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Swiss Emergency Research collection

2021

  • Beysard, N., Pasquier, M., Zingg, T., Carron, P. N., and Darioli, V. “The Use Of Foley Catheter Tamponade For Bleeding Control In Penetrating Injuries”. Scand J Trauma Resusc Emerg Med 29, no. 1: 165. doi:10.1186/s13049-021-00975-2.
    Tags: *Hemorrhage/etiology/therapy, *Wounds, Penetrating/therapy, Catheters, Humans.
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  • Prepoudis, A., Koechlin, L., Nestelberger, T., Boeddinghaus, J., Lopez-Ayala, P., Wussler, D., Zimmermann, T., et al. “Incidence, Clinical Presentation, Management, And Outcome Of Acute Pericarditis And Myopericarditis”. Eur Heart J Acute Cardiovasc Care 11, no. 2: 137-147. doi:10.1093/ehjacc/zuab108.
    Abstract: AIMS: Little is known about the epidemiology, clinical presentation, management, and outcome of acute pericarditis and myopericarditis. METHODS AND RESULTS: The final diagnoses of acute pericarditis, myopericarditis, and non-ST-segment elevation myocardial infarction (NSTEMI) of patients presenting to seven emergency departments in Switzerland with acute chest pain were centrally adjudicated by two independent cardiologists using all information including serial measurements of high-sensitivity cardiac troponin T. The overall incidence of pericarditis and myopericarditis was estimated relative to the established incidence of NSTEMI. Current management and long-term outcome of both conditions were also assessed. Among 2533 chest pain patients, the incidence of pericarditis, myopericarditis, and NSTEMI were 1.9% (n = 48), 1.1% (n = 29), and 21.6% (n = 548), respectively. Accordingly, the estimated incidence of pericarditis and myopericarditis in Switzerland was 10.1 [95% confidence interval (95% CI) 9.3-10.9] and 6.1 (95% CI 5.6-6.7) cases per 100 000 population per year, respectively, vs. 115.0 (95% CI 112.3-117.6) cases per 100 000 population per year for NSTEMI. Pericarditis (85% male, median age 46 years) and myopericarditis (62% male, median age 56 years) had male predominance, and commonly (50% and 97%, respectively) resulted in hospitalization. No patient with pericarditis or myopericarditis died or had life-threatening arrhythmias within 30 days [incidence 0% (95% CI 0.0-4.8%)]. Compared with NSTEMI, the 2-year all-cause mortality adjusted hazard ratio of pericarditis and myopericarditis was 0.40 (95% CI 0.05-2.96), being 0.59 (95% CI 0.40-0.88) for non-cardiac causes of chest pain. CONCLUSION: Pericarditis and myopericarditis are substantially less common than NSTEMI and have an excellent short- and long-term outcome. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov, number NCT00470587, https://clinicaltrials.gov/ct2/show/NCT00470587.
    Tags: *Myocarditis/diagnosis/epidemiology/therapy, *Non-ST Elevated Myocardial Infarction, *Pericarditis/diagnosis/epidemiology/therapy, Chest Pain/diagnosis/epidemiology/etiology, Female, Humans, Incidence, Male, Middle Aged, Myopericarditis, Nstemi, Outcome, Pericarditis, Presentation.
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  • Genecand, C., Mongin, D., Koegler, F., Lebowitz, D., Regard, S., Falcone, J. L., Nehme, M., et al. “Cohort Profile: Actionable Register Of Geneva Outpatients And Inpatients With Sars-Cov-2 (Argos)”. Bmj Open 11, no. 11: e048946. doi:10.1136/bmjopen-2021-048946.
    Abstract: PURPOSE: The Actionable Register of Geneva Outpatients and inpatients with SARS-CoV-2 (ARGOS) is an ongoing prospective cohort created by the Geneva Directorate of Health. It consists of an operational database compiling all SARS-CoV-2 test results recorded in the Geneva area since late February 2020. This article aims at presenting this comprehensive cohort, in light of some of the varying public health measures in Geneva, Switzerland, since March 2020. PARTICIPANTS: As of 1 June 2021, the database included 360 525 patients, among which 65 475 had at least one positive test result for SARS-CoV-2. Among all positive patients, 37.6% were contacted only once, 10.6% had one follow-up call, 8.5% had two and 27.7% had three or more follow-up calls. Participation rate among positive patients is 94%. Data collection is ongoing. FINDINGS TO DATE: ARGOS data illustrates the magnitude of COVID-19 pandemic in Geneva, Switzerland, and details a variety of population factors and outcomes. The content of the cohort includes demographic data, comorbidities and risk factors for poor clinical outcome, self-reported COVID-19 symptoms, environmental and socioeconomic factors, prospective and retrospective contact tracing data, travel quarantine data and deaths. The registry has already been used in several publications focusing on symptoms and long COVID-19, infection fatality rate and re-infection. FUTURE PLANS: The data of this large real-world registry provides a valuable resource for various types of research, such as clinical research, epidemiological research or policy assessment as it illustrates the impact of public health policies and overall disease burden of COVID-19.
    Tags: *COVID-19/complications, *SARS-CoV-2, Covid-19, epidemiology, Humans, Inpatients, Outpatients, Pandemics, Post-Acute COVID-19 Syndrome, Prospective Studies, public health, Retrospective Studies.
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  • Ravioli, S., Moser, N., Ryser, B., Pfortmueller, C. A., and Lindner, G. “Gender Distribution In Boards Of Intensive Care Medicine Societies”. J Crit Care 68: 157-162. doi:10.1016/j.jcrc.2021.11.006.
    Abstract: PURPOSE: The established gender gap in intensive care medicine is larger compared to other medical specialties. The aim of this study was to evaluate gender distribution in boards of intensive care medicine societies worldwide. METHODS: In this cross-sectional analysis, board members and presidents of all intensive care medicine societies associated with the European Society of Intensive Care Medicine were eligible for study inclusion. Exclusion criteria were: A) society without focus on intensive care and B) online information unavailable. RESULTS: In 2021, 65 presidents and 820 board members were analyzed. Ten presidents (15%) and 231 board members (28%) were women. The proportion of women presidents reached from 0% in Africa to 20% in Europe and South America. The proportion of women board members was highest in North and South America with 42% and 46% respectively and lowest in Africa (21%) and Asia (10%). In Europe, 31% of board members were women and 35% in Australia/New Zealand. Among presidents, women were underrepresented in all continents while gender distribution among board members varied significantly between countries (p < 0.0001). CONCLUSION: Our analysis reveals an inequality in gender distribution in the boards of national intensive care medicine societies which varies but persists for all global regions.
    Tags: *Medicine, *Societies, Medical, Critical Care, Cross-Sectional Studies, Diversity, Europe, Female, Gender, Gender disparities, Humans, Intensive care medicine, Male.
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  • Grin, N., Rousson, V., Darocha, T., Hugli, O., Carron, P. N., Zingg, T., and Pasquier, M. “Hypothermia Outcome Prediction After Extracorporeal Life Support For Hypothermic Cardiac Arrest Patients: Assessing The Performance Of The Hope Score In Case Reports From The Literature”. Int J Environ Res Public Health 18, no. 22. doi:10.3390/ijerph182211896.
    Abstract: Aims: The hypothermia outcome prediction after extracorporeal life support (ECLS) score, or HOPE score, provides an estimate of the survival probability in hypothermic cardiac arrest patients undergoing ECLS rewarming. The aim of this study was to assess the performance of the HOPE score in case reports from the literature. Methods: Cases were identified through a systematic review of the literature. We included cases of hypothermic cardiac arrest patients rewarmed with ECLS and not included in the HOPE derivation and validation studies. We calculated the survival probability of each patient according to the HOPE score. Results: A total of 70 patients were included. Most of them (62/70 = 89%) survived. The discrimination using the HOPE score was good (Area Under the Receiver Operating Characteristic Curve = 0.78). The calibration was poor, with HOPE survival probabilities averaging 54%. Using a HOPE survival probability threshold of at least 10% as a decision criterion for rewarming a patient would have resulted in only five false positives and a single false negative, i.e., 64 (or 91%) correct decisions. Conclusions: In this highly selected sample, the HOPE score still had a good practical performance. The selection bias most likely explains the poor calibration found in the present study, with survivors being more often described in the literature than non-survivors. Our finding underscores the importance of working with a representative sample of patients when deriving and validating a score, as was the case in the HOPE studies that included only consecutive patients in order to minimize the risk of publication bias and lower the risk of overly optimistic outcomes.
    Tags: *Cardiopulmonary Resuscitation, *Extracorporeal Membrane Oxygenation, *Heart Arrest/therapy, *Hypothermia/therapy, accidental, cardiac arrest, Ecmo, Ecpr, Humans, hypothermia, potassium, publication bias, resuscitation, Retrospective Studies, Rewarming, selection bias, triage.
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  • Jakob, D. A., Lewis, M., Benjamin, E. R., Mitchao, D. P., Exadaktylos, A. K., and Demetriades, D. “Timing Of Venous Thromboembolic Pharmacological Prophylaxis In Traumatic Combined Subdural And Subarachnoid Hemorrhage”. Am J Surg 223, no. 6: 1194-1199. doi:10.1016/j.amjsurg.2021.11.021.
    Abstract: BACKGROUND: The combination of subdural and subarachnoid hemorrhage is the most common intracranial bleeding. The present study evaluated the timing and type of venous thromboembolic chemoprophylaxis (VTEp) for efficacy and safety in patients with blunt head trauma with combined acute subdural and subarachnoid hemorrhage. METHODS: Patients with isolated combined acute subdural and subarachnoid hemorrhage were extracted from the ACS-TQIP database (2013-2017). After 1:1 cohort matching of patients receiving early prophylaxis (EP, </=48 h) versus late prophylaxis (LP, >48 h) outcomes were compared with univariable and multivariable regression analysis. RESULTS: Multivariable regression analysis identified EP as an independent protective factor for VTE complications (OR 0.468, CI 0.293-0.748) but not mortality (p = 0.485). The adjusted risk for delayed craniectomy was not associated with EP compared to LP (p = 0.283). The type of VTEp was not associated with VTE complications (p = 0.301), mortality (p = 0.391) or delayed craniectomy (p = 0.126). CONCLUSIONS: Early VTEp (</=48 h) was associated with fewer VTE complications in patients and did not increase the risk for craniectomies in patients with combined acute subdural and subarachnoid hemorrhage.
    Tags: *Head Injuries, Closed/complications, *Subarachnoid Hemorrhage/complications/drug therapy/surgery, *Venous Thromboembolism/etiology/prevention & control, Anticoagulants/therapeutic use, Humans, Intracranial Hemorrhages, Prophylaxis, Retrospective Studies, Subarachnoid hemorrhage, Subdural hematoma, Venous thromboembolism.
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  • Istampoulouoglou, I., Dimitriou, G., Spani, S., Christ, A., Zimmermanns, B., Koechlin, S., Stoeckmann, O., et al. “Myocarditis And Pericarditis In Association With Covid-19 Mrna-Vaccination: Cases From A Regional Pharmacovigilance Centre”. Glob Cardiol Sci Pract 2021, no. 3: e202118. doi:10.21542/gcsp.2021.18.
    Abstract: In this article we summarize suspected adverse events following immunization (AEFI) of pericarditis, myocarditis and perimyocarditis that were reported by our regional pharmacovigilance centre after COVID-19 mRNA-vaccination and discuss their association with these vaccines. Seventeen cases were reported between March and July 2021. Of these, nine had perimyocarditis, five myocarditis and three pericarditis. Twelve patients were male (71%). The median age was 38 years (range 17-88). The most commonly observed presenting symptom was acute chest pain (65%). While 47% of the patients were previously healthy, 53% had at least one pre-existing comorbidity, with hypertension being the most prevalent (24%). The European Society of Cardiology diagnostic criteria for the reported AEFIs were fulfilled in twelve cases (71%). The AEFIs occurred after the first vaccine dose in six cases (35%), after the second vaccine dose in ten cases (59%) and after both doses in one case (6%). The median latency of all AEFIs taken together was 14 days (range 1-28) after the first vaccination and 3 days (range 1-17) after the second one. All patients except one were hospitalized (94%) with a median length of stay of 7.5 days (range 3-13). The majority of patients (n = 11, 65%) did not experience any complications, and 13 (77%) of the patients had recovered or were recovering at the time of discharge. In 16 of the 17 cases (94%), the association between the AEFI and mRNA-vaccination was considered possible by the pharmacovigilance centre.
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  • Giacalone, S., Kottmann, A., Darioli, V., Carron, P. N., Desseauve, D., Albrecht, R., and Pasquier, M. “Clinical Characteristics And Haemodynamic State Of Patients Undergoing Interhospital Transfer For Postpartum Haemorrhage: A Study Of A Single-Centre Helicopter Emergency Medical Service”. Eur J Obstet Gynecol Reprod Biol 268: 48-55. doi:10.1016/j.ejogrb.2021.11.004.
