Home > Bibliographic references

Swiss Emergency Research collection

2023

  • Rauch, S., Lechner, R., Strapazzon, G., Mortimer, R. B., Ellerton, J., Skaiaa, S. C., Huber, T., Brugger, H., Pasquier, M., and Paal, P. “Suspension Syndrome: A Scoping Review And Recommendations From The International Commission For Mountain Emergency Medicine (Icar Medcom)”. Scand J Trauma Resusc Emerg Med 31, no. 1: 95. doi:10.1186/s13049-023-01164-z.
    Abstract: BACKGROUND: Suspension syndrome describes a multifactorial cardio-circulatory collapse during passive hanging on a rope or in a harness system in a vertical or near-vertical position. The pathophysiology is still debated controversially. AIMS: The International Commission for Mountain Emergency Medicine (ICAR MedCom) performed a scoping review to identify all articles with original epidemiological and medical data to understand the pathophysiology of suspension syndrome and develop updated recommendations for the definition, prevention, and management of suspension syndrome. METHODS: A literature search was performed in PubMed, Embase, Web of Science and the Cochrane library. The bibliographies of the eligible articles for this review were additionally screened. RESULTS: The online literature search yielded 210 articles, scanning of the references yielded another 30 articles. Finally, 23 articles were included into this work. CONCLUSIONS: Suspension Syndrome is a rare entity. A neurocardiogenic reflex may lead to bradycardia, arterial hypotension, loss of consciousness and cardiac arrest. Concomitant causes, such as pain from being suspended, traumatic injuries and accidental hypothermia may contribute to the development of the Suspension Syndrome. Preventive factors include using a well-fitting sit harness, which does not cause discomfort while being suspended, and activating the muscle pump of the legs. Expediting help to extricate the suspended person is key. In a peri-arrest situation, the person should be positioned supine and standard advanced life support should be initiated immediately. Reversible causes of cardiac arrest caused or aggravated by suspension syndrome, e.g., hyperkalaemia, pulmonary embolism, hypoxia, and hypothermia, should be considered. In the hospital, blood and further exams should assess organ injuries caused by suspension syndrome.
    Tags: *Emergency Medicine, *Heart Arrest, *Hypothermia/therapy, *Mountaineering/injuries, Circumrescue collapse, Harness, Humans, Iron-Dextran Complex, Neurocardiac syncope, Rescue death, Resuscitation, Suspension syndrome.
  • Rasiah, R., Gregoriano, C., Mueller, B., Kutz, A., and Schuetz, P. “Hospital Outcomes In Medical Patients With Alcohol-Related And Non-Alcohol-Related Wernicke Encephalopathy”. Mayo Clin Proc 99, no. 5: 740-753. doi:10.1016/j.mayocp.2023.07.021.
    Abstract: OBJECTIVE: To conduct a nationwide retrospective cohort study to assess trends and hospitalization-associated outcomes in patients with Wernicke encephalopathy. PATIENTS AND METHODS: In this nationwide retrospective cohort study, we used in-hospital claims data of patients hospitalized with Wernicke encephalopathy in Switzerland from January 1, 2012, to December 31, 2020. We estimated incidence rates per 100,000 person-years among the overall Swiss population stratified by alcohol and non-alcohol-induced Wernicke encephalopathy. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included progression to Korsakoff syndrome and 1-year hospital readmission. We estimated odds ratios (ORs) for binary outcomes. RESULTS: It was found that 4098 of 4393 hospitalizations (93.3%) for Wernicke encephalopathy during the 8-year study were alcohol-related. Incidence rates for hospitalizations were 14-fold higher in alcohol-related compared with non-alcohol-related Wernicke encephalopathy (5.43 vs 0.39 per 100,000 person-years). The risk for in-hospital mortality was significantly lower in patients with alcohol-related vs non-alcohol-related Wernicke encephalopathy (3.2% vs 8.5%; adjusted OR, 0.38; 95% CI, 0.23 to 0.62). Patients with alcohol-related Wernicke encephalopathy had higher risk for development of Korsakoff syndrome (16.9% vs 1.7%; adjusted OR, 10.64; 95% CI, 4.37 to 25.92) and 1-year hospital readmission (31.6% vs 18.7%; adjusted OR, 1.4; 95% CI, 1.04 to 1.88). CONCLUSION: In this Swiss nationwide cohort study, Wernicke encephalopathy was a rare but serious cause for hospitalization and mainly alcohol-related. Patients with alcohol-related Wernicke encephalopathy had lower risks of in-hospital mortality but were more likely to develop Korsakoff syndrome and be readmitted to the hospital.
    Tags: *Hospital Mortality, *Hospitalization/statistics & numerical data, *Wernicke Encephalopathy/epidemiology/etiology, Adult, Aged, Alcoholism/complications/epidemiology, Female, Humans, Incidence, Korsakoff Syndrome/epidemiology/etiology, Male, Middle Aged, Patient Readmission/statistics & numerical data, Retrospective Studies, Switzerland/epidemiology.
  • Schnuriger, B., Jakob, D. A., and Exadaktylos, A. “The Critical Role Of Organ Donation Following Resuscitative Thoracotomy”. Injury 55, no. 2: 111245. doi:10.1016/j.injury.2023.111245.
    Tags: *Thoracotomy, *Tissue and Organ Procurement, competing financial interests or personal relationships that could have appeared, Humans, Resuscitation, Retrospective Studies, to influence the work reported in this paper..
  • Abdurashidova, T., Muller, M., Schukraft, S., Soborun, N., Pitta-Gros, B., Kikoine, J., Lu, H., et al. “European Society Of Cardiology Guidelines And 1 Year Outcomes Of Acute Heart Failure Treatment In Central Asia And Europe”. Esc Heart Fail 11, no. 1: 483-491. doi:10.1002/ehf2.14591.
    Abstract: AIMS: Outcomes reported for patients with hospitalization for acute heart failure (AHF) treatment vary worldwide. Ethnicity-associated characteristics may explain this observation. This observational study compares characteristics and 1-year outcomes of Kyrgyz and Swiss AHF patients against the background of European Society of Cardiology guidelines-based cardiovascular care established in both countries. METHODS AND RESULTS: The primary endpoint was 1 year all-cause mortality (ACM); the secondary endpoint was 1 year ACM or HF-related rehospitalization. A total of 538 Kyrgyz and 537 Swiss AHF patients were included. Kyrgyz patients were younger (64.0 vs. 83.0 years, P < 0.001); ischaemic or rheumatic heart disease and chronic obstructive pulmonary disease were more prevalent (always P < 0.001). In Swiss patients, smoking, dyslipidaemia, hypertension, and atrial flutter/fibrillation were more frequent (always P </= 0.035); moreover, left ventricular ejection fraction (LVEF) was higher (47% vs. 36%; P < 0.001), and >mild aortic stenosis was more prevalent (P < 0.001). Other valvular pathologies were more prevalent in Kyrgyz patients (P < 0.001). At discharge, more Swiss patients were on vasodilatory treatment (P < 0.006), while mineralocorticoid receptor antagonists (P = 0.001), beta-blockers (P = 0.001), or loop diuretics (P < 0.001) were less often prescribed. In Kyrgyz patients, unadjusted odds for the primary and secondary endpoints were lower [odds ratio (OR) 0.68, 95% confidence interval (CI): 0.51-0.90, P = 0.008; OR 0.72, 95% CI: 0.56-0.91, P = 0.006, respectively]. After adjustment for age and LVEF, no difference remained (primary endpoint: OR 1.03, 95% CI: 0.71-1.49, P = 0.894; secondary endpoint: OR 0.82, 95% CI: 0.60-1.12, P = 0.206). CONCLUSIONS: On the background of identical guidelines, age- and LVEF-adjusted outcomes were not different between Central Asian and Western European AHF patients despite of large ethnical disparity.
    Tags: *Cardiology, *Heart Failure/drug therapy/epidemiology, Acute heart failure, Asia, ESC guidelines, Ethnicity, Humans, Outcome, Stroke Volume, Ventricular Function, Left.
  • Koechlin, L., Boeddinghaus, J., Lopez-Ayala, P., Wildi, K., Nestelberger, T., Wussler, D., Guzman Tacla, C. A., et al. “External Validation Of The 0/1H-Algorithm And Derivation Of A 0/2H-Algorithm Using A New Point-Of-Care Hs-Ctni Assay”. Am Heart J 268: 104-113. doi:10.1016/j.ahj.2023.11.014.
    Abstract: BACKGROUND: The high-sensitivity cardiac troponin (hs-cTn) I point-of-care (POC) hs-cTnI-PATHFAST assay has recently become clinically available. METHODS: We aimed to externally validate the hs-cTnI-PATHFAST 0/1h-algorithm recently developed for the early diagnosis of non-ST-segment-elevation myocardial infarction (NSTEMI) and derive and validate a 0/2-algorithm in patients presenting to the emergency department with acute chest discomfort included in a multicenter diagnostic study. Two independent cardiologists centrally adjudicated the final diagnoses using all the clinical and study-specific information available including serial measurements of hs-cTnI-Architect. RESULTS: Among 1,532 patients (median age 60 years, 33% [n = 501] women), NSTEMI was the final diagnosis in 13%. External validation of the hs-cTnI-PATHFAST 0/1h-algorithm showed very high negative predictive value (NPV; 100% [95%CI, 99.5%-100%]) and sensitivity 100% (95%CI, 98.2%-100%) for rule-out of NSTEMI. Positive predictive value (PPV) and specificity for rule-in of NSTEMI were high (74.9% [95%CI, 68.3%-80.5%] and 96.4% [95%CI, 95.2%-97.3%], respectively). Among 1,207 patients (median age 61 years, 32% [n = 391] women) available for the derivation (n = 848) and validation (n = 359) of the hs-cTnI-PATHFAST 0/2h-algorithm, a 0h-concentration <3 ng/L or a 0h-concentration <4 ng/L with a 2h-delta <4ng/L ruled-out NSTEMI in 52% of patients with a NPV of 100% (95%CI, 98-100) and sensitivity of 100% (95%CI, 92.9%-100%) in the validation cohort. A 0h-concentration >/=90ng/L or a 2h-delta >/= 55ng/L ruled-in 38 patients (11%): PPV 81.6% (95%CI, 66.6-90.8), specificity 97.7% (95%CI, 95.4-98.9%). CONCLUSIONS: The POC hs-cTnI-PATHFAST assay allows rapid and effective rule-out and rule-in of NSTEMI using both a 0/1h- and a 0/2h-algorithm with high NPV/sensitivity for rule-out and high PPV/specificity for rule-in. CLINICAL TRIAL REGISTRATION: NCT00470587.
    Tags: *Myocardial Infarction/diagnosis, *Non-ST Elevated Myocardial Infarction/diagnosis, *ST Elevation Myocardial Infarction, Algorithms, Biomarkers, Female, Humans, Middle Aged, Point-of-Care Systems, Prospective Studies, Troponin I, Troponin T.
  • Malagic Polutak, M., and Hartel, M. “A Rare Case Of A Sporadic Retroperitoneal Hemangioblastoma”. J Surg Case Rep 2023, no. 11: rjad629. doi:10.1093/jscr/rjad629.
    Abstract: Hemangioblastoma is a rare, benign, and morphologically distinctive tumor. In most cases, the tumor involves the central nervous system. Extraneural occurrences are rare, with just a few reports of hemangioblastoma situated outside of neural tissue, such as the retroperitoneum. We report a case of sporadic retroperitoneal hemangioblastoma in an 87-year-old male patient, diagnosed as an incidental finding in a CT scan performed because of kidney stone disease. The CT scan showed a mass in the retroperitoneum posterior to the inferior vena cava. The patient reported no remarkable symptoms. We describe our path to diagnosis, the possible differential diagnosis for retroperitoneal masses, and the histopathologic features of the tumor. There are <250 reported extra neuraxial hemangioblastomas and just 14 reported cases situated outside of the neural tissue. Our case is the eighth case report of a hemangioblastoma arising from the soft tissue of the retroperitoneum.
    Tags: extraneural hemangioblastoma, hemangioblastoma, retroperitoneal tumors, sporadic hemangioblastoma.
  • Klasen, J. M., Poljo, A., Sortino, R., Bogie, B. J. M., Schoenbaechler, Z., Meienberg, A., Nickel, C., Bingisser, R., and LaDonna, K. A. “Medical Students On The Covid-19 Frontline: A Qualitative Investigation Of Experiences Of Relief, Stress, And Mental Health”. Front Med (Lausanne) 10: 1249618. doi:10.3389/fmed.2023.1249618.
    Abstract: OBJECTIVE: During the early stages of the COVID-19 pandemic, medical students were abruptly removed from clinical rotations and transitioned to virtual learning. This study investigates the impact of this shift on students' wellbeing and preparedness for advanced training. METHODS: Through qualitative research methods, including semi-structured interviews, the experiences of medical students working on the COVID-19 frontline were explored. RESULTS: The comprehensive findings of the study shed light on the profound emotional journey that medical students embarked upon during the relentless public health crisis. Within the chaos and overwhelming demands of the pandemic, medical students discovered a profound sense of purpose and fulfillment in their contributions to the welfare of the community. Despite the personal sacrifices they had to make, such as long hours, limited social interactions, and potentially risking their own health, students reported feelings of relief and gratitude. CONCLUSION: Tailored support systems for medical students' wellbeing are crucial for improving healthcare delivery during crises. Medical schools should adopt a holistic curriculum approach, integrating interdisciplinary learning and prioritizing student wellbeing. Recognizing the pandemic's impact on students and implementing targeted support measures ensures resilience and contributes to an improved healthcare system.
    Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., Covid-19, education, healthcare professional, medical student, qualitative study, wellbeing.
  • Egger, C., Fernandez-Tenorio, M., Blanch, J., Janicek, R., and Egger, M. “Dual Mode Of Action Of Ip(3)-Dependent Sr-Ca(2+) Release On Local And Global Sr-Ca(2+) Release In Ventricular Cardiomyocytes”. J Mol Cell Cardiol 186: 107-110. doi:10.1016/j.yjmcc.2023.11.009.
    Abstract: In heart muscle, the physiological function of IP(3)-induced Ca(2+) release (IP(3)ICR) from the sarcoplasmic reticulum (SR) is still the subject of intense study. A role of IP(3)ICR may reside in modulating Ca(2+)-dependent cardiac arrhythmogenicity. Here we observe the propensity of spontaneous intracellular Ca(2+) waves (SCaW) driven by Ca(2+)-induced Ca(2+) release (CICR) in ventricular myocytes as a correlate of arrhythmogenicity on the organ level. We observe a dual mode of action of IP(3)ICR on SCaW generation in an IP(3)R overexpression model. This model shows a mild cardiac phenotype and mimics pathophysiological conditions of increased IP(3)R activity. In this model, IP(3)ICR was able to increase or decrease the occurrence of SCaW depending on global Ca(2+) activity. This IP(3)ICR-based regulatory mechanism can operate in two "modes" depending on the intracellular CICR activity and efficiency (e.g. SCaW and/or local Ryanodine Receptor (RyR) Ca(2+) release events, respectively): a) in a mode that augments the CICR mechanism at the cellular level, resulting in improved excitation-contraction coupling (ECC) and ultimately better contraction of the myocardium, and b) in a protective mode in which the CICR activity is curtailed to prevent the occurrence of Ca(2+) waves at the cellular level and thus reduce the probability of arrhythmogenicity at the organ level.
    Tags: *Myocytes, Cardiac/metabolism, *Sarcoplasmic Reticulum/metabolism, Arrhythmias, Cardiac/metabolism, Ca(2+) puffs, Ca(2+) Sparks, Calcium Signaling, Calcium/metabolism, Cicr, Ecc, Excitation Contraction Coupling, Humans, Ryanodine Receptor Calcium Release Channel/metabolism, RyR, Ventricular myocytes.
  • Buda, N., Mendrala, K., Skoczynski, S., Pasquier, M., Mazur, P., Garcia, E., and Darocha, T. “Basics Of Point-Of-Care Lung Ultrasonography”. N Engl J Med 389, no. 21: e44. doi:10.1056/NEJMvcm2108203.
    Abstract: Lung ultrasonography is a well-established, broadly accessible, and cost-effective diagnostic tool for patients with dyspnea. It may be used for diagnosis, treatment monitoring, or the detection of complications or overlapping diseases. Findings on lung ultrasonography should be interpreted within the clinical context. © 2023 Massachussetts Medical Society. All rights reserved.
    Tags: *Lung Diseases/diagnostic imaging, *Lung/diagnostic imaging, *Point-of-Care Systems, *Ultrasonography/methods, Humans.
  • Albrecht, R., Espejo, T., Riedel, H. B., Nissen, S. K., Banerjee, J., Conroy, S. P., Dreher-Hummel, T., Brabrand, M., Bingisser, R., and Nickel, C. H. “Clinical Frailty Scale At Presentation To The Emergency Department: Interrater Reliability And Use Of Algorithm-Assisted Assessment”. Eur Geriatr Med 15, no. 1: 105-113. doi:10.1007/s41999-023-00890-y.
    Abstract: PURPOSE: The Clinical Frailty Scale (CFS) allows health care providers to quickly stratify older patients, to support clinical decision-making. However, few studies have evaluated the CFS interrater reliability (IRR) in Emergency Departments (EDs), and the freely available smartphone application for CFS assessment was never tested for reliability. This study aimed to evaluate the interrater reliability of the Clinical Frailty Scale (CFS) ratings between experienced and unexperienced staff (ED clinicians and a study team (ST) of medical students supported by a smartphone application to assess the CFS), and to determine the feasibility of CFS assignment in patients aged 65 or older at triage. METHODS: Cross-sectional study using consecutive sampling of ED patients aged 65 or older. We compared assessments by ED clinicians (Triage Clinicians (TC) and geriatric ED trained nurses (geriED-TN)) and a study team (ST) of medical students using a smartphone application for CFS scoring. The study is registered on Clinicaltrials.gov (NCT05400707). RESULTS: We included 1349 patients aged 65 and older. Quadratic-weighted kappa values for ordinal CFS levels showed a good IRR between TC and ST (varkappa = 0.73, 95% CI 0.69-0.76), similarly to that between TC and geriED-TN (varkappa = 0.75, 95% CI 0.66-0.82) and between the ST and geriED-TN (varkappa = 0.74, 95% CI 0.63-0.81). A CFS rating was assigned to 972 (70.2%) patients at triage. CONCLUSION: We found good IRR in the assessment of frailty with the CFS in different ED providers and a team using a smartphone application to support rating. A CFS assessment occurred in more than two-thirds (70.2%) of patients at triage.
    Tags: *Frailty/diagnosis/epidemiology, Aged, Algorithms, Cfs, Clinical Frailty Scale, conflict of interest., Cross-Sectional Studies, Emergency department, Emergency Service, Hospital, Frailty, Geriatric acuity, Humans, Interrater reliability, Reproducibility of Results.
  • Durmisi, M., Kaegi-Braun, N., Muller, N. A., Wunderle, C., Tribolet, P., Stanga, Z., Mueller, B., and Schuetz, P. “Association Of Admission Cortisol Levels With Outcomes And Treatment Response In Patients At Nutritional Risk : A Secondary Analysis Of A Randomized Clinical Trial”. Nutr J 22, no. 1: 59. doi:10.1186/s12937-023-00881-6.
    Abstract: INTRODUCTION: Cortisol is a metabolically active stress hormone that may play a role in the pathogenesis of malnutrition. We studied the association between admission cortisol levels and nutritional parameters, disease severity, and response to nutritional support among medical inpatients at nutritional risk. METHODS: Admission cortisol was measured in a subset of 764 patients participating in the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a multicentre, randomized-controlled trial that compared individualized nutritional support with usual nutritional care. RESULTS: Overall, mean cortisol levels were 570 (+/- 293) nmol/L and significantly higher in patients with high nutritional risk (NRS >/= 5) and in patients reporting loss of appetite. Cortisol levels in the highest quartile (> 723 nmol/l) were associated with adverse outcomes including mortality at 30 days and 5 years (adjusted HR 2.31, [95%CI 1.47 to 3.62], p = 0.001 and 1.51, [95%CI 1.23 to 1.87], p < 0.001). Nutritional treatment tended to be more effective regarding mortality reduction in patients with high vs. low cortisol levels (adjusted OR of nutritional support 0.54, [95%CI 0.24 to 1.24] vs. OR 1.11, [95%CI 0.6 to 2.04], p for interaction = 0.134). This effect was most pronounced in the subgroup of patients with severe malnutrition (NRS 2002 >/= 5, p for interaction = 0.047). CONCLUSION: This secondary analysis of a randomized nutritional trial suggests that cortisol levels are linked to nutritional and clinical outcome among multimorbid medical patients at nutritional risk and may help to improve risk assessment, as well as response to nutritional treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02517476.
    Tags: *Hydrocortisone, *Malnutrition/therapy, Acute and chronic stress, Cortisol, Critical Illness, Diagnostics, not related to this project. No other disclosures are reported., Hospitalization, HPA-axis, Humans, Inpatients, Mortality, Nestle Health Science, Thermofisher, BioMerieux, Abbott Nutrition and Roche, Nutritional risk, Nutritional Support.
  • Bima, P., Lopez-Ayala, P., Koechlin, L., Boeddinghaus, J., Nestelberger, T., Okamura, B., Muench-Gerber, T. S., et al. “Chest Pain In Cancer Patients: Prevalence Of Myocardial Infarction And Performance Of High-Sensitivity Cardiac Troponins”. Jacc Cardiooncol 5, no. 5: 591-609. doi:10.1016/j.jaccao.2023.08.001.
    Abstract: BACKGROUND: Little is known about patients with cancer presenting with acute chest discomfort to the emergency department (ED). OBJECTIVES: The aim of this study was to assess the prevalence of acute myocardial infarction (AMI), outcomes, and the diagnostic utility of recommended diagnostic tools in this population. METHODS: Patients presenting with chest pain to the ED were prospectively enrolled in an international multicenter diagnostic study with central adjudication. Cancer status was assessed prospectively and additional cancer details retrospectively. Findings were externally validated in an independent multicenter cohort. RESULTS: Among 8,267 patients, 711 (8.6%) had cancer. Patients with cancer had a higher burden of cardiovascular risk factors and pre-existing cardiac disease. Total length of stay in the ED (5.2 hours vs 4.3 hours) and hospitalization rate (49.8% vs 34.3%) were both increased in patients with cancer (P < 0.001 for both). Among 8,093 patients eligible for the AMI analyses, those with cancer more often had final diagnoses of AMI (184 of 686 with cancer [26.8%] vs 1,561 of 7,407 without cancer [21.1%]; P < 0.001). In patients with cancer, high-sensitivity cardiac troponin T (hs-cTnT) but not high sensitivity cardiac troponin I (hs-cTnI) concentration had lower diagnostic accuracy for non-ST-segment elevation myocardial infarction (for hs-cTnT, area under the curve: 0.89 [95% CI: 0.86-0.92] vs 0.94 [95% CI: 0.93-0.94] [P < 0.001]; for hs-cTnI, area under the curve: 0.93 [95% CI: 0.91-0.95] vs 0.95 [95% CI: 0.94-0.95] [P = 0.10]). In patients with cancer, the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms maintained very high safety but had lower efficacy, with twice the number of patients remaining in the observe zone. Similar findings were obtained in the external validation cohort. CONCLUSIONS: Patients with cancer have a substantially higher prevalence of AMI as the cause of chest pain. Length of ED stay and hospitalization rates are increased. The diagnostic performance of hs-cTnT and the efficacy of both the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms is reduced. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587).
    Tags: (P400PM_191037/1), the Prof Dr Max Cloetta Foundation, Margarete und Walter, Abbott, and Orion-Pharma, outside the submitted work. Dr Mueller has received, acute coronary syndrome, advisory, or consulting fees from Novartis, Merck Sharpe & Dohme, Bristol Myers, and consulting honoraria from Abbott, Ortho Clinical Diagnostics, Roche, and, and has, and has received research grants from the Spanish, and has received speaker, and has received speaker honoraria, and has received speaker honoraria from, Basel, Abbott, Beckman Coulter, Roche, Ortho Clinical Diagnostics, Quidel,, Basel, the Wesley Medical Research Foundation, the Prince Charles Hospital, Beckman Coulter, Bayer, Ortho Clinical Diagnostics, and Orion Pharma, outside the, Beckman Coulter, Biomerieux, Brahms, Mitsubishi, Novartis, Ortho Clinical,, biomarkers, Bristol Myers Squibb, Osler, Novartis, Roche, Siemens, SpinChip, and Singulex,, cancer survivorship, Cardiorentis, and Sanofi, contents of this paper to disclose. The investigated high-sensitivity cardiac, coronary artery disease, decision to submit the manuscript for publication., diagnosis, Foundation, and the University of Queensland, all outside the submitted work. All, Foundation, the KTI, the University Hospital Basel, the University of Basel,, Foundation, the Swiss Heart Foundation, the European Union, the Cardiovascular, Freiwillige Akademische Gesellschaft Basel, from Roche Diagnostics, Abbott, and Siemens, outside the submitted work. Dr, has received research grants from the University of Basel, the Swiss Academy of, Heart Foundation (FF20079 and FF21103), honoraria and consulting honoraria from AstraZeneca, Bayer, Boehringer Ingelheim,, Lichtenstein-Stiftung (3MS1038), and the University Hospital Basel, Medical Sciences, the Gottfried and Julia Bangerter-Rhyner Foundation, and, Ministry of Health and FEDER, Mapfre, Novartis, Bayer, Merck Sharpe & Dohme,, of Basel and the Division of Internal Medicine, the Swiss Academy of Medical, of the study, the analysis of the data, the preparation of the manuscript, or the, other authors have reported that they have no relationships relevant to the, outcomes, outside the submitted work, and all paid to the institution. Dr Wildi has, QuAcuidel, Roche, Siemens, Singulex, and Sphingotec, Quidel, paid to the institution, outside the submitted work. Dr Nestelberger has, received funding from Julia und Gottfried Bangerter Stiftung, the University of, received research support from the Swiss National Science Foundation, received speaker honoraria and consulting honoraria from B. Braun, Siemens,, received speaker honoraria from Siemens, outside the submitted work. Dr Koechlin, Research Foundation Basel, the University Hospital Basel, the University of, research support from the Swiss National Science Foundation, the Swiss Heart, Rubini Gimenez has received research grants from the Swiss Heart Foundation and, Sciences, and the Gottfried and Julia Bangerter-Rhyner-Foundation, Siemens, and Singulex. Dr Lopez-Ayala has received research grants from the Swiss, Siemens, outside the submitted work. Dr Martin-Sanchez has received speaker,, Squibb, Pfizer, The Medicines Company, Otsuka, Thermo Fisher Scientific,, submitted work. Dr Boeddinghaus has received research grants from the University, the Swiss National Science Foundation (P400PM_180828), troponin assays were donated by the manufacturer, who had no role in the design.
