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Swiss Emergency Research collection

2022

  • Straessle, R., and Bello, C. “Reply To "Epidemiologic Analysis Of 8000 Acute Vertebral Fractures: Evolution Of Treatment And Complications At 10-Year Follow-Up": Food For Thought Outside The Box”. J Orthop Surg Res 17, no. 1: 390. doi:10.1186/s13018-022-03280-5.
    Tags: *Spinal Fractures/epidemiology/etiology, Follow-Up Studies, Humans, Thoracic Vertebrae/injuries.
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  • Matsangos, M., Ziaka, L., Exadaktylos, A. K., Klukowska-Rotzler, J., and Ziaka, M. “Health Status Of Afghan Refugees In Europe: Policy And Practice Implications For An Optimised Healthcare”. Int J Environ Res Public Health 19, no. 15. doi:10.3390/ijerph19159157.
    Abstract: Four decades of civil war, violence, and destabilisation have forced millions of Afghans to flee their homes and to move to other countries worldwide. This increasing phenomenon may challenge physicians unfamiliar with the health status of this population, which may be markedly different from that of the host country. Moreover, several factors during their migration, such as transport in closed containers, accidental injuries, malnutrition, and accommodation in detention centres and refugee camps have a major influence on the health of refugees. By taking into account the variety of the specific diseases among migrant groups, the diversity of the origins of refugees and asylum seekers, and the increasing numbers of Afghan refugees, in this review we focus on the population of Afghans and describe their health status with the aim of optimising our medical approach and management. Our literature review shows that the most prevalent reported infections are tuberculosis and other respiratory tract infections and parasitic diseases, for example leishmaniasis, malaria, and intestinal parasitic infections. Anaemia, hyperlipidaemia, arterial hypertension, diabetes, smoking, overweight, malnutrition, low socioeconomic status, and poor access to healthcare facilities are additional risk factors for non-communicable diseases among Afghan refugees. With regards mental health issues, depression and post-traumatic stress disorder (PTSD) are the most common diagnoses and culture shock and the feeling of being uprooted modulate their persistence. Further research is needed in order to provide us with extensive, high-quality data about the health status of Afghan refugees. The main objective of this review is to identify protective factors which could ensure key health concepts and good clinical practice.
    Tags: *Malnutrition/epidemiology, *Refugees/psychology, Afghan refugees, asylum seekers policy and practice, biopsychosocial factors, communicable diseases, Delivery of Health Care, displacement, epigenetic changes, Health Status, Humans, internal conflicts, mental health, migration, non-communicable diseases, Policy, sexual violence, war, women's healthcare.
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  • Ceruti, S., Minotti, B., Glotta, A., Biggiogero, M., Bona, G., Marzano, M., Greco, P., Spagnoletti, M., Garzoni, C., and Bendjelid, K. “Reply To Boning Et Al. Comment On "Ceruti Et Al. Temporal Changes In The Oxyhemoglobin Dissociation Curve Of Critically Ill Covid-19 Patients. J. Clin. Med. 2022, 11, 788"”. J Clin Med 11, no. 15. doi:10.3390/jcm11154547.
    Abstract: We would like to thank Boning et al. for all the important issues raised in the present commentary [...].
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  • Zuniga, F., Gaertner, K., Weber-Schuh, S. K., Low, B., Simon, M., and Muller, M. “Inappropriate And Potentially Avoidable Emergency Department Visits Of Swiss Nursing Home Residents And Their Resource Use: A Retrospective Chart-Review”. Bmc Geriatr 22, no. 1: 659. doi:10.1186/s12877-022-03308-9.
    Abstract: BACKGROUND: Emergency department (ED) visits for nursing home residents lead to higher morbidity and mortality. Therefore, inappropriate visits (for conditions treatable elsewhere) or potentially avoidable visits (those avoidable through adequate chronic care management) must be minimized. This study aimed to investigate factors and resource consumption patterns associated with inappropriate and potentially avoidable visits in a Swiss tertiary hospital. METHODS: This is a single-center retrospective chart review in an urban Swiss university hospital ED. A consecutive sample of 1276 visits by nursing home residents (>/= 65 years old), recorded between January 1, 2015 and December 31, 2017 (three calendar years) were included. Case characteristics were extracted from ED electronic documentation. Appropriateness was assessed via a structured Appropriateness Evaluation Protocol; potentially avoidable visits-measured as ambulatory-care sensitive conditions (ACSCs)-were analyzed separately. Inter-group differences concerning ED resource use were tested respectively with chi-square or Wilcoxon rank sum tests. To identify predictors of inappropriate or potentially-avoidable visits, we used multivariable logistic regression analysis. RESULTS: Six percent of visits were rated as inappropriate: they had lower triage levels (OR 0.55 [95%-CI 0.33-0.92], p=0.024) and, compared to ambulance calls, they had higher odds of initiation via either patient-initiated walk-in (OR 3.42 [95%-CI 1.79-6.55], p</=0.001) or GP referrals (OR 2.13 [95%-CI 1.16-3.90], p=0.015). For inappropriate visits, overall ED resource use was significantly lower (median 568 vs. 1403 tax points, p</=0.001). Of all visits included, 29% were due to (often potentially-avoidable) ACSCs. In those cases, compared to ambulance initiation, odds of being potentially-avoidable were considerably lower for walk-in patients (OR 0.46 [95%-CI 0.27-0.77], p=0.004) but higher for GP referrals (OR 1.40 [95%-CI 1.00-1.94], p=0.048). Nurse work (93 tax points vs. 64, p</=0.001) and laboratory resource use (334 tax points vs. 214, p</=0.001) were higher for potentially-avoidable ED visits. CONCLUSIONS: We revealed substantial differences between the investigated groups. While nearly one third of ED visits from nursing homes were potentially avoidable, inappropriate visits were lower in numbers and not resource-intensive. Further research is required to differentiate potentially avoidable visits from inappropriate ones and to determine these findings' public health implications.
    Tags: *Emergency Service, Hospital, *Nursing Homes, Aged, Avoidable, Emergency departments, Hospitalization, Humans, Inappropriate, Long-Term Care, Nursing homes, Quality management, Resource consumption, Retrospective Studies, Switzerland/epidemiology.
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  • Baumer-Mouradian, S. H., Hart, R. J., Bone, J. N., Seiler, M., Olson, P., Keitel, K., Manzano, S., et al. “Should Covid-19 Vaccines Be Mandated In Schools? - An International Caregiver Perspective”. Vaccine 40, no. 36: 5384-5390. doi:10.1016/j.vaccine.2022.07.038.
    Abstract: OBJECTIVES: Caregiver attitudes toward mandating COVID-19 vaccines for their children are poorly understood. We aimed to determine caregiver acceptability of COVID-19 vaccine mandates for schools/daycares and assess if opposition to mandates would result in removal of children from the educational system. STUDY DESIGN: Perform a cross-sectional, anonymous survey of adult caregivers with children </= 18 years presenting to 21 pediatric emergency departments in the United States, Canada, Israel, and Switzerland, November 1st through December 31st, 2021. The primary outcome was caregiver acceptance rates for school vaccine mandates, and the secondary outcomes included factors associated with mandate acceptance and caregiver intention to remove the child from school. RESULTS: Of 4,393 completed surveys, 37% of caregivers were opposed to any school vaccine mandate. Caregiver acceptance was lowest for daycare settings (33%) and increased as the child's level of education increased, college (55%). 26% of caregivers report a high likelihood (score of 8-10 on 0-10 scale) to remove their child from school if the vaccine became mandatory. Child safety was caregivers' greatest concern over vaccine mandates. A multivariable model demonstrated intent to vaccinate their child for COVID-19 (OR = 8.9, 95% CI 7.3 to 10.8; P < 0.001) and prior COVID-19 vaccination for the caregiver (OR = 3.8, 95% CI 3.0 to 4.9; P < 0.001) had the greatest odds of increasing mandate acceptance for any school level. CONCLUSIONS: Many caregivers are resistant to COVID-19 vaccine mandates for schools, and acceptance varies with school level. One-fourth of caregivers plan to remove their child from the educational system if vaccines become mandated.
    Tags: *COVID-19/prevention & control, *Vaccines, Adult, Caregivers, Child, COVID-19 Vaccines, Cross-Sectional Studies, Humans, Schools, United States, Vaccination.
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  • Iattoni, M., Ormazabal, M., Luvini, G., and Uccella, L. “Effect Of Structured Briefing Prior To Patient Arrival On Interprofessional Communication And Collaboration In The Trauma Team”. Open Access Emerg Med 14: 385-393. doi:10.2147/OAEM.S373044.
    Abstract: PURPOSE: Treating a multiple trauma patient is multidisciplinary team work. The performance of the trauma team is crucial to treating the patients safely and effectively. The fundamentals of the performance are the quality of interprofessional collaboration and the communication inside the team and its efficacy for patients' safety and team's well being. This is a prospective interventional study. The aim of this paper was to assess interprofessional collaboration and perceived efficacy inside the trauma team and to evaluate the effects of the implementation of a trauma team briefing tool before the arrival of the patient on perceived teamwork performance. PARTICIPANTS AND METHODS: The study took place in the emergency department. Participants were members of the trauma team (emergency physicians and nurses). Two validated scales were selected that address interprofessional collaboration and team perceived efficacy: the TEAM survey (revised version) and the Mayo High Performance Teamwork Scale. A detailed and structured team briefing was used. The trauma team filled in the two scales (46 participants). Prior to every multiple trauma patient arrival, the briefing was then implemented for 3 months. At the end of the third month, the two scales were re-administered and the results analysed (31 participants). The main outcome was the variation of proportion of desirable answers. We considered significant only clearly separated confidence intervals (95% CI). RESULTS: All items in the questionnaires had better responses in the second round. In 16 items, the differences found were statistically significant with a 95% confidence interval and p<0.05. The perceived communication and collaboration by healthcare professionals of the trauma team improved with the introduction of the tool. CONCLUSION: A team briefing prior to the arrival of a multiple trauma patient enhances providers' self perception of interprofessional collaboration in the management of multiple trauma patients.
    Tags: communication, critical care, interprofessional collaboration, multiple trauma, team briefing.
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  • Sinnberg, T., Lichtensteiger, C., Ali, O. H., Pop, O. T., Jochum, A. K., Risch, L., Brugger, S. D., et al. “Pulmonary Surfactant Proteins Are Inhibited By Immunoglobulin A Autoantibodies In Severe Covid-19”. Am J Respir Crit Care Med 207, no. 1: 38-49. doi:10.1164/rccm.202201-0011OC.
    Abstract: Rationale: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome with fatal outcomes. Evidence suggests that dysregulated immune responses, including autoimmunity, are key pathogenic factors. Objectives: To assess whether IgA autoantibodies target lung-specific proteins and contribute to disease severity. Methods: We collected 147 blood, 9 lung tissue, and 36 BAL fluid samples from three tertiary hospitals in Switzerland and one in Germany. Severe COVID-19 was defined by the need to administer oxygen. We investigated the presence of IgA autoantibodies and their effects on pulmonary surfactant in COVID-19 using the following methods: immunofluorescence on tissue samples, immunoprecipitations followed by mass spectrometry on BAL fluid samples, enzyme-linked immunosorbent assays on blood samples, and surface tension measurements with medical surfactant. Measurements and Main Results: IgA autoantibodies targeting pulmonary surfactant proteins B and C were elevated in patients with severe COVID-19 but not in patients with influenza or bacterial pneumonia. Notably, pulmonary surfactant failed to reduce surface tension after incubation with either plasma or purified IgA from patients with severe COVID-19. Conclusions: Our data suggest that patients with severe COVID-19 harbor IgA autoantibodies against pulmonary surfactant proteins B and C and that these autoantibodies block the function of lung surfactant, potentially contributing to alveolar collapse and poor oxygenation.
    Tags: *covid-19, *Pulmonary Surfactants/metabolism, Autoantibodies, autoimmunity, Bronchoalveolar Lavage Fluid/chemistry, Covid-19, Humans, Immunoglobulin A, pulmonary surfactant, pulmonary-associated surfactant protein, Surface-Active Agents.