    Abstract: OBJECTIVE: Uterine artery embolization is an attractive option for the management of postpartum haemorrhage, however it is not available in every hospital. We compared the clinical characteristics and haemodynamic state of patients with postpartum haemorrhage, before and after helicopter transfer to a tertiary hospital for possible uterine artery embolization. We also analysed whether the type of treatment could modify the outcome. STUDY DESIGN: Between 1999 and 2019 in Switzerland, we retrospectively found 82 consecutive patients with postpartum haemorrhage who were transferred by a physician-staffed helicopter emergency medical service to the tertiary hospital for potential uterine artery embolization. The collected data included the type of delivery, estimated blood loss, shock index and blood lactate levels before transfer and at destination, uterine artery embolization rate and hospital mortality rate. Our primary outcome was to describe the clinical characteristics, outcomes and haemodynamic state of the patients with postpartum haemorrhage before and after helicopter transfer. Our secondary outcome was to report the treatments performed at the tertiary hospital. The collected data were analysed with Stata version 14 (Stata Corporation, College Station, TX, USA). Continuous data are compared by using the Student's t-test or the Mann-Whitney U test, as appropriate. RESULTS: We included 69 patients. Postpartum haemorrhage occurred after vaginal delivery in 38 cases (55%). Blood loss prior to transfer exceeded 2 L in 34% of cases. The median shock index was 1 (IQR 0.8-1.1) before transfer and 0.9 (IQR 0.8-1.1) after transfer (p = 0.41). The median lactate level was 2.9 mmol/L (IQR 2.1-6.8) before, and 2.1 mmol/L (IQR 1.55-3.5) after transfer (p = 0.90). Forty-four patients underwent uterine artery embolization (64%), with an overall success rate of 93%. One patient died (1.4%), from a haemorrhagic shock of abdominal origin. CONCLUSIONS: Interhospital helicopter transfer of patients with postpartum haemorrhage to a tertiary hospital seems to be safe in our setting, despite a significant proportion of patients exhibiting signs of haemodynamic instability. Decision criteria would be helpful to better guide choices regarding the transfer of patients with postpartum haemorrhage.
    Tags: *Emergency Medical Services, *Postpartum Hemorrhage/therapy, Aircraft, competing financial interests or personal relationships that could have appeared, Emergency medical services, Female, Hemodynamics, Humans, Postpartum haemorrhage, Retrospective Studies, to influence the work reported in this paper., Treatment Outcome, Uterine artery embolization.
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  • Paal, P., Zafren, K., and Pasquier, M. “Higher Pre-Hospital Anaesthesia Case Volumes Result In Lower Mortality Rates: Implications For Mass Casualty Care”. Br J Anaesth 128, no. 2: e89-e92. doi:10.1016/j.bja.2021.10.022.
    Abstract: Senior physicians with a higher pre-hospital anaesthesia case volume have higher first-pass tracheal intubation success rates, shorter on-site times, and lower patient mortality rates than physicians with lower case volumes. A senior physician's skill set includes the basics of management of airway and breathing (ventilating and oxygenating the patient), circulation, disability (anaesthesia), and environment (especially maintaining core temperature). Technical rescue skills may be required to care for patients requiring pre-hospital airway management especially in hazardous environments, such as road traffic accidents, chemical incidents, terror attacks or warfare, and natural disasters. Additional important tactical skills in mass casualty situations include patient triage, prioritising, allocating resources, and making transport decisions.
    Tags: *Anesthesia, *Mass Casualty Incidents, Airway Management, anaesthesia, anaesthesiologist, emergency medical services, Hospitals, Humans, mass casualty incidents, tracheal intubation, Triage, videolaryngoscopy.
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  • Boldt, J., Steinfort, F., Muller, M., Exadaktylos, A. K., and Klukowska-Roetzler, J. “Online Newspaper Reports On Ambulance Accidents In Austria, Germany, And Switzerland: Retrospective Cross-Sectional Review”. Jmir Public Health Surveill 7, no. 11: e25897. doi:10.2196/25897.
    Abstract: BACKGROUND: Ambulance accidents are an unfortunate indirect result of ambulance emergency calls, which create hazardous environments for personnel, patients, and bystanders. However, in European German-speaking countries, factors contributing to ambulance accidents have not been optimally researched and analyzed. OBJECTIVE: The objective of this study was to extract, analyze, and compare data from online newspaper articles on ambulance accidents for Austria, Germany, and Switzerland. We hope to highlight future strategies to offset the deficit in research data and official registers for prevention of ambulance and emergency vehicle accidents. METHODS: Ambulance accident data were collected from Austrian, German, and Swiss free web-based daily newspapers, as listed in Wikipedia, for the period between January 2014 and January 2019. All included newspapers were searched for articles reporting ambulance accidents using German terms representing "ambulance" and "ambulance accident." Characteristics of the accidents were compiled and analyzed. Only ground ambulance accidents were covered. RESULTS: In Germany, a total of 597 ambulance accidents were recorded, corresponding to 0.719 (95% CI 0.663-0.779) per 100,000 inhabitants; 453 of these accidents left 1170 people injured, corresponding to 1.409 (95% CI 1.330-1.492) per 100,000 inhabitants, and 28 of these accidents caused 31 fatalities, corresponding to 0.037 (95% CI 0.025-0.053) per 100,000 inhabitants. In Austria, a total of 62 ambulance accidents were recorded, corresponding to 0.698 (95% CI 0.535-0.894) per 100,000 inhabitants; 47 of these accidents left 115 people injured, corresponding to 1.294 (95% CI 1.068-1.553) per 100,000 inhabitants, and 6 of these accidents caused 7 fatalities, corresponding to 0.079 (95% CI 0.032-0.162) per 100,000 inhabitants. In Switzerland, a total of 25 ambulance accidents were recorded, corresponding to 0.293 (95% CI 0.189-0.432) per 100,000 inhabitants; 11 of these accidents left 18 people injured, corresponding to 0.211(95% CI 0.113-0.308) per 100,000 inhabitants. There were no fatalities. In each of the three countries, the majority of the accidents involved another car (77%-81%). In Germany and Switzerland, most accidents occurred at an intersection. In Germany, Austria, and Switzerland, 38.7%, 26%, and 4%, respectively, of ambulance accidents occurred at intersections for which the ambulance had a red light (P<.001). In all three countries, most of the casualties were staff and not uncommonly a third party. Most accidents took place on weekdays and during the daytime. Ambulance accidents were evenly distributed across the four seasons. The direction of travel was reported in 28%-37% of the accidents and the patient was in the ambulance approximately 50% of the time in all countries. The cause of the ambulance accidents was reported to be the ambulance itself in 125 (48.1% of accidents where the cause was reported), 22 (42%), and 8 (40%) accidents in Germany, Austria, and Switzerland, respectively (P=.02), and another vehicle in 118 (45.4%), 29 (56%), and 9 (45%) accidents, respectively (P<.001). A total of 292 accidents occurred while blue lights and sirens were used, which caused 3 deaths and 577 injuries. CONCLUSIONS: This study draws attention to much needed auxiliary sources of data that may allow for creation of a contemporary registry of all ambulance accidents in Austria, Germany, and Switzerland. To improve risk management and set European standards, it should be mandatory to collect standardized goal-directed and representative information using various sources (including the wide range presented by the press and social media), which should then be made available for audit, analysis, and research.
    Tags: *Accidents, *Ambulances, accident, ambulance, ambulance accidents, ambulance collisions, ambulance crashes, Austria, Austria/epidemiology, cross-sectional, Cross-Sectional Studies, data, German-speaking European countries, Germany, Germany/epidemiology, Humans, media, media-based, media-based review, newspaper, newspaper review, retrospective, Retrospective Studies, review, Switzerland, Switzerland/epidemiology.
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  • Kammer, J. E., and Hautz, W. E. “Beyond Competence: Towards A More Holistic Perspective In Medical Education”. Med Educ 56, no. 1: 4-6. doi:10.1111/medu.14692.
    Abstract: The authors draw connections between four State of the Science articles that encourage diversity in our field while worrying about heterogeneity of terminology impeding theory integration and practical impact.
    Tags: *Education, Medical, Clinical Competence, Humans.
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  • Birrenbach, T., Geissbuhler, A., Exadaktylos, A. K., Hautz, W. E., Sauter, T. C., and Muller, M. “A Dangerously Underrated Entity? Non-Specific Complaints At Emergency Department Presentation Are Associated With Utilisation Of Less Diagnostic Resources”. Bmc Emerg Med 21, no. 1: 133. doi:10.1186/s12873-021-00531-2.
    Abstract: BACKGROUND: Patients presenting with non-specific complaints (NSC), such as generalised weakness, or feeling unwell, constitute about 20% of emergency care consultations. In contrast to patients presenting with specific symptoms, these patients experience more hospitalisations, longer stays in hospital and even higher mortality. However, little is known about the actual resources spent on patients with NSC in the emergency department (ED). METHODS: We have conducted a retrospective analysis from January 1st, 2013 until December 31st, 2017 in a Swiss tertiary care ED to assess the impact of NSC on the utilisation of diagnostic resources in adult patients with highlyurgent or urgent medical complaints. RESULTS: We randomly selected 1500 medical consultations from our electronic health record database: The majority of patients (n = 1310, 87.3%) presented with a specific complaint; n = 190 (12.7%) with a NSC. Univariate analysis showed no significant difference in the utilisation of total diagnostic resources in the ED [specific complaints: 844 (577-1313) vs. NSC: 778 (551-1183) tax points, p = 0.092, median (interquartile range)]. A backward selection logistic regression model was adjusted for the identified covariates (age, diabetes, cerebrovascular and liver disease, malignancy, past myocardial infarction, antihypertensive, antithrombotic or antidiabetic medication, night or weekend admission and triage category). This identified a significant association of NSC with lower utilisation of ED diagnostic resources [geometric mean ratio (GMR) 0.91, 95% CI: 0.84-0.99, p = 0.042]. CONCLUSIONS: Non-specific complaints (NSC) are a frequent reason for emergency medicine consultations and are associated with lower utilisation of diagnostic resources during ED diagnostic testing than with specific complaints.
    Tags: *Emergency Medical Services, *Emergency Service, Hospital, Adult, Daiichi-Sankyo and the Gottfried and Julia Bangerter-Rhyner-Foundation. WEH has, Emergency department, Hospitalization, Humans, Mundipharma Medical Basel. All other authors have nothing to disclose., Non-specific complaints, received speaker fees from the AO foundation Zurich and research funding from, research grants or lecture fees from Bayer, Boehringer Ingelheim, and, Resource utilisation, Retrospective Studies, Sciences through the "Young Talents in Clinical Research" (grant TCR 14/17) as, Triage, well as with an in-house grant of the Clinical Trial Unit. TCS has received.
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  • Jauslin, A. S., Schultze, L., Knuchel, D., Simon, N. R., Nickel, C. H., and Bingisser, R. “Disparities In Emergency Department Access, Resource Allocation, And Outcomes Between Migrants And The Local Population”. Swiss Med Wkly 151, no. 43-44: w30070. doi:10.4414/smw.2021.w30070.
    Abstract: AIMS: To characterize a group of migrant emergency department (ED) patients regarding demographics, access to the ED, mode of referral, use of resources, and short-term outcomes, and to compare them to a group of local ED patients. METHODS: Prospective cohort study with consecutive enrollment of adult patients presenting to the ED of a Swiss tertiary care hospital from October 21st to November 11th, 2013 and February 1st to February 23rd, 2015. In accordance with the International Organization for Migration, we defined migrants as persons who have changed their country of usual residence, irrespective of their legal status. The primary outcome was defined as the number of resources allocated to migrants, as compared to local patients, using uni- and multivariable quasi-Poisson regressions. Acute morbidity, hospitalization, intensive care unit (ICU) admission, and 30-day mortality were assessed as secondary outcomes. RESULTS: Migrant patients were younger, more often male and self-presenters, and of lower acuity. After adjustment for age, gender and acuity, we observed a non-significant difference of 3.6% in the mean number of resources allocated to migrant patients as compared to local patients (adjusted RR 0.964, CI 0.923-1.006). No difference in 30-day mortality (adjusted OR 0.777, CI 0.346-1.559) was observed between the two patient groups, but migrant patients had lower odds of acute morbidity (adjusted OR 0.652, CI 0.560-0.759), hospitalization (adjusted OR 0.666, CI 0.555-0.799), and ICU admission (adjusted OR 0.649, CI 0.456-0.910). CONCLUSIONS: ED access approximation, resource allocation, and mortality were comparable between migrant patients and local patients. Lower admission rates to wards and the ICU may raise concerns but can be explained by lower acute morbidity in migrant patients.
