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Swiss Emergency Research collection

2024



  • Abbassi F, Pfister M, Lucas KL, et al. Milestones in Surgical Complication Reporting: Clavien-Dindo Classification 20 Years and Comprehensive Complication Index 10 Years. Ann Surg. 2024;280(5):763-771. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39101214. Accessed no date.
    Abstract: OBJECTIVE: To provide improved guidance for the consistent application of the Clavien-Dindo classification (CDC) and Comprehensive Complication Index (CCI (R) ) in challenging clinical scenarios. BACKGROUND: Standardized outcome reporting is key for the proper assessment of surgical procedures. A recent consensus conference recommended the CDC and the CCI (R) for assessing postoperative morbidity. Several challenging scenarios for grading complications still require evidence-based guidance, and the use of the 2 metrics in randomized controlled trials (RCTs) remains unexplored. METHODS: We assessed the use of the CDC and CCI (R) as an outcome measure in a systematic literature search. In addition, we asked 163 international surgeons to critically evaluate and independently grade complications in 20 complex clinical scenarios. Finally, a Core Group of 5 experts used this information to develop consistent recommendations. RESULTS: Until July 2023, 1327 RCTs selected the CDC and/or CCI (R) to assess morbidity. Annual use was steadily increasing with now over 200 new RCTs per year. However, only a third (n = 335) of published RCTs provided the complete range of CDC grades, including all subgrades. Eighty-nine out of 163 surgeons (response rate: 55%) completed the questionnaire that served as a basis for the recommendations: repetitive interventions that are required to treat one complication, complications followed by further complications, complications occurring before referral, and expected and unrelated complications to the original procedure should all be counted separately and included in the CCI (R) . Invasive blank diagnostic interventions should not be considered a complication. CONCLUSIONS: The increasing use of the CDC and CCI (R) in RCTs highlights the importance of their standardized application. The current consensus on various difficult scenarios may offer novel guidance for the consistent use of the CDC and CCI (R) , aiming to improve complication reporting and better quality control, ultimately benefiting all health care stakeholders and, first and foremost, all patients.
    Tags: *Postoperative Complications/epidemiology/classification, conflicts of interest., Humans, Randomized Controlled Trials as Topic, the Comprehensive Complication Index (CCI (R) ). The remaining authors report no.


  • Abbiati M, Nendaz MR, Cerutti B, et al. Exploring Medical Career Choice to Better Inform Swiss Physician Workforce Planning: Protocol for a National Cohort Study. JMIR Res Protoc. 2024;13(1):e53138. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38231561. Accessed no date.
    Abstract: BACKGROUND: A medical student's career choice directly influences the physician workforce shortage and the misdistribution of resources. First, individual and contextual factors related to career choice have been evaluated separately, but their interaction over time is unclear. Second, actual career choice, reasons for this choice, and the influence of national political strategies are currently unknown in Switzerland. OBJECTIVE: The overall objective of this study is to better understand the process of Swiss medical students' career choice and to predict this choice. Our specific aims will be to examine the predominately static (ie, sociodemographic and personality traits) and predominately dynamic (ie, learning context perceptions, anxiety state, motivation, and motives for career choice) variables that predict the career choice of Swiss medical school students, as well as their interaction, and to examine the evolution of Swiss medical students' career choice and their ultimate career path, including an international comparison with French medical students. METHODS: The Swiss Medical Career Choice study is a national, multi-institution, and longitudinal study in which all medical students at all medical schools in Switzerland are eligible to participate. Data will be collected over 4 years for 4 cohorts of medical students using questionnaires in years 4 and 6. We will perform a follow-up during postgraduate training year 2 for medical graduates between 2018 and 2022. We will compare the different Swiss medical schools and a French medical school (the University of Strasbourg Faculty of Medicine). We will also examine the effect of new medical master's programs in terms of career choice and location of practice. For aim 2, in collaboration with the Swiss Institute for Medical Education, we will implement a national career choice tracking system and identify the final career choice of 2 cohorts of medical students who graduated from 4 Swiss medical schools from 2010 to 2012. We will also develop a model to predict their final career choice. Data analysis will be conducted using inferential statistics, and machine learning approaches will be used to refine the predictive model. RESULTS: This study was funded by the Swiss National Science Foundation in January 2023. Recruitment began in May 2023. Data analysis will begin after the completion of the first cohort data collection. CONCLUSIONS: Our research will inform national stakeholders and medical schools on the prediction of students' future career choice and on key aspects of physician workforce planning. We will identify targeted actions that may be implemented during medical school and may ultimately influence career choice and encourage the correct number of physicians in the right specialties to fulfill the needs of currently underserved regions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53138.
    Tags: career choice, machine learning, medical specialty, medical students, medically underserved area, motivation, physician workforce, prediction model, professional practice, residents.


  • Abdurashidova T, Muller M, Schukraft S, et al. European Society of Cardiology guidelines and 1 year outcomes of acute heart failure treatment in Central Asia and Europe. ESC Heart Fail. 2024;11(1):483-491. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38059306. Accessed no date.
    Abstract: AIMS: Outcomes reported for patients with hospitalization for acute heart failure (AHF) treatment vary worldwide. Ethnicity-associated characteristics may explain this observation. This observational study compares characteristics and 1-year outcomes of Kyrgyz and Swiss AHF patients against the background of European Society of Cardiology guidelines-based cardiovascular care established in both countries. METHODS AND RESULTS: The primary endpoint was 1 year all-cause mortality (ACM); the secondary endpoint was 1 year ACM or HF-related rehospitalization. A total of 538 Kyrgyz and 537 Swiss AHF patients were included. Kyrgyz patients were younger (64.0 vs. 83.0 years, P < 0.001); ischaemic or rheumatic heart disease and chronic obstructive pulmonary disease were more prevalent (always P < 0.001). In Swiss patients, smoking, dyslipidaemia, hypertension, and atrial flutter/fibrillation were more frequent (always P </= 0.035); moreover, left ventricular ejection fraction (LVEF) was higher (47% vs. 36%; P < 0.001), and >mild aortic stenosis was more prevalent (P < 0.001). Other valvular pathologies were more prevalent in Kyrgyz patients (P < 0.001). At discharge, more Swiss patients were on vasodilatory treatment (P < 0.006), while mineralocorticoid receptor antagonists (P = 0.001), beta-blockers (P = 0.001), or loop diuretics (P < 0.001) were less often prescribed. In Kyrgyz patients, unadjusted odds for the primary and secondary endpoints were lower [odds ratio (OR) 0.68, 95% confidence interval (CI): 0.51-0.90, P = 0.008; OR 0.72, 95% CI: 0.56-0.91, P = 0.006, respectively]. After adjustment for age and LVEF, no difference remained (primary endpoint: OR 1.03, 95% CI: 0.71-1.49, P = 0.894; secondary endpoint: OR 0.82, 95% CI: 0.60-1.12, P = 0.206). CONCLUSIONS: On the background of identical guidelines, age- and LVEF-adjusted outcomes were not different between Central Asian and Western European AHF patients despite of large ethnical disparity.
    Tags: *Cardiology, *Heart Failure/drug therapy/epidemiology, Acute heart failure, Asia, ESC guidelines, Ethnicity, Humans, Outcome, Stroke Volume, Ventricular Function, Left.


  • Abou Fayad A, Rafei R, Njamkepo E, et al. An unusual two-strain cholera outbreak in Lebanon, 2022-2023: a genomic epidemiology study. Nat Commun. 2024;15(1):6963. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39138238. Accessed no date.
    Abstract: Cholera is a life-threatening gastrointestinal infection caused by a toxigenic bacterium, Vibrio cholerae. After a lull of almost 30 years, a first case of cholera was detected in Lebanon in October 2022. The outbreak lasted three months, with 8007 suspected cases (671 laboratory-confirmed) and 23 deaths. In this study, we use phenotypic methods and microbial genomics to study 34 clinical and environmental Vibrio cholerae isolates collected throughout this outbreak. All isolates are identified as V. cholerae O1, serotype Ogawa strains from wave 3 of the seventh pandemic El Tor (7PET) lineage. Phylogenomic analysis unexpectedly reveals the presence of two different strains of the seventh pandemic El Tor (7PET) lineage. The dominant strain has a narrow antibiotic resistance profile and is phylogenetically related to South Asian V. cholerae isolates and derived African isolates from the AFR15 sublineage. The second strain is geographically restricted and extensively drug-resistant. It belongs to the AFR13 sublineage and clusters with V. cholerae isolates collected in Yemen. In conclusion, the 2022-2023 Lebanese cholera outbreak is caused by the simultaneous introduction of two different 7PET strains. Genomic surveillance with cross-border collaboration is therefore crucial for the identification of new introductions and routes of circulation of cholera, improving our understanding of cholera epidemiology.
    Tags: *Cholera/epidemiology/microbiology, *Disease Outbreaks, *Phylogeny, Adolescent, Adult, Anti-Bacterial Agents/pharmacology, Child, Female, Genome, Bacterial/genetics, Genomics/methods, Humans, Lebanon/epidemiology, Male, Middle Aged, Molecular Epidemiology, Vibrio cholerae O1/genetics/isolation & purification/classification, Vibrio cholerae/genetics/isolation & purification/classification, Young Adult.


  • Abramovich I, Crisan I, Scudellari A, Bilotta F. Recent educational tools in anaesthesiology residency training programs aligned with the European training requirements. European Journal of Anaesthesiology Intensive Care. 2024;3(5):e0058. Available at: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85206246405&doi=10.1097%2fEA9.0000000000000058&partnerID=40&md5=1f41ccf01293629ab3092f81682b5b42. Accessed no date.


  • Agri F, Pache B, Bourgeat M, et al. Performance of three predictive scores to avoid delayed diagnosis of significant blunt bowel and mesenteric injury: A 12-year retrospective cohort study. J Trauma Acute Care Surg. 2024;96(5):820-830. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38111096. Accessed no date.
    Abstract: BACKGROUND: Avoiding missed diagnosis and therapeutic delay for significant blunt bowel and mesenteric injuries (sBBMIs) after trauma is still challenging despite the widespread use of computed tomography (CT). Several scoring tools aiming at reducing this risk have been published. The purpose of the present work was to assess the incidence of delayed (>24 hours) diagnosis for sBBMI patients and to compare the predictive performance of three previously published scores using clinical, radiological, and laboratory findings: the Bowel Injury Prediction Score (BIPS) and the scores developed by Raharimanantsoa Score (RS) and by Faget Score (FS). METHODS: A population-based retrospective observational cohort study was conducted; it included adult trauma patients after road traffic crashes admitted to Lausanne University Hospital, Switzerland, between 2008 and 2019 (n = 1,258) with reliable information about sBBMI status (n = 1,164) and for whom all items for score calculation were available (n = 917). The three scores were retrospectively applied on all patients to assess their predictive performance. RESULTS: The incidence of sBBMI after road traffic crash was 3.3% (38 of 1,164), and in 18% (7 of 38), there was a diagnostic and treatment delay of more than 24 hours. The diagnostic performances of the FS, the RS, and the BIPS to predict sBBMI, expressed as the area under the receiver operating characteristic curve, were 95.3% (95% confidence interval [CI], 92.7-97.9%), 89.2% (95% CI, 83.2-95.3%), and 87.6% (95% CI, 81.8-93.3%) respectively. CONCLUSION: The present study confirms that diagnostic delays for sBBMI still occur despite the widespread use of abdominal CT. When CT findings during the initial assessment are negative or equivocal for sBBMI, using a score may be helpful to select patients for early diagnostic laparoscopy. The FS had the best individual diagnostic performance. However, the BIPS or the RS, relying on clinical and laboratory variables, may be helpful to select patients for early diagnostic laparoscopy when there are unspecific CT signs of bowel or mesenteric injury. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.
    Tags: *Delayed Diagnosis/statistics & numerical data, *Mesentery/injuries/diagnostic imaging, *Tomography, X-Ray Computed, *Wounds, Nonpenetrating/diagnosis/epidemiology, Abdominal Injuries/diagnosis/epidemiology/diagnostic imaging, Accidents, Traffic/statistics & numerical data, Adult, Aged, Female, Humans, Incidence, Injury Severity Score, Intestines/injuries/diagnostic imaging, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Switzerland/epidemiology.


  • Ahmad SJ, Ahmed AR, Mohajer-Bastami A, et al. Evaluating the effectiveness of citation count as a measure of methodological quality in esophagogastric surgery research: a comparative analysis with the MINORS score and levels of evidence. Gastroenterol Hepatol Bed Bench. 2024;17(3):212-224. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39308541. Accessed no date.
    Abstract: AIM: The primary objective was to assess the relationship between the citation number and the quality of the articles, as compared with the level of evidence and the MINORS score. This study's secondary objective was to characterize the 50 most cited articles in the field of oesophagectomy research. BACKGROUND: There has been an increased need for an evaluation tool to indicate research quality. Available quality assessment tools include the Level of Evidence, the MINORS score, the Cochrane Risk of Bias 2.0 Tool, the Newcastle Ottawa Scale, CASP Appraisal Checklists, and Legend Evidence Evaluation tools. METHODS: The Web of Science allowed evaluating and comparing articles on oesophagectomy research. The quality of the 50 most cited articles was assessed using the Oxford Centre level of evidence classification and the methodological index for non-randomized studies (MINORS). RESULTS: Level of evidence II studies were cited more than level IV (P=0.008). There was a significant positive correlation between citation number and MINORS score (P=0.002). The median MINORS score was highest amongst level II studies, followed by levels III, IV, and I. The median MINORS score for level II evidence was significantly higher than for level IV (P=0.001). The study sample size is associated with higher levels of evidence but does not correlate with the citation number. Female authors contributed to 4 out of 50 articles. Recently published articles tended to be cited more frequently. More authors equated to more citations. Prospective studies are more likely to be cited. CONCLUSION: Citation analysis can be used as an indicator of quality when assessing articles. It should, however, be used with caution as highly cited work, famous authors, and journals are all more likely to be cited. Citation analysis should be used alongside other well-established tools.
    Tags: Ivor Lewis, Mckeown, Oesophageal Adenocarcinoma, Oesophageal Cancer, Oesophageal Carcinoma, Oesophageal Resection, Oesophageal Squamous Cell Carcinoma, Oesophagectomy, Oesophagus, Transhiatal Resection.