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  • Pietsch, U., Moeckel, J., Koppenberg, J., Josi, D., Jungwirth, A., Hautz, W. E., Wenzel, V., Strecke, S., and Albrecht, R. “Stability Of Drugs Stored In Helicopters For Use By Emergency Medical Services: A Prospective Observational Study”. Ann Emerg Med 80, no. 4: 364-370. doi:10.1016/j.annemergmed.2022.05.038.
    Abstract: STUDY OBJECTIVE: Drugs stored in rescue helicopters may be subject to extreme environmental conditions. The aim of this study was to measure whether drugs stored under the real-life conditions of a Swiss helicopter emergency medical service (HEMS) would retain their potency over the course of 1 year. METHODS: A prospective, longitudinal study measuring the temperature exposure and concentration of drugs stored on 2 rescue helicopters in Switzerland over 1 year. The study drugs included epinephrine, norepinephrine, amiodarone, midazolam, fentanyl, naloxone, rocuronium, etomidate, and ketamine. Temperatures were measured inside the medication storage bags and the crew cabins at 10-minute intervals. Drug stability was measured on a monthly basis over the course of 12 months using high-performance liquid chromatography. The medications were considered stable at a minimum remaining drug concentration of 90% of the label claim. RESULTS: Temperatures ranged from -1.2 degrees C to 38.1 degrees C (29.84 degrees F to 100.58 degrees F) inside the drug storage bags. Of all the temperature measurements inside the drug storage bags, 37% lay outside the recommended storage conditions. All drugs maintained a concentration above 90% of the label claim. The observation periods for rocuronium and etomidate were shortened to 7 months because of a supply shortage of reference samples. CONCLUSION: Drugs stored under the real-life conditions of Swiss HEMS are subjected to temperatures outside the manufacturer's approved storage requirements. Despite this, all drugs stored under these conditions remained stable throughout our study. Real-life stability testing could be a way to extend drug exchange intervals.
    Tags: *Amiodarone, *Emergency Medical Services, *Etomidate, *Ketamine, Aircraft, Chromatography, High Pressure Liquid, Drug Stability, Drug Storage, Epinephrine, Fentanyl, Humans, Longitudinal Studies, Midazolam, Naloxone, Norepinephrine, Prospective Studies, Rocuronium, Temperature.
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  • Hullin, R., Tzimas, G., Barras, N., Abdurashidova, T., Soborun, N., Aur, S., Regamey, J., et al. “Decongestion Improving Right Heart Function Ameliorates Prognosis After An Acute Heart Failure Episode”. Esc Heart Fail 9, no. 6: 3814-3824. doi:10.1002/ehf2.14077.
    Abstract: BACKGROUND: The prognostic role of decongestion-related change of cardiac morphology and in particular right heart function has not been investigated comprehensively in AHF patients. METHODS AND RESULTS: This prospective observational single-centre study included consecutive patients hospitalized for treatment of AHF with reduced, mildly-reduced or preserved left ventricular ejection fraction (LVEF). Comprehensive transthoracic echocardiography at admission and discharge assessed decongestion-related change of cardiac function and morphology. The combined endpoint of 1 year all-cause mortality and cardiovascular rehospitalization explored the prognostic importance of decongestion-related change. The 176 study participants were 83 years old [74-87] and 54% were men. Fifty one (29%) had rLVEF, 65 (37%) mrLVEF, and 60 (34%) pLVEF. The proportion of de novo or worsening chronic HF was not different between LVEF groups. HF aetiology and cardiovascular risk factors were equally distributed across all groups except for a higher BMI in the pLVEF group. Decongestion equally reduced body weight, heart rate, systolic and diastolic blood pressure, tricuspid regurgitation gradient, and inferior vena cava diameter across all groups (P < 0.004 for all). Decongestion-related increase in TAPSE independent of the LVEF was associated with improvement of right-ventricular-pulmonary artery coupling and a lower incidence of the combined outcome in the Cox proportional hazard risk analysis (unadjusted HR 0.50 95% CI 0.33-0.78, P = 0.002; adjusted HR 0.46 95% CI: 0.33-0.78, P = 0.001). CONCLUSIONS: Decongestion-related increase in TAPSE and recovery of RV/pulmonary artery coupling was observed across all LVEF groups and associated with a risk reduction for the combined endpoint highlighting the important prognostic role of right heart recovery after an AHF episode.
    Tags: *Heart Failure/complications, *Ventricular Function, Left, Acute heart failure, Aged, 80 and over, Decongestion, Echocardiography, Female, Humans, Left heart systolic and diastolic function, Male, Prognosis, Right heart, Stroke Volume/physiology.
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  • Korda, A., Wimmer, W., Zamaro, E., Wagner, F., Sauter, T. C., Caversaccio, M. D., and Mantokoudis, G. “Videooculography "Hints" In Acute Vestibular Syndrome: A Prospective Study”. Front Neurol 13: 920357. doi:10.3389/fneur.2022.920357.
    Abstract: OBJECTIVE: A three-step bedside test ("HINTS": Head Impulse-Nystagmus-Test of Skew), is a well-established way to differentiate peripheral from central causes in patients with acute vestibular syndrome (AVS). Nowadays, the use of videooculography gives physicians the possibility to quantify all eye movements. The goal of this study is to compare the accuracy of VOG "HINTS" (vHINTS) to an expert evaluation. METHODS: We performed a prospective study from July 2015 to April 2020 on all patients presenting at the emergency department with signs of AVS. All the patients underwent clinical HINTS (cHINTS) and vHINTS followed by delayed MRI, which served as a gold standard for stroke confirmation. RESULTS: We assessed 46 patients with AVS, 35 patients with acute unilateral vestibulopathy, and 11 patients with stroke. The overall accuracy of vHINTS in detecting a central pathology was 94.2% with 100% sensitivity and 88.9% specificity. Experts, however, assessed cHINTS with a lower accuracy of 88.3%, 90.9% sensitivity, and 85.7% specificity. The agreement between clinical and video head impulse tests was good, whereas for nystagmus direction was fair. CONCLUSIONS: vHINTS proved to be very accurate in detecting strokes in patients AVS, with 9% points better sensitivity than the expert. The evaluation of nystagmus direction was the most difficult part of HINTS.
    Tags: acute unilateral vestibulopathy, commercial or financial relationships that could be construed as a potential, conflict of interest., Hints, stroke, vertigo, videooculography.
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  • Pasquier, M., Hugli, O., Hall, N., Rousson, V., and Darocha, T. “Outcome Prediction For Hypothermic Patients In Cardiac Arrest”. J Intensive Care 10, no. 1: 37. doi:10.1186/s40560-022-00630-7.
    Abstract: The 5A score predicts in-hospital mortality of patients suffering from accidental hypothermia, including those not in cardiac arrest. The HOPE score was specifically developed to predict survival for the subgroup of hypothermic patients in cardiac considered for extracorporeal life support rewarming. The C-statistic in the external validation study of the HOPE score was 0.825 (95% CI: 0.753-0.897), confirming its excellent discrimination. In addition, its good calibration allows for a reliable interpretation of the corresponding survival probability after rewarming. The HOPE score should be used for predicting outcome and selecting hypothermic patients in cardiac arrest for rewarming.
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  • Sathanantham, V., Alberio, L., Bovet, C., Fontana, P., Gerber, B., Graf, L., Mendez, A., et al. “Prothrombinase-Induced Clotting Time To Measure Drug Concentrations Of Rivaroxaban, Apixaban, And Edoxaban In Clinical Practice: A Cross-Sectional Study”. Life (Basel) 12, no. 7. doi:10.3390/life12071027.
    Abstract: Prothrombinase-induced clotting time (PiCT) is proposed as a rapid and inexpensive laboratory test to measure direct oral anticoagulant (DOAC) drug levels. In a prospective, multicenter cross-sectional study, including 851 patients, we aimed to study the accuracy of PiCT in determining rivaroxaban, apixaban, and edoxaban drug concentrations and assessed whether clinically relevant drug levels could be predicted correctly. Citrated plasma samples were collected, and the Pefakit((R)) PiCT was utilized. Ultra-high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) was performed to measure drug concentrations. Cut-off levels were established using receiver-operating characteristics curves. We calculated sensitivities and specificities with respect to clinically relevant drug concentrations. Spearman's correlation coefficient between PiCT and drug concentrations was 0.85 in the case of rivaroxaban (95% CI 0.82, 0.88), 0.66 for apixaban (95% CI 0.60, 0.71), and 0.78 for edoxaban (95% CI 0.65, 0.86). The sensitivity to detect clinically relevant drug concentrations was 85.1% in the case of 30 microg L(-1) (95% CI 82.0, 87.7; specificity 77.9; 72.1, 82.7), 85.7% in the case of 50 microg L(-1) (82.4, 88.4; specificity 77.3; 72.5, 81.5), and 85.1% in the case of 100 microg L(-1) (80.9, 88.4; specificity 73.2%; 69.1, 76.9). In conclusion, the association of PiCT with DOAC concentrations was fair, and the majority of clinically relevant drug concentrations were correctly predicted.
    Tags: analysis, the decision to publish, or manuscript preparation. MN reports research, and from Alexion Pharma GmbH, all outside the submitted work. JDS reports lecture, and honoraria for participating in scientific advisory boards from Bayer, Pfizer,, apixaban, cross-sectional studies, CSL-Behring, Novartis, Novo Nordisk, Roche, Sobi, and Takeda. WAW reports, diagnostic accuracy, direct oral anticoagulants, edoxaban, fees and advisory honoraria from Bayer Healthcare, Pfizer, Takeda, Siemens, and, from Bayer Healthcare, and Daiichi Sankyo. LA reports research grants from Bayer,, grants from Bayer Healthcare, outside of the submitted work, lecture honoraria, laboratory monitoring, Pentapharm. These companies had no role in study design, data collection and, prothrombinase-induced clotting time, research grants from Bayer Healthcare, BMS-Pfizer, Daiichi Sankyo, and Sanofi,, rivaroxaban, Sanofi., sensitivity and specificity, substances: Bayer Healthcare AG, Bristol-Myers Squibb, Daiichi Sankyo, and.
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  • Opitz, I., Patella, M., Lauk, O., Inci, I., Bettex, D., Horisberger, T., Schupbach, R., et al. “Acute On Chronic Thromboembolic Pulmonary Hypertension: Case Series And Review Of Management”. J Clin Med 11, no. 14. doi:10.3390/jcm11144224.
    Abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct form of precapillary pulmonary hypertension classified as group 4 by the World Symposium on Pulmonary Hypertension (WSPH) and should be excluded during an episode of acute pulmonary embolism (PE). Patients presenting to emergency departments with sudden onset of signs and symptoms of acute PE may already have a pre-existing CTEPH condition decompensated by the new PE episode. Identifying an underlying and undiagnosed CTEPH during acute PE, while challenging, is an important consideration as it will alter the patients' acute and long-term management. Differential diagnosis and evaluation require an interdisciplinary expert team. Analysis of the clinical condition, the CT angiogram, and the hemodynamic situation are important considerations; patients with CTEPH usually have significantly higher sPAP at the time of index PE, which is unusual and unattainable in the context of acute PE and a naive right ventricle. The imaging may reveal signs of chronic disease such as right ventricle hypertrophy bronchial collaterals and atypical morphology of the thrombus. There is no standard for the management of acute on chronic CTEPH. Herein, we provide a diagnostic and management algorithm informed by several case descriptions and a review of the literature.
