EMresearch.ch

Tharakan, S. J., Subotic, U., Kalisch, M., Staubli, G., and Weber, D. M. “Compartment Pressures In Children With Normal And Fractured Forearms: A Preliminary Report”. J Pediatr Orthop 36, no. 4: 410-5. doi:10.1097/BPO.0000000000000471.

Abstract: INTRODUCTION: Acute compartment syndrome (ACS) can lead to irreversible damage if fasciotomy is not performed in a timely manner. Needle manometry is a tool to confirm suspected ACS. The threshold for compartment pressures that can be tolerated has been debated. The aim of this study is to assess the normal compartment pressures in noninjured forearms of children. Further, we sought to quantify the maximum tolerable compartment pressures in fractured forearms of children, thus establishing a baseline and providing guidance in evidence-based decision making to evaluate children with suspected ACS. METHODS: This prospective study included children up to the age of 16 years with forearm fractures that needed reduction with or without osteosynthesis. Between June 2009 and March 2013, 41 children were included. Mean age was 9.25 years (range, 4 to 15.4 y). We used needle manometry to measure the pressures in the superficial and deep volar as well as in the dorsal compartments (DCs) on both the forearms. The mean pressures between compartments in healthy versus injured arms were analyzed using a 1-sided, paired t test. RESULTS: On the injured side, the mean compartment pressure was 19.12 mm Hg (range, 3 to 49 mm Hg) in the deep volar compartment, 15.56 mm Hg (range, 5 to 37 mmHg) in the DC, and 14.8 mm Hg (range, 2 to 35 mm Hg) in the superficial volar compartment. On the noninjured side, the mean compartment pressure was 12.9 mm Hg (range, 6 to 31 mm Hg) in the DC, 10.22 mm Hg (range, 3 to 22 mm Hg) in the deep volar compartment, and 9.66 mm Hg (range, 3 to 21 mm Hg) in the superficial volar compartment. We measured an absolute compartment pressure of >30 mm Hg in 15 patients on the fractured side. Three of them had an absolute compartment pressure of >45 mm Hg. Only 1 had ACS. This patient underwent fasciotomy and was excluded for further analysis. On follow-up (mean, 24.84 mo), no patient was found to have any sequelae of ACS. DISCUSSION: This is the first study to report normal compartment pressure measurements in noninjured forearms and in fractured forearms without clinical suspicion of ACS in children.The mean compartment pressure measured in the deep volar compartment (DVC) in healthy children was 10.22 mm Hg (range, 3 to 22 mm Hg) and therefore slightly higher than in adults. Some children with fractures tolerated absolute compartment pressures >30 mm Hg without clinical signs of ACS. Fasciotomy in children under close observation could eventually be delayed despite surpassing the accepted pressure limits for adults. LEVEL OF EVIDENCE: Level I-prognostic.

Tags: *Forearm, *Manometry, *Pressure, Adolescent, Case-Control Studies, Casts, Surgical, Child, Child, Preschool, Closed Fracture Reduction, Compartment Syndromes/etiology/*physiopathology/therapy, Fasciotomy, Female, Forearm Injuries/complications/*physiopathology/therapy, Fracture Fixation, Internal, Fractures, Bone/complications/*physiopathology/therapy, Humans, Male, Manipulation, Orthopedic, Prospective Studies, Reference Values.

Gaspoz, J. M. “Smarter Medicine: Do Physicians Need Political Pressure To Eliminate Useless Interventions?”. Swiss Med Wkly 145: w14125. doi:10.4414/smw.2015.14125.

Abstract: Echoing the "less is more" and "choosing wisely" campaigns in the USA, the "smarter medicine" campaign launched in 2014 by the Swiss Society of General Internal Medicine listed five tests or treatments that are often prescribed in ambulatory general internal medicine, but that may not provide any meaningful benefit and may carry the risk of generating harms and costs. In the United Kingdom, the National Institute for Health and Care Excellence (NICE) supported the National Health Services in identifying "low value" activities that should be stopped. Political pressure and stringent regulatory measures for pharmaceuticals and medical technology triggered major controversy and opposition. NICE efforts now concentrate on editing guidelines based on consensus techniques, which integrate the evidence from systematic reviews with social values and patient preferences. To obtain significant changes and promote the paradigm of reducing unnecessary waste of medical resources, opinion leaders and leading scientific or academic institutions, as well as medical societies, can make a difference, together with consumer associations and the lay press. Politicians can undoubtedly contribute to the success of these strategies, but rather than putting physicians alone under pressure and setting up stringent regulatory measures, they should network with all stakeholders and put emphasis on a broader agenda, the one of improving healthcare quality and efficiency.

Tags: *Politics, *Practice Patterns, Physicians', *Unnecessary Procedures/economics, Attitude of Health Personnel, Cost Control, Evidence-Based Medicine, Humans, Switzerland, United Kingdom, United States.

Carron, P. N., Dami, F., Yersin, B., Toppet, V., Burnand, B., and Pittet, V. “Increasing Prehospital Emergency Medical Service Interventions For Nursing Home Residents”. Swiss Med Wkly 145: w14126. doi:10.4414/smw.2015.14126.