  • Ahmad SJ, Degiannis JR, Borucki J, et al. Fatality Rates After Infection With the Omicron Variant (B.1.1.529): How Deadly has it been? A Systematic Review and Meta-Analysis. J Acute Med. 2024;14(2):51-60. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38855048. Accessed no date.
    Abstract: BACKGROUND: Since late 2019, the global community has been gripped by the uncertainty surrounding the SARS-CoV-2 pandemic. In November 2021, the emergence of the Omicron variant in South Africa added a new dimension. This study aims to assess the disease's severity and determine the extent to which vaccinations contribute to reducing mortality rates. METHODS: A systematic review and meta-analysis of the epidemiological implications of the omicron variant of SARS-CoV-2 were performed, incorporating an analysis of articles from November 2021that address mortality rates. RESULTS: The analysis incorporated data from 3,214,869 patients infected with omicron, as presented in 270 articles. A total of 6,782 deaths from the virus were recorded (0.21%). In the analysed articles, the pooled mortality rate was 0.003 and the pooled in-house mortality rate was 0.036. Vaccination is an effective step in preventing death (odds ratio: 0.391, p < 0.01). CONCLUSION: The mortality rates for the omicron variant are lower than for the preceding delta variant. mRNA vaccination affords secure and effective protection against severe disease and death from omicron.
    Tags: B.1.1.529, Covid-19, ICU care, intensive care, Omicron, SARS-CoV-2.


  • Ahmad SJ, Head M, Ahmed AR. Understanding Early Predictors and Inflammatory Markers for Mid-Term Outcomes in Laparoscopic Sleeve Gastrectomy. Obes Surg. 2024;34(7):2329-2330. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38851647. Accessed no date.
    Tags: *Biomarkers/blood, *Laparoscopy, *Obesity, Morbid/surgery, Adult, Female, Gastrectomy/methods, Humans, Male, Treatment Outcome, Weight Loss.


  • Albrecht R, Espejo T, Riedel HB, et al. Clinical Frailty Scale at presentation to the emergency department: interrater reliability and use of algorithm-assisted assessment. Eur Geriatr Med. 2024;15(1):105-113. Available at: https://www.ncbi.nlm.nih.gov/pubmed/37971677. Accessed no date.
    Abstract: PURPOSE: The Clinical Frailty Scale (CFS) allows health care providers to quickly stratify older patients, to support clinical decision-making. However, few studies have evaluated the CFS interrater reliability (IRR) in Emergency Departments (EDs), and the freely available smartphone application for CFS assessment was never tested for reliability. This study aimed to evaluate the interrater reliability of the Clinical Frailty Scale (CFS) ratings between experienced and unexperienced staff (ED clinicians and a study team (ST) of medical students supported by a smartphone application to assess the CFS), and to determine the feasibility of CFS assignment in patients aged 65 or older at triage. METHODS: Cross-sectional study using consecutive sampling of ED patients aged 65 or older. We compared assessments by ED clinicians (Triage Clinicians (TC) and geriatric ED trained nurses (geriED-TN)) and a study team (ST) of medical students using a smartphone application for CFS scoring. The study is registered on Clinicaltrials.gov (NCT05400707). RESULTS: We included 1349 patients aged 65 and older. Quadratic-weighted kappa values for ordinal CFS levels showed a good IRR between TC and ST (varkappa = 0.73, 95% CI 0.69-0.76), similarly to that between TC and geriED-TN (varkappa = 0.75, 95% CI 0.66-0.82) and between the ST and geriED-TN (varkappa = 0.74, 95% CI 0.63-0.81). A CFS rating was assigned to 972 (70.2%) patients at triage. CONCLUSION: We found good IRR in the assessment of frailty with the CFS in different ED providers and a team using a smartphone application to support rating. A CFS assessment occurred in more than two-thirds (70.2%) of patients at triage.
    Tags: *Frailty/diagnosis/epidemiology, Aged, Algorithms, Cfs, Clinical Frailty Scale, conflict of interest., Cross-Sectional Studies, Emergency department, Emergency Service, Hospital, Frailty, Geriatric acuity, Humans, Interrater reliability, Reproducibility of Results.


  • Altmann-Schneider I, Kellenberger CJ, Pistorius SM, et al. Artificial intelligence-based detection of paediatric appendicular skeletal fractures: performance and limitations for common fracture types and locations. Pediatr Radiol. 2024;54(1):136-145. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38099929. Accessed no date.
    Abstract: BACKGROUND: Research into artificial intelligence (AI)-based fracture detection in children is scarce and has disregarded the detection of indirect fracture signs and dislocations. OBJECTIVE: To assess the diagnostic accuracy of an existing AI-tool for the detection of fractures, indirect fracture signs, and dislocations. MATERIALS AND METHODS: An AI software, BoneView (Gleamer, Paris, France), was assessed for diagnostic accuracy of fracture detection using paediatric radiology consensus diagnoses as reference. Radiographs from a single emergency department were enrolled retrospectively going back from December 2021, limited to 1,000 radiographs per body part. Enrolment criteria were as follows: suspected fractures of the forearm, lower leg, or elbow; age 0-18 years; and radiographs in at least two projections. RESULTS: Lower leg radiographs showed 607 fractures. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were high (87.5%, 87.5%, 98.3%, 98.3%, respectively). Detection rate was low for toddler's fractures, trampoline fractures, and proximal tibial Salter-Harris-II fractures. Forearm radiographs showed 1,137 fractures. Sensitivity, specificity, PPV, and NPV were high (92.9%, 98.1%, 98.4%, 91.7%, respectively). Radial and ulnar bowing fractures were not reliably detected (one out of 11 radial bowing fractures and zero out of seven ulnar bowing fractures were correctly detected). Detection rate was low for styloid process avulsions, proximal radial buckle, and complete olecranon fractures. Elbow radiographs showed 517 fractures. Sensitivity and NPV were moderate (80.5%, 84.7%, respectively). Specificity and PPV were high (94.9%, 93.3%, respectively). For joint effusion, sensitivity, specificity, PPV, and NPV were moderate (85.1%, 85.7%, 89.5%, 80%, respectively). For elbow dislocations, sensitivity and PPV were low (65.8%, 50%, respectively). Specificity and NPV were high (97.7%, 98.8%, respectively). CONCLUSIONS: The diagnostic performance of BoneView is promising for forearm and lower leg fractures. However, improvement is mandatory before clinicians can rely solely on AI-based paediatric fracture detection using this software.
    Tags: *Joint Dislocations, *Radius Fractures/diagnostic imaging, *Salter-Harris Fractures, *Ulna Fractures/diagnostic imaging, Adolescent, Appendicular skeleton, Artificial Intelligence, Child, Child, Preschool, Fracture, Gleamer with our study proposal and the software was provided for this, Humans, Infant, Infant, Newborn, investigation free of charge as a trial version. No additional funding was, Paediatric, Radiograph, Radiography, received., Retrospective Studies.


  • Amacher SA, Arpagaus A, Sahmer C, et al. Prediction of outcomes after cardiac arrest by a generative artificial intelligence model. Resusc Plus. 2024;18:100587. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38433764. Accessed no date.
    Abstract: AIMS: To investigate the prognostic accuracy of a non-medical generative artificial intelligence model (Chat Generative Pre-Trained Transformer 4 - ChatGPT-4) as a novel aspect in predicting death and poor neurological outcome at hospital discharge based on real-life data from cardiac arrest patients. METHODS: This prospective cohort study investigates the prognostic performance of ChatGPT-4 to predict outcomes at hospital discharge of adult cardiac arrest patients admitted to intensive care at a large Swiss tertiary academic medical center (COMMUNICATE/PROPHETIC cohort study). We prompted ChatGPT-4 with sixteen prognostic parameters derived from established post-cardiac arrest scores for each patient. We compared the prognostic performance of ChatGPT-4 regarding the area under the curve (AUC), sensitivity, specificity, positive and negative predictive values, and likelihood ratios of three cardiac arrest scores (Out-of-Hospital Cardiac Arrest [OHCA], Cardiac Arrest Hospital Prognosis [CAHP], and PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages [PROLOGUE score]) for in-hospital mortality and poor neurological outcome. RESULTS: Mortality at hospital discharge was 43% (n = 309/713), 54% of patients (n = 387/713) had a poor neurological outcome. ChatGPT-4 showed good discrimination regarding in-hospital mortality with an AUC of 0.85, similar to the OHCA, CAHP, and PROLOGUE (AUCs of 0.82, 0.83, and 0.84, respectively) scores. For poor neurological outcome, ChatGPT-4 showed a similar prediction to the post-cardiac arrest scores (AUC 0.83). CONCLUSIONS: ChatGPT-4 showed a similar performance in predicting mortality and poor neurological outcome compared to validated post-cardiac arrest scores. However, more research is needed regarding illogical answers for potential incorporation of an LLM in the multimodal outcome prognostication after cardiac arrest.
    Tags: Artificial intelligence, Cardiac arrest, Cardiopulmonary resuscitation, Mortality prediction, Neurological outcome, personal relationships that could have appeared to influence the work reported in, this paper..


  • Amacher SA, Gross S, Becker C, et al. Misconceptions and do-not-resuscitate preferences of healthcare professionals commonly involved in cardiopulmonary resuscitations: A national survey. Resusc Plus. 2024;17:100575. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38375442. Accessed no date.
    Abstract: AIMS: To assess the DNR preferences of critical care-, anesthesia- and emergency medicine practitioners, to identify factors influencing decision-making, and to raise awareness for misconceptions concerning CPR outcomes. METHODS: A nationwide multicenter survey was conducted in Switzerland confronting healthcare professionals with a case vignette of an adult patient with an out-of-hospital cardiac arrest (OHCA). The primary outcome was the rate of DNR Code Status vs. CPR Code Status when taking the perspective from a clinical case vignette of a 70-year-old patient. Secondary outcomes were participants' personal preferences for DNR and estimates of survival with good neurological outcome after in- and out-of-hospital cardiac arrest. RESULTS: Within 1803 healthcare professionals, DNR code status was preferred in 85% (n = 1532) in the personal perspective of the case vignette and 53.2% (n = 932) when making a decision for themselves. Main predictors for a DNR Code Status regarding the case vignette included preferences for DNR Code Status for themselves (n [%] 896 [58.5] vs. 87 [32.1]; adjusted odds ratio [OR] 2.97, 95% confidence interval [CI] 2.25-3.92; p < 0.001) and lower estimated OHCA survival (mean [+/-SD] 12.3% [+/-11.8] vs. 14.7%[+/-12.8]; adjusted OR 0.98, 95% CI 0.97-0.99; p = 0.001). Physicians chose a DNR order more often when compared to nurses and paramedics. CONCLUSIONS: The estimation of outcomes following cardiac arrest and personal living conditions are pivotal factors influencing code status preferences in healthcare professionals. Healthcare professionals should be aware of cardiac arrest prognosis and potential implications of personal preferences when engaging in code status- and end-of-life discussions with patients and their relatives.
    Tags: Basel, the Scientific Society Basel, and the Gottfried Julia Bangerter- Rhyner, Cardiac arrest, Cardiopulmonary resuscitation, End-of-life care, Ethics, Foundation. Sabina Hunziker was supported by the Gottfried Julia Bangerter-, Grant References 10001C_192850/1 and 10531C_182422., grants from the Mach-Gaensslen Foundation Switzerland and the Nora van, Meeuwen-Haefliger Foundation of the University of Basel, Switzerland outside the, Personal preferences, potential conflict of interest relevant to this study. Simon Amacher has received, present work. Raoul Sutter has received research grants from the Swiss National, Rhyner Foundation, the Swiss National Science Foundation (SNSF) and the Swiss, Science Foundation (No. 320030_169379), the Research Fund of the University of, Shared decision-making, Society of General Internal Medicine (SSGIM) during the conduct of the study., which may be considered as potential competing interests: The authors disclose no.