    Tags: (consultant), Merck (speaker fees), and Roche (consultant). None of the, (Institutional Grant), Intuitive (Proctorship). Nils Kucher reports institutional, Actelion (consultant), Bayer (speaker fees), AstraZeneca (Ad Board), BMS, acute pulmonary embolism, AstraZeneca (Advisory Board and Speakers Bureau), MSD (Advisory Board), Medtronic, Bard, Bentley, Boston Scientific, INARI, Sanofi, and Bayer, and personal fees, chronic thromboembolic pulmonary hypertension, disclosures had a role in the design of the study, for John Granton: J.G. has received support for research and training fellowships, Frauenfelder: AGFA (Advisory Board) and Boehringer (Advisory Board). Disclosures, from Bayer, Boston Scientific, and INARI. Disclosures for Reto Schupbach:, from his hospital foundation through unrestricted grants from Janssen and Bayer., Hamilton Medical (institutional collaboration). Disclosures for Thomas, He has received speaker's fees from Janssen. Disclosures of Silvia Ulrich: S.U., in the collection, analyses,, in the writing of the manuscript, Miriam Patella, Thomas Pfammatter, Olivia Lauk, Ilhan Inci, Dominique Bettex,, or in the decision, or interpretation of data, pulmonary endarterectomy, reports speakers' fees, support for congress presentations, and unrestricted, research grants from the Swiss National Science Foundation, Concept Medical,, research grants outside of the submitted work from MSD SA, Janssen SA, Actelion, SA, Orpha Swiss, and Novartis. Disclosures for Marc de Perrot: personal fees from, Thomas Horisberger, and Dagmar I. Keller., to publish the results. The following authors declare no conflict of interest:.
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  • Krutkyte, G., Wenk, L., Odermatt, J., Schuetz, P., Stanga, Z., and Friedli, N. “Refeeding Syndrome: A Critical Reality In Patients With Chronic Disease”. Nutrients 14, no. 14. doi:10.3390/nu14142859.
    Abstract: Malnutrition is one of the most frequent metabolic challenges in the population of chronically ill patients. This results in increased administration of nutritional therapy in inpatient settings, which poses the risk of side effects, in particular, the development of refeeding syndrome. If not managed accordingly, it leads to a significant rise in morbidity and mortality. However, despite its importance, evidence-based recommendations on the management of refeeding syndrome are largely lacking, and only a few randomized controlled trials have been conducted. In light of this, the aim of this review is to raise awareness of refeeding syndrome in chronically ill patients by critically reviewing recent literature and providing a short overview as well as diagnosis and treatment algorithms of this underreported metabolic condition. In summary, recent findings suggest undergoing risk assessment and stratification for every patient receiving nutritional therapy. According to this, adaptation of energy and fluid support during the replenishment phase should be implemented in the nutritional therapy for patients at high risk. Additionally, continuous monitoring should take place, and appropriate actions should be initiated when necessary.
    Tags: *Malnutrition/diagnosis/etiology/therapy, *Refeeding Syndrome/diagnosis/prevention & control, catabolism, Chronic Disease, design of the study, Humans, in, in the collection, analyses, or interpretation of data, malnutrition, nutritional support, Nutritional Support/methods, refeeding syndrome, Risk Assessment, the writing of the manuscript, or in the decision to publish the results..
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  • Michel, J., Mettler, A., Starvaggi, C., Travaglini, N., Aebi, C., Keitel, K., and Sauter, T. C. “The Utility Of A Pediatric Covid-19 Online Forward Triage Tool In Switzerland”. Front Public Health 10: 902072. doi:10.3389/fpubh.2022.902072.
    Abstract: BACKGROUND: To offset the burden on the health system, hospitals set up telehealth interventions, such as online forward triage tools (OFTT). The website www.coronabambini.ch was developed to specifically address the needs of children and their families in Switzerland and to facilitate the decision to test, isolate, attend school, or access the health care system. METHODS: Video interviews were held with key informants (n = 20) from a population of parents, teachers, guardians, as well as doctors who had used the child-specific COVID-19 OFTT and had consented to a further study. Convenience and quota sampling were done to include a variety of key informants. Interviews were recorded, transcribed verbatim, and analyzed for themes. RESULTS: Three main themes emerged: i) the usefulness of the OFTT to the users, ii) expectation management and importance of stakeholder involvement in OFTT development, and iii) OFTT limitations. CONCLUSION: Our study highlights opportunities, limitations, and lessons to consider when developing a pediatric COVID-19 OFTT. The involvement of stakeholders, parents, teachers, and health care providers in the design, set up, implementation, and evaluation of telehealth interventions is critical as this can help with expectation management and enhance OFTT utility.
    Tags: *COVID-19/epidemiology, *Triage, Child, children, commercial or financial relationships that could be construed as a potential, conflict of interest., Coronavirus, Covid-19, digital triage, expectation management, Health Personnel, Humans, lessons learned, Parents, Switzerland, utility.
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  • Michel, J., Kilb, T. S., Mettler, A., Muller, M., Hautz, W. E., Hautz, S. C., and Sauter, T. C. “The Utility Of An Online Forward Triage Tool During The Sars-Cov-2 Pandemic: Health Care Provider And Health Authority Perspectives”. Front Public Health 10: 845996. doi:10.3389/fpubh.2022.845996.
    Abstract: INTRODUCTION: The SARS CoV-2 pandemic poses major challenges not only to patients but also to health care professionals and policy-makers, with rapidly changing, sometimes complex, recommendations, and guidelines to the population. Online forward triage tools (OFTT) got a major boost from the pandemic as they helped with the implementation and monitoring of recommendations. METHODS: A multiphase mixed method sequential explanatory study design was employed. Quantitative data were collected first and informed the qualitative interview guides. Video interviews were held with key informants (health care providers and health authorities) between 2 September and 10 December 2020. Audio-recordings were transcribed verbatim, coded thematically and compared with patient perspectives (framework). OBJECTIVES: To explore the perspectives of health care providers and authorities in Canton Bern on the utility of a COVID-19 OFTT, as well as elicit recommendations for telehealth in future. RESULTS: The following themes emerged; (i) accessibility (ii) health system burden reduction (iii) utility in preventing onward transmission (iv) utility in allaying fear and anxiety (v) medical decision-making utility (vi) utility as information source (vii) utility in planning and systems thinking. The health care providers and health authorities further provided insights on potential barriers and facilitators of telehealth in future. CONCLUSION: Similar to patients, health care providers acknowledge the potential and utility of the COVID-19 OFTT particularly as an information source and in reducing the health system burden. Data privacy, doctor-patient relationship, resistance to change, regulatory, and mandate issues, and lack of systems thinking were revealed as barriers to COVID-19 OFTT utility.
    Tags: *COVID-19/epidemiology, *SARS-CoV-2, any commercial or financial relationships that could be construed as a potential, Bern, Switzerland. The funder, Touring Club Switzerland, has no influence on the, conflict of interest., Covid-19, Foundation, Zoll Foundation, Drr Medical Germany, Mundipharma Research UK, MDI, has received research funding from the European Union, the Swiss National Science, health authorities, health care providers, Health Personnel, Humans, International Australia, Roche Diagnostics Germany, Mundipharma Medical Switzerland, VisualDx USA, all outside the submitted work., OFTT utility, pandemic, Pandemics, perceived barriers and drivers, perspectives, Physician-Patient Relations, provided paid consultancies, received financial, research performed, the content of any manuscript or any decision to publish. WH, support for a congress he chaired from EBSCO Germany, Isabel Healthcare UK,, telehealth in future, The remaining authors declare that the research was conducted in the absence of, to AO Foundation Switzerland and MDI International Australia, Triage.
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  • Lindner, G., Schwarz, C., Haidinger, M., and Ravioli, S. “Hyponatremia In The Emergency Department”. Am J Emerg Med 60: 1-8. doi:10.1016/j.ajem.2022.07.023.
    Abstract: Hyponatremia, defined as a serum sodium <135 mmol/L, is frequently encountered in patients presenting to the emergency department. Symptoms are often unspecific and include a recent history of falls, weakness and vertigo. Common causes of hyponatremia include diuretics, heart failure as well as Syndrome of Inappropriate Antidiuresis (SIAD) and correct diagnosis can be challenging. Emergency treatment of hyponatremia should be guided by presence of symptoms and focus on distinguishing between acute and chronic hyponatremia.
    Tags: *Hyponatremia/diagnosis/etiology/therapy, *Inappropriate ADH Syndrome/complications/diagnosis/therapy, Diuretics/therapeutic use, Electrolytes, Emergency, Emergency Service, Hospital, Humans, Hyponatremia, Sodium.
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  • Goldman, R. D., Seiler, M., Olson, P. G., Hart, R. J., Bone, J. N., Baumer-Mouradian, S. H., and International, Covid-Parental Attitude Study Group. “Factors Associated With Unvaccinated Caregivers Who Plan To Vaccinate Their Children”. Prev Med 162: 107121. doi:10.1016/j.ypmed.2022.107121.
    Abstract: Vaccine hesitancy is complex and a threat to global public health during the ongoing COVID-19 pandemic. Our objective was to determine factors associated with caregivers' willingness to vaccinate children despite not being immunized themselves against COVID-19. The International COVID-19 Parental Attitude Study (COVIPAS), a multinational cohort study, recruited caregivers of children 0-18 years old in 21 Emergency Departments (EDs) in USA, Canada, Israel, and Switzerland during November-December 2021. Of a total of 4536 caregivers who completed the survey, 882 (19.4%) were unvaccinated, and 62 (7.0%) of the unvaccinated planned to vaccinate their children. Unvaccinated caregivers with children that had their childhood vaccines up-to-date (OR 3.03 (1.36, 8.09), p = 0.01), and those very worried their child has COVID-19 in the ED (OR 3.11 (1.44, 6.34), p < 0.01) were much more likely to plan to immunize their children. Primary care providers and public health agencies should not assume that unvaccinated parents will not vaccinate their children. Determining child's vaccination status and parental level of concern about COVID-19 may help identify caregivers who are open to give their children the vaccine.
    Tags: *COVID-19/prevention & control, Adolescent, Caregivers, Child, Child, Preschool, Cohort Studies, Covid-19, Humans, Infant, Infant, Newborn, Pandemics, Parents, Sars-cov-2, Unvaccinated, Vaccination, Vaccine hesitancy.
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  • Fehlmann, C. A., Nickel, C. H., Cino, E., Al-Najjar, Z., Langlois, N., and Eagles, D. “Frailty Assessment In Emergency Medicine Using The Clinical Frailty Scale: A Scoping Review”. Intern Emerg Med 17, no. 8: 2407-2418. doi:10.1007/s11739-022-03042-5.
    Abstract: BACKGROUND: Frailty is a common condition present in older Emergency Department (ED) patients that is associated with poor health outcomes. The Clinical Frailty Scale (CFS) is a tool that measures frailty on a scale from 1 (very fit) to 9 (terminally ill). The goal of this scoping review was to describe current use of the CFS in emergency medicine and to identify gaps in research. METHODS: We performed a systemic literature search to identify original research that used the CFS in emergency medicine. Several databases were searched from January 2005 to July 2021. Two independent reviewers completed screening, full text review and data abstraction, with a focus on study characteristics, CFS assessment (evaluators, timing and purpose), study outcomes and statistical methods. RESULTS: A total of 4818 unique citations were identified; 34 studies were included in the final analysis. Among them, 76% were published after 2018, mainly in Europe or North America (79%). Only two assessed CFS in the pre-hospital setting. The nine-point scale was used in 74% of the studies, and patient consent was required in 69% of them. The main reason to use CFS was as a main exposure (44%), a potential predictor (15%) or an outcome (15%). The most frequently studied outcomes were mortality and hospital admission. CONCLUSION: The use of CFS in emergency medicine research is drastically increasing. However, the reporting is not optimal and should be more standardized. Studies evaluating the impact of frailty assessment in the ED are needed. REGISTRATION: https://doi.org/10.17605/OSF.IO/W2F8N.
    Tags: *Emergency Medicine, *Frailty/diagnosis, Aged, Clinical Frailty Scale, Emergency medicine, Emergency Service, Hospital, Frail Elderly, Frailty, Geriatric, Geriatric Assessment/methods, Humans, Older patients.
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  • Celi, J., Berger, A., Lungu, A., and Grosgurin, O. “Westermark Sign On Chest X-Ray In A Patient Following Cardiac Arrest Due To Massive Pulmonary Embolism”. Bmj Case Rep 15, no. 7. doi:10.1136/bcr-2022-250557.
    Tags: *Cardiopulmonary Resuscitation, *Heart Arrest/etiology, *Pulmonary Embolism/complications/diagnostic imaging, Humans, Pulmonary embolism, Resuscitation, X-Rays.
