & dosage, Female, France, Humans, Male, Mental Recall, Meta-analysis, Middle Aged, New Zealand, Nutrients, Population study, Russia, Sample Size, Seasonal variation, Surveys and Questionnaires, Switzerland.
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  • Kuster, M., Haltmeier, T., Exadaktylos, A., and Schnuriger, B. “Non-Invasive Cardiac Output Monitoring Device "Icon" In Trauma Patients: A Feasibility Study”. Eur J Trauma Emerg Surg 45, no. 6: 1069-1076. doi:10.1007/s00068-018-0984-x.
    Abstract: PURPOSE: Assessment of hemodynamics is crucial for the evaluation of major trauma patients. Cardiac output (CO) monitoring provides additional information and may improve volume resuscitation. The goal of this prospective pilot study was to evaluate the feasibility of a new non-invasive CO monitoring (NICOM) device in the emergency department (ED). METHODS: Single-center prospective observational pilot study including 20 trauma patients admitted to a level 1 trauma center. CO was continuously monitored for 60 min after ED admission using the new NICOM device ICON((R)). This device measures changes of the thoracic bioimpedance to calculate CO. Conventional vital signs were recorded simultaneously. Feasibility, safety, reliability, user-friendliness, and impact of the device on standard ED procedures were assessed. RESULTS: Thirteen (65%) patients were male, median age was 57.5 (IQR 25), and median ISS was 10.5 (IQR 14.8). Median CO over time was 9.8 l/min (IQR 4.6). No adverse effects were recorded. The device proved to be user-friendly with no negative impact on routine ED care. In four patients, detachment of electrodes was observed, and in four patients, the CO recording was temporary discontinued. Short-term changes of the CO were observed 44 times after the placement of electrodes and during patient transfers. CONCLUSIONS: Non-invasive CO monitoring proved to be feasible and safe for the initial hemodynamic evaluation of trauma patients. Problems with the NICOM device were detachment of electrodes and temporary signal loss. Due to the small sample size and relatively low injury burden of the patients included in this study, further prospective investigation is warranted.
    Tags: *Cardiac Output, Cardiac output, Emergency department, Emergency Service, Hospital, Feasibility Studies, Female, Humans, Initial care, Male, Middle Aged, Monitoring, Physiologic/*instrumentation/methods, Non-invasive hemodynamic monitoring, Pilot Projects, Prospective Studies, Reproducibility of Results, Trauma, Vital Signs, Wounds and Injuries/*physiopathology.
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  • Pataky, Z., Guessous, I., Caillon, A., Golay, A., Rohner-Jeanrenaud, F., and Altirriba, J. “Variable Oxytocin Levels In Humans With Different Degrees Of Obesity And Impact Of Gastric Bypass Surgery”. Int J Obes (Lond) 43, no. 5: 1120-1124. doi:10.1038/s41366-018-0150-x.
    Abstract: Exogenous oxytocin administration in obese mice, rats, and monkeys was shown to induce sustained weight loss, mostly due to a decrease in fat mass, accompanied by an improvement of glucose metabolism. A pilot study in obese humans confirmed the weight-reducing effect of oxytocin. Knowledge about circulating oxytocin levels in human obesity might help indicating which obese subjects could potentially benefit from an oxytocin treatment. Conclusive results on this topic are missing. The aim of this study was to measure circulating oxytocin levels in lean (n = 37) and obese (n = 72) individuals across a wide range of body mass index (BMI) values (18.5-60 kg/m(2)) and to determine the impact of pronounced body weight loss following gastric bypass surgery in 12 morbidly obese patients. We observed that oxytocin levels were unchanged in overweight and in class I and II obese subjects and only morbidly obese patients (obesity class III, BMI > 40 kg/m(2)) exhibited significantly higher levels than lean individuals, with no modification 1 year after gastric bypass surgery, despite substantial body weight loss. In conclusion, morbidly obese subjects present elevated oxytocin levels which were unaltered following pronounced weight loss.
    Tags: Adiposity, Female, Gastric Bypass/*statistics & numerical data, Humans, Male, Middle Aged, Obesity, Morbid/*metabolism/physiopathology/surgery, Oxytocin/*metabolism/therapeutic use, Pilot Projects, Treatment Outcome, Weight Loss/*physiology.
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  • Malinovska, A., Nickel, C. H., and Bingisser, R. “Trajectories Of Survival In Patients With Nonspecific Complaints”. Eur J Intern Med 55: e17-e18. doi:10.1016/j.ejim.2018.06.020.
    Tags: *Chronic Disease/mortality/therapy, *Diagnostic Self Evaluation, Acute medicine, Aged, 80 and over, Disease Progression, Emergency medicine, Emergency Service, Hospital/*statistics & numerical data, Female, Geriatric, Humans, Internal medicine, Male, Nonspecific complaints, Outcome, Patient Acuity, Prognosis, Prospective Studies, Survival Analysis, Switzerland/epidemiology.
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  • Maggio, A. B. R., Farpour-Lambert, N. J., Aggoun, Y., Galan, K., Montecucco, F., Mach, F., and Beghetti, M. “Serum Cardiovascular Risk Biomarkers In Pre-Pubertal Obese Children”. Eur J Clin Invest 48, no. 9: e12995. doi:10.1111/eci.12995.
    Abstract: BACKGROUND: Childhood obesity is associated with premature cardiovascular complications. However, little is known about the effect of a family-based behavioural intervention on the relationship between arterial function, blood pressure and biomarkers in pre-pubertal children with obesity. DESIGN: This was a single centre randomized controlled trial (RCT) including 74 children randomized to a 6-month behavioural intervention to treat obesity. In 48 children (13 controls and 35 interventions), we assessed: serum level of cytokine (CCL2), adiponectin, and neutrophil product (MMP-8), as well as carotid intima-media thickness, flow-mediated dilation (FMD), nitroglycerin-mediated dilation; arterial stiffness (incremental elastic modulus, Einc), pulse wave velocity (PWV), resting and 24-hour blood pressure (BP). RESULTS: At baseline, resting systolic BP was positively associated with MMP-8 levels which was significantly higher in children with hypertension (P = 0.033). Biochemical markers were not related to endothelial function at baseline, but they globally increased after 6 months in the intervention group. The significant increase of CCL2 levels in the intervention group was associated with a decrease in diastolic BP. Furthermore, adiponectin change was positively related to a change in FMD and negatively to change in Einc and PWV. CONCLUSIONS: The usefulness of serum biomarkers for the detection of cardiovascular diseases is not well established in children. In our population, MMP-8 concentration was higher in hypertensive children. Furthermore, behavioural interventions resulted in a paradoxical increase in some biomarkers in children, with potentially beneficial effects detected with CCL2 changes. Caution should be taken when using nonspecific serum biomarkers for the clinical monitoring of children with obesity.
    Tags: Adiponectin/*blood, Behavior Therapy, biomarker, Biomarkers/blood, blood pressure, Blood Pressure Monitoring, Ambulatory, Blood Pressure/physiology, Cardiovascular Diseases/*blood/physiopathology, Carotid Intima-Media Thickness, Chemokine CCL2/*blood, Child, children, Elastic Modulus, endothelial function, Endothelium, Vascular/physiopathology, Female, Humans, Hypertension/blood/physiopathology, Male, Matrix Metalloproteinase 8/*blood, Nitroglycerin, obesity, Pediatric Obesity/*blood/therapy, Pulse Wave Analysis, randomized controlled trial, Randomized Controlled Trials as Topic, Risk, Vascular Stiffness/physiology, Vasodilation/physiology, Vasodilator Agents.
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  • Anthimopoulos, M., Christodoulidis, S., Ebner, L., Geiser, T., Christe, A., and Mougiakakou, S. “Semantic Segmentation Of Pathological Lung Tissue With Dilated Fully Convolutional Networks”. Ieee J Biomed Health Inform 23, no. 2: 714-722. doi:10.1109/JBHI.2018.2818620.
    Abstract: Early and accurate diagnosis of interstitial lung diseases (ILDs) is crucial for making treatment decisions, but can be challenging even for experienced radiologists. The diagnostic procedure is based on the detection and recognition of the different ILD pathologies in thoracic CT scans, yet their manifestation often appears similar. In this study, we propose the use of a deep purely convolutional neural network for the semantic segmentation of ILD patterns, as the basic component of a computer aided diagnosis system for ILDs. The proposed CNN, which consists of convolutional layers with dilated filters, takes as input a lung CT image of arbitrary size and outputs the corresponding label map. We trained and tested the network on a data set of 172 sparsely annotated CT scans, within a cross-validation scheme. The training was performed in an end-to-end and semisupervised fashion, utilizing both labeled and nonlabeled image regions. The experimental results show significant performance improvement with respect to the state of the art.
    Tags: *Neural Networks, Computer, Humans, Image Interpretation, Computer-Assisted/*methods, Lung Diseases, Interstitial/*diagnostic imaging, Lung/*diagnostic imaging, Semantics, Supervised Machine Learning, Tomography, X-Ray Computed.
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  • Kaeser, D., Guerra, R., Keidar, O., Lanz, U., Moses, M., Kobel, C., Exadaktylos, A. K., and Ricklin, M. E. “Verbal And Non-Verbal Aggression In A Swiss University Emergency Room: A Descriptive Study”. Int J Environ Res Public Health 15, no. 7. doi:10.3390/ijerph15071423.
    Abstract: Workplace violence (WPV) by patients and visitors is a hazard in many emergency departments (ED), with serious consequences for both staff and patients. Patients with a migratory background seem to be prone to being involved in WPV. We therefore reviewed all reports of ED staff who experienced WPV over a 4-year period (2013(-)2016). We analyzed data on the reasons for the incident, the time of day, the manner of violence, the consequences, and the migratory background of the aggressor. In total, 83 cases of WPV were reported over a four-year period. The average age of the violent person was 33.1 years; in 35 cases (42.0%), aggressors were younger than 30 years old, 53 (63.8%) were male, 49 (59%) were of Swiss nationality, and 35(-)40% had a migratory background. The odds ratio of people originating from a low- to middle-income country versus those originating from a high-income country was 1.8. Furthermore, 45.8% of the patients arrived by ambulance (n = 38) and 19 patients (22.9%) were self-presenting. Most cases (92.8%) involved verbal aggression, but in more than half of the cases, physical assault (56.6%) was also reported. In addition, 43 (51.8%) of the events occurred during the night. Results also showed that 42 (50.6%) of patients who were involved in WPV were under the influence of alcohol and 29 (34.9%) suffered from psychiatric disorders. Security personnel and police were involved in 53 (63.9%) and 47 (56.6%) cases, respectively. Twenty patients (24.1%) were sedated and 16 (19.3%) were restrained. In 18 cases (21.7%), the psychiatrist ordered compulsory hospitalization in a psychiatric institution. Taken together, WPV is a relatively common event in our ED and persons with a migratory background are involved more often relative to their frequency of ED visits.