    Tags: *Transients and Migrants, Adult, Emergency Service, Hospital, Hospitalization, Humans, Intensive Care Units, Male, Prospective Studies, Resource Allocation, Retrospective Studies.
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  • Fujii, T., Salanti, G., Belletti, A., Bellomo, R., Carr, A., Furukawa, T. A., Luethi, N., et al. “Effect Of Adjunctive Vitamin C, Glucocorticoids, And Vitamin B1 On Longer-Term Mortality In Adults With Sepsis Or Septic Shock: A Systematic Review And A Component Network Meta-Analysis”. Intensive Care Med 48, no. 1: 16-24. doi:10.1007/s00134-021-06558-0.
    Abstract: We aimed to compare the effects of vitamin C, glucocorticoids, vitamin B1, combinations of these drugs, and placebo or usual care on longer-term mortality in adults with sepsis or septic shock. MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and WHO-ICTRP were searched. The final search was carried out on September 3rd, 2021. Multiple reviewers independently selected randomized controlled trials (RCTs) comparing very-high-dose vitamin C (>/= 12 g/day), high-dose vitamin C (< 12, >/= 6 g/day), vitamin C (< 6 g/day), glucocorticoid (< 400 mg/day of hydrocortisone), vitamin B1, combinations of these drugs, and placebo/usual care. We performed random-effects network meta-analysis and, where applicable, a random-effects component network meta-analysis. We used the Confidence in Network Meta-Analysis framework to assess the degree of treatment effect certainty. The primary outcome was longer-term mortality (90-days to 1-year). Secondary outcomes were severity of organ dysfunction over 72 h, time to cessation of vasopressor therapy, and length of stay in intensive care unit (ICU). Forty-three RCTs (10,257 patients) were eligible. There were no significant differences in longer-term mortality between treatments and placebo/usual care or between treatments (10 RCTs, 7,096 patients, moderate to very-low-certainty). We did not find any evidence that vitamin C or B1 affect organ dysfunction or ICU length of stay. Adding glucocorticoid to other treatments shortened duration of vasopressor therapy (incremental mean difference, - 29.8 h [95% CI - 44.1 to - 15.5]) and ICU stay (incremental mean difference, - 1.3 days [95% CI - 2.2 to - 0.3]). Metabolic resuscitation with vitamin C, glucocorticoids, vitamin B1, or combinations of these drugs was not significantly associated with a decrease in longer-term mortality.
    Tags: *Sepsis, *Shock, Septic/drug therapy, Adult, Ascorbic Acid/therapeutic use, Glucocorticoids/therapeutic use, Humans, Hydrocortisone, Network meta-analysis, Sepsis, Systematic review, Thiamine, Thiamine/therapeutic use, Vitamin C.
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  • Nissen, S. K., Candel, B. G. J., Nickel, C. H., de Jonge, E., Ryg, J., Bogh, S. B., de Groot, B., and Brabrand, M. “The Impact Of Age On Predictive Performance Of National Early Warning Score At Arrival To Emergency Departments: Development And External Validation”. Ann Emerg Med 79, no. 4: 354-363. doi:10.1016/j.annemergmed.2021.09.434.
    Abstract: STUDY OBJECTIVE: To investigate how age affects the predictive performance of the National Early Warning Score (NEWS) at arrival to the emergency department (ED) regarding inhospital mortality and intensive care admission. METHODS: International multicenter retrospective cohorts from 2 Danish and 3 Dutch ED. Development cohort: 14,809 Danish patients aged >/=18 years with at least systolic blood pressure or pulse measured from the Danish Multicenter Cohort. External validation cohort: 50,448 Dutch patients aged >/=18 years with all vital signs measured from the Netherlands Emergency Department Evaluation Database (NEED). Multivariable logistic regression was used for model building. Performance was evaluated overall and within age categories: 18 to 64 years, 65 to 80 years, and more than 80 years. RESULTS: In the Danish Multicenter Cohort, a total of 2.5% died inhospital, and 2.8% were admitted to the ICU, compared with 2.8% and 1.6%, respectively, in the NEED. Age did not add information for the prediction of intensive care admission but was the strongest predictor for inhospital mortality. For NEWS alone, severe underestimation of risk was observed for persons above 80 while overall Area Under Receiver Operating Characteristic (AUROC) was 0.82 (confidence interval [CI] 0.80 to 0.84) in the Danish Multicenter Cohort versus 0.75 (CI 0.75 to 0.77) in the NEED. When combining NEWS with age, underestimation of risks was eliminated for persons above 80, and overall AUROC increased significantly to 0.86 (CI 0.85 to 0.88) in the Danish Multicenter Cohort versus 0.82 (CI 0.81 to 0.83) in the NEED. CONCLUSION: Combining NEWS with age improved the prediction performance regarding inhospital mortality, mostly for persons aged above 80, and can potentially improve decision policies at arrival to EDs.
    Tags: *Early Warning Score, Adolescent, Adult, Aged, Emergency Service, Hospital, Hospital Mortality, Humans, Intensive Care Units, Middle Aged, Retrospective Studies, ROC Curve, Young Adult.
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  • Magyar, C. T. J., Bednarski, P., Jakob, D. A., Schnuriger, B., and Swiss Trauma, Registry. “Severe Penetrating Trauma In Switzerland: First Analysis Of The Swiss Trauma Registry (Str)”. Eur J Trauma Emerg Surg 48, no. 5: 3837-3846. doi:10.1007/s00068-021-01822-w.
    Abstract: PURPOSE: The purpose of this study was to examine the epidemiology, demographics, injury characteristics and outcomes of patients who presented to Swiss trauma centers following severe penetrating trauma. METHODS: Swiss Trauma Registry (STR)-cohort analysis including patients with severe (ISS >/= 16 or AIS head >/= 3) penetrating trauma between 2017 and 2019. Primary outcome was mortality. Secondary outcomes were hospital and intensive care unit (ICU) length of stay (LOS), and prehospital times. RESULTS: During the 3-year study period, 134 (1.6% of entire STR) patients with severe penetrating trauma were identified [64 (48%) gunshot wounds (GSW), 70 (52%) stab wounds (SW)]. Median age was 40.5 (IQR 29.0-59.0) and 82.8% were male. Mortality rate was 50% for GSW; 9% for SW. Overall, prehospital time [incident to arrival emergency department (ED)] was 65 (IQR 45-94) minutes. The median number of patients admitted for a severe GSW/SW per center and year was 2 (range 0-14). Of 64 patients who sustained a GSW, 42 (65.6%) were self-inflicted. Mortality in self-inflicted GSW reached 66.7%, with the head being severely injured in 78.6%. The 67 patients with severe isolated torso GSW/SW had an ISS of 20 (IQR 16-26) and a mortality of 15%. Multivariable analysis identified severe chest trauma, ED Glasgow Coma Scale </= 8, age, self-infliction, massive blood transfusion and ISS as independent predictors for mortality. CONCLUSION: Severe penetrating trauma is very rare in Switzerland. Mortality ranges from 9% in SW to 67% in self-inflicted GSW. Particularly in the setting of GSW/SW to the torso, reduction in prehospital time may further improve patient outcomes.
    Tags: *Wounds, Gunshot/epidemiology, *Wounds, Penetrating/epidemiology/therapy, *Wounds, Stab/epidemiology, Adult, Female, Gunshot wound, Humans, Injury Severity Score, Male, Mortality, Penetrating trauma, Prehospital, Registries, Retrospective Studies, Stab wound, Swiss Trauma Registry, Switzerland/epidemiology, Trauma Centers.
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  • Wohlfarth, B., Gloor, B., and Hautz, W. E. “Challenges Of Students And Residents Of Human Medicine In The First Four Months Of The Fight Against The Covid-19 Pandemic - Implications For Future Waves And Scenarios”. Bmc Med Educ 21, no. 1: 554. doi:10.1186/s12909-021-02962-8.
    Abstract: INTRODUCTION: In the fight against the Covid-19 pandemic, medical students and residents are expected to adapt and contribute in a healthcare environment characterized by ever-changing measures and policies. The aim of this narrative review is to provide a summary of the literature that addresses the challenges of students and residents of human medicine in the first 4 months of the fight against the Covid-19 pandemic in order to identify gaps and find implications for improvement within the current situation and for potential future scenarios. METHODS: We performed a systematic literature search and content analysis (CA) of articles available in English language that address the challenges of students and residents of human medicine in the first 4 months of the fight against the Covid-19 pandemic. RESULTS: We retrieved 82 articles from a wide range of journals, professional backgrounds and countries. CA identified five recurring subgroup topics: "faculty preparation", <<uncertainties and mental health>>, <<clinical knowledge>>, <<rights and obligations>> and <<(self-) support and supply>>. Within these subgroups the main concerns of (re-)deployment, interruption of training and career, safety issues, transmission of disease, and restricted social interaction were identified as potential stressors that hold a risk for fatigue, loss of morale and burnout. DISCUSSION: Students and residents are willing and able to participate in the fight against Covid-19 when provided with appropriate deployment, legal guidance, safety measures, clinical knowledge, thorough supervision, social integration and mental health support. Preceding interviews to decide on reasonable voluntary deployment, the use of new technology and frequent feedback communication with faculties, educators and policymakers can further help with a successful and sustainable integration of students and residents in the fight against the pandemic. CONCLUSION: It is critical that faculties, educators and policymakers have a thorough understanding of the needs and concerns of medical trainees during pandemic times. Leaders should facilitate close communication with students and residents, value their intrinsic creativeness and regularly evaluate their needs in regards to deployment, knowledge aspects, safety measures, legal concerns and overall well-being.
    Tags: *covid-19, *Students, Medical, Delivery of Health Care, Humans, Pandemics/prevention & control, SARS-CoV-2.
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  • Simma, L., Stocker, M., Lehner, M., Wehrli, L., and Righini-Grunder, F. “Critically Ill Children In A Swiss Pediatric Emergency Department With An Interdisciplinary Approach: A Prospective Cohort Study”. Front Pediatr 9: 721646. doi:10.3389/fped.2021.721646.
    Abstract: Objective: Delivery of prompt and adequate care for critically ill and injured children presenting to the pediatric emergency department (PED) is paramount for optimal outcomes. Knowledge of the local epidemiology, patient profile, and presentation modes are key for organizational planning, staff education strategy, and optimal care in a PED. Our aim was to analyze the profile of critically ill and injured children admitted to a tertiary, non-academic Swiss PED, to investigate potential risk factors associated with admission to the pediatric intensive care unit (PICU), and the outcomes mortality and PICU admission. Methods: Prospective cohort study of critically ill and injured children presenting to the PED over a two-year period (2018-2019). Inclusion criteria were Australasian triage scale category (ATS) 1, trauma team activation (TTA), medical emergency response (MER) activation, additional critical care consult, and transfer to an outside hospital. Results: Of 42,579 visits during the two-year period, 347 presentations matched the inclusion criteria (0.81%). Leading presentations were central nervous system (CNS) disorders (26.2%), trauma (25.1%), and respiratory emergencies (24.2%). 288 out of 347 cases (83%) arrived during the day or evening with an even distribution over the days of the week. 128 out of 347 (37%) arrived unexpectedly as walk-ins. 233 (67.15%) were ATS category 1. 51% of the cohort was admitted to PICU. Australasian triage scale category 1 was significantly more common in this group (p = 0.0001). Infants with respiratory disease had an increased risk of PICU transfer compared to other age groups (OR 4.18 [95%CI 2.46, 7.09] p = 0.0001), and this age group presented mainly as walk-in (p = 0.0001). Pediatric intensive care unit admissions had a longer hospital stay (4 [2, 8] days vs. 2 [1, 4] days, p = 0.0001) compared to other patients. 0.045% of all PED patients had to be transferred out. Three deaths (0.86%) occurred in the PED, 10 patients died in the PICU (2.9%). Conclusions: High acuity presentations in the PED were rare, more likely to be young with CNS disorders, trauma and respiratory diseases. A significant proportion were unexpected walk-in presentations, mainly during day and evening shifts. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED.
    Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., critical care, critical ill children, emergency care, emergency service, pediatric intensive care unit, pediatrics-children, resuscitation, Switzerland/epidemiology.
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  • Ehrler, F., Tuor, C., Rey, R., and Siebert, J. N. “A Mobile App To Improve Patient Management In Emergency Departments: Caregiver Needs Analysis, Design And Early Technology Acceptance Assessment”. In, 285:233-238, 2021. doi:10.3233/SHTI210605.