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  • Simon, N. R., Jauslin, A. S., Bingisser, R., and Nickel, C. H. “Emergency Presentations Of Older Patients Living With Frailty: Presenting Symptoms Compared With Non-Frail Patients”. Am J Emerg Med 59: 111-117. doi:10.1016/j.ajem.2022.06.046.
    Abstract: BACKGROUND AND OBJECTIVE: Symptoms may differ between frail and non-frail patients presenting to Emergency Departments (ED). However, the association between frailty status and type of presenting symptoms has not been investigated. We aimed to systematically analyse presenting symptoms in frail and non-frail older emergency patients and hypothesized that frailty may be associated with nonspecific complaints (NSC), such as generalised weakness. METHODS: Secondary analysis of a prospective, single centre, observational all-comer cohort study conducted in the ED of a Swiss tertiary care hospital. All presentations of patients aged 65 years and older were analysed. At triage, presenting symptoms and frailty were systematically assessed using a questionnaire. Patients with a Clinical Frailty Scale (CFS) > 4 were considered frail. Presenting symptoms, stratified by frailty status, were analysed. The association between frailty and generalised weakness was tested by logistic regression. RESULTS: Overall, 2'416 presentations of patients 65 years and older were analysed. Mean age was 78.9 (SD 8.4) years, 1'228 (50.8%) patients were female, and 885 (36.6%) patients were frail (CFS > 4). Generalised weakness, dyspnea, localised weakness, speech disorder, loss of consciousness and gait disturbance were recorded more often in frail patients, whereas chest pain was reported more often by non-frail patients. Generalised weakness was reported as presenting symptom in 166 (18.8%) frail patients and in 153 (10.0%) non-frail patients. Frailty was associated with generalised weakness after adjusting for age, gender and elevated National Early Warning Score 2 (NEWS) >/= 3 (OR 1.19, CI 1.10-1.29, p < 0.001). CONCLUSION: Presenting symptoms differ in frail and non-frail patients. Frailty is associated with generalised weakness at ED presentation.
    Tags: *Frailty/complications/diagnosis, Aged, Clinical frailty scale, Cohort Studies, Emergency department, Emergency Service, Hospital, Female, Frail Elderly, Frailty, Geriatric Assessment, Humans, Male, Muscle Weakness/etiology, Nonspecific complaints, Presenting symptoms, Prospective Studies, Weakness.
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  • Reichlin, M., Bosbach, S. J., and Minotti, B. “Splenic Infarction Diagnosed By Contrast-Enhanced Ultrasound In Infectious Mononucleosis - An Appropriate Diagnostic Option: A Case Report With Review Of The Literature”. J Med Ultrasound 30, no. 2: 140-142. doi:10.4103/JMU.JMU_87_21.
    Abstract: Infectious mononucleosis is caused by Epstein.Barr virus (EBV) infection. Although typically self.limiting, complications such as splenic infarction and splenic rupture are described. A 17.year.old man presented in the emergency department due to a 3 days history of fever with chills, soreness, fatigue, and loose stool. Ultrasound examination showed a homoechogenic splenomegaly. Viral enteritis was diagnosed and the patient was dismissed. Six days later, he reassessed due to increasing left upper quadrant abdominal pain. Ultrasound showed inhomogeneous splenomegaly with irregular hypoechogenic subcapsular lesions. Contrast.enhanced ultrasound (CEUS) characterized the lesions as not perfused tissue until the late venous phase, compatible with spleen infarctions. Serologic studies were positive for EBV. In the literature, splenic infarction is considered under.recognized. Contrast.enhanced computed tomography (CECT) and magnetic resonance imaging are associated with costs and radiation (CECT). B.mode ultrasound examination is usually used as the first imaging modality, although showing a poor sensitivity in the question of splenic lesions/infarctions. CEUS has shown instead very good sensitivity and does not harm. Therefore, we recommend CEUS examination as the first imaging modality if suspicion of spleen infarction arises, especially when B.mode ultrasound is normal.
    Tags: Contrast-enhanced ultrasound, infectious mononucleosis, spleen infarction, ultrasound.
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  • Mohan, V., Laska, P., Meier, A., and Minotti, B. “Acute Appendicitis With The Presence Of Peristalsis Seen In Ultrasound”. J Med Ultrasound 30, no. 2: 138-139. doi:10.4103/JMU.JMU_177_20.
    Abstract: A 27-year-old male patient presented in the emergency department (ED) with right acute abdominal pain, tenderness of the abdominal wall, and abdominal guarding. With suspicion of acute appendicitis, we performed bedside sonography. A blind-ending tubular structure, originating from the base of cecum with the presence of an intraluminal calcified "stone," with the presence of clear peristalsis was seen. Whether this structure represented the appendix or the small bowel, it was not distinguishable sonographically. A consequent surgical consultation indicated a computer tomography scan, and the finding showed acute appendicitis with appendicolith. An inflamed appendix of 15 cm in length was seen laparoscopically and consequently an appendectomy was performed. The histology confirmed a putrid, ulcero-phlegmonous, and hemorrhagic appendicitis with appendicolith. Postoperatively, the patient made a good recovery without complications. The absence of peristalsis is a well-known criterion for diagnosing acute appendicitis. However, we have shown here, that this should be taken into account with caution, as in rare cases such as this appendicitis can be present with peristalsis.
    Tags: Acute appendicitis, emergency department, peristalsis, ultrasound.
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  • Michel, J., Mettler, A., Stuber, R., Muller, M., Ricklin, M. E., Jent, P., Hautz, W. E., and Sauter, T. C. “Effects And Utility Of An Online Forward Triage Tool During The Sars-Cov-2 Pandemic: A Mixed Method Study And Patient Perspectives, Switzerland”. Bmj Open 12, no. 7: e059765. doi:10.1136/bmjopen-2021-059765.
    Abstract: OBJECTIVE: To assess the effects (quantitatively) and the utility (qualitatively) of a COVID-19 online forward triage tool (OFTT) in a pandemic context. DESIGN: A mixed method sequential explanatory study was employed. Quantitative data of all OFTT users, between 2 March 2020 and 12 May 2020, were collected. Second, qualitative data were collected through key informant interviews (n=19) to explain the quantitative findings, explore tool utility, user experience and elicit recommendations. SETTING: The working group e-emergency medicine at the emergency department developed an OFTT, which was made available online. PARTICIPANTS: Participants included all users above the age of 18 that used the OFTT between 2 March 2020 and 12 May 2020. INTERVENTION: An OFTT that displayed the current test recommendations of the Federal Office of Public Health on whether someone needed testing for COVID-19 or not. No diagnosis was provided. RESULTS: In the study period, 6272 users consulted our OFTT; 40.2% (1626/4049) would have contacted a healthcare provider had the tool not existed. 560 participants consented to a follow-up survey and provided a valid email address. 31.4% (176/560) participants returned a complete follow-up questionnaire. 84.7% (149/176) followed the recommendations given. 41.5% (73/176) reported that their fear was allayed after using the tool. Qualitatively, seven overarching themes emerged namely (1) accessibility of tool, (2) user-friendliness of tool, (3) utility of tool as an information source, (4) utility of tool in allaying fear and anxiety, (5) utility of tool in medical decision-making (6) utility of tool in reducing the potential for onward transmissions and (7) utility of tool in reducing health system burden. CONCLUSION: Our findings demonstrated that a COVID-19 OFTT does not only reduce the health system burden but can also serve as an information source, reduce anxiety and fear, reduce potential for cross infections and facilitate medical decision-making.
    Tags: *COVID-19/epidemiology, *Triage, Covid-19, COVID-19 Testing, epidemiology, Humans, Pandemics, public health, qualitative research, SARS-CoV-2, Switzerland/epidemiology, telemedicine, telemedicine at University of Bern, Switzerland..
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  • Ehrhard, S., Botte, F., Klukowska-Rotzler, J., Exadaktylos, A. K., and Jakob, D. A. “Cattle-Related Trauma: A 10-Year Retrospective Cohort Study Of Patients Admitted To A Single Tertiary Trauma Centre In Switzerland”. Swiss Med Wkly 152, no. 2728: w30201. doi:10.4414/smw.2022.w30201.
    Abstract: AIMS OF THE STUDY: Switzerland is traditionally an agricultural country with more than 50,000 farms and 1.5 million registered cows. However, contemporary literature on cattle-related trauma in Switzerland remain limited. The purpose of this study was to examine injury patterns and outcomes of patients who presented to a tertiary trauma centre in Switzerland following cattle-related trauma. METHODS: Retrospective single-centre study over a 10-year period (2012-2021) including all patients experiencing cattle-related trauma. From retrieved charts demographics, injury data, and outcomes were collected and subsequently analysed. RESULTS: A total of 94 patients with cattle-related injuries were identified. The median age was 52 years (interquartile range [IQR] 37-63) and 75% were male. Cattle-related injuries were most frequent among farmers (73%) and were most often caused by cows (86%), followed by bulls (10%). Blunt trauma (89%) was the leading mechanism of injury including headbutt (36%), kick (35%), physical contact (20%) and trampling injury (12%). Penetrating injury occurred in 11%, all caused by headbutt. Contusions (82%) and lacerations (45%) were the leading injuries, followed by face fractures (28%), closed head trauma (19%) and chest injuries (17%). Overall, 10% of all patients had a head abbreviated injury scale (AIS) score of >/=3 and 8% had a chest AIS of >/=3. The hospital admission rate was 49% for cow-related injury vs 90% for bull-related injuries, p = 0.023. Overall, in-hospital mortality was 3% and the median length of stay was 4.5 days (IQR 3-8) among patients admitted to the hospital. CONCLUSIONS: Cattle-related injuries in Switzerland mainly affect farmers and are associated with considerable morbidity, especially when caused by bulls. Facial fractures, head injuries and chest injuries are common, and the latter two in particular can be severe. The results of the present study can be used for the implementation of data-driven prevention measures for the safe handling of cattle in Switzerland.
    Tags: *Thoracic Injuries, *Trauma Centers, Animals, Cattle, Female, Humans, Injury Severity Score, Male, Retrospective Studies, Switzerland/epidemiology.
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  • Suttels, V., Du Toit, J. D., Fiogbe, A. A., Wachinou, A. P., Guendehou, B., Alovokpinhou, F., Toukoui, P., et al. “Point-Of-Care Ultrasound For Tuberculosis Management In Sub-Saharan Africa-A Balanced Swot Analysis”. Int J Infect Dis 123: 46-51. doi:10.1016/j.ijid.2022.07.009.
    Abstract: Point-of-care ultrasound (POCUS) is an increasingly accessible skill, allowing for the decentralization of its use to nonspecialist healthcare workers to guide routine clinical decision-making. The advent of ultrasound-on-a-chip has transformed the technology into a portable mobile health device. Because of its high sensitivity to detect small consolidations, pleural effusions, and subpleural nodules, POCUS has recently been proposed as a sputum-free likely triage tool for tuberculosis (TB). To make an objective assessment of the potential and limitations of POCUS in routine TB management, we present a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis based on a review of the relevant literature and focusing on Sub-Saharan Africa (SSA). We identified numerous strengths and opportunities of POCUS for TB management, e.g., accessible, affordable, easy to use and maintain, expedited diagnosis, extrapulmonary TB detection, safer pleural/pericardial puncture, use in children/pregnant women/people living with HIV, targeted screening of TB contacts, monitoring TB sequelae, and creating artificial intelligence decision support. Weaknesses and external threats such as operator dependency, lack of visualization of central lung pathology, poor specificity, lack of impact assessments and data from SSA must be taken into consideration to ensure that the potential of the technology can be fully realized in research as in practice.
    Tags: *Point-of-Care Systems, *Tuberculosis/diagnostic imaging/drug therapy, Artificial Intelligence, Child, Female, Humans, Point-of-Care Testing, Point-of-care ultrasound, Pregnancy, Sub-Saharan Africa, Tuberculosis, Ultrasonography.
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  • Rupp, S., Papaefthymiou, A., Chatzimichael, E., Polyzos, S. A., Spreitzer, S., Doulberis, M., Kuntzen, T., and Kountouras, J. “Diagnostic Approach To Helicobacter Pylori-Related Gastric Oncogenesis”. Ann Gastroenterol 35, no. 4: 333-344. doi:10.20524/aog.2022.0725.