Abstract: QUESTION: In the ageing European population, the proportion of interventions by the emergency medical services (EMS) for elderly patients is increasing, but little is known about the recent trend of EMS interventions in nursing homes. The aim of this analysis was to describe the evolution of the incidence of requests for prehospital EMS interventions for nursing home residents aged 65 years and over between 2004 and 2013. METHODS: A prospective population-based register of routinely collected data for each EMS intervention in the Canton of Vaud. Linear time trends of incidence of requests to the EMS in nursing homes were calculated and stratified by age categories. RESULTS: The number of ambulance interventions in nursing homes for people aged 65 years and over (65+) increased by 68.9% (1124‒1898) between 2004 and 2013. A significant linear increase of the annual incidence of requests to EMS per 1,000 nursing home residents was found for people aged 65-79 (10.2, 95% confidence interval [CI] 6.2-14.2), 80-89 (16.5, 95% CI 14.0-19.0) and over 90 (12.1, 95% CI 5.8-18.4). EMS interventions in nursing home residents who required an emergency physician increased during the same period by 205.6% (from 106 to 324), representing an increase from 2% to 7% of all emergency physician interventions in the Canton. CONCLUSIONS: Our results confirmed an important increase in the incidence of EMS interventions in nursing homes during the last decade, far exceeding the actual increase of the nursing home population during the same period. This evolution represents an important opportunity to reconsider the EMS missions in the context of an ageing society.

Tags: Age Factors, Aged, Aged, 80 and over, Emergency Medical Services/statistics & numerical data/*trends, Emergency Medicine/*statistics & numerical data/*trends, Female, Humans, Male, Nursing Homes/*statistics & numerical data, Residence Characteristics, Switzerland.

Stringhini, S., Haba-Rubio, J., Marques-Vidal, P., Waeber, G., Preisig, M., Guessous, I., Bovet, P., Vollenweider, P., Tafti, M., and Heinzer, R. “Association Of Socioeconomic Status With Sleep Disturbances In The Swiss Population-Based Colaus Study”. Sleep Med 16, no. 4: 469-76. doi:10.1016/j.sleep.2014.12.014.

Abstract: OBJECTIVE: To examine the association of socioeconomic status (SES) with subjective and objective sleep disturbances and the role of socio-demographic, behavioural and psychological factors in explaining this association. METHODS: Analyses are based on 3391 participants (53% female, aged 40-81 years) of the follow-up of the CoLaus study (2009-2012), a population-based sample of the city of Lausanne, Switzerland. All participants completed a sleep questionnaire and a sub-sample (N = 1569) underwent polysomnography. RESULTS: Compared with men with a high SES, men with a low SES were more likely to suffer from poor sleep quality [prevalence ratio (PR) for occupational position = 1.68, 95% Confidence Interval (CI): 1.30-2.17], and to have long sleep latency (PR = 4.90, 95%CI: 2.14-11.17), insomnia (PR = 1.47, 95% CI: 1.12-1.93) and short sleep duration (PR = 3.03, 95% CI: 1.78-5.18). The same pattern was observed among women (PR = 1.29 for sleep quality, 2.34 for sleep latency, 2.01 for daytime sleepiness, 3.16 for sleep duration, 95%CIs ranging from 1.00 to 7.51). Use of sleep medications was not patterned by SES. SES differences in sleep disturbances were only marginally attenuated by adjustment for other socio-demographic, behavioural and psychological factors. Results from polysomnography confirmed poorer sleep patterns among participants with low SES (p <0.05 for sleep efficiency/stage shifts), but no SES differences were found for sleep duration. CONCLUSIONS: In this population-based sample, low SES was strongly associated with sleep disturbances, independently of socio-demographic, behavioural, and psychological factors. Further research should establish the extent to which social differences in sleep contribute to socioeconomic differences in health outcomes.

Tags: Adult, Aged, Aged, 80 and over, Cohort, Female, Humans, Male, Middle Aged, Polysomnography, Population-based, Risk Factors, Sex Factors, Sleep, Sleep Deprivation/epidemiology, Sleep Initiation and Maintenance Disorders/epidemiology, Sleep Wake Disorders/*epidemiology, Socioeconomic Factors, Socioeconomic status, Switzerland/epidemiology.

Kuster, M., Exadaktylos, A., and Schnuriger, B. “Non-Invasive Hemodynamic Monitoring In Trauma Patients”. World J Emerg Surg 10, no. 1: 11. doi:10.1186/s13017-015-0002-0.