  • Jama, M. A., Majdzadeh, R., Reynolds, T., Nur, I. M., Ismail, A. A., Mohamud, N. A., Griekspoor, A., et al. “Revising The Essential Package Of Health Services Through Stakeholder Alignment, Somalia”. Bull World Health Organ 101, no. 11: 738-742. doi:10.2471/BLT.23.289733.
    Abstract: PROBLEM: The fragmented health sector in Somalia, burdened by financial challenges and an inadequate regulatory system, struggles to provide equitable essential health services to the entire population. APPROACH: To revise an essential package of health services that stakeholders could support and that aligned with stakeholders' financial and technical resources, the federal health ministry invited all key stakeholders in 2020 to participate in the revision process of the essential package. The ministry distributed a concept note to invited stakeholders, describing the scope and purpose of the revision process of the essential package. The note also contained a timeline and the expected contribution of each stakeholder. Stakeholders nominated representatives based on their technical expertise and knowledge of the health sector in Somalia. LOCAL SETTING: The health sector in Somalia involves multiple stakeholders, including the health ministry and many development partners. The private sector plays a substantial role in health-care provision. Public spending is an estimated 17% of the total health expenditure. RELEVANT CHANGES: After an 18-month revision process, the health ministry and development partners agreed to prioritize high-impact, cost-effective services and use a progressive realization of the package to improve access and coverage. The implementation strategy considers the health system and operational capacity of service providers, particularly in security-compromised areas. LESSONS LEARNT: The approach showed that inclusivity, collaboration and transparency were of importance for a successful revision of the package. These achievements in consensus-building and priority alignment advance the government's pursuit of equitable and comprehensive health care for all.
    Tags: *Health Expenditures, *Health Services, Humans, Somalia.
  • Ruder, T. D., Gonzenbach, A., Heimer, J., Arneberg, L., Klukowska-Rotzler, J., Blunier, S., Exadaktylos, A. K., Zech, W. D., and Wagner, F. “Imaging Of Alert Patients After Non-Self-Inflicted Strangulation: Mri Is Superior To Ct”. Eur Radiol 34, no. 6: 3813-3822. doi:10.1007/s00330-023-10354-3.
    Abstract: OBJECTIVE: To assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS. MATERIAL AND METHODS: The study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre. RESULTS: The study included 116 patients (71% women, p < .001, chi(2)), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, chi(2)) or assault by unknown offender (88% of men, p < 0.002 chi(2)). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT. CONCLUSIONS: The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations. CLINICAL RELEVANCE STATEMENT: MRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation. KEY POINTS: * Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender. * Expert read-outs of CT and MRI revealed potentially dangerous injuries in one of 14 patients. * MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation.
    Tags: *Asphyxia/diagnostic imaging, *Magnetic Resonance Imaging/methods, *Sensitivity and Specificity, *Tomography, X-Ray Computed/methods, Adolescent, Adult, Aged, Blunt cerebrovascular injury, Emergency radiology, Female, Humans, Intimate Partner Violence, Larynx fracture, Male, Middle Aged, Neck Injuries/diagnostic imaging, Non-accidental injury, Non-fatal strangulation, products or services may be related to the subject matter of the article., Retrospective Studies, Young Adult.
  • Lacroix, L., Papis, S., Mardegan, C., Luterbacher, F., L'Huillier, A., Sahyoun, C., Keitel, K., et al. “Host Biomarkers And Combinatorial Scores For The Detection Of Serious And Invasive Bacterial Infection In Pediatric Patients With Fever Without Source”. Plos One 18, no. 11: e0294032. doi:10.1371/journal.pone.0294032.
    Abstract: BACKGROUND: Improved tools are required to detect bacterial infection in children with fever without source (FWS), especially when younger than 3 years old. The aim of the present study was to investigate the diagnostic accuracy of a host signature combining for the first time two viral-induced biomarkers, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and interferon gamma-induced protein-10 (IP-10), with a bacterial-induced one, C-reactive protein (CRP), to reliably predict bacterial infection in children with fever without source (FWS) and to compare its performance to routine individual biomarkers (CRP, procalcitonin (PCT), white blood cell and absolute neutrophil counts, TRAIL, and IP-10) and to the Labscore. METHODS: This was a prospective diagnostic accuracy study conducted in a single tertiary center in children aged less than 3 years old presenting with FWS. Reference standard etiology (bacterial or viral) was assigned by a panel of three independent experts. Diagnostic accuracy (AUC, sensitivity, specificity) of host individual biomarkers and combinatorial scores was evaluated in comparison to reference standard outcomes (expert panel adjudication and microbiological diagnosis). RESULTS: 241 patients were included. 68 of them (28%) were diagnosed with a bacterial infection and 5 (2%) with invasive bacterial infection (IBI). Labscore, ImmunoXpert, and CRP attained the highest AUC values for the detection of bacterial infection, respectively 0.854 (0.804-0.905), 0.827 (0.764-0.890), and 0.807 (0.744-0.869). Labscore and ImmunoXpert outperformed the other single biomarkers with higher sensitivity and/or specificity and showed comparable performance to one another although slightly reduced sensitivity in children < 90 days of age. CONCLUSION: Labscore and ImmunoXpert demonstrate high diagnostic accuracy for safely discriminating bacterial infection in children with FWS aged under and over 90 days, supporting their adoption in the assessment of febrile patients.
    Tags: *Bacterial Infections/complications/diagnosis, *Chemokine CXCL10, Biomarkers, C-Reactive Protein/metabolism, Child, Child, Preschool, Fever, Humans, Infant, Prospective Studies, Tumor Necrosis Factors.
  • Hêche, F., Barakat, O., Desmettre, T., Marx, T., and Robert-Nicoud, S. “Inhomogeneous Poisson Process For Ambulance Relocation”. In, 1-8, 2023. doi:10.1145/3615895.3628172.
    Abstract: This paper proposes a statistical approach for real-time ambulance relocation in an Emergency Medical Service (EMS) system. First, based on the idea of measuring the probability that there is no ambulance available for a life-threatening call at the closest ambulance station, the risk of the environment is introduced. Then, a method for ambulance relocation to minimize this risk is developed. To assess the proposed approach, historical data spanning six years provided by the Centre Hospitalier Universitaire Vaudois (CHUV) are used. Data from 2015 to 2020 is utilized to build our method and the data from 2021 is used for the evaluation. The use of real-world data and an API to estimate travel times makes our experiments representative of real-world situations. In all experiments, our approach enables us to significantly decrease the risk of the environment. Furthermore, the proposed method reduces the mean response time by up to 30 seconds. Finally, the computation time is negligible and through the adjustment of specific hyperparameters, it becomes feasible to control the frequency of resource relocations throughout the day. This adjustment offers the flexibility to tailor the strategy according to the specific requirements of each EMS system. Moreover, our method demonstrates particular utility in situations with limited resources, which makes it especially valuable in crisis situations. These observations collectively suggest that our method has the potential to enhance the quality of EMS and, consequently, save lives. © 2023 Owner/Author(s).
  • Djokic, D., Milani, G. P., Lava, S. A. G., Gualco, G., Corigliano, T., Bianchetti, M. G., and Lavagno, C. “Hair-Thread Strangulation Syndrome In Childhood: A Systematic Review”. Swiss Med Wkly 153, no. 11: 40124. doi:10.57187/smw.2023.40124.
    Abstract: INTRODUCTION: Hair-thread strangulation syndrome describes the constriction of a body part by a tightly wound hair or thread. This research aims to review the literature about this entity. METHODS: A systematic review was performed to characterise hair-thread strangulation syndrome in subjects aged </=16 years. This pre-registered review (PROSPERO ID: CRD42022363996) followed the PRISMA methodology. RESULTS: Subjects with digital strangulation were significantly younger (median = 4.0 [interquartile range: 2.0-6.1] months; n = 143) than females with genital strangulation (9.0 [6.8-11] years; n = 36), males with genital strangulation (5.1 [1.9-8.0] years; n = 36), and subjects with non-digital and non-genital strangulation (24 [13-48] months; n = 11). Digital strangulation was followed by an amputation in five (3.5%) and a reconstructive surgical intervention in seven (4.9%) cases. Sequelae occurred in four (11%) cases after female genital strangulation: clitoris autoamputation (n = 2) and surgical removal of a necrotic labium minus (n = 2). Severe complications were observed in 14 (39%) cases with male genital strangulation: urethral fistula (n = 7), urethral transection (n = 2), and partial penile autoamputation (n = 5). A partial uvular autoamputation was observed in one case (9.0%) with non-digital and non-genital strangulation. CONCLUSIONS: Early recognition and management are crucial to avoid sequelae or long-term care in hair-thread strangulation syndrome.
    Tags: *Hair, *Plastic Surgery Procedures, Disease Progression, Female, Humans, Male, Software.
  • Henke, K., Ntovas, S., Xourgia, E., Exadaktylos, A. K., Klukowska-Rotzler, J., and Ziaka, M. “Who Let The Dogs Out? Unmasking The Neglected: A Semi-Systematic Review On The Enduring Impact Of Toxocariasis, A Prevalent Zoonotic Infection”. Int J Environ Res Public Health 20, no. 21. doi:10.3390/ijerph20216972.
    Abstract: Toxocariasis remains an important neglected parasitic infection representing one of the most common zoonotic infections caused by the parasite Toxocara canis or, less frequently, by Toxocara cati. The epidemiology of the disease is complex due to its transmission route by accidental ingestion of embryonated Toxocara eggs or larvae from tissues from domestic or wild paratenic hosts. Even though the World Health Organization and Centers for Disease Control classified toxocariasis amongst the top six parasitic infections of priority to public health, global epidemiological data regarding the relationship between seropositivity and toxocariasis is limited. Although the vast majority of the infected individuals remain asymptomatic or experience a mild disease, the infection is associated with important health and socioeconomic consequences, particularly in underprivileged, tropical, and subtropical areas. Toxocariasis is a disease with multiple clinical presentations, which are classified into five distinct forms: the classical visceral larva migrans, ocular toxocariasis, common toxocariasis, covert toxocariasis, and cerebral toxocariasis or neurotoxocariasis. Anthelmintic agents, for example, albendazole or mebendazole, are the recommended treatment, whereas a combination with topical or systemic corticosteroids for specific forms is suggested. Prevention strategies include educational programs, behavioral and hygienic changes, enhancement of the role of veterinarians, and anthelmintic regimens to control active infections.
    Tags: *Anthelmintics/therapeutic use, *Toxocariasis/epidemiology, Albendazole, Animals, Humans, parasitic infection, Public Health, Toxocara canis, Toxocara cati, toxocariasis, visceral larva migrans, Zoonoses/epidemiology.
  • Wespi, R., Birrenbach, T., Schauber, S. K., Manser, T., Sauter, T. C., and Kammer, J. E. “Exploring Objective Measures For Assessing Team Performance In Healthcare: An Interview Study”. Front Psychol 14: 1232628. doi:10.3389/fpsyg.2023.1232628.
    Abstract: INTRODUCTION: Effective teamwork plays a critical role in achieving high-performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach. METHODS: A total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question. RESULTS: The findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures. DISCUSSION: The study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research.
    Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., healthcare, medical simulation training, objective measures, performance assessment, team performance.
  • Thilemann, S., Traenka, C. K., Schaub, F., Nussbaum, L., Bonati, L., Peters, N., Fladt, J., et al. “Real-Time Video Analysis Allows The Identification Of Large Vessel Occlusion In Patients With Suspected Stroke: Feasibility Trial Of A "Telestroke" Pathway In Northwestern Switzerland”. Front Neurol 14: 1232401. doi:10.3389/fneur.2023.1232401.
    Abstract: BACKGROUND AND AIM: Loss of time is a major obstacle to efficient stroke treatment. Our telestroke path intends to optimize prehospital triage using a video link connecting ambulance personnel and a stroke physician. The objectives were as follows: (1) To identify patients suffering a stroke and (2) in particular large vessel occlusion (LVO) strokes as candidates for endovascular treatment. We have chosen the Rapid Arterial Occlusion Evaluation (RACE) scale for this purpose. METHODS: This analysis aimed to verify the feasibility of prehospital stroke identification by video assessment. In this prospective telestroke cohort study, we included 97 subjects, in which the RACE score (items: facial palsy, arm and leg motor function, head and gaze deviation, and aphasia or agnosia) was applied, and the assessment videotaped by a trained member of the Emergency Medical Services (EMS) in the field using a mobile device. Each recorded patient video was independently assessed by three experienced stroke physicians from a certified stroke center and compared to the neuroimaging gold standard. Within this feasibility study, the stroke code was not altered by the outcome of the RACE assessment, and all patients underwent the standard procedures within the emergency unit. RESULTS: We analyzed 97 patients (median age 78 years, 53% women), of whom 51 (52.6%) suffered an acute stroke, 12 (23.5%) of which were due to an LVO and 46 patients had symptoms mimicking a stroke. The sensitivity of stroke identification was 77.8%, and specificity was 53.6%. In regard to the identification of an LVO, sensitivity was 69.4% and specificity was 84.3%. The inter-rater agreement in the RACE-score assessment was ICC = 0.82 (intraclass-correlation coefficient). CONCLUSION: These results confirm our hypothesis that the local telestroke concept is feasible. It allows correct (i) stroke and (ii) LVO identification in the majority of the cases and thus has the potential to assist in efficient prehospital triage.
    Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., Lvo, pre-hospital, stroke, telemedicine, telestroke, treatment, triage.