    Tags: *Aggression, *Emergency Service, Hospital, Adolescent, Adult, aggression, emergency department, Emigrants and Immigrants/psychology, Female, Hospitals, University, Humans, Male, Middle Aged, migrants, Retrospective Studies, Switzerland, Verbal Behavior, workplace violence, Workplace Violence/psychology/*statistics & numerical data, Young Adult.
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  • Kottmann, A., Carron, P. N., Theiler, L., Albrecht, R., Tissi, M., and Pasquier, M. “Identification Of The Technical And Medical Requirements For Hems Avalanche Rescue Missions Through A 15-Year Retrospective Analysis In A Hems In Switzerland: A Necessary Step For Quality Improvement”. Scand J Trauma Resusc Emerg Med 26, no. 1: 54. doi:10.1186/s13049-018-0520-3.
    Abstract: BACKGROUND: Avalanche rescues mostly rely on helicopter emergency medical services (HEMS) and include technical rescue and complex medical situations under difficult conditions. The adequacy of avalanche victim management has been shown to be unexpectedly low, suggesting the need for quality improvement. We analyse the technical rescue and medical competency requirements of HEMS crewmembers for avalanche rescue missions, as well as their clinical exposure. The study aims to identify areas that should be the focus of future quality improvement efforts. METHODS: This 15-year retrospective study of avalanche rescue by the Swiss HEMS Rega includes all missions where at least one patient had been caught by an avalanche, found within 24 h of the alarm being raised, and transported. RESULTS: Our analyses included 422 missions (596 patients). Crews were frequently confronted with technical rescue aspects, including winching (29%) and patient location and extrication (48%), as well as multiple casualty accidents (32%). Forty-seven percent of the patients suffered potential or overt vital threat; 29% were in cardiac arrest. The on-site medical management of the victims required a large array of basic and advanced medical skills. Clinical exposure was low, as 56% of the physicians were involved in only one avalanche rescue mission over the study period. CONCLUSIONS: Our data provide a solid baseline measure and valuable starting point for improving our understanding of the challenges encountered during avalanche rescue missions. We further suggest QI interventions, that might be immediately useful for HEMS operating under similar settings. A coordinated approach using a consensus process to determine quality indicators and a minimal dataset for the specific setting of avalanche rescue would be the logical next step.
    Tags: *Avalanches, *Quality Improvement, Adult, Air Ambulances/*organization & administration, authors declare that they have no competing interests PUBLISHER'S NOTE: Springer, Avalanche, Clinical exposure, data by the medical director of Rega-Swiss Air Ambulance. As only anonymous data, Emergency Medical Services/*organization & administration, Female, Hems, Humans, institutional affiliations., local ethic committee (Human Research Ethics Committee of the Canton of Vaud,, Male, Middle Aged, Mission, Nature remains neutral with regard to jurisdictional claims in published maps and, Quality improvement, Requirements, Rescue, Retrospective Studies, Switzerland, Switzerland). CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The, Technical rescue, were available for this research, we were exempted from a formal agreement by the.
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  • Dell'Era, S., Hugli, O., and Dami, F. “Hospital Disaster Preparedness In Switzerland Over A Decade: A National Survey”. Disaster Med Public Health Prep 13, no. 3: 433-439. doi:10.1017/dmp.2018.59.
    Abstract: OBJECTIVE: The present study aimed to provide a comprehensive assessment of Swiss hospital disaster preparedness in 2016 compared with the 2006 data. METHODS: A questionnaire was addressed in 2016 to all heads responsible for Swiss emergency departments (EDs). RESULTS: Of the 107 hospitals included, 83 (78%) returned the survey. Overall, 76 (92%) hospitals had a plan in case of a mass casualty incident, and 76 (93%) in case of an accident within the hospital itself. There was a lack in preparedness for specific situations: less than a third of hospitals had a specific plan for nuclear/radiological, biological, chemical, and burns (NRBC+B) patients: nuclear/radiological (14; 18%), biological (25; 31%), chemical (27; 34%), and burns (15; 49%), and 48 (61%) of EDs had a decontamination area. Less than a quarter of hospitals had specific plans for the most vulnerable populations during disasters, such as seniors (12; 15%) and children (19; 24%). CONCLUSIONS: The rate of hospitals with a disaster plan has increased since 2006, reaching a level of 92%. The Swiss health care system remains vulnerable to specific threats like NRBC. The lack of national legislation and funds aimed at fostering hospitals' preparedness to disasters may be the root cause to explain the vulnerability of Swiss hospitals regarding disaster medicine. (Disaster Med Public Health Preparedness. 2019;13:433-439).
    Tags: *Time Factors, Chi-Square Distribution, Civil Defense/*standards/statistics & numerical data, decontamination, Hics, hospital disaster plan, hospital preparedness, Hospitals/*standards/statistics & numerical data, Humans, Nrbc, Surveys and Questionnaires, Switzerland.
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  • Ghazali, D. A., Guericolas, M., Thys, F., Sarasin, F., Arcos Gonzalez, P., and Casalino, E. “Climate Change Impacts On Disaster And Emergency Medicine Focusing On Mitigation Disruptive Effects: An International Perspective”. Int J Environ Res Public Health 15, no. 7. doi:10.3390/ijerph15071379.
    Abstract: In recent decades, climate change has been responsible for an increase in the average temperature of the troposphere and of the oceans, with consequences on the frequency and intensity of many extreme weather phenomena. Climate change&rsquo;s effects on natural disasters can be expected to induce a rise in humanitarian crises. In addition, it will surely impact the population&rsquo;s long-term general health, especially among the most fragile. There are foreseeable health risks that both ambulatory care organizations and hospitals will face as global temperatures rise. These risks include the geographic redistribution of infectious (particularly zoonotic) diseases, an increase in cardiac and respiratory illnesses, as well as a host of other health hazards. Some of these risks have been detailed for most developed countries as well as for some developing countries. Using these existing risk assessments as a template, organizational innovations as well as implementation strategies should be proposed to mitigate the disruptive effects of these health risks on emergency departments and by extension, reduce the negative impact of climate change on the populations they serve.
    Tags: *Climate Change, *Disasters, *Emergency Medicine, *Internationality, climate change, disaster preparedness, emergency medicine, European perspective, health, Humans, management.
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  • Surial, B., Atkinson, A., Nuesch, S., Schefold, J. C., and Marschall, J. “Promoting An Action Plan For Devices In The Emergency Department-Does It Impact Catheter Duration?”. Infect Control Hosp Epidemiol 39, no. 8: 1011-1012. doi:10.1017/ice.2018.132.
    Tags: Catheters/*statistics & numerical data, Documentation/methods/*statistics & numerical data, Emergency Service, Hospital, Health Promotion/methods, Hospitals, University, Humans, Physicians, Switzerland, Time Factors.
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  • Poletti, P. A., Botsikas, D., Becker, M., Picarra, M., Rutschmann, O. T., Buchs, N. C., Zaidi, H., and Platon, A. “Suspicion Of Appendicitis In Pregnant Women: Emergency Evaluation By Sonography And Low-Dose Ct With Oral Contrast”. Eur Radiol 29, no. 1: 345-352. doi:10.1007/s00330-018-5573-1.
    Abstract: OBJECTIVES: To evaluate non-intravenously enhanced low-dose computed tomography with oral contrast (LDCT) for the assessment of pregnant women with right lower quadrant pain, when magnetic resonance imaging (MRI) is not immediately available. METHODS: One hundred and thirty-eight consecutive pregnant women with acute abdominal pain were admitted in our emergency centre. Thirty-seven (27%) of them, with clinical suspicion of acute appendicitis, underwent abdominal ultrasonography (US). No further examination was recommended when US was positive for appendicitis, negative with low clinical suspicion or showed an alternative diagnosis which explained the clinical presentation. All other patients underwent LDCT (<2.5 mSv). Standard intravenously enhanced CT or MRI was performed when LDCT was indeterminate. RESULTS: Eight (22%) of 37 US exams were reported normal, 25 (67%) indeterminate, 1 (3%) positive for appendicitis, 3 (8%) positive for an alternative diagnosis. LDCT was obtained in 29 (78%) patients. It was reported positive for appendicitis in 9 (31%), for alternative diagnosis in 2 (7%), normal in 13 (45%) and indeterminate in 5 (17%). Further imaging (standard CT or MRI) showed appendicitis in 2 of these 5 patients, was truly negative in 1, indeterminate in 1 and falsely positive in 1. An appendicitis was confirmed at surgery in 12 (32%) of the 37 patients. The sensitivity and the specificity of the algorithm for appendicitis were 100% (12/12) and 92% (23/25), respectively. CONCLUSIONS: The proposed algorithm is very sensitive and specific for detection of acute appendicitis in pregnant women; it reduces the need of standard CTs when MRI is not available as second-line imaging. KEY POINTS: * In pregnant women, US is limited by an important number of indeterminate results * Low-dose CT can be used after an inconclusive US for the diagnosis of appendicitis in pregnant women * An algorithm integrating US and low-dose CT is highly sensitive and specific for appendicitis in pregnant women.
    Tags: *Algorithms, Acute Disease, Administration, Oral, Adolescent, Adult, Appendicitis, Appendicitis/*diagnosis, Contrast Media/*administration & dosage, Diagnosis, Differential, Emergencies, Female, Humans, Middle Aged, Pregnancy, Pregnancy Complications/*diagnosis, Pregnant women, Radiation dosage, Tomography, X-ray computed, Tomography, X-Ray Computed/*methods, Ultrasonography/*methods, Young Adult.