  • Amacher SA, Sahmer C, Becker C, et al. Post-intensive care syndrome and health-related quality of life in long-term survivors of cardiac arrest: a prospective cohort study. Sci Rep. 2024;14(1):10533. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38719863. Accessed no date.
    Abstract: Patients discharged from intensive care are at risk for post-intensive care syndrome (PICS), which consists of physical, psychological, and/or neurological impairments. This study aimed to analyze PICS at 24 months follow-up, to identify potential risk factors for PICS, and to assess health-related quality of life in a long-term cohort of adult cardiac arrest survivors. This prospective cohort study included adult cardiac arrest survivors admitted to the intensive care unit of a Swiss tertiary academic medical center. The primary endpoint was the prevalence of PICS at 24 months follow-up, defined as impairments in physical (measured through the European Quality of Life 5-Dimensions-3-Levels instrument [EQ-5D-3L]), neurological (defined as Cerebral Performance Category Score > 2 or Modified Rankin Score > 3), and psychological (based on the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised) domains. Among 107 cardiac arrest survivors that completed the 2-year follow-up, 46 patients (43.0%) had symptoms of PICS, with 41 patients (38.7%) experiencing symptoms in the physical domain, 16 patients (15.4%) in the psychological domain, and 3 patients (2.8%) in the neurological domain. Key predictors for PICS in multivariate analyses were female sex (adjusted odds ratio [aOR] 3.17, 95% CI 1.08 to 9.3), duration of no-flow interval during cardiac arrest (minutes) (aOR 1.17, 95% CI 1.02 to 1.33), post-discharge job-loss (aOR 31.25, 95% CI 3.63 to 268.83), need for ongoing psychological support (aOR 3.64, 95% CI 1.29 to 10.29) or psychopharmacologic treatment (aOR 9.49, 95% CI 1.9 to 47.3), and EQ-visual analogue scale (points) (aOR 0.88, 95% CI 0.84 to 0.93). More than one-third of cardiac arrest survivors experience symptoms of PICS 2 years after resuscitation, with the highest impairment observed in the physical and psychological domains. However, long-term survivors of cardiac arrest report intact health-related quality of life when compared to the general population. Future research should focus on appropriate prevention, screening, and treatment strategies for PICS in cardiac arrest patients.
    Tags: & Johnson., *Heart Arrest/psychology/epidemiology, *Quality of Life, *Survivors/psychology, 320030_169379), the Research Fund of the University Basel, the Scientific Society, Adult, Aged, Basel, and the Gottfried Julia Bangerter-Rhyner Foundation. He received personal, Cardiopulmonary resuscitation, Critical Care, Critical Illness, Female, Follow-Up Studies, grants from UCB-pharma and holds stocks from Novartis, Roche, Alcon, and Johnson, Humans, Intensive Care Units, Long-term outcomes, Male, Middle Aged, Post-intensive care syndrome, Prospective Studies, Risk Factors.


  • Arleth T, Baekgaard J, Rosenkrantz O, et al. Clinicians' attitudes towards supplemental oxygen for trauma patients - A survey. Injury. 2024:111929. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39379198. Accessed no date.
    Abstract: INTRODUCTION: The Advanced Trauma Life Support guidelines (ATLS; 2018, 10th ed.) recommend an early and liberal supplemental oxygen for all severely injured trauma patients to prevent hypoxaemia. As of 2024, these guidelines remain the most current. This may lead to hyperoxaemia, which has been associated with increased mortality and respiratory complications. We aimed to investigate the attitudes among clinicians, defined as physicians and prehospital personnel, towards the use of supplemental oxygen in trauma cases. MATERIALS AND METHODS: A European, web-based, cross-sectional survey was conducted consisting of 23 questions. The primary outcome was the question: "In your opinion, should all severely injured trauma patients always be given supplemental oxygen, regardless of arterial oxygen saturation measured by pulse oximetry?". RESULTS: The survey was answered by 707 respondents, which corresponded to a response rate of 52 %. The respondents were predominantly male (76 %), with the largest representation from Denmark (82 %), and primarily educated as physicians (62 %). A majority of respondents (73 % [95 % CI: 70 to 76 %]) did not support that supplemental oxygen should always be provided to all severely injured trauma patients without consideration of their arterial oxygen saturation as measured by pulse oximetry (SpO(2)), with no significant difference between physicians and non-physicians (p = 0.08). Based on the respondents' preferred dosages, the median initial administered dosage of supplemental oxygen for spontaneously breathing trauma patients with a normal SpO(2) in the first few hours after trauma was 0 (interquartile range [IQR] 0-3) litres per minute, with 58 % of respondents opting not to provide any supplemental oxygen. The lowest acceptable SpO(2) goal in the first few hours after trauma was 94 % (IQR 92-95). In clinical scenarios with TBI, higher dosage of supplemental oxygen and fraction of inspired oxygen (FiO(2)) were preferred, as well as targeting partial pressure of oxygen in arterial blood as opposed to adjusting the FiO(2) directly, compared to no TBI. CONCLUSION: Almost three out of four clinicians did not support the administration of supplemental oxygen to all severely injured trauma patients, regardless of SpO(2). This corresponds to a more restrictive approach than recommended in the current ATLS (2018, 10th ed.) guidelines.
    Tags: and he received funding for the TRAUMOX2 trial from the Novo Nordisk Foundation., attended a Secma ultrasound course, and is an IDMC consultant for the GA Targets, Attitudes, Australia. Jacob Steinmetz receives funding of his professorship from the, Baekgaard received funding for the TRAUMOX2 trial from the Novo Nordisk, biomarker Copenhagen sub-trial of TRAUMOX2 from the Holger and Ruth Hesses, Clinicians, Consultant Dr. Med. Edgar Schnohr and wife Gilberte Schnohrs Foundation. Josefine, European, Foundation and the European Union. Wolf E. Hautz received consulting fees and, Foundation and was awarded with the prize for "talented young researcher" by The, honorarias from the AO Foundation Zurich, and Mundipharma Switzerland gave him, Injury, interest to declare regarding the present manuscript. For conflicts of interests, Lundbeck Foundation, of which 47.000euro was allocated to research. Stine T. Zwisler, Memorial Foundation and Danish Air Ambulance, and received funding for three, months of research PhD programme exchange from Knud Hojgaard's Foundation, the, Norwegian Air Ambulance Foundation where payments are made to his organization,, related to any entity the past 36 months not related to the present manuscript,, Supplemental oxygen, support for attending meetings, alongside participating in a DMSC for MDI, Survey, the author or the author's affiliation did not receive any payments in, the Medical Science Faculty Foundation of Copenhagen University, and the, The rest of the authors have nothing to declare., these authors have the following to declare: Tobias Arleth received funding for a, this regard. Wolf. E. Hautz received funding from the Swiss National Science, Trauma, Trial, William Demant Foundation, Christian and Ottilia Brorson's Travel Scholarships,.


  • Assouline B, Mentha N, Wozniak H, et al. Improved Extracorporeal Cardiopulmonary Resuscitation (ECPR) Outcomes Is Associated with a Restrictive Patient Selection Algorithm. J Clin Med. 2024;13(2). Available at: https://www.ncbi.nlm.nih.gov/pubmed/38256631. Accessed no date.
    Abstract: INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality. Despite decades of intensive research and several technological advancements, survival rates remain low. The integration of extracorporeal cardiopulmonary resuscitation (ECPR) has been recognized as a promising approach in refractory OHCA. However, evidence from recent randomized controlled trials yielded contradictory results, and the criteria for selecting eligible patients are still a subject of debate. METHODS: This study is a retrospective analysis of refractory OHCA patients treated with ECPR. All adult patients who received ECPR, according to the hospital algorithm, from 2013 to 2021 were included. Two different algorithms were used during this period. A "permissive" algorithm was used from 2013 to mid-2016. Subsequently, a revised algorithm, more "restrictive", based on international guidelines, was implemented from mid-2016 to 2021. Key differences between the two algorithms included reducing the no-flow time from less than three minutes to zero minutes (implying that the cardiac arrests must occur in the presence of a witness with immediate CPR initiation), reducing low-flow duration from 100 to 60 min, and lowering the age limit from 65 to 55 years. The aim of this study is to compare these two algorithms (permissive (1) and restrictive (2)) to determine if the use of a restrictive algorithm was associated with higher survival rates. RESULTS: A total of 48 patients were included in this study, with 23 treated under Algorithm 1 and 25 under Algorithm 2. A significant difference in survival rate was observed in favor of the restrictive algorithm (9% vs. 68%, p < 0.05). Moreover, significant differences emerged between algorithms regarding the no-flow time (0 (0-5) vs. 0 (0-0) minutes, p < 0.05). Survivors had a significantly shorter no-flow and low-flow time (0 (0-0) vs. 0 (0-3) minutes, p < 0.01 and 40 (31-53) vs. 60 (45-80) minutes, p < 0.05), respectively. CONCLUSION: The present study emphasizes that a stricter selection of OHCA patients improves survival rates in ECPR.
    Tags: Ecpr, out-of-hospital cardiac arrest, Va-ecmo.


  • Assunta F, Matteo A, Severine V, et al. Feasibility and acceptability of a serious game to study the effects of environmental distractors on emergency room nurse triage accuracy: A pilot study. Int Emerg Nurs. 2024;76:101504. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39159597. Accessed no date.
    Abstract: BACKGROUND: Emergency triage, which involves complex decision-making under stress and time constraints, may suffer from inaccuracies due to workplace distractions. A serious game was developed to simulate the triage process and environment. A pilot study was undertaken to collect preliminary data on the effects of distractors on emergency nurse triage accuracy. METHOD: A 2 x 2 factorial randomized controlled trial (RCT) was designed for the study. A sample of 70 emergency room nurses was randomly assigned to three experimental groups exposed to different distractors (noise, task interruptions, and both) and one control group. Nurses had two hours to complete a series of 20 clinical vignettes, in which they had to establish a chief complaint and assign an emergency level. RESULTS: Fifty-five nurses completed approximately 15 vignettes each during the allotted time. No intergroup differences emerged in terms of triage performance. Nurses had a very favorable appreciation of the serious game focusing on triage. CONCLUSION: The results show that both the structure of our study and the serious game can be used to carry out a future RCT on a larger scale. The lack of a distractor effect raises questions about the frequency and intensity required to find a significant impact on triage performance.
    Tags: *Emergency Service, Hospital, *Triage/methods, Adult, competing financial interests or personal relationships that could have appeared, Decision-making, Emergency Nursing, Feasibility Studies, Female, Gamification, Humans, Interruptions, Male, Middle Aged, Nurses/psychology, Patient safety, Pilot Projects, Quality improvement, to influence the work reported in this paper., Triage accuracy.


  • Becker C, Beck K, Moser C, et al. The association of vaccination status with perceived discrimination in patients with COVID-19: results from a cross-sectional study. Swiss Med Wkly. 2024;154(5):3634. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38749418. Accessed no date.
    Abstract: STUDY AIMS: During the COVID-19 pandemic, there was increasing pressure to be vaccinated to prevent further spread of the virus and improve outcomes. At the same time, part of the population expressed reluctance to vaccination, for various reasons. Only a few studies have compared the perceptions of vaccinated and non-vaccinated patients being treated in hospitals for COVID-19. Our aim was to investigate the association between vaccination status and perceived healthcare-associated discrimination in patients with COVID-19 receiving hospital treatment. METHODS: Adult patients presenting to the emergency department or hospitalised for inpatient care due to or with COVID-19 from 1 June to 31 December 2021 in two Swiss hospitals were eligible. The primary endpoint was patients' perceived healthcare-associated discrimination, measured with the Discrimination in Medical Settings (DMS) scale. Secondary endpoints included different aspects of perceived quality of care and symptoms of psychological distress measured with the Hospital Anxiety and Depression Scale. RESULTS: Non-vaccinated patients (n = 113) had significantly higher DMS scores compared to vaccinated patients (n = 80) (mean: 9.54 points [SD: 4.84] vs 7.79 points [SD: 1.85]; adjusted difference: 1.18 [95% CI: 0.04-2.33 points]) and 21 of 80 vaccinated patients felt discriminated against vs 54 of 113 non-vaccinated patients (adjusted OR: 2.09 [95% CI: 1.10-3.99 ]). Non-vaccinated patients reported lower scores regarding respectful treatment by the nursing team (mean: 8.39 points [SD: 2.39] vs 9.30 points [SD: 1.09]; adjusted difference: -0.6 [95% CI: -1.18 - -0.02 points]). CONCLUSION: We found an association between vaccination status and perceived healthcare-associated discrimination. Healthcare workers should act in a professional manner regardless of a patient's vaccination status; in doing so, they might prevent the creation of negative perceptions in patients.
    Tags: *COVID-19 Vaccines, *COVID-19/prevention & control/psychology, *SARS-CoV-2, *Vaccination/psychology, Adult, Aged, Cross-Sectional Studies, Female, Hospitalization/statistics & numerical data, Humans, Male, Middle Aged, Quality of Health Care, Switzerland.


  • Bekka E, Christen SE, Hermann L, Exadaktylos AK, Haschke M, Liakoni E. Residents' Knowledge regarding Recreational Drug Screening Immunoassays at a Swiss Hospital Group. Int J Anal Chem. 2024;2024:4400606. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38938263. Accessed no date.
    Abstract: INTRODUCTION: In case of suspected acute recreational drug toxicity, immunoassays are commonly used as diagnostic tools. Although easy to handle, understanding of their limitations is necessary for a correct interpretation of the results. The aim of this project was to investigate residents' knowledge regarding drug screening immunoassays at a Swiss hospital group. METHODS: All residents of a large hospital group in Switzerland were invited by e-mail to participate in an anonymous survey. Following ten multiple choice questions on drug screening tests, the participants were also asked about their demographics, whether they used drug screening tests on a regular basis, and how confident they felt in their ability to interpret test results. RESULTS: The ten knowledge questions were answered by 110 of the 1026 residents (11%). Among the 108 participants with available demographics, 90% were 25-35 years old, 63% were female, and 70% were at least in their 4(th) year of residency. The median score of correct answers was 4 out of 10 (range 0-7) and in 50% of the questions, the correct answer was the most frequently selected response. No significant differences in the knowledge scores were found based on the training, confidence level, or the frequency of drug tests used in daily work. CONCLUSION: This survey revealed widespread knowledge gaps among residents regarding the interpretation of immunoassay-based drug test results. These findings can be used to implement educational measures on this topic and might provide a basis for targeted information on common pitfalls to be included in laboratory reports.


