Home > Bibliographic references

Swiss Emergency Research collection

2015

  • Maatoug, J., Sahli, J., Harrabi, I., Chouikha, F., Hmad, S., Dendana, E., Fredj, S. B., et al. “Assessment Of The Validity Of Self-Reported Smoking Status Among Schoolchildren In Sousse, Tunisia”. Int J Adolesc Med Health 28, no. 2: 211-6. doi:10.1515/ijamh-2015-0013.
    Abstract: INTRODUCTION: Tobacco use, which begins in adolescence and childhood and continues in later life, is the major avoidable risk for non-communicable diseases and death in the world. Self-reports have frequently been used to estimate smoking prevalence and health consequences. This study explores the validity of self-reports of smoking behavior among schoolchildren in Tunisia. MATERIALS AND METHODS: This study was conducted in March 2014 among a sample of 147 schoolchildren randomly selected. Data concerning the smoking habit were collected by a questionnaire designed for the purposes of this work. Then, exhaled CO, a biochemical marker of smoke exposure, was measured using piCO+ Smokerlyzer(R) breath CO monitor among participants. Sensitivity and specificity of self-reports were calculated. RESULTS: The prevalence of reported smoking was 9.5% with 16.7% and 1.7% respectively among boys and girls. Their mean age was 14.5+/-1.28 years old. When considering 4 ppm as the cut-off level of breath CO, sensitivity and specificity of self-reports were 100% and 93.7%, respectively. But at a breath CO cut-off of 3 ppm, self-reporting was 62.5% sensitive and 93.5% specific. CONCLUSION: According to our findings, we suggest that self-reports can be considered as a good tool to be used with a reasonable confidence to assess the smoking status.
    Tags: Adolescent, Biomarkers/analysis, Carbon Monoxide/analysis, Child, Female, Humans, Male, Prevalence, Schools, Self Report/*standards, Smoking/*epidemiology, Students, Surveys and Questionnaires/*standards, Tunisia/epidemiology.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Saillant, S., Hudelson, P., Dominice Dao, M., and Junod Perron, N. “The Primary Care Physician/Psychiatrist Joint Consultation: A Paradigm Shift In Caring For Patients With Mental Health Problems?”. Patient Educ Couns 99, no. 2: 279-83. doi:10.1016/j.pec.2015.08.028.
    Abstract: OBJECTIVE: Thirty to forty percent of patients seen in primary care medicine suffer from mental health problems, but primary care physicians (PCPs) often feel unprepared to deal with their patients' mental health problems. Joint consultations conducted with a liaison psychiatrist can help. The purpose of this study was to evaluate the experience of joint consultations in a primary care service in Geneva, Switzerland. METHODS: We retrospectively analyzed reports of psychiatric evaluations conducted between October 2010 and August 2012 (n=182), in the Primary Care Service of the Geneva University Hospitals. We also carried out 4 focus groups with 23 physicians-in-training to explore their experiences and perceptions of the joint consultations. RESULTS: Seventy two percent of the evaluations resulted in a psychiatric diagnosis. Psychiatric follow-up was not considered necessary in 61% of cases. Focus groups revealed that prior to experiencing joint consultations, PCPs considered mental health problems to be the domain of psychiatrists and outside their own area of competence. Joint consultations helped to demystify the role of psychiatrists, reduce their anxiety and increase PCPs' confidence in dealing with patients' mental health problems. CONCLUSION: Joint consultations enabled PCPs to shift away from a dichotomous view of somatic versus mental health problems and their management, and towards a more integrated view. IMPLICATIONS FOR PRACTICE: Joint consultations provide a useful strategy for training primary care physicians in the management of mental health problems. Integrated management of somatic and mental health problems can lead to a better understanding of the patient and improve the therapeutic relationship.
    Tags: *Cooperative Behavior, *Physicians, Primary Care, *Psychiatry, *Referral and Consultation, Adult, Female, Focus Groups, Humans, joint consultation, liaison psychiatry, Male, Mental Disorders/*therapy, Mental Health Services/organization & administration, Middle Aged, primary care, Primary Health Care/*organization & administration, Retrospective Studies, Surveys and Questionnaires, Switzerland, training primary care physicians.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Jordi, K., Grossmann, F., Gaddis, G. M., Cignacco, E., Denhaerynck, K., Schwendimann, R., and Nickel, C. H. “Nurses' Accuracy And Self-Perceived Ability Using The Emergency Severity Index Triage Tool: A Cross-Sectional Study In Four Swiss Hospitals”. Scand J Trauma Resusc Emerg Med 23, no. 1: 62. doi:10.1186/s13049-015-0142-y.
    Abstract: BACKGROUND: The Emergency Severity Index (ESI) is an English language emergency department patient triage tool. After translation, it has been adapted for use to triage patients in growing numbers of emergency departments in non-English-speaking countries. Few reports of the proficiency of triage nurses to score an ESI exist. We sought to determine accuracy, inter-rater reliability, and subjective confidence of triage nurses at four hospitals to determine an ESI from standardized ESI scenarios. METHODS: Triage nurses assigned an ESI score to each of 30 standard ESI (ESI Implementation Handbook Version 4) translated teaching case scenarios. Accuracy and Inter-rater reliability (Krippendorff's alpha) of the ESI scoring was measured. Nurses' subjective confidence applying the ESI algorithm was obtained by a Likert scale. RESULTS: Sixty-nine nurses from four EDs participated in the study. They scored 59.6 % of the case scenarios correctly. Inter-rater reliability was 0.78 (Krippendorff's alpha). Most (54/69, 78 %) felt confident in their ability to apply the ESI. CONCLUSIONS: Low accuracy of ESI score assignment was observed when nurses scored an ESI for 30 standard written case scenarios, translated into nurses' native language, despite a good inter-rater reliability and high nurse confidence in their ability to apply the ESI. Although feasible, using standard written case scenarios to determine ESI triage scoring effectiveness may not be the optimum means to rate nurses' triage skills.
    Tags: *Clinical Competence, *Severity of Illness Index, *Trauma Severity Indices, *Triage, Adult, Cross-Sectional Studies, Education, Nursing, Continuing, Emergency Nursing/*education, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Observer Variation, Surveys and Questionnaires, Switzerland.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Schuetz, P., and Mueller, B. “Procalcitonin: An Effective Screening Tool And Safe Therapeutic Decisionmaking Aid For Emergency Department Patients With Suspected Sepsis”. Ann Emerg Med 66, no. 3: 318-9. doi:10.1016/j.annemergmed.2015.03.029.
    Tags: *Emergency Service, Hospital, Biomarkers/blood, Calcitonin Gene-Related Peptide, Calcitonin/*blood, Decision Making, Humans, Protein Precursors/*blood, Sensitivity and Specificity, Sepsis/blood/*diagnosis.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Manzano, S., Holzinger, I. B., Kellenberger, C. J., Lacroix, L., Klima-Lange, D., Hersberger, M., La Scala, G., Altermatt, S., and Staubli, G. “Diagnostic Performance Of S100B Protein Serum Measurement In Detecting Intracranial Injury In Children With Mild Head Trauma”. Emerg Med J 33, no. 1: 42-6. doi:10.1136/emermed-2014-204513.
    Abstract: OBJECTIVE: To assess the accuracy of S100B serum level to detect intracranial injury in children with mild traumatic brain injury. METHODS: A multicenter prospective cohort study was carried out in the paediatric emergency departments of three tertiary hospitals in Switzerland between January 2009 and December 2011. Participants included children aged <16 years with a mild traumatic brain injury (GCS >/=13) for whom a head CT was requested by the attending physician. Venous blood was obtained within 6 h of the trauma in all children for S100B measurement before a head CT was performed. As the S100B value was not available during the acute care period, the patient's management was not altered. The main measures were protein S100B value and the CT result. RESULTS: 20/73 (27.4%) included children had an intracranial injury detected on CT. S100B receiver operating characteristics area under the curve was 0.73 (95% CI 0.60 to 0.86). With a 0.14 microg/L cut-off point, S100B reached an excellent sensitivity of 95% (95% CI 77% to 100%) and 100% (95% CI 81% to 100%) in all children and in children aged >2 years, respectively. The specificity, however, was 34% (95% CI 27% to 36%) and 37% (95% CI 30% to 37%), respectively. CONCLUSIONS: S100B has an excellent sensitivity but poor specificity. It is therefore an accurate tool to help rule out an intracranial injury but cannot be used as the sole marker owing to its specificity. Used with clinical decision rules, S100B may help to reduce the number of unnecessary CT scans.
    Tags: Adolescent, Biomarkers/blood, Brain Injuries/*blood/*diagnosis, Child, Child, Preschool, diagnosis, Emergency Service, Hospital/statistics & numerical data, Female, Glasgow Coma Scale, Humans, Infant, Male, paediatric emergency med, Predictive Value of Tests, Prospective Studies, ROC Curve, S100 Calcium Binding Protein beta Subunit/*blood, Sensitivity and Specificity, Switzerland, Tomography, X-Ray Computed, Trauma, head.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Giulieri, S., Chapuis-Taillard, C., Jaton, K., Cometta, A., Chuard, C., Hugli, O., Du Pasquier, R., et al. “Csf Lactate For Accurate Diagnosis Of Community-Acquired Bacterial Meningitis”. Eur J Clin Microbiol Infect Dis 34, no. 10: 2049-55. doi:10.1007/s10096-015-2450-6.
    Abstract: CSF lactate measurement is recommended when nosocomial meningitis is suspected, but its value in community-acquired bacterial meningitis is controversial. We evaluated the diagnostic performance of lactate and other CSF parameters in a prospective cohort of adult patients with acute meningitis. Diagnostic accuracy of lactate and other CSF parameters in patients with microbiologically documented episodes was assessed by receiver operating characteristic (ROC) curves. The cut-offs with the best diagnostic performance were determined. Forty-five of 61 patients (74%) had a documented bacterial (n = 18; S. pneumoniae, 11; N. meningitidis, 5; other, 2) or viral (n = 27 enterovirus, 21; VZV, 3; other, 3) etiology. CSF parameters were significantly different in bacterial vs. viral meningitis, respectively (p < 0.001 for all comparisons): white cell count (median 1333 vs. 143/mm(3)), proteins (median 4115 vs. 829 mg/l), CSF/blood glucose ratio (median 0.1 vs. 0.52), lactate (median 13 vs. 2.3 mmol/l). ROC curve analysis showed that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5 mmol/l providing 100% sensitivity, specificity, PPV, NPV, and efficiency. CSF lactate had the best accuracy for discriminating bacterial from viral meningitis and should be included in the initial diagnostic workup of this condition.
    Tags: Adolescent, Adult, Aged, Aged, 80 and over, Cohort Studies, Cross Infection/*diagnosis, Female, Humans, Lactic Acid/*blood, Male, Meningitis, Bacterial/*blood/*diagnosis, Meningitis, Viral/*blood/*diagnosis, Middle Aged, Prospective Studies, Receptors, Colony-Stimulating Factor/*blood, Sensitivity and Specificity, Switzerland, Young Adult.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Dorribo, V., Lazor-Blanchet, C., Hugli, O., and Zanetti, G. “Health Care Workers' Influenza Vaccination: Motivations And Mandatory Mask Policy”. Occup Med (Lond) 65, no. 9: 739-45. doi:10.1093/occmed/kqv116.
    Abstract: BACKGROUND: Vaccination of health care workers (HCW) against seasonal influenza (SI) is recommended but vaccination rate rarely reach >30%. Vaccination coverage against 2009 pandemic influenza (PI) was 52% in our hospital, whilst a new policy requiring unvaccinated HCW to wear a mask during patient care duties was enforced. AIMS: To investigate the determinants of this higher vaccination acceptance for PI and to look for an association with the new mask-wearing policy. METHODS: A retrospective cohort study, involving HCW of three critical departments of a 1023-bed, tertiary-care university hospital in Switzerland. Self-reported 2009-10 SI and 2009 PI vaccination statuses, reasons and demographic data were collected through a literature-based questionnaire. Descriptive statistics, uni- and multivariate analyses were then performed. RESULTS: There were 472 respondents with a response rate of 54%. Self-reported vaccination acceptance was 64% for PI and 53% for SI. PI vaccination acceptance was associated with being vaccinated against SI (OR 9.5; 95% CI 5.5-16.4), being a physician (OR 7.7; 95% CI 3.1-19.1) and feeling uncomfortable wearing a mask (OR 1.7; 95% CI 1.0-2.8). Main motives for refusing vaccination were: preference for wearing a surgical mask (80% for PI, not applicable for SI) and concerns about vaccine safety (64%, 50%) and efficacy (44%, 35%). CONCLUSIONS: The new mask-wearing policy was a motivation for vaccination but also offered an alternative to non-compliant HCW. Concerns about vaccine safety and efficiency and self-interest of health care workers are still main determinants for influenza vaccination acceptance. Better incentives are needed to encourage vaccination amongst non-physician HCW.