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  • Boeddinghaus, J., Twerenbold, R., Nestelberger, T., Badertscher, P., Wildi, K., Puelacher, C., du Fay de Lavallaz, J., et al. “Clinical Validation Of A Novel High-Sensitivity Cardiac Troponin I Assay For Early Diagnosis Of Acute Myocardial Infarction”. Clin Chem 64, no. 9: 1347-1360. doi:10.1373/clinchem.2018.286906.
    Abstract: BACKGROUND: Clinical performance of the novel high-sensitivity cardiac troponin I (Siemens-hs-cTnI-Centaur) assay is unknown. We aimed to clinically validate the Siemens-hs-cTnI-Centaur assay and develop 0/1-h and 0/2-h algorithms. METHODS: We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by 2 independent cardiologists including all clinical information twice: first, using serial hs-cTnT (Roche-Elecsys, primary analysis); second, using hs-cTnI (Abbott-Architect, secondary analysis) measurements in addition to the clinically applied (hs)-cTn. Siemens-hs-cTnI-Centaur was measured at presentation, 1 h, and 2 h. The primary objective was a direct comparison of diagnostic accuracy, quantified by the area under the ROC curve (AUC), of Siemens-hs-cTnI-Centaur vs the 2 established hs-cTn assays (Roche-hs-cTnT-Elecsys, Abbott-hs-cTnI-Architect). Secondary objectives included the development of Siemens-hs-cTnI-Centaur-specific 0/1-h and 0/2-h algorithms. RESULTS: AMI was the final diagnosis in 318 of 1755 (18%) patients (using Roche-hs-cTnT-Elecsys for adjudication). The AUC at presentation for Siemens-hs-cTnI-Centaur was 0.94 (95% CI, 0.92-0.96) and comparable with 0.95 (95% CI, 0.93-0.97) for Roche-hs-cTnT-Elecsys and 0.93 (95% CI, 0.90-0.96) for Abbott-hs-cTnI-Architect. Applying the derived Siemens-hs-cTnI-Centaur 0/1-h algorithm to the validation cohort, 46% of patients were ruled out (sensitivity, 99.1%; 95% CI, 95.3-100), and 18% of patients were ruled in (specificity, 94.1%; 95% CI, 91.8-95.9). The Siemens-hs-cTnI-Centaur 0/2-h algorithm ruled out 55% of patients (sensitivity, 100%; 95% CI, 94.1-100), and ruled in 18% of patients (specificity, 96.0%; 95% CI, 93.1-97.9). Findings were confirmed in the secondary analyses using serial measurements of Abbott-hs-cTnI-Architect for adjudication. CONCLUSIONS: Diagnostic accuracy and clinical utility of the novel Siemens-hs-cTnI-Centaur assay are high and comparable with the established hs-cTn assays. ClinicalTrials.gov Identifier: NCT00470587.
    Tags: Algorithms, Chest Pain, Early Diagnosis, Electrocardiography, Female, Humans, Male, Myocardial Infarction/*diagnosis/physiopathology, Reproducibility of Results, Sensitivity and Specificity, Troponin I/*blood.
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  • Schoretsanitis, G., Eisenhardt, S., Ricklin, M. E., Srivastava, D. S., Walther, S., and Exadaktylos, A. “Psychiatric Emergencies Of Asylum Seekers; Descriptive Analysis And Comparison With Immigrants Of Warranted Residence”. Int J Environ Res Public Health 15, no. 7. doi:10.3390/ijerph15071300.
    Abstract: Background: The aim of our study was to assess utilization patterns of psychiatric services by asylum seekers. Methods: We included 119 adults who presented themselves at the University Emergency Department between 1 March 2012 and 1 January 2017 for psychiatric consultation. Descriptive data were compared with a control group of non-Swiss individuals with warranted residence permits using Mann-Whitney-U and chi square (&chi;(2)) tests. Results: Patients were mainly single, male, residing in reception centers, and presented themselves most frequently due to suicidal ideation. Almost 60% of the patients were assigned to inpatient treatments, with 28 involuntary cases. Compared to the control group, asylum seekers were younger and more often men (p < 0.001 for both). Further, they less often had family in Switzerland (&chi;(2) = 9.91, p = 0.007). The proportion of patients coming in as walk-ins was significantly higher in the control group than in asylum seekers (&chi;(2) = 37.0, p < 0.001). Asylum seekers were more frequently referred due to suicidal ideation and aggressive behavior than participants in the control group (&chi;(2) = 80.07, p < 0.001). Diagnoses for asylum seekers infrequently included mood, as they often reported stress-related disorders (&chi;(2) = 19.6, p = 0.021) and they were infrequently released home (&chi;(2) = 9.19, p = 0.027). Conclusion: Asylum seekers more frequently demonstrated severe symptoms such as suicidal ideation and aggressive behavior and they were mainly treated as inpatients, potentially due to minimal social resources.
    Tags: *Suicidal Ideation, Adult, asylum seekers, authors declare no conflicts of interest., Emergency Services, Psychiatric/*statistics & numerical data, Emigrants and Immigrants/*psychology, Female, Hospitalization/*statistics & numerical data, Humans, involuntary treatment, Male, psychiatric emergency services, psychiatric hospitalization, Refugees/*psychology, speaker in educational programs from Eli Lilly, Janssen, Lundbeck, and Otsuka. He, Switzerland, was an advisory board member for Lundbeck and Otsuka from 2015 to 2016. All other, Young Adult.
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  • Tramer, L., Becker, C., Hochstrasser, S., Marsch, S., and Hunziker, S. “Association Of Electrocardiogram Alterations Of Rescuers And Performance During A Simulated Cardiac Arrest: A Prospective Simulation Study”. Plos One 13, no. 6: e0198661. doi:10.1371/journal.pone.0198661.
    Abstract: BACKGROUND: Performance of cardiopulmonary resuscitation (CPR) causes significant mental stress for rescuers, especially if performed by inexperienced individuals. Our aim was to study electrocardiogram (ECG) alterations in rescuers and its association with gender and CPR performance. METHODS: We included 126 medical students in this prospective, observational simulator study. Each student was equipped with a 3-lead continuous ECG device tracking the individual electrocardiographic output before, during and after CPR. We analyzed variations in heart rate, heart-rate variability (HRV) and ST- and T-wave morphology. RESULTS: Compared to baseline, mean heart rate (bpm) significantly increased during resuscitation and again decreased after resuscitation (from 87 to 97 to 80, p<0.001). Heart-rate variability (the standard deviation of all N-N intervals, SDNN) (ms2) showed the opposite pattern, decreasing during resuscitation and increasing after resuscitation (117 to 92 to 93ms, p<0.001). Abnormalities in T-waves and ST-segments were observed in 29.4% of participants. Maximal heart rate (r = 0.25, p = 0.046) as well as heart rate reactivity (r = 0.7, p<0.001) correlated with hands-on time, a measure of CPR performance. Compared to males, female rescuers had a significantly higher maximal heart rate (136bpm vs. 126bpm, p = 0.008) and lower HRV (SDNN 102 vs. 119ms, p = 0.004) and tended to show more abnormalities in T-waves and ST-segments (36% vs. 21%, p = 0.080). CONCLUSION: CPR causes significant ECG alterations in healthy medical students with ST-segment and T-wave abnormalities, with more pronounced effects in females. Clinical implications of these findings need to be further investigated.
    Tags: *Cardiopulmonary Resuscitation/psychology, *Electrocardiography, *Heart Rate, *Students, Medical/psychology, Female, Heart Arrest/therapy, Heart/*physiopathology, Humans, Male, Manikins, Occupational Stress/etiology/*physiopathology, Prospective Studies, Sex Factors.
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  • Lhopitallier, L., Moulin, E., Hugli, O., Cavassini, M., and Darling, K. E. A. “Missed Opportunities For Hiv Testing Among Patients Newly Presenting For Hiv Care At A Swiss University Hospital: A Retrospective Analysis”. Bmj Open 8, no. 6: e019806. doi:10.1136/bmjopen-2017-019806.
    Abstract: OBJECTIVES: To determine the frequency of missed opportunities (MOs) among patients newly diagnosed with HIV, risk factors for presenting MOs and the association between MOs and late presentation (LP) to care. DESIGN: Retrospective analysis. SETTING: HIV outpatient clinic at a Swiss tertiary hospital. PARTICIPANTS: Patients aged >/=18 years newly presenting for HIV care between 2010 and 2015. MEASURES: Number of medical visits, up to 5 years preceding HIV diagnosis, at which HIV testing had been indicated, according to Swiss HIV testing recommendations. A visit at which testing was indicated but not performed was considered an MO for HIV testing. RESULTS: Complete records were available for all 201 new patients of whom 51% were male and 33% from sub-Saharan Africa. Thirty patients (15%) presented with acute HIV infection while 119 patients (59%) were LPs (CD4 counts <350 cells/mm(3) at diagnosis). Ninety-four patients (47%) had presented at least one MO, of whom 44 (47%) had multiple MOs. MOs were more frequent among individuals from sub-Saharan Africa, men who have sex with men and patients under follow-up for chronic disease. MOs were less frequent in LPs than non-LPs (42.5% vs 57.5%, p=0.03). CONCLUSIONS: At our centre, 47% of patients presented at least one MO. While our LP rate was higher than the national figure of 49.8%, LPs were less likely to experience MOs, suggesting that these patients were diagnosed late through presenting late, rather than through being failed by our hospital. We conclude that, in addition to optimising provider-initiated testing, access to testing must be improved among patients who are unaware that they are at HIV risk and who do not seek healthcare.
    Tags: Adolescent, Adult, Africa South of the Sahara/ethnology, Aged, Ambulatory Care, Delayed Diagnosis/*statistics & numerical data, Female, Hiv diagnosis, Hiv indicator conditions, HIV Infections/*diagnosis/ethnology, Hiv testing, Homosexuality, Male/*statistics & numerical data, Hospitals, University, Humans, late presenters, Logistic Models, Male, Mass Screening/*methods, Middle Aged, missed opportunities, Multivariate Analysis, Retrospective Studies, Risk Factors, Switzerland, Young Adult.