  • Cuenod, A., Agnetti, J., Seth-Smith, H. M. B., Roloff, T., Walchli, D., Shcherbakov, D., Akbergenov, R., et al. “Bacterial Genome-Wide Association Study Substantiates Papgii Of Escherichia Coli As A Major Risk Factor For Urosepsis”. Genome Med 15, no. 1: 89. doi:10.1186/s13073-023-01243-x.
    Abstract: BACKGROUND: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, often caused by uropathogenic Escherichia coli. Multiple bacterial virulence factors or patient characteristics have been linked separately to progressive, more invasive infections. In this study, we aim to identify pathogen- and patient-specific factors that drive the progression to urosepsis by jointly analysing bacterial and host characteristics. METHODS: We analysed 1076 E. coli strains isolated from 825 clinical cases with UTI and/or bacteraemia by whole-genome sequencing (Illumina). Sequence types (STs) were determined via srst2 and capsule loci via fastKaptive. We compared the isolates from urine and blood to confirm clonality. Furthermore, we performed a bacterial genome-wide association study (bGWAS) (pyseer) using bacteraemia as the primary clinical outcome. Clinical data were collected by an electronic patient chart review. We concurrently analysed the association of the most significant bGWAS hit and important patient characteristics with the clinical endpoint bacteraemia using a generalised linear model (GLM). Finally, we designed qPCR primers and probes to detect papGII-positive E. coli strains and prospectively screened E. coli from urine samples (n = 1657) at two healthcare centres. RESULTS: Our patient cohort had a median age of 75.3 years (range: 18.00-103.1) and was predominantly female (574/825, 69.6%). The bacterial phylogroups B2 (60.6%; 500/825) and D (16.6%; 137/825), which are associated with extraintestinal infections, represent the majority of the strains in our collection, many of which encode a polysaccharide capsule (63.4%; 525/825). The most frequently observed STs were ST131 (12.7%; 105/825), ST69 (11.0%; 91/825), and ST73 (10.2%; 84/825). Of interest, in 12.3% (13/106) of cases, the E. coli pairs in urine and blood were only distantly related. In line with previous bGWAS studies, we identified the gene papGII (p-value < 0.001), which encodes the adhesin subunit of the E. coli P-pilus, to be associated with 'bacteraemia' in our bGWAS. In our GLM, correcting for patient characteristics, papGII remained highly significant (odds ratio = 5.27, 95% confidence interval = [3.48, 7.97], p-value < 0.001). An independent cohort of cases which we screened for papGII-carrying E. coli at two healthcare centres further confirmed the increased relative frequency of papGII-positive strains causing invasive infection, compared to papGII-negative strains (p-value = 0.033, chi-squared test). CONCLUSIONS: This study builds on previous work linking papGII with invasive infection by showing that it is a major risk factor for progression from UTI to bacteraemia that has diagnostic potential.
    Tags: *Bacteremia, *Escherichia coli Infections/diagnosis, *Sepsis, *Urinary Tract Infections/diagnosis/microbiology, *Uropathogenic Escherichia coli/genetics, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, bGWAS, Escherichia coli, Female, Genome-Wide Association Study, Humans, Invasiveness, Male, Middle Aged, papGII, Risk Factors, Urinary tract infection, Virulence Factors/genetics, Young Adult.
  • Schuetz, P. “Response To Jpen Journal Club 80. Prespecified Outcomes”. Jpen J Parenter Enteral Nutr 48, no. 3: 254-255. doi:10.1002/jpen.2571.
    Tags: *Enteral Nutrition, *Parenteral Nutrition, biomarker, malnutrition, nutritional support, outcomes, prealbumin, visceral proteins.
  • Pasierski, J., Kleger, G. R., and Imboden, P. “Do We Need Standardized Management After Termination-Of-Resuscitation Attempts? Autoresuscitation In A 67-Year-Old Woman”. Scand J Trauma Resusc Emerg Med 31, no. 1: 62. doi:10.1186/s13049-023-01137-2.
    Abstract: BACKGROUND: Autoresuscitation is the phenomenon of spontaneous return of circulation after cessation of CPR, also known as the Lazarus phenomenon. Most of the evidence is based on case reports and a few systematic reviews. The occurrence of autoresuscitation may lead to self-reproach and dismay in affected emergency personnel and may rise questions about the correct procedure after terminating resuscitative efforts. In contrast to existing cardiac arrest guidelines there is no standardized approach to terminating resuscitative attempts. CASE: We report a case of out of hospital autoresuscitation in a 67-year-old female after 60 min of advanced cardiac life support. After shock refractory shockable rhythm, we recorded pulseless electrical activity and fixed pupils, consequently resuscitation was terminated. About 50 min later the patient surprisingly showed signs of life. Due to the suggestive history a coronary angiography was performed, showing severe coronary heart disease which necessitated surgical intervention. After ACBP surgery and intensive care followed by treatment on the cardiological ward, she was finally discharged to neurological rehabilitation. CONCLUSION: As already proposed by existing literature, there should be at least a 10-min interval of close monitoring after abandoning CPR. Transport of a deceased patient should only take place after secure signs of death can be detected. Further investigation is needed to determine which patients are most likely to benefit from an extended observation period. Our case reports highlights the difficulties in death declaration and the importance of close monitoring after abandoning CPR.
    Tags: *Cardiopulmonary Resuscitation/methods, *Heart Arrest/etiology, *Out-of-Hospital Cardiac Arrest/complications, Aged, Autoresuscitation, Cardiopulmonary resuscitation, Emergency medicine, Female, Hospitals, Humans, Lazarus phenomenon, Return of Spontaneous Circulation, Termination of resuscitation, Time Factors.
  • Haas, C., Salzmann, A. P., Binz, T. M., Staubli, G., Seiler, M., and Steuer, A. E. “Analytical Description Of Adolescent Binge Drinking Patients”. Bmc Pediatr 23, no. 1: 512. doi:10.1186/s12887-023-04325-2.
    Abstract: BACKGROUND: Binge drinking is a widespread health compromising behavior among adolescents and young adults, leading to significant health problems, injuries and mortality. However, data on alcohol consumption is often unreliable, as it is mainly based on self-reporting surveys. In this five-year study (2014-2019) at the University Children's Hospital Zurich, we analyzed blood samples from adolescent binge drinking patients to investigate blood alcohol concentrations (BACs), co-ingestion of drugs, assess compliance between self-reported and measured substance use, and test for genetic components of innate alcohol tolerance. Furthermore, hair analysis was performed to retrospectively access drug exposure and to evaluate the potential of hair analysis to assess binge drinking. METHODS: In a prospective, single-center study, patients with alcohol intoxications aged 16 years and younger were included. Blood and hair samples were analyzed by sensitive liquid chromatography - tandem mass spectrometry drug analysis. HTTLPR genotyping was performed with PCR and fragment analysis. RESULTS: Among 72 cases, 72 blood and 13 hair samples were analyzed. BACs ranged from 0.08-3.20 per thousand (mean 1.63 per thousand, median 1.60 per thousand), while a mean concentration of 3.64 pg/mg hair (median 3.0 pg/mg) of the alcohol marker ethyl glucuronide (EtG) was detected in eleven hair samples, providing no evidence of chronic excessive drinking. In 47% of the cases, co-ingested drugs were qualitatively detected next to ethanol, but only 9% of the detected drugs had blood concentrations classified as pharmacologically active. Cannabis consumption (22%) and stimulant intake (16%) were the most frequently observed drugs. Compliance between patients' statements and measured substances matched well. Although we investigated the genetic contribution to innate alcohol tolerance via the 5-HTTLPR polymorphism, the diverse genetic background of the cohort and small sample size did not allow any conclusions to be drawn. CONCLUSION: Almost half of our binge drinking patients tested positive for other substances, primarily cannabis. We anticipate that our study enhances understanding of consumption behavior of young people and encourage continued efforts to address the harmful effects of binge drinking and co-occurring substance use.
    Tags: *Binge Drinking, Adolescent, Alcohol Drinking, Alcoholism, Binge drinkers, Biomarkers/analysis, Blood Alcohol Content, Child, Ethanol, Forensic science, Humans, Prospective Studies, Retrospective Studies, Young Adult, Youth.
  • Fehlmann, C. A., Stuby, L., Graf, C., Genoud, M., Rigney, R., Goldstein, J., Eagles, D., and Suppan, L. “Assessment Of Frailty By Paramedics Using The Clinical Frailty Scale - An Inter-Rater Reliability And Accuracy Study”. Bmc Emerg Med 23, no. 1: 121. doi:10.1186/s12873-023-00875-x.
    Abstract: BACKGROUND: Frailty assessment by paramedics in the prehospital setting is understudied. The goals of this study were to assess the inter-rater reliability and accuracy of frailty assessment by paramedics using the Clinical Frailty Scale (CFS). METHODS: This was a cross-sectional study with paramedics exposed to 30 clinical vignettes created from real-life situations. There was no teaching intervention prior to the study and paramedics were only provided with the French version of the CFS (definitions and pictograms). The primary outcome was the inter-rater reliability of the assessment. The secondary outcome was the accuracy, compared with the expert-based assessment. Reliability was determined by calculating an intraclass correlation coefficient (ICC). Accuracy was assessed through a mixed effects logistic regression model. A sensitivity analysis was carried out by considering that an assessment was still accurate if the score differed from no more than 1 level. RESULTS: A total of 56 paramedics completed the assessment. The overall assessment was found to have good inter-rater reliability (ICC = 0.87 [95%CI 0.81-0.93]). The overall accuracy was moderate at 60.6% (95%CI 54.9-66.1) when considering the full scale. It was however much higher (94.8% [95%CI 92.0-96.7] when close assessments were considered as accurate. The only factor associated with accurate assessment was field experience. CONCLUSION: The assessment of frailty by paramedics was reliable in this vignette-based study. However, the accuracy deserved to be improved. Future research should focus on the clinical impact of these results and on the association of prehospital frailty assessment with patient outcomes. REGISTRATION: This study was registered on the Open Science Framework registries ( https://doi.org/10.17605/OSF.IO/VDUZY ).
    Tags: *Frailty/diagnosis, Accuracy, Cfs, Clinical frailty scale, Cross-Sectional Studies, Emergency medical services, Humans, Logistic Models, Paramedics, Prehospital care, Reliability, Reproducibility of Results, Triage system.
  • Gagliano, M., Bula, C. J., Seematter-Bagnoud, L., Michalski-Monnerat, C., Nguyen, S., Carron, P. N., and Mabire, C. “Older Patients Referred For Geriatric Consultation In The Emergency Department: Characteristics And Healthcare Utilization”. Bmc Geriatr 23, no. 1: 642. doi:10.1186/s12877-023-04321-2.
    Abstract: BACKGROUND: Comprehensive geriatric assessment (CGA) is difficult to perform in the emergency department (ED) environment and performance of screening tools in identifying vulnerable older ED patients who are best candidates for a geriatric consultation remain questionable. AIM: To determine the characteristics of older patients referred for a geriatric consultation by ED staff and to investigate these patients' subsequent healthcare utilization. METHODS: Secondary analysis of data previously collected for a prospective observational study of patients aged 75 + years visiting the ED of an academic hospital in Switzerland over four months (Michalski-Monnerat et al., J Am Geriatr Soc 68(12):2914-20, 2020). Socio-demographic, health, functional (basic activities of daily living; BADL), cognitive, and affective status data were collected at admission by a research nurse using a standardized brief geriatric assessment. Information on geriatric consultations, hospitalization, discharge destination, and 30-day readmission were retrieved from hospital database. Bivariable and multivariable analyses were performed using this data set collected previously. RESULTS: Thirty-two (15.8%) of the 202 enrolled patients were referred for a geriatric consultation. Compared to the others, they were older (84.9 +/- 5.4 vs 82.9 +/- 5.4 years, p = .03), more impaired in BADL (4.8 +/- 1.6 vs 5.5 +/- 1.0, p = .01), with more comorbid conditions (5.3 +/- 1.5 vs 4.5 +/- 1.9, p = .03), more frequently admitted after a fall (43.7% vs 19.4%, p = .01), and hospitalized over the previous 6-month period (53.1% vs 30.6%, p = .02). Multivariable analyses that adjusted for variables significantly associated with outcomes in bivariable analysis found that being admitted after a fall (AdjOR 4.0, 95%CI 1.7-9.4, p < .01) and previously hospitalized (AdjOR 2.7, 95% CI 1.2-6.2, p = .02) remained associated with increased odds of consultation, whereas the inverse association with BADL performance remained (AdjOR 0.7, 95%CI 0.5-0.9, p = .01). Patients referred for geriatric consultation had higher odds of hospitalization (84.4% vs 49.4%; AdjOR 5.9, 95%CI 2.1-16.8, p < .01), but similar odds of home discharge when admitted, and of 30-day readmission. CONCLUSION: About one in six older ED patients were referred for a geriatric consultation who appeared to be those most vulnerable, as suggested by their increased hospitalization rate. Alternative strategies are needed to enhance access to geriatric consultation in the ED.
    Tags: *Emergency Service, Hospital, *Geriatric Assessment, *Hospitalization, *Referral and Consultation, 30-day readmission, Activities of Daily Living, Aged, Comprehensive geriatric assessment, Functional status, Geriatric consultation, hospital admission, Geriatric emergency medicine, Humans, manuscript to declare., Older patients, Patient Acceptance of Health Care.
  • Birrenbach, T., Wespi, R., Hautz, W. E., Berger, J., Schwab, P. R., Papagiannakis, G., Exadaktylos, A. K., and Sauter, T. C. “Development And Usability Testing Of A Fully Immersive Vr Simulation For Reboa Training”. Int J Emerg Med 16, no. 1: 67. doi:10.1186/s12245-023-00545-6.