    Tags: *Hospitals, *Influenza Vaccines, *Vaccination, Adult, Attitude of Health Personnel, Female, Health care workers, Health Personnel/*statistics & numerical data, Health Policy, Humans, Influenza, Human/*prevention & control/transmission, Male, Masks/*statistics & numerical data, microbiological hazards, Motivation, Occupational Diseases/epidemiology/*prevention & control, Occupational Exposure/*prevention & control/statistics & numerical data, occupational health policy, Pandemics/*prevention & control, Retrospective Studies, risk management, Surveys and Questionnaires, Switzerland/epidemiology, vaccination, workplace health promotion..
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Baggio, S., Iglesias, K., Hugli, O., Burnand, B., Ruggeri, O., Wasserfallen, J. B., Moschetti, K., et al. “Associations Between Perceived Discrimination And Health Status Among Frequent Emergency Department Users”. Eur J Emerg Med 24, no. 2: 136-141. doi:10.1097/MEJ.0000000000000311.
    Abstract: OBJECTIVE: Frequent Emergency Department (ED) users are vulnerable individuals and discrimination is usually associated with increased vulnerability. The aim of this study was to investigate frequent ED users' perceptions of discrimination and to test whether they were associated with increased vulnerability. METHODS: In total, 250 adult frequent ED users were interviewed in Lausanne University Hospital. From a previously published questionnaire, we assessed 15 dichotomous sources of perceived discrimination. Vulnerability was assessed using health status: objective health status (evaluation by a healthcare practitioner including somatic, mental health, behavioral, and social issues - dichotomous variables) and subjective health status [self-evaluation including health-related quality of life (WHOQOL) and quality of life (EUROQOL) - mean-scores]. We computed the prevalence rates of perceived discrimination and tested associations between perceived discrimination and health status (Fischer's exact tests, Mann-Whitney U-tests). RESULTS: A total of 35.2% of the frequent ED users surveyed reported at least one source of perceived discrimination. Objective health status was not significantly related to perceived discrimination. In contrast, experiencing perceived discrimination was associated with worse subjective health status (P<0.001). CONCLUSION: Frequent ED users are highly likely to report perceived discrimination during ED use, and this was linked to a decrease in their own rating of their health. Hence, discrimination should be taken into account when providing care to such users as it may constitute an additional risk factor for this vulnerable population. Perceived discrimination may also be of concern to professionals seeking to improve practices and provide optimal care to frequent ED users.
    Tags: Emergency Service, Hospital/*statistics & numerical data, Female, Health Status, Humans, Male, Middle Aged, Prejudice/*psychology/statistics & numerical data, Socioeconomic Factors, Surveys and Questionnaires.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Haller, D. M., Meynard, A., Lefebvre, D., Hasselgard-Rowe, J., Broers, B., and Narring, F. “Excessive Substance Use Among Young People Consulting Family Doctors: A Cross-Sectional Study”. Fam Pract 32, no. 5: 500-4. doi:10.1093/fampra/cmv058.
    Abstract: BACKGROUND: Family doctors can only play a role in the prevention of excessive substance use in young people if those affected are seen in the practice. OBJECTIVE: To describe the prevalence of excessive substance use among young people consulting family doctors in a European context. METHODS: As part of a trial of an intervention addressing substance use we collected data from young people consulting 32 family doctors in the French-speaking part of Switzerland. Before the consultation, consecutive patients aged 15-24 years completed a self-administered questionnaire on their general health and substance use. Outcomes were excessive alcohol (defined as >/=1 episode of binge drinking), excessive cannabis (use >/=1/week), regular tobacco (>/=1 cigarettes a day) and/or any other substance use in the past 30 days. Prevalence data were computed with 95% confidence intervals (CIs) adjusted for clustering within practices, stratified by age and gender. RESULTS: Between February 2009 and November 2010, 636 patients were eligible. Participation rate was 93.4% (n=594, 53% female). The prevalence of excessive use in the past 30 days was alcohol 44.9% (95% CI: 37.8-52.1), cannabis 11.1% (95% CI: 8.0-14.1), tobacco 23.4% (95% CI: 19.0-28.1) and any other drug 2.6 (95% CI: 1.4-4.2). Excessive use was higher in males than in females. Except for tobacco prevalence of excessive use was only slightly higher in young adults compared to adolescents. CONCLUSION: Excessive substance use is frequent among young people consulting family doctors in a European context. Future research should provide guidance about how to best seize this window of opportunity for prevention and early intervention.
    Tags: Adolescent, Age Factors, binge drinking, Binge Drinking/*epidemiology, Cross-Sectional Studies, family practice, Family Practice/*statistics & numerical data, Female, Health Surveys, Humans, Male, Marijuana Abuse/*epidemiology, marijuana smoking, Prevalence, Sex Factors, Smoking/*epidemiology, Switzerland/epidemiology, tobacco use., Young Adult.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Haider, D. G., Lindner, G., Wolzt, M., Ahmad, S. S., Sauter, T., Leichtle, A. B., Fiedler, G. M., Fuhrmann, V., and Exadaktylos, A. K. “Hyperphosphatemia Is An Independent Risk Factor For Mortality In Critically Ill Patients: Results From A Cross-Sectional Study”. Plos One 10, no. 8: e0133426. doi:10.1371/journal.pone.0133426.
    Abstract: BACKGROUND: Phosphate imbalances or disorders have a high risk of morbidity and mortality in patients with chronic kidney disease. It is unknown if this finding extends to mortality in patients presenting at an emergency room with or without normal kidney function. METHODS AND PATIENTS: This cross sectional analysis included all emergency room patients between 2010 and 2011 at the Inselspital Bern, Switzerland. A multivariable cox regression model was applied to assess the association between phosphate levels and in-hospital mortality up to 28 days. RESULTS: 22,239 subjects were screened for the study. Plasma phosphate concentrations were measured in 2,390 patients on hospital admission and were included in the analysis. 3.5% of the 480 patients with hypophosphatemia and 10.7% of the 215 patients with hyperphosphatemia died. In univariate analysis, phosphate levels were associated with mortality, age, diuretic therapy and kidney function (all p<0.001). In a multivariate Cox regression model, hyperphosphatemia (OR 3.29, p<0.001) was a strong independent risk factor for mortality. Hypophosphatemia was not associated with mortality (p>0.05). CONCLUSION: Hyperphosphatemia is associated with 28-day in-hospital mortality in an unselected cohort of patients presenting in an emergency room.
    Tags: Adult, Aged, Critical Illness/*mortality, Cross-Sectional Studies, Female, Hospital Mortality, Hospitalization, Humans, Hyperphosphatemia/*complications/*mortality, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Risk Factors.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Hupin, D., Roche, F., Gremeaux, V., Chatard, J. C., Oriol, M., Gaspoz, J. M., Barthelemy, J. C., and Edouard, P. “Even A Low-Dose Of Moderate-To-Vigorous Physical Activity Reduces Mortality By 22% In Adults Aged ≫/=60 Years: A Systematic Review And Meta-Analysis”. Br J Sports Med 49, no. 19: 1262-7. doi:10.1136/bjsports-2014-094306.
    Abstract: BACKGROUND: The health benefits of 150 min a week of moderate-to-vigorous-intensity physical activity (MVPA) in older adults, as currently recommended, are well established, but the suggested dose in older adults is often not reached. OBJECTIVES: We aimed to determine whether a lower dose of MVPA was effective in reducing mortality, in participants older than 60 years. METHODS: The PubMed and Embase databases were searched from inception to February 2015. Only prospective cohorts were included. Risk ratios of death were established into four doses based on weekly Metabolic Equivalent of Task (MET)-minutes, defined as inactive (reference), low (1-499), medium (500-999) or high (>/=1000). Data were pooled and analysed through a random effects model using comprehensive meta-analysis software. RESULTS: Of the 835 reports screened, nine cohort studies remained, totalling 122 417 participants, with a mean follow-up of 9.8+/-2.7 years and 18 122 reported deaths (14.8%). A low dose of MVPA resulted in a 22% reduction in mortality risk (RR=0.78 (95% CI 0.71 to 0.87) p<0.0001). MVPA beyond this threshold brought further benefits, reaching a 28% reduction in all-cause mortality in older adults who followed the current recommendations (RR=0.72 (95% CI 0.65 to 0.80) p<0.0001) and a 35% reduction beyond 1000 MET-min per week (RR=0.65 (95% CI 0.61 to 0.70) p<0.0001). CONCLUSIONS: A dose of MVPA below current recommendations reduced mortality by 22% in older adults. A further increase in physical activity dose improved these benefits in a linear fashion. Older adults should be encouraged to include even low doses of MVPA in their daily lives.
    Tags: *Mortality, Aged, Elderly people, Exercise/*physiology, Female, Health Behavior, Health promotion, Humans, Male, Meta-analysis, Middle Aged, Physical activity, Public health, Risk Factors.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Rohacek, M., and Baddour, L. M. “Cardiovascular Implantable Electronic Device Infections: Associated Risk Factors And Prevention”. Swiss Med Wkly 145: w14157. doi:10.4414/smw.2015.14157.
    Abstract: Infections of cardiovascular implantable electric devices (CIED) are a burden on patients and healthcare systems and should be prevented. The most frequent pathogens are coagulase-negative staphylococci and Staphylococcus aureus. The most important risk factors for CIED infections are diabetes mellitus, renal and heart failure, corticosteroid use, oral anticoagulation, fever within 24 hours before the procedure and leucocytosis, implantable cardioverter defibrillator compared with pacemaker, especially in the case of Staphylococcus aureus bacteraemia, lack of antibiotic prophylaxis, and postoperative haematoma and other wound complications. Other important risk factors are history of prior procedures and previous CIED infections, number of leads, use of povidone-iodine compared with chlorhexidine-alcohol, and centres and operators with a low volume of implants. To prevent CIED infections, patients undergoing CIED procedures and appropriate devices should be carefully selected, and interventions should be performed by trained operators. Antibiotic prophylaxis should be administered, and skin antisepsis should be done with chlorhexidine-alcohol. Oral anticoagulation should be continued during CIED procedures in high-risk patients for thromboembolism, instead of bridging with heparin. Early reintervention in cases of haematoma or lead dislodgement should be avoided. The implementation of infection prevention programmes reduces infection rates. More randomised controlled studies are needed to evaluate prevention strategies, especially skin preparation and antibiotic prophylaxis with glycopeptides.
    Tags: Age Factors, Antibiotic Prophylaxis/methods, Cardiovascular Diseases/*therapy, Comorbidity, Defibrillators, Implantable/*microbiology, Humans, Infection Control/methods, Pacemaker, Artificial/*microbiology, Postoperative Complications/*epidemiology/microbiology/prevention & control, Retrospective Studies, Risk Factors, Sex Factors, Staphylococcal Infections/epidemiology/prevention & control, Staphylococcus aureus.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Beun, L., Yersin, B., Osterwalder, J., and Carron, P. N. “Pulseless Electrical Activity Cardiac Arrest: Time To Amend The Mnemonic "4H&Amp;4T"?”. Swiss Med Wkly 145: w14178. doi:10.4414/smw.2015.14178.
    Abstract: BACKGROUND: Pulseless electrical activity (PEA) cardiac arrest is characterised by a residual organised electrical activity. PEA is frequently induced by reversible conditions. The mnemonic "4H&4T" was proposed as a reminder to assess for Hypoxia, Hypovolaemia, Hypo/Hyperkalaemia, Hypothermia, Thrombosis, cardiac Tamponade, Toxins, and Tension pneumothorax. Other potential aetiologies have been identified, but their respective probability and frequencies are unclear. The aim of this study was to analyse the aetiologies of PEA out-of-hospital cardiac arrests and to evaluate their relative frequencies. METHODS: This was a retrospective study based on data routinely and prospectively collected. All adult patients with PEA as the first recorded rhythm and admitted between 2002 and 2012 to the emergency department (ED) after return of spontaneous circulation or under resuscitation were included. RESULTS: A total of 1,866 out-of-hospital cardiac arrests were included. PEA was the first recorded rhythm in 232 adult patients (12.4%) and 144 of these were admitted to the ED. The mean age was 63.8 +/- 20.0 years, 58.3% were men. The survival rate at 48 hours was 29%. Hypoxia (23.6%), acute coronary syndrome (12.5%) and trauma (12.5%) were the most frequent causes. We were unable to identify a specific cause in 17.4%. Pulmonary embolism, hypovolaemia, intoxication and hypo/hyperkalaemia occurred in fewer than 10% of the cases. Nonischaemic cardiac disorders and intracranial haemorrhage occurred in 8.3% and 6.9%, respectively. CONCLUSIONS: Intracranial haemorrhage and nonischaemic cardiac disorders represent significant causes of PEA, with a prevalence equalling or exceeding the frequency of classical 4H&4T aetiologies. These conditions are potentially accessible to simple diagnostic procedures (computed tomography or echocardiography).