Abstract: BACKGROUND: The assessment of hemodynamic status is a crucial task in the initial evaluation of trauma patients. However, blood pressure and heart rate are often misleading, as multiple variables may impact these conventional parameters. More reliable methods such as pulmonary artery thermodilution for cardiac output measuring would be necessary, but its applicability in the Emergency Department is questionable due to their invasive nature. Non-invasive cardiac output monitoring devices may be a feasible alternative. METHODS: A systematic literature review was conducted. Only studies that explicitly investigated non-invasive hemodynamic monitoring devices in trauma patients were considered. RESULTS: A total of 7 studies were identified as suitable and were included into this review. These studies evaluated in a total of 1,197 trauma patients the accuracy of non-invasive hemodynamic monitoring devices by comparing measurements to pulmonary artery thermodilution, which is the gold standard for cardiac output measuring. The correlation coefficients r between the two methods ranged from 0.79 to 0.92. Bias and precision analysis ranged from -0.02 +/- 0.78 l/min/m(2) to -0.14 +/- 0.73 l/min/m(2). Additionally, data on practicality, limitations and clinical impact of the devices were collected. CONCLUSION: The accuracy of non-invasive cardiac output monitoring devices in trauma patients is broadly satisfactory. As the devices can be applied very early in the shock room or even preclinically, hemodynamic shock may be recognized much earlier and therapeutic interventions could be applied more rapidly and more adequately. The devices can be used in the daily routine of a busy ED, as they are non-invasive and easy to master.

Tags: Hypovolemic shock, Initial care, Non-invasive hemodynamic monitoring, Trauma.

Langewitz, W., Ackermann, S., Heierle, A., Hertwig, R., Ghanim, L., and Bingisser, R. “Improving Patient Recall Of Information: Harnessing The Power Of Structure”. Patient Educ Couns 98, no. 6: 716-21. doi:10.1016/j.pec.2015.02.003.

Abstract: OBJECTIVE: Assess the amount of medical information laypeople recall, investigate the impact of structured presentation on recall. METHODS: 105 first-year psychology students (mean age 21.5+/-3.8 years; 85% female) were randomised to two information-presentation conditions: structured (S group) and nonstructured (NS group). Students watched a video of a physician discharging a patient from the emergency department. In the S Group, content (28 items of information) was divided into explicit "chapters" with "chapter headings" preceding new information. Afterwards, participants wrote down all information they recalled on an empty sheet of paper. RESULTS: The S group (N=57) recalled significantly more items than NS group (N=41) (8.12+/-4.31 vs. 5.71+/-3.73; p=0.005), rated information as easier to understand (8.0+/-1.9 vs. 6.1+/-2.2; p<0.001) and better structured (8.5+/-1.5 vs. 5.5+/-2.7; p<0.001); they rather recommended the physician to friends (7.1+/-2.7 vs. 5.8+/-2.6; p<0.01). CONCLUSION: University students recalled around 7/28 items of information presented. Explicit structure improved recall. PRACTICE IMPLICATIONS: Practitioners must reduce the amount of information conveyed and structure information to improve recall.

Tags: *Communication, *Comprehension, *Mental Recall, *Retention, Psychology, Adult, Book metaphor, Counseling, Emergency Service, Hospital, Female, Humans, Improving recall, Information recall, Male, Patient Education as Topic, Patient information, Physician-Patient Relations, Physicians, Structuring information.

Nickel, C. H., Malinovska, A., and Bingisser, R. “Should Weakness Be Subsumed To Nonspecific Complaints?-Correspondence In Response To Bhalla Et Al”. Am J Emerg Med 33, no. 5: 722-3. doi:10.1016/j.ajem.2015.02.019.

Tags: Fatigue/*epidemiology, Female, Humans, Male, Muscle Weakness/*epidemiology.

Peng, A., Rohacek, M., Ackermann, S., Ilsemann-Karakoumis, J., Ghanim, L., Messmer, A. S., Misch, F., Nickel, C. H., and Bingisser, R. “The Proportion Of Correct Diagnoses Is Low In Emergency Patients With Nonspecific Complaints Presenting To The Emergency Department”. Swiss Med Wkly 145: w14121. doi:10.4414/smw.2015.14121.

Abstract: OBJECTIVE: To determine the proportion of correct emergency department (ED) diagnoses and of hospital discharge diagnoses, in comparison with final diagnoses at the end of a 30-day follow-up, in patients presenting with nonspecific complaints (NSCs) to the ED; to determine differences between male and female patients in the proportion of missed diagnoses. METHODS: Prospective observational study. Diagnoses made at the ED, hospital discharge diagnoses, and final diagnoses were compared. RESULTS: Of 22,782 nontrauma patients presenting to the ED from May 2007 until May 2009, 9,926 were triaged as emergency severity index level 2 or 3, of whom 789 presented with NSCs. After exclusion of 217 patients, 572 were included for final analysis. The final diagnosis at the end of follow-up was taken to be the correct "gold standard" diagnosis. In 263 (46.0%) patients, this corresponded to the primary ED diagnosis, and in 292 (51%) patients to the hospital discharge diagnosis. The most frequent final diagnoses were urinary tract infections (n=49), electrolyte disorders (n=40) and pneumonia (n=37), and were correctly diagnosed at the ED in 23, 21 and 27 patients, respectively. Of the twelve most common diagnoses (corresponding to 354 patients), functional impairment was most frequently missed. Among these 354 patients, diagnoses were significantly more often missed in women than in men (142 of 231 [62%] women vs 57 of 123 [46%] men, p=0.004). CONCLUSION: Patients presenting to the ED with NSCs present a diagnostic challenge. New diagnostic tools are needed to help in the diagnosis of these patients.

