Praxis
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Care Management for Polytrauma Patients in a Level-1 Trauma Centre Abstract. In our level-1 trauma institution, polytrauma patients with an Injury Severity Score of 16 or higher are facing waiting times for transfer to a rehabilitation facility, causing a negative financial outcome for our institution. The purpose of this study is to stimulate rapid transfer to a rehabilitation facility. ⋯ Trauma patients for a rehabilitation centre have a higher Case Mix Index (CMI) compared to those who do not require inpatient rehabilitation (4.22 versus 1.04, p <0.0001). With about 280 trauma patients annually waiting an extra 5.1 days for transfer to a rehabilitation facility, the financial burden for our department amounts to Swiss francs 885,360 without reimbursement. Since no extra bed capacities in rehabilitation facilities are available in our area, it may be advised to set up an early in-hospital trauma rehabilitation program in a level-1 trauma centre in order to reduce financial loss.
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Fatigue - a Common Symptom in General Practice Abstract. When patients suffering from fatigue consult a GP surgery, GPs should understand what patients mean by fatigue, how strongly they are affected in everyday life and how they themselves explain the symptom. In a next step, dangerous diseases such as depression, addiction or sleep apnea syndrome must be excluded. ⋯ A simple physical exam and a few lab examinations are sufficient to capture the major disorders that present with the isolated symptom of fatigue. For further care, a primary biopsychosocial approach with a viable physician-patient relationship is crucial. Rough conclusions based on laboratory findings should be avoided; comorbidities must be considered.
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CME: Zoonosis in Switzerland: Leptospirosis Abstract. Leptospirosis is worldwide a common zoonosis that also occurs in Switzerland. ⋯ In order to make the diagnosis, it is important to recognize the typical findings and perform the appropriate diagnostic workup. In this article, we discuss the clinical signs, diagnostic workup, therapy and prevention of leptospirosis and present the case of a 54-year-old patient with severe leptospirosis.
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Although snake bites are rare in Europe, there are a constant number of snake bites in Switzerland. There are two domestic venomous snakes in Switzerland: the aspic viper (Vipera aspis) and the common European adder (Vipera berus). ⋯ Potentially fatal systemic complications are related to disturbances of the hemostatic- and cardiovascular system as well as the central or peripheral nervous system. Beside a symptomatic therapy the administration of antivenom is the only causal therapy to neutralize the venomous toxins.