    Abstract: Helicobacter pylori (H. pylori) is a causative agent of peptic ulcer disease and plays an important role in the development of various other upper and lower gastrointestinal tract and systemic diseases; in addition to carcinogenesis and the development of mucosa-associated lymphoid tissue lymphoma, extragastric manifestations of H. pylori are increasingly being unraveled. Therefore, prompt and accurate diagnosis is essential. Within this narrative review we present an overview of the current trend in the diagnosis of H. pylori infection and its potential oncogenic sequelae, including gastric mucosa atrophy, intestinal metaplasia, dysplasia and gastric cancer. Signs of H. pylori-related gastric cancer risk can be assessed by endoscopy using the Kyoto classification score. New technology, such as optical or digital chromoendoscopy, improves diagnostic accuracy and provides information regarding H. pylori-related gastric preneoplastic and malignant lesions. In addition, a rapid urease test or histological examination should be performed, as these offer a high diagnostic sensitivity; both are also useful for the diagnosis of sequelae including gastric and colon neoplasms. Culture is necessary for resistance testing and detecting H. pylori-related gastric dysbiosis involved in gastric oncogenesis. Likewise, molecular methods can be utilized for resistance testing and detecting H. pylori-related gastric cancer development and progression. Noninvasive tests, such as the urea breath and stool antigen tests, can also be implemented; these are also suitable for monitoring eradication success and possibly for detecting H. pylori-related gastric malignancy. Serological tests may help to exclude infection in specific populations and detect gastric and colon cancers. Finally, there are emerging potential diagnostic biomarkers for H. pylori-related gastric cancer.
    Tags: diagnosis, Doulberis and T. Kuntzen have received a travel grant from Gilead Sciences, Helicobacter pylori, histology, rapid urease test, Switzerland Sarl. S. Rupp and T. Kuntzen have also received a travel grant from, urea breath test, Vifor. The rest of the authors declare no conflict of interest..
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  • Schumacher, L., Senhaji, S., Gartner, B. A., Carrez, L., Dupuis, A., Bonnabry, P., and Widmer, N. “Full-Scale Simulations To Improve Disaster Preparedness In Hospital Pharmacies”. Bmc Health Serv Res 22, no. 1: 853. doi:10.1186/s12913-022-08230-9.
    Abstract: PURPOSE: Assess whether full-scale simulation exercises improved hospital pharmacies' disaster preparedness. METHODS: Swiss hospital pharmacies performed successive full-scale simulation exercises at least four months apart. An interprofessional team created two scenarios, each representing credible regional-scale disasters involving approximately fifty casualties (a major road accident and a terrorist attack). Four exercise assessors used appraisal forms to evaluate participants' actions and responses during the simulation (rating them using five-point Likert scales). RESULTS: Four hospital pharmacies performed two full-scale simulation exercises each. Differences between exercises one and two were observed. On average, the four hospitals accomplished 69% +/- 6% of the actions expected of them during exercise one. The mean rate of expected actions accomplished increased to 84% +/- 7% (p < 0.005) during exercise two. Moreover, the average quality of actions improved from 3.0/5 to 3.6/5 (p = 0.01), and the time required to gather a crisis management team drastically decreased between simulations (from 23 to 5 min). The main challenges were communication (reformulation) and crisis management. Simulation exercise number one resulted in three hospital pharmacies creating disaster action plans and the fourth improving its already existing plan. CONCLUSION: This study highlighted the value of carrying out full-scale disaster simulations for hospital pharmacies as they improved overall institutional preparedness and increased staff awareness. The number of expected actions accomplished increased significantly. In the future, large-scale studies and concept dissemination are warranted.
    Tags: *Disaster Planning, *Disasters, *Pharmacies, Disaster planning, from the funding of the study., Full-scale exercises, Hospital, Hospitals, Humans, Pharmacy service, Simulation.
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  • Barco, S., Voci, D., Held, U., Sebastian, T., Bingisser, R., Colucci, G., Duerschmied, D., et al. “Enoxaparin For Primary Thromboprophylaxis In Symptomatic Outpatients With Covid-19 (Ovid): A Randomised, Open-Label, Parallel-Group, Multicentre, Phase 3 Trial”. Lancet Haematol 9, no. 8: e585-e593. doi:10.1016/S2352-3026(22)00175-2.
    Abstract: BACKGROUND: COVID-19 is a viral prothrombotic respiratory infection. Heparins exert antithrombotic and anti-inflammatory effects, and might have antiviral properties. We aimed to investigate whether thromboprophylaxis with enoxaparin would prevent untoward hospitalisation and death in symptomatic, but clinically stable outpatients with COVID-19. METHODS: OVID was a randomised, open-label, parallel-group, investigator-initiated, phase 3 trial and was done at eight centres in Switzerland and Germany. Outpatients aged 50 years or older with acute COVID-19 were eligible if they presented with respiratory symptoms or body temperature higher than 37.5 degrees C. Eligible participants underwent block-stratified randomisation (by age group 50-70 vs >70 years and by study centre) in a 1:1 ratio to receive either subcutaneous enoxaparin 40 mg once daily for 14 days versus standard of care (no thromboprophylaxis). The primary outcome was a composite of any untoward hospitalisation and all-cause death within 30 days of randomisation. Analysis of the efficacy outcomes was done in the intention-to-treat population. The primary safety outcome was major bleeding. The study was registered in ClinicalTrials.gov (NCT04400799) and has been completed. FINDINGS: At the predefined formal interim analysis for efficacy (50% of total study population), the independent Data Safety Monitoring Board recommended early termination of the trial on the basis of predefined statistical criteria having considered the very low probability of showing superiority of thromboprophylaxis with enoxaparin for the primary outcome under the initial study design assumptions. Between Aug 15, 2020, and Jan 14, 2022, from 3319 participants prescreened, 472 were included in the intention-to-treat population and randomly assigned to receive enoxaparin (n=234) or standard of care (n=238). The median age was 57 years (IQR 53-62) and 217 (46%) were women. The 30-day risk of the primary outcome was similar in participants allocated to receive enoxaparin and in controls (8 [3%] of 234 vs 8 [3%] of 238; adjusted relative risk 0.98; 95% CI 0.37-2.56; p=0.96). All hospitalisations were related to COVID-19. No deaths were reported during the study. No major bleeding events were recorded. Eight serious adverse events were recorded in the enoxaparin group versus nine in the control group. INTERPRETATION: These findings suggest thromboprophylaxis with enoxaparin does not reduce early hospitalisations and deaths among outpatients with symptomatic COVID-19. Futility of the treatment under the initial study design assumptions could not be conclusively assessed owing to under-representation of older patients and consequent low event rates. FUNDING: SNSF (National Research Programme COVID-19 NRP78: 198352), University Hospital Zurich, University of Zurich, Dr-Ing Georg Pollert (Berlin), Johanna Durmuller-Bol Foundation.
    Tags: *COVID-19/epidemiology, *Enoxaparin/adverse effects, *Thrombosis/prevention & control, Aged, Female, Humans, Male, Middle Aged, Outpatients, SARS-CoV-2, Treatment Outcome.
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  • Sendi, P., Thierstein, M., Widmer, N., Babongo Bosombo, F., Buchi, A. E., Guntensperger, D., Blum, M. R., et al. “Serosurveillance After A Covid-19 Vaccine Campaign In A Swiss Police Cohort”. Immun Inflamm Dis 10, no. 7: e640. doi:10.1002/iid3.640.
    Abstract: INTRODUCTION: To assess the risk for COVID-19 of police officers, we are studying the seroprevalence in a cohort. The baseline cross-sectional investigation was performed before a vaccination campaign in January/February 2021, and demonstrated a seroprevalence of 12.9%. Here, we demonstrate serosurveillance results after a vaccination campaign. METHODS: The cohort consists of 1022 study participants. The 3- and 6-month follow-up visits were performed in April/May and September 2021. Data on infection and vaccination rates were obtained via measuring antibodies to the nucleocapsid protein and spike protein and online questionnaires. RESULTS: The mean age of the population was 41 (SD 8.8) years, 72% were male and 76% had no comorbidity. Seroconversion was identified in 1.05% of the study population at the 3-month visit and in 0.73% at the 6-month visit, resulting in an infection rate of 1.8% over a time period of 6 months. In comparison, the infection rate in the general population over the same time period was higher (3.18%, p = .018). At the 6-month visit, 77.8% of participants reported being vaccinated once and 70.5% twice; 81% had an anti-S antibody titer of >250 U/ml and 87.1% of >/=2 U/ml. No significant association between infection and job role within the department, working region, or years of experience in the job was found. Anti-spike antibody titers of vaccinated study participants showed a calculated decreasing trend 150-200 days after the second vaccine dose. CONCLUSION: These data confirm the value of the vaccination campaign in an exposed group other than healthcare professionals.
    Tags: *COVID-19 Vaccines, *COVID-19/epidemiology/prevention & control, Adult, anti-NCP-antibodies, anti-S-antibodies, COVID-19 seroprevalence, Cross-Sectional Studies, Female, Humans, Male, Police, SARS-CoV-2, Seroepidemiologic Studies, Switzerland/epidemiology.
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  • Schmutz, T., Guechi, Y., Le Terrier, C., and Ribordy, V. “Emergency Endotracheal Intubation: Best Practice Versus Reality”. Swiss Med Wkly 152, no. 23-24: w30189. doi:10.4414/smw.2022.w30189.
    Tags: *Emergency Medical Services, *Intubation, Intratracheal, Humans.
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  • Schaad, S., Brahier, T., Hartley, M. A., Cordonnier, J. B., Bosso, L., Espejo, T., Pantet, O., et al. “Point-Of-Care Lung Ultrasonography For Early Identification Of Mild Covid-19: A Prospective Cohort Of Outpatients In A Swiss Screening Center”. Bmj Open 12, no. 6: e060181. doi:10.1136/bmjopen-2021-060181.
    Abstract: OBJECTIVES: Early identification of SARS-CoV-2 infection is important to guide quarantine and reduce transmission. This study evaluates the diagnostic performance of lung ultrasound (LUS), an affordable, consumable-free point-of-care tool, for COVID-19 screening. DESIGN, SETTING AND PARTICIPANTS: This prospective observational cohort included adults presenting with cough and/or dyspnoea at a SARS-CoV-2 screening centre of Lausanne University Hospital between 31 March and 8 May 2020. INTERVENTIONS: Investigators recorded standardised LUS images and videos in 10 lung zones per patient. Two blinded independent experts reviewed LUS recording and classified abnormal findings according to prespecified criteria to investigate their predictive value to diagnose SARS-CoV-2 infection according to PCR on nasopharyngeal swabs (COVID-19 positive vs COVID-19 negative). PRIMARY AND SECONDARY OUTCOME MEASURES: We finally combined LUS and clinical findings to derive a multivariate logistic regression diagnostic score. RESULTS: Of 134 included patients, 23% (n=30/134) were COVID-19 positive and 77% (n=103/134) were COVID-19 negative; 85%, (n=114/134) cases were previously healthy healthcare workers presenting within 2-5 days of symptom onset (IQR). Abnormal LUS findings were significantly more frequent in COVID-19 positive compared with COVID-19 negative (45% vs 26%, p=0.045) and mostly consisted of focal pathologic B lines. Combining clinical findings in a multivariate logistic regression score had an area under the receiver operating curve of 80.3% to detect COVID-19, and slightly improved to 84.5% with the addition of LUS features. CONCLUSIONS: COVID-19-positive patients are significantly more likely to have lung pathology by LUS. However, LUS has an insufficient sensitivity and is not an appropriate screening tool in outpatients. LUS only adds little value to clinical features alone.
    Tags: *COVID-19/diagnostic imaging, Adult, Covid-19, diagnostic radiology, Humans, infectious diseases, Lung/diagnostic imaging, Outpatients, Point-of-Care Systems, Prospective Studies, SARS-CoV-2, Switzerland/epidemiology, ultrasonography, Ultrasonography/methods.