Tags: Adult, Aged, Aged, 80 and over, Diagnostic Errors/*statistics & numerical data, Emergency Service, Hospital/*standards/*statistics & numerical data, Female, Humans, Male, Middle Aged, Patient Discharge Summaries, Pneumonia/*diagnosis, Prospective Studies, Severity of Illness Index, Sex Factors, Urinary Tract Infections/*diagnosis, Water-Electrolyte Imbalance/*diagnosis.

Imstepf, V. A., Braun, C. T., Ricklin, M. E., and Exadaktylos, A. K. “Time For A Break: Admissions To An Urban Emergency Department After Working Out--A Retrospective Study From Switzerland”. Biomed Res Int 2015: 610137. doi:10.1155/2015/610137.

Abstract: BACKGROUND: The present retrospective study was intended to investigate whether working out and other low-speed sports can provoke cardiovascular, neurological, or traumatic damage. MATERIAL AND METHODS: Patient data from 2007 to 2013 was collected and saved at the university department of emergency medicine in an electronic patient record database. RESULTS: Of the 138 patients included in this study, 83.3% (n = 115) were male and 16.7% female (n = 23). Most admissions were due to musculoskeletal accidents (n = 77; 55.8%), followed by neurological incidents (n = 23; 16.7%), cardiovascular incidents (n = 19; 13.8%), soft tissue injuries (n = 3; 2.2%), and others (n = 16; 11.6%). The mean age of the allover injured people was 36.7 years. The majority of the patients (n = 113; 81.9%) were treated as outpatients; 24 (17.4%) were inpatients. Discussion. In Switzerland, this is the first study that describes emergency department admissions after workout and examines trauma and neurological and cardiovascular incidents. As specific injuries, such as brain haemorrhages, STEMIs, and epileptic seizures, were relatively frequent, it was hypothesised that workout with its physiological changes may be an actual trigger for these injuries, at least for a specific population. CONCLUSION: Strenuous physical activity may trigger the risk of cardiovascular, neurological, or trauma events.

Tags: Adolescent, Adult, Aged, Aged, 80 and over, Athletic Injuries/*epidemiology, Brain Diseases/*epidemiology, Cardiovascular Diseases/*epidemiology, Comorbidity, Emergency Service, Hospital, Female, Hospitals, Urban, Humans, Male, Middle Aged, Physical Conditioning, Human/*statistics & numerical data, Prevalence, Risk Assessment, Switzerland/epidemiology, Young Adult.

Suurmond, J. L., Hudelson, P., and Dogra, N. “Culture And Health”. Lancet 385, no. 9968: 602. doi:10.1016/S0140-6736(15)60228-8.

Tags: *Culture, *Health Status, Humans.

Selby, K., Gaspoz, J. M., Rodondi, N., Neuner-Jehle, S., Perrier, A., Zeller, A., and Cornuz, J. “Creating A List Of Low-Value Health Care Activities In Swiss Primary Care”. Jama Intern Med 175, no. 4: 640-2. doi:10.1001/jamainternmed.2014.8111.

Tags: Delivery of Health Care/economics/standards/trends, Delphi Technique, Humans, Internal Medicine, Practice Guidelines as Topic, Primary Health Care/*economics, Societies, Medical, Switzerland.

Sebo, P., Haller, D., Pechere-Bertschi, A., Bovier, P., and Herrmann, F. “Accuracy Of Doctors' Anthropometric Measurements In General Practice”. Swiss Med Wkly 145: w14115. doi:10.4414/smw.2015.14115.

Abstract: PURPOSE: There is increasing pressure on general practitioners (GPs) to identify patients with abdominal obesity in order to reduce the life-threatening consequences of this condition in the population. We aimed to confirm previous findings on the inaccuracy of anthropometric measurements performed by GPs in an academic primary care clinic and to assess the effect of theoretical training to improve the quality of these measurements. METHODS: This cross-sectional study involved 26 GPs from private practices in Geneva, Switzerland. They were asked to measure weight, height, waist and hip circumference on ten volunteers within their practice. Two trained research assistants repeated the measurementss after the GPs ("gold standard"). The GPs were then randomised to receive information detailing the correct method for taking measurements (intervention, 14 doctors) or simple information about obesity (control, 12 doctors). Measurements were repeated a few weeks later. Measurement error was computed by comparing the GPs' values with the average value of two measurements taken in turn by the research assistants, and agreement was examined by Bland-Altman plots. The GPs' skills were assessed through auto-questionnaire and direct observation. RESULTS: All measurements except height were prone to measurement error, the least affected being weight (and therefore body mass index [BMI]). Following training, measurement errors were slightly less prominent in the intervention group. GPs' skills in measuring waist and hip circumference were frequently assessed as inadequate, but showed improvement after training. CONCLUSIONS: Without proper training, priority should be given to using classical anthropometric measurements (i.e. weight, height and BMI determination) in daily practice.

Tags: Adult, Anthropometry/*methods, Body Height, Body Mass Index, Body Weight, Body Weights and Measures/*standards, Cross-Sectional Studies, Female, General Practice/*standards, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Obesity/diagnosis, Reproducibility of Results, Surveys and Questionnaires, Switzerland, Waist Circumference.