    Abstract: Emergency care is very complex in that it requires patient-centered care in a coordinated manner among multiple providers in a highly distractible, unpredictable and stressful environment. Sharing information efficiently between providers in this context is difficult. Connecting emergency providers with each other through a digital communication channel could improve the efficiency of information sharing and emergency care. This study describes the development process of PIMPmyHospital, a mobile app dedicated to emergency department physicians and nurses to collaboratively manage their patients. We relied on a user-centered design process involving caregivers from a pediatric emergency department. The process started with semi-structured interviews that informed the specifications of the app, followed by an iterative design and development approach. The resulting prototype was evaluated by end-users using the perceived usefulness dimension of the technology acceptance model questionnaire. Early user engagement during the design and development of a dedicated mobile app must be taken into account to improve its perceived usefulness and future adoption. © 2021 The authors and IOS Press.
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  • Cvetkovic, D., Schiffmann Maag, A., Bischof, P., Fischer, T., Fischer, M., and Minotti, B. “Construction Worker With Painful Swelling On The Hand”. Ann Emerg Med 78, no. 5: 686-696. doi:10.1016/j.annemergmed.2021.05.033.
    Tags: *Construction Industry, Adult, Arteriovenous Malformations/*diagnostic imaging/surgery, Computed Tomography Angiography, Edema/*diagnostic imaging/surgery, Hand/*diagnostic imaging/surgery, Humans, Radial Artery/*abnormalities/*diagnostic imaging/surgery.
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  • Paioni, P., Jaggi, V. F., Tilen, R., Seiler, M., Baumann, P., Bram, D. S., Jetzer, C., et al. “Gentamicin Population Pharmacokinetics In Pediatric Patients-A Prospective Study With Data Analysis Using The Saemix Package In R”. Pharmaceutics 13, no. 10. doi:10.3390/pharmaceutics13101596.
    Abstract: The aminoglycoside gentamicin is used for the empirical treatment of pediatric infections. It has a narrow therapeutic window. In this prospective study at University Children's Hospital Zurich, Switzerland, we aimed to characterize the pharmacokinetics of gentamicin in pediatric patients and predict plasma concentrations at typical recommended doses. We recruited 109 patients aged from 1 day to 14 years, receiving gentamicin (7.5 mg/kg at age >/= 7 d or 5 mg/kg). Plasma levels were determined 30 min, 4 h and 24 h after the infusion was stopped and then transferred, together with patient data, to the secure BioMedIT node Leonhard Med. Population pharmacokinetic modeling was performed with the open-source R package saemix on the SwissPK(cdw) platform in Leonhard Med. Data followed a two-compartment model. Bodyweight, plasma creatinine and urea were identified as covariates for clearance, with bodyweight as a covariate for central and peripheral volumes of distribution. Simulations with 7.5 mg/kg revealed a 95% CI of 13.0-21.2 mg/L plasma concentration at 30 min after the stopping of a 30-min infusion. At 24 h, 95% of simulated plasma levels were <1.8 mg/L. Our study revealed that the recommended dosing is appropriate. It showed that population pharmacokinetic modeling using R provides high flexibility in a secure environment.
    Tags: design of the study, dosing regimen, gentamicin, in, in the collection, analyses, or interpretation of data, non-linear mixed-effects modeling, open-source, population pharmacokinetics, R-project, saemix, the writing of the manuscript, or in the decision to publish the results..
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  • Kottmann, A., Kruger, A. J., Sunde, G. A., Roislien, J., Heltne, J. K., Carron, P. N., Lockey, D., and Sollid, S. J. M. “Establishing Quality Indicators For Pre-Hospital Advanced Airway Management: A Modified Nominal Group Technique Consensus Process”. Br J Anaesth 128, no. 2: e143-e150. doi:10.1016/j.bja.2021.08.031.
    Abstract: BACKGROUND: Pre-hospital advanced airway management is a complex intervention composed of numerous steps, interactions, and variables that can be delivered to a high standard in the pre-hospital setting. Standard research methods have struggled to evaluate this complex intervention because of considerable heterogeneity in patients, providers, and techniques. In this study, we aimed to develop a set of quality indicators to evaluate pre-hospital advanced airway management. METHODS: We used a modified nominal group technique consensus process comprising three email rounds and a consensus meeting among a group of 16 international experts. The final set of quality indicators was assessed for usability according to the National Quality Forum Measure Evaluation Criteria. RESULTS: Seventy-seven possible quality indicators were identified through a narrative literature review with a further 49 proposed by panel experts. A final set of 17 final quality indicators composed of three structure-, nine process-, and five outcome-related indicators, was identified through the consensus process. The quality indicators cover all steps of pre-hospital advanced airway management from preoxygenation and use of rapid sequence induction to the ventilatory state of the patient at hospital delivery, prior intubation experience of provider, success rates and complications. CONCLUSIONS: We identified a set of quality indicators for pre-hospital advanced airway management that represent a practical tool to measure, report, analyse, and monitor quality and performance of this complex intervention.
    Tags: *Quality Indicators, Health Care, airway management, Airway Management/*methods/standards, Consensus, critical care, Emergency Medical Services/*methods/standards, emergency medicine, Humans, intubation, Intubation, Intratracheal/*methods/standards, pre-hospital, quality improvement, quality indicator.
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  • Jauslin, A. S., Kellett, J., Brabrand, M., Simon, N. R., Rueegg, M., Twerenbold, R., Osswald, S., et al. “D-Dimer Levels For Risk Stratification In Patients With Suspected Covid-19 - A Prospective Observational Study”. Acute Med 20, no. 3: 193-203. doi:10.52964/AMJA.0864.
    Abstract: BACKGROUND: Elevated D-dimer levels have been observed in COVID-19 and are of prognostic value, but have not been compared to an appropriate control group. METHODS: Observational cohort study including emergency patients with suspected or confirmed COVID-19. Logistic regression defined the association of D-dimer levels, COVID-19 positivity, age, and gender with 30-day-mortality. RESULTS: 953 consecutive patients (median age 58, 43% women) presented with suspected COVID-19: 12 (7.4%) patients with confirmed SARS-CoV-2-infection died, compared with 28 (3.5%) patients without SARS-CoV-2-infection. Overall, most (56%) patients had elevated D-dimer levels (>/=0.5mg/l). Age (OR 1.07, CI 1.05-1.10), D-dimer levels >/=0.5mg/l (OR 2.44, CI 0.98-7.39), and COVID-19 (OR 2.79, CI 1.28-5.80) were associated with 30-day-mortality. CONCLUSION: D-dimer levels are effective prognosticators in both patient groups.
    Tags: *covid-19, Female, Fibrin Fibrinogen Degradation Products, Humans, Male, Middle Aged, Risk Assessment, SARS-CoV-2.
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  • Loretz, N., Becker, C., Hochstrasser, S., Metzger, K., Beck, K., Mueller, J., Gross, S., et al. “Activation Of The Kynurenine Pathway Predicts Mortality And Neurological Outcome In Cardiac Arrest Patients: A Validation Study”. J Crit Care 67: 57-65. doi:10.1016/j.jcrc.2021.09.025.
    Abstract: PURPOSE: Activation of the kynurenine pathway (KP) has been shown to predict outcome in cardiac arrest (CA) patients. We validated these findings in a Swiss cohort. METHODS: We measured admission tryptophan and kynurenine levels in 270 consecutive CA patients (38 in-hospital CA) and investigated associations with in-hospital mortality and neurological outcome at hospital discharge. RESULTS: 120 of 270 (44%) patients died in the hospital. Compared to survivors, non-survivors showed higher median initial kynurenine levels (5.28 mumol/l [IQR 2.91 to 7.40] vs 3.58 mumol/l [IQR 2.47 to 5.46]; p < 0.001) and a higher median kynurenine/tryptophan ratio (0.10 mumol/l [IQR 0.07 to 0.17] vs 0.07 mumol/l [IQR 0.05 to 0.1]; p < 0.001). In a model adjusted for age, gender and comorbidities, kynurenine (OR 1.16, 95% CI 1.05 to 1.27; p = 0.001) and kynurenine/tryptophan ratio (OR 1.19, 95% CI 1.08 to 1.31; p = 0.003) were significantly associated with mortality. Results were similar for neurological outcome. CONCLUSIONS: Our findings validate a previous study and show associations of the activation of the KP with unfavorable outcomes after CA. Future studies should evaluate whether therapeutic modulation of the KP may impact clinical outcomes after CA.
    Tags: *Heart Arrest/therapy, *Kynurenine/metabolism, Cardiac arrest, Cohort Studies, Hospital Mortality, Humans, Intensive care medicine, Kynurenine, Post-cardiac arrest syndrome, Prognostication, Tryptophan.
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  • Hautz, W. E., Kundig, M. M., Tschanz, R., Birrenbach, T., Schuster, A., Burkle, T., Hautz, S. C., Sauter, T. C., and Krummrey, G. “Automated Identification Of Diagnostic Labelling Errors In Medicine”. Diagnosis (Berl) 9, no. 2: 241-249. doi:10.1515/dx-2021-0039.
    Abstract: OBJECTIVES: Identification of diagnostic error is complex and mostly relies on expert ratings, a severely limited procedure. We developed a system that allows to automatically identify diagnostic labelling error from diagnoses coded according to the international classification of diseases (ICD), often available as routine health care data. METHODS: The system developed (index test) was validated against rater based classifications taken from three previous studies of diagnostic labeling error (reference standard). The system compares pairs of diagnoses through calculation of their distance within the ICD taxonomy. Calculation is based on four different algorithms. To assess the concordance between index test and reference standard, we calculated the area under the receiver operating characteristics curve (AUROC) and corresponding confidence intervals. Analysis were conducted overall and separately per algorithm and type of available dataset. RESULTS: Diagnoses of 1,127 cases were analyzed. Raters previously classified 24.58% of cases as diagnostic labelling errors (ranging from 12.3 to 87.2% in the three datasets). AUROC ranged between 0.821 and 0.837 overall, depending on the algorithm used to calculate the index test (95% CIs ranging from 0.8 to 0.86). Analyzed per type of dataset separately, the highest AUROC was 0.924 (95% CI 0.887-0.962). CONCLUSIONS: The trigger system to automatically identify diagnostic labeling error from routine health care data performs excellent, and is unaffected by the reference standards' limitations. It is however only applicable to cases with pairs of diagnoses, of which one must be more accurate or otherwise superior than the other, reflecting a prevalent definition of a diagnostic labeling error.
    Tags: *Algorithms, all outside the submitted work. WEH has provided paid consultancies to AO, decision support, diagnostic error, Diagnostic Errors/prevention & control, foundation Switzerland, MDI International Australia, outside the submitted work., Humans, Isabel Healthcare UK, Mundipharma Medical Switzerland, VisualDx USA, all outside, Mundipharma Research UK, MDI International Australia, Roche Diagnostics Germany,, quality improvement, the submitted work., the Swiss National Science foundation, Zoll foundation, Drager Medical Germany,, WEH has received financial support for a congress he chaired from EBSCO Germany,.
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  • Papaefthymiou, A., Doulberis, M., Karafyllidou, K., Chatzimichael, E., Deretzi, G., Exadaktylos, A. K., Sampsonas, F., et al. “Effect Of Spironolactone On Pharmacological Treatment Of Nonalcoholic Fatty Liver Disease”. Minerva Endocrinol (Torino) 48, no. 3: 346-359. doi:10.23736/S2724-6507.21.03564-8.
    Abstract: Nonalcoholic fatty liver disease (NAFLD) was recently renamed to metabolic (dysfunction)-associated fatty liver disease (MAFLD) to better characterize its pathogenic origin. NAFLD represents, at least in western societies, a potential epidemic with raising prevalence. Its multifactorial pathogenesis is partially unraveled and till now there is no approved pharmacotherapy for NAFLD. A plethora of various choices are investigated in clinical trials, targeting an arsenal of different pathways and molecules. Since the mineralocorticoid receptor (MR) and renin-angiotensin-aldosterone system (RAAS) appear to be implicated in NAFLD, within this concise review, we focus on a rather classical and inexpensive pharmacological agent, spironolactone. We present the current lines of evidence of MR and RAAS-related preclinical models and human trials reporting an association with NAFLD. In conclusion, evidence about spironolactone of RAAS is commented, as potential future pharmacological management of NAFLD.
    Tags: *Non-alcoholic Fatty Liver Disease/drug therapy/epidemiology/metabolism, *Spironolactone/therapeutic use/pharmacology, Humans, Mineralocorticoid Receptor Antagonists/therapeutic use/pharmacology, Renin-Angiotensin System.
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  • Siegrist, V., Mata, R., Langewitz, W., Gerger, H., Furger, S., Hertwig, R., and Bingisser, R. “Does Information Structuring Improve Recall Of Discharge Information? A Cluster Randomized Clinical Trial”. Plos One 16, no. 10: e0257656. doi:10.1371/journal.pone.0257656.