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  • Zafren, K., Brants, A., Tabner, K., Nyberg, A., Pun, M., Basnyat, B., and Brodmann Maeder, M. “Wilderness Mass Casualty Incident (Mci): Rescue Chain After Avalanche At Everest Base Camp (Ebc) In 2015”. Wilderness Environ Med 29, no. 3: 401-410. doi:10.1016/j.wem.2018.03.007.
    Abstract: The Nepal Earthquake of 2015 killed over 8000 people and injured over 20,000 in Nepal. Moments after the earthquake, an avalanche of falling ice came down from above Everest Base Camp (EBC). The air blast created by the avalanche flattened the middle part of EBC, killing 15 people and injuring at least 70. The casualties were initially triaged and treated at EBC and then evacuated by air to Kathmandu for definitive care. There were intermediate stops at the villages of Pheriche and Lukla during which the casualties were offloaded, retriaged, treated, and loaded again for further transport. Most of the authors of this article helped to provide primary disaster relief at EBC, Pheriche, or Lukla immediately after the earthquake. We describe the process by which an ad hoc rescue chain evacuated the casualties. We discuss challenges, both medical and nonmedical, what went well, and lessons learned. We make recommendations for disaster planning in the Khumbu (Everest) region, an isolated high altitude roadless area of Nepal.
    Tags: *Avalanches, *Mass Casualty Incidents, air medical transport, avalanche, disaster, Disaster Planning, Earthquakes, Emergency Medical Services/*methods/*organization & administration, helicopter emergency medical services, Humans, Interinstitutional Relations, Interprofessional Relations, Nepal, Rescue Work, trauma, Triage, Wilderness, Wilderness Medicine/*methods/*organization & administration.
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  • Wildi, K., Singeisen, H., Twerenbold, R., Badertscher, P., Wussler, D., Klinkenberg, L. J. J., Meex, S. J. R., et al. “Circadian Rhythm Of Cardiac Troponin I And Its Clinical Impact On The Diagnostic Accuracy For Acute Myocardial Infarction”. Int J Cardiol 270: 14-20. doi:10.1016/j.ijcard.2018.05.136.
    Abstract: BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) blood concentrations were shown to exhibit a diurnal rhythm, characterized by gradually decreasing concentrations throughout daytime, rising concentrations during nighttime and peak concentrations in the morning. We aimed to investigate whether this also applies to (h)s-cTnI assays and whether it would affect diagnostic accuracy for acute myocardial infarction (AMI). METHODS: Blood concentrations of cTnI were measured at presentation and after 1 h using four different cTnI assays: three commonly used sensitive (s-cTnI Architect, Ultra and Accu) and one experimental high-sensitivity assay (hs-cTnI Accu) in a prospective multicenter diagnostic study of patients presenting to the emergency department with suspected AMI. These concentrations and their diagnostic accuracy for AMI (quantified by the area under the curve (AUC)) were compared between morning (11 p.m. to 2 p.m.) and evening (2 p.m. to 11 p.m.) presenters. RESULTS: Among 2601 patients, AMI was the final diagnosis in 17.6% of patients. Concentrations of (h)s-cTnI as measured using all four assays were comparable in patients presenting in the morning versus patients presenting in the evening. Diagnostic accuracy for AMI of all four (h)s-cTnI assays were high and comparable between patients presenting in the morning versus presenting in the evening (AUC at presentation: 0.90 vs 0.93 for s-cTnI Architect; 0.91 vs 0.94 for s-cTnI Ultra; 0.89 vs 0.94 for s-cTnI Accu; 0.91 vs 0.94 for hs-cTnI Accu). CONCLUSIONS: Cardiac TnI does not seem to express a diurnal rhythm. Diagnostic accuracy for AMI is very high and does not differ with time of presentation. CLINICAL TRIAL REGISTRATION: NCT00470587, http://clinicaltrials.gov/show/NCT00470587.
    Tags: Acute myocardial infarction, Aged, Biomarkers/blood, Circadian rhythm, Circadian Rhythm/*physiology, Diagnosis, Female, Follow-Up Studies, High-sensitivity cardiac troponin I, Humans, Male, Middle Aged, Myocardial Infarction/*blood/*diagnostic imaging, Prospective Studies, Troponin I/*blood.
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  • Bschor, T., Henssler, J., Muller, M., and Baethge, C. “Baclofen For Alcohol Use Disorder-A Systematic Meta-Analysis”. Acta Psychiatr Scand 138, no. 3: 232-242. doi:10.1111/acps.12905.
    Abstract: OBJECTIVE: To evaluate the efficacy and tolerability of baclofen vs. placebo for long-term treatment of alcohol use disorder. METHOD: Systematic review and meta-analysis following methods of the Cochrane Collaboration Handbook (PROSPERO registration: CRD42017073663). Primary outcome was the random-effects summary estimate of all standardized mean differences (SMDs), as calculated from the primary outcomes of each study. RESULTS: Fourteen double-blind RCTs (1522 patients) were included. Heterogeneity was substantial for most analyses (I(2) about 75%). Baclofen showed a small, but not statistically significant superiority over placebo: SMD = 0.22 ([95% CI: -0.03; 0.47], P = 0.09). This result was supported by a leave-one-out-analysis, and Orwin's fail-safe N, by predefined secondary analyses (on abstinence rates and amount of drinking), and by a post hoc-analysis of high-dose studies (>80 mg/day). An analysis of low risk of bias studies (SMD = 0.10 [-0.20; 0.41], P = 0.51, I(2) = 43.3%) found no effect. Exclusion of four studies focusing on patients with comorbidity yielded a small positive effect. Drop-out rates were similar. CONCLUSION: Our results question baclofen's utility in the long-term treatment of alcohol use disorder at both normal and high doses. While the confidence intervals indicate that marginally harmful or moderately beneficial effects of baclofen remain a possibility, the most likely effect size is slightly above placebo effects.
    Tags: alcohol dependence, Alcohol Drinking/*adverse effects/psychology, alcohol use disorder, Alcoholism/*drug therapy/psychology, baclofen, Baclofen/administration & dosage/*therapeutic use, Double-Blind Method, Female, GABA-B Receptor Agonists/therapeutic use, Humans, Male, meta-analysis, Outcome Assessment, Health Care, Placebos/administration & dosage, Randomized Controlled Trials as Topic.
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  • Wachelder, J. J. H., van Galen, L. S., Kellett, J., Nickel, C. H., Haak, H. R., and safer@home, consortium. “Unplanned Readmissions Among Patients Presenting With Nonspecific Complaints”. Eur J Intern Med 54: e36-e37. doi:10.1016/j.ejim.2018.05.020.
    Tags: Aged, Aged, 80 and over, Emergency department, Emergency medicine, Emergency Service, Hospital/*statistics & numerical data, Europe, Female, Humans, Male, Middle Aged, Non-specific complaints, Patient Readmission/*statistics & numerical data, Prospective Studies, Readmissions.
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  • Hautz, W. E. “When I Say.. Diagnostic Error”. Med Educ 52, no. 9: 896-897. doi:10.1111/medu.13602.
  • Badertscher, P., Boeddinghaus, J., Twerenbold, R., Nestelberger, T., Wildi, K., Wussler, D., Schwarz, J., et al. “Direct Comparison Of The 0/1H And 0/3H Algorithms For Early Rule-Out Of Acute Myocardial Infarction”. Circulation 137, no. 23: 2536-2538. doi:10.1161/CIRCULATIONAHA.118.034260.
    Tags: *Algorithms, Aged, Disease-Free Survival, Female, Humans, Male, Middle Aged, myocardial infarction, ST Elevation Myocardial Infarction/*diagnosis/*mortality/*physiopathology, Survival Rate, troponin.
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  • Joost, S., Haba-Rubio, J., Himsl, R., Vollenweider, P., Preisig, M., Waeber, G., Marques-Vidal, P., Heinzer, R., and Guessous, I. “Spatial Clusters Of Daytime Sleepiness And Association With Nighttime Noise Levels In A Swiss General Population (Geohypnolaus)”. Int J Hyg Environ Health 221, no. 6: 951-957. doi:10.1016/j.ijheh.2018.05.004.
    Abstract: INTRODUCTION: Daytime sleepiness is highly prevalent in the general adult population and has been linked to an increased risk of workplace and vehicle accidents, lower professional performance and poorer health. Despite the established relationship between noise and daytime sleepiness, little research has explored the individual-level spatial distribution of noise-related sleep disturbances. We assessed the spatial dependence of daytime sleepiness and tested whether clusters of individuals exhibiting higher daytime sleepiness were characterized by higher nocturnal noise levels than other clusters. DESIGN AND METHODS: Population-based cross-sectional study, in the city of Lausanne, Switzerland. Sleepiness was measured using the Epworth Sleepiness Scale (ESS) for 3697 georeferenced individuals from the CoLaus|PsyCoLaus cohort (period = 2009-2012). We used the sonBASE georeferenced database produced by the Swiss Federal Office for the Environment to characterize nighttime road traffic noise exposure throughout the city. We used the GeoDa software program to calculate the Getis-Ord G(i)* statistics for unadjusted and adjusted ESS in order to detect spatial clusters of high and low ESS values. Modeled nighttime noise exposure from road and rail traffic was compared across ESS clusters. RESULTS: Daytime sleepiness was not randomly distributed and showed a significant spatial dependence. The median nighttime traffic noise exposure was significantly different across the three ESS Getis cluster classes (p < 0.001). The mean nighttime noise exposure in the high ESS cluster class was 47.6, dB(A) 5.2 dB(A) higher than in low clusters (p < 0.001) and 2.1 dB(A) higher than in the neutral class (p < 0.001). These associations were independent of major potential confounders including body mass index and neighborhood income level. CONCLUSIONS: Clusters of higher daytime sleepiness in adults are associated with higher median nighttime noise levels. The identification of these clusters can guide tailored public health interventions.
    Tags: *Noise, *Sleepiness, Adult, Aged, Cluster Analysis, Epworth sleepiness scale, Female, General population, Gis, Humans, Male, Middle Aged, Spatial Analysis, Spatial clustering, Switzerland, Traffic noise exposure.
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  • Muller, M., Khamis, D., Srivastava, D., Exadaktylos, A. K., and Pfortmueller, C. A. “Understanding Refugees' Health”. Semin Neurol 38, no. 2: 152-162. doi:10.1055/s-0038-1649337.