Rohacek, M., Nickel, C. H., Dietrich, M., and Bingisser, R. “Clinical Intuition Ratings Are Associated With Morbidity And Hospitalisation”. Int J Clin Pract 69, no. 6: 710-7. doi:10.1111/ijcp.12606.

Abstract: OBJECTIVE: To evaluate how the rating of the severity of sickness - as performed by the physician, nurse and patient - is associated with hospitalisation and acute morbidity. METHODS: Prospective observational study, performed in the emergency department of a tertiary hospital. Patients, physicians and nurses were interviewed separately after the first contact from 21 October through to 11 November 2013. RESULTS: Of 2426 presenting patients, 1861 were screened, and 1196 were included. A total of 299 (25%) were hospitalised, 504 (42%) suffered acute morbidity. In the univariate analysis, the physician's, nurse's and patient's rating of severity of sickness, expressed on a scale from 0 to 10, was significantly associated with hospitalisation (physicians: OR 1.61, 95% CI 1.50-1.73; nurses: OR 1.52, 1.41-1.64; patients: OR 1.16, 1.10-1.22), and with acute morbidity (OR 1.49, 1.40-1.59; OR 1.39, 1.30-1.48 and OR 1.05, 1.003-1.09 respectively). The area under the curve of the receiver operating characteristic curves was 0.77, 0.72 and 0.61 for hospitalisation, and 0.72, 0.68 and 0.54 for acute morbidity. The interrater reliability was estimated by the intraclass correlation, which was 0.49 for physician/nurse, 0.17 for nurse/patient and 0.07 for physician/patient. In a multivariable analysis model consisting of age, male sex, ethnic origin, ratings of severity of sickness, symptoms, ability to go home and hospitalisation during the preceding 12 months, only age, and the physician's and nurses' rating of severity of sickness remained significantly associated with both outcomes. CONCLUSION: The first impression of severity of sickness was associated with hospitalisation and morbidity.

Tags: *Intuition, *Morbidity, *Severity of Illness Index, Acute Disease, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Area Under Curve, Emergency Service, Hospital/statistics & numerical data, Female, Hospitalization/*statistics & numerical data, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Young Adult.

Tsai, D. H., Guessous, I., Riediker, M., Paccaud, F., Gaspoz, J. M., Theler, J. M., Waeber, G., Vollenweider, P., and Bochud, M. “Short-Term Effects Of Particulate Matters On Pulse Pressure In Two General Population Studies”. J Hypertens 33, no. 6: 1144-52. doi:10.1097/HJH.0000000000000533.

Abstract: OBJECTIVES: To explore the association of short-term exposure to particulate matter with aerodynamic diameters less than 10 mum (PM10) with pulse pressure, SBP, and DBP taking outdoor temperature into account in two large population-based studies in Switzerland. METHODS: We used data from the Bus Sante study including 5605 adults in Geneva and the CoLaus study including 6183 adults in Lausanne. PM10 and meteorological data were measured from fixed monitoring stations. We analyzed the association of short-term exposure to PM10 (on the day of examination visit and up to 7 days before) with pulse pressure, SBP, and DBP by linear regression, controlling for potential confounders and effect modifiers. RESULTS: Average PM10 levels were 22.4 mug/m in Geneva and 31.7 mug/m in Lausanne. In adjusted models, for each 10 mug/m increase in 7-day PM10 average, pulse pressure and SBP increased by 0.583 (95% confidence interval, 0.296-0.870) mmHg and 0.490 (0.056-0.925) mmHg in Geneva, and 0.183 (0.017-0.348) mmHg and 0.036 (0.042-0.561) mmHg in Lausanne, respectively. Stronger associations of pulse pressure and SBP with PM10 were observed when outdoor temperature was above 5 degrees C. CONCLUSION: Positive associations of pulse pressure and SBP with short-term exposure to PM10 were found and replicated in the Swiss adult population. Our results suggest that even low levels of air pollution may substantially impact cardiovascular risk in the general population.

Tags: *Blood Pressure, Adult, Aged, Air Pollutants/*toxicity, Cardiovascular Diseases/epidemiology, Female, Humans, Male, Middle Aged, Models, Theoretical, Particulate Matter/*toxicity, Risk Factors, Switzerland, Temperature, Time Factors.

Junod Perron, N., Sommer, J., Louis-Simonet, M., and Nendaz, M. “Teaching Communication Skills: Beyond Wishful Thinking”. Swiss Med Wkly 145: w14064. doi:10.4414/smw.2015.14064.

Abstract: Communication skills tend to decline with time unless they are regularly recalled and practiced. However, most medical schools still deliver clinical communication training only during pre-clinical years although the clinical environment is considered to be ideal for acquiring and teaching clinical communication. The aim of this article is to review the barriers that prevent communication skills teaching and training from occurring in clinical practice and describe strategies that may help enhance such activities. Barriers occur at several levels: students, junior doctors and clinical supervisors sometimes have negative attitudes towards communication training; structured training in communication skills is often insufficient; clinical supervisors behave as poor role models and lack effective communication and teaching skills; finally, there are organisational constraints such as lack of time, competing priorities, weak hierarchy support and lack of positive incentives for using, training or teaching good communication skills in clinical practice. Given the difficulty of assessing transfer of communication skills in practice, only few studies describe successful educational interventions. In order to optimise communication skills learning in practice, there is need to: (1.) modify the climate and structure of the working environment so that that use, training and teaching of good communication skills in clinical practice becomes valued, supported and rewarded; (2.) extend communication skills training to any field of medicine; (3.) provide regular structured trainings and tailor them to trainees' needs. Practical implications of such findings are discussed at the end of this review.