  • Benhamou J, Espejo T, Riedel HB, et al. On-site physiotherapy in older emergency department patients following a fall: a randomized controlled trial. Eur Geriatr Med. 2024. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39548032. Accessed no date.
    Abstract: PURPOSE: Greater fear of falling (FOF) is associated with an increased risk of falling in patients aged 65 and older. This study aims to assess the impact of physiotherapy on FOF in older patients and investigates the feasibility of such an intervention in the emergency department (ED) setting. METHODS: All patients aged 65 or older, who presented to the ED of the University Hospital Basel after a fall between January 2022 and June 2023 were screened for inclusion. Participants were assigned to an intervention or control group depending on the randomized presence or absence of a physiotherapist at inclusion. Both groups received the same fall prevention booklet. Physiotherapists instructed and performed exercises with patients in the intervention group. The primary outcome was the difference in FOF between groups 7 days post inclusion, assessed by short Falls Efficacy Scale International (sFES-I). Secondary outcomes included feasibility, overall reduction of FOF, patient satisfaction, the occurrence of falls post inclusion and the use of medical resources. RESULTS: Of the 1204 patients screened for inclusion, 104 older adults with a recent fall were enrolled (intervention: n = 44, control: n = 60); median age was 81 years and 59.1% were female. There was no between-group difference in FOF as measured by sFES-I within a week of inclusion (p = 0.663, effect size = 0.012 [95% confidence interval (CI) - 0.377 to 0.593]). Despite the intervention being deemed feasible from the physiotherapist's perspective, the study encountered challenges, such as low recruitment (with the planned sample size not being reached) and a notable dropout rate before the first follow-up. CONCLUSION: A physiotherapy intervention in the ED showed no improvement in FOF when compared to a control group. TRIAL REGISTRATION: Trial registration number and date NCT05156944, 01.12.2021.
    Tags: Emergency department, Falls, Feasibility, Informed consent was obtained from all individual participants included in the, line with the principles of the Declaration of Helsinki. Approval was granted by, non-financial interests to disclose. Ethical approval This study was performed in, Older, Physiotherapy, Randomized controlled trial, study., the local ethics committee (N degrees 2021-02165, 07.12.2021). Consent to participate.


  • Bessat C, Bingisser R, Schwendinger M, et al. PLUS-IS-LESS project: Procalcitonin and Lung UltraSonography-based antibiotherapy in patients with Lower rESpiratory tract infection in Swiss Emergency Departments: study protocol for a pragmatic stepped-wedge cluster-randomized trial. Trials. 2024;25(1):86. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38273319. Accessed no date.
    Abstract: BACKGROUND: Lower respiratory tract infections (LRTIs) are among the most frequent infections and a significant contributor to inappropriate antibiotic prescription. Currently, no single diagnostic tool can reliably identify bacterial pneumonia. We thus evaluate a multimodal approach based on a clinical score, lung ultrasound (LUS), and the inflammatory biomarker, procalcitonin (PCT) to guide prescription of antibiotics. LUS outperforms chest X-ray in the identification of pneumonia, while PCT is known to be elevated in bacterial and/or severe infections. We propose a trial to test their synergistic potential in reducing antibiotic prescription while preserving patient safety in emergency departments (ED). METHODS: The PLUS-IS-LESS study is a pragmatic, stepped-wedge cluster-randomized, clinical trial conducted in 10 Swiss EDs. It assesses the PLUS algorithm, which combines a clinical prediction score, LUS, PCT, and a clinical severity score to guide antibiotics among adults with LRTIs, compared with usual care. The co-primary endpoints are the proportion of patients prescribed antibiotics and the proportion of patients with clinical failure by day 28. Secondary endpoints include measurement of change in quality of life, length of hospital stay, antibiotic-related side effects, barriers and facilitators to the implementation of the algorithm, cost-effectiveness of the intervention, and identification of patterns of pneumonia in LUS using machine learning. DISCUSSION: The PLUS algorithm aims to optimize prescription of antibiotics through improved diagnostic performance and maximization of physician adherence, while ensuring safety. It is based on previously validated tests and does therefore not expose participants to unforeseeable risks. Cluster randomization prevents cross-contamination between study groups, as physicians are not exposed to the intervention during or before the control period. The stepped-wedge implementation of the intervention allows effect calculation from both between- and within-cluster comparisons, which enhances statistical power and allows smaller sample size than a parallel cluster design. Moreover, it enables the training of all centers for the intervention, simplifying implementation if the results prove successful. The PLUS algorithm has the potential to improve the identification of LRTIs that would benefit from antibiotics. When scaled, the expected reduction in the proportion of antibiotics prescribed has the potential to not only decrease side effects and costs but also mitigate antibiotic resistance. TRIAL REGISTRATION: This study was registered on July 19, 2022, on the ClinicalTrials.gov registry using reference number: NCT05463406. TRIAL STATUS: Recruitment started on December 5, 2022, and will be completed on November 3, 2024. Current protocol version is version 3.0, dated April 3, 2023.
    Tags: *Pneumonia/diagnostic imaging/drug therapy, *Respiratory Tract Infections/diagnostic imaging/drug therapy, Adult, Algorithm, Anti-Bacterial Agents/adverse effects, Antibiotic prescription, Clinical trial, Community-acquired pneumonia, Diagnostic tool, Emergency department, Emergency Service, Hospital, Humans, Lower respiratory tract infection, Lung ultrasound, Lung/diagnostic imaging, Procalcitonin, Protocol, Quality of Life, Randomized Controlled Trials as Topic, Switzerland, Ultrasonography.


  • Betti C, Lavagno C, Bianchetti MG, et al. Transient secondary pseudo-hypoaldosteronism in infants with urinary tract infections: systematic literature review. Eur J Pediatr. 2024;183(10):4205-4214. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38985174. Accessed no date.
    Abstract: Infants with a congenital anomaly of the kidney and urinary tract sometimes present with hyponatremia, hyperkalemia, and metabolic acidosis due to under-responsiveness to aldosterone, hereafter referred to as secondary pseudo-hypoaldosteronism. The purpose of this report is to investigate pseudo-hypoaldosteronism in infant urinary tract infection. A systematic review was conducted following PRISMA guidelines after PROSPERO (CRD42022364210) registration. The National Library of Medicine, Excerpta Medica, Web of Science, and Google Scholar without limitations were used. Inclusion criteria involved pediatric cases with documented overt pseudo-hypoaldosteronism linked to urinary tract infection. Data extraction included demographics, clinical features, laboratory parameters, management, and course. Fifty-seven reports were selected, detailing 124 cases: 95 boys and 29 girls, 10 months or less of age (80% of cases were 4 months or less of age). The cases exhibited hyponatremia, hyperkalemia, acidosis, and activated renin-angiotensin II-aldosterone system. An impaired kidney function was found in approximately every third case. Management included antibiotics, fluids, and, occasionally, emergency treatment of hyperkalemia, hyponatremia, or acidosis. The recovery time averaged 1 week for electrolyte, acid-base imbalance, and kidney function. Notably, anomalies of the kidney and urinary tract were identified in 105 (85%) cases. CONCLUSIONS: This review expands the understanding of overt transient pseudo-hypoaldosteronism complicating urinary tract infection. Management involves antimicrobials, fluid replacement, and consideration of electrolyte imbalances. Raising awareness of this condition within pediatric hospitalists is desirable. WHAT IS KNOWN: * Infants affected by a congenital anomaly of the kidney and urinary tract may present with clinical and laboratory features resembling primary pseudo-hypoaldosteronism. * Identical features occasionally occur in infant urinary tract infection. WHAT IS NEW: * Most cases of secondary pseudo-hypoaldosteronism associated with a urinary tract infection are concurrently affected by a congenital anomaly of the kidney and urinary tract. * Treatment with antibiotics and parenteral fluids typically results in the normalization of sodium, potassium, bicarbonate, and creatinine within approximately 1 week.
    Tags: *Hypoaldosteronism/complications/diagnosis, *Urinary Tract Infections/complications/diagnosis, Acidosis, Acidosis/etiology/diagnosis, authors declare no conflicts of interest., Female, Humans, Hyperkalemia, Hyperkalemia/etiology/diagnosis, Hyponatremia, Hyponatremia/etiology/diagnosis, Infant, Infant, Newborn, Male, Under-responsiveness to aldosterone, Urinary tract infection.


  • Bettschen D, Tsichlaki D, Chatzimichail E, et al. Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study. BMC Emerg Med. 2024;24(1):121. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39020294. Accessed no date.
    Abstract: BACKGROUND: The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED). METHODS: Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT. RESULTS: The study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases). CONCLUSIONS: This study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.
    Tags: *Anticoagulants/adverse effects/administration & dosage, *Maxillofacial Injuries/epidemiology, Aged, Aged, 80 and over, Anticoagulation, Antiplatelet therapy, Bleeding complications, Elderly falls, Emergency Service, Hospital/statistics & numerical data, Female, Fibrinolytic Agents/administration & dosage/adverse effects, Fractures, Geriatric patients, Humans, Male, Maxillofacial injury, Platelet Aggregation Inhibitors/administration & dosage/adverse effects, Retrospective Studies, Switzerland/epidemiology.


  • Bettschen E, Siepen BM, Goeldlin MB, et al. Time for "code ICH"? - Workflow metrics of hyperacute treatments and outcome in patients with intracerebral haemorrhage. Cerebrovasc Dis. 2024. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38198772. Accessed no date.
    Abstract: INTRODUCTION: Knowledge about uptake and workflow metrics of hyperacute treatments in patients with non-traumatic intracerebral haemorrhage (ICH) in the emergency department are scarce. METHODS: Single centre retrospective study of consecutive patients with ICH between 01/2018-08/2020. We assessed uptake and workflow metrics of acute therapies overall and according to referral mode (stroke code, transfer from other hospital or other). RESULTS: We enrolled 332 patients (age 73years, IQR 63-81 and GCS 14 points, IQR 11-15, onset-to-admission-time 284 minutes, IQR 111-708minutes) of whom 101 patients (35%) had lobar haematoma. Mode of referral was stroke code in 129 patients (38%), transfer from other hospital in 143 patients (43%) and arrival by other means in 60 patients (18%). Overall, 143 of 216 (66%) patients with systolic blood pressure >150mmHG received IV antihypertensive and 67 of 76 (88%) on therapeutic oral anticoagulation received prothrombin complex concentrate treatment (PCC). Forty-six patients (14%) received any neurosurgical intervention within 3 hours of admission. Median treatment times from admission to first IV-antihypertensive treatment was 38 minutes (IQR 18-72minutes) and 59 minutes (IQR 37-111 minutes) for PCC, with significant differences according to mode of referral (p<0.001) but not early arrival (</=6hours of onset, p=0.92). The median time in the emergency department was 139 minutes (IQR 85-220 minutes) and among patients with elevated blood pressure, only 44% achieved a successful control (<140mmHG) during ED stay. In multivariate analysis, code ICH concordant treatment was associated with significantly lower odds for in-hopsital mortality (aOR 0.30, 95%CI 0.12-0.73, p=0.008) and a non-significant trends towards better functional outcome measured using the modified Rankin scale score at 3 months (aOR for ordinal shift 0.54 95%CI 0.26-1.12, p=0.097). CONCLUSION: Uptake of hyperacute therapies for ICH treatment in the ED is heterogeneous. Treatment delays are short but not all patients achieve treatment targets during ED stay. Code ICH concordant treatment may improve clinical outcomes. Further improvements seem achievable advocating for a "code ICH" to streamline acute treatments.


  • Beynon F, Langet H, Bohle LF, et al. The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms. Glob Health Action. 2024;17(1):2326253. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38683158. Accessed no date.
    Abstract: Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal. Devices are implemented with guidance and training, mentorship, and community engagement. Sociodemographic and clinical data are collected from caregivers and records of enrolled sick children aged 0-59 months at study facilities, with phone follow-up on Day 7 (and Day 28 in the RCT). The primary outcomes assessed for the RCT are severe complications (mortality and secondary hospitalisations) by Day 7 and primary hospitalisations (within 24 hours and with referral); and, for the pre-post study, referrals and antibiotic. Secondary outcomes on other aspects of health status, hypoxaemia, referral, follow-up and antimicrobial prescription are also evaluated. In all countries, embedded mixed-method studies further evaluate the effects of the intervention on care and care processes, implementation, cost and cost-effectiveness. Pilot and baseline studies started mid-2021, RCT and post-intervention mid-2022, with anticipated completion mid-2023 and first results late-2023. Study approval has been granted by all relevant institutional review boards, national and WHO ethical review committees. Findings will be shared with communities, healthcare providers, Ministries of Health and other local, national and international stakeholders to facilitate evidence-based decision-making on scale-up.Study registration: NCT04910750 and NCT05065320. Pulse oximetry and clinical decision support algorithms show potential for supporting healthcare providers to identify and manage severe illness among children under-five attending primary care in resource-constrained settings, whilst promoting resource stewardship but scale-up has been hampered by evidence gaps.This study design article describes the largest scale evaluation of these interventions to date, the results of which will inform country- and global-level policy and planning . eng
    Tags: *Algorithms, *Decision Support Systems, Clinical, *Oximetry, Child, Preschool, cluster randomized controlled trial, Humans, Hypoxaemia, Imci, India, Infant, Infant, Newborn, Kenya, primary care, Primary Health Care/organization & administration, quality of care, Senegal, Tanzania.