    Abstract: According to the United Nations Refugee Agency (UNHCR), 65.6 million people have been forcibly displaced worldwide. Several factors have a major influence on asylum seekers' health; so, their health profile is markedly different from that of the population in the country of asylum. The aim of this study is to review the major issues physicians need to be aware of when treating asylum seekers, with a special focus on the neurological problems of asylum seekers and refugees. The major impact factors on refugees' health are linked to experiences and exposure (1) in the country of origin, (2) in refugee camps and en route to Europe, and (3) in the process of immigration into the host country and living in European asylum centers. Refugees' health is also affected by psychological problems and by infectious diseases. Additionally, chronic diseases resulting in polymorbidity, cancer, and neurological diseases are easy to overlook and demand special attention. Neurological injuries/diseases may be traumatic (e.g., spinal cord injuries), posttraumatic (e.g., chronic pain syndromes), the result of cerebral infections, or the consequences of starvation (e.g., epilepsy, ataxia, and paraesthesia). The main challenges for physicians are lack of awareness of the asylum seekers' specific health care problems, language and intercultural communication problems, as well as access and integration of asylum seekers into the health care system. The health issues of asylum seekers are manifold and challenging to physicians. Awareness of these conditions is mandatory to ensure good clinical practice for this patient population, which has a huge burden in chronic, infectious, mental, and neurological diseases.
    Tags: *Health Services, *Health Status, *Refugees/statistics & numerical data, Delivery of Health Care, Health Services Accessibility, Health Status Disparities, Humans.
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  • Saillant, S., Della Santa, V., Golay, P., and Amirat, M. “The Code White Protocol”. Swiss Archives Of Neurology, Psychiatry And Psychotherapy 169, no. 04: 121-126. doi:10.4414/sanp.2018.00586.
    Abstract: Objectives: Clinical management of patients presenting with acute psychomotor agitation is difficult, often because there is no predefined protocol for dealing with it. The main objective of this article is to describe our institution's Code White mixed somatic-psychiatric protocol for managing acute agitation in an emergency department. Its second objective is to present data on how long it took to initiate and complete treatment. Methods: We retrospectively analysed 250 clinical situations over 3 years (2014-2016) from the hospital emergency department in the canton of Neuchâtel, Switzerland. Results: The median time from emergency department arrival to treatment initiation was 7 minutes; the median duration of treatment was 119 minutes. The rate of hospitalisation after emergency department treatment was 49.2%. Conclusion: This mixed somatic-psychiatric protocol seemed to reduce both the time before treatment initiation and treatment duration for patients presenting with acute psychomotor agitation in an emergency department. Implications for practice: The Code White protocol improved the emergency department's ability to keep acutely agitated patients flowing smoothly and efficiently through it to other units or to discharge. On the qualitative level, it also improved staff safety and peace of mind, allowing them to carry out their many tasks more calmly. © 2018 EMH Swiss Medical Publishers Ltd. All rights reserved.
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  • Tschopp, C., Tramer, M. R., Schneider, A., Zaarour, M., and Elia, N. “Benefit And Harm Of Adding Epinephrine To A Local Anesthetic For Neuraxial And Locoregional Anesthesia: A Meta-Analysis Of Randomized Controlled Trials With Trial Sequential Analyses”. Anesth Analg 127, no. 1: 228-239. doi:10.1213/ANE.0000000000003417.
    Abstract: BACKGROUND: This systematic review examines the benefit and harm of adding epinephrine to local anesthetics for epidural, intrathecal, or locoregional anesthesia. METHODS: We searched electronic databases to October 2017 for randomized trials comparing any local anesthetic regimen combined with epinephrine, with the same local anesthetic regimen without epinephrine, reporting on duration of analgesia, time to 2 segments regression, or any adverse effects. Trial quality was assessed using the Cochrane risk of bias tool and a random-effects model was used. Trial sequential analyses (TSA) were applied to identify the information size (IS; number of patients needed to reach a definite conclusion) and were set to detect an increase or decrease of effect of 30%-50%, depending on the end point considered. Alpha levels were adjusted (1%) for multiple outcome testing. RESULTS: We identified 70 trials (3644 patients, 17 countries, from 1970 to 2017). Median number of patients per trial was 44 (range, 9-174). Thirty-seven trials (1781 patients) tested epinephrine for epidural, 27 (1660) for intrathecal, and 6 (203) for locoregional anesthesia (sciatic, femoral, popliteal, axillary blocks). TSA enabled us to conclude that adding epinephrine to epidural local anesthetics could not decrease postoperative pain intensity by 30%, and did not impact the risk of intraoperative arterial hypotension. IS was insufficient to conclude on the impact of epinephrine on the risk of motor block (IS, 4%), arterial hypotension (20%), urinary retention (23%), or pain intensity at rest (27%) during labor. TSA confirmed that adding epinephrine to intrathecal local anesthetics increased the duration of motor block (weighted mean difference [WMD] 64 minutes; 99% CI, 37-91), analgesia (WMD 34 minutes; 99% CI, 6-62), and the time to 2 segments regression (WMD 20 minutes; 99% CI, 11-28). IS was insufficient to conclude on its impact on arterial hypotension (IS, 15%), or when administrated in a combined spinal-epidural, on motor block (IS, 11%) or arterial hypotension (IS, 11%). Adding epinephrine to local anesthetics for a locoregional block increased the duration of analgesia (WMD 66 minutes; 98% CI, 32-100]). CONCLUSIONS: Adding epinephrine to intrathecal or locoregional local anesthetics prolongs analgesia and motor block by no more than 60 minutes. The impact of adding epinephrine to epidural local anesthetics or to a combined spinal-epidural remains uncertain.
    Tags: Analgesia, Obstetrical/adverse effects/*methods, Anesthesia, Obstetrical/adverse effects/*methods, Anesthesia, Spinal/adverse effects/*methods, Anesthetics, Local/*administration & dosage/adverse effects, Epinephrine/*administration & dosage/adverse effects, Female, Humans, Male, Motor Activity/drug effects, Nerve Block/adverse effects/*methods, Pain Threshold/drug effects, Pregnancy, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome.
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  • van der Linden, B. W. A., Courvoisier, D. S., Cheval, B., Sieber, S., Bracke, P., Guessous, I., Burton-Jeangros, C., Kliegel, M., and Cullati, S. “Effect Of Childhood Socioeconomic Conditions On Cancer Onset In Later Life: An Ambidirectional Cohort Study”. Int J Public Health 63, no. 7: 799-810. doi:10.1007/s00038-018-1111-9.
    Abstract: OBJECTIVES: Living in low socioeconomic conditions during childhood is associated with poor health outcomes in later life. Whether this link also applies to cancer is unclear. We examined whether childhood socioeconomic conditions (CSCs) are associated with cancer risk in later life and whether this effect remained after adjusting for adulthood socioeconomic conditions (ASCs). METHODS: Data for 26,431 individuals >/= 50 years old included in SHARE were analysed. CSCs were constructed by using indicators of living conditions at age 10. ASC indicators were education, main occupation, and household income. Gender-stratified associations of CSCs with cancer onset (overall and by site) were assessed by Cox regression. RESULTS: In total, 2852 individuals were diagnosed with cancer. For both men and women, risk of overall cancer was increased for advantaged CSCs and remained so after adjusting for ASCs (hazard ratio = 1.36, 95% CI 1.10, 1.63, and 1.70, 95% CI 1.41, 2.07). CONCLUSIONS: Advantaged CSCs are associated with an increased risk of overall cancer at older age, but results vary by cancer sites and sex. Participation in cancer screening or exposure to risk factors may differ by social conditions.
    Tags: *Health Status Disparities, Aged, Ageing, APPROVAL: The study was part of the Survey of Health, Ageing and Retirement in, Cancer, Child, Cohort Studies, countries and Israel (see www.share-project.org). During waves 1-4, SHARE was, database of microdata on health, socioeconomic status and social and family, Europe (SHARE) study, which is a multidisciplinary and cross-national panel, Female, Humans, informed consent was obtained from all individuals included in the study., Life course, Male, Middle Aged, Neoplasms/*epidemiology, networks of more than 120,000 individuals aged 50 or older and covers 27 European, Old age, Planck Society for the Advancement of Science (MPG). INFORMED CONSENT: Written, reviewed and approved by the Ethics Committee of the University of Mannheim. From, Risk, Socioeconomic conditions, Socioeconomic Factors, wave 4 onwards, SHARE was reviewed and approved by the Ethics Council of the Max.
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  • Di Rocco, D., Pasquier, M., Albrecht, E., Carron, P. N., and Dami, F. “Hems Inter-Facility Transfer: A Case-Mix Analysis”. Bmc Emerg Med 18, no. 1: 13. doi:10.1186/s12873-018-0163-8.
    Abstract: BACKGROUND: Helicopter emergency medical services (HEMS) are popular rescue systems despite inconsistent evidence in the scientific literature to support their use for primary interventions, as well as for inter-facility transfer (IFT). There is little research about IFT by HEMS, hence questions remain about the appropriateness of this method of transport. The aim of this study was to describe a case-mix of operational and medical characteristics for IFT activity of a sole HEMS base, and identify indicators of over-triage. METHODS: This is a retrospective study on HEMS IFT over 36 months, from January 1st 2013 to December 31st 2015. Medical and operational data from the database of the Emergency Department of Lausanne University Hospital, which provides the emergency physicians for this helicopter base, were reviewed. It included distance and time of flight transport, type of care during flight, and estimated distance of transport if conducted by ground. RESULTS: There were 2194 HEMS missions including 979 IFT (44.6%). Most transfers involved adults (> 17 years old; 799 patients, 81.6%). Forty patients (4.1%) were classified as having benefitted from resuscitation or life-saving measures performed in flight, 615 (62.8%) from emergency treatment and 324 (33.1%) from simple clinical examination. The median distance by air between hospitals was 35.4 km. The estimated median distance by road was 47.7 km. The median duration time from origin to destination by air was 12 min. CONCLUSIONS: This case-mix of IFTs by HEMS presents a high severity. There are many signs in favour of over-triage. We propose indicators to help choosing whether HEMS is the most appropriate mean of transport to perform the transfer regarding patient condition, geography, and medical competences available aboard ground ambulances; this may reduce over-triage.