Tags: *Health Communication, *Physician-Patient Relations, Attitude of Health Personnel, Clinical Competence, Education, Medical, Undergraduate/*methods, Humans, Students, Medical/psychology, Teaching.

Stewardson, A. J., Gaia, N., Francois, P., Malhotra-Kumar, S., Delemont, C., Martinez de Tejada, B., Schrenzel, J., et al. “Collateral Damage From Oral Ciprofloxacin Versus Nitrofurantoin In Outpatients With Urinary Tract Infections: A Culture-Free Analysis Of Gut Microbiota”. Clin Microbiol Infect 21, no. 4: 344 e1-11. doi:10.1016/j.cmi.2014.11.016.

Abstract: Recent treatment guidelines for uncomplicated urinary tract infections (UTIs) discourage fluoroquinolone prescription because of collateral damage to commensal microbiota, but the ecologic impact of alternative agents has not been evaluated by culture-free techniques. We prospectively collected faecal samples at three time points from ambulatory patients with UTIs treated with ciprofloxacin or nitrofurantoin, patients not requiring antibiotics and household contacts of ciprofloxacin-treated patients. We described changes in gut microbiota using a culture-independent approach based on pyrosequencing of the V3-V4 region of the bacterial 16S rRNA gene. All groups were similar at baseline. Ciprofloxacin had a significant global impact on the gut microbiota whereas nitrofurantoin did not. The end of ciprofloxacin treatment correlated with a reduced proportion of Bifidobacterium (Actinobacteria), Alistipes (Bacteroidetes) and four genera from the phylum Firmicutes (Faecalibacterium, Oscillospira, Ruminococcus and Dialister) and an increased relative abundance of Bacteroides (Bacteroidetes) and the Firmicutes genera Blautia, Eubacterium and Roseburia. Substantial recovery had occurred 4 weeks later. Nitrofurantoin treatment correlated with a reduced relative proportion of the genus Clostridium and an increased proportion of the genus Faecalibacterium. This study supports use of nitrofurantoin over fluoroquinolones for treatment of uncomplicated UTIs to minimize perturbation of intestinal microbiota.

Tags: Adult, Anti-Bacterial Agents/*therapeutic use, Antibiotics, Bacteria/*classification/*drug effects/genetics/isolation & purification, Ciprofloxacin/*therapeutic use, DNA, Bacterial/chemistry/genetics, DNA, Ribosomal/chemistry/genetics, ecologic damage, Feces/microbiology, Female, Gastrointestinal Microbiome/*drug effects, Humans, Male, microbiomics, microbiota, Middle Aged, Nitrofurantoin/*therapeutic use, Outpatients, Prospective Studies, RNA, Ribosomal, 16S/genetics, Sequence Analysis, DNA, urinary tract infection, Urinary Tract Infections/*drug therapy, Young Adult.

Sieber, R., and Osterwalder, J. “Treatment Algorithm Reduces Oxygen Use In The Emergency Department”. Eur J Emerg Med 23, no. 2: 114-8. doi:10.1097/MEJ.0000000000000243.

Abstract: OBJECTIVES: Evaluation of an O2 treatment algorithm on the basis of current recommendations to reduce the number of patients unnecessarily treated with O2 in the Emergency Department of a tertiary hospital compared with the traditional application, and analysis of the use of O2. DESIGN: This was a single-centre cohort study with 4 weeks of observation before and after the introduction of an O2 treatment algorithm. The main outcome measures were the proportion of patients treated with O2, distribution of indications for O2 therapy and occurrence of hypoxia and hypercapnia as undesired effects. RESULTS: The 4-week period before the intervention included 2190 patients and the 4-week period after the intervention included 2122 patients. The indications for O2 therapy were very similar in the two periods. After the intervention, the proportion of patients with supplemental O2 therapy was reduced from 11% (246) to 9% (182) (P<0.003), a relative decrease of 18%. Undesired effects were similar in nature and frequency in the two observation periods. CONCLUSION: The introduction of an O2 treatment algorithm in the Emergency Department reduced the number of patients treated with O2, and the nature and frequency of undesired effects was similar before and after the intervention.

Tags: *Decision Support Systems, Clinical, *Emergency Service, Hospital/statistics & numerical data, Algorithms, Female, Humans, Male, Oxygen Inhalation Therapy/*statistics & numerical data.

Richard-Lepouriel, H., Weber, K., Baertschi, M., DiGiorgio, S., Sarasin, F., and Canuto, A. “Predictors Of Recurrent Use Of Psychiatric Emergency Services”. Psychiatr Serv 66, no. 5: 521-6. doi:10.1176/appi.ps.201400097.