  • Bigdon SF, Muller M, Rutsch N. Reply to Letter to the Editor "Cervical spine trauma - Evaluating the diagnostic power of CT, MRI, X-ray and Lodox". Injury. 2024;55(4):111453. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38428101. Accessed no date.
    Tags: *Magnetic Resonance Imaging, *Spinal Diseases, and writing of this manuscript. They have collectively reviewed and approved the, authors (SFB, MM, and NR) made substantial contributions to the conceptualization, Cervical Vertebrae/diagnostic imaging, final version., Humans, Radiography, Tomography, X-Ray Computed, X-Rays.


  • Birrenbach T, Stuber R, Muller CE, et al. Virtual reality simulation to enhance advanced trauma life support trainings - a randomized controlled trial. BMC Med Educ. 2024;24(1):666. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38886688. Accessed no date.
    Abstract: BACKGROUND: Advanced Trauma Life Support (ATLS) is the gold standard of initial assessment of trauma patients and therefore a widely used training program for medical professionals. Practical application of the knowledge taught can be challenging for medical students and inexperienced clinicians. Simulation-based training, including virtual reality (VR), has proven to be a valuable adjunct to real-world experiences in trauma education. Previous studies have demonstrated the effectiveness of VR simulations for surgical and technical skills training. However, there is limited evidence on VR simulation training specifically for trauma education, particularly within the ATLS curriculum. The purpose of this pilot study is to evaluate the feasibility, effectiveness, and acceptance of using a fully immersive VR trauma simulation to prepare medical students for the ATLS course. METHODS: This was a prospective randomised controlled pilot study on a convenience sample of advanced medical students (n = 56; intervention group with adjunct training using a commercially available semi-automated trauma VR simulation, n = 28, vs control group, n = 28) taking part in the ATLS course of the Military Physician Officer School. Feasibility was assessed by evaluating factors related to technical factors of the VR training (e.g. rate of interruptions and premature termination). Objective and subjective effectiveness was assessed using confidence ratings at four pre-specified points in the curriculum, validated surveys, clinical scenario scores, multiple choice knowledge tests, and ATLS final clinical scenario and course pass rates. Acceptance was measured using validated instruments to assess variables of media use (Technology acceptance, usability, presence and immersion, workload, and user satisfaction). RESULTS: The feasibility assessment demonstrated that only one premature termination occurred and that all remaining participants in the intervention group correctly stabilised the patient. No significant differences between the two groups in terms of objective effectiveness were observed (p = 0.832 and p = 0.237 for the pretest and final knowledge test, respectively; p = 0.485 for the pass rates for the final clinical scenario on the first attempt; all participants passed the ATLS course). In terms of subjective effectiveness, the authors found significantly improved confidence post-VR intervention (p < .001) in providing emergency care using the ATLS principles. Perceived usefulness in the TEI was stated with a mean of 4 (SD 0.8; range 0-5). Overall acceptance and usability of the VR simulation was rated as positive (System Usability Scale total score mean 79.4 (SD 11.3, range 0-100). CONCLUSIONS: The findings of this prospective pilot study indicate the potential of using VR trauma simulations as a feasible and acceptable supplementary tool for the ATLS training course. Where objective effectiveness regarding test and scenario scores remained unchanged, subjective effectiveness demonstrated improvement. Future research should focus on identifying specific scenarios and domains where VR can outperform or enhance traditional learning methods in trauma simulation.
    Tags: (grant TCR 14/17) as well with an in-house grant of the Clinical Trial Unit and, *Advanced Trauma Life Support Care, *Simulation Training, *Virtual Reality, Academy of Medical Sciences through the "Young Talents in Clinical Research", Adult, Atls, Clinical Competence, Curriculum, decision to publish. The other authors declare that they have no competing, Educational Measurement, Feasibility Studies, Female, Healthcare UK, Mundipharma Medical Switzerland, VisualDx USA, all outside the, Humans, interests., Male, MDI International Australia, and SIWF, all outside the submitted work.WEH has, Medical education, Pilot Projects, professorship of emergency telemedicine at the University of Bern sponsored by, Prospective Studies, received financial support for a congress he chaired from EBSCO Germany, Isabel, research grants from the Swiss heart foundation.TCS holds the endowed, Science foundation, Zoll foundation, Drager Medical Germany, Mundipharma Research, Simulation, Students, Medical, submitted work. WEH has provided paid consultancies to AO foundation Switzerland,, submitted work.MM has been funded by the Bangerter Foundation and the Swiss, the Touring Club Switzerland. The sponsor has no influence on the research or, Trauma management, UK, MDI International Australia, Roche Diagnostics Germany, all outside the, Virtual reality, Young Adult.


  • Blanc S, Studer J, Magill M, et al. Young adults' change talk within brief motivational intervention in the emergency department and booster sessions is associated with a decrease in heavy drinking over 1 year. Psychol Addict Behav. 2024;38(3):243-254. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38546556. Accessed no date.
    Abstract: OBJECTIVE: Investigate the effect of change talk (CT) within successive brief motivational interventions (BMIs) as a mechanism of change for alcohol use. METHOD: We conducted a secondary analysis of data from a randomized controlled trial in which 344 young adults (18-35 years old) admitted to a Swiss emergency department with alcohol intoxication received either BMI (N = 171) or brief advice (N = 173). Participants with a baseline audio-recorded BMI were included (N = 140; median age 23 [Q1-Q3: 20-27], 72.9% men). Up to three booster sessions by phone were offered at 1 week, 1 month, and 3 months. Percent CT and CT Average Strength were used as predictor variables. The outcome was the number of heavy drinking days (HDD) over the 30 days prior to research assessments at 1-, 3-, 6-, and 12-month follow-up. A latent growth curve modeling framework was first used to estimate predictor and outcome variable growth parameters (i.e., intercept and slope) over time, and then to regress HDD growth parameters on CT growth parameters. RESULTS: CT increased specifically from baseline to the 1-week booster session and thereafter remained stable. Higher baseline CT was associated with lower HDD at 1 month (Percent CT: b = -0.04, 95% confidence interval [-0.06, -0.01]; Average Strength: b = -0.99 [-1.67, -0.31]). An increase in CT from baseline to the 1-week booster session was related to a decrease in HDD from 1 month to 12 months (Percent CT: b = -0.08 [-0.14, -0.03]; Average Strength: b = -2.29 [-3.52, -1.07]). CONCLUSIONS: Both baseline CT and CT trajectory over the first week are meaningful predictors of HDD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
    Tags: *Emergency Service, Hospital, *Motivational Interviewing/methods, Adolescent, Adult, Alcohol Drinking/therapy, Alcoholic Intoxication, Female, Humans, Male, Motivation, Psychotherapy, Brief/methods, Switzerland, Young Adult.


  • Blanchard MD, Herzog SM, Kammer JE, Zoller N, Kostopoulou O, Kurvers R. Collective Intelligence Increases Diagnostic Accuracy in a General Practice Setting. Med Decis Making. 2024;44(4):451-462. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38606597. Accessed no date.
    Abstract: BACKGROUND: General practitioners (GPs) work in an ill-defined environment where diagnostic errors are prevalent. Previous research indicates that aggregating independent diagnoses can improve diagnostic accuracy in a range of settings. We examined whether aggregating independent diagnoses can also improve diagnostic accuracy for GP decision making. In addition, we investigated the potential benefit of such an approach in combination with a decision support system (DSS). METHODS: We simulated virtual groups using data sets from 2 previously published studies. In study 1, 260 GPs independently diagnosed 9 patient cases in a vignette-based study. In study 2, 30 GPs independently diagnosed 12 patient actors in a patient-facing study. In both data sets, GPs provided diagnoses in a control condition and/or DSS condition(s). Each GP's diagnosis, confidence rating, and years of experience were entered into a computer simulation. Virtual groups of varying sizes (range: 3-9) were created, and different collective intelligence rules (plurality, confidence, and seniority) were applied to determine each group's final diagnosis. Diagnostic accuracy was used as the performance measure. RESULTS: Aggregating independent diagnoses by weighing them equally (i.e., the plurality rule) substantially outperformed average individual accuracy, and this effect increased with increasing group size. Selecting diagnoses based on confidence only led to marginal improvements, while selecting based on seniority reduced accuracy. Combining the plurality rule with a DSS further boosted performance. DISCUSSION: Combining independent diagnoses may substantially improve a GP's diagnostic accuracy and subsequent patient outcomes. This approach did, however, not improve accuracy in all patient cases. Therefore, future work should focus on uncovering the conditions under which collective intelligence is most beneficial in general practice. HIGHLIGHTS: We examined whether aggregating independent diagnoses of GPs can improve diagnostic accuracy.Using data sets of 2 previously published studies, we composed virtual groups of GPs and combined their independent diagnoses using 3 collective intelligence rules (plurality, confidence, and seniority).Aggregating independent diagnoses by weighing them equally substantially outperformed average individual GP accuracy, and this effect increased with increasing group size.Combining independent diagnoses may substantially improve GP's diagnostic accuracy and subsequent patient outcomes.
    Tags: *General Practice/methods, Artificial Collective Intelligence in Open-Ended Decision Making")., Clinical Decision-Making/methods, collective intelligence, Computer Simulation, decision support systems, Decision Support Systems, Clinical, diagnostic accuracy, Diagnostic Errors/statistics & numerical data, European Commission (Horizon Europe grant 101070588 "HACID: Hybrid Human, Female, general practice, General Practitioners, Humans, Male, medical diagnostics, publication of this article: RHJMK and SMH acknowledge financial support from the, receipt of the following financial support for the research, authorship, and/or, research, authorship, and/or publication of this article. The authors disclosed, wisdom of crowds.


  • Boeddinghaus J, Doudesis D, Lopez-Ayala P, et al. Machine Learning for Myocardial Infarction Compared With Guideline-Recommended Diagnostic Pathways. Circulation. 2024;149(14):1090-1101. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38344871. Accessed no date.
    Abstract: BACKGROUND: Collaboration for the Diagnosis and Evaluation of Acute Coronary Syndrome (CoDE-ACS) is a validated clinical decision support tool that uses machine learning with or without serial cardiac troponin measurements at a flexible time point to calculate the probability of myocardial infarction (MI). How CoDE-ACS performs at different time points for serial measurement and compares with guideline-recommended diagnostic pathways that rely on fixed thresholds and time points is uncertain. METHODS: Patients with possible MI without ST-segment-elevation were enrolled at 12 sites in 5 countries and underwent serial high-sensitivity cardiac troponin I concentration measurement at 0, 1, and 2 hours. Diagnostic performance of the CoDE-ACS model at each time point was determined for index type 1 MI and the effectiveness of previously validated low- and high-probability scores compared with guideline-recommended European Society of Cardiology (ESC) 0/1-hour, ESC 0/2-hour, and High-STEACS (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome) pathways. RESULTS: In total, 4105 patients (mean age, 61 years [interquartile range, 50-74]; 32% women) were included, among whom 575 (14%) had type 1 MI. At presentation, CoDE-ACS identified 56% of patients as low probability, with a negative predictive value and sensitivity of 99.7% (95% CI, 99.5%-99.9%) and 99.0% (98.6%-99.2%), ruling out more patients than the ESC 0-hour and High-STEACS (25% and 35%) pathways. Incorporating a second cardiac troponin measurement, CoDE-ACS identified 65% or 68% of patients as low probability at 1 or 2 hours, for an identical negative predictive value of 99.7% (99.5%-99.9%); 19% or 18% as high probability, with a positive predictive value of 64.9% (63.5%-66.4%) and 68.8% (67.3%-70.1%); and 16% or 14% as intermediate probability. In comparison, after serial measurements, the ESC 0/1-hour, ESC 0/2-hour, and High-STEACS pathways identified 49%, 53%, and 71% of patients as low risk, with a negative predictive value of 100% (99.9%-100%), 100% (99.9%-100%), and 99.7% (99.5%-99.8%); and 20%, 19%, or 29% as high risk, with a positive predictive value of 61.5% (60.0%-63.0%), 65.8% (64.3%-67.2%), and 48.3% (46.8%-49.8%), resulting in 31%, 28%, or 0%, who require further observation in the emergency department, respectively. CONCLUSIONS: CoDE-ACS performs consistently irrespective of the timing of serial cardiac troponin measurement, identifying more patients as low probability with comparable performance to guideline-recommended pathways for MI. Whether care guided by probabilities can improve the early diagnosis of MI requires prospective evaluation. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00470587.
    Tags: *Acute Coronary Syndrome/diagnosis, *Myocardial Infarction/diagnosis, Abbott Diagnostics, outside the submitted work. Dr Koechlin received a research, algorithm. The other authors have reported no relationships relevant to the, and travel support from Medtronic, all outside the submitted work. Dr Lopez-Ayala, Biomarkers, Boeddinghaus, Doudesis, Lee, Bularga, Ferry, Tuck, Anand, and Gray are employees, Boehringer Ingelheim, Bayer, BMS, Idorsia, Novartis, Osler, Roche, and Sanofi,, contents of this article to disclose., Coulter, Bayer, Ortho Clinical Diagnostics, and Orion Pharma, outside the, Diagnostics, Ortho Clinical Diagnostics, Quidel Corporation, and Beckman Coulter,, Diagnostics, Siemens Healthineers, and Abbott Diagnostics, outside the submitted, Diagnostics, Siemens Healthineers, and LumiraDx. Dr Mueller has received research, Diagnostics, which had no role in the study design, data analysis, manuscript, Dr Nestelberger has received research support from the Swiss National Science, Edinburgh and honoraria or consultancy from Abbott Diagnostics, Roche, Female, Foundation (grant P400PM_191037/1), the Prof Dr Max Cloetta Foundation, the, Freiwillige Akademische Gesellschaft, as well as speaker honoraria from Roche, grant from the University of Basel, the Swiss Heart Foundation, the SAMW, and the, has received speaker honoraria or consultancy from Quidel, paid to the, Hospital Basel, as well as speaker or consulting honoraria from Siemens, Beckman, Humans, institution, outside the submitted work. Dr Lee has received honoraria from, Machine Learning, Male, Margarete und Walter Lichtenstein-Stiftung (grant 3MS1038), and the University, Middle Aged, myocardial infarction, of the University of Edinburgh, which has filed for a patent on the CoDE-ACS, Ortho Clinical Diagnostics, Quidel, Roche, Siemens, Singulex, and Sphingotec, as, outside of the submitted work. The cardiac troponin assay was donated by Abbott, preparation, or the decision to submit the manuscript for publication. Drs Mills,, submitted work. Dr Mills has received research grants to the University of, support from Abbott Diagnostics, Beckman Coulter, bioMerieux, Idorsia, Novartis,, the University of Queensland, Brisbane, Australia, and the University of Basel., Troponin, Troponin T.