    Abstract: BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially life-saving procedure for bleeding trauma patients. Being a rare and complex procedure performed in extreme situations, repetitive training of REBOA teams is critical. Evidence-based guidelines on how to train REBOA are missing, although simulation-based training has been shown to be effective but can be costly and complex. We aimed to determine the feasibility and acceptance of REBOA training using a fully immersive virtual reality (VR) REBOA simulation, as well as assess the confidence in conducting the REBOA procedure before and after the training. METHODS: Prospective feasibility pilot study of prehospital emergency physicians and paramedics in Bern, Switzerland, from November 2020 until March 2021. Baseline characteristics of trainees, prior training and experience in REBOA and with VR, variables of media use (usability: system usability scale, immersion/presence: Slater-Usoh-Steed, workload: NASA-TLX, user satisfaction: USEQ) as well as confidence prior and after VR training were accessed. RESULTS: REBOA training in VR was found to be feasible without relevant VR-specific side-effects. Usability (SUS median 77.5, IQR 71.3-85) and sense of presence and immersion (Slater-Usoh-Steed median 4.8, IQR 3.8-5.5) were good, the workload without under-nor overstraining (NASA-TLX median 39, IQR 32.8-50.2) and user satisfaction high (USEQ median 26, IQR 23-29). Confidence of trainees in conducting REBOA increased significantly after training (p < 0.001). CONCLUSIONS: Procedural training of the REBOA procedure in immersive virtual reality is possible with a good acceptance and high usability. REBOA VR training can be an important part of a training curriculum, with the virtual reality-specific advantages of a time- and instructor-independent learning.
    Tags: and MDI International Australia, all outside the submitted work. WEH has received, financial support for a congress he chaired from EBSCO Germany, Isabel Healthcare, influence on the research or decision to publish. GP is co-founder, CEO and CTO, Medical education, of ORamaVR. The company had no influence on the study setup and interpretation of, Reboa, Science foundation, Zoll foundation, Drager Medical Germany, Mundipharma Research, submitted work. WEH has provided paid consultancies to AO foundation Switzerland, the results or decision to publish. All other authors have nothing to disclose., Trauma resuscitation, UK, MDI International Australia, Roche Diagnostics Germany, all outside the, UK, Mundipharma Medical Switzerland, VisualDx USA, all outside the submitted, University of Bern sponsored by the Touring Club Switzerland. The sponsor has no, Virtual reality, work. TCS holds the endowed professorship of emergency telemedicine at the.
  • Nickel, C. H., and Kellett, J. “Assessing Physiologic Reserve And Frailty In The Older Emergency Department Patient: Should The Paradigm Change?”. Clin Geriatr Med 39, no. 4: 475-489. doi:10.1016/j.cger.2023.05.004.
    Abstract: Older patients are more vulnerable to acute illness or injury because of reduced physiologic reserve associated with aging. Therefore, their assessment in the emergency department (ED) should include not only vital signs and their baseline values but also changes that reflect physiologic reserve, such as mobility, mental status, and frailty. Combining aggregated vitals sign scores and frailty might improve risk stratification in the ED. Implementing these changes in ED assessment may require the introduction of senior-friendly processes to ensure ED treatment is appropriate to the older patients' immediate discomfort, personal goals, and likely prognosis.
    Tags: *Frailty/diagnosis, Aged, Aggregated vital sign score, Aging, Clinical frailty scale, Emergency Service, Hospital, Frailty, Geriatric Assessment, Humans, News, Prognosis, Prognostication, Undertriage.
  • Fermann, G. J., Cash, B. D., Coelho-Prabhu, N., Maegele, M., Bingisser, R., Sehgal, V., Cohen, A. T., et al. “Definition Of Factor Xa Inhibitor-Related, Life-Threatening Gastrointestinal Bleeding And Guidance On When To Use Reversal Therapy: A Delphi Panel”. J Am Coll Emerg Physicians Open 4, no. 5: e13043. doi:10.1002/emp2.13043.
    Abstract: OBJECTIVE: To define and contextualize life-threatening gastrointestinal (GI) bleeding in the setting of factor Xa (FXa) inhibitor therapy and to derive a consensus-based, clinically oriented approach to the administration of FXa inhibitor reversal therapy. METHODS: We convened an expert panel of clinicians representing specialties in emergency medicine, gastroenterology, vascular medicine, and trauma surgery. Consensus was reached among the clinician panelists using the Delphi technique, which consisted of 2 survey questionnaires followed by virtual, real-time consensus-building exercises. RESULTS: Hypovolemia and hemodynamic instability were considered the most important clinical signs of FXa inhibitor-related, life-threatening GI bleeds. Clinician panelists agreed that potentially life-threatening GI bleeding should be determined on the basis of hemodynamic instability, signs of shock, individual patient characteristics, and clinical judgment. Last, the panel agreed that all patients with life-threatening, FXa inhibitor-associated GI bleeding should be considered for FXa inhibitor reversal therapy; the decision to reverse FXa inhibition should be individualized, weighing the risks and benefits of reversal; and when reversal is elected, therapy should be administered within 1 h after initial emergency department evaluation, when possible. CONCLUSIONS: Consensus-based definitions of life-threatening GI bleeding and approaches to FXa inhibitor reversal centered on hemodynamic instability, signs of shock, individual patient characteristics, and clinical judgment. The results from this Delphi panel may inform clinical decision-making for the treatment of patients experiencing GI bleeding associated with FXa inhibitor use in the emergency department setting.
    Tags: a consultant for Apollo Endosurgery, Pentax, Medtronic, Pharmacosmos, Microtech,, and AstraZeneca, and has received educational grants from Apollo Endosurgery, Pentax, and, and may hold shares and/or stock options in the company. Mary J. Christoph was an, and payments or, and Phillips point-of-care systems, and serves as an editor for medStandards. Vinay Sehgal has served as, anticoagulant reversal, AstraZeneca, AstraZeneca, Bayer AG, Bristol-Myers Squibb, and Pfizer, AstraZeneca, Bristol-Myers Squibb, and Pfizer, AstraZeneca. Nayantara Coelho-Prabhu has served as a consultant for Boston, at the time this research was conducted. Bruce Koch is an employee of AstraZeneca, CellPhire, Acasti Pharma, and Octapharma., consulting fees from Alexion,, employee of AstraZeneca at the time this research was conducted and may hold, factor Xa inhibitor, Fujifilm. Roland Bingisser has served as a consultant for AstraZeneca, SpinChip,, gastrointestinal hemorrhage, has received fees for presentations from, has served on advisory boards for Pharmacosmos and Microtech, Health Solutions, an independent nonprofit research organization, which was, honoraria from Alexion, AstraZeneca, Bayer AG, Bristol-Myers Squibb, and Pfizer., Medtronic. Alexander T. Cohen has received grants or contracts from Alexion,, of Health. Brooks D. Cash and Marc Maegele have served as consultants for, on which they work. Allen Mangel was a full-time employee of RTI Health Solutions, retained by Alexion, AstraZeneca Rare Disease, to conduct the research that is, scientific advisory board for Milestone Pharmaceuticals, as a consultant to Astra, Scientific and Alexion and has received research funding from Cook Endoscopy and, shares and/or stock options in the company. Gregory J. Fermann has served on the, support from Siemens, Abbott, InCarda Therapeutics, and the National Institutes, the subject of this manuscript. Their compensation is unconnected to the studies, Truman J. Milling Jr. has served as a consultant for AstraZeneca, CSL Behring,, Zeneca, and on Speaker's Bureau for Astra Zeneca, and has received research.
  • Dack, E., Brigato, L., McMurray, M., Fontanellaz, M., Frauenfelder, T., Hoppe, H., Exadaktylos, A., et al. “An Empirical Analysis For Zero-Shot Multi-Label Classification On Covid-19 Ct Scans And Uncurated Reports”. In, 2626-2635, 2023. doi:10.1109/ICCVW60793.2023.00278.
    Abstract: The pandemic resulted in vast repositories of unstructured data, including radiology reports, due to increased medical examinations. Previous research on automated diagnosis of COVID-19 primarily focuses on X-ray images, despite their lower precision compared to computed tomography (CT) scans. In this work, we leverage unstructured data from a hospital and harness the fine-grained details offered by CT scans to perform zero-shot multi-label classification based on contrastive visual language learning. In collaboration with human experts, we investigate the effectiveness of multiple zero-shot models that aid radiologists in detecting pulmonary embolisms and identifying intricate lung details like ground glass opacities and consolidations. Our empirical analysis provides an overview of the possible solutions to target such fine-grained tasks, so far overlooked in the medical multimodal pretraining literature. Our investigation promises future advancements in the medical image analysis community by addressing some challenges associated with unstructured data and fine-grained multi-label classification. © 2023 IEEE.
  • Vrotniakaite-Bajerciene, K., Rutsche, S., Calzavarini, S., Quarroz, C., Stalder, O., Mean, M., Righini, M., et al. “Thrombin Generation Is Associated With Venous Thromboembolism Recurrence, But Not With Major Bleeding And Death In The Elderly: A Prospective Multicenter Cohort Study”. J Clin Med 12, no. 18. doi:10.3390/jcm12186050.
    Abstract: It is currently unknown whether thrombin generation is associated with venous thromboembolism (VTE) recurrence, major bleeding, or mortality in the elderly. Therefore, our aim was to prospectively study the association between thrombin generation and VTE recurrence, major bleeding, and mortality in elderly patients with acute VTE. Consecutive patients aged >/=65 years with acute VTE were followed for 2 years, starting from 1 year after the index VTE. Primary outcomes were VTE recurrence, major bleeding, and mortality. Thrombin generation was assessed in 551 patients 1 year after the index VTE. At this time, 59% of the patients were still anticoagulated. Thrombin generation was discriminatory for VTE recurrence, but not for major bleeding and mortality in non-anticoagulated patients. Moreover, peak ratio (adjusted subhazard ratio 4.09, 95% CI, 1.12-14.92) and normalized peak ratio (adjusted subhazard ratio 2.18, 95% CI, 1.28-3.73) in the presence/absence of thrombomodulin were associated with VTE recurrence, but not with major bleeding and mortality after adjustment for potential confounding factors. In elderly patients, thrombin generation was associated with VTE recurrence, but not with major bleeding and/or mortality. Therefore, our study suggests the potential usefulness of thrombin generation measurement after anticoagulation completion for VTE to help identify among elderly patients those at higher risk of VTE recurrence.
    Tags: bleeding, elderly, mortality, thrombin generation, venous thromboembolism.
  • Simma, L., Romano, F., Schmidt, S., Ramantani, G., and Bolsterli, B. K. “Integrating Neuromonitoring In Pediatric Emergency Medicine: Exploring Two Options For Point-Of-Care Electroencephalogram (Poceeg) Via Patient Monitors-A Technical Note”. J Pers Med 13, no. 9. doi:10.3390/jpm13091411.
    Abstract: Central nervous system (CNS) disorders are among the most frequent presentations in critically ill children. Status epilepticus (SE) is a frequent scenario in the resuscitation bay. In patients with altered mental status, non-convulsive SE (NCSE) is often underrecognized and critically impacts the neurological outcome and duration of hospitalization. An electroencephalogram (EEG) is required to diagnose NCSE. However, standard EEG recordings are time- and staff-intensive, and their availability is limited, especially outside regular working hours. We aimed to improve patient care by developing a simplified EEG recording method, using a reduced lead montage (point-of-care EEG-pocEEG), that is suitable for use in pediatric emergency departments. The objective was to devise a cost-effective unit with low space requirements that fitted the existing technical infrastructure. We present two technical options for clinical pocEEG acquisition using patient monitors (GE Carescape, Philips IntelliVue) that enable data collection for educational and research purposes. A simplified, rapid response EEG like the pocEEG enables neuromonitoring of patients with CNS disorders in pediatric emergency settings, facilitating timely diagnosis and treatment initiation when standard EEG is not readily available.
    Tags: altered mental status, design of the study, electroencephalogram, emergency department, in, in the collection, analyses, or interpretation of data, non-convulsive status epilepticus, or in the decision to publish the results., pediatric emergency medicine, point-of-care EEG, rapid response EEG, reduced lead electroencephalogram, simplified electroencephalogram, status epilepticus, the writing of the manuscript.
  • Rodieux, F., Storelli, F., Curtin, F., Manzano, S., Gervaix, A., Posfay-Barbe, K. M., Desmeules, J., Daali, Y., and Samer, C. F. “Evaluation Of Pupillometry For Cyp2D6 Phenotyping In Children Treated With Tramadol”. Pharmaceuticals (Basel) 16, no. 9. doi:10.3390/ph16091227.
    Abstract: Following the contraindication of codeine use in children, increasing use of tramadol has been observed in pain management protocols. However, tramadol's pharmacokinetics (PK) and pharmacodynamics are influenced by cytochrome P450 (CYP)2D6 activity, similarly to codeine. Previous studies in adults have demonstrated a correlation between pupillary response and tramadol PK. Our objective was to evaluate pupillometry as a phenotyping method to assess CYP2D6 activity in children treated with tramadol. We included 41 children (mean age 11 years) receiving a first dose of tramadol (2 mg/kg) in the emergency room (ER) as part of their routine care. CYP2D6 phenotyping and genotyping were performed. The concentrations of tramadol and its active metabolite, M1, were measured, and static and dynamic pupillometry was conducted using a handheld pupillometer at the time of tramadol administration and during the ER stay. Pupillometric measurements were obtained for 37 children. Tramadol affected pupillary parameters, with a decrease in pupil diameter in 83.8% of children (p = 0.002) (mean decrease 14.1 +/- 16.7%) and a decrease in reflex amplitude constriction in 78.4% (p = 0.011) (mean decrease 17.7 +/- 34.5%) at T150 compared to T0. We were unable to identify a correlation between pupillometry measurements and CYP2D6 activity. Likely confounding factors include light intensity, pain, and stress, making the procedure less feasible in paediatric emergency settings.