Abstract: OBJECTIVE: Many patients visit psychiatric emergency services several times per year, which raises questions about the limits of this treatment setting. Previous studies have focused on recurrent visits over one year of follow-up. This study examined sociodemographic and diagnostic predictors of recurrent visits (three or more visits a year) to a psychiatric emergency service over three consecutive years. METHODS: This three-year retrospective cohort study used data from computerized administrative and medical records of 4,322 patients who visited the psychiatric emergency service of the University Hospitals of Geneva, Switzerland, at least once in 2008. RESULTS: A total of 210 (5%) of the 4,322 patients had three or more visits in 2008. Of these, 22% also had recurrent use (three or more visits per year) in 2009, 2010, or 2011, and 78% did not. Recurrent visits were not predicted by sociodemographic characteristics, such as age, gender, marital status, professional activity, and citizenship. Two variables were significant predictors of recurrent visits: a diagnosis of a personality disorder and recurrent use of the emergency service in the 18 months before study entry in 2008. CONCLUSIONS: Patients with personality disorders and past recurrent use of emergency services appeared to rely more on psychiatric emergency services for continuous psychiatric care than patients without past recurrent use of emergency services and patients with mood, substance use, anxiety, or psychotic disorders. Creation of a follow-up treatment program for this clinical population within the psychiatric emergency setting itself may provide better access to care for these patients.

Tags: Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Cohort Studies, Emergency Services, Psychiatric/*statistics & numerical data, Female, Follow-Up Studies, Hospitals, Teaching, Humans, Male, Marital Status, Mental Disorders/*therapy, Middle Aged, Recurrence, Retrospective Studies, Sex Distribution, Socioeconomic Factors, Switzerland, Young Adult.

Guessous, I., and Dash, C. “Direct To Consumer Advertising: The Case For Greater Consumer Control”. J Gen Intern Med 30, no. 4: 392-4. doi:10.1007/s11606-015-3187-8.

Tags: Direct-to-Consumer Advertising/*methods, Humans, Interrupted Time Series Analysis/*methods, Male, Prostatic Hyperplasia/*drug therapy.

Blum, C. A., Nigro, N., Briel, M., Schuetz, P., Ullmer, E., Suter-Widmer, I., Winzeler, B., et al. “Adjunct Prednisone Therapy For Patients With Community-Acquired Pneumonia: A Multicentre, Double-Blind, Randomised, Placebo-Controlled Trial”. Lancet 385, no. 9977: 1511-8. doi:10.1016/S0140-6736(14)62447-8.

Abstract: BACKGROUND: Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia. We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia. METHODS: In this double-blind, multicentre, randomised, placebo-controlled trial, we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerland within 24 h of presentation. Patients were randomly assigned (1:1 ratio) to receive either prednisone 50 mg daily for 7 days or placebo. The computer-generated randomisation was done with variable block sizes of four to six and stratified by study centre. The primary endpoint was time to clinical stability defined as time (days) until stable vital signs for at least 24 h, and analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00973154. FINDINGS: From Dec 1, 2009, to May 21, 2014, of 2911 patients assessed for eligibility, 785 patients were randomly assigned to either the prednisone group (n=392) or the placebo group (n=393). Median time to clinical stability was shorter in the prednisone group (3.0 days, IQR 2.5-3.4) than in the placebo group (4.4 days, 4.0-5.0; hazard ratio [HR] 1.33, 95% CI 1.15-1.50, p<0.0001). Pneumonia-associated complications until day 30 did not differ between groups (11 [3%] in the prednisone group and 22 [6%] in the placebo group; odds ratio [OR] 0.49 [95% CI 0.23-1.02]; p=0.056). The prednisone group had a higher incidence of in-hospital hyperglycaemia needing insulin treatment (76 [19%] vs 43 [11%]; OR 1.96, 95% CI 1.31-2.93, p=0.0010). Other adverse events compatible with corticosteroid use were rare and similar in both groups. INTERPRETATION: Prednisone treatment for 7 days in patients with community-acquired pneumonia admitted to hospital shortens time to clinical stability without an increase in complications. This finding is relevant from a patient perspective and an important determinant of hospital costs and efficiency. FUNDING: Swiss National Science Foundation, Viollier AG, Nora van Meeuwen Haefliger Stiftung, Julia und Gottfried Bangerter-Rhyner Stiftung.

Tags: Aged, Aged, 80 and over, Anti-Bacterial Agents/therapeutic use, Anti-Inflammatory Agents/*administration & dosage, Community-Acquired Infections/drug therapy/microbiology, Double-Blind Method, Drug Administration Schedule, Drug Therapy, Combination, Female, Hospitalization, Humans, Intention to Treat Analysis, Male, Middle Aged, Pneumonia/*drug therapy/microbiology, Prednisone/*administration & dosage, Switzerland, Treatment Outcome.

Westphal, M., Bingisser, M. B., Feng, T., Wall, M., Blakley, E., Bingisser, R., and Kleim, B. “Protective Benefits Of Mindfulness In Emergency Room Personnel”. J Affect Disord 175: 79-85. doi:10.1016/j.jad.2014.12.038.