    Abstract: OBJECTIVES: The impact of the quality of discharge communication between physicians and their patients is critical on patients' health outcomes. Nevertheless, low recall of information given to patients at discharge from emergency departments (EDs) is a well-documented problem. Therefore, we investigated the outcomes and related benefits of two different communication strategies: Physicians were instructed to either use empathy (E) or information structuring (S) skills hypothesizing superior recall by patients in the S group. METHODS: For the direct comparison of two communication strategies at discharge, physicians were cluster-randomized to an E or a S skills training. Feasibility was measured by training completion rates. Outcomes were measured in patients immediately after discharge, after 7, and 30 days. Primary outcome was patients' immediate recall of discharge information. Secondary outcomes were feasibility of training implementation, patients' adherence to recommendations and satisfaction, as well as the patient-physician relationship. RESULTS: Of 117 eligible physicians, 80 (68.4%) completed the training. Out of 256 patients randomized to one of the two training groups (E: 146 and S: 119) 196 completed the post-discharge assessment. Patients' immediate recall of discharge information was superior in patients in the S-group vs. E-group. Patients in the S-group adhered to more recommendations within 30 days (p = .002), and were more likely to recommend the physician to family and friends (p = .021). No differences were found on other assessed outcome domains. CONCLUSIONS AND PRACTICE IMPLICATIONS: Immediate recall and subsequent adherence to recommendations were higher in the S group. Feasibility was shown by a 69.6% completion rate of trainings. Thus, trainings of discharge information structuring are feasible and improve patients' recall, and may therefore improve quality of care in the ED.
    Tags: *Communication, *Physician-Patient Relations, Abdominal Pain/epidemiology/therapy, Adult, Aftercare/standards, Emergency Service, Hospital/*standards, Female, Humans, Male, Mental Recall/physiology, Middle Aged, Patient Discharge/*standards, Patient Satisfaction/statistics & numerical data, Randomized Controlled Trials as Topic.
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  • Schuetz, P., Seres, D., Lobo, D. N., Gomes, F., Kaegi-Braun, N., and Stanga, Z. “Management Of Disease-Related Malnutrition For Patients Being Treated In Hospital”. Lancet 398, no. 10314: 1927-1938. doi:10.1016/S0140-6736(21)01451-3.
    Abstract: Disease-related malnutrition in adult patients who have been admitted to hospital is a syndrome associated with substantially increased morbidity, disability, short-term and long-term mortality, impaired recovery from illness, and cost of care. There is uncertainty regarding optimal diagnostic criteria, definitions for malnutrition, and how to identify patients who would benefit from nutritional intervention. Malnutrition has become the focus of research aimed at translating current knowledge of its pathophysiology into improved diagnosis and treatment. Researchers are particularly interested in developing nutritional interventions that reverse the negative effects of disease-related malnutrition in the hospital setting. High-quality randomised trials have provided evidence that nutritional therapy can reduce morbidity and other complications associated with malnutrition in some patients. Screening of patients for risk of malnutrition at hospital admission, followed by nutritional assessment and individualised nutritional interventions for malnourished patients, should become part of routine clinical care and multimodal treatment in hospitals worldwide.
    Tags: (1410.000.058 and 1410.000.044), Nestle Health Science, and Abbott Nutrition. ZS, *Nutrition Assessment, Adult, B Braun., Foundation (PP00P3_150531), the Research Committee of the Kantonsspital Aarau, Hospitalization, Humans, Malnutrition/*diagnosis/*diet therapy, Nutrition Therapy/*methods, reports grants from Nestle Health Science, Abbott Nutrition, Fresenius Kabi, and.
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  • Ziaka, M., and Exadaktylos, A. “Brain-Lung Interactions And Mechanical Ventilation In Patients With Isolated Brain Injury”. Crit Care 25, no. 1: 358. doi:10.1186/s13054-021-03778-0.
    Abstract: During the last decade, experimental and clinical studies have demonstrated that isolated acute brain injury (ABI) may cause severe dysfunction of peripheral extracranial organs and systems. Of all potential target organs and systems, the lung appears to be the most vulnerable to damage after brain injury (BI). The pathophysiology of these brain-lung interactions are complex and involve neurogenic pulmonary oedema, inflammation, neurodegeneration, neurotransmitters, immune suppression and dysfunction of the autonomic system. The systemic effects of inflammatory mediators in patients with BI create a systemic inflammatory environment that makes extracranial organs vulnerable to secondary procedures that enhance inflammation, such as mechanical ventilation (MV), surgery and infections. Indeed, previous studies have shown that in the presence of a systemic inflammatory environment, specific neurointensive care interventions-such as MV-may significantly contribute to the development of lung injury, regardless of the underlying mechanisms. Although current knowledge supports protective ventilation in patients with BI, it must be born in mind that ABI-related lung injury has distinct mechanisms that involve complex interactions between the brain and lungs. In this context, the role of extracerebral pathophysiology, especially in the lungs, has often been overlooked, as most physicians focus on intracranial injury and cerebral dysfunction. The present review aims to fill this gap by describing the pathophysiology of complications due to lung injuries in patients with a single ABI, and discusses the possible impact of MV in neurocritical care patients with normal lungs.
    Tags: *Brain Injuries/physiopathology/therapy, *Respiration, Artificial, Acute respiratory distress syndrome, Brain damage, Brain-lung interactions, Brain/physiology, Humans, Inflammation, Lung/physiology, Mechanical ventilation, Ventilator induced lung injury.
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  • Kummer, M., Muller, T., Exadaktylos, A. K., Krahenbuhl, S., and Liakoni, E. “Characteristics Of Presentations To The Emergency Department Following Attempted Suicide With Drugs”. Int J Environ Res Public Health 18, no. 19. doi:10.3390/ijerph181910232.
    Abstract: A relatively high proportion of attempted suicides employ self-poisoning with medication. Data from emergency department presentations can help to identify possible risk drug classes and provide a basis for preventive measures. This retrospective analysis included cases presenting at the emergency department of the University Hospital of Bern, Switzerland, from May 2012 to August 2016, after attempted suicide with drugs. We excluded attempted suicides with only alcohol or other non-medical substances. During the study period, there were 488 cases (466 patients) of attempted suicide with medical substances. The median patient age was 33 years (range 16-93) and 354 (73%) cases were female. The most commonly involved substances/drug classes were benzo-diazepines (n = 167, 34%), neuroleptics (n = 114, 23%) and paracetamol (n = 111, 23%). A total of 231 (47%) cases employed only a single substance. Common symptoms included somnolence (n = 245, 50%), tachycardia (n = 119, 24%) and nausea/vomiting (n = 76, 16%). In most cases, the poisoning was of minor severity (n = 231, 47%) and the patients were admitted to a psychiatric hospital (n = 264, 54%). Important preventive measures may include careful monitoring for suicidal behaviour when prescribing psychotropic drugs, in addition to restrictions in pack size. Efforts should also be made to enhance the awareness of health professionals qualified to prescribe or supply paracetamol.
    Tags: *Pharmaceutical Preparations, *Poisoning, Adolescent, Adult, Aged, Aged, 80 and over, article., drug poisoning, emergency department, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Psychotropic Drugs/adverse effects, Retrospective Studies, suicidal attempt, suicide, Suicide, Attempted, Young Adult.
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  • Wallner, B., Giesbrecht, G., Pasquier, M., Gordon, L., Lechner, R., Brugger, H., Paal, P., Darocha, T., and Zafren, K. “Resuscitation Of An Unconscious Victim Of Accidental Hypothermia In 1805”. Wilderness Environ Med 32, no. 4: 548-553. doi:10.1016/j.wem.2021.08.007.
    Abstract: In 1805, W.D., a 16-y-old boy, became hypothermic after he was left alone on a grounded boat in Leith Harbour, near Edinburgh, Scotland. He was brought to his own house and resuscitated with warm blankets, smelling salts, and massage by Dr. George Kellie. W.D. made an uneventful recovery. We discuss the pathophysiology and treatment of accidental hypothermia, contrasting treatment in 1805 with treatment today. W.D. was hypothermic when found by passersby. Although he appeared dead, he was rewarmed with help from Dr. Kellie and his assistants over 200 y ago using simple methods. One concept that has not changed is the critical importance of attempting resuscitation, even if it seems to be futile. Don't give up!
    Tags: *Hypothermia/therapy, emergencies, Humans, Male, prehospital, Resuscitation, Rewarming, Scotland, unconsciousness.
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  • Birrenbach, T., Zbinden, J., Papagiannakis, G., Exadaktylos, A. K., Muller, M., Hautz, W. E., and Sauter, T. C. “Effectiveness And Utility Of Virtual Reality Simulation As An Educational Tool For Safe Performance Of Covid-19 Diagnostics: Prospective, Randomized Pilot Trial”. Jmir Serious Games 9, no. 4: e29586. doi:10.2196/29586.
    Abstract: BACKGROUND: Although the proper use of hygiene and personal protective equipment (PPE) is paramount for preventing the spread of diseases such as COVID-19, health care personnel have been shown to use incorrect techniques for donning/doffing of PPE and hand hygiene, leading to a large number of infections among health professionals. Education and training are difficult owing to the social distancing restrictions in place, shortages of PPE and testing material, and lack of evidence on optimal training. Virtual reality (VR) simulation can offer a multisensory, 3-D, fully immersive, and safe training opportunity that addresses these obstacles. OBJECTIVE: The aim of this study is to explore the short- and long-term effectiveness of a fully immersive VR simulation versus a traditional learning method regarding a COVID-19-related skill set and media-specific variables influencing training outcomes. METHODS: This was a prospective, randomized controlled pilot study on medical students (N=29; intervention VR training, n=15, vs control video-based instruction, n=14) to compare the performance of hand disinfection, nasopharyngeal swab taking, and donning/doffing of PPE before and after training and 1 month later as well as variables of media use. RESULTS: Both groups performed significantly better after training, with the effect sustained over one month. After training, the VR group performed significantly better in taking a nasopharyngeal swab, scoring a median of 14 out of 17 points (IQR 13-15) versus 12 out of 17 points (IQR 11-14) in the control group, P=.03. With good immersion and tolerability of the VR simulation, satisfaction was significantly higher in the VR group compared to the control group (median score of User Satisfaction Evaluation Questionnaire 27/30, IQR 23-28, vs 22/30, IQR 20-24, in the control group; P=.01). CONCLUSIONS: VR simulation was at least as effective as traditional learning methods in training medical students while providing benefits regarding user satisfaction. These results add to the growing body of evidence that VR is a useful tool for acquiring simple and complex clinical skills.
    Tags: "Mixed-method evaluation of an online forward triage tool within the COVID-19, company had no influence on the study protocol, the analysis, the results, or the, consultancies to AO Foundation Switzerland, outside the submitted work. WEH, Covid-19, decision to publish. This study was funded in part by a grant from the Swiss, diagnostic, Diagnostics Germany, all outside the submitted work. WEH has provided paid, effectiveness, Germany, Mundipharma Research UK, MDI International Australia, and Roche, hand hygiene, Healthcare UK, Mundipharma Medical Switzerland, and VisualDx USA, all outside the, medical education, nasopharyngeal swab, National Science foundation (grant number 31CA30_196615) for the project, Officer of ORamaVR, the company that developed the software for this study. The, pandemic" to TCS and WEH. The other authors report no conflict of interest., particular on the results or the decision to publish. GP is Chief Technical, pilot study, Ppe, protection, received financial support for a congress he chaired from EBSCO Germany, Isabel, simulation, submitted work. TCS holds an endowed professorship supported by the Touring Club, Switzerland. The sponsor has no influence on the research conducted, in, testing, the Swiss National Science Foundation, the Zoll Foundation, Drager Medical, utility, virtual reality, Vr.
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  • Lacour, M., Bloudeau, L., Combescure, C., Haddad, K., Hugon, F., Suppan, L., Rodieux, F., et al. “Impact Of A Mobile App On Paramedics' Perceived And Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within A Multicenter Randomized Controlled Trial”. Jmir Mhealth Uhealth 9, no. 10: e31748. doi:10.2196/31748.