    Tags: *Algorithms, Adult, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Hospitals, University, Humans, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/*classification/diagnosis/*etiology, Retrospective Studies, Survival Analysis.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Kleim, B., Bingisser, M. B., Westphal, M., and Bingisser, R. “Frozen Moments: Flashback Memories Of Critical Incidents In Emergency Personnel”. Brain Behav 5, no. 7: e00325. doi:10.1002/brb3.325.
    Abstract: BACKGROUND: Emergency Department personnel regularly face highly stressful situations or critical incidents (CIs) that may subsequently be recalled as unbidden intrusive memories. In their most extreme form, such memories are reexperienced as if they were happening again in the present, as flashbacks. This study examined (1) which CIs are associated with flashback memories; (2) candidate person and work-related features that predict flashback memories; and (3) the association between flashback memories and anxiety, depression, and emotional exhaustion. METHODS: Emergency nurses (N = 91; 80.2% female) were recruited from two urban teaching hospitals and filled in self-report questionnaires. RESULTS: A majority (n = 59, 65%) experienced intrusive memories; almost half of the sample reported that their memories had flashback character. Those involved in resuscitations in the past week were at a fourfold risk for experiencing flashbacks. Having worked more consecutive days without taking time off was associated with a somewhat lower incidence of flashbacks. Moreover, older individuals who reported more work-related conflicts were at greater risk for experiencing flashback memories than their younger colleagues with heightened work conflict and flashback memory scores, respectively. Flashback memories were associated with heightened symptoms of anxiety, depression, and emotional exhaustion. CONCLUSIONS: The present findings have implications for evidence-based health promotion in emergency personnel and other individuals regularly exposed to CIs.
    Tags: *Emergency Medical Services, *Memory, Adult, Age Factors, Anxiety, burnout, Conflict, Psychological, Depression, emergency department, emotional memory, Fatigue, Female, flashback, Hospitals, Teaching, Humans, intrusion, Male, Nurses/*psychology, Self Report, Surveys and Questionnaires, Urban Population.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • van der Steen, J. T., Sampson, E. L., Van den Block, L., Lord, K., Vankova, H., Pautex, S., Vandervoort, A., et al. “Tools To Assess Pain Or Lack Of Comfort In Dementia: A Content Analysis”. J Pain Symptom Manage 50, no. 5: 659-75 e3. doi:10.1016/j.jpainsymman.2015.05.015.
    Abstract: CONTEXT: There is need for tools to help detect pain or lack of comfort in persons unable to communicate. However, pain and (dis)comfort tools have not been compared, and it is unclear to what extent they discriminate between pain and other possible sources of discomfort, or even if items differ. OBJECTIVES: To map and compare items in tools that assess pain and the broader notion of discomfort or comfort in people with severe dementia or at the end of life. METHODS: Using qualitative content analysis with six classifications, we categorized each item of four thoroughly tested observational pain tools (Pain Assessment in Advanced Dementia [PAINAD], Pain Assessment Checklist for Seniors with Limited Ability to Communicate [PACSLAC], Doloplus-2, and draft Pain Assessment in Impaired Cognition [PAIC]), and four discomfort tools (including distress, comfort, and quality of life in severe dementia or at the end of life; Discomfort Scale-Dementia Alzheimer Type [DS-DAT], Disability Distress Assessment Tool [DisDAT], End-of-Life in Dementia-Comfort Assessment in Dying with Dementia [EOLD-CAD], and Quality of Life in Late-Stage Dementia [QUALID] scale). We calculated median proportions to compare distributions of categories of pain and discomfort tools. RESULTS: We found that, despite variable content across tools, items from pain and discomfort tools overlapped considerably. For example, positive elements such as smiling and spiritual items were more often included in discomfort tools but were not unique to these. Pain tools comprised more "mostly descriptive" (median 0.63 vs. 0.44) and fewer "highly subjective" items (0.06 vs. 0.18); some used time inconsistently, mixing present and past observations. CONCLUSION: This analysis may inform a more rigorous theoretical underpinning and (re)development of pain and discomfort tools and calls for empirical testing of a broad item pool for sensitivity and specificity in detecting and discriminating pain from other sources of discomfort.
    Tags: *Pain Measurement, Dementia, Dementia/*diagnosis/physiopathology, Evidence-Based Practice/methods, Humans, pain measurement, Pain/*diagnosis/physiopathology, palliative care, Palliative Care/methods, Quality of Life, symptom assessment, Symptom Assessment/*methods.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Bruck, K., Jager, K. J., Dounousi, E., Kainz, A., Nitsch, D., Arnlov, J., Rothenbacher, D., et al. “Methodology Used In Studies Reporting Chronic Kidney Disease Prevalence: A Systematic Literature Review”. Nephrol Dial Transplant 30 Suppl 4, no. Suppl 4: iv6-16. doi:10.1093/ndt/gfv131.
    Abstract: BACKGROUND: Many publications report the prevalence of chronic kidney disease (CKD) in the general population. Comparisons across studies are hampered as CKD prevalence estimations are influenced by study population characteristics and laboratory methods. METHODS: For this systematic review, two researchers independently searched PubMed, MEDLINE and EMBASE to identify all original research articles that were published between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European adult general population. Data on study methodology and reporting of CKD prevalence results were independently extracted by two researchers. RESULTS: We identified 82 eligible publications and included 48 publications of individual studies for the data extraction. There was considerable variation in population sample selection. The majority of studies did not report the sampling frame used, and the response ranged from 10 to 87%. With regard to the assessment of kidney function, 67% used a Jaffe assay, whereas 13% used the enzymatic assay for creatinine determination. Isotope dilution mass spectrometry calibration was used in 29%. The CKD-EPI (52%) and MDRD (75%) equations were most often used to estimate glomerular filtration rate (GFR). CKD was defined as estimated GFR (eGFR) <60 mL/min/1.73 m(2) in 92% of studies. Urinary markers of CKD were assessed in 60% of the studies. CKD prevalence was reported by sex and age strata in 54 and 50% of the studies, respectively. In publications with a primary objective of reporting CKD prevalence, 39% reported a 95% confidence interval. CONCLUSIONS: The findings from this systematic review showed considerable variation in methods for sampling the general population and assessment of kidney function across studies reporting CKD prevalence. These results are utilized to provide recommendations to help optimize both the design and the reporting of future CKD prevalence studies, which will enhance comparability of study results.
    Tags: *Glomerular Filtration Rate, *Sampling Studies, Adult, Biomarkers/*analysis, Calibration, Ckd, CKD-EPI equation, epidemiology, Europe/epidemiology, Humans, Mdrd, Prevalence, Renal Insufficiency, Chronic/*epidemiology/*physiopathology, systematic review.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Alwan, H., Ehret, G., Ponte, B., Pruijm, M., Ackermann, D., Guessous, I., Staessen, J. A., et al. “Heritability Of Ambulatory And Office Blood Pressure In The Swiss Population”. J Hypertens 33, no. 10: 2061-7. doi:10.1097/HJH.0000000000000681.
    Abstract: BACKGROUND: Blood pressure (BP) is known to aggregate in families. Yet, heritability estimates are population-specific and no Swiss data have been published so far. We estimated the heritability of ambulatory and office BP in a Swiss population-based sample. METHODS: The Swiss Kidney Project on Genes in Hypertension is a population-based family study focusing on BP genetics. Office and ambulatory BP were measured in 1009 individuals from 271 nuclear families. Heritability was estimated for SBP, DBP, and pulse pressure using a maximum likelihood method implanted in the Statistical Analysis in Genetic Epidemiology software. RESULTS: The 518 women and 491 men included in this analysis had a mean (+/-SD) age of 48.3 (+/-17.4) and 47.3 (+/-17.7) years, and a mean BMI of 23.8 (+/-4.2) and 25.9 (+/-4.1) kg/m, respectively. Narrow-sense heritability estimates (+/-standard error) for ambulatory SBP, DBP, and pulse pressure were 0.37 +/- 0.07, 0.26 +/- 0.07, and 0.29 +/- 0.07 for 24-h BP; 0.39 +/- 0.07, 0.28 +/- 0.07, and 0.27 +/- 0.07 for day BP; and 0.25 +/- 0.07, 0.20 +/- 0.07, and 0.30 +/- 0.07 for night BP, respectively (all P < 0.001). Heritability estimates for office SBP, DBP, and pulse pressure were 0.21 +/- 0.08, 0.25 +/- 0.08, and 0.18 +/- 0.07 (all P < 0.01). CONCLUSIONS: We found significant heritability estimates for both ambulatory and office BP in this Swiss population-based study. Our findings justify the ongoing search for the genetic determinants of BP.
    Tags: *Hypertension/epidemiology/genetics, Adult, Blood Pressure Determination, Blood Pressure/*genetics, Female, Humans, Male, Middle Aged, Switzerland/epidemiology, White Coat Hypertension/epidemiology/genetics.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Hirzel, C., Nueesch, S., Wendland, T., and Langer, R. “Necrotizing Herpes-Simplex Virus Tonsillitis Mimicking Peritonsillar Abscess”. Infection 44, no. 2: 267-8. doi:10.1007/s15010-015-0823-5.
    Tags: Female, Herpes Simplex/*diagnosis/*pathology, Histocytochemistry, Humans, Immunohistochemistry, Microscopy, Middle Aged, Neck/diagnostic imaging, Peritonsillar Abscess/*pathology, Simplexvirus/*isolation & purification, Tomography, X-Ray Computed, Tonsillitis/*diagnosis/*pathology.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Anderson de la Llana, R., Dubois-Ferriere, V., Maggio, A., Cherkaoui, A., Manzano, S., Renzi, G., Hibbs, J., Schrenzel, J., and Ceroni, D. “Oropharyngeal Kingella Kingae Carriage In Children: Characteristics And Correlation With Osteoarticular Infections”. Pediatr Res 78, no. 5: 574-9. doi:10.1038/pr.2015.133.
    Abstract: BACKGROUND: The aim of this study was to investigate changes in oropharyngeal K. kingae carriage during the first 4 y of life, including seasonal variation and comparison of asymptomatic carriage with cases of invasive osteoarticular infections (OAI). METHODS: Oropharyngeal bacterial K. kingae carriage was screened in 744 healthy children aged 7-48 mo between January 2009 and December 2012. Oropharyngeal swabs were analyzed by rt-PCR targeting the DNA of K. kingae RTX toxin, epidemiological characteristics of asymptomatic carriers and OAI case patients were recorded. RESULTS: The carriage prevalence showed no significant difference between age groups or seasons. Compared with asymptomatic carriers, OAI cases were more likely to be aged from 7 to 12 mo (OR = 2.5; 95% CI (1.2-5.0)) and 13-24 mo (OR = 2.2; 95% CI (1.2-3.9)), and less likely over 36 mo (OR = 0.2; 95% CI (0.1-0.7)). Fewer OAI cases were identified in spring compared to asymptomatic carriers (OR = 0.3; 95% CI (0.1-0.7)), while more were detected in autumn (OR = 2.5; 95% CI (1.4-4.4)). CONCLUSION: Although oropharyngeal K. kingae colonization is a prerequisite for further invasive infection, this epidemiological study emphasizes that the carriage rate variations do not correlate with the variations of OAI incidence by gender, season, or age group.
    Tags: Age Distribution, Age Factors, Asymptomatic Diseases, Bacterial Typing Techniques/methods, Bone Diseases, Infectious/diagnosis/epidemiology/*microbiology, Case-Control Studies, Child, Preschool, DNA, Bacterial/genetics, Female, Humans, Incidence, Infant, Kingella kingae/genetics/*isolation & purification, Male, Neisseriaceae Infections/diagnosis/epidemiology/*microbiology, Odds Ratio, Oropharynx/*microbiology, Prevalence, Prospective Studies, Real-Time Polymerase Chain Reaction, Risk Factors, Seasons, Sex Distribution, Sex Factors, Switzerland/epidemiology, Time Factors.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Richoz, B., Hugli, O., Dami, F., Carron, P. N., Faouzi, M., and Michel, P. “Acute Stroke Chameleons In A University Hospital: Risk Factors, Circumstances, And Outcomes”. Neurology 85, no. 6: 505-11. doi:10.1212/WNL.0000000000001830.