    Tags: children, commercial or financial relationships that could be construed as potential, conflicts of interest., Cyp2d6, genotyping, pharmacogenomics, phenotyping, tramadol.
  • Hartnack, S., Nilius, H., Jegerlehner, S., Suter-Riniker, F., Bittel, P., Jent, P., and Nagler, M. “Determination Of The Diagnostic Performance Of Laboratory Tests In The Absence Of A Perfect Reference Standard: The Case Of Sars-Cov-2 Tests”. Diagnostics (Basel) 13, no. 18. doi:10.3390/diagnostics13182892.
    Abstract: BACKGROUND: Currently, assessing the diagnostic performance of new laboratory tests assumes a perfect reference standard, which is rarely the case. Wrong classifications of the true disease status will inevitably lead to biased estimates of sensitivity and specificity. OBJECTIVES: Using Bayesian' latent class models (BLCMs), an approach that does not assume a perfect reference standard, we re-analyzed data of a large prospective observational study assessing the diagnostic accuracy of an antigen test for the diagnosis of SARS-CoV-2 infection in clinical practice. METHODS: A cohort of consecutive patients presenting to a COVID-19 testing facility affiliated with a Swiss University Hospital were recruited (n = 1465). Two real-time PCR tests were conducted in parallel with the Roche/SD Biosensor rapid antigen test on nasopharyngeal swabs. A two-test (PCR and antigen test), three-population BLCM was fitted to the frequencies of paired test results. RESULTS: Based on the BLCM, the sensitivities of the RT-PCR and the Roche/SD Biosensor rapid antigen test were 98.5% [95% CRI 94.8;100] and 82.7% [95% CRI 66.8;100]. The specificities were 97.7% [96.1;99.7] and 99.9% [95% CRI 99.6;100]. CONCLUSIONS: Applying the BLCM, the diagnostic accuracy of RT-PCR was high but not perfect. In contrast to previous results, the sensitivity of the antigen test was higher. Our results suggest that BLCMs are valuable tools for investigating the diagnostic performance of laboratory tests in the absence of perfect reference standard.
    Tags: Blcm, diagnostic accuracy, no gold standard models, work. All other authors declare that no conflict of interest exist..
  • Van Singer, M., Brahier, T., Koch, J., Hugli, P. O., Weckman, A. M., Zhong, K., Kain, T. J., et al. “Validation Of Strem-1 And Il-6 Based Algorithms For Outcome Prediction Of Covid-19”. Bmc Infect Dis 23, no. 1: 630. doi:10.1186/s12879-023-08630-0.
    Abstract: BACKGROUND: A prospective observational cohort study of COVID-19 patients in a single Emergency Department (ED) showed that sTREM-1- and IL-6-based algorithms were highly predictive of adverse outcome (Van Singer et al. J Allergy Clin Immunol 2021). We aim to validate the performance of these algorithms at ED presentation. METHODS: This multicentric prospective observational study of PCR-confirmed COVID-19 adult patients was conducted in the ED of three Swiss hospitals. Data of the three centers were retrospectively completed and merged. We determined the predictive accuracy of the sTREM-1-based algorithm for 30-day intubation/mortality. We also determined the performance of the IL-6-based algorithm using data from one center for 30-day oxygen requirement. RESULTS: 373 patients were included in the validation cohort, 139 (37%) in Lausanne, 93 (25%) in St.Gallen and 141 (38%) in EOC. Overall, 18% (93/373) patients died or were intubated by day 30. In Lausanne, 66% (92/139) patients required oxygen by day 30. The predictive accuracy of sTREM-1 and IL-6 were similar compared to the derivation cohort. The sTREM-1-based algorithm confirmed excellent sensitivity (90% versus 100% in the derivation cohort) and negative predictive value (94% versus 100%) for 30-day intubation/mortality. The IL-6-based algorithm performance was acceptable with a sensitivity of 85% versus 98% in the derivation cohort and a negative predictive value of 60% versus 92%. CONCLUSION: The sTREM-1 algorithm demonstrated good reproducibility. A prospective randomized controlled trial, comparing outcomes with and without the algorithm, is necessary to assess its safety and impact on hospital and ICU admission rates. The IL-6 algorithm showed acceptable validity in a single center and need additional validation before widespread implementation.
    Tags: *COVID-19/diagnosis, AC, SP, DVG, KCK and NBB have no relevant conflict of interest., Adult, Algorithms, Biomarkers, Clinical support decision tool, Covid-19, Humans, in advisory boards for Pfizer, MSD, GSK, Sanofi and OM Pharma, with, Interleukin-6, MVS, TB, JK, OH, AMW, KZ, TJK, AL, EB,, Prospective Studies, reimbursements paid to his institution, Reproducibility of Results, Retrospective Studies, sTREM-1, Validation study.
  • Wanigaratne, S., Lu, H., Gandhi, S., Shetty, J., Stukel, T. A., Piche-Renaud, P. P., Brandenberger, J., Abdi, S., and Guttmann, A. “Covid-19 Vaccine Equity: A Retrospective Population-Based Cohort Study Examining Primary Series And First Booster Coverage Among Persons With A History Of Immigration And Other Residents Of Ontario, Canada”. Front Public Health 11: 1232507. doi:10.3389/fpubh.2023.1232507.
    Abstract: INTRODUCTION: Immigrants were disproportionately impacted by COVID-19 and experience unique vaccination barriers. In Canada (37 million people), 23% of the population is foreign-born. Immigrants constitute 60% of the country's racialized (non-white) population and over half of immigrants reside in Ontario, the country's most populous province. Ontario had several strategies aimed at improving vaccine equity including geographic targeting of vaccine supply and clinics, as well as numerous community-led efforts. Our objectives were to (1) compare primary series vaccine coverage after it was widely available, and first booster coverage 6 months after its availability, between immigrants and other Ontario residents and (2) identify subgroups experiencing low coverage. MATERIALS AND METHODS: Using linked immigration and health administrative data, we conducted a retrospective population-based cohort study including all community-dwelling adults in Ontario, Canada as of January 1, 2021. We compared primary series (two-dose) vaccine coverage by September 2021, and first booster (three-dose) coverage by March 2022 among immigrants and other Ontarians, and across sociodemographic and immigration characteristics. We used multivariable log-binomial regression to estimate adjusted risk ratios (aRR). RESULTS: Of 11,844,221 adults, 22% were immigrants. By September 2021, 72.6% of immigrants received two doses (vs. 76.4%, other Ontarians) and by March 2022 46.1% received three doses (vs. 58.2%). Across characteristics, two-dose coverage was similar or slightly lower, while three-dose coverage was much lower, among immigrants compared to other Ontarians. Across neighborhood SARS-CoV-2 risk deciles, differences in two-dose coverage were smaller in higher risk deciles and larger in the lower risk deciles; with larger differences across all deciles for three-dose coverage. Compared to other Ontarians, immigrants from Central Africa had the lowest two-dose (aRR = 0.60 [95% CI 0.58-0.61]) and three-dose coverage (aRR = 0.36 [95% CI 0.34-0.37]) followed by Eastern Europeans and Caribbeans, while Southeast Asians were more likely to receive both doses. Compared to economic immigrants, resettled refugees and successful asylum-claimants had the lowest three-dose coverage (aRR = 0.68 [95% CI 0.68-0.68] and aRR = 0.78 [95% CI 0.77-0.78], respectively). CONCLUSION: Two dose coverage was more equitable than 3. Differences by immigrant region of birth were substantial. Community-engaged approaches should be re-invigorated to close gaps and promote the bivalent booster.
    Tags: *COVID-19 Vaccines, *COVID-19/prevention & control, Adult, Cohort Studies, could be construed as a potential conflict of interest., COVID-19 vaccine, Emigration and Immigration, Humans, immigrants, Ontario, Ontario (Canada), public health, refugees, Retrospective Studies, SARS-CoV-2, social determinants of health, that is unrelated to this study. The remaining authors declare that the research, was conducted in the absence of any commercial or financial relationships that.
  • Moser, A., Wagner, S., Habegger, K., Cioccari, L., and Tosetti, S. “From The Operating Room To The Cave: Ultrasound-Guided Locoregional Anesthesia In The Setting Of Cave Rescue-A Description Of 2 Cases”. Wilderness Environ Med 34, no. 4: 553-557. doi:10.1016/j.wem.2023.07.009.
    Abstract: Caving accidents are rare, but when they occur, they represent a unique logistical and medical challenge. Retrieving the patient to the surface often means navigating stretchers through narrow corridors with limited options for monitoring and interventions. Because the patient is usually not fasting, opioids and sedatives should be used with extreme caution. Therefore, alternative analgesic techniques such as locoregional nerve blocks are a promising strategy to improve patient comfort and safety during cave rescues. In this article, we describe 2 cases in which portable point-of-care ultrasound equipment was used to supplement clinical assessment and provide locoregional anesthesia to facilitate patient evacuation and transport. In this context, we discuss the role of portable ultrasound-guided locoregional anesthesia in cave rescue and in the global preclinical context. In summary, our cases demonstrated that the administration of ultrasound-guided prehospital locoregional anesthesia is a safe, rapid, and effective procedure even in extreme situations such as cave rescues. The advent of portable, high-quality ultrasound equipment may open the door for more widespread application of this technique in the global preclinical setting.
    Tags: *Nerve Block/methods, *Operating Rooms, Caves, difficult setting rescue, Humans, prehospital point-of-care ultrasound, prehospital regional anesthesia, prehospital trauma care, Ultrasonography, Ultrasonography, Interventional/methods.
  • Nikles, F., Kerkeni, H., Zamaro, E., Korda, A., Wagner, F., Sauter, T. C., Kalla, R., Morrison, M., and Mantokoudis, G. “Do Monosymptomatic Stroke Patients With Dizziness Present A Vestibular Syndrome Without Nystagmus? An Underestimated Entity”. Eur J Neurol 31, no. 1: e16066. doi:10.1111/ene.16066.
    Abstract: BACKGROUND AND PURPOSE: Vestibular symptoms are common in emergency department (ED) patients and have various causes, including stroke. Accurate identification of stroke in patients with vestibular symptoms is crucial for timely management. We conducted a prospective cross-sectional study from 2015 to 2019 to determine stroke prevalence and associated symptoms in ED patients with vestibular symptoms, aiming to improve diagnosis and outcomes. METHODS: As part of the DETECT project, we screened 1647 ED patients with acute vestibular symptoms. Following a retrospective analysis of 961 head and neck magnetic resonance imaging (MRI) scans, we included 122 confirmed stroke cases and assessed them for vestibular signs and symptoms. RESULTS: Stroke prevalence in dizzy patients was 13% (122/961 MRI scans). Most patients (95%) presented with acute vestibular symptoms with or without nystagmus, whereas 5% had episodic vestibular syndrome (EVS). Nystagmus was present in 50% of stroke patients. Eighty percent had a purely posterior circulation stroke, and nystagmus was absent in 46% of these patients. Seven patients (6%) had lesions in both the anterior and posterior circulation. Vertigo was experienced by 52% regardless of territory. CONCLUSIONS: A stroke was identified in 13% of ED patients presenting with acute vestibular symptoms. In 5%, it was EVS. Most strokes were in the posterior circulation territory; vertigo occurred with similar frequency in anterior and posterior circulation stroke, and absence of nystagmus was common in both.
    Tags: *Nystagmus, Pathologic/epidemiology/etiology, *Stroke/complications/diagnostic imaging/epidemiology, *Vestibular Diseases/complications/diagnosis/epidemiology, anterior circulation, Cross-Sectional Studies, Dizziness/epidemiology/etiology, Humans, nystagmus, or affiliations that represent a relevant financial conflict of interest with, posterior circulation, Prospective Studies, respect to the conduct or analysis of this study., Retrospective Studies, stroke, vertigo, Vertigo/etiology/complications.
  • Messmer, A., Pietsch, U., Siegemund, M., Buehler, P., Waskowski, J., Muller, M., Uehlinger, D. E., et al. “Protocolised Early De-Resuscitation In Septic Shock (Reduce): Protocol For A Randomised Controlled Multicentre Feasibility Trial”. Bmj Open 13, no. 9: e074847. doi:10.1136/bmjopen-2023-074847.
    Abstract: BACKGROUND: Fluid overload is associated with excess mortality in septic shock. Current approaches to reduce fluid overload include restrictive administration of fluid or active removal of accumulated fluid. However, evidence on active fluid removal is scarce. The aim of this study is to assess the efficacy and feasibility of an early de-resuscitation protocol in patients with septic shock. METHODS: All patients admitted to the intensive care unit (ICU) with a septic shock are screened, and eligible patients will be randomised in a 1:1 ratio to intervention or standard of care. INTERVENTION: Fluid management will be performed according to the REDUCE protocol, where resuscitation fluid will be restricted to patients showing signs of poor tissue perfusion. After the lactate has peaked, the patient is deemed stable and assessed for active de-resuscitation (signs of fluid overload). The primary objective of this study is the proportion of patients with a negative cumulative fluid balance at day 3 after ICU. Secondary objectives are cumulative fluid balances throughout the ICU stay, number of patients with fluid overload, feasibility and safety outcomes and patient-centred outcomes. The primary outcome will be assessed by a logistic regression model adjusting for the stratification variables (trial site and chronic renal failure) in the intention-to-treat population. ETHICS AND DISSEMINATION: The study was approved by the respective ethical committees (No 2020-02197). The results of the REDUCE trial will be published in an international peer-reviewed medical journal regardless of the results. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT04931485.