    Tags: Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Air Ambulances/*statistics & numerical data, Case-mix, Child, Child, Preschool, Diagnosis-Related Groups, Female, Helicopter emergency medical services (HEMS), Humans, Infant, Inter-facility transfer (IFT), Male, maps and institutional affiliations., Middle Aged, Over-triage, Patient Transfer/*statistics & numerical data, Retrospective Studies, Severity of Illness Index, Sex Factors, Young Adult.
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  • Pasquier, M., de Riedmatten, M., and Paal, P. “Autoresuscitation In Accidental Hypothermia”. Am J Med 131, no. 9: e367-e368. doi:10.1016/j.amjmed.2018.04.026.
    Tags: *Blood Circulation, *Cardiovascular Physiological Phenomena, *Death, *Respiration, Cardiopulmonary Resuscitation, Heart Arrest/therapy, Humans, Hypothermia/*complications, Male, Middle Aged, Ventricular Fibrillation/therapy.
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  • Busetto, L., Dicker, D., Azran, C., Batterham, R. L., Farpour-Lambert, N., Fried, M., Hjelmesaeth, J., et al. “Obesity Management Task Force Of The European Association For The Study Of Obesity Released "Practical Recommendations For The Post-Bariatric Surgery Medical Management"”. Obes Surg 28, no. 7: 2117-2121. doi:10.1007/s11695-018-3283-z.
    Abstract: Bariatric patients may face specific clinical problems after surgery, and multidisciplinary long-term follow-up is usually provided in specialized centers. However, physicians, obstetricians, dieticians, nurses, clinical pharmacists, midwives, and physical therapists not specifically trained in bariatric medicine may encounter post-bariatric patients with specific problems in their professional activity. This creates a growing need for dissemination of first level knowledge in the management of bariatric patients. Therefore, the Obesity Management Task Force (OMTF) of the European Association for the Study of Obesity (EASO) decided to produce and disseminate a document containing practical recommendations for the management of post-bariatric patients. The list of practical recommendations included in the EASO/OMTF document is reported in this brief communication.
    Tags: *Advisory Committees/organization & administration/standards, *Societies, Medical/organization & administration/standards, Bariatric surgery, Bariatric Surgery/*rehabilitation/standards, Diabetes mellitus, Europe, European guidelines, Humans, Hypertension, Nutrition, Nutritionists, Obesity management, Obesity Management/methods/*organization & administration/*standards, Obesity, Morbid/surgery/*therapy, Physicians, Postoperative Care/methods/*standards, Postoperative Complications/prevention & control/therapy, Practice Guidelines as Topic, Pregnancy, Psychological aspects, Sleep apnea, Weight maintenance.
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  • Oris, C., Pereira, B., Durif, J., Simon-Pimmel, J., Castellani, C., Manzano, S., Sapin, V., and Bouvier, D. “The Biomarker S100B And Mild Traumatic Brain Injury: A Meta-Analysis”. Pediatrics 141, no. 6. doi:10.1542/peds.2018-0037.
    Abstract: CONTEXT: The usefulness of S100B has been noted as a biomarker in the management of mild traumatic brain injury (mTBI) in adults. However, S100B efficacy as a biomarker in children has previously been relatively unclear. OBJECTIVE: A meta-analysis is conducted to assess the prognostic value of S100B in predicting intracerebral lesions in children after mTBI. DATA SOURCES: Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and Google Scholar. STUDY SELECTION: Studies including children suffering mTBI who underwent S100B measurement and computed tomography (CT) scans were included. DATA EXTRACTION: Of 1030 articles screened, 8 studies met the inclusion criteria. RESULTS: The overall pooled sensitivity and specificity were 100% (95% confidence interval [CI]: 98%-100%) and 34% (95% CI: 30%-38%), respectively. A second analysis was based on the collection of 373 individual data points from 4 studies. Sensitivity and specificity results, obtained from reference ranges in children with a sampling time <3 hours posttrauma, were 97% (95% CI: 84.2%-99.9%) and 37.5% (95% CI: 28.8%-46.8%), respectively. Only 1 child had a low S100B level and a positive CT scan result without clinically important traumatic brain injury. LIMITATIONS: Only patients undergoing both a CT scan and S100B testing were selected for evaluation. CONCLUSIONS: S100B serum analysis as a part of the clinical routine could significantly reduce the number of CT scans performed on children with mTBI. Sampling should take place within 3 hours of trauma. Cutoff levels should be based on pediatric reference ranges.
    Tags: Biomarkers/blood, Brain Concussion/blood/*diagnosis/diagnostic imaging/etiology, Child, conflicts of interest to disclose., Humans, Reference Values, S100 Calcium Binding Protein beta Subunit/*blood, Sensitivity and Specificity, Time Factors, Tomography, X-Ray Computed.
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  • Rauch, S., Strapazzon, G., Brodmann, M., Fop, E., Masoner, C., Rauch, L., Forti, A., Pietsch, U., Mair, P., and Brugger, H. “Implementation Of A Mechanical Cpr Device In A Physician Staffed Hems - A Prospective Observational Study”. Scand J Trauma Resusc Emerg Med 26, no. 1: 36. doi:10.1186/s13049-018-0503-4.
    Abstract: In this prospective, observational study we describe the incidence and characteristics of out of hospital cardiac arrest (OHCA) cases who received mechanical CPR, after the implementation of a mechanical CPR device (LUCAS 2; Physio Control, Redmond, WA, USA) in a physician staffed helicopter emergency medical service (HEMS) in South Tyrol, Italy. During the study period (06/2013-04/2016), 525 OHCA cases were registered by the dispatch centre, 271 (51.6%) were assisted by HEMS. LUCAS 2 was applied in 18 (6.6%) of all HEMS-assisted OHCA patients; ten were treated with LUCAS 2 at the scene only, and eight were transported to hospital with ongoing CPR. Two (11.1%) of the 18 patients survived long term with full neurologic recovery. In seven of eight patients transferred to hospital with ongoing CPR, CPR was ceased in the emergency room without further intervention. Retrospectively, all HEMS-assisted OHCA cases were screened for proposed indication criteria for prolonged CPR. Thirteen patients fulfilled these criteria, but only two of them were transported to hospital. Based on these results, we propose a standard operating procedure for HEMS-assisted patients with refractory OHCA in a region without hospitals with ECLS capacity.
    Tags: *Aircraft, *Emergency Medical Services, Adolescent, Adult, Aged, Cardiopulmonary Resuscitation/*instrumentation, Female, Humans, Incidence, Italy/epidemiology, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/epidemiology/*therapy, Physicians/*supply & distribution, Prospective Studies, Retrospective Studies, Workforce, Young Adult.
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  • Andersson, R. E., Doll, D., Stauffer, V. K., Vogt, A. P., Boggs, S. D., and Luedi, M. M. “Interdisciplinary Dialogue Is Needed When Defining Perioperative Recommendations: Conflicting Guidelines For Anesthetizing Patients For Pilonidal Surgery”. A A Pract 11, no. 8: 227-229. doi:10.1213/XAA.0000000000000780.
    Abstract: National or international guidelines can help surgeons and anesthesiologists make treatment decisions, but the existence of conflicting recommendations can hinder treatment rather than helping. A case in point is the treatment of pilonidal sinus disease, a chronic subcutaneous infection located in the sacrococcygeal area. Its incidence is rising, reaching almost 100/100,000 inhabitants. Three surgical societies have proposed guidelines for treating the disease, but these guidelines vary greatly in their approach to anesthesia. Who should provide input into guidelines? And how can medical disciplines successfully collaborate? Anesthesiologists must be involved in defining perioperative recommendations not only in patients with pilonidal sinus disease.
    Tags: *Guidelines as Topic, Anesthesia/*standards, Humans, Interdisciplinary Communication, Perioperative Care, Pilonidal Sinus/*surgery.
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  • Keitel, K., and D'Acremont, V. “Electronic Clinical Decision Algorithms For The Integrated Primary Care Management Of Febrile Children In Low-Resource Settings: Review Of Existing Tools”. Clin Microbiol Infect 24, no. 8: 845-855. doi:10.1016/j.cmi.2018.04.014.
    Abstract: BACKGROUND: The lack of effective, integrated diagnostic tools poses a major challenge to the primary care management of febrile childhood illnesses. These limitations are especially evident in low-resource settings and are often inappropriately compensated by antimicrobial overprescription. Electronic clinical decision algorithms (eCDAs) have the potential to close these gaps by guiding antibiotic use and better identifying serious disease. AIMS: This narrative review summarizes existing eCDAs, to provide an overview of their degree of validation and to identify gaps in current knowledge and prospects for future innovation. SOURCES: Structured literature review in PubMed and Embase complemented by Google search and contact with developers. CONTENT: Six integrated eCDAs were identified: three (eIMCI, REC and Bangladesh digital IMCI) based on Integrated Management of Childhood Illnesses (IMCI); four (SL electronic iCCM, MEDSINC, electronic iCCM and D-Tree electronic iCCM) on Integrated Community Case Management (iCCM); two (ALMANACH, MSFeCARE) with a modified IMCI content; and one (ePOCT) that integrates novel content with biomarker testing. The types of publications and evaluation studies varied greatly: the content and evidence base were published for two (ALMANACH and ePOCT) and ALMANACH and ePOCT were validated in efficacy studies. Other types of evaluations, such as compliance and acceptability, were available for D-Tree electronic iCCM, eIMCI and ALMANACH. Several evaluations are still ongoing. Future prospects include conducting effectiveness and impact studies using data gathered through larger studies to adapt the medical content to local epidemiology, improving the software and sensors, and assessing factors that influence compliance and scale-up. IMPLICATIONS: eCDAs are valuable tools that have the potential to improve management of febrile children in primary care and increase the rational use of diagnostics and antimicrobials. Next steps in the evidence pathway should be larger effectiveness and impact studies (including cost analysis) and continuous integration of clinically useful diagnostic and treatment innovations.