    Abstract: BACKGROUND: Out-of-hospital cardiac arrests (OHCAs) are stressful, high-stake events that are associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services. Children are particularly vulnerable to such errors. To date, no app has been validated to specifically support emergency drug preparation by paramedics through reducing the stress level of this procedure and medication errors. OBJECTIVE: This study aims to determine the effectiveness of an evidence-based mobile app compared with that of the conventional preparation methods in reducing acute stress in paramedics at the psychological and physiological levels while safely preparing emergency drugs during simulated pediatric OHCA scenarios. METHODS: In a parent, multicenter, randomized controlled trial of 14 emergency medical services, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario in an 18-month-old child. The primary outcome was participants' self-reported psychological stress perceived during sequential preparations of 4 intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate) with the support of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory and Visual Analog Scale questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of the participants' heart rate with optical photoplethysmography. RESULTS: From September 3, 2019, to January 21, 2020, 150 advanced paramedics underwent randomization. A total of 74 participants were assigned to the mobile app (intervention group), and 76 did not use the app (control group). A total of 600 drug doses were prepared. Higher State-Trait Anxiety Inventory-perceived stress increase from baseline was observed during the scenario using the conventional methods (mean 35.4, SD 8.2 to mean 49.8, SD 13.2; a 41.3%, 35.0 increase) than when using the app (mean 36.1, SD 8.1 to mean 39.0, SD 8.4; a 12.3%, 29.0 increase). This revealed a 30.1% (95% CI 20.5%-39.8%; P<.001) lower relative change in stress response in participants who used the app. On the Visual Analog Scale questionnaire, participants in the control group reported a higher increase in stress at the peak of the scenario (mean 7.1, SD 1.8 vs mean 6.4, SD 1.9; difference: -0.8, 95% CI -1.3 to -0.2; P=.005). Increase in heart rate during the scenario and over the 4 drugs was not different between the 2 groups. CONCLUSIONS: Compared with the conventional method, dedicated mobile apps can reduce acute perceived stress during the preparation of emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. TRIAL REGISTRATION: ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-019-3726-4.
    Tags: *Cardiopulmonary Resuscitation, *Emergency Medical Services, *Mobile Applications, Allied Health Personnel, app. The app is currently commercially available on Google Play Store and App, cardiopulmonary resuscitation, Child, commercialization (ie, without personal enrichment). The authors declare no other, declare individual intellectual property rights on this app and, as employees of, drugs, Editors uniform disclosure form and declare no support from commercial entities, emergency medical services, Emergency Service, Hospital, entities that might have an interest in the submitted work in the previous 3, for the submitted work, and no financial relationships with any commercial, Geneva University Hospitals, indirect institutional rewarding through its, Humans, Infant, medication errors, mobile apps, mobile health, out-of-hospital cardiac arrest, paramedics, pediatrics, relationships or activities that could appear to have influenced the submitted, State-Trait Anxiety Inventory, Store (Apple) for research and educational purposes. JNS, CL, AG, FE, and SM, stress, work. All authors have completed the International Committee of Medical Journal, years..
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  • Calleja, N., AbdAllah, A., Abad, N., Ahmed, N., Albarracin, D., Altieri, E., Anoko, J. N., et al. “A Public Health Research Agenda For Managing Infodemics: Methods And Results Of The First Who Infodemiology Conference”. Jmir Infodemiology 1, no. 1: e30979. doi:10.2196/30979.
    Abstract: BACKGROUND: An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. OBJECTIVE: The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. METHODS: As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. RESULTS: The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. CONCLUSIONS: Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider.
    Tags: access to information, analytics and policy analysis. The center has supported Pan American Health, and BY are staff of the World Health Organization, are staff members of the European Centre for Disease Prevention and Control. RH, are staff members of the US Centers for Disease Control and Prevention, attitudes, beliefs, communications media, community resilience, Covid-19, data analysis for emergency preparedness and supported the work described in the, disinformation, educational grants/funding from Merck Canada, Pfizer Canada, Pfizer Global,, evidence synthesis, for which she is project co-primary investigator. This project is not related to, funding from Carlsberg Foundation for a research project about online hostility, Immunize Canada/Canadian Public Health Association, which has received, in this paper, and they do not represent the views of their organizations. BS, infodemic, infodemic management, infodemiology, information literacy, information-seeking behavior, internet, is staff of UNICEF. These authors alone are responsible for the views expressed, knowledge translation, LE and AW, message amplification, misinformation, Moderna Canada, Seqirus, Sanofi Canada, GSK Canada and the Public Health Agency, NA, AI, AK, SK, PP, DP, and EW, of Canada (PHAC). These funds are not related to the paper. AB has received, on information systems for health, which supports WHO with broader digital health, Organization (PAHO)/WHO with infodemic analytics during COVID-19. LMB works for, paper during his consultancy contract. IB is Director of WHO Collaborating Center, participated in the conference while being staff of WHO. SB consults for WHO in, research agenda, research policy, risk communication, SARS-CoV-2, the deliberation described in this publication..
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  • Lucke, J. A., Mooijaart, S. P., Conroy, S., Blomaard, L. C., De Groot, B., and Nickel, C. H. “Mortality Risk For Different Presenting Complaints Amongst Older Patients Assessed With The Manchester Triage System”. Eur Geriatr Med 13, no. 2: 323-328. doi:10.1007/s41999-021-00568-3.
    Abstract: PURPOSE: Older people often present to the Emergency Department with nonspecific complaints. We aimed (1) to examine characteristics of older patients presenting to the ED triaged with the presentational flowchart 'unwell adult' of the Manchester triage system (MTS) and (2) to assess the different mortality and admission rates among triage categories. METHODS: Retrospective cohort study including all consecutive patients aged 70 years and older who visited the ED of a tertiary care hospital in the Netherlands during a 1-year period. The primary outcome was 30-day mortality. Secondary outcomes were 7-day mortality, hospital admission and ED length of stay. RESULTS: 4255 patients were included in this study. Mean age was 78 years (IQR 73.9-83.4) and 2098 were male (49.3%). The MTS presentational flowchart 'unwell adult' was the most commonly used flowchart (n = 815, 19.3%). After the infrequent flowchart 'major trauma' (n = 9, 13.8%), 'unwell adult' had the highest 30-day mortality (n = 88, 10.8%). When compared to all other flowcharts, patients assigned as 'unwell adult' have significantly higher 30-day mortality rates (OR 1.89 (95%CI 1.46-2.46), p = < 0.001), also when adjusted for age, gender and triage priority (OR 1.75 (95%CI 1.32-2.31), p = < 0.001). Patients from the 'unwell adult' flowchart had the highest hospital admission rate (n = 540, 66.3%), and had among the longest ED length of stay. CONCLUSIONS: Older ED patients are most commonly assigned the presentational flowchart 'unwell adult' when using the MTS. Patients in this category have the highest non-trauma mortality and highest hospital admission rates when compared to other presenting complaints.
    Tags: *Emergency Service, Hospital, *Triage, Aged, Aged, 80 and over, Emergency department, Female, Hospitalization, Humans, Male, Manchester triage system, Mortality, Netherlands/epidemiology, Non-specific complaints, Older patients, Retrospective Studies, Triage.
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  • Mendrala, K., Kosinski, S., Podsiadlo, P., Pasquier, M., Paal, P., Mazur, P., and Darocha, T. “The Efficacy Of Renal Replacement Therapy For Rewarming Of Patients In Severe Accidental Hypothermia-Systematic Review Of The Literature”. Int J Environ Res Public Health 18, no. 18. doi:10.3390/ijerph18189638.
    Abstract: BACKGROUND: Renal replacement therapy (RRT) can be used to rewarm patients in deep hypothermia. However, there is still no clear evidence for the effectiveness of RRT in this group of patients. This systematic review aims to summarize the rewarming rates during RRT in patients in severe hypothermia, below or equal to 32 degrees C. METHODS: This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (identifier CRD42021232821). We searched Embase, Medline, and Cochrane databases using the keywords hypothermia, renal replacement therapy, hemodialysis, hemofiltration, hemodiafiltration, and their abbreviations. The search included only articles in English with no time limit, up until 30 June 2021. RESULTS: From the 795 revised articles, 18 studies including 21 patients, were selected for the final assessment and data extraction. The mean rate of rewarming calculated for all studies combined was 1.9 degrees C/h (95% CI 1.5-2.3) and did not differ between continuous (2.0 degrees C/h; 95% CI 0.9-3.0) and intermittent (1.9 degrees C/h; 95% CI 1.5-2.3) methods (p > 0.9). CONCLUSIONS: Based on the reviewed literature, it is currently not possible to provide high-quality recommendations for RRT use in specific groups of patients in accidental hypothermia. While RRT appears to be a viable rewarming strategy, the choice of rewarming method should always be determined by the specific clinical circumstances, the available resources, and the current resuscitation guidelines.
    Tags: *Hypothermia/therapy, Humans, hypothermia, Renal Dialysis, renal replacement therapy, Rewarming, Time Factors.
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  • Kottmann, A., Pasquier, M., Strapazzon, G., Zafren, K., Ellerton, J., and Paal, P. “Quality Indicators For Avalanche Victim Management And Rescue”. Int J Environ Res Public Health 18, no. 18. doi:10.3390/ijerph18189570.
    Abstract: Decisions in the management and rescue of avalanche victims are complex and must be made in difficult, sometimes dangerous, environments. Our goal was to identify indicators for quality measurement in the management and rescue of avalanche victims. The International Commission for Mountain Emergency Medicine (ICAR MedCom) convened a group of internal and external experts. We used brainstorming and a five-round modified nominal group technique to identify the most relevant quality indicators (QIs) according to the National Quality Forum Measure Evaluation Criteria. Using a consensus process, we identified a set of 23 QIs to measure the quality of the management and rescue of avalanche victims. These QIs may be a valuable tool for continuous quality improvement. They allow objective feedback to rescuers regarding clinical performance and identify areas that should be the foci of further quality improvement efforts in avalanche rescue.
    Tags: *Avalanches, *Emergency Medical Services, *Emergency Medicine, *Mountaineering, avalanche, consensus process, emergency medical services, emergency medicine, quality improvement, quality indicator, Quality Indicators, Health Care, rescue, Rescue Work, resuscitation.
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  • Hymczak, H., Podsiadlo, P., Kosinski, S., Pasquier, M., Mendrala, K., Hudziak, D., Gocol, R., Plicner, D., and Darocha, T. “Prognosis Of Hypothermic Patients Undergoing Ecls Rewarming-Do Alterations In Biochemical Parameters Matter?”. Int J Environ Res Public Health 18, no. 18. doi:10.3390/ijerph18189764.
    Abstract: BACKGROUND: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. METHODS: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients >/=18 years old who had a core temperature (Tc) < 30 degrees C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 degrees C, and at 2 and 4 h after Tc 30 degrees C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline. RESULTS: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 +/- 15 years old, and the mean Tc was 24.5 +/- 12.6 degrees C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased -2.42 +/- 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 degrees C, while in the non-survivors' group (p = 0.024), it increased 1.44 +/- 6.41 mmol/L. CONCLUSIONS: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 degrees C is also associated with a poor prognosis.
    Tags: *Extracorporeal Membrane Oxygenation, *Hypothermia, accidental hypothermia, Adolescent, Adult, Aged, Ecls, Humans, lactate, lactate kinetics, Lactic Acid, Middle Aged, Retrospective Studies, Rewarming.
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  • Brockhus, L. A., Bartsch, M., Exadaktylos, A. K., Keitel, K., Klukowska-Rotzler, J., and Muller, M. “Clinical Presentations Of Adolescents Aged 16-18 Years In The Adult Emergency Department”. Int J Environ Res Public Health 18, no. 18. doi:10.3390/ijerph18189578.
    Abstract: BACKGROUND: In many large hospitals in Switzerland, adolescents 16 years and older are treated in adult emergency departments (ED). There have been few publications about this specific patient population, especially in Switzerland. This study aims to provide an overview of emergency presentations of adolescents between 16-18 years of age when compared to adults and focuses on their principle complaints. METHODS: We conducted a single-centre, retrospective, cross-sectional study of all patients aged 16 years and older presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from 2013 to 2017. This analysis gives an overview of emergency presentations of adolescents between 16-18 years of age in this time period and compares their consultation characteristics to those of adult patients. RESULTS: Data of a total of 203,817 patients who presented to our adult ED between 2013 and 2017 were analysed. Adolescents account for 2.5% of all emergency presentations. The number of ED presentations in the reviewed time period rose for adults (+2368, 95% CI: 1695, 3041, p = 0.002 consultations more per year; +25% comparing 2013 with 2017), while adolescent presentations did not significantly increase (p = 0.420). In comparison to adult patients, adolescents presented significantly more often during the night (39.1% vs. 31.5%, p < 0.001), as walk-ins (54.2% vs. 44.9%, p < 0.001), or with less highly acute complaints at triage (21% vs. 31%, p < 0.001). They were more likely to be discharged (70.8% vs. 52.2%, p < 0.001). We found a significant association between the two age groups and principle complaints. In comparison to adults, trauma and psychiatric problems were significantly more common among adolescents. CONCLUSIONS: Our data showed that complaints in adolescent patients under 18 years of age significantly differ from those in older patients. The artificial age cut-off therefore puts this vulnerable population at risk of receiving inadequate diagnostic testing and treatment adapted only for adults. Additional studies are needed on the reasons adolescents and young adults seek ED care, as this could lead to improvements in the care processes for this vulnerable population.