    Tags: *Kidney Failure, Chronic, *Shock, Septic/therapy, Adult intensive & critical care, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG,, Astellas, AstraZeneca, CSL Behring, Novartis, Covidien, Phagenesis, Cytel and, Dialysis, Feasibility Studies, Fresenius Kabi, Getinge Group Maquet AG, Drager AG, Teleflex Medical GmbH,, GlaxoSmithKline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter,, Humans, Inselspital (AM, JW, DB, CAP and JCS) reports grants from Orion Pharma, Abbott, INTENSIVE & CRITICAL CARE, Lactic Acid, Multicenter Studies as Topic, no, Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences, Nycomed outside the project. The money was paid into departmental funds, personal financial gain applied. All other authors have nothing to disclose., Randomized Controlled Trials as Topic, Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG,, Resuscitation, Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical.
  • Gross, S., Becker, C., Beck, K., Memma, V., Gaab, J., Schutz, P., Leuppi, J. D., et al. “Occurrence Of Sensitive Topics During Ward Round: An Ancillary Analysis Of The Bedside-Outside Trial”. Bmj Open 13, no. 9: e073584. doi:10.1136/bmjopen-2023-073584.
    Abstract: OBJECTIVE: Discussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre randomised BEDSIDE-OUTSIDE trial focusing on communication during ward rounds, we investigated the interplay between sensitive topics and low reported satisfaction with care. DESIGN: Pre-planned secondary analysis of a randomised controlled trial. For this analysis data of the original trial was pooled across intervention groups. SETTING: Three Swiss teaching hospitals. PARTICIPANTS: Adult patients hospitalised for medical care. INTERVENTIONS: We analysed predefined sensitive health topics and specific elements of communication from audiotapes recorded during ward rounds, for both patients dealing with and without sensitive topics. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was overall patient satisfaction with care; measured on a Visual Analogue Scale from 0 to 100. Secondary endpoints included duration of ward rounds and further satisfaction outcomes. RESULTS: Of the 919 included patients, 474 had at least one sensitive topic including medical uncertainty (n=251), psychiatric comorbidities (n=161), tumour diagnosis (n=137) and social issues (n=125). Compared with patients without sensitive topics, patients with sensitive topics reported lower satisfaction with care (mean (SD), 87.7 (+/-14.6) vs 90.2 (+/-12.1), adjusted difference -2.5 (95% CI -4.28 to -0.72), p=0.006. Among patients with sensitive topics, risk factors for low satisfaction included several parameters concerning patient-physician interaction such as disagreements during ward rounds (mean (SD), 14/212 (6.6%) vs 41/254 (16.1%), adjusted OR 2.78 (95% CI 1.47 to 5.27), p=0.002). CONCLUSIONS: A large proportion of medical inpatients must deal with sensitive health topics. This is associated with lower satisfaction with care, particularly if the patient perceives the interaction with doctors during ward rounds as unsatisfactory. Educating physicians on specific communication techniques may help improve care for these patients. TRIAL REGISTRATION NUMBER: NCT03210987.
    Tags: (Forschungsrat) of the Kantonsspital Aarau (1410.000.058 and 1410.000.044) and, (Ref SNFS-160072 und -185592). JDL has also received unrestricted grant money, *Health Facilities, *Inpatients, 1500000083). PS has previously received unrestricted grant money unrelated to, 22.00094. RS received a speaker honorarium from Novartis. MT is recipient of a, Adult, and has research collaborations with Roche, Novartis and Idorsia (all, Bangerter-Rhyner-Stiftung under projects no. PC 28/17 and PC 05/18, from the, Communication, Dissent and Disputes, Driver-Project - 2018DR108)) and the Swiss National Science Foundation (SNSF), from the Stanley Thomas Johnson Stiftung & Gottfried und Julia, Funds of the Argovia Professorship of the Medical University Clinic (FG, Gottfried Julia Bangerter-Rhyner Foundation (8472/HEG-DSV). PS has received, hospitalization, Hospitals, Teaching, Humans, internal medicine, K50001, and in the context of a Horizon Europe project from the Swiss State, medical education & training, medical ethics, project grant of the Swiss National Science Foundation (grant No. 320030_200423), Promotion Sante Suisse (Gesundheitsforderung Schweiz) under contract no. 18.191/, research team are supported by the Swiss Personalized Health Network (Ref, Science Foundation (SNSF) (Ref 10001C_192850/1 and 10531C_182422) and the, Secretariat for Education, Research and lnnovation (SERI) under contract number, support from the SNF (SNSF Professorship, PP00P3_150531), the Research Committee, Swiss Cancer League (Krebsliga Schweiz) under project no. KLS-4304-08-2017, from, Switzerland)., Switzerland, GSK AG Switzerland and Novartis AG Switzerland. RS received funding, this project from Nestle Health Science and Abbott Nutrition. JDL and his, unrelated to the project from AstraZeneca AG Switzerland, Boehringer GmbH.
  • Collaborators, Gbd Imid. “Global, Regional, And National Incidence Of Six Major Immune-Mediated Inflammatory Diseases: Findings From The Global Burden Of Disease Study 2019”. Eclinicalmedicine 64: 102193. doi:10.1016/j.eclinm.2023.102193.
    Abstract: BACKGROUND: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. METHODS: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. FINDINGS: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of -0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = -0.41), inflammatory bowel disease (AAPC = -0.72), multiple sclerosis (AAPC = -0.26), psoriasis (AAPC = -0.77), and atopic dermatitis (AAPC = -0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. INTERPRETATION: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. FUNDING: The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).
    Tags: Academy of Pharmacy as council member and bursar, outside the submitted work. K, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners,, all outside, all outside the submitted work. A K Demetriades reports leadership or fiduciary, all outside the submitted work. C R Simpson reports research grants, and A Radfar report payment or honoraria for lectures, presentations, speakers, anti-pollution mask, A system and method for electricity generation through crop, as personal payments, bureaus, manuscript writing or educational events from Avicenna Medical and, Clinical Research Institute. T Fukumoto reports payment or honoraria for, Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis and, consulting fees, consulting fees from Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs Inc.,, Department of Anthropology, Panjab University, Chandigarh, India, outside the, Digitalization, MCID, for project titled "Enhancing institutional performance, editor and director (unpaid), equipment (PPE) into biofuel through pyrolysis and method, A novel herbal, European Association of Neurosurgical Societies (EANS) as President and with, events from AbbVie, Eli Lilly, Sanofi, Pfizer, Maruho, Novartis, Taiho, Sun, fiduciary role in other board, society, committee or advocacy group, paid or, Foundation, Australian Department of Health to their institution, from MBIE (NZ), HRC (NZ), Ministry of Health (NZ), MRC (UK), HDRUK, and CSO (UK), from TARGET RWE, Global burden of disease study, Global Neuro Foundation as Board Member, all outside the submitted work. I Filip, Hub Health Germany as Founding Member and Co-manager, all outside the submitted, Immune-mediated inflammatory disease, Incidence, India, Member Secretary-DSTPURSE Program., interests as an employee of AstraZeneca, outside the submitted work. E Upadhyay, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global, Krishan reports non-financial support from UGC Centre of Advanced Study, CAS II,, Labs, Pieris Pharmaceuticals, Enzolytics Inc., Seres Therapeutics, Tonix, leadership, leadship for Joint Secretary of Indian Meteorological Society, Jaipur Chapter,, lectures, presentations, speakers bureaus, manuscript writing or educational, licenses from UptoDate as personal payments for a chapter on plantar fasciitis, Life Science, UBM, Trio Health, Medscape, WebMD, Practice Point Communications,, OMERACT, or fiduciary role in board, society, committee or advocacy group, paid or unpaid,, other board, society, committee or advocacy group, unpaid, with the Malaysian, other financial interests from PRAHS/ICON PLC through, outside the submitted work. N Ismail reports leadership or fiduciary role in, outside the submitted work. S Bhaskar reports leadership or, owned stock options in Amarin, Viking, and Moderna Pharmaceuticals, payment or honoraria for speakers' bureaus from Simply, Pharma, UCB, and Janssen Pharma, all outside the submitted work. C Herteliu, pharmaceutical aid for formulation of gel and method thereof, and reports, Pharmaceuticals Holding Corp., and Charlotte's Web Holdings, Inc., and previously, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter, reports a published patent for A system and method of reusable filters for, reports a research grant from Romanian Ministry of Research Innovation and, Research Council (NHMRC), Arthritis Australia, Cabrini Foundation, HCF, restricted stock units, Rheumatology Field Advisory Committee as Chair (unpaid), and with the UAB, role in other board, society, committee or advocacy group, paid or unpaid, with, Rotary District 9675 as Chair of Diversity, Equity and Inclusion, and with Global, royalties or, SARS-CoV-2 preimmune epitopes, SNC to their institution, University of California San Francisco, Speaking, stock or stock options in Atai Life Sciences,, stock or stock options in ICON PLC through, stubble by using microbial fuel cells, A system for disposed personal protection, submitted work. V Shivarov reports a pending Bulgarian patent for Possible, support for attending meetings or travel from the steering committee of, Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax, the National Institutes of Health, and the American College of Rheumatology all, the submitted work. M Zielinska reports other financial or non-financial, their salary, through development of infrastructure and transdisciplinary research ecosystem, to their institution, all outside the submitted work. J A Singh reports, Trend, unpaid participation on a Data Safety Monitoring Board or Advisory Board, unpaid, with the Rotary Club or Sydney as Board Director and Chair of Youth, with, with OMERACT as a steering committee member, with the Veterans Affairs, with the US Food and Drug Administration Arthritis Advisory Committee, within socio-economic domain-PERFECTIS," project number ID-585-CTR-42-PFE-2021,, work. R Buchbinder reports grants from Australian National Health and Medical.
  • Hamblion, E., Saad, N. J., Greene-Cramer, B., Awofisayo-Okuyelu, A., Selenic Minet, D., Smirnova, A., Engedashet Tahelew, E., et al. “Global Public Health Intelligence: World Health Organization Operational Practices”. Plos Glob Public Health 3, no. 9: e0002359. doi:10.1371/journal.pgph.0002359.
    Abstract: Early warning and response are key to tackle emerging and acute public health risks globally. Therefore, the World Health Organization (WHO) has implemented a robust approach to public health intelligence (PHI) for the global detection, verification and risk assessment of acute public health threats. WHO's PHI operations are underpinned by the International Health Regulations (2005), which require that countries strengthen surveillance efforts, and assess, notify and verify events that may constitute a public health emergency of international concern (PHEIC). PHI activities at WHO are conducted systematically at WHO's headquarters and all six regional offices continuously, throughout every day of the year. We describe four interlinked steps; detection, verification, risk assessment, and reporting and dissemination. For PHI operations, a diverse and interdisciplinary workforce is needed. Overall, PHI is a key feature of the global health architecture and will only become more prominent as the world faces increasing public health threats.
  • Schuetz, P. “Effort Protein Trial: Questions Remain”. Lancet 402, no. 10406: 963. doi:10.1016/S0140-6736(23)01255-2.
  • Urben, T., Amacher, S. A., Becker, C., Gross, S., Arpagaus, A., Tisljar, K., Sutter, R., Pargger, H., Marsch, S., and Hunziker, S. “Red Blood Cell Distribution Width For The Prediction Of Outcomes After Cardiac Arrest”. Sci Rep 13, no. 1: 15081. doi:10.1038/s41598-023-41984-8.
    Abstract: The red blood cell distribution width (RDW) is a routinely available blood marker that measures the variation of the size/volume of red blood cells. The aim of our study was to investigate the prognostic value of RDW in cardiac arrest patients and to assess whether RDW improves the prognostic value of three cardiac arrest-specific risk scores. Consecutive adult cardiac arrest patients admitted to the ICU of a Swiss university hospital were included. The primary outcome was poor neurological outcome at hospital discharge assessed by Cerebral Performance Category. Of 702 patients admitted to the ICU after cardiac arrest, 400 patients (57.0%) survived, of which 323 (80.8%) had a good neurological outcome. Higher mean RDW values showed an independent association with poor neurological outcomes at hospital discharge (adjusted OR 1.27, 95% CI 1.14 to 1.41; p < 0.001). Adding the maximum RDW value to the OHCA- CAHP- and PROLOGUE cardiac arrest scores improved prognostic performance. Within this cohort of cardiac arrest patients, RDW was an independent outcome predictor and slightly improved three cardiac arrest-specific risk scores. RDW may therefore support clinical decision-making.
    Tags: *Erythrocytes, *Heart Arrest, Adult, Clinical Decision-Making, Erythrocyte Indices, Ethnicity, Humans.
  • Schmid, C., Fongaufier, C., Hamza, B., Hohn, T., Staubli, G., and Stadlinger, B. “A 3-Year Retrospective Analysis Of Dento-Alveolar Injuries At The University Children's Hospital Zurich (2018-2020)”. Swiss Dent J 134, no. 1: 18-35. doi:10.61872/sdj-2024-03-01.