    Abstract: OBJECTIVE: To identify risk factors, circumstances, and outcomes for individuals with acute ischemic stroke (AIS) chameleons (AIS-C) arriving in the emergency department of a university hospital. METHODS: We retrospectively reviewed all patients with AIS from the prospectively constructed Acute Stroke Registry and Analysis of Lausanne during 8.25 years. AIS-C were defined as a failure to suspect stroke or as incorrect exclusion of stroke diagnosis. They were compared with patients diagnosed correctly at the time of admission. RESULTS: Forty-seven of 2,200 AIS were missed (2.1%). These AIS-C were either very mild or very severe strokes. Multivariate analysis showed a younger age in patients with AIS-C (odds ratio [OR] per year 0.98, p < 0.01), less prestroke statin treatment (OR 0.29, p = 0.04), and lower diastolic admission blood pressure (OR 0.98 p = 0.04). They showed less eye deviation (OR 0.21, p = 0.04) and more cerebellar strokes (OR 3.78, p < 0.01). AIS-C were misdiagnosed as other neurologic (42.6% of cases) or nonneurologic (17.0%) disease, as unexplained decreased level of consciousness (21.3%), and as concomitantly present disease (19.1%). At 12 months, patients with AIS-C had less favorable outcomes (adjusted OR 0.21, p < 0.01) and higher mortality (adjusted OR 4.37, p < 0.01). CONCLUSIONS: AIS are missed in patients with younger age with a lower cerebrovascular risk profile and may be masked by other acute conditions. Patients with chameleons present more often with milder strokes or coma, fewer focal signs and cerebellar strokes, and have higher disability and mortality rates at 12 months. These findings may be used to raise awareness in emergency departments to recognize and treat such patients appropriately.
    Tags: *Treatment Outcome, Adult, Age Factors, Aged, Aged, 80 and over, Analysis of Variance, Disability Evaluation, Emergency Service, Hospital, Female, Hospitals, University/*statistics & numerical data, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Registries, Retrospective Studies, Risk Factors, Stroke/*diagnosis/epidemiology/physiopathology/*therapy.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Marques-Vidal, P., Vollenweider, P., Guessous, I., Henry, H., Boulat, O., Waeber, G., and Jornayvaz, F. R. “Serum Vitamin D Concentrations Are Not Associated With Insulin Resistance In Swiss Adults”. J Nutr 145, no. 9: 2117-22. doi:10.3945/jn.115.211763.
    Abstract: BACKGROUND: Low vitamin D status has been associated with an increased risk of developing type 2 diabetes and insulin resistance (IR), although this has been recently questioned. OBJECTIVE: We examined the association between serum vitamin D metabolites and incident IR. METHODS: This was a prospective, population-based study derived from the CoLaus (Cohorte Lausannoise) study including 3856 participants (aged 51.2 +/- 10.4 y; 2217 women) free from diabetes or IR at baseline. IR was defined as a homeostasis model assessment (HOMA) index >2.6. Fasting plasma insulin and glucose were measured at baseline and at follow-up to calculate the HOMA index. The association of vitamin D metabolites with incident IR was analyzed by logistic regression, and the results were expressed for each independent variable as ORs and 95% CIs. RESULTS: During the 5.5-y follow-up, 649 (16.9%) incident cases of IR were identified. Participants who developed IR had lower baseline serum concentrations of 25-hydroxyvitamin D3 [25(OH)D3 (25-hydroxycholecalciferol); 45.9 +/- 22.8 vs. 49.9 +/- 22.6 nmol/L; P < 0.001], total 25(OH)D3 (25(OH)D3 + epi-25-hydroxyvitamin D3 [3-epi-25(OH)D3]; 49.1 +/- 24.3 vs. 53.3 +/- 24.1 nmol/L; P < 0.001), and 3-epi-25(OH)D3 (4.2 +/- 2.9 vs. 4.3 +/- 2.5 nmol/L; P = 0.01) but a higher 3-epi- to total 25(OH)D3 ratio (0.09 +/- 0.05 vs. 0.08 +/- 0.04; P = 0.007). Multivariable analysis adjusting for month of sampling, age, and sex showed an inverse association between 25(OH)D3 and the likelihood of developing IR [ORs (95% CIs): 0.86 (0.68, 1.09), 0.60 (0.46, 0.78), and 0.57 (0.43, 0.75) for the second, third, and fourth quartiles compared with the first 25(OH)D3 quartile; P-trend < 0.001]. Similar associations were found between total 25(OH)D3 and incident IR. There was no significant association between 3-epi-25(OH)D3 and IR, yet a positive association was observed between the 3-epi- to total 25(OH)D3 ratio and incident IR. Further adjustment for body mass index, sedentary status, and smoking attenuated the association between 25(OH)D3, total 25(OH)D3, and the 3-epi- to total 25(OH)D3 ratio and the likelihood of developing IR. CONCLUSION: In the CoLaus study in healthy adults, the risk of incident IR is not associated with serum concentrations of 25(OH)D3 and total 25(OH)D3.
    Tags: *Insulin Resistance, Adult, Blood Glucose/metabolism, Body Mass Index, Calcifediol/*blood, Diabetes Mellitus, Type 2/blood/*epidemiology, Female, Follow-Up Studies, Homa, Humans, insulin resistance, Insulin/blood, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prevalence, Prospective Studies, prospective study, Switzerland/epidemiology, type 2 diabetes, vitamin D, Vitamin D Deficiency/*blood/*epidemiology.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Sauter, T. C., Lindner, G., Ahmad, S. S., Leichtle, A. B., Fiedler, G. M., Exadaktylos, A. K., and Haider, D. G. “Calcium Disorders In The Emergency Department: Independent Risk Factors For Mortality”. Plos One 10, no. 7: e0132788. doi:10.1371/journal.pone.0132788.
    Abstract: BACKGROUND: Calcium disorders are common in both intensive care units and in patients with chronic kidney disease and are associated with increased morbidity and mortality. It is unknown whether calcium abnormalities in unselected emergency department admissions have an impact on in-hospital mortality. METHODS: This cross-sectional analysis included all admissions to the Emergency Department at the Inselspital Bern, Switzerland from 2010 to 2011. For hyper- and hypocalcaemic patients with a Mann-Whitney U-test, the differences between subgroups divided by age, length of hospital stay, creatinine, sodium, chloride, phosphate, potassium and magnesium were compared. Associations between calcium disorders and 28-day in-hospital mortality were assessed using the Cox proportional hazard regression model. RESULTS: 8,270 patients with calcium measurements were included in our study. Overall 264 (3.2%) patients died. 150 patients (6.13%) with hypocalcaemia and 7 patients with hypercalcaemia (6.19%) died, in contrast to 104 normocalcaemic patients (1.82%). In univariate analysis, calcium serum levels were associated with sex, mortality and pre-existing diuretic therapy (all p<0.05). In multivariate Cox regression analysis, hypocalcaemia and hypercalcaemia were independent risk factors for mortality (HR 2.00 and HR 1.88, respectively; both p<0.01). CONCLUSION: Both hypocalcaemia and hypercalcaemia are associated with increased 28-day in-hospital mortality in unselected emergency department admissions.
    Tags: Calcium/*metabolism, Chlorides/metabolism, Creatinine/metabolism, Cross-Sectional Studies, Emergency Service, Hospital, Female, Hospital Mortality, Humans, Hypercalcemia/*complications/metabolism, Hypocalcemia/*complications/metabolism, Intensive Care Units, Length of Stay, Magnesium/metabolism, Male, Middle Aged, Potassium/metabolism, Proportional Hazards Models, Risk Factors, Sodium/metabolism, Switzerland.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Pont, J., Stover, H., Getaz, L., Casillas, A., and Wolff, H. “Prevention Of Violence In Prison - The Role Of Health Care Professionals”. J Forensic Leg Med 34: 127-32. doi:10.1016/j.jflm.2015.05.014.
    Abstract: The World Health Organization (WHO) classifies violence prevention as a public health priority. In custodial settings, where violence is problematic, administrators and custodial officials are usually tasked with the duty of addressing this complicated issue-leaving health care professionals largely out of a discussion and problem-solving process that should ideally be multidisciplinary in approach. Health care professionals who care for prisoners are in a unique position to help identify and prevent violence, given their knowledge about health and violence, and because of the impartial position they must sustain in the prison environment in upholding professional ethics. Thus, health care professionals working in prisons should be charged with leading violence prevention efforts in custodial settings. In addition to screening for violence and detecting violent events upon prison admission, health care professionals in prison must work towards uniform in-house procedures for longitudinal and systemized medical recording/documentation of violence. These efforts will benefit the future planning, implementation, and evaluation of focused strategies for violence prevention in prisoner populations.
    Tags: *Health Personnel, *Prisoners, *Prisons, *Professional Role, Documentation, Harm reduction, Health care professional duty, Humans, Medical ethics, Medical History Taking, Prevention, Prison violence, Violence/*prevention & control.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Carron, P. N., Pantet, R., Pasquier, M., and Hugli, O. “Mechanical Chest Compression In The Paramedic Trial”. Lancet 386, no. 9988: 26. doi:10.1016/S0140-6736(15)61196-5.
    Tags: Cardiopulmonary Resuscitation/*methods, Female, Humans, Male, Out-of-Hospital Cardiac Arrest/*therapy.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Fedewa, S. A., Cullati, S., Bouchardy, C., Welle, I., Burton-Jeangros, C., Manor, O., Courvoisier, D. S., and Guessous, I. “Colorectal Cancer Screening In Switzerland: Cross-Sectional Trends (2007-2012) In Socioeconomic Disparities”. Plos One 10, no. 7: e0131205. doi:10.1371/journal.pone.0131205.
    Abstract: BACKGROUND: Despite universal health care coverage, disparities in colorectal cancer (CRC) screening by income in Switzerland have been reported. However, it is not known if these disparities have changed over time. This study examines the association between socioeconomic position and CRC screening in Switzerland between 2007 and 2012. METHODS: Data from the 2007 (n = 5,946) and 2012 (n = 7,224) population-based Swiss Health Interview Survey data (SHIS) were used to evaluate the association between monthly household income, education, and employment with CRC screening, defined as endoscopy in the past 10 years or fecal occult blood test (FOBT) in the past 2 years. Multivariable Poisson regression was used to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and health utilization. RESULTS: CRC screening increased from 18.9% in 2007 to 22.2% in 2012 (padjusted: = 0.036). During the corresponding time period, endoscopy increased (8.2% vs. 15.0%, padjusted:<0.001) and FOBT decreased (13.0% vs. 9.8%, padjusted:0.002). CRC screening prevalence was greater in the highest income (>$6,000) vs. lowest income (</=$2,000) group in 2007 (24.5% vs. 10.5%, PR:1.37, 95%CI: 0.96-1.96) and in 2012 (28.6% vs. 16.0%, PR:1.45, 95%CI: 1.09-1.92); this disparity did not significantly change over time. CONCLUSIONS: While CRC screening prevalence in Switzerland increased from 2007 to 2012, CRC screening coverage remains low and disparities in CRC screening by income persisted over time. These findings highlight the need for increased access to CRC screening as well as enhanced awareness of the benefits of CRC screening in the Swiss population, particularly among low-income residents.
    Tags: *Healthcare Disparities, *Social Class, Colorectal Neoplasms/*diagnosis, Cross-Sectional Studies, Humans, Switzerland.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Karakoumis, J., Nickel, C. H., Kirsch, M., Rohacek, M., Geigy, N., Muller, B., Ackermann, S., and Bingisser, R. “Emergency Presentations With Nonspecific Complaints-The Burden Of Morbidity And The Spectrum Of Underlying Disease: Nonspecific Complaints And Underlying Disease”. Medicine (Baltimore) 94, no. 26: e840. doi:10.1097/MD.0000000000000840.
    Abstract: The prevalence of diagnoses, morbidity, and mortality of patients with nonspecific complaints (NSC) presenting to the emergency department (ED) is unknown.To determine the prevalence of diagnoses, acute morbidity, and mortality of patients with NSC.Prospective observational study with a 30-day follow-up. Patients presenting to 2 EDs were enrolled by a study team and diagnosed according to the World Health Organization ICD-10 System.Of 217,699 presentations to the ED from May 2007 through to February 2011, a total of 1300 patients were enrolled. After exclusion of 90 patients who fulfilled exclusion criteria, 1210 patients were analyzed. No patient was lost to follow-up. In patients with NSC, the underlying diseases were spread throughout 18 chapters of the ICD-10. A total of 58.7% of the patients were diagnosed with acute morbidity. Thirty-day mortality was 6.4% overall. Patients with acute morbidity and suffering from heart failure and pneumonia had mortalities >15%; patients lacking acute morbidity, but suffering from functional impairment or depression/anxiety had mortalities of 0%. Although the history did not allow any prediction, age and sex were predictive of morbidity and mortality.The differential diagnoses in patients presenting with NSC is broad. Acute morbidity and mortality were high in the presented cohort, the predictors of morbidity and mortality being age and sex rather than the nature of the complaints. Urgently needed management strategies could be based on these results.ClinicalTrials.gov (#NCT00920491).