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  • Ageron, F. X., Shakur-Still, H., and Roberts, I. “Effects Of Tranexamic Acid Treatment In Severely And Non-Severely Injured Trauma Patients”. Transfusion 62 Suppl 1, no. Suppl 1: S151-S157. doi:10.1111/trf.16954.
    Abstract: BACKGROUND: Urgent treatment with tranexamic acid (TXA) reduces bleeding deaths but there is disagreement about which patients should be treated. We examine the effects of TXA treatment in severely and non-severely injured trauma patients. STUDY DESIGN AND METHODS: We did an individual patient data meta-analysis of randomized trials with over 1000 trauma patients that assessed the effects of TXA on survival. We defined the severity of injury according to characteristics at first assessment: systolic blood pressure of less than 90 mm Hg and a heart rate greater than 120 beats per minute or Glasgow Coma Scale score of less than nine or any GCS with one or more fixed dilated pupils. The primary measure was survival on the day of the injury. We examined the effect of TXA on survival in severely and non-severely injured patients and how these effects vary with the time from injury to treatment. RESULTS: We obtained data for 32,944 patients from two randomized trials. Tranexamic acid significantly increased survival on the day of the injury (OR = 1.22, 95% CI 1.11-1.34; p < .01). The effect of tranexamic acid on survival in non-severely injured patients (OR = 1.25, 1.03-1.50) was similar to that in severely injured patients (OR = 1.22, 1.09-1.37) with no significant heterogeneity (p = .87). In severely and non-severely injured pateints, treatment within the first hour after injury was the most effective. DISCUSSION: Early tranexamic acid treatment improves survival in both severely and non-severely injured trauma patients. Its use should not be restricted to the severely injured.
    Tags: *Antifibrinolytic Agents/therapeutic use, *Tranexamic Acid/therapeutic use, *Wounds and Injuries/drug therapy, blood management, Glasgow Coma Scale, Hemorrhage/drug therapy, hemostasis, Humans.
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  • Ravioli, S., Germann, C., Gygli, R., Exadaktylos, A. K., and Lindner, G. “Age- And Sex-Related Differences In Community-Acquired Pneumonia At Presentation To The Emergency Department: A Retrospective Cohort Study”. Eur J Emerg Med 29, no. 5: 366-372. doi:10.1097/MEJ.0000000000000933.
    Abstract: BACKGROUND AND IMPORTANCE: Because of its associated high morbidity and mortality, early identification and treatment of community-acquired pneumonia (CAP) are essential. OBJECTIVES: To investigate age- and sex-related differences in clinical symptoms, radiologic findings and outcomes in patients presenting to the emergency department (ED) with CAP. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Patients admitted to one Swiss ED with radiologically confirmed CAP between 1 January 2017 and 31 December 2018. OUTCOME MEASURES AND ANALYSIS: Primary aim was to evaluate differences in clinical and radiologic presentation of men vs. women and patients >65 years vs. <65 years with CAP. Secondary outcomes were age- and sex-related differences in terms of Pneumonia Severity Index (PSI) risk class, need for ICU referral, mechanical ventilation, in-hospital mortality, 30-day readmission and 180-day pneumonia recurrence. MAIN RESULTS: In total 467 patients with CAP were included. 211 were women (45%). 317 were >/=65 years (68%), of which 145 were women (46%). Older patients less commonly reported chest pain (13 vs. 27%; effect size 14%; 95% CI, 0.07-0.23), fever (39 vs. 53%, effect size 14%; 95% CI, 0.05-0.24), chills (6 vs. 20%; effect size 14%; 95% CI, 0.08-0.0.214), cough (44 vs. 57%; effect size 13%; 95% CI, 0.03-0.22), headache (5 vs. 15%, effect size 10%, 95% CI, 0.04-0.17) and myalgias (5 vs. 19%; effect size 14%; 95% CI, 0.07-0.21). However, 85% of patients with no symptoms were >/=65 years. PSI was lower in women [95 (SD 31) vs. 104 (SD 31); 95% CI, -14.44 to 2.35] and sputum was more common in men (32 vs. 22%; effect size 10%; 95% CI, -0.18 to -0.02). Raw mortality was higher in elderly patients [14 vs. 3%; odds ratio (OR), 4.67; 95% CI, 1.81-12.05], whereas it was similar in men and women (11 vs. 10%; OR, 1.22; 95% CI, 0.67-2.23). CONCLUSION: Patients, less than 65 years with CAP presenting to the ED had significantly more typical symptoms such as chest pain, fever, chills, cough, headache and myalgias than those being above 65 years. No relevant differences between men and women were found in clinical presentation, except for PSI on admission, and radiologic findings and neither age nor sex was a predictor for mortality in CAP.
    Tags: *Community-Acquired Infections/diagnosis/therapy, *Pneumonia/diagnosis/therapy, Aged, Chest Pain, Cough, Emergency Service, Hospital, Female, Headache, Humans, Male, Retrospective Studies.
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  • Birrenbach, T., Buhlmann, F., Exadaktylos, A. K., Hautz, W. E., Muller, M., and Sauter, T. C. “Virtual Reality For Pain Relief In The Emergency Room (Viper) - A Prospective, Interventional Feasibility Study”. Bmc Emerg Med 22, no. 1: 113. doi:10.1186/s12873-022-00671-z.
    Abstract: BACKGROUND: Pain is one of the most common, yet challenging problems leading to emergency department (ED) presentation, despite the availability of a wide range of pharmacological therapies. Virtual reality (VR) simulations are well studied in a wide variety of clinical settings, including acute and chronic pain management, as well as anxiety disorders. However, studies in the busy environment of an adult ED are scarce. The aim of this study is to explore the feasibility and effectiveness of a VR simulation for pain and anxiety control in a convenience sample of adult ED patients presenting with traumatic and non-traumatic pain triaged 2-5 (i.e., urgent to non-urgent) with a pain rating of >/= 3 on a numeric rating scale (NRS 0-10). METHODS: Prospective within-subject, repeated measures interventional feasibility pilot study at a Swiss University ED. The intervention consisted of a virtual reality simulation in addition to usual care. Pain and anxiety levels were measured using a verbally administered numeric rating scale (NRS) before and after the intervention. Information on patient experience was collected using established rating scales. RESULTS: Fifty-two patients were enrolled. The most common pain localisations were extremities (n = 15, 28.8%) and abdomen (n = 12, 23.1%). About one third of patients presented with trauma-associated pain (n = 16, 30.8%). Duration of pain was mainly acute (< 24 h) (n = 16, 30.8%) or subacute (> 24 h) (n = 32, 61.5%). The majority of patients were triage category 3, i.e. semi-urgent (n = 48, 92.3%). Significant reduction in pain (NRS median pre-VR simulation 4.5 (IQR 3-7) vs. median post-VR simulation 3 (IQR 2-5), p < 0.001), and anxiety levels (NRS median pre-VR simulation 4 (IQR 2-5) vs. median post-VR simulation 2 (IQR 0-3), p < 0.001) was achieved, yielding moderate to large effect sizes (Cohen's d estimate for pain reduction = 0.59 (95% CI 0.19-0.98), for anxiety level on NRS = 0.75 (95% CI 0.34-1.15). With medium immersion and good tolerability of the VR simulation, user satisfaction was high. CONCLUSIONS: Virtual reality analgesia for pain and anxiety reduction in the busy setting of an ED is feasible, effective, with high user satisfaction. Further randomized controlled studies are needed to better characterize its impact on pain perception and resource utilization.
    Tags: *Pain Management, *Virtual Reality, 14/17) as well with an in-house grant of the Clinical Trial Unit. TCS holds the, Adult, and MDI International Australia, all outside the submitted work.WEH has received, Anxiety, e-Health, Emergency department, Emergency Service, Hospital, endowed professorship of emergency telemedicine at the University of Bern, Feasibility Studies, financial support for a congress he chaired from EBSCO Germany, Isabel Healthcare, Humans, Medical Sciences through the "Young Talents in Clinical Research" (grant TCR, Pain, Pain management, Pain Measurement, Pilot Projects, Prospective Studies, research or decision to publish. All other authors have nothing to disclose., Science foundation, Zoll foundation, Drager Medical Germany, Mundipharma Research, sponsored by the Touring Club Switzerland. The sponsor has no influence on the, submitted work. WEH has provided paid consultancies to AO foundation Switzerland, Telehealth, Telemedicine, UK, MDI International Australia, Roche Diagnostics Germany, all outside the, UK, Mundipharma Medical Switzerland, VisualDx USA, all outside the submitted, Virtual reality simulation, work. MM has been funded by the Bangerter Foundation and the Swiss Academy of.
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  • Marti, F., Lindner, G., and Ravioli, S. “Resistance To Local Anaesthetics: A Literature Review”. Br J Anaesth 129, no. 2: e43-e45. doi:10.1016/j.bja.2022.05.006.
    Tags: *Anesthesia, Local, *Anesthetics, Local, chronic opioid use, Ehlers-Danlos syndrome, Humans, local anaesthetic, resistance, voltage-gated sodium channel.
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  • Gonzalez-Jaramillo, V., Maessen, M., Luethi, N., Guyer, J., Hunziker, L., Eychmuller, S., and Zambrano, S. C. “Unmet Needs In Patients With Heart Failure: The Importance Of Palliative Care In A Heart Failure Clinic”. Front Cardiovasc Med 9: 866794. doi:10.3389/fcvm.2022.866794.
    Abstract: BACKGROUND: There are increasing calls to establish heart failure (HF) clinics due to their effectiveness in the interdisciplinary management of people living with HF. However, although a recommendation exists for palliative care (PC) providers to be part of the interdisciplinary team, few of the established HF clinics include them in their teams. Therefore, in this qualitative study, we aimed to understand the unmet PC needs of patients with HF attending an already established HF clinic. METHODS: Secondary qualitative analysis of structured interviews undertaken within a larger study to validate the German version of the Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF). The NAT: PD-HF is a tool that aims to assess unmet needs in patients with HF. The interviews took place between January and March 2020 with patients from the ambulatory HF Clinic of a University Hospital in Switzerland. For this analysis, we transcribed and thematically analyzed the longest and most content-rich interviews until we reached data saturation at 31 participants. The interviews lasted 31 min on average (24-48 min). RESULTS: Participants (n = 31) had a median age of 64 years (IQR 56-77), the majority had reduced ejection fraction, were men, and were classified as having a New York Heart Association functional class II. Participants were in general satisfied with the treatment and information received at the HF clinic. However, they reported several unmet needs. We therefore identified three ambivalences as main themes: (I) "feeling well-informed but missing essential discussions", (II) "although feeling mostly satisfied with the care, remaining with unmet care needs", and (III) "fearing a referral to palliative care but acknowledging its importance". CONCLUSION: Although patients who are receiving multidisciplinary management in ambulatory HF clinics are generally satisfied with the care received, they remain with unmet needs. These unmet needs, such as the need for advance care planning or the need for timely and tactful end-of-life discussions, can be fulfilled by PC providers. Including personnel trained in PC as part of the multidisciplinary team could help to address patients' needs, thus improving the quality of care and the quality of life of people living with HF.
    Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., heart failure, multidisciplinary team, palliative care, patient-centered care, qualitative study, quality of care/care delivery.
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  • Birrenbach, T., Hoffmann, M., Hautz, S. C., Kammer, J. E., Exadaktylos, A. K., Sauter, T. C., Muller, M., and Hautz, W. E. “Frequency And Predictors Of Unspecific Medical Diagnoses In The Emergency Department: A Prospective Observational Study”. Bmc Emerg Med 22, no. 1: 109. doi:10.1186/s12873-022-00665-x.