    Abstract: Children and adolescents are vulnerable to dental trauma due to their active lifestyles, lack of coordination, and inexperience in recognizing potentially dangerous situations. Early recognition and proper management of dental trauma is crucial in order to minimize the risk of complications and ensure optimal outcomes. The aim of this study was to perform a retrospective analysis of all dento-alveolar injuries in children and adolescents who were treated at the University Children's Hospital Zurich from 2018-2020 by the resident physicians of the Centre of Dental Medicine of the University of Zurich. All information concerning age and sex distribution, seasonal and weekly variations, as well as aetiology, types of trauma and co-affected structures in the head and neck area from 389 patients was analysed. For data extraction, a parameterised Excel list was created, enabling a continuous data collection. In the study, 65% of the patients were male and 35% female. The average patient age was 7 years and 4 months. The highest frequency of trauma occurred in mixed dentition (49%), followed by deciduous dentition (36%) and permanent dentition (15%). Most of the accidents occurred in the second quarter of the year, especially in the month of May slightly more injuries were reported. The most common injuries were increased tooth mobility (40%) and tooth fractures without pulp exposure (34%). Less frequent were tooth fractures with pulp exposure (12%), lateral dislocations (29%), avulsions (21%), intrusions (8%), extrusions (6%) and root fractures (4%). As in many studies the upper central incisors were most often affected. Main causes of dental trauma were falls, especially by bike (18%) or scooter (14%). Soft tissue injuries or fractures, in the area of the head and neck occurred in 59% and 10% of the cases simultaneously accompanied by dento-alveolar trauma.
    Tags: *Hospitals, Pediatric/statistics & numerical data, *Tooth Injuries/epidemiology/etiology, Adolescent, Aetiology, Child, Child, Preschool, Dentition stage, Dento-alveolar Trauma, Female, Hospitals, University/statistics & numerical data, Humans, Infant, Male, Retrospective Studies, Switzerland/epidemiology, Tooth injury.
  • Knapp, J., Doppmann, P., Huber, M., Meuli, L., Albrecht, R., Sollid, S., and Pietsch, U. “Pre-Hospital Endotracheal Intubation In Severe Traumatic Brain Injury: Ventilation Targets And Mortality-A Retrospective Analysis Of 308 Patients”. Scand J Trauma Resusc Emerg Med 31, no. 1: 46. doi:10.1186/s13049-023-01115-8.
    Abstract: BACKGROUND: Traumatic brain injury (TBI) remains one of the main causes of mortality and long-term disability worldwide. Maintaining physiology of brain tissue to the greatest extent possible through optimal management of blood pressure, airway, ventilation, and oxygenation, improves patient outcome. We studied the quality of prehospital care in severe TBI patients by analyzing adherence to recommended target ranges for ventilation and blood pressure, prehospital time expenditure, and their effect on mortality, as well as quality of prehospital ventilation assessed by arterial partial pressure of CO(2) (PaCO(2)) at hospital admission. METHODS: This is a retrospective cohort study of all TBI patients requiring tracheal intubation on scene who were transported to one of two major level 1 trauma centers in Switzerland between January 2014 and December 2019 by Swiss Air Rescue (Rega). We assessed systolic blood pressure (SBP), end-tidal partial pressure of CO(2) (PetCO(2)), and PaCO(2) at hospital admission as well as prehospital and on-scene time. Quality markers of prehospital care (PetCO(2), SBP, prehospital times) and prehospital ventilation (PaCO(2)) are presented as descriptive analysis. Effect on mortality was calculated by multivariable regression analysis and a logistic general additive model. RESULTS: Of 557 patients after exclusions, 308 were analyzed. Adherence to blood pressure recommendations was 89%. According to PetCO(2,) 45% were normoventilated, and 29% had a SBP >/= 90 mm Hg and were normoventilated. Due to the poor correlation between PaCO(2) and PetCO(2), only 33% were normocapnic at hospital admission. Normocapnia at hospital admission was strongly associated with reduced probability of mortality. Prehospital and on-scene times had no impact on mortality. CONCLUSIONS: PaCO(2) at hospital admission is strongly associated with mortality risk, but normocapnia is achieved only in a minority of patients. Therefore, the time required for placement of an arterial cannula and prehospital blood gas analysis may be warranted in severe TBI patients requiring on-scene tracheal intubation.
    Tags: *Brain Injuries, Traumatic/therapy, *Carbon Dioxide, content of this article., Hems, Hospitals, Humans, Intubation, Intratracheal, Prehospital emergency medicine, Retrospective Studies, Tracheal intubation, Traumatic brain injury, Ventilation.
  • Balet, L., Ageron, F. X., Pasquier, M., Zingg, T., and The Swiss Trauma, Registry. “Performance Assessment Of Out-Of-Hospital Use Of Pelvic Circumferential Compression Devices For Severely Injured Patients In Switzerland: A Nationwide Retrospective Cross-Sectional Study”. J Clin Med 12, no. 17. doi:10.3390/jcm12175509.
    Abstract: BACKGROUND: Patients with severe pelvic fractures carry a greater risk of severe bleeding, and pelvic compression devices (PCCD) are used to stabilize the pelvis on the pre-hospital scene. The aim of this study was to describe the use of PCCD in the pre-hospital setting on a nationwide scale (Switzerland) and determine the sensitivity, specificity and rates of over- and under-triage of the current application practices. The secondary objective was to identify pre-hospital factors associated with unstable pelvic fractures. METHODS: Retrospective cross-sectional study using anonymized patient data (1 January 2015-31 December 2020) from the Swiss Trauma Registry (STR). Based on AIS scores, patients were assigned a unique principal diagnosis among three categories (unstable pelvic fracture-stable pelvic fracture-other) and assessed for use or not of PCCD. Secondarily, patient characteristics, initial pre-hospital vital signs, means of pre-hospital transport and trauma mechanism were also extracted from the database. RESULTS: 2790 patients were included for analysis. A PCCD was used in 387 (13.9%) patients. In the PCCD group, 176 (45.5%) had an unstable pelvic fracture, 52 (13.4%) a stable pelvic fracture and 159 (41.1%) an injury unrelated to the pelvic region. In the group who did not receive a PCCD, 214 (8.9%) had an unstable pelvic fracture, 182 (7.6%) a stable pelvic fracture and 2007 (83.5%) an injury unrelated to the pelvic region. The nationwide sensitivity of PCCD application was 45.1% (95% CI 40.1-50.2), the specificity 91.2% (95% CI 90-92.3), with both over- and under-triage rates of 55%. The prevalence of unstable fractures in our population was 14% (390/2790). We identified female sex, younger age, lower systolic blood pressure, higher shock index, pedestrian hit and fall >/=3 m as possible risk factors for an unstable pelvic fracture. CONCLUSIONS: Our results demonstrate a nationwide both over- and under-triage rate of 55% for out-of-hospital PCCD application. Female gender, younger age, lower blood pressure, higher shock index, pedestrian hit and fall >3 m are possible risk factors for unstable pelvic fracture, but it remains unclear if those parameters are relevant clinically to perform pre-hospital triage.
    Tags: emergency, Pccd, pelvic fracture, pre-hospital.
  • Yufera-Sanchez, A., Lopez-Ayala, P., Nestelberger, T., Wildi, K., Boeddinghaus, J., Koechlin, L., Rubini Gimenez, M., et al. “Combining Glucose And High-Sensitivity Cardiac Troponin In The Early Diagnosis Of Acute Myocardial Infarction”. Sci Rep 13, no. 1: 14598. doi:10.1038/s41598-023-37093-1.
    Abstract: Glucose is a universally available inexpensive biomarker, which is increased as part of the physiological stress response to acute myocardial infarction (AMI) and may therefore help in its early diagnosis. To test this hypothesis, glucose, high-sensitivity cardiac troponin (hs-cTn) T, and hs-cTnI were measured in consecutive patients presenting with acute chest discomfort to the emergency department (ED) and enrolled in a large international diagnostic study (NCT00470587). Two independent cardiologists centrally adjudicated the final diagnosis using all clinical data, including serial hs-cTnT measurements, cardiac imaging and clinical follow-up. The primary diagnostic endpoint was index non-ST-segment elevation MI (NSTEMI). Prognostic endpoints were all-cause death, and cardiovascular (CV) death or future AMI, all within 730-days. Among 5639 eligible patients, NSTEMI was the adjudicated final diagnosis in 1051 (18.6%) patients. Diagnostic accuracy quantified using the area under the receiver-operating characteristics curve (AUC) for the combination of glucose with hs-cTnT and glucose with hs-cTnI was very high, but not higher versus that of hs-cTn alone (glucose/hs-cTnT 0.930 [95% CI 0.922-0.937] versus hs-cTnT 0.929 [95% CI 0.922-0.937]; glucose/hs-cTnI 0.944 [95% CI 0.937-0.951] versus hs-cTnI 0.944 [95% CI 0.937-0.951]). In early-presenters, a dual-marker strategy (glucose < 7 mmol/L and hs-cTnT < 5/hs-cTnI < 4 ng/L) provided very high and comparable sensitivity to slightly lower hs-cTn concentrations (cTnT/I < 4/3 ng/L) alone, and possibly even higher efficacy. Glucose was an independent predictor of 730-days endpoints. Our results showed that a dual marker strategy of glucose and hs-cTn did not increase the diagnostic accuracy when used continuously. However, a cutoff approach combining glucose and hs-cTn may provide diagnostic utility for patients presenting </= 3 h after onset of symptoms, also providing important prognostic information.
    Tags: *Myocardial Infarction, *Non-ST Elevated Myocardial Infarction, Early Diagnosis, Glucose, Humans, Troponin.
  • Waskowski, J., Salvato, S. M., Muller, M., Hofer, D., van Regenmortel, N., and Pfortmueller, C. A. “Choice Of Creep Or Maintenance Fluid Type And Their Impact On Total Daily Icu Sodium Burden In Critically Ill Patients: A Systematic Review And Meta-Analysis”. J Crit Care 78: 154403. doi:10.1016/j.jcrc.2023.154403.
    Abstract: PURPOSE: Maintenance and hidden/creep fluids are a major source of fluid and sodium intake in intensive care unit (ICU) patients. Recent research indicates that low versus high sodium content maintenance fluids could decrease fluid and sodium burden. We conducted a systematic review (SR) with meta-analysis to summarize the impact of maintenance fluid choice on total daily sodium in ICU patients. MATERIALS AND METHODS: Systematic literature search in Pubmed, Embase, the Cochrane Library and the. CLINICAL TRIALS REGISTRY: Only controlled clinical trials were included. EXCLUSION CRITERIA: trials on resuscitation fluids, performed in the emergency department only and in pediatric patients. Primary objective was the reduction in mean total sodium intake with low versus high sodium content maintenance/creep fluids. RESULTS: Five studies (1105 patients) were included. Heterogeneity was high.Risk of bias was moderate. Mean daily sodium reduction was 117 mmol (95%Confidence Interval [CI] -174; -59; p < 0.001) with low versus high sodium content maintenance/creep fluids. Incidence of hyperchloremia was lower (OR 0.26; 95%CI 0.1; 0.64) with low sodium. There were no differences in the incidences of hyper-/hyponatremia and fluid balances. CONCLUSION: Using low sodium content maintenance/creep fluids substantially reduces daily sodium burden in adult ICU patients. Significant knowledge/research gaps exist regarding relevance and safety. TRIAL REGISTRATION: PROSPERO 2022 CRD42022300577 (February 2022).
    Tags: *Hyponatremia, *Sodium, Dietary, Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton, Adult, authors have nothing to disclose., Boehringer-Ingelheim, Aseptuva, Astellas, Astra Zeneca, CSL Behring, Novartis,, Child, Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A.,, Covidien, and Nycomed outside the submitted work. The money was paid into, Creep fluids, Critical Illness, Critically ill, departmental funds, Fluid accumulation, GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter,, Humans, Hyperchloremia, Hypernatremia, Intensive Care Units, Lifesciences Services GmbH, Kenta Biotech Ltd., Maquet Critical Care AB, Omnicare, Maintenance fluids, Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Drager AG, Teleflex Medical, no personal financial gain applied. NVR has received, Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards, Sodium, speaker's fees and participated in advisory boards organized by Baxter. All other.
  • Rigling, M., Schuetz, P., and Kaegi-Braun, N. “Is Food Insecurity Contributing To Malnutrition In Older Adults In Switzerland? - A Cross-Sectional Study”. Front Nutr 10: 1228826. doi:10.3389/fnut.2023.1228826.
    Abstract: BACKGROUND: Food insecurity has been defined as "limited access to food, at the level of individuals or households, due to lack of money or other resources" and may increase the nutritional risk, which in turn leads to poor health, development of chronic diseases, poor psychological and cognitive functioning, and substandard academic achievements. There is limited data on the importance of food insecurity in a rich country such as Switzerland. METHODS: This is a cross-sectional analysis of data from a structured survey in an elderly population of Switzerland. The data was assessed between June and August 2021 in the course of a 7-year phone call follow-up from the EFFORT trial, which included medical inpatients at nutritional risk from 2014 to 2018. A validated questionnaire (Six-Item Short Form 2012 of the U.S: Household Food Security Survey Module) was used to assess food security status. RESULTS: Of the 433 included patients, 30 (6.9%) were food insecure. A significant association between food insecurity and age, governmental financial support and self-reported loneliness was found. When compared with the food secure group, there was a significant lower quality of life measured by the EQ-5D VAS. CONCLUSION: In an older Swiss population of patients at nutritional risk, food insecurity was named as a contributing factor for malnutrition in about 7% of patients, particularly younger individuals with financial support, and self-reported loneliness. In the assessment of malnutrition, physician and dieticians should ask for food insecurity and if detect take appropriate actions.
    Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., food insecurity, food security, health, malnutrition, nutritional risk, older adults, quality of life, risk factors.
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