    Tags: Age Factors, Aged, Aged, 80 and over, Disease/*etiology, Emergency Service, Hospital/*statistics & numerical data, Female, Humans, Male, Mortality, Prevalence, Prospective Studies, Sex Factors, Switzerland/epidemiology.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Pfortmueller, C. A., Pauchard-Neuwerth, S. E., Leichtle, A. B., Fiedler, G. M., Exadaktylos, A. K., and Lindner, G. “Primary Hyperventilation In The Emergency Department: A First Overview”. Plos One 10, no. 6: e0129562. doi:10.1371/journal.pone.0129562.
    Abstract: BACKGROUND: Primary hyperventilation is defined as a state of alveolar ventilation in excess of metabolic requirements, leading to decreased arterial partial pressure of carbon dioxide. The primary aim of this study was to characterise patients diagnosed with primary hyperventilation in the ED. METHODS: Our retrospective cohort study comprised adult (>/=16 years) patients admitted to our ED between 1 January 2006 and 31 December 2012 with the primary diagnosis of primary (=psychogenic) hyperventilation. RESULTS: A total of 616 patients were eligible for study. Participants were predominantely female (341 [55.4%] female versus 275 [44.6%] male respectively, p <0.01). The mean age was 36.5 years (SD 15.52, range 16-85). Patients in their twenties were the most common age group (181, 29.4%), followed by patients in their thirties (121, 19.6%). Most patients presented at out-of-office hours (331 [53.7%]. The most common symptom was fear (586, 95.1%), followed by paraesthesia (379, 61.5%) and dizziness (306, 49.7%). Almost a third (187, 30.4%) of our patients had previously experienced an episode of hyperventilation and half (311, 50.5%) of patients had a psychiatric co-morbidity. CONCLUSION: Hyperventilation is a diagnostic chimera with a wide spectrum of symptoms. Patients predominantly are of young age, female sex and often have psychiatric comorbidities. The severity of symptoms accompanied with primary hyperventilation most often needs further work-up to rule out other diagnosis in a mostly young population. In the future, further prospective multicentre studies are needed to evaluate and establish clear diagnostic criteria for primary hyperventilation and possible screening instruments.
    Tags: *Emergency Service, Hospital, Adolescent, Adult, Aged, Aged, 80 and over, Dizziness/*complications/diagnosis/psychology, Fear/*psychology, Female, Humans, Hyperventilation/complications/*diagnosis/psychology, Male, Middle Aged, Paresthesia/*complications/diagnosis/psychology, Retrospective Studies, Severity of Illness Index, Sex Factors, Symptom Assessment, Young Adult.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Tatuene, J. K., Excoffier, S., Vallee, J. P., and Kleinschmidt, A. “Putative Pathophysiological Mechanisms In Recurrent Hemicrania From Aortic Dissection: A Case Report”. Bmc Res Notes 8, no. 1: 246. doi:10.1186/s13104-015-1223-8.
    Abstract: BACKGROUND: Transient or permanent neurological symptoms occur in 17-40% of patients with aortic dissection. They can distract from or even mask the underlying life-threatening condition. CASE PRESENTATION: We present the case of a young Caucasian man who consulted for recurrent episodes of stereotyped right-sided sudden-onset severe headache. Upon questioning, he also reported a dull chest pain. Clinical examination and brain magnetic resonance imaging were unremarkable. The concomitant presence of chest pain made us consider aortic dissection. Contrast-enhanced cervico-thoraco-abdominal computerized tomography revealed type A aortic dissection. The patient underwent surgical replacement of the ascending aorta and reported no further episode of headache thereafter. Differential diagnosis of headache in this case includes paroxysmal hemicrania, cluster headache, migraine, trigeminal neuralgia and short lasting unilateral neuralgiform headache with conjunctival injection and tearing. Failure to match diagnostic criteria for any of these primary headache disorders and the resolution of pain episodes following surgery led us to postulate that these new-onset hemicrania episodes were symptomatic of aortic dissection. We hypothesize that aortic wall ischemia could have activated the trigeminovascular system and thereby caused hemicranial pain. Such an effect might be mediated by two different pathways that can be referred to as anatomical and humoral. The humoral hypothesis would posit that ischemia results in synthesis of pro-inflammatory mediators released from the aortic wall into the blood stream, such that they reach the central nervous system and directly stimulate specific receptors. The anatomical hypothesis would imply that pain signals generated by nociceptors in the aortic wall are transferred to the trigeminal ganglion via the cardiac plexus, the first cervical ganglion and the internal carotid nerve such that pain perception is referred to related cranio-cervical dermatomes. CONCLUSION: In cases of isolated headache that does not match key diagnostic criteria for a primary headache entity; a thorough review of systems should be performed to look for symptoms that may indicate symptomatic headache from potentially life-threatening conditions. Neurologists should consider aortic dissection in patients presenting with acute headache and chest pain. Further clinical or experimental studies are required to refute or validate the pathophysiological hypothesis discussed here.
    Tags: Adult, Angioplasty/*methods, Aorta/pathology/physiopathology/surgery, Aortic Aneurysm, Thoracic/*diagnosis/pathology/physiopathology/surgery, Chest Pain/pathology/physiopathology/surgery, Diagnosis, Differential, Headache/*diagnosis/pathology/physiopathology/surgery, Humans, Male, Migraine Disorders/*diagnosis/pathology/physiopathology/surgery, Paroxysmal Hemicrania/*diagnosis/pathology/physiopathology/surgery, Trigeminal Neuralgia/*diagnosis/pathology/physiopathology/surgery.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Evangelopoulos, D. S., Huesler, M., Ahmad, S. S., Aghayev, E., Neukamp, M., Roder, C., Exadaktylos, A., Bonel, H., and Kohl, S. “Mapping Tibiofemoral Gonarthrosis: An Mri Analysis Of Non-Traumatic Knee Cartilage Defects”. Br J Radiol 88, no. 1052: 20140542. doi:10.1259/bjr.20140542.
    Abstract: OBJECTIVE: Arthroscopy is "the gold standard" for the diagnosis of knee cartilage lesions. However, it is invasive and expensive, and displays all the potential complications of an open surgical procedure. Ultra-high-field MRI now offers good opportunities for the indirect assessment of the integrity and structural changes of joint cartilage of the knee. The goal of the present study is to determine the site of early cartilaginous lesions in adults with non-traumatic knee pain. METHODS: 3-T MRI examinations of 200 asymptomatic knees with standard and three-dimensional double-echo steady-state (3D-DESS) cartilage-specific sequences were prospectively studied for early degenerative lesions of the tibiofemoral joint. Lesions were classified and mapped using the modified Outerbridge and modified International Cartilage Repair Society classifications. RESULTS: A total of 1437 lesions were detected: 56.1% grade I, 33.5% grade II, 7.2% grade III and 3.3% grade IV. Cartographically, grade I lesions were most common in the anteromedial tibial areas; grade II lesions in the anteromedial L5 femoral areas; and grade III in the centromedial M2 femoral areas. CONCLUSION: 3-T MRI with standard and 3D-DESS cartilage-specific sequences demonstrated that areas predisposed to early osteoarthritis are the central, lateral and ventromedial tibial plateau, as well as the central and medial femoral condyle. ADVANCES IN KNOWLEDGE: In contrast with previous studies reporting early cartilaginous lesions in the medial tibial compartment and/or in the medial femoral condyle, this study demonstrates that, regardless of grade, lesions preferentially occur at the L5 and M4 tibial and L5 and L2 femoral areas of the knee joint.
    Tags: Adolescent, Adult, Aged, Aged, 80 and over, Cartilage Diseases/*pathology, Female, Femur, Humans, Joint Diseases/*pathology, Knee Joint/*pathology, Magnetic Resonance Imaging/methods, Male, Middle Aged, Prospective Studies, Tibia, Young Adult.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Guessous, I. “Role Of Vitamin D Deficiency In Extraskeletal Complications: Predictor Of Health Outcome Or Marker Of Health Status?”. Biomed Res Int 2015: 563403. doi:10.1155/2015/563403.
    Abstract: The relationship of vitamin D with extraskeletal complications, such as cardiovascular disease, cancer, and autoimmune disease, is of major interest considering its roles in key biological processes and the worldwide high prevalence of vitamin D deficiency. However, the causal relationships between vitamin D and most extraskeletal complications are weak. Currently, a heated debate over vitamin D is being conducted according to two hypotheses. In this review, we first present the different arguments that suggest a major role of vitamin D in a very broad type of extraskeletal complications (hypothesis #1). We then present results from recent meta-analyses of randomized controlled trials indicating a lack of association of vitamin D with major extraskeletal complications (hypothesis #2). We discuss different issues (e.g., causality, confounding, reverse causation, misclassification, and Mendelian randomization) that contribute to the favoring of one hypothesis over the other. While ultimately only one hypothesis is correct, we anticipate that the results from the ongoing randomized controlled trials will be unlikely to reconcile the divided experts.
    Tags: *Autoimmune Diseases/etiology/metabolism, *Cardiovascular Diseases/etiology/metabolism, *Vitamin D Deficiency/complications/metabolism, Humans, Vitamin D/*metabolism.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Sebo, P., Herrmann, F. R., and Haller, D. M. “How Do Gps In Switzerland Perceive Their Patients' Satisfaction And Expectations? An Observational Study”. Bmj Open 5, no. 6: e007085. doi:10.1136/bmjopen-2014-007085.
    Abstract: OBJECTIVES: To assess doctors' perceptions of their patients' satisfaction and expectations in primary care. STUDY DESIGN: Cross-sectional study using questionnaires completed by general practitioners (GPs) and their patients. SETTING: Primary care practices in Geneva, Switzerland. PARTICIPANTS: 23 GPs from a random list of 75 GPs practising in the canton of Geneva (participation rate 31%), who each recruited between 50 and 100 consecutive patients coming to the practice for a scheduled medical consultation, leading to a total of 1637 patients (participation rate: 97%, women: 63%, mean age: 54 years). Patient exclusion criteria were: new patients, those consulting in an emergency situation or suffering from disorders affecting their ability to consent, and those who did not speak French. MAIN OUTCOME MEASURES: Patients satisfaction with and expectations from the care they received in this practice; GPs perceptions of their patient's satisfaction and expectations. RESULTS: GPs underestimated all patient satisfaction items (p<0.001 for all items) whereas they overestimated their expectations, except for equipment (laboratory and X-ray) and some accessibility items. In a multivariate analysis to assess which GP factors were associated with correct assessment of their patients' views, only GPs' certification status was a significant factor. CONCLUSIONS: GPs tend to underestimate patients' satisfaction but overestimate their expectations in primary care. These findings may help GPs to understand patients' views in order to adequately meet their expectations and concerns.
    Tags: *Patient Satisfaction, *Perception, *Primary Health Care, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Epidemiology, Female, General Practitioners/*psychology, Health Care Surveys, Humans, Male, Middle Aged, Physician-Patient Relations, Primary care, Social medicine, Switzerland, Young Adult.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Que, Y. A., Guessous, I., Dupuis-Lozeron, E., de Oliveira, C. R. A., Oliveira, C. F., Graf, R., Seematter, G., et al. “Prognostication Of Mortality In Critically Ill Patients With Severe Infections”. Chest 148, no. 3: 674-682. doi:10.1378/chest.15-0123.
    Abstract: BACKGROUND: The purpose of this study was to confirm the prognostic value of pancreatic stone protein (PSP) in patients with severe infections requiring ICU management and to develop and validate a model to enhance mortality prediction by combining severity scores with biomarkers. METHODS: We enrolled prospectively patients with severe sepsis or septic shock in mixed tertiary ICUs in Switzerland (derivation cohort) and Brazil (validation cohort). Severity scores (APACHE [Acute Physiology and Chronic Health Evaluation] II or Simplified Acute Physiology Score [SAPS] II) were combined with biomarkers obtained at the time of diagnosis of sepsis, including C-reactive-protein, procalcitonin (PCT), and PSP. Logistic regression models with the lowest prediction errors were selected to predict in-hospital mortality. RESULTS: Mortality rates of patients with septic shock enrolled in the derivation cohort (103 out of 158) and the validation cohort (53 out of 91) were 37% and 57%, respectively. APACHE II and PSP were significantly higher in dying patients. In the derivation cohort, the models combining either APACHE II, PCT, and PSP (area under the receiver operating characteristic curve [AUC], 0.721; 95% CI, 0.632-0.812) or SAPS II, PCT, and PSP (AUC, 0.710; 95% CI, 0.617-0.802) performed better than each individual biomarker (AUC PCT, 0.534; 95% CI, 0.433-0.636; AUC PSP, 0.665; 95% CI, 0.572-0.758) or severity score (AUC APACHE II, 0.638; 95% CI, 0.543-0.733; AUC SAPS II, 0.598; 95% CI, 0.499-0.698). These models were externally confirmed in the independent validation cohort. CONCLUSIONS: We confirmed the prognostic value of PSP in patients with severe sepsis and septic shock requiring ICU management. A model combining severity scores with PCT and PSP improves mortality prediction in these patients.