    Tags: *Emergency Service, Hospital, Adolescent, adolescents 16-18 years, comparison adults and adolescents, Cross-Sectional Studies, ED presentation, Hospitals, University, Humans, Retrospective Studies, Triage.
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  • Meihandoest, T., Studt, J. D., Mendez, A., Alberio, L., Fontana, P., Wuillemin, W. A., Schmidt, A., et al. “Automated Thrombin Generation Assay For Rivaroxaban, Apixaban, And Edoxaban Measurements”. Front Cardiovasc Med 8: 717939. doi:10.3389/fcvm.2021.717939.
    Abstract: Background: The thrombin generation assay (TG) is a promising approach to measure the degree of anticoagulation in patients treated with direct oral anticoagulants (DOAC). A strong association with plasma drug concentrations would be a meaningful argument for the potential use to monitor DOAC. Objectives: We aimed to study the correlation of TG with rivaroxaban, apixaban, and edoxaban drug concentrations in a large, prospective multicenter cross-sectional study. Methods: Five-hundred and fifty-nine patients were included in nine tertiary hospitals. The Technothrombin(R) TG was conducted in addition to an anti-Xa assay; LC-MS/MS was performed as the reference standard. Results: Correlation (r(s)) between thrombin generation measurements and drug concentrations was -0.72 for peak thrombin generation (95% confidence interval, CI, -0.77, -0.66), -0.55 for area under the curve (AUC; 95% CI -0.61, -0.48), and 0.80 for lag time (95% CI 0.75, 0.84). In contrast, r(s) was 0.96 with results of the anti-Xa activity (95% CI 0.95-0.97). Sensitivity with regard to the clinically relevant cut-off value of 50 mugL(-1) was 49% in case of peak thrombin generation (95% CI, 44, 55), 29% in case of AUC (95% CI, 24, 34), and 64% in case of lag time (95% CI, 58, 69). Sensitivity of the anti-Xa assay was 95% (95% CI, 92, 97). Conclusions: The correlation of thrombin generation measurements with DOAC drug concentrations was weak, and clinically relevant drug levels were not predicted correctly. Our results do not support an application of TG in the monitoring of DOAC.
    Tags: analysis, the decision to publish, or manuscript preparation. MN reports research, analyzers, and technical expertise. The remaining authors declare that the, and advisory honoraria from Bayer Healthcare, Pfizer, Takeda, Siemens, and, anti-Xa assay, apixaban, CSL-Behring, Novartis, Novo Nordisk, Roche, Sobi, and Takeda. WW reports research, diagnostic accuracy, direct oral anticoagulants, edoxaban, from Alexion Pharma GmbH, all outside the submitted. J-DS reports lecture fees, from Bayer Healthcare, and Daiichi Sankyo. LA reports research grants from Bayer,, grants from Bayer Healthcare, BMS-Pfizer, Daiichi Sankyo and Sanofi, and, grants from Bayer Healthcare, outside of the submitted work, lecture honoraria, honoraria for participating in scientific advisory boards from Bayer, Pfizer, and, laboratory monitoring, relationships that could be construed as a potential conflict of interest., research was conducted in the absence of any commercial or financial, rivaroxaban, Sanofi. The study was supported by Technoclone, Vienna, Austria with reagents,, substances: Bayer Healthcare AG, Bristol-Myers Squibb, and Daiichi Sankyo,, Technoclone. These companies had no role in study design, data collection and, thrombin generation assay.
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  • Lindner, G., and Ryser, B. “The Syndrome Of Inappropriate Antidiuresis After Vaccination Against Covid-19: Case Report”. Bmc Infect Dis 21, no. 1: 1000. doi:10.1186/s12879-021-06690-8.
    Abstract: BACKGROUND: The Syndrome of Inappropriate Antidiuresis (SIADH) has been described to be associated with a multitude of conditions and medications, including the severe acute respiratory syndrome coronavirus 2. We describe the case of a patient with newly diagnosed and symptomatic SIADH after receiving the second COVID-19 vaccination not explained otherwise. CASE PRESENTATION: A 79-year-old male person was admitted to the emergency department due to a worsening of his general health state expressed by weakness, fatigue and anorexia. Vital signs and clinical findings were normal, in particular the patient was considered to be euvolemic. Laboratory investigations revealed a serum sodium of 117 mmol/L, a serum osmolality of 241 mosm/kg and a urea of 1.2 mmol/L with creatinine within normal range. Urine chemistry showed a urine osmolality of 412 mosm/kg and urine sodium of 110 mmol/L. TSH, C-reactive protein, and basal cortisol levels were normal. Under therapy with balanced crystalloid fluids, hyponatremia worsened and in absence of diuretic medications, diagnosis of SIADH was made. Since fluid restriction was not sufficiently effective, oral urea was administered. Under this therapy regimen hyponatremia resolved. CONCLUSIONS: Local as well as systemic reactions have been described for the new mRNA-based vaccines including pain and fever. Therefore, it is imaginable that the vaccine might trigger SIADH in some patients.
    Tags: *covid-19, *Hyponatremia/etiology, *Inappropriate ADH Syndrome/chemically induced, Aged, Case report, COVID-19 vaccination, COVID-19 Vaccines, Humans, Hyponatremia, Male, SARS-CoV-2, Siadh, Vaccination.
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  • Ambrosetti, J., Macheret, L., Folliet, A., Wullschleger, A., Amerio, A., Aguglia, A., Serafini, G., et al. “Psychiatric Emergency Admissions During And After Covid-19 Lockdown: Short-Term Impact And Long-Term Implications On Mental Health”. Bmc Psychiatry 21, no. 1: 465. doi:10.1186/s12888-021-03469-8.
    Abstract: BACKGROUND: The 'lockdown' measures, adopted to restrict population movements in order to help curb the novel coronavirus disease 2019 (COVID-19) pandemic, contributed to a global mental health crisis. Although several studies have extensively examined the impact of lockdown measures on the psychological well-being of the general population, little is known about long-term implications. This study aimed to identify changes in psychiatric emergency department (ED) admissions between two 8-week periods: during and immediately after lifting the lockdown. METHODS: Socio-demographic and clinical information on 1477 psychiatric ED consultations at the University Hospital of Geneva (HUG) were retrospectively analyzed. RESULTS: When grouped according to admission dates, contrary to what we expected, the post-lockdown group presented with more severe clinical conditions (as measured using an urgency degree index) compared to their lockdown counterparts. Notably, after the lockdown had been lifted we observed a statistically significant increase in suicidal behavior and psychomotor agitation and a decrease in behavior disorder diagnoses. Furthermore, more migrants arrived at the HUG ED after the lockdown measures had been lifted. Logistic regression analysis identified diagnoses of suicidal behavior, behavioral disorders, psychomotor agitation, migrant status, involuntary admission, and private resident discharge as predictors of post-lockdown admissions. CONCLUSIONS: Collectively, these findings can have implications concerning the prioritization of mental health care facilities and access for patients at risk of psychopathological decompensation in time of confinement policies, but above all, provide a foundation for future studies focusing on the long-term impact of the pandemic and its associated sanitary measures on mental health. TRIAL REGISTRATION: Research Ethics Committee of Geneva, Registration number 2020-01510, approval date: 29 June 2020.
    Tags: *covid-19, *Mental Health, Communicable Disease Control, Coronavirus, COVID-19 pandemic, Depression, Emergency department, Emergency Service, Hospital, Humans, Psychiatric admissions, Psychotic episode, Public mental health, Retrospective Studies, SARS-CoV-2, Substance use disorder, Suicidal behavior, Suicide.
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  • Villiger, K., Meier, M. K., Hasler, R. M., Bastian, J. D., Tannast, M., Exadaktylos, A. K., and Steppacher, S. D. “Demographic Changes In Pelvic Fracture Patterns At A Swiss Academic Trauma Center From 2007 To 2017”. J Trauma Acute Care Surg 92, no. 5: 862-872. doi:10.1097/TA.0000000000003398.
    Abstract: BACKGROUND: Increasing life expectancy has led to higher incidence of fragility fractures of the pelvis. These demographic changes may have a direct impact on fracture patterns. The goal of this study was (1) to evaluate demographical trends in patients with pelvic ring injuries at a tertiary Swiss trauma center and (2) to analyze the influence on fracture patterns. METHODS: We performed a retrospective cross-sectional study including 958 patients (mean +/- SD age, 57 +/- 21 years; 48% women) with a pelvic ring injury between 2007 and 2017. Fractures were classified according to Tile, Young and Burgess or Rommens and Hofmann (fragility fractures) using conventional and computer tomography imaging. Low-energy fractures were defined as fractures resulting from fall from standing height or less. Fracture classifications, age, sex, Injury Severity Score, and trauma mechanism were compared using analysis of variance or chi2 test. Cluster analysis was performed to identify groups with similarities in fracture patterns and demographic parameters. RESULTS: From 2007 to 2017, the frequency of pelvic ring injuries increased by 115% (increase per decade), and mean age increased by 15% (p = 0.031). A trimodal age distribution was found; highest increase for fractures occurred in the older (265%) patient group. Low-energy fracture was the most common trauma mechanism (43% of all fractures, an increase of 249%). Changes in fracture pattern showed a disproportioned increase of lateral compression (LC) fractures (LC type 1 in 64%) or partially stable fracture (B2, with 39%). In patient older than 65 years, the strongest increase was found for nondisplaced posterior fractures with an overall prevalence of 62%. Five clusters were found with the most frequent cluster representing older female patients with low-energy fracture (LC, Tile type B) in 30%. CONCLUSION: The current results corroborate the trend of increasing frequency of fragility fractures in an aging society. The demographic shift has a direct impact on fracture pattern with a disproportionate increase in partially stable compression fracture of the pelvis. LEVEL OF EVIDENCE: Prognostic/Epidemiologic, Level III.
    Tags: *Fractures, Bone/diagnostic imaging/epidemiology/etiology, *Trauma Centers, Adult, Aged, Cross-Sectional Studies, Ethnicity, Female, Humans, Male, Middle Aged, Retrospective Studies, Switzerland/epidemiology, Tomography, X-Ray Computed/adverse effects.
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  • Muller, M., Traschitzger, M., Nagler, M., Arampatzis, S., Exadaktylos, A. K., and Sauter, T. C. “Impaired Kidney Function At Ed Admission: A Comparison Of Bleeding Complications Of Patients With Different Oral Anticoagulants”. Bmc Emerg Med 21, no. 1: 105. doi:10.1186/s12873-021-00497-1.
    Abstract: BACKGROUND: Up to a fourth of patients at emergency department (ED) presentation suffer from acute deterioration of renal function, which is an important risk factor for bleeding events in patients on oral anticoagulation therapy. We hypothesized that outcomes of patients, bleeding characteristics, therapy, and outcome differ between direct oral anticoagulants (DOACs) and vitamin-K antagonists (VKAs). METHODS: All anticoagulated patients older than 17 years with an impaired kidney function treated for an acute haemorrhage in a large Swiss university ED from 01.06.2012 to 01.07.2017 were included in this retrospective cohort study. Patient, treatment, and bleeding characteristics as well as outcomes (length of stay ED, intensive care unit and in-hospital admission, ED resource consumption, in-hospital mortality) were compared between patients on DOAC or VKA anticoagulant. RESULTS: In total, 158 patients on DOAC and 419 patients on VKA with acute bleeding and impaired renal function were included. The renal function in patients on VKA was significantly worse compared to patients on DOAC (VKA: median 141 mumol/L vs. DOAC 132 mumol/L, p = 0.002). Patients on DOAC presented with a smaller number of intracranial bleeding compared to VKA (14.6% DOAC vs. 22.4% VKA, p = 0.036). DOAC patients needed more emergency endoscopies (15.8% DOAC vs, 9.1% VKA, p = 0.020) but less interventional emergency therapies to stop the bleeding (13.9% DOAC vs. 22.2% VKA, p = 0.027). Investigated outcomes did not differ significantly between the two groups. CONCLUSIONS: DOAC patients were found to have a smaller proportional incidence of intracranial bleedings, needed more emergency endoscopies but less often interventional therapy compared to patients on VKA. Adapted treatment algorithms are a potential target to improve care in patients with DOAC.
    Tags: *Anticoagulants/adverse effects, *Vitamin K/antagonists & inhibitors, Administration, Oral, Aged, Aged, 80 and over, Anticoagulants, Bangerter Rhyner Foundation. MN has received research grants or lecture fees from, Bayer, CSL Behring, Roche diagnostics, and Instrumentation Laboratory. AKE is, Bleeding, conflict of interest., Direct oral anticoagulants, Emergency Service, Hospital, Female, Foundation. MM has received a research grant from the Gottfried and Julia, Hemorrhage/*diagnosis, Humans, Ingelheim, and Daiichi-Sankyo as well as the Gottfried and Julia Bangerter Rhyner, Kidney function, Kidney Function Tests, Kidney/*physiopathology, Male, member of the advisory boards of all registered DOAC. MT and SA report no, Retrospective Studies, Vitamin-K antagonist.