Abstract: BACKGROUND: Recent meta-analyses have found that mindfulness practice may reduce anxiety and depression in clinical populations and there is growing evidence that mindfulness may also improve well-being and quality of care in health professionals. This study examined whether mindfulness protects against the impact of work-related stress on mental health and burnout in emergency room (ER) nurses. METHODS: ER nurses (N=50) were recruited from an urban teaching hospital in Switzerland and completed a survey on work-related stressors, mindfulness, burnout, depression, and anxiety. RESULTS: The most frequently reported work-related stressor was interpersonal conflict. Nurses working more consecutive days since last taking time off were at greater risk for depression and those reporting more work-related interpersonal conflicts were at greater risk for burnout. Mindfulness was associated with reduced anxiety, depression, and burnout. Mindfulness was a significant predictor of anxiety, depression, and burnout and moderated the impact of work-related stressors on mental health and burnout. LIMITATIONS: The sample is limited to nurses and results need to be replicated in other groups (e.g., medical staff or ambulance workers). We assessed clinical symptoms with questionnaires and it would be desirable to repeat this assessment with clinical diagnostic interviews. CONCLUSIONS: The findings have implications for stress management in ER nurses and health professionals working in comparable settings (e.g., urgent care). The robust associations between mindfulness and multiple indices of psychological well-being suggest that ER staff exposed to high levels of occupational stress may benefit from mindfulness practice to increase resistance to mental health problems and burnout.

Tags: *Emergency Service, Hospital, *Mindfulness, Adult, Anxiety, Anxiety/*psychology, Burnout, Burnout, Professional/*psychology, Conflict, Psychological, Depression, Depression/*psychology, Emergency care, Female, Health Surveys, Humans, Male, Mindfulness, Nurses, Nurses/*psychology, Protective Factors, Switzerland, Young Adult.

Sauter, T., Haider, D. G., Ricklin, M. E., and Exadaktylos, A. K. “The Snow, The Men, The Shovel, The Risk? Er Admissions After Snow Shovelling: 13 Winters In Bern”. Swiss Med Wkly 145: w14104. doi:10.4414/smw.2015.14104.

Tags: *Seasons, Emergencies/*epidemiology, Emergency Service, Hospital, Female, Heart Function Tests/methods, Household Articles, Humans, Male, Middle Aged, Patient Admission/*statistics & numerical data, Physical Exertion/*physiology, Risk, Sex Factors, Snow, Switzerland/epidemiology, Time Factors.

Pfortmueller, C. A., Funk, G. C., Potura, E., Reitere, C., Kabon, B., Druml, W., Fleischmann, E., and Lindner, G. “Balanced Crystalloid Use Is Associated With Haemodynamic Stability And Less Need For Vasopressors In Patients Receiving Renal Transplantation Compared To 0.9% Saline”. Intensive Care Medicine Experimental 3, no. S1. doi:10.1186/2197-425x-3-s1-a18.

Dickmann, Petra, McClelland, Amanda, Gamhewage, Gaya M., Portela de Souza, Patricia, and Apfel, Franklin. “Making Sense Of Communication Interventions In Public Health Emergencies – An Evaluation Framework For Risk Communication”. Journal Of Communication In Healthcare 8, no. 3: 233-240. doi:10.1080/17538068.2015.1101962.

Abstract: Communication interventions during public health emergencies (e.g. infectious disease outbreaks) are increasingly acknowledged as a determinant of success in preparedness, response and recovery. Challenges related to the current outbreak of Ebola virus in West Africa once again reveal the need to strengthen our understanding of the central importance and complexity of risk communication and social mobilisation strategies. There is little hard evidence, however, on the impact of various communication interventions upon the dynamics of public health emergencies to guide our capacity development. This article proposes a new evaluative framework which builds on an understanding of risk communication as an interactive, holistic, continuous and engaging activity that focuses on dialogue, intelligence gathering, building relationships over time with a knowledge base informed by new and accessible communication technologies (e.g. social media and networks) and supportive environments. Our hypothesis is that impact is measureable through the evaluation of identifiable performance parameters related to the dynamics of an outbreak. Our assumption is that risk communication interventions that lead to earlier detection, faster response, smoother coordination and a smarter legacy (ability to use processes and outcomes to improve current and future performance) lead to lower morbidity and mortality (reduced AUCepidemic curve). This new evaluation framework for risk communication measures the relation between a baseline dynamic of epidemic and communication activities and the changed dynamic resulting from risk communication activities (e.g. earlier detection, faster response, smoother coordination and smarter legacy). We believe that a better understanding of how the two dynamics relate can lead to a better management of future public health emergencies. © W. S. Maney & Son Ltd 2015.

Dami, F. “Acute Stroke Management: Models Of Pre-Hospital Organisation”. Schweizer Archiv Fur Neurologie Und Psychiatrie 166, no. 2: 59-60. https://www.scopus.com/inward/record.uri?eid=2-s2.0-84923668418&partnerID=40&md5=ff524117bbd6c1cd2ffda9523686f43a.

Swiss Emergency Research collection

2015

2014