    Tags: *Critical Care, *Critical Illness, Biomarkers/*metabolism, Brazil/epidemiology, C-Reactive Protein/metabolism, Calcitonin Gene-Related Peptide, Calcitonin/metabolism, Female, Hospital Mortality, Humans, Lithostathine/metabolism, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Protein Precursors/metabolism, Sepsis/metabolism/*mortality, Severity of Illness Index, Switzerland/epidemiology.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Gilliot, G., Monney, P., Muller, O., and Hugli, O. “Significance Of An Isolated New Right Bundle Branch Block In A Patient With Chest Pain”. Bmj Case Rep 2015. doi:10.1136/bcr-2015-209435.
    Abstract: Chest pain is a common presenting symptom in emergency departments, and a typical manifestation of acute myocardial infarction (AMI). Recognition of ECG changes in AMI is essential for timely diagnosis and treatment. Right bundle branch block (RBBB) may be an isolated sign of AMI, and was previously considered as a criterion for fibrinolytic therapy. Since the most recent European Society of Cardiology and American Heart Association guidelines in 2013, RBBB alone is no longer considered a diagnostic criterion of AMI, even if it occurs in the context of acute chest pain, as RBBB does not usually interfere with the interpretation of ST-segment alteration. Our case illustrates an acute septal myocardial infarction with an isolated RBBB, and thus the importance of recognising this pattern in order to permit timely diagnosis and treatment.
    Tags: Arrhythmias, Cardiac/diagnosis/etiology, Brugada Syndrome, Bundle of His/*pathology, Bundle-Branch Block/*diagnosis/etiology, Cardiac Conduction System Disease, Chest Pain/*diagnosis/etiology, Electrocardiography, Heart Conduction System/abnormalities, Humans, Male, Middle Aged, Myocardial Infarction/complications/*diagnosis/pathology.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Haider, D. G., Lindner, G., Ahmad, S. S., Sauter, T., Wolzt, M., Leichtle, A. B., Fiedler, G. M., Exadaktylos, A. K., and Fuhrmann, V. “Hypermagnesemia Is A Strong Independent Risk Factor For Mortality In Critically Ill Patients: Results From A Cross-Sectional Study”. Eur J Intern Med 26, no. 7: 504-7. doi:10.1016/j.ejim.2015.05.013.
    Abstract: BACKGROUND: Patients with electrolyte imbalances or disorders have a high risk of mortality. It is unknown if this finding from sodium or potassium disorders extends to alterations of magnesium levels. METHODS AND PATIENTS: In this cross-sectional analysis, all emergency room patients between 2010 and 2011 at the Inselspital Bern, Switzerland, were included. A multivariable logistic regression model was performed to assess the association between magnesium levels and in-hospital mortality up to 28days. RESULTS: A total of 22,239 subjects were screened for the study. A total of 5339 patients had plasma magnesium concentrations measured at hospital admission and were included into the analysis. A total of 6.3% of the 352 patients with hypomagnesemia and 36.9% of the 151 patients with hypermagnesemia died. In a multivariate Cox regression model hypermagnesemia (HR 11.6, p<0.001) was a strong independent risk factor for mortality. In these patients diuretic therapy revealed to be protective (HR 0.5, p=0.007). Hypomagnesemia was not associated with mortality (p>0.05). Age was an independent risk factor for mortality (both p<0.001). CONCLUSION: The study does demonstrate a possible association between hypermagnesemia measured upon admission in the emergency department, and early in-hospital mortality.
    Tags: Adult, Aged, Critical Illness/*mortality, Critically ill, Cross-Sectional Studies, Emergency room, Female, Hospital Mortality, Hospitalization/*statistics & numerical data, Humans, Hypermagnesemia, Hypomagnesemia, Kaplan-Meier Estimate, Logistic Models, Magnesium Deficiency/diagnosis/*epidemiology, Magnesium/*blood, Male, Middle Aged, Mortality, Multivariate Analysis, Normomagnesemia, Prognosis, Risk Factors, Switzerland.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Hasler, R. M., Baschera, D., Taugwalder, D., Exadaktylos, A. K., and Raabe, A. “Cohort Study On The Association Between Helmet Use And Traumatic Brain Injury In Snowboarders From A Swiss Tertiary Trauma Center”. World Neurosurg 84, no. 3: 805-12. doi:10.1016/j.wneu.2015.05.016.
    Abstract: BACKGROUND: Since the introduction of helmets in winter sports there is on-going debate on whether they decrease traumatic brain injuries (TBI). METHODS: This cohort study included 117 adult (>/= 16 years) snowboarders with TBI admitted to a level I alpine trauma center in Switzerland between 2000/2001 and 2010/2011. The primary objective was to examine the association between helmet use and moderate-to-severe TBI. Secondary objectives were to describe the epidemiology of TBI during the past decade in relation to increased helmet use. RESULTS: Of 691 injured snowboarders evaluated, 117 (17%) suffered TBI. Sixty-six percent were men (median age, 23 years). Two percent of accidents were fatal. Ninety-two percent of patients sustained minor, 1% moderate, and 7% severe TBI according to the Glasgow coma scale. Pathologic computed tomography findings were present in 16% of patients, 26% of which required surgery. Eighty-three percent of TBIs occurred while riding on-slope. There was no trend in the TBI rate during the studied period, although helmet use increased from 10% to 69%. Comparing patients with and without a helmet showed no significant difference in odds ratios for the severity of TBI. However, of the 5 patients requiring surgery only 1 was wearing a helmet. Off-piste compared with on-slope snowboarders showed an odds ratio of 26.5 (P = 0.003) for sustaining a moderate-to-severe TBI. CONCLUSIONS: Despite increased helmet use we found no decrease in TBI among snowboarders. The possibility of TBI despite helmet use and the dangers of riding off-piste should be a focus of future prevention programs.
    Tags: *Head Protective Devices, Adolescent, Adult, Brain Hemorrhage, Traumatic/*epidemiology/surgery, Cohort Studies, Coma/etiology, Female, Glasgow Coma Scale, Helmet, Humans, Male, Neurosurgical Procedures/statistics & numerical data, Skiing/*injuries, Snowboarding, Switzerland/epidemiology, Tbi, Trauma Centers, Traumatic brain injury, Young Adult.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Shaha, M., Gmur, S., Schoenenberger, A. W., Gerber, F. S., and Exadaktylos, A. K. “Trends And Characteristics Of Attendance At The Emergency Department Of A Swiss University Hospital: 2002-2012”. Swiss Med Wkly 145: w14141. doi:10.4414/smw.2015.14141.
    Abstract: BACKGROUND: The numbers of people attending emergency departments (EDs) at hospitals are increasing. We aimed to analyse trends in ED attendance at a Swiss university hospital between 2002 and 2012, focussing on age-related differences and hospital admission criteria. METHODS: We used hospital administrative data for all patients aged >/=16 years who attended the ED (n=298,306) at this university hospital between 1 January 2002, and 31 December 2012. We descriptively analysed the numbers of ED visits according to the admission year and stratified by age (>/=65 vs <65 years). RESULTS: People attending the ED were on average 46.6 years old (standard deviation 20 years, maximum range 16‒99 years). The annual number of ED attendances grew by n=6,639 (27.6%) from 24,080 in 2002 to 30,719 in 2012. In the subgroup of patients aged >/=65 the relative increase was 42.3%, which is significantly higher (Pearson's chi2=350.046, df=10; p=0.000) than the relative increase of 23.4% among patients<65 years. The subgroup of patients>/=65 years attended the ED more often because of diseases (n=56,307; 85%) than accidents (n=9,844; 14.9%). This subgroup (patients>/=65 years) was also more often admitted to hospital (Pearson's chi2=23,377.190; df=1; p=0.000) than patients<65 years. CONCLUSIONS: ED attendance of patients>/=65 years increased in absolute and relative terms. The study findings suggest that staff of this ED may want to assess the needs of patients>/=65 years and, if necessary, adjust the services (e.g., adapted triage scales, adapted geriatric screenings, and adapted hospital admission criteria).
    Tags: Accidents/statistics & numerical data, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Disease, Emergency Service, Hospital/statistics & numerical data/*trends, Female, Hospitalization/*statistics & numerical data/trends, Hospitals, University/statistics & numerical data/*trends, Humans, Male, Middle Aged, Retrospective Studies, Switzerland, Young Adult.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Pivin, E., Ponte, B., Pruijm, M., Ackermann, D., Guessous, I., Ehret, G., Liu, Y. P., et al. “Inactive Matrix Gla-Protein Is Associated With Arterial Stiffness In An Adult Population-Based Study”. Hypertension 66, no. 1: 85-92. doi:10.1161/HYPERTENSIONAHA.115.05177.
    Abstract: Increased pulse wave velocity (PWV) is a marker of aortic stiffness and an independent predictor of mortality. Matrix Gla-protein (MGP) is a vascular calcification inhibitor that needs vitamin K to be activated. Inactive MGP, known as desphospho-uncarboxylated MGP (dp-ucMGP), can be measured in plasma and has been associated with various cardiovascular markers, cardiovascular outcomes, and mortality. In this study, we hypothesized that high levels of dp-ucMGP are associated with increased PWV. We recruited participants via a multicenter family-based cross-sectional study in Switzerland. Dp-ucMGP was quantified in plasma by sandwich ELISA. Aortic PWV was determined by applanation tonometry using carotid and femoral pulse waveforms. Multiple regression analysis was performed to estimate associations between PWV and dp-ucMGP adjusting for age, renal function, and other cardiovascular risk factors. We included 1001 participants in our analyses (475 men and 526 women). Mean values were 7.87+/-2.10 m/s for PWV and 0.43+/-0.20 nmol/L for dp-ucMGP. PWV was positively associated with dp-ucMGP both before and after adjustment for sex, age, body mass index, height, systolic and diastolic blood pressure (BP), heart rate, renal function, low- and high-density lipoprotein, glucose, smoking status, diabetes mellitus, BP and cholesterol lowering drugs, and history of cardiovascular disease (P</=0.01). In conclusion, high levels of dp-ucMGP are independently and positively associated with arterial stiffness after adjustment for common cardiovascular risk factors, renal function, and age. Experimental studies are needed to determine whether vitamin K supplementation slows arterial stiffening by increasing MGP carboxylation.
    Tags: Adult, Age Factors, Aged, Blood Glucose/analysis, Body Mass Index, calcium-binding protein, Calcium-Binding Proteins/*blood/chemistry, Cardiovascular Diseases/epidemiology, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus/epidemiology, Extracellular Matrix Proteins/*blood/chemistry, Female, Hemodynamics, Humans, Kidney/physiology, Lipids/blood, Male, Matrix Gla Protein, matrix Gla-protein, Middle Aged, Phosphorylation, Protein Processing, Post-Translational, Pulse Wave Analysis, pulse wave velocity, Sampling Studies, Smoking/epidemiology, Switzerland/epidemiology, vascular stiffness, Vascular Stiffness/*physiology, vitamin K.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Drozdov, D., Schwarz, S., Kutz, A., Grolimund, E., Rast, A. C., Steiner, D., Regez, K., et al. “Procalcitonin And Pyuria-Based Algorithm Reduces Antibiotic Use In Urinary Tract Infections: A Randomized Controlled Trial”. Bmc Med 13, no. 1: 104. doi:10.1186/s12916-015-0347-y.
    Abstract: BACKGROUND: Urinary tract infections (UTIs) are common drivers of antibiotic use. The minimal effective duration of antibiotic therapy for UTIs is unknown, but any reduction is important to diminish selection pressure for antibiotic resistance, costs, and drug-related side-effects. The aim of this study was to investigate whether an algorithm based on procalcitonin (PCT) and quantitative pyuria reduces antibiotic exposure. METHODS: From April 2012 to March 2014, we conducted a factorial design randomized controlled open-label trial. Immunocompetent adults with community-acquired non-catheter-related UTI were enrolled in the emergency department of a tertiary-care 600-bed hospital in northwestern Switzerland. Clinical presentation was used to guide initiation and duration of antibiotic therapy according to current guidelines (control group) or with a PCT-pyuria-based algorithm (PCT-pyuria group). The primary endpoint was overall antibiotic exposure within 90 days. Secondary endpoints included duration of the initial antibiotic therapy, persistent infection 7 days after end of therapy and 30 days after enrollment, recurrence and rehospitalizations within 90 days. RESULTS: Overall, 394 patients were screened, 228 met predefined exclusion criteria, 30 declined to participate, and 11 were not eligible. Of these, 125 (76% women) were enrolled in the intention-to-treat (ITT) analysis and 96 patients with microbiologically confirmed UTI constituted the per protocol group; 84 of 125 (67%) patients had a febrile UTI, 28 (22%) had bacteremia, 5 (4%) died, and 3 (2%) were lost to follow-up. Overall antibiotic exposure within 90 days was shorter in the PCT-pyuria group than in the control group (median 7.0 [IQR, 5.0-14.0] vs. 10.0 [IQR, 7.0-16.0] days, P = 0.011) in the ITT analysis. Mortality, rates of persistent infections, recurrences, and rehospitalizations were not different. CONCLUSIONS: A PCT-pyuria-based algorithm reduced antibiotic exposure by 30% when compared to current guidelines without apparent negative effects on clinical outcomes.