  • Bonhomme V, Putensen C, Böttiger BW, et al. Brain health. European Journal of Anaesthesiology Intensive Care. 2024;3(6):e0063. Available at: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85207432140&doi=10.1097%2fEA9.0000000000000063&partnerID=40&md5=28346f6c877bc84517c68f6c31971c47. Accessed no date.
    Abstract: Damage to the brain can have disastrous and long-lasting consequences. The European Society of Anaesthesiology and Intensive Care (ESAIC) is aware of the importance of taking good care of the brain, both of patients and of anaesthesia and intensive care unit (ICU) caregivers, and has organised a complete learning track on brain health to bring this concern to the attention of practitioners. This learning track included an online Focus Meeting on Brain Health (November 25, 2023). We here provide readers with a digest of the information that was delivered during that meeting in an opinion paper driven by the authors’ own reading of the literature. It is divided according to the meeting’s sessions, including how to improve the health of an injured brain, how to keep a young or old brain healthy, how to keep a healthy adult brain unimpaired, how monitoring can impact brain health in the operating room and in the intensive care unit, and how to keep the anaesthesia and ICU caregivers’ brain healthy. Each part is a brief and focused summary. The main delivered messages are that the management of injured brain patients involves an adequate choice of sedation, adequate brain monitoring, and focused attention to specific points depending on the underlying pathology; that several measures can be undertaken to protect the brain of the very young needing anaesthesia; that it is possible to detect older patients at risk of postoperative neurocognitive disorders, and that dedicated perioperative management by a multidisciplinary expert team may improve their outcomes; that apparently healthy adult brains may suffer during anaesthesia; that the electroencephalogram may track peri-operative brain dysfunction, and that female patients should be given special care in this respect; that multimodal brain monitoring helps to detect pathological processes and to maintain brain homeostasis; and that burnout in anaesthesiologists can be effectively fought using personal, organisational, managerial and legal approaches. Copyright © 2024 The Author(s).


  • Bountouvis N, Koumpa E, Skoutarioti N, Kladitis D, Exadaktylos AK, Anitsakis C. Burden of Disease in Refugee Patients with Diabetes on the Island of Lesvos-The Experience of a Frontline General Hospital. Int J Environ Res Public Health. 2024;21(7). Available at: https://www.ncbi.nlm.nih.gov/pubmed/39063405. Accessed no date.
    Abstract: Diabetes mellitus is a non-communicable disease which poses a great burden on refugee populations, who are confronted with limited access to healthcare services and disruption of pre-existing pharmacological treatment. AIMS: We sought to evaluate the degree of hyperglycaemia in refugees with known or recently diagnosed diabetes, to assess cardiovascular comorbidities and diabetes complications, to review and provide available therapeutic options, and to compare, if possible, the situation in Lesvos with other locations hosting refugee populations, thus raising our awareness towards barriers to accessing healthcare and managing diabetes in these vulnerable populations and to propose follow-up strategies. METHODS: We retrospectively studied 69 refugee patients (68% of Afghan origin, 64% female) with diabetes mellitus (81% with type 2 diabetes), who were referred to the diabetes outpatient clinics of the General Hospital of Mytilene, Lesvos, Greece, between June 2019 and December 2020. Age, Body Mass Index, diabetes duration, glycaemic control (HbA1c and random glucose), blood pressure, estimated renal function, lipid profile, diabetes complications and current medication were documented at presentation and during subsequent visits. RESULTS: For all patients with type 1 diabetes and type 2 diabetes, age at presentation was 17.7 and 48.1 years, BMI 19.6 kg/m(2) and 28.9 kg/m(2) and HbA1c 9.6% and 8.7%, respectively (all medians). One-third (29%) of patients with type 2 diabetes presented either with interrupted or with no previous pharmacological treatment. Insulin was administered to only 21% of refugees with poorly controlled type 2 diabetes. Only half of the patients (48%) with hypertension were taking antihypertensive medication and one-sixth (17%) were taking lipid-lowering medication. Forty-two per cent (42%) of patients were lost to follow-up. CONCLUSIONS: Our results showed that a significant portion of refugees with diabetes have either no treatment at all or have had their treatment discontinued, that insulin is still underutilised and that a significant portion of patients are lost to follow-up. It is essential to enhance our ability to identify refugees who may be at risk of developing diabetes or experiencing complications related to the disease. Additionally, it is important to expand access to crucial treatment and monitoring services. By improving our policies for managing non-communicable diseases, we can better support the health and well-being of these vulnerable populations. Furthermore, it is vital to recognize that Greece cannot bear the burden of the refugee crisis alone; international support and collaboration are necessary to address these challenges effectively.
    Tags: *Diabetes Mellitus, Type 2/drug therapy/complications, *Refugees/statistics & numerical data, Adolescent, Adult, Aged, barriers to accessing healthcare, Cost of Illness, diabetes, Diabetes Mellitus, Type 1/drug therapy/complications, Female, Hospitals, General, Humans, Lesvos refugee camps, Male, Middle Aged, refugees, Retrospective Studies, Young Adult.


  • Bourlond B, Dupre M, Carron PN, Liaudet L, Eeckhout E. Outcomes and relevance of emergency percutaneous coronary angiography and intervention after resuscitated cardiac arrest: a retrospective study. BMC Cardiovasc Disord. 2024;24(1):425. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39138425. Accessed no date.
    Abstract: BACKGROUND: In patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established. METHODS: We retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses. RESULTS: We analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients. CONCLUSIONS: Our results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.
    Tags: *Cardiopulmonary Resuscitation, *Coronary Angiography, *Out-of-Hospital Cardiac Arrest/diagnostic imaging/mortality, Cardiac arrest, Coronary angiography, Emergencies, Humans, Percutaneous intervention, Retrospective Studies, ST segment elevation, Survival.


  • Brasier N, Frobert O, De Ieso F, Meyer D, Kowatsch T, Ghaffari R. The potential of wearable sweat sensors in heart failure management. Nature Electronics. 2024;7(3):182-184. Available at: ://WOS:001190194000001. Accessed no date.
    Abstract: Wearable sweat sensors could be used to monitor patients with heart failure, providing a route to personalized and automated patient management in hospitals and at home.


  • Brauer SK, Musy AA, Schneider S, et al. Using Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a Rescue Strategy in Severe Postpartum Hemorrhage: A Case Report. Diagnostics (Basel). 2024;14(17). Available at: https://www.ncbi.nlm.nih.gov/pubmed/39272763. Accessed no date.
    Abstract: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Routine treatment of PPH includes uterotonics, tranexamic acid, curettage, uterine (balloon) tamponade, compression sutures, uterine artery ligation, and, if available, transcatheter arterial embolization (TAE). In cases of severe PPH refractory to standard medical and surgical management, hysterectomy is usually the ultima ratio, and is equally associated with a higher rate of complications. In addition, this sudden loss of fertility, especially in young women, can be devastating. Here, we report a case of a 29-year-old woman who suffered from severe PPH with a blood loss > 1500 mL and hemodynamic instability after delivery of her first baby at a smaller hospital. She was consequently successfully treated with resuscitative endovascular balloon occlusion of the aorta (REBOA) by first placing a balloon catheter into the infra-renal aorta and subsequent TAE after failure of all other available treatment options prior to hysterectomy. TAE has been suggested in PPH treatment to avoid hysterectomies and thus to preserve patients' reproductive function. If hemodynamic stabilization cannot be achieved with mass transfusion, REBOA seems to be an effective rescue strategy with which to achieve hemodynamic stabilization and gain additional time for embolization. Although REBOA is already recommended in several PPH guidelines, this approach seems relatively unknown in German-speaking countries.
    Tags: multidisciplinary approach, postpartum hysterectomy, Reboa, resuscitative endovascular balloon occlusion of the aorta, severe postpartum hemorrhage.


  • Breindahl N, Bierens JLM, Wiberg S, Barcala-Furelos R, Maschmann C. Prehospital guidelines on in-water traumatic spinal injuries for lifeguards and prehospital emergency medical services: an international Delphi consensus study. Scand J Trauma Resusc Emerg Med. 2024;32(1):76. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39180135. Accessed no date.
    Abstract: BACKGROUND: Trauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed. METHODS: An international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (>/= 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75-85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (< 75% agreement) were excluded. In Delphi round 3, the level of consensus for each of the final recommendations and each of the routes in the flowchart was tested using the same procedure as in Delphi round 2. RESULTS: Twenty-four experts participated in Delphi round one. The response rates for Delphi rounds two and three were 92% and 88%, respectively. The study resulted in 25 recommendations and one flowchart with four flowchart paths; 24 recommendations received strong consensus (>/= 85%), and one recommendation received moderate consensus (81%). Each of the four paths in the flowchart received strong consensus (90-95%). The integral flowchart received strong consensus (93%). CONCLUSIONS: This study produced expert consensus on 25 recommendations and a flowchart on handling patients with suspected in-water TSCI by trained lifeguards and prehospital EMS. These results provide clear and simple guidelines on SMR, which can standardise training and guidelines on SMR performed by trained lifeguards or prehospital EMS.
    Tags: *Consensus, *Delphi Technique, *Emergency Medical Services/standards, *Spinal Cord Injuries/therapy, Delphi, Drowning, Emergency medical service (EMS), Guideline, Humans, Lifeguard, Practice Guidelines as Topic, Spinal cord injuries, Spinal fractures, Spinal injuries, Spinal Injuries/therapy, Trauma, Water.


  • Brockhus LA, Liasidis P, Lewis M, Jakob DA, Demetriades D. Injury patterns and outcomes in motorcycle driver crashes in the United States: The effect of helmet use. Injury. 2024;55(3):111196. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38030451. Accessed no date.
    Abstract: BACKGROUND: Motorcycle crashes pose a persistent public health problem with disproportionate rates of severe injuries and mortality. This study aims to analyze injury patterns and outcomes with regard to helmet use. We hypothesized that helmet use is associated with fewer head injuries and does not increase the risk of cervical spine injuries. METHODS: The National Trauma Data Bank was queried for all motorcycle driver crashes between 2007-2017. Univariable analysis was used to compare demographics, clinical data, injury patterns using abbreviated injury scale, and outcomes between helmeted motorcycle drivers and non-helmeted motorcycle drivers who were injured in traffic crashes. Independent factors associated with mortality were determined by regression analysis after adjustment for potential confounders. RESULTS: A total of 315,258 patients were included for analysis, 66 % of these patients were helmeted. The sample was 92.5 % male and the median age was 41 years. Non-helmeted motorcycle drivers were more likely to sustain severe head trauma (head abbreviated injury scale >/= 3: 28.5 % vs. 13.3 %, p < 0.001), had higher intensive care unit-admission (38 % vs. 30.2 %, p<0.001), mechanical ventilation (20.1 % vs. 13 %, p<0.001) and overall mortality rates (6.2 % vs. 3.9 %, p<0.001). Cervical spine injuries occurred in 10.6 % of non-helmeted motorcycle drivers and in 9.5 % of helmeted motorcycle drivers (p<0.001). Helmet use was identified as an independent factor associated with lower mortality [OR 0.849 (0.809-0.891), p<0.001]. CONCLUSION: Helmet use is protective for severe head injuries and associated with decreased mortality. Helmet use was not associated with increased rates of cervical spine injuries. On the contrary, fewer injuries were observed in helmeted motorcycle drivers. Public health initiatives should be aimed at enforcement of universal helmet laws within the United States and across the world.
    Tags: *Craniocerebral Trauma/epidemiology/prevention & control, *Neck Injuries, *Spinal Injuries/epidemiology/prevention & control, Accidents, Accidents, Traffic, Adult, Cervical spine, Crash, Female, Head Protective Devices, Helmet, Humans, interest and these data have not been published elsewhere., Male, Motorcycle, Motorcycles, United States/epidemiology.