    Tags: *Delivery of Health Care, Integrated/standards/statistics & numerical data, *Health Resources, *Medical Informatics/methods, *Primary Health Care/standards/statistics & numerical data, Acute febrile illness, Age Factors, Algorithms, Bangladesh/epidemiology, Child, children, Clinical Decision-Making/methods, computerized decision support system, Decision Trees, diagnostic tools, Disease Management, electronic decision trees, Fever/diagnosis/*epidemiology/etiology/therapy, Humans, low-resource countries, Population Surveillance, primary care, Reproducibility of Results, Software.
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  • Eckart, A., Hausfater, P., Amin, D., Amin, A., Haubitz, S., Bernard, M., Baumgartner, A., et al. “Hyponatremia And Activation Of Vasopressin Secretion Are Both Independently Associated With 30-Day Mortality: Results Of A Multicenter, Observational Study”. J Intern Med 284, no. 3: 270-281. doi:10.1111/joim.12764.
    Abstract: BACKGROUND: Hyponatremia is a common feature of acute illness and associated with increased mortality. This may be explained by a stress-mediated activation of the vasopressin system with an increase in free-water reabsorption. OBJECTIVES: To investigate whether the association between hyponatremia and mortality could be explained by activation of the vasopressin system. METHODS: We prospectively enrolled adult, medical patients seeking emergency care in three centres in Switzerland, France and the United States. We investigated associations between admission plasma sodium and copeptin, a stable portion of the vasopressin-precursor peptide, with 30-day mortality. We performed uni- and multivariate regression analysis. RESULTS: Of 6962 included patients, 18% had hyponatremia (sodium </=135 mmol L(-1) ), which doubled their risk for mortality compared to patients with normonatremia (8.3% vs. 3.8%). This association was confirmed in a multivariate-adjusted logistic regression analysis [adjusted odds ratio (OR) 1.47, 95% CI 1.12-1.93, P = 0.005]. Vasopressin levels, mirrored by copeptin, were also increased in nonsurvivors and strongly associated with mortality (adjusted OR 3.42, 95% CI 2.76-4.25, P < 0.001). The association between hyponatremia and mortality remained unchanged when adding copeptin levels to the regression model (fully adjusted OR 1.53, 95% CI 1.16-2.00, P = 0.002). CONCLUSION: This prospective study including medical patients upon emergency room admission found hyponatremia as well as an activation of the vasopressin system to be independently associated with mortality. This suggests that stress- and vasopressin-independent mechanisms are responsible for the association of low sodium levels with mortality.
    Tags: Acute Disease/*mortality, Adult, Aged, Cohort Studies, Correlation of Data, Cross-Cultural Comparison, electrolytes, Emergency Service, Hospital, Female, France, Glycopeptides/blood, Humans, Hyponatremia/*blood/*mortality, Male, Middle Aged, mortality, Prospective Studies, Risk, Secretory Rate/physiology, Sodium/blood, stress, Switzerland, United States, Vasopressins/*blood.
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  • Muller, M., Schefold, J. C., Guignard, V., Exadaktylos, A. K., and Pfortmueller, C. A. “Hyponatraemia Is Independently Associated With In-Hospital Mortality In Patients With Pneumonia”. Eur J Intern Med 54: 46-52. doi:10.1016/j.ejim.2018.04.008.
    Abstract: BACKGROUND: Hyponatraemia on hospital admission has been shown to be a risk factor for illness severity in critically ill patients. The aim of the present study was to investigate whether hyponatraemia on emergency department (ED) admission independently influences in-hospital mortality, ICU admission, and/or length of hospitalisation in patients with pneumonia. METHODS: 610 patients (64.4% male, median 66 years) diagnosed with pneumonia were identified by retrospective screening of electronic admission data (06/2011-06/2013). Patients were admitted to the ED of Bern University Hospital, Switzerland. Patient characteristics, potential confounders, and patient-centred clinical outcomes, including mortality, ICU admission, and length of hospitalisation, were analysed. Multivariate logistic analysis adjusted for typical confounders was performed to analyse the association of hyponatraemia with clinical outcomes. RESULTS: In a large cohort of consecutive acutely admitted patients with pneumonia, the overall in-hospital mortality rate was 12.5%; 21.2% of patients required primary or secondary ICU admission, and the median length of hospital stay was 8 (IQR 5-13) days. At baseline, 47 patients (7.7%) were found to have concomitant hyponatraemia. Multivariate regression revealed a significant association between hyponatraemia and in-hospital mortality (adjusted OR: 2.7, 95% CI: 1.3-5.9, p = 0.010), but not with ICU admission (adjusted OR: 1.8, 95% CI: 0.9-3.6, p = 0.103) or length of hospitalisation (p = 0.493) after adjustment for age, neoplasia, COPD, suspected sepsis, and cardiac disease. The association was robust if controlled for other covariates, e.g. CRB-65 score. CONCLUSIONS: Hyponatraemia on admission predicts poor outcome and is an independent risk factor for in-hospital mortality in admitted patients diagnosed with pneumonia.
    Tags: *Hospital Mortality, Aged, Critical illness, Electrolyte disorder, Emergency admissions, Female, Humans, Hyponatraemia, Hyponatremia/*complications, Intensive Care Units, Logistic Models, Male, Middle Aged, Mortality prediction, Multivariate Analysis, Patient Admission, Patient Outcome Assessment, Pneumonia, Pneumonia/*mortality, Retrospective Studies, Risk Factors, Severity of Illness Index, Switzerland/epidemiology.
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  • Christ, M., Geier, F., Blaschke, S., Giannitsis, E., Khellaf, M., Mair, J., Pariente, D., Scharnhorst, V., Semjonow, V., and Hausfater, P. “Clinical Performance Of A New Point-Of-Care Cardiac Troponin I Test”. Clin Chem Lab Med 56, no. 8: 1336-1344. doi:10.1515/cclm-2017-0693.
    Abstract: BACKGROUND: We evaluated the clinical performance of the Minicare cardiac troponin-I (cTnI), a new point-of-care (POC) cTnI test for the diagnosis of acute myocardial infarction (AMI) in a prospective, multicentre study (ISRCTN77371338). METHODS: Of 474 patients (>/=18 years) admitted to an emergency department (ED) or chest pain unit (CPU) with symptoms suggestive of acute coronary syndrome (ACS; </=12 h from symptom onset), 465 were eligible. Minicare cTnI was tested immediately, 3 h and 6 h after presentation. AMI diagnoses were adjudicated independently based on current guidelines. RESULTS: The diagnostic performance of the Minicare cTnI test at 3 h was similar for whole blood and in plasma: sensitivity 0.92 vs. 0.90; specificity 0.91 vs. 0.90; positive predictive value (PPV) 0.68 vs. 0.66; negative predictive value (NPV) 0.98 vs. 0.98; positive likelihood ratio (LR+) 10.18 vs. 9.41; negative likelihood ratio (LR-) 0.09 vs. 0.11. The optimal diagnostic performance was obtained at 3 h using cut-offs cTnI >43 ng/L plus cTnI change from admission >/=18.5 ng/L: sensitivity 0.90, specificity 0.96, PPV 0.81, NPV 0.98, and LR+ 21.54. The area under the receiver operating characteristics (ROC) curve for cTnI whole blood baseline value and absolute change after 3 h curve was 0.93. CONCLUSIONS: These data support the clinical usefulness of Minicare cTnI within a 0 h/3 h-blood sampling protocol supported by current guidelines for the evaluation of suspected ACS.
    Tags: acute coronary syndrome, Aged, Biomarkers/*blood, Blood Chemical Analysis/instrumentation/*methods, cardiac biomarkers, cardiac troponin I, emergency medicine, False Negative Reactions, Female, Humans, Male, Middle Aged, myocardial infarction, Myocardial Infarction/diagnosis, non-ST-elevation myocardial infarction, point-of-care, Point-of-Care Testing, Prospective Studies, ROC Curve, Single-Blind Method, troponin, Troponin I/*blood.
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  • Bonnet, R., Laurencet, M., Gaspoz, J. M., and Kherad, O. “Creating A List Of Low-Value Health Care Interventions According To Medical Students Perspective”. Eur J Intern Med 52: e41-e42. doi:10.1016/j.ejim.2018.03.018.
    Tags: *Practice Guidelines as Topic, *Students, Medical, Health Knowledge, Attitudes, Practice, Humans, Internal Medicine, Primary Health Care/*economics, Societies, Medical, Switzerland.
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  • Vermunt, L., Veal, C. D., Ter Meulen, L., Chrysostomou, C., van der Flier, W., Frisoni, G. B., Guessous, I., et al. “European Prevention Of Alzheimer's Dementia Registry: Recruitment And Prescreening Approach For A Longitudinal Cohort And Prevention Trials”. Alzheimers Dement 14, no. 6: 837-842. doi:10.1016/j.jalz.2018.02.010.
    Abstract: INTRODUCTION: It is a challenge to find participants for Alzheimer's disease (AD) prevention trials within a short period of time. The European Prevention of Alzheimer's Dementia Registry (EPAD) aims to facilitate recruitment by preselecting subjects from ongoing cohort studies. This article introduces this novel approach. METHODS: A virtual registry, with access to risk factors and biomarkers for AD through minimal data sets of ongoing cohort studies, was set up. RESULTS: To date, ten cohorts have been included in the EPAD. Around 2500 participants have been selected, using variables associated with the risk for AD. Of these, 15% were already recruited in the EPAD longitudinal cohort study, which serves as a trial readiness cohort. DISCUSSION: This study demonstrates that a virtual registry can be used for the preselection of participants for AD studies.
    Tags: *Clinical Trials as Topic, *Patient Selection, *Registries, Aged, Aged, 80 and over, Alzheimer Disease/*prevention & control, Biomarkers, Clinical trial, Epad, Europe, Female, Humans, Longitudinal Studies, Male, Middle Aged, Participant recruitment, Preclinical AD, Prodromal AD, Prodromal Symptoms, Research registry, Risk Factors.
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  • Liakoni, E., Gartwyl, F., Ricklin, M., Exadaktylos, A. K., and Krahenbuhl, S. “Psychoactive Substances And Violent Offences: A Retrospective Analysis Of Presentations To An Urban Emergency Department In Switzerland”. Plos One 13, no. 3: e0195234. doi:10.1371/journal.pone.0195234.