    Abstract: BACKGROUND: Misdiagnosis is a major public health problem, causing increased morbidity and mortality. In the busy setting of an emergency department (ED) patients are diagnosed under difficult circumstances. As a consequence, the ED diagnosis at hospital admittance may often be a descriptive diagnosis, such as "decreased general condition". Our objective was to determine in how far patients with such an unspecific ED diagnosis differ from patients with a specific ED diagnosis and whether they experience a worse outcome. METHODS: We conducted a prospective observational study in Bern university hospital in Switzerland for all adult non-trauma patients admitted to any internal medicine ward from August 15th 2015 to December 7th 2015. Unspecific ED diagnoses were defined through the clinical classification software for ICD-10 by two outcome assessors. As outcome parameters, we assessed in-hospital mortality and length of hospital stay. RESULTS: Six hundred eighty six consecutive patients were included. Unspecific diagnoses were identified in 100 (14.6%) of all consultations. Patients receiving an unspecific diagnosis at ED discharge were significantly more often women (56.0% vs. 43.9%, p = 0.024), presented more often with a non-specific complaint (34% vs. 21%, p = 0.004), were less often demonstrating an abnormal heart rate (5.0% vs. 12.5%, p = 0.03), and less often on antibiotics (32.0% vs. 49.0%, p = 0.002). Apart from these, no studied drug intake, laboratory or clinical data including change in diagnosis was associated significantly with an unspecific diagnosis. Unspecific diagnoses were neither associated with in-hospital mortality in multivariable analysis (OR = 1.74, 95% CI: 0.60-5.04; p = 0.305) adjusted for relevant confounders nor with length of hospital stay (GMR = 0.87, 95% CI: 0.23-3.32; p = 0.840). CONCLUSIONS: Women and patients with non-specific presenting complaints and no abnormal heart rate are at risk of receiving unspecific ED diagnoses that do not allow for targeted treatment, discharge and prognosis. This study did not find an effect of such diagnoses on length of hospital stay nor in-hospital mortality.
    Tags: *Emergency Service, Hospital, *Patient Discharge, Adult, Club Switzerland. The founder has no influence on the research agenda, results or, Diagnostic error, Emergency department, Female, Hospital Mortality, Humans, Length of Stay, Non-specific complaints, nothing to disclose., Prospective Studies, the decision to publish. WEH has received speaker fees from the AO Foundation, Unspecific diagnoses, Zurich and research funding from Mundipharma Medical Basel. All authors have.
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  • Michel, J., Murugasampillay, S., Sauter, T. C., and Tanner, M. “Teleeducation: Pandemic Proofing Global Education”. Int J Public Health 67: 1604872. doi:10.3389/ijph.2022.1604872.
    Tags: *Pandemics, *Telemedicine, commercial or financial relationships that could be construed as a potential, conflict of interest., decolonising global health, Educational Status, equitable access to global education, Global Health, Humans, international collaborations, pandemic, teleeducation.
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  • Kennedy, A., Holland, M., Sullivan, P., Gebril, A., Arora, N., Vijayakumar, V., Hoole, A., et al. “Developing Priorities For Quality Improvement In Acute Medicine Using A Modified Delphi Method A Consensus Process Hosted By The Society For Acute Medicine Quality Improvement Committee (Sam-Qi)”. Acute Med 21, no. 2: 74-79. doi:10.52964/AMJA.0901.
    Abstract: INTRODUCTION: The SAM Quality Improvement Committee (SAM-QI), set up in 2016, has worked over the last year to determine the priority Acute Medicine QI topics. They have also discussed and put forward proposals to improve QI training for Acute Medicine professionals. METHODS: A modified Delphi process was completed over four rounds to determine priority QI topics. Online meetings were also used to develop proposals for QI training. RESULTS: Same Day Emergency Care (SDEC) was chosen as the priority topic for QI work within Acute Medicine. CONCLUSION: The SAM-QI group settled on SDEC being the priority topic for Acute Medicine QI development. Throughout the Delphi process SAM-QI has also developed proposals for QI training that will help Acute Medicine professionals deliver coordinated meaningful improvements in care.
    Tags: *Medicine, *Quality Improvement, Consensus, Delphi Technique, Humans.
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  • Gruber, B. U., Girsberger, V., Kusstatscher, L., Funk, S., Luethy, A., Jakus, L., Maillard, J., Steiner, L. A., Dell-Kuster, S., and Burkhart, C. S. “Comparing Propofol Anaesthesia Guided By Bispectral Index Monitoring And Frontal Eeg Wave Analysis With Standard Monitoring In Laparoscopic Surgery: Protocol For The 'Eeg In General Anaesthesia - More Than Only A Bispectral Index' Trial, A Multicentre, Double-Blind, Randomised Controlled Trial”. Bmj Open 12, no. 6: e059919. doi:10.1136/bmjopen-2021-059919.
    Abstract: INTRODUCTION: The use of Bispectral Index (BIS) monitors for assessing depth of sedation has led to a reduction in both the incidence of awareness and anaesthetic consumption in total intravenous anaesthesia. However, these monitors are vulnerable to artefacts. In addition to the processed number, the raw frontal electroencephalogram (EEG) can be displayed as a curve on the same monitor. Anaesthesia practitioners can learn to interpret the EEG in a short tutorial and may be quicker and more accurate thanBIS in assessing anaesthesia depth by recognising EEG patterns. We hypothesise that quality of recovery (QoR) in patients undergoing laparoscopic surgery is better, if propofol is titrated by anaesthesia practitioners able to interpret the EEG. METHODS AND ANALYSIS: This is a multicentre, double-blind (patients and outcome assessors) randomised controlled trial taking place in four Swiss hospitals. Patients aged 18 years or older undergoing laparoscopic procedures with general anaesthesia using propofol and anaesthesia practitioners with more than 2 years experience will be eligible. The primary study outcome is the difference in QoR 24 hours after surgery. Secondary outcomes are propofol consumption, incidence of postoperative nausea and vomiting (PONV) and postoperative delirium.QoR and propofol consumption are compared between both groups using a two-sample t-test. Fisher's exact test is used to compare the incidences of PONV and delirium. A total of 200 anaesthesia practitioners (and 200 patients) are required to have an 80% chance of detecting the minimum relevant difference for the QoR-15 as significant at the 5% level assuming a SD of 20. ETHICS AND DISSEMINATION: Ethical approval has been obtained from all responsible ethics committees (lead committee: Ethikkommission Nordwest- und Zentralschweiz, 16 January 2021). The findings of the trial will be published in a peer-reviewed journal, presented at international conferences, and may lead to a change in titrating propofol in clinical practice. TRIAL REGISTRATION NUMBER: www. CLINICALTRIALS: gov:NCT04105660.
    Tags: *Delirium/etiology, *Laparoscopy/adverse effects, *Propofol/adverse effects, adult anaesthesia, anaesthesia in neurology, Anesthesia, General/adverse effects, education & training (see medical education & training), Electroencephalography, Humans, Multicenter Studies as Topic, neurophysiology, Postoperative Nausea and Vomiting/chemically induced, Randomized Controlled Trials as Topic.
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  • Gosselin, M., Mabire, C., Pasquier, M., Carron, P. N., Hugli, O., Ageron, F. X., and Dami, F. “Prevalence And Clinical Significance Of Point Of Care Elevated Lactate At Emergency Admission In Older Patients: A Prospective Study”. Intern Emerg Med 17, no. 6: 1803-1812. doi:10.1007/s11739-022-03005-w.
    Abstract: OBJECTIVE: Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales. METHODS: This monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if >/= 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions. RESULTS: In total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome. CONCLUSION: The prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above.
    Tags: *Point-of-Care Systems, *Sepsis, Aged, Emergency, Emergency Service, Hospital, Hospital Mortality, Humans, Lactate, Lactic Acid, Mews, News, Older people, Point-of-care, Poor outcome, Prevalence, Prospective Studies, qSOFA, Retrospective Studies, ROC Curve.
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  • Rubinelli, S., Purnat, T. D., Wilhelm, E., Traicoff, D., Namageyo-Funa, A., Thomson, A., Wardle, C., Lamichhane, J., Briand, S., and Nguyen, T. “Correction To: Who Competency Framework For Health Authorities And Institutions To Manage Infodemics: Its Development And Features”. Hum Resour Health 20, no. 1: 49. doi:10.1186/s12960-022-00750-z.
    Abstract: Following publication of the original article [1], the authors identified an error in the author name of Elisabeth Wilhelm. The incorrect author name is: Elisabeth Wihelm The correct author name is: Elisabeth Wilhelm The author group has been updated above and the original article [1] has been corrected. © The Author(s) 2022.
    Tags: erratum.
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  • Ford, K. L., Prado, C. M., Weimann, A., Schuetz, P., and Lobo, D. N. “Unresolved Issues In Perioperative Nutrition: A Narrative Review”. Clin Nutr 41, no. 7: 1578-1590. doi:10.1016/j.clnu.2022.05.015.
    Abstract: Surgical patients are at an increased risk of negative outcomes if they are malnourished or at risk of malnutrition preoperatively. Optimisation of nutritional status should be a focus throughout the perioperative continuum to promote improved surgical outcomes. Enhanced Recovery after Surgery (ERAS) protocols are increasingly applied in the surgical setting but are not yet widespread. This narrative review focused on areas of perioperative nutrition that are perceived as controversial or are lacking in agreement. A search for available literature was conducted on 1 March 2022 and relevant high-quality articles published since 2015 were considered for inclusion. Most malnutrition screening tools are not specific to the surgical population except for the Perioperative Nutrition Screen (PONS) although more large-scale initiatives are needed to improve the prevalence of preoperative nutrition screening. Poor muscle health is common in patients with malnutrition and further exacerbates negative health outcomes indicating that prevention, detection and treatment is of high importance in this population. Although a lack of consensus remains for who should receive preoperative nutritional therapy, evidence suggests a positive impact on muscle health. Additionally, postoperative nutritional support benefits surgical outcomes, with some patients requiring enteral and/or parenteral feeding routes and showing benefit from immunonutrition. The importance of nutrition extends beyond the time in hospital and should remain a priority post-discharge. The impact of individual or personalised nutrition based on select patient characteristics remains to be further investigated. Overall, the importance of perioperative nutrition is evident in the literature despite select ongoing areas of contention.
    Tags: *Malnutrition/prevention & control, *Nutritional Status, Aftercare, also received speakers honoraria from Baxter, BBraun and Fresenius Kabi. P.S. has, Humans, Immunonutrition, Muscle, Muscle health, Nutricia, Nestle Health Science, Fresenius Kabi, Pfizer, and Helsinn. A.W. has, Nutritional interventions, Nutritional screening, Parenteral Nutrition/methods, Patient Discharge, Perioperative Care/methods, Perioperative nutrition, Postoperative Complications/prevention & control, received research grants for unrelated work from Abbott Nutrition, Nestle,, received research grants for unrelated work from BBraun, Mucos and Seca. He has, reports receiving honoraria and/or paid consultancy from Abbott Nutrition,, Thermofisher and bioMerieux..
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  • Bauer, M., Kitila, F., Mwasongwe, I., Abdallah, I. S., Siongo, E., Kasunga, S., Gingo, W., et al. “Ultrasonographic Findings In Patients With Abdominal Symptoms Or Trauma Presenting To An Emergency Room In Rural Tanzania”. Plos One 17, no. 6: e0269344. doi:10.1371/journal.pone.0269344.
    Abstract: BACKGROUND: Frequencies of ultrasonographic findings and diagnoses in emergency departments in sub-Saharan Africa are unknown. This study aimed to describe the frequencies of different sonographic findings and diagnoses found in patients with abdominal symptoms or trauma presenting to a rural referral hospital in Tanzania. METHODS: In this prospective observational study, we consecutively enrolled patients with abdominal symptoms or trauma triaged to the emergency room of the Saint Francis Referral Hospital, Ifakara. Patients with abdominal symptoms received an abdominal ultrasound. Patients with an abdominal or thoracic trauma received an Extended Focused Assessment with Ultrasound in Trauma (eFAST). RESULTS: From July 1st 2020 to June 30th 2021, a total of 88838 patients attended the emergency department, of which 7590 patients were triaged as 'very urgent' and were seen at the emergency room. A total of 1130 patients with abdominal symptoms received an ultrasound. The most frequent findings were abnormalities of the uterus or adnexa in 409/754 females (54.2%) and abdominal free fluid in 368 (32.6%) patients; no abnormality was found in 150 (13.5%) patients. A tumour in the abdomen or pelvis was found in 183 (16.2%) patients, an intrauterine pregnancy in 129/754 (17.1%) females, complete or incomplete abortion in 96 (12.7%), and a ruptured ectopic pregnancy in 32 (4.2%) females. In males, most common diagnosis was intestinal obstruction in 54/376 (14.4%), and splenomegaly in 42 (11.2%). Of 1556 trauma patients, 283 (18.1%) received an eFAST, and 53 (18.7%) had positive findings. A total of 27 (9.4%) trauma patients and 51 (4.5%) non-trauma patients were sent directly to the operating theatre. CONCLUSION: In this study, ultrasound examination revealed abnormal findings for the majority of patients with non-traumatic abdominal symptoms. Building up capacity to provide diagnostic ultrasound is a promising strategy to improve emergency services, especially in a setting where diagnostic modalities are limited.