    Tags: *Algorithms, *Pyuria, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents/*therapeutic use, Biomarkers/analysis, Calcitonin Gene-Related Peptide, Calcitonin/*analysis, Female, Humans, Male, Middle Aged, Protein Precursors/*analysis, Switzerland, Urinary Tract Infections/*drug therapy.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Wildi, K., Zellweger, C., Twerenbold, R., Jaeger, C., Reichlin, T., Haaf, P., Faoro, J., et al. “Incremental Value Of Copeptin To Highly Sensitive Cardiac Troponin I For Rapid Rule-Out Of Myocardial Infarction”. Int J Cardiol 190, no. 1: 170-6. doi:10.1016/j.ijcard.2015.04.133.
    Abstract: BACKGROUND: The incremental value of copeptin, a novel marker of endogenous stress, for rapid rule-out of non-ST-elevation myocardial infarction (NSTEMI) is unclear when sensitive or even high-sensitivity cardiac troponin cTn (hs-cTn) assays are used. METHODS: In an international multicenter study we evaluated 1929 consecutive patients with symptoms suggestive of acute myocardial infarction (AMI). Measurements of copeptin, three sensitive and three hs-cTn assays were performed at presentation in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists using all clinical information including coronary angiography and levels of hs-cTnT. The incremental value in the diagnosis of NSTEMI was quantified using four outcome measures: area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI), sensitivity and negative predictive value (NPV). Early presenters (< 4h since chest pain onset) were a pre-defined subgroup. RESULTS: NSTEMI was the adjudicated final diagnosis in 358 (18.6%) patients. As compared to the use of cTn alone, copeptin significantly increased AUC for two (33%) and IDI (between 0.010 and 0.041 (all p < 0.01)), sensitivity and NPV for all six cTn assays (100%); NPV to 96-99% when the 99 th percentile of the respective cTnI assay was combined with a copeptin level of 9 pmol/l (all p < 0.01). The incremental value in early presenters was similar to that of the overall cohort. CONCLUSION: When used for rapid rule-out of NSTEM in combination with sensitive or hs-cTnI assays, copeptin provides a numerically small, but statistically and likely also clinically significant incremental value.
    Tags: *Internationality, Acute myocardial infarction, Aged, Aged, 80 and over, Biomarkers/blood, Chest Pain/blood/diagnosis/epidemiology, Copeptin, Female, Glycopeptides/*blood, Highly sensitive Troponin I, Humans, Male, Middle Aged, Myocardial Infarction/*blood/*diagnosis/epidemiology, Prospective Studies, Sensitivity and specificity, Time Factors, Troponin I/*blood.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Dami, F., Carron, P. N., Yersin, B., and Hugli, O. “University Hospital Struck Deaf And Silent By Lightning: Lessons To Learn”. Disaster Med Public Health Prep 9, no. 4: 440-3. doi:10.1017/dmp.2015.40.
    Abstract: We describe how an electromagnetic wave after a lightning strike affected a university hospital, including the communication shutdown that followed, the way it was handled, and the lessons learned from this incident.
    Tags: *Hospitals, University, *Lightning, *Power, Psychological, communication shutdown, Disaster Medicine/*methods, electromagnetic wave, Hospital Communication Systems/*standards, Humans, lightning struck.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Guessous, I., McClellan, W., Kleinbaum, D., Vaccarino, V., Hugues, H., Boulat, O., Marques-Vidal, P., et al. “Serum 25-Hydroxyvitamin D Level And Kidney Function Decline In A Swiss General Adult Population”. Clin J Am Soc Nephrol 10, no. 7: 1162-9. doi:10.2215/CJN.04960514.
    Abstract: BACKGROUND AND OBJECTIVES: Molecular evidence suggests that levels of vitamin D are associated with kidney function loss. Still, population-based studies are limited and few have considered the potential confounding effect of baseline kidney function. This study evaluated the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline, and incidence of CKD and albuminuria. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Baseline (2003-2006) and 5.5-year follow-up data from a Swiss adult general population were used to evaluate the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline (annual loss >3 ml/min per 1.73 m(2)), and incidence of CKD and albuminuria. Serum 25-hydroxyvitamin D was measured at baseline using liquid chromatography-tandem mass spectrometry. eGFR and albuminuria were collected at baseline and follow-up. Multivariate linear and logistic regression models were used considering potential confounding factors. RESULTS: Among the 4280 people included in the analysis, the mean+/-SD annual eGFR change was -0.57+/-1.78 ml/min per 1.73 m(2), and 287 (6.7%) participants presented rapid eGFR decline. Before adjustment for baseline eGFR, baseline 25-hydroxyvitamin D level was associated with both mean annual eGFR change and risk of rapid eGFR decline, independently of baseline albuminuria. Once adjusted for baseline eGFR, associations were no longer significant. For every 10 ng/ml higher baseline 25-hydroxyvitamin D, the adjusted mean annual eGFR change was -0.005 ml/min per 1.73 m(2) (95% confidence interval, -0.063 to 0.053; P=0.87) and the risk of rapid eGFR decline was null (odds ratio, 0.93; 95% confidence interval, 0.79 to 1.08; P=0.33). Baseline 25-hydroxyvitamin D level was not associated with incidence of CKD or albuminuria. CONCLUSIONS: The association of 25-hydroxyvitamin D with eGFR decline is confounded by baseline eGFR. Sufficient 25-hydroxyvitamin D levels do not seem to protect from eGFR decline independently from baseline eGFR.
    Tags: *Glomerular Filtration Rate, Adult, Aged, Albuminuria/diagnosis/*epidemiology/physiopathology, Biomarkers/blood, Chromatography, Liquid, chronic kidney disease, epidemiology and outcomes, Female, Follow-Up Studies, glomerular filtration rate, Humans, Incidence, Kidney/*physiopathology, Linear Models, Logistic Models, Male, Middle Aged, Multivariate Analysis, Population Surveillance, Prevalence, Prognosis, Protective Factors, renal function decline, Renal Insufficiency, Chronic/diagnosis/*epidemiology/physiopathology, Risk Assessment, Risk Factors, Switzerland/epidemiology, Tandem Mass Spectrometry, Time Factors, vitamin D, Vitamin D Deficiency/blood/diagnosis/*epidemiology, Vitamin D/*analogs & derivatives/blood.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Stocklin, B., Fouzas, S., Schillinger, P., Cayir, S., Skendaj, R., Ramser, M., Weber, P., and Wellmann, S. “Copeptin As A Serum Biomarker Of Febrile Seizures”. Plos One 10, no. 4: e0124663. doi:10.1371/journal.pone.0124663.
    Abstract: BACKGROUND AND OBJECTIVES: Accurate diagnosis of febrile seizures in children presenting after paroxysmal episodes associated with fever, is hampered by the lack of objective postictal biomarkers. The aim of our study was to investigate whether FS are associated with increased levels of serum copeptin, a robust marker of arginine vasopressin secretion. METHODS: This was a prospective emergency-setting cross-sectional study of 161 children between six months and five years of age. Of these, 83 were diagnosed with febrile seizures, 69 had a febrile infection without seizures and nine had epileptic seizures not triggered by infection. Serum copeptin and prolactin levels were measured in addition to standard clinical, neurophysiological, and laboratory assessment. CLINICAL TRIAL REGISTRATION: NCT01884766. RESULTS: Circulating copeptin was significantly higher in children with febrile seizures (median [interquartile range] 18.9 pmol/L [8.5-36.6]) compared to febrile controls (5.6 pmol/L [4.1-9.4]; p < 0.001), with no differences between febrile and epileptic seizures (21.4 pmol/L [16.1-46.6]; p = 0.728). In a multivariable regression model, seizures were the major determinant of serum copeptin (beta 0.509; p < 0.001), independently of clinical and baseline laboratory indices. The area under the receiver operating curve for copeptin was 0.824 (95% CI 0.753-0.881), significantly higher compared to prolactin (0.667 [0.585-0.742]; p < 0.001). The diagnostic accuracy of copeptin increased with decreasing time elapsed since the convulsive event (at 120 min: 0.879 [0.806-0.932] and at <60 min: 0.975 [0.913-0.997]). CONCLUSIONS: Circulating copeptin has high diagnostic accuracy in febrile seizures and may be a useful adjunct for accurately diagnosing postictal states in the emergency setting.
    Tags: Biomarkers/blood, Child, Preschool, Glycopeptides/*blood, Humans, Infant, Infections/complications, Male, Seizures, Febrile/*blood/complications/diagnosis, Sensitivity and Specificity.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Grange, M., Mayen, A. L., Guessous, I., Waeber, G., Vollenweider, P., and Marques-Vidal, P. “Lost In Translation: Dietary Management Of Cardiovascular Risk Factors Is Seldom Implemented”. Prev Med 76: 68-73. doi:10.1016/j.ypmed.2015.03.024.
    Abstract: OBJECTIVE: To assess dietary management of cardiovascular risk factors (CVRFs) in the general population. METHOD: Cross-sectional study conducted between 2009 and 2012 on 4811 participants (2567 women, 58+/-11years) living in Lausanne, Switzerland. RESULTS: Sixteen percent of participants diagnosed with overweight/obesity reported a slimming diet. Slimming diet was associated with diagnosis of hypertension: Odds ratio and (95% confidence interval): 0.61 (0.40-0.93); older age [0.84 (0.58-1.21), 0.79 (0.53-1.18) and 0.47 (0.27-0.81) for [50-60[, [60-70[ and [70+ years, respectively]; female gender [1.84 (1.36-2.48)] and diagnosis of diabetes [2.16 (1.13-4.12)]. Only 8% of participants diagnosed with hypertension reported a low-salt diet. Low-salt diet was associated with antihypertensive drug treatment [2.17 (1.28-3.68)] and diagnosis of diabetes [2.72 (1.26-5.86)]. One-third of participants diagnosed with dyslipidemia reported a low-fat diet. Low-fat diet was associated with female gender [1.47 (1.17-1.86)]; older age [1.29 (0.89-1.87), 1.71 (1.18-2.48) and 2.01 (1.33-3.03) for [50-60[, [60-70[ and [70+ years, respectively]; hypolipidemic drug treatment [OR=1.68 (1.29-2.18)]; current smoking [0.70 (0.51-0.96)] and obesity [0.67 (0.45-1.00)]. Approximately half of participants diagnosed with diabetes reported an antidiabetic diet. Antidiabetic diet was associated with current smoking [0.44 (0.22-0.88)] and antidiabetic drug treatment [OR=3.26 (1.81-5.86)]. CONCLUSION: Dietary management of CVRFs is seldom implemented in Switzerland.
    Tags: *Diet, Fat-Restricted, *Diet, Reducing, Adult, Aged, Antihypertensive Agents/therapeutic use, Body Mass Index, Cardiovascular Diseases/*diet therapy, Cross-Sectional Studies, Diabetes, Diabetes Mellitus/diet therapy, Diet, Sodium-Restricted, Dietary prevention, Dyslipidemia, Dyslipidemias/diet therapy, Epidemiology, Female, Humans, Hypertension, Hypertension/drug therapy, Male, Middle Aged, Odds Ratio, Risk Factors, Switzerland.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Dami, F., Fuchs, V., and Hugli, O. “Dispatch Centres: What Is The Right Population Catchment Size?”. Scand J Trauma Resusc Emerg Med 23, no. 1: 32. doi:10.1186/s13049-015-0111-5.
    Abstract: Literature on medical dispatch is growing, focusing mainly on efficiency (under and overtriage) and dispatch-assisted CPR. But the issue of population catchment size, functional costs and rationalization is rarely addressed. If we can observe a trend toward a decreasing number of dispatch centres in many European countries, there is today no evidence on what is the right catchment size to reach the best balance between quality of services and costs.