  • Brockhus L, Hofmann E, Keitel K, Bartsch M, Muller M, Klukowska-Rotzler J. Emergency department utilisation and treatment for trauma-related presentations of adolescents aged 16-18: a retrospective cross-sectional study. BMC Emerg Med. 2024;24(1):33. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38413869. Accessed no date.
    Abstract: BACKGROUND: A recent study conducted at our tertiary hospital emergency department (ED) reviewed ED consultations and found that adolescents aged 16-18 years present significantly more often for trauma and psychiatric problems than adults over 18 years. Accidental injuries are one of the greatest health risks for children and adolescents. In view of the increased vulnerability of the adolescent population, this study aimed to further analyse trauma-related presentations in adolescents. METHODS: We conducted a single-centre, retrospective, cross-sectional study of all adolescent trauma patients aged 16 to 18 years presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from January 2013 to July 2017. We analysed presentation data as well as inpatient treatment and cost-related data. Data of female and male patients were compared by univariable analysis. A comparison group was formed consisting of 200 randomly chosen patients aged 19-25 years old with the same presentation characteristics. Predictive factors for surgical treatment were obtained by multivariable analysis. RESULTS: The study population included a total of 1,626 adolescent patients aged 16-18 years. The predominant causes for ED presentation were consistent within case and comparison groups for sex and age and were sports accidents, falls and violence. Male patients were more likely to need surgical treatment (OR 1.8 [95% CI: 1.2-2.5], p = 0.001) and consequently inpatient treatment (OR 1.5 [95% CI: 1.1-2.1], p = 0.01), associated with higher costs (median 792 Swiss francs [IQR: 491-1,598]). Other independent risk factors for surgical treatment were violence-related visits (OR 2.1 [95% CI: 1.3-3.5, p = 0.004]) and trauma to the upper extremities (OR 2.02 [95% CI: 1.5-2.8], p < 0.001). Night shift (OR 0.56 [95% CI: 0.37-0.86], 0.008) and walk-in consultations (OR 0.3 [95% CI: 0.2; 0.4, < 0.001] were preventive factors for surgical treatment. CONCLUSIONS: Male adolescents account for the majority of emergency visits and appear to be at higher risk for accidents as well as for surgical treatment and/or inpatient admission due to sports accidents or injuries from violence. We suggest that further preventive measures and recommendations should be implemented and that these should focus on sport activities and injuries from violence.
    Tags: *Emergency Service, Hospital, *Hospitalization, Accidents, Adolescent, Adolescents, Adult, Child, Cross-Sectional Studies, Female, Humans, Male, Retrospective Studies, Sex comparison, Trauma, Young Adult.


  • Brugger H, Maeder MB. Mountain emergency medicine. In: Safeguarding Mountain Social-Ecological Systems.; 2024:57-61. Available at: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85184316664&doi=10.1016%2fB978-0-12-822095-5.00009-7&partnerID=40&md5=e8985f1eebb24d7876b1bdcb4411059d. Accessed no date.
    Abstract: “Mountain emergency medicine” by definition is an emergency. In the wilderness, a mild disease or slight injury can become a serious problem. Mountain rescue originated among people who had established a close relationship with the mountains and stemmed from a strong sense of solidarity and thorough experience of the mountain environment. In Europe and North America, around 40,000 rescuers and 750 helicopters are ready for evacuation of casualties and patients in mountain areas. More than 1300 physicians and 50,000 paramedics take part in ground and air mountain rescue operations. Outside of Europe and North America, mountain emergency medicine is, however, still almost nonexistent, although 10% of the global population lives at altitudes >1500m and recreational activities in the mountains worldwide are significantly increasing. In the near future, climate change will become more and more the greatest challenge. Numbers of serious weather-related events are increasing as well as heat-related illnesses and vector-borne diseases. Robust rescue chains must be implemented, especially in developing countries. Nations should be supported by regional networks and mechanisms as well as international organizations for operational emergency response. © 2024 Elsevier Inc. All rights reserved.


  • Brunner L, Siebert JN, Ehrler F, Manzano S, Marti J. Evaluating the Economic Impact of the PedAMINES App in Reducing Medication Errors in Pediatric Emergency Care: Cost-Effectiveness Analysis. J Med Internet Res. 2024;26:e52077. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39454199. Accessed no date.
    Abstract: BACKGROUND: The administration of drugs in pediatric emergency care is a time-consuming process and is associated with a higher occurrence of medication errors compared with adult care. This is attributed to the intricacies of administration, which involve calculating doses based on the child's weight or age. To mitigate the occurrence of adverse drug events (ADEs), the PedAMINES (Pediatric Accurate Medication in Emergency Situations; Geneva University Hospitals) mobile app has been developed. This app offers a step-by-step guide for preparing and administering pediatric drugs during emergency interventions by automating the dose calculation process. Although previous simulation-based randomized controlled trials conducted in emergency care have demonstrated the efficacy of the PedAMINES app in reducing drug administration errors, there is a lack of evidence regarding its economic implications. OBJECTIVE: This study aims to evaluate the cost-effectiveness of implementing the PedAMINES app for 4 emergency drugs: epinephrine, norepinephrine, dopamine, and midazolam. METHODS: The economic evaluation was conducted by combining hospital data from 2019, previous trial outcomes, information extracted from existing literature, and PedAMINES maintenance costs. The cost per avoided medication error was calculated, along with the number of administrations needed to achieve a positive return on investment. Subsequently, Monte Carlo simulations were used to identify the key parameters contributing to result uncertainty. RESULTS: The study revealed the number of preventable errors per administration for the 4 examined drugs: 0.513 for epinephrine, 0.484 for norepinephrine, 0.500 for dopamine, and 0.671 for midazolam. The cost-effectiveness ratios per ADE prevented were computed as follows: US $4808 for epinephrine, US $9705 for norepinephrine, US $6957 for dopamine, and US $2074 for midazolam. Accounting for the economic impact of ADEs, the analysis estimated that 16 administrations of epinephrine, 17 of norepinephrine and dopamine, and 13 of midazolam would be required to attain a positive return on investment. This corresponds to roughly one-third of the annual administrations at a major university hospital in Switzerland. The primary factors influencing the uncertainty in the estimated cost per ADE include the cost of maintenance of the app, the likelihood of an ADE resulting from an administration error, and the frequency of underdosing in the trial's control group. CONCLUSIONS: A dedicated mobile app presents an economically viable solution to alleviate the health and economic burden of drug administration errors in in-hospital pediatric emergency care. The widespread adoption of this app is advocated to pool costs and extend the benefits on a national scale in Switzerland.
    Tags: *Cost-Benefit Analysis/methods, *Medication Errors/prevention & control/economics, *Mobile Applications/economics, adverse drug event, All authors declare no competing interests. The PedAMINES mobile app is owned by, ambulance care, Child, child care, cost-effectiveness, Cost-Effectiveness Analysis, dopamine, Dopamine/economics/therapeutic use, economic evaluation, emergency care, Emergency Medical Services/economics, employees of Geneva University Hospitals, JNS, FE, and SM may receive, epinephrine, Epinephrine/economics/administration & dosage/therapeutic use, evidence-based, Geneva University Hospitals and is not currently available for commercial use. As, health information technology, Humans, institutional benefits if the app is commercialized in the future., medical app, medication error, midazolam, Midazolam/therapeutic use/economics/administration & dosage, mobile phone, norepinephrine, Norepinephrine/economics/therapeutic use/administration & dosage, PedAMINES, pediatric, Pediatric Accurate Medication in Emergency Situations, pediatric care, pediatric emergency care, Pediatrics/economics/methods, Situations) app is not available on the Google Play Store or the Apple App Store., Switzerland.


  • Buchkremer F, Schuetz P, Mueller B, Segerer S. Corrigendum to "Classifying Hypotonic Hyponatremia by Projected Treatment Effects - A Quantitative 3-Dimensional Framework" [Kidney International Reports Volume 8, Issue 12, December 2023, Pages 2720-2732]. Kidney Int Rep. 2024;9(4):1142-1143. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38765584. Accessed no date.
    Abstract: [This corrects the article DOI: 10.1016/j.ekir.2023.09.002.].


  • Buchmueller LC, Wunderle C, Laager R, et al. Association of phenylalanine and tyrosine metabolism with mortality and response to nutritional support among patients at nutritional risk: a secondary analysis of the randomized clinical trial EFFORT. Front Nutr. 2024;11:1451081. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39600719. Accessed no date.
    Abstract: BACKGROUND: Elevated phenylalanine serum level is a surrogate marker of whole-body proteolysis and has been associated with increased mortality in critically ill patients. Tyrosine is a metabolite of phenylalanine and serves as a precursor of thyroid hormones and catecholamines with important functions in the oxidative stress response among others. Herein, we examined the prognostic significance of phenylalanine, tyrosine, as well as its metabolites nitrotyrosine, L-3,4-dihydroxyphenylalanine (DOPA), and dopamine regarding clinical outcomes and response to nutritional therapy in patients at nutritional risk. METHODS: This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized controlled trial investigating individualized nutritional support compared to standard care in patients at risk of malnutrition. The primary outcome was 30-day all-cause mortality. RESULTS: We analyzed data of 238 patients and found a significant association between low plasma levels of phenylalanine [adjusted HR 2.27 (95% CI 1.29 to 3.00)] and tyrosine [adjusted HR 1.91 (95% CI 1.11 to 3.28)] with increased 30-day mortality. This association persisted over a longer period, extending to 5 years. Additionally, trends indicated elevated mortality rates among patients with low nitrotyrosine and high DOPA and dopamine levels. Patients with high tyrosine levels showed a more pronounced response to nutritional support compared to patients with low tyrosine levels (HR 0.45 versus 1.46, p for interaction = 0.02). CONCLUSION: In medical inpatients at nutritional risk, low phenylalanine and tyrosine levels were associated with increased short-and long-term mortality and patients with high tyrosine levels showed a more pronounced response to nutritional support. Further research is warranted to gain a deeper understanding of phenylalanine and tyrosine pathways, their association with clinical outcomes in patients at nutritional risk, as well as their response to nutritional therapy. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov, identifier NCT02517476.
    Tags: advisory. The funders were not involved in the study design, collection,, advisory. ZS reports a relationship with Fresenius Kabi that includes: consulting, analysis, interpretation of data, the writing of this article, or the decision to, be construed as a potential conflict of interest., biomarker, conducted in the absence of any commercial or financial relationships that could, grants and speaking and lecture fees. PS reports a relationship with Abbott that, includes: funding grants and speaking and lecture fees. PS reports a relationship, individualized nutrition support, malnutrition, or advisory. ZS reports a relationship with B. Braun that includes: consulting or, phenylalanine, polymorbid patient, PS reports a relationship with Nestle Health Science that includes: funding, relationship with Nestle Health Science that includes: consulting or advisory. ZS, reports a relationship with Abbott Nutrition that includes: consulting or, submit it for publication. The remaining authors declare that the research was, tyrosine, with Fresenius that includes: speaking and lecture fees. ZS reports a.


  • Buclin CP, Doninelli M, Bertini L, et al. Monitoring equity in the delivery of health services: a Delphi process to select healthcare equity indicators. Swiss Med Wkly. 2024;154(10):3714. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39463419. Accessed no date.
    Abstract: AIMS OF THE STUDY: Health equity is a key component of quality of care and an objective for a growing number of quality improvement projects for deontological, ethical, public health and economic reasons. To monitor equity in the delivery of health services in Switzerland, there is a need to implement valid, measurable and actionable equity indicators, along with vulnerability stratifiers such as migrant status, which could lead to differences in quality of care. The aim of this study was to develop a set of healthcare equity indicators and stratifiers targeting inpatient and outpatient populations and to test their feasibility. METHODS: A scoping literature review and inputs from a national interprofessional expert taskforce provided a set of indicators and vulnerability stratifiers. The most valid and measurable indicators and stratifiers were retained using a Delphi process. They were then operationalised, and their implementation tested in three Swiss hospitals from the three language regions. RESULTS: A taskforce of 18 experts, including a patient representative, selected 11 indicators that evaluate structures, processes and outcomes, and five vulnerability stratifiers. Although most indicators and stratifiers could be implemented in all three hospitals, data availability was limited for some variables, including patient satisfaction and access to interpreters for foreign-language patients. CONCLUSIONS: The equity indicators and stratifiers identified by this two-stage process have content validity, wide patient coverage and are focused on inequities in the healthcare system that are actionable through improvement projects. Both the indicators and the project methodology could be replicated in institutions aiming for more equitable care.
    Tags: *Delivery of Health Care/standards, *Delphi Technique, *Health Equity, *Quality Indicators, Health Care, Health Services Accessibility, Healthcare Disparities, Humans, Quality Improvement, Quality of Health Care, Switzerland.


  • Buclin CP, Uribe A, Daverio JE, et al. Validation of French versions of the 15-item picker patient experience questionnaire for adults, teenagers, and children inpatients. Front Public Health. 2024;12:1297769. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38439757. Accessed no date.
    Abstract: OBJECTIVES: No French validated concise scales are available for measuring the experience of inpatients in pediatrics. This study aims to adapt the adult PPE-15 to a pediatric population, and translating it in French, as well as to establish reference values for adults, teenagers, and parents of young children. METHODS: Cultural adaptation involved forward and backward translations, along with pretests in all three populations. Dimensional structure and internal consistency were assessed using principal component analysis, exploratory factor analysis, and Cronbach's alpha. Construct validity was assessed by examining established associations between patient satisfaction and inpatient variables, including length of stay, and preventable readmission. RESULTS: A total of 25,626 adults, 293 teenagers and 1,640 parents of young children completed the French questionnaires. Factor analysis supported a single dimension (Cronbach's alpha: adults: 0.85, teenagers: 0.82, parents: 0.80). Construct validity showed the expected pattern of association, with dissatisfaction correlating with patient- and stay-related factors, notably length of stay, and readmission. CONCLUSION: The French versions of the PPE-15 for adults, teenagers and parents of pediatric patients stand as valid and reliable instruments for gauging patient satisfaction regarding their hospital stay after discharge.
    Tags: *Emotions, *Inpatients, Adolescent, Adult, Child, Child, Preschool, commercial or financial relationships that could be construed as a potential, conflict of interest., Factor Analysis, Statistical, healthcare access, healthcare evaluation, healthcare quality, hospitals, Humans, inpatients background, Parents, Patient Outcome Assessment, patient satisfaction, validation study.