    Tags: *Abdominal Injuries/diagnostic imaging, *Thoracic Injuries, Emergency Service, Hospital, Female, Humans, Male, Pregnancy, Tanzania/epidemiology, Ultrasonography.
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  • du Fay de Lavallaz, J., Zimmermann, T., Badertscher, P., Lopez-Ayala, P., Nestelberger, T., Miro, O., Salgado, E., et al. “Performance Of The American Heart Association/American College Of Cardiology/Heart Rhythm Society Versus European Society Of Cardiology Guideline Criteria For Hospital Admission Of Patients With Syncope”. Heart Rhythm 19, no. 10: 1712-1722. doi:10.1016/j.hrthm.2022.05.024.
    Abstract: BACKGROUND: Current American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) and European Society of Cardiology (ESC) guidelines recommend different strategies to avoid low-yield admissions in patients with syncope. OBJECTIVE: The purpose of this study was to directly compare the safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the emergency department in 2 multicenter studies. METHODS: The international BASEL IX (BAsel Syncope EvaLuation) study (median age 71 years) and the U.S. SRS (Improving Syncope Risk Stratification in Older Adults) study (median age 72 years) were investigated. Primary endpoints were sensitivity/specificity for the adjudicated diagnosis of cardiac syncope (BASEL IX only) and 30-day major adverse cardiovascular events (30d-MACE). RESULTS: Among 2560 patients in the BASEL IX and 2085 in SRS studies, ACC/AHA/HRS and ESC criteria recommended admission for a comparable number of patients in BASEL IX (27% vs 28%), but ACC/AHA/HRS criteria less often in SRS (19% vs 32%; P <.01). Recommendations were discordant in approximately 25% of patients. In BASEL IX, sensitivity for cardiac syncope and 30d-MACE among patients without admission criteria was comparable for ACC/AHA/HRS and ESC criteria (64% vs 65%, P = .86; and 67% vs 71%, P = .15, respectively). In SRS, sensitivity for 30d-MACE was lower with ACC/AHA/HRS (54%) vs ESC criteria (88%; P <.001). Similarly, specificity for cardiac syncope and 30d-MACE in BASEL IX was comparable for both guidelines, but in SRS the ACC/AHA/HRS guidelines showed a higher specificity for 30d-MACE than the ESC guidelines. CONCLUSION: ACC/AHA/HRS and ESC guidelines showed disagreement regarding admission for 1 in 4 patients and had only modest sensitivity, all indicating possible opportunities for improvements.
    Tags: *American Heart Association, *Cardiology, Admission, Aged, Diagnosis, Guidelines, Hospitalization, Hospitals, Humans, Safety, Syncope, Syncope/diagnosis/therapy, United States/epidemiology.
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  • Klasen, J. M., Schoenbaechler, Z., Bogie, B. J. M., Meienberg, A., Nickel, C., Bingisser, R., and LaDonna, K. “Medical Students' Perceptions Of Learning And Working On The Covid-19 Frontlines: '.. A Confirmation That I Am In The Right Place Professionally'”. Med Educ Online 27, no. 1: 2082265. doi:10.1080/10872981.2022.2082265.
    Abstract: The COVID-19 pandemic caused complex and enduring challenges for healthcare providers and medical educators. The rapid changes to the medical education landscape forced universities across the world to pause traditional medical training. In Basel, Switzerland, however, medical students had the opportunity to work on the COVID-19 frontlines. Our purpose was to understand how they perceived both learning and professional identity development in this novel context. We conducted semi-structured interviews with 21 medical students who worked in a COVID-19 testing facility at the University Hospital of Basel. Using constructivist grounded theory methodology, we collected and analyzed data iteratively using the constant comparative approach to develop codes and theoretical themes. Most participants perceived working on the pandemic frontlines as a positive learning experience, that was useful for improving their technical and communication skills. Participants particularly valued the comradery amongst all team members, perceiving that the hierarchy between faculty and students was less evident in comparison to their usual learning environments. Since medical students reported that their work on the pandemic frontlines positively affected their learning, the need to create more hands-on learning opportunities for medical students challenges curriculum developers. Medical students wish to feel like full-fledged care team members rather than observing sideliners. Performing simple clinical tasks and collaborative moments in a supportive learning environment may promote learning and professional development and should be encouraged in the post-pandemic era.
    Tags: *COVID-19/epidemiology, *Students, Medical, Covid-19, COVID-19 Testing, Humans, Learning, medical education, Medical students, Pandemics, professional identity formation.
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  • Bosso, L., Espejo, T., Taffe, P., Caillet-Bois, D., Christen, T., Berna, C., and Hugli, O. “Analgesic And Anxiolytic Effects Of Virtual Reality During Minor Procedures In An Emergency Department: A Randomized Controlled Study”. Ann Emerg Med 81, no. 1: 84-94. doi:10.1016/j.annemergmed.2022.04.015.
    Abstract: STUDY OBJECTIVE: We aimed to assess the analgesic and anxiolytic efficacy of distraction, a nonpharmacologic intervention provided by 3-dimensional (3D) virtual reality (VR) compared with that provided by 2-dimensional (2D) VR during minor emergency department (ED) procedures. METHODS: This randomized controlled study conducted in the ED of a teaching hospital included patients aged more than or equal to 18 years undergoing minor procedures. The patients watched the same computer-generated VR world either in 3D in a head-mounted display (intervention) or in 2D on a laptop screen (control). Our main outcomes were pain and anxiety during the procedure, assessed on a 100-mm visual analog scale. Secondary outcomes included the impression of telepresence in the computer-generated world assessed using the Igroup Presence Questionnaire, and the prevalence and intensity of cybersickness measured on a 100-mm visual analog scale. RESULTS: The final analysis included 117 patients. The differences in median procedural pain and anxiety levels between the 2D and 3D VR groups were not significant: -3 mm (95% confidence interval [CI] -14 to 8) and -4 mm (95% CI -15 to 3), respectively; the difference in telepresence was 2.0 point (95% CI 0 to 2.0), and the proportion difference of cybersickness was -4% (95% CI -22 to 14), with an intensity difference of -5 mm (95% CI -9 to 3). CONCLUSION: During minor procedures in adult patients in the ED, distraction by viewing a 3D virtual world in a head-mounted VR display did not result in lower average levels of procedural pain and anxiety than that by 2D viewing on a screen despite a higher sense of telepresence. There were no significant differences in the prevalence and intensity of cybersickness between the 2 groups.
    Tags: *Anti-Anxiety Agents, *Pain, Procedural/prevention & control, *Virtual Reality, Adult, Analgesics, Anxiety/prevention & control, Emergency Service, Hospital, Humans.
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  • Arslani, K., Eken, C., Tschudin-Sutter, S., Gebhard, C. E., Zellweger, N., Bassetti, S., Bingisser, R., et al. “Sex Disparities In Patients With Suspected Covid-19 Presenting At An Emergency Department In Switzerland”. Swiss Med Wkly 152, no. 19-20: w30167. doi:10.4414/smw.2022.w30167.
    Abstract: AIMS OF THE STUDY: In the global COVID-19 pandemic, female sex is associated with comparable infection rates but better outcome. However, most studies lacked appropriate controls. We investigated whether these sex disparity findings are specific to patients with COVID-19 or generalizable to patients presenting to the emergency room (ER) with similar symptoms but no COVID-19. METHODS: In this prospective cohort study, consecutive patients presenting with symptoms suggestive of COVID-19 were recruited at the ER of the University Hospital Basel, Switzerland from March to June 2020. Patients were categorized as SARS-CoV-2 positive (cases) or negative (controls) based on nasopharyngeal PCR swab tests. The final clinical diagnosis was determined for all patients. The primary outcome was a composite of intensive care admission, rehospitalization for respiratory distress and all-cause death within 30 days. We used Kaplan-Meier curves and Cox proportional hazards models to explore associations between sex and outcomes. RESULTS: Among 1,081 consecutive ER patients, 191 (18%) tested positive for SARS-CoV-2, with an even sex distribution (17.9% female vs. 17.5% male, p = 0.855). In COVID-19 patients, female sex was associated with lower risk of hospitalization (51% vs. 66%, p = 0.034), lower necessity of haemodynamic support (8% vs. 20%, p = 0.029), lower rates of intubation (10% vs. 21%, p = 0.037) and the primary outcome (18% vs. 31%, p = 0.045; age-adjusted HR 0.536, 95%CI 0.290-0.989, p = 0.046) compared with male sex. Sex disparities were most prominent in patients >/=55 years (HR for composite primary outcome in women 0.415, 95%CI 0.201-0.855, p = 0.017). In contrast to the COVID-19 patients, no sex-specific differences in outcomes were observed in the unselected overall control group (age-adjusted HR 0.844, 95%CI 0.560-1.273, p = 0.419) or in a subgroup of controls with upper respiratory tract infections or pneumonia (age-adjusted HR 0.840, 95%CI 0.418-1.688, p = 0.624). CONCLUSION: In this unselected, consecutive cohort study at a tertiary hospital in Switzerland, female sex is associated with better outcome in patients presenting to the ER with COVID-19. These sex disparities seem to be at least partly specific to COVID-19, as they were not observed in comparable controls.
    Tags: *COVID-19/diagnosis/epidemiology, Cohort Studies, Emergency Service, Hospital, Female, Humans, Male, Pandemics, Prospective Studies, SARS-CoV-2, Switzerland/epidemiology.
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  • Tribolet, P., Kaegi-Braun, N., Gressies, C., Baumgartner, A., Wagner, K. H., Stanga, Z., and Schuetz, P. “Handgrip Strength Values Depend On Tumor Entity And Predict 180-Day Mortality In Malnourished Cancer Patients”. Nutrients 14, no. 10. doi:10.3390/nu14102173.
    Abstract: BACKGROUND: Cancer-related malnutrition is a prevalent condition associated with a loss of muscle mass and impaired functional status, leading to immunodeficiency, impaired quality of life and adverse clinical outcomes. Handgrip strength (HGS) is a practical measure to assess muscle strength in individual patients during clinical practice. However, HGS reference values refer to populations of healthy people, and population-specific values, such as those in the population of cancer patients, still need to be defined. METHODS: Within a secondary analysis of a previous randomized controlled nutritional trial focusing on hospitalized cancer patients at risk for malnutrition, we investigated sex-specific HGS values stratified by age and tumor entity. Additionally, we examined the association between HGS and 180-day all-cause mortality. RESULTS: We included data from 628 cancer patients, which were collected from eight hospitals in Switzerland. Depending on the age of patients, HGS varied among female patients from 7 kg to 26 kg and among male patients from 20.5 kg to 44 kg. An incremental decrease in handgrip strength by 10 kg resulted in a 50% increase in 180-day all-cause mortality (odds ratio 1.52 (95%CI 1.19 to 1.94), p = 0.001). CONCLUSION: Our data provide evidence of the prognostic implications of HGS measurement in cancer patients and validate the prognostic value of handgrip strength in regard to long-term mortality. In addition, our results provide expected HGS values in the population of hospitalized malnourished cancer patients, which may allow better interpretation of values in individual patients.
    Tags: *Malnutrition/diagnosis, *Neoplasms/complications, Braun and Fresenius Kabi. All other authors report no conflict of interest., cancer, clinical outcomes, Female, Hand Strength/physiology, handgrip strength, Humans, Male, malnutrition, Muscle Strength, nutritional support, provided unrestricted grant money to the institution of P.S. The institution of, Quality of Life, Z.S. received research support from Nestle Health Science, Abbott Nutrition, B..
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