    Tags: *Catchment Area, Health, administration, Efficiency, Organizational, Emergency Medical Service Communication Systems/economics/*organization &, Emergency Medical Services/economics/*supply & distribution, Europe, Humans, Triage.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Sampson, E. L., van der Steen, J. T., Pautex, S., Svartzman, P., Sacchi, V., Van den Block, L., and Van Den Noortgate, N. “European Palliative Care Guidelines: How Well Do They Meet The Needs Of People With Impaired Cognition?”. Bmj Support Palliat Care 5, no. 3: 301-5. doi:10.1136/bmjspcare-2014-000813.
    Abstract: OBJECTIVE: Numbers of people dying with cognitive impairment (intellectual disability (ID), dementia or delirium) are increasing. We aimed to examine a range of European national palliative care guidelines to determine if, and how well, pain detection and management for people dying with impaired cognition are covered. METHODS: Questionnaires were sent to 14 country representatives of the European Pain and Impaired Cognition (PAIC) network who identified key national palliative care guidelines. Data was collected on guideline content: inclusion of advice on pain management, whether cognitively impaired populations were mentioned, assessment tools and management strategies recommended. Quality of guideline development was assessed with the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. RESULTS: 11 countries identified palliative care guidelines, 10 of which mentioned pain management in general. Of these, seven mentioned cognitive impairment (3 dementia, 2 ID and 4 delirium). Half of guidelines recommended the use of pain tools for people with cognitive impairment; recommended tools were not all validated for the target populations. Guidelines from the UK, the Netherlands and Finland included most information on pain management and detection in impaired cognition. Guidelines from Iceland, Norway and Spain scored most highly on AGREE rating in terms of developmental quality. CONCLUSIONS: European national palliative care guidelines may not meet the needs of the growing population of people dying with cognitive impairment. New guidelines should consider suggesting the use of observational pain tools for people with cognitive impairment. Better recognition of their needs in palliative care guidelines may drive improvements in care.
    Tags: *Practice Guidelines as Topic, Clinical Guidelines, Cognition Disorders/*psychology, Cognitive Impairment, Delirium/psychology, Dementia, Dementia/psychology, Europe, Health Services Needs and Demand/*standards, Humans, Intellectual Disability, Pain, Pain Management/psychology/standards, Pain Measurement/methods/standards, Palliative care, Palliative Care/psychology/*standards, Surveys and Questionnaires, Terminal Care/psychology/*standards.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Reichlin, T., Twerenbold, R., Wildi, K., Gimenez, M. R., Bergsma, N., Haaf, P., Druey, S., et al. “Prospective Validation Of A 1-Hour Algorithm To Rule-Out And Rule-In Acute Myocardial Infarction Using A High-Sensitivity Cardiac Troponin T Assay”. Cmaj 187, no. 8: E243-E252. doi:10.1503/cmaj.141349.
    Abstract: BACKGROUND: We aimed to prospectively validate a novel 1-hour algorithm using high-sensitivity cardiac troponin T measurement for early rule-out and rule-in of acute myocardial infarction (MI). METHODS: In a multicentre study, we enrolled 1320 patients presenting to the emergency department with suspected acute MI. The high-sensitivity cardiac troponin T 1-hour algorithm, incorporating baseline values as well as absolute changes within the first hour, was validated against the final diagnosis. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, echocardiography, follow-up data and serial measurements of high-sensitivity cardiac troponin T levels. RESULTS: Acute MI was the final diagnosis in 17.3% of patients. With application of the high-sensitivity cardiac troponin T 1-hour algorithm, 786 (59.5%) patients were classified as "rule-out," 216 (16.4%) were classified as "rule-in" and 318 (24.1%) were classified to the "observational zone." The sensitivity and the negative predictive value for acute MI in the rule-out zone were 99.6% (95% confidence interval [CI] 97.6%-99.9%) and 99.9% (95% CI 99.3%-100%), respectively. The specificity and the positive predictive value for acute MI in the rule-in zone were 95.7% (95% CI 94.3%-96.8%) and 78.2% (95% CI 72.1%-83.6%), respectively. The 1-hour algorithm provided higher negative and positive predictive values than the standard interpretation of highsensitivity cardiac troponin T using a single cut-off level (both p < 0.05). Cumulative 30-day mortality was 0.0%, 1.6% and 1.9% in patients classified in the rule-out, observational and rule-in groups, respectively (p = 0.001). INTERPRETATION: This rapid strategy incorporating high-sensitivity cardiac troponin T baseline values and absolute changes within the first hour substantially accelerated the management of suspected acute MI by allowing safe rule-out as well as accurate rule-in of acute MI in 3 out of 4 patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00470587.
    Tags: Aged, Aged, 80 and over, Algorithms, Biomarkers/blood, Decision Support Techniques, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction/blood/*diagnosis, Prospective Studies, Troponin T/*blood.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Rast, A. C., Kutz, A., Felder, S., Faessler, L., Steiner, D., Laukemann, S., Haubitz, S., et al. “Procalcitonin Improves The Glasgow Prognostic Score For Outcome Prediction In Emergency Patients With Cancer: A Cohort Study”. Dis Markers 2015: 795801. doi:10.1155/2015/795801.
    Abstract: The Glasgow Prognostic Score (GPS) is useful for predicting long-term mortality in cancer patients. Our aim was to validate the GPS in ED patients with different cancer-related urgency and investigate whether biomarkers would improve its accuracy. We followed consecutive medical patients presenting with a cancer-related medical urgency to a tertiary care hospital in Switzerland. Upon admission, we measured procalcitonin (PCT), white blood cell count, urea, 25-hydroxyvitamin D, corrected calcium, C-reactive protein, and albumin and calculated the GPS. Of 341 included patients (median age 68 years, 61% males), 81 (23.8%) died within 30 days after admission. The GPS showed moderate prognostic accuracy (AUC 0.67) for mortality. Among the different biomarkers, PCT provided the highest prognostic accuracy (odds ratio 1.6 (95% confidence interval 1.3 to 1.9), P < 0.001, AUC 0.69) and significantly improved the GPS to a combined AUC of 0.74 (P = 0.007). Considering all investigated biomarkers, the AUC increased to 0.76 (P < 0.001). The GPS performance was significantly improved by the addition of PCT and other biomarkers for risk stratification in ED cancer patients. The benefit of early risk stratification by the GPS in combination with biomarkers from different pathways should be investigated in further interventional trials.
    Tags: *Glasgow Outcome Scale, Aged, Biomarkers, Tumor/*blood, C-Reactive Protein/metabolism, Calcitonin Gene-Related Peptide, Calcitonin/*blood, Calcium/blood, Cohort Studies, Female, Humans, Male, Middle Aged, Neoplasms/*blood/pathology, Predictive Value of Tests, Protein Precursors/*blood, Serum Albumin/metabolism, Urea/blood, Vitamin D/analogs & derivatives/blood.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Forni Ogna, V., Ogna, A., Vuistiner, P., Pruijm, M., Ponte, B., Ackermann, D., Gabutti, L., et al. “New Anthropometry-Based Age- And Sex-Specific Reference Values For Urinary 24-Hour Creatinine Excretion Based On The Adult Swiss Population”. Bmc Med 13, no. 1: 40. doi:10.1186/s12916-015-0275-x.
    Abstract: BACKGROUND: Urinary creatinine excretion is used as a marker of completeness of timed urine collections, which are a keystone of several metabolic evaluations in clinical investigations and epidemiological surveys. METHODS: We used data from two independent Swiss cross-sectional population-based studies with standardised 24-hour urinary collection and measured anthropometric variables. Only data from adults of European descent, with estimated glomerular filtration rate (eGFR) >/=60 ml/min/1.73 m2 and reported completeness of the urinary collection were retained. A linear regression model was developed to predict centiles of the 24-hour urinary creatinine excretion in 1,137 participants from the Swiss Survey on Salt and validated in 994 participants from the Swiss Kidney Project on Genes in Hypertension. RESULTS: The mean urinary creatinine excretion was 193 +/- 41 mumol/kg/24 hours in men and 151 +/- 38 mumol/kg/24 hours in women in the Swiss Survey on Salt. The values were inversely correlated with age and body mass index (BMI). CONCLUSIONS: We propose a validated prediction equation for 24-hour urinary creatinine excretion in the general European population, based on readily available variables such as age, sex and BMI, and a few derived normograms to ease its clinical application. This should help healthcare providers to interpret the completeness of a 24-hour urine collection in daily clinical practice and in epidemiological population studies.
    Tags: Adult, Aged, Anthropometry, Biomarkers/*urine, Body Mass Index, Creatinine/*urine, Cross-Sectional Studies, Ethnicity, Female, Humans, Linear Models, Male, Middle Aged, Reference Values, Switzerland, Urinalysis/*standards.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Schuetz, P., Leuppi, J. D., Bingisser, R., Bodmer, M., Briel, M., Drescher, T., Duerring, U., et al. “Prospective Analysis Of Adrenal Function In Patients With Acute Exacerbations Of Copd: The Reduction In The Use Of Corticosteroids In Exacerbated Copd (Reduce) Trial”. Eur J Endocrinol 173, no. 1: 19-27. doi:10.1530/EJE-15-0182.
    Abstract: OBJECTIVE: To analyze prospectively the hypothalamic-pituitary-adrenal (HPA) axis and clinical outcome in patients treated with prednisone for exacerbated chronic obstructive pulmonary disease (COPD). DESIGN: Prospective observational study. SUBJECTS AND METHODS: Patients presenting to the emergency department were randomized to receive 40 mg prednisone daily for 5 or 14 days in a placebo-controlled manner. The HPA axis was longitudinally assessed with the 1 mug corticotropin test and a clinical hypocortisolism score at baseline, on day 6 before blinded treatment, at hospital discharge, and for up to 180 days of follow-up. Prednisone was stopped abruptly, irrespective of the test results. Patients discharged with pathological test results received instructions about emergency hydrocortisone treatment. RESULTS: A total of 311 patients were included in the analysis. Mean basal and stimulated serum total cortisol levels were highest on admission (496+/-398 and 816+/-413 nmol/l respectively) and lowest on day 6 (235+/-174 and 453+/-178 nmol/l respectively). Pathological stimulation tests were found in 63, 38, 9, 3, and 2% of patients on day 6, at discharge, and on days 30, 90, and 180 respectively, without significant difference between treatment groups. Clinical indicators of hypocortisolism did not correlate with stimulation test results, but cortisol levels were inversely associated with re-exacerbation risk. There were no hospitalizations or deaths as a result of adrenal crisis. CONCLUSION: Dynamic changes in the HPA axis occur during and after the treatment of acute exacerbations of COPD. In hypocortisolemic patients who were provided with instructions about stress prophylaxis, the abrupt termination of prednisone appeared safe.
    Tags: *Adrenal Cortex Hormones/adverse effects/therapeutic use, *Adrenal Glands/physiopathology, *Pulmonary Disease, Chronic Obstructive/drug therapy/physiopathology, Adrenal Cortex Function Tests, Adrenal Insufficiency/physiopathology, Adrenocorticotropic Hormone, Aged, Female, Follow-Up Studies, Humans, Hydrocortisone/deficiency, Hypothalamo-Hypophyseal System/drug effects, Male, Middle Aged, Pituitary-Adrenal System/drug effects, Prednisone/adverse effects/therapeutic use, Prospective Studies, Treatment Outcome.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
  • Diserens, L., Egli, L., Fustinoni, S., Santos-Eggimann, B., Staeger, P., and Hugli, O. “Emergency Department Visits For Non-Life-Threatening Conditions: Evolution Over 13 Years In A Swiss Urban Teaching Hospital”. Swiss Med Wkly 145: w14123. doi:10.4414/smw.2015.14123.
    Abstract: INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients' characteristics and reasons for consultation had changed over 13 years. METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP). RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p=0.128). Of these patients, 54.0% vs 57.0% were male (p=0.329), 55.5% vs 58.7% were Swiss (p=0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p<0.001); 57.7% vs., 58.3% consulted during out-of- hours (p=0.821). Trauma-related visits decreased from 34.2% to 23.7% (p<0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of >/=1 week increased from 14.3% to 26.9% (p<0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP's treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p<0.001). CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.
    Tags: Adult, Aged, Appointments and Schedules, Emergency Service, Hospital/statistics & numerical data/*trends, Female, General Practice/statistics & numerical data, Hospitals, Teaching/trends, Hospitals, Urban/trends, Humans, Male, Middle Aged, Motivation, Patient Acceptance of Health Care/psychology/*statistics & numerical data, Patient Acuity, Referral and Consultation/*trends, Switzerland/ethnology, Time-to-Treatment/trends.
    Export the reference: BibTeX | MODS | Refer/BibIX | Bibliographic Ontology RDF | Unqualified Dublin Core RDF | Zotero RDF | RIS (EndNote) | Wikipedia Citation Templates
--- Export the selection using the format