    Abstract: BACKGROUND: Psychoactive substances are often regarded as causal factors contributing to violent injuries, sexual abuse and homicides. While these effects have been demonstrated for some substances (e.g. cocaine), current available data for others are more controversial (e.g. cannabis) or very limited (e.g. ecstasy). AIMS OF THE STUDY: To collect data on the type and frequency of psychoactive substance use in cases of emergency department (ED) presentations related to interpersonal violence. METHODS: Retrospective study at the University Hospital of Bern, Switzerland, between May 2012 and June 2016. The study covered cases of violent crime associated with psychoactive substances. Cases of isolated ethanol intoxication, suicide attempts, and substance use for medical purposes were excluded. RESULTS: The study included 103 cases among the 164,846 ED attendances. In the majority of the cases, the type of violence was bodily force (52%) related to urban violence (83%). The mean patient age was 29 years and 79% were male. 63% of the patients reported use of more than one drug; alcohol co-use was reported in 60% of the cases. Besides alcohol, the substances most often reported were cannabis (50%) and cocaine (21%). Alcohol and cannabis was also the most commonly reported substance combination (36% of the total cases). Urine drug screening was performed in 34% of the cases and cannabis and cocaine were the most commonly detected substances (46% and 19%, respectively). There were no cases of novel substances. 23% of the patients were admitted to a hospital ward, 10% to a psychiatric clinic. CONCLUSION: Cannabis and cocaine were, besides alcohol, the substances most often reported in ED presentations related to offences of violence. Because of the high prevalence of alcohol co-use, no final conclusions can be drawn on the contribution of single substances.
    Tags: *Violence, Adolescent, Adult, Alcohol Drinking/*adverse effects, Cannabis/*adverse effects, Central Nervous System Agents/adverse effects, Cocaine/*adverse effects, Criminals, Emergency Service, Hospital/*statistics & numerical data, Female, Humans, Illicit Drugs/*adverse effects, Male, Middle Aged, Retrospective Studies, Substance-Related Disorders/*epidemiology/etiology, Switzerland, Urban Population, Vasoconstrictor Agents/adverse effects, Young Adult.
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  • Klingberg, K., Gadelhak, K., Jegerlehner, S. N., Brown, A. D., Exadaktylos, A. K., and Srivastava, D. S. “Bad Manners In The Emergency Department: Incivility Among Doctors”. Plos One 13, no. 3: e0194933. doi:10.1371/journal.pone.0194933.
    Abstract: INTRODUCTION: Negative workplace behaviour, especially negative communication is a recognised problem in many organisations and is known to have serious impact on workplace performance, productivity and personal wellbeing. Emergency Departments (ED) can be high stress environments in which communication and perceptions of respect between physicians and other staff may underlie individual functioning. We conducted a study to estimate the influence of incivility (ICV) among physicians in the ED. METHODS: We developed an online survey to assess workplace incivility in the ED. We focussed on frequency, origin, reasons and situations where ICV was reported. To measure the levels and the potential influence of ICV on psychological safety, social stress and personal wellbeing we correlated our questionnaire to standard psychological scales. Statistical analysis included Students t-test, chi squared distribution and Pearson correlation coefficient. RESULTS: We invited all seventy-seven ED physicians to participate in our survey. Among those that completed (n = 50, 65%) the survey, 9% of ED physicians reported frequent (1/week) and 38% occasional (1/month) incidents of ICV. 28% of physicians reported experiencing ICV once per quarter and 21% reported a frequency of only once per year, no physician reported ICV on a daily basis. Levels of ICV were significantly higher in interactions with specialists from outside then within the ED (p<0.01). ICV was perceived particularly during critical situations. Our findings showed a significant correlation between internal (within the ED team) ICV and psychological safety. To ED physicians internal ICV was associated with lower levels of psychological safety (p<0.01). ICV displayed from sources outside the ED team was not associated with psychological safety, but we found a significant influence of external ICV on personal irritability and reduced wellbeing (p<0.01). DISCUSSION: The incidence of incivility was high among the ED physicians. Although this was a small sample, the association between workplace ICV and psychological safety, personal irritation as well personal comfort suggests that ICV may be an important variable underlying ED team performance. These findings further underscore the need to foster a culture of respect and good communication between departments, as levels of ICV were highest with physicians from outside the ED. Future research would benefit from examining strategies to prevent and reduce ICV and identify reasons for personal variation in perception of ICV. During critical situations and in general collaboration with specialists, awareness of ICV and countermeasures are important to avoid decreased performance and negative impact on staff and patient.
    Tags: Emergency Service, Hospital/*statistics & numerical data, Female, Humans, Incivility/*statistics & numerical data, Male, Physicians/psychology/*statistics & numerical data, Surveys and Questionnaires.
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  • Brodmann Maeder, M., Brugger, H., Pun, M., Strapazzon, G., Dal Cappello, T., Maggiorini, M., Hackett, P., Bartsch, P., Swenson, E. R., and Zafren, K. “The Star Data Reporting Guidelines For Clinical High Altitude Research”. High Alt Med Biol 19, no. 1: 7-14. doi:10.1089/ham.2017.0160.
    Abstract: Brodmann Maeder, Monika, Hermann Brugger, Matiram Pun, Giacomo Strapazzon, Tomas Dal Cappello, Marco Maggiorini, Peter Hackett, Peter Baartsch, Erik R. Swenson, Ken Zafren (STAR Core Group), and the STAR Delphi Expert Group. The STARdata reporting guidelines for clinical high altitude research. High AltMedBiol. 19:7-14, 2018. AIMS: The goal of the STAR (STrengthening Altitude Research) initiative was to produce a uniform set of key elements for research and reporting in clinical high-altitude (HA) medicine. The STAR initiative was inspired by research on treatment of cardiac arrest, in which the establishment of the Utstein Style, a uniform data reporting protocol, substantially contributed to improving data reporting and subsequently the quality of scientific evidence. MATERIALS AND METHODS: The STAR core group used the Delphi method, in which a group of experts reaches a consensus over multiple rounds using a formal method. We selected experts in the field of clinical HA medicine based on their scientific credentials and identified an initial set of parameters for evaluation by the experts. RESULTS: Of 51 experts in HA research who were identified initially, 21 experts completed both rounds. The experts identified 42 key parameters in 5 categories (setting, individual factors, acute mountain sickness and HA cerebral edema, HA pulmonary edema, and treatment) that were considered essential for research and reporting in clinical HA research. An additional 47 supplemental parameters were identified that should be reported depending on the nature of the research. CONCLUSIONS: The STAR initiative, using the Delphi method, identified a set of key parameters essential for research and reporting in clinical HA medicine.
    Tags: *Altitude, *Guidelines as Topic, Altitude Sickness/*diagnosis/*physiopathology, Biomedical Research/*standards, clinical research, Consensus, Delphi method, Delphi Technique, guidelines, high altitude, Humans, Research Design/*standards, Utstein style.
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  • Eikelboom, J. W., Kozek-Langenecker, S., Exadaktylos, A., Batorova, A., Boda, Z., Christory, F., Gornik, I., et al. “Emergency Care Of Patients Receiving Non-Vitamin K Antagonist Oral Anticoagulants”. Br J Anaesth 120, no. 4: 645-656. doi:10.1016/j.bja.2017.11.082.
    Abstract: Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associated-as any anticoagulant-with a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an update on the management of NOAC-treated patients who experience a bleeding episode or require an urgent procedure. Recent advances in the development of targeted reversal agents are expected to help streamline the management of NOAC-treated patients in whom rapid reversal of anticoagulation is required.
    Tags: Administration, Oral, anticoagulants, Anticoagulants/*adverse effects, Antithrombins/*adverse effects, coagulation monitoring, emergencies, Emergency Medical Services/*methods, haemorrhage, Hemorrhage/*chemically induced/*therapy, Humans, reversal.
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  • Simma, L., Fontana, M., and Schmitt-Mechelke, T. “Resuscitation Of A Patient With An Implanted Electronic Device”. Ann Emerg Med 71, no. 4: 467-469. doi:10.1016/j.annemergmed.2017.07.009.
    Tags: *Pacemaker, Artificial, Cardiopulmonary Resuscitation/*methods, Female, Humans, Ventricular Fibrillation/*therapy, Young Adult.
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  • Schneid Schuh, D., Campos Pellanda, L., Guessous, I., and Marques-Vidal, P. “Trends And Determinants Of Change In Compliance To Dietary Guidelines In A Swiss Community-Dwelling Sample”. Prev Med 111: 198-203. doi:10.1016/j.ypmed.2018.03.008.
    Abstract: Adherence to dietary guidelines is associated with significantly better health outcomes. Studies across the world shows that compliance with the guidelines was low, but data in Switzerland are lacking. Hence, we aimed to assess the 5-year trends in dietary compliance regarding food guidelines in Switzerland in a prospective, population-based observational study. Data from 2882 participants (1591 women, 35-75 years), from the first (2009-2012) and second (2014-2017) follow-up. Dietary intake was assessed using a validated food frequency questionnaire. Compliance with the guidelines of the Swiss society of nutrition was assessed at baseline and 5.5 years afterwards. Prevalence rates for compliance were calculated using the exact Poisson method. Factors associated with changes in compliance (never, shifter or maintainer) were assessed by multinomial logistic regression using "Never compliers" as reference. Overall, improvements in compliance to fruits (42.4% to 45.1%) vegetables (6.9% to 8.6%) and fish (66.6% to 60.5%) were found, while compliance to meat decreased (61.1% to 58.5%). The prevalence of participants complying with at least three dietary recommendations did not change (24.1% to 25.2%). During follow-up, only 11.6% of participants maintained compliance to at least three dietary recommendations, and 62.4% never managed to comply. Female gender and older age were associated with maintaining compliance during the two study periods. In conclusion, compliance with dietary guidelines is a dynamic status, and only a small fraction of the population achieves sustained compliance with at least three guidelines. Almost two thirds of the population never achieve compliance with three guidelines.
    Tags: *Feeding Behavior, *Independent Living, *Patient Compliance, Adult, Age Factors, Aged, Body Mass Index, Dietary guidelines, Epidemiology, Female, Humans, Male, Middle Aged, Nutrition Policy/*trends, Nutritional Status, Prospective Studies, Prospective study, Public health, Sex Factors, Surveys and Questionnaires, Switzerland, Switzerland/epidemiology.
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