  • Calvisi SL, Olarte D, Meloni M, Bianchi S. Sonographic diagnosis of radiographically undetectable bennet fracture. J Ultrasound. 2024. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38691324. Accessed no date.
    Abstract: Intra-articular fractures of the base of the first metacarpal (Bennet fractures) are prone to dislocation and require surgical reduction and fixation to prevent secondary degenerative joint disease and chronic dysfunction. Therefore, a prompt diagnosis is necessary, mostly achieved by conventional roentgenograms. We report the case of a 62-year-old man in whom a Bennet fracture was highly suspected on ultrasound (US) examination realized after a fall. Standard radiographs, obtained after US to confirm the diagnosis, were interpreted as normal. A computed tomography was then performed showing a typical Bennet fracture. This case report demonstrates that a careful assessment of bones must be an integral part of any routine musculo-skeletal US examination, particularly in post-traumatic patients. US can detect bone fractures where radiograph is not discriminating.
    Tags: Bennet fractures, Joints, Musculo-skeletal ultrasound, Trauma.


  • Camporesi S, Xin L, Golay P, et al. Neurocognition and NMDAR co-agonists pathways in individuals with treatment resistant first-episode psychosis: a 3-year follow-up longitudinal study. Mol Psychiatry. 2024;29(11):3669-3679. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38849515. Accessed no date.
    Abstract: This study aims to determine whether 1) individuals with treatment-resistant schizophrenia display early cognitive impairment compared to treatment-responders and healthy controls and 2) N-methyl-D-aspartate-receptor hypofunction is an underlying mechanism of cognitive deficits in treatment-resistance. In this case‒control 3-year-follow-up longitudinal study, n = 697 patients with first-episode psychosis, aged 18 to 35, were screened for Treatment Response and Resistance in Psychosis criteria through an algorithm that assigns patients to responder, limited-response or treatment-resistant category (respectively resistant to 0, 1 or 2 antipsychotics). Assessments at baseline: MATRICS Consensus Cognitive Battery; N-methyl-D-aspartate-receptor co-agonists biomarkers in brain by MRS (prefrontal glutamate levels) and plasma (D-serine and glutamate pathways key markers). Patients were compared to age- and sex-matched healthy controls (n = 114). Results: patient mean age 23, 27% female. Treatment-resistant (n = 51) showed lower scores than responders (n = 183) in processing speed, attention/vigilance, working memory, verbal learning and visual learning. Limited responders (n = 59) displayed an intermediary phenotype. Treatment-resistant and limited responders were merged in one group for the subsequent D-serine and glutamate pathway analyses. This group showed D-serine pathway dysregulation, with lower levels of the enzymes serine racemase and serine-hydroxymethyltransferase 1, and higher levels of the glutamate-cysteine transporter 3 than in responders. Better cognition was associated with higher D-serine and lower glutamate-cysteine transporter 3 levels only in responders; this association was disrupted in the treatment resistant group. Treatment resistant patients and limited responders displayed early cognitive and persistent functioning impairment. The dysregulation of NMDAR co-agonist pathways provides underlying molecular mechanisms for cognitive deficits in treatment-resistant first-episode psychosis. If replicated, our findings would open ways to mechanistic biomarkers guiding response-based patient stratification and targeting cognitive improvement in clinical trials.
    Tags: *Antipsychotic Agents/therapeutic use/pharmacology, *Cognitive Dysfunction/drug therapy/metabolism, *Psychotic Disorders/drug therapy/metabolism, *Receptors, N-Methyl-D-Aspartate/metabolism, Adolescent, Adult, Brain/metabolism, Case-Control Studies, Cognition/physiology/drug effects, Female, Follow-Up Studies, Glutamic Acid/metabolism, Humans, Longitudinal Studies, Male, Neuropsychological Tests, Schizophrenia, Treatment-Resistant/drug therapy/metabolism, Schizophrenia/drug therapy/metabolism, Young Adult.


  • Cazzaniga S, Heidemeyer K, Zahn CA, et al. Dermatological emergencies and determinants of hospitalization in Switzerland: A retrospective study. J Eur Acad Dermatol Venereol. 2024. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38959376. Accessed no date.
    Abstract: BACKGROUND: Dermatologic conditions are estimated to account worldwide for approximately 8% of all visits at emergency departments (EDs). Although rarely life-threatening, several dermatologic emergencies may have a high morbidity. Little is known about ED consultations of patients with dermatological emergencies and their subsequent hospital disposal. OBJECTIVE: We explore determinants and clinical variables affecting patients' disposal and hospitalization of people attending the ED at a Swiss University Hospital, over a 56-month observational period, for a dermatological problem. METHODS: De-identified patients' information was extracted from the hospital electronic medical record system. Generalized estimating equations were used to explore determinants of patient's disposition. RESULTS: Out of 5096 consecutive patients with a dermatological main problem evaluated at the ED, 79% of patients were hospitalized after initial assessment. In multivariable analyses, factors which were significantly associated with an increased admission rate included length of ED stay, age >/= 45 years, male sex, distinct vital signs, high body mass index, low oxygen saturation, admission time in the ED and number and type of dermatological diagnoses. Only 2.2% of the hospitalized patients were admitted to a dermatology ward, despite the fact that they had dermatological diagnoses critically determining the diagnostic related group (DRG) payment. The number of patients managed by dermatologists during in-patient treatment significantly decreased over the study period. CONCLUSIONS: Our study identifies a number of independent predictors affecting the risk of hospital admission for patients with dermatological conditions, which may be useful to improve patients' disposal in EDs. The results indicate that the dermatological specialty is becoming increasingly marginalized in the management of patients in the Swiss hospital setting. This trend may have significant implications for the delivery of adequate medical care, outcomes and cost-effectiveness. Dermatologists should be more engaged to better position their specialty and to effectively collaborate with nondermatologists to enhance patient care.


  • Chaibi S, Roy PM, Guenegou AA, et al. Outpatient management of cancer-associated pulmonary embolism: A post-hoc analysis from the HOME-PE trial. Thromb Res. 2024;235:79-87. Available at: https://www.ncbi.nlm.nih.gov/pubmed/38308882. Accessed no date.
    Abstract: INTRODUCTION: Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of patients with low-risk cancer-associated PE. METHODS: In the HOME-PE trial, hemodynamically stable patients with symptomatic PE were randomized to either triaging with Hestia criteria or sPESI score. We analyzed 3 groups of low-risk PE patients: 47 with active cancer treated at home (group 1), 691 without active cancer treated at home (group 2), and 33 with active cancer as the only sPESI criterion qualifying them for hospitalization (group 3). The main outcome was the composite of recurrent venous thromboembolism, major bleeding, and all-cause death within 30 days after randomization. RESULTS: Patients treated at home had composite outcome rates of 4.3 % (2/47) for those with cancer vs. 1.0 % (7/691) for those without (odds ratio (OR) 4.98, 95%CI 1.15-21.49). Patients with cancer had rates of complications of 4.3 % when treated at home vs. 3.0 % (1/33) when hospitalized (OR 1.19, 95%CI 0.15-9.47). In multivariable analysis, active cancer was associated with an increased risk of complications for patients treated at home (OR 7.95; 95%CI 1.48-42.82). For patients with active cancer, home treatment was not associated with the primary outcome (OR 1.19, 95%CI 0.15-9.74). CONCLUSIONS: Among patients treated at home, active cancer was a risk factor for complications, but among patients with active cancer, home treatment was not associated with adverse outcomes.
    Tags: *Neoplasms/complications/therapy, *Pulmonary Embolism/complications/therapy, Ambulatory Care, board membership, consulting or advisory, and speaking and lecture fees. Olivier, board membership, funding grants, and speaking and lecture fees. Olivier SANCHEZ, cancer, fees. Olivier SANCHEZ reports a relationship with Pfizer France that includes:, Humans, Inc that includes: board membership and funding grants. Olivier SANCHEZ reports a, includes: board membership, funding grants, and speaking and lecture fees., interests or personal relationships that could have appeared to influence the, interests/personal relationships which may be considered as potential competing, interests: Olivier SANCHEZ reports a relationship with Bayer AG that includes:, membership, consulting or advisory, and speaking and lecture fees. Olivier, membership, consulting or advisory, funding grants, and speaking and lecture, membership. Olivier SANCHEZ reports a relationship with Inari Medical Inc that, Olivier SANCHEZ reports a relationship with Boehringer Ingelheim Pharmaceuticals, Outpatient treatment, Outpatients, Prognosis, Pulmonary embolism, relationship with LEO Pharma France that includes: speaking and lecture fees. If, reports a relationship with Sanofi Aventis France that includes: board, Risk Factors, SANCHEZ reports a relationship with Boston Scientific Corp that includes: board, SANCHEZ reports a relationship with Bristol Myers Squibb Co that includes: board, there are other authors, they declare that they have no known competing financial, work reported in this paper..


  • Chiollaz AC, Pouillard V, Habre C, et al. Diagnostic potential of IL6 and other blood-based inflammatory biomarkers in mild traumatic brain injury among children. Front Neurol. 2024;15:1432217. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39055316. Accessed no date.
    Abstract: OBJECTIVES: Inflammatory biomarkers, as indicators of biological states, provide a valuable approach for accurate and reproducible measurements, crucial for the effective management of mild traumatic brain injury (mTBI) in pediatric patients. This study aims to assess the diagnostic utility of blood-based inflammatory markers IL6, IL8, and IL10 in children with mTBI, including those who did not undergo computed tomography (CT) scans. METHODS: A prospective multicentric cohort study involving 285 pediatric mTBI patients was conducted, stratified into CT-scanned and non-CT-scanned groups within 24 h post-trauma, alongside 74 control subjects. Biomarker levels were quantitatively analyzed using ELISA. Sensitivity and specificity metrics were calculated to determine the diagnostic efficacy of each biomarker. RESULTS: A total of 223 mTBI patients (78%) did not undergo CT scan examination but were kept in observation for symptoms monitoring at the emergency department (ED) for more than 6 h (in-hospital-observation patients). Among CT-scanned patients (n = 62), 14 (23%) were positive (CT+). Elevated levels of IL6 and IL10 were found in mTBI children compared to controls. Within mTBI patients, IL6 was significantly increased in CT+ patients compared to both CT- and in-hospital-observation patients. No significant differences were observed for IL8 among the compared groups. IL6 yielded a specificity of 48% in identifying CT- and in-hospital-observation patients, with 100% sensitivity in excluding all CT+ cases. These performances were maintained whether IL6 was measured within 6 h or within 24 h after the trauma. CONCLUSION: The inflammatory marker IL6 emerges as a robust biomarker, showing promising stratification value for pediatric mTBI patients undergoing CT scans or staying in observation in a pediatric ED.
    Tags: biomarkers, commercial or financial relationships that could be construed as a potential, conflict of interest., cytokines, diagnosis, emergency, mild traumatic brain injury (mTBI), pediatric.


  • Chiollaz AC, Pouillard V, Spigariol F, et al. Management of Pediatric Mild Traumatic Brain Injury Patients: S100b, Glial Fibrillary Acidic Protein, and Heart Fatty-Acid-Binding Protein Promising Biomarkers. Neurotrauma Rep. 2024;5(1):529-539. Available at: https://www.ncbi.nlm.nih.gov/pubmed/39071980. Accessed no date.
    Abstract: Children are highly vulnerable to mild traumatic brain injury (mTBI). Blood biomarkers can help in their management. This study evaluated the performances of biomarkers, in discriminating between children with mTBI who had intracranial injuries (ICIs) on computed tomography (CT+) and (1) patients without ICI (CT-) or (2) both CT- and in-hospital-observation without CT patients. The aim was to rule out the need of unnecessary CT scans and decrease the length of stay in observation in the emergency department (ED). Newborns to teenagers (</=16 years old) with mTBI (Glasgow Coma Scale > 13) were included. S100b, glial fibrillary acidic protein (GFAP), and heart fatty-acid-binding protein (HFABP) performances to identify patients without ICI were evaluated through receiver operating characteristic curves, where sensitivity was set at 100%. A total of 222 mTBI children sampled within 6 h since their trauma were reported. Nineteen percent (n = 43/222) underwent CT scan examination, whereas the others (n = 179/222) were kept in observation at the ED. Sixteen percent (n = 7/43) of the children who underwent a CT scan had ICI, corresponding to 3% of all mTBI-included patients. When sensibility (SE) was set at 100% to exclude all patients with ICI, GFAP yielded 39% specificity (SP), HFABP 37%, and S100b 34% to rule out the need of CT scans. These biomarkers were even more performant: 52% SP for GFAP, 41% for HFABP, and 39% for S100b, when discriminating CT+ versus both in-hospital-observation and CT- patients. These markers can significantly help in the management of patients in the ED, avoiding unnecessary CT scans, and reducing length of stay for children and their families.
    Tags: biomarkers, diagnostics, emergency, mild traumatic brain injury (mTBI), pediatric, triage.
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