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  • Bah, M., Abdulcadir, J., Tataru, C., Caillet, M., Hatem-Gantzer, G., and Maraux, B. “Postoperative Pain After Clitoral Reconstruction In Women With Female Genital Mutilation: An Evaluation Of Practices”. J Gynecol Obstet Hum Reprod 50, no. 10: 102230. doi:10.1016/j.jogoh.2021.102230.
    Abstract: INTRODUCTION: More than 200 million women and girls have undergone genital mutilation. Clitoral reconstruction (CR) can improve the quality of life of some of them, but is accompanied by significant postoperative pain. OBJECTIVE: Assess and describe the management of postoperative pain after CR, and the practices amongst specialists in different countries. METHODS: Between March and June 2020, 32 surgeons in 14 countries (Germany, Austria, Belgium, Burkina Faso, Canada, Ivory Coast, Egypt, Spain, United States of America, France, the Netherlands, Senegal, Switzerland, Sweden) responded to an online questionnaire on care and analgesic protocols for CR surgery. RESULTS: At day 7 post CR, 97% of the surgeons observed pain amongst their patients, which persisted up to 1 month for half of them. 22% of the participants reported feeling powerless in the management of such pain. The analgesic treatments offered are mainly step II and anti-inflammatory drugs (61%). Screening for neuropathic pain is rare (3%), as is the use of pudendal nerve block, used by 8% of the care providers and only for a small percentage of women. CONCLUSION: Pain after CR is frequent, long-lasting, and potentially an obstacle for the women who are willing to undergo clitoral surgery and also their surgeons. Most surgeons from different countries follow analgesic protocols that do not use the full available therapeutic possibilities. Early treatment of neuropathic pain, optimisation of dosing of standard analgesics, addition of opioids, use of acupuncture, and routine intraoperative use of pudendal nerve block might improve the management of pain after CR.
    Tags: Adult, Austria, Belgium, Burkina Faso, Canada, Circumcision, Female/methods, Clitoral reconstruction, Clitoris, Clitoris/drug effects/*injuries/physiopathology, Cote d'Ivoire, declare. This research did not receive any specific grant from funding agencies, Egypt, Female, Female genital cutting, Female genital mutilation, France, Germany, Humans, in the public, commercial, or not-for-profit sectors., Nerve Block/methods/*standards/statistics & numerical data, Netherlands, Pain, Postoperative/*drug therapy/physiopathology, Plastic Surgery Procedures/methods/standards/statistics & numerical data, Postoperative pain, Practice Guidelines as Topic, Pudendal Nerve/*drug effects/physiopathology, Reconstruction surgery, Senegal, Spain, Surveys and Questionnaires, Sweden, Switzerland, United States.
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  • Siebert, J. N., Glangetas, A., Grange, M., Haddad, K., Courvoisier, D. S., and Lacroix, L. “Impact Of Blended Learning On Manual Defibrillator's Use: A Simulation-Based Randomized Trial”. Nurs Crit Care 27, no. 4: 501-511. doi:10.1111/nicc.12713.
    Abstract: BACKGROUND: Blended learning, defined as the combination of traditional face-to-face instructor-led learning and e-learning course, has never been validated as a teaching method for the effective use of manual defibrillators in cardiopulmonary resuscitation. AIM: To evaluate whether paediatric emergency and critical care providers exposed to a blended learning session performed better and recalled more defibrillator skills than those exposed to face-to-face learning only. STUDY DESIGN: A two-period prospective, stratified, single-centre, simulation-based, randomized, controlled trial. METHODS: Registered nurses and postgraduate residents from either a paediatric emergency department or an intensive care unit were randomly assigned to a blended learning or face-to-face learning sessions on the recommended use of a manual defibrillator. Participants' adherence to recommendations was assessed by testing defibrillator skills in three consecutive paediatric cardiopulmonary scenarios performed on the day of the training and once again 2 months later. The primary endpoint was the number of errors observed during defibrillation, cardioversion, and transcutaneous pacing at the time of the initial intervention. RESULTS: Fifty participants were randomized to receive the intervention and 51 to the control group. When pooling all three procedures, the median total errors per participant was lower (2 [IQR: 1-4]) in providers exposed to blended learning than in those exposed to face-to-face learning only (3 [IQR: 2-5]; P = .06). The median of total errors per procedure was also lower. However, both training methods appeared insufficient to maintain appropriate skill retention over time as a repetition of procedures 2 months later without any refresher learning session yielded more errors in both groups. CONCLUSIONS: Learners exposed to blended learning showed a reduced number in the total amount of errors compared with those exposed to face-to-face learning alone, with waning of skills over time. RELEVANCE TO CLINICAL PRACTICE: Proficiently teaching the use of a manual defibrillator can be performed through blended learning.
    Tags: *Educational Measurement, *Learning, blended learning, Child, Clinical Competence, defibrillator, Defibrillators, education, educational technology, emergency medicine, Humans, nursing, paediatrics, Prospective Studies.
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  • Mueller, M., Ebrahimi, F., Christ, E., Nebiker, C. A., Schuetz, P., Mueller, B., and Kutz, A. “Safety Of Parathyroidectomy In Older Vs. Younger Patients With Primary Hyperparathyroidism”. Endocr Connect 10, no. 10: 1273-1282. doi:10.1530/EC-21-0363.
    Abstract: BACKGROUND: Primary hyperparathyroidism is a prevalent endocrinopathy for which surgery is the only curative option. Parathyroidectomy is primarily recommended in younger and symptomatic patients, while there are still concerns regarding surgical complications in older patients. We therefore assessed the association of age with surgical outcomes in patients undergoing parathyroidectomy in a large population in Switzerland. METHODS: Population-based cohort study of adult patients with primary hyperparathyroidism undergoing parathyroidectomy in Switzerland between 2012 and 2018. The cohort was divided into four age groups (<50 years, 50-64 years, 65-74 years, >/=75 years). The primary outcome was a composite of in-hospital postoperative complications. Secondary outcomes were intensive care unit (ICU) admission, unplanned 30-day-readmission, and prolonged length of hospital stay. RESULTS: We studied 2642 patients with a median (IQR) age of 62 (53-71) years. Overall, 111 patients had complications including surgical re-intervention, hypocalcemia, and vocal cord paresis. As compared to <50 year-old patients, older patients had no increased risk for in-hospital complications after surgery (50-64 years: odds ratio (OR): 0.51 (95% CI, 0.28 to 0.92); 65-74 years: OR: 0.72 (95% CI, 0.39 to 1.33); >/=75 years: OR: 1.03 (95% CI, 0.54 to 1.95), respectively. There was also no association of age and rates of ICU-admission and unplanned 30-day-readmission, but oldest patients had longer hospital stays (OR: 2.38 (95% CI, 1.57 to 3.60)). CONCLUSION: >/=50 year-old patients undergoing parathyroidectomy had comparable risk of in-hospital complications as compared with younger ones. These data support parathyroidectomy in even older patients with primary hyperparathyroidism as performed in clinical routine.
    Tags: age, older patients, outcome, parathyroidectomy, postoperative complications, primary hyperparathyroidism.
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  • Barth, K., Sedivy, M., Lindner, G., and Schwarz, C. “Successful Treatment With Denosumab For Two Cases With Hypercalcemia Due To Vitamin D Intoxication And Associated Acute Kidney Injury”. Cen Case Rep 11, no. 1: 141-145. doi:10.1007/s13730-021-00643-5.
    Abstract: Hypervitaminosis D is a rare reason for hypercalcemia and associated with acute kidney injury. We report on two cases of hypercalcemia and acute kidney injury because of vitamin D intoxication successfully treated with denosumab. Case 1 is an 83-year-old woman, who was initially treated for 2 weeks with intravenous hydration, steroids and thereafter with furosemide without any effect on serum calcium levels and renal function. Because acute renal failure discouraged us to use intravenous bisphosphonate therapy, we applicated 60 mg denusomab subcutaneously. This led to a prompt reduction in serum calcium levels and improvement of renal function within 1 week. Case 2 is a 45-year-old athletic woman, who refused the standard therapy of steroids and forced diuresis for vitamin D intoxication. After 1 day of rehydration therapy, she received 60 mg denusomab. Similar to case 1 serum calcium declined and renal function improved within 7 days.
    Tags: *Acute Kidney Injury/complications/therapy, *Hypercalcemia/diagnosis/drug therapy/etiology, Acute kidney injury, Aged, 80 and over, Calcium, Denosumab, Denosumab/therapeutic use, Female, Humans, Hypercalcemia, Hypervitaminosis D, Male, Middle Aged, Vitamin D/therapeutic use.
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  • Koechlin, L., Boeddinghaus, J., Nestelberger, T., Lopez-Ayala, P., Wussler, D., Shrestha, S., Resa, T., et al. “Performance Of The Esc 0/2H-Algorithm Using High-Sensitivity Cardiac Troponin I In The Early Diagnosis Of Myocardial Infarction”. Am Heart J 242: 132-137. doi:10.1016/j.ahj.2021.08.008.
    Abstract: The 2020 guidelines of the European Society of Cardiology (ESC) recommend a novel ESC 0/2h-algorithm as the preferred alternative to the ESC 0/1h-algorithm in the early triage for rule-out and/or rule-in of Non-ST-segment-elevation myocardial infarction (NSTEMI). The aim was to prospectively validate the performance of the ESC 0/2h-algorithm using the high-sensitivity cardiac troponin I (hs-cTnI) assay (ARCHITECT) in an international, multicenter diagnostic study enrolling patients presenting with acute chest discomfort to the emergency department.
    Tags: *Algorithms, *Myocardial Infarction/blood/diagnosis, *Troponin I/blood, Biomarkers/blood, Early Diagnosis, Humans, Predictive Value of Tests, Prospective Studies, Reproducibility of Results.
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  • Stierli, R., Rozsnyai, Z., Felber, R., Jorg, R., Kraft, E., Exadaktylos, A. K., and Streit, S. “Primary Care Physician Workforce 2020 To 2025 - A Cross-Sectional Study For The Canton Of Bern”. Swiss Med Wkly 151, no. 35-36: w30024. doi:10.4414/SMW.2021.w30024.
    Abstract: AIM OF THIS STUDY: The Swiss primary care sector faces a lack in its workforce and the Canton of Bern - the second largest canton (i.e. federal state) - is believed to be more affected than others. To be able to predict a shortage in the overall workforce, reliable numbers for the workforce of all general practitioners (GPs) and paediatricians (primary care physicians, PCPs) actively working in the Canton of Bern are needed. Switzerland has no registry of active PCPs; therefore, our goal was to (1) define the number and characteristics of all PCPs in the Canton of Bern, (2) to establish the workforce density for the whole canton and its administrative districts, and (3) to forecast the next five years with respect to the PCP workforce development. METHODS: In this cross-sectional study, we contacted all potential PCPs of the Canton of Bern. We included all board-certified physicians in general internal medicine, paediatrics and physicians with the title "Praktischer Arzt (practical doctor)" with a professional license from the available registers (MedReg and the FMH register). All potential PCPs received a questionnaire to assess their involvement in the primary care setting, their personal characteristics including workload (current and in 5 years to allow us to estimate the projected workforce per projected population size in 2025), type of practice, administrative district, and additional questions on their acceptance of new patients and their perception of a shortage in their region. The data from non-responders were collected via follow-up letters, emails and phone calls. The density was calculated as full-time equivalent PCPs per 1000 inhabitants in total and per district. RESULTS: From all potential PCPs (n = 2217), we identified 972 working in the Canton of Bern, 851 as GPs (88%) and 121 as paediatricians (12%). From these physicians, we had a response rate of 95%. The mean age was 53 years for GPs and 50 years for paediatricians. Thirteen percent of all PCPs were aged 65 or older. The average workload was 7.6 half-days (GPs) and 6.9 half-days (paediatricians). We found a density of 0.75 (95% confidence interval [CI] 0.69-0.81) full-time equivalents per 1000 inhabitants for the total of the Canton of Bern, and a regional variability with densities between 0.59 to 0.93. Without new PCPs, the workforce density of PCPs will drop to 0.56 (95% CI 0.49-0.62) within the next 5years. CONCLUSION: This is the first study in which 95% of active PCPs participated and it demonstrated that within the next 5 years there will be a shortage in the workforce of PCPs that can only be improved by higher numbers of new domestic PCPs - even after accounting for the current inflow of foreign PCPs.
    Tags: *General Practitioners, *Physicians, Primary Care, Child, Cross-Sectional Studies, Humans, Middle Aged, Primary Health Care, Workforce.
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