Swiss medical weekly
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Swiss medical weekly · Jan 2012
Comparative StudySun protective behaviour of primary and secondary school students in North-Western Switzerland.
The skin cancer incidence in Switzerland is one of the highest in Europe and still on the rise. Sun protection is the main preventive measure and of utmost importance during childhood and adolescence, since sunburns within these early phases of life increase the risk of developing skin cancer in adulthood. ⋯ In order to reduce the incidence of skin cancer in Switzerland, it is essential to improve children's and adolescents' sun protective behaviour. Future skin cancer prevention campaigns should teach proper use of sunscreen, and emphasise the value of wearing clothing and seeking shade as the most effective sun protection. Furthermore, major efforts are needed to change adolescents' attitude towards a suntan.
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Swiss medical weekly · Jan 2012
Diagnostic errors and flaws in clinical reasoning: mechanisms and prevention in practice.
Diagnostic errors account for more than 8% of adverse events in medicine and up to 30% of malpractice claims. Mechanisms of errors may be related to the working environment but cognitive issues are involved in about 75% of the cases, either alone or in association with system failures. The majority of cognitive errors are not related to knowledge deficiency but to flaws in data collection, data integration, and data verification that may lead to premature diagnostic closure. ⋯ It reviews the strategies described to prevent cognitive diagnostic errors. Many approaches propose awareness and reflective practice during daily activities, but the improvement of the quality of training at the pre-graduate, postgraduate and continuous levels, by using evidence-based education, should also be considered. Several conditions must be fulfilled to increase the understanding, the prevention, and the correction of diagnostic errors related to clinical reasoning: physicians must be willing to understand their own reasoning and decision processes; training efforts should be provided during the whole continuum of a clinician's career; and the involvement of medical schools, teaching hospitals, and medical societies in medical education research should be increased to improve evidence about error prevention.
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Meta-analyses overcome the limitation of small sample sizes or rare outcomes by pooling results from a number of individual studies to generate a single best estimate. As long as a meta-analysis is not limited by poor quality of included trials, unexplainable heterogeneity and/or reporting bias of individual trials, meta-analyses can be instrumental in reliably demonstrating benefit or harm of an intervention when results of individual randomised controlled trials are conflicting or inconclusive. Therefore meta-analyses should be conducted as part of a systematic review, i.e., a systematic approach to answer a focused clinical question. ⋯ As opposed to meta-analysis based on aggregate study data, individual patient data meta-analyses offer the advantage to use standardised criteria across trials and reliably investigate subgroup effects of interventions. Network meta-analysis allows the integration of data from direct and indirect comparisons in order to compare multiple treatments in a comprehensive analysis and determine the best treatment among several options. We conclude that meta-analysis has become a popular, versatile, and powerful tool. If rigorously conducted as part of a systematic review, it is essential for evidence-based decision making in clinical practice as well as on the health policy level.
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Swiss medical weekly · Jan 2012
Comparative StudyManagement and outcome of severely elevated blood pressure in primary care: a prospective observational study.
In primary care the management of patients with acute severely elevated blood pressure (BP) is challenging. The aim of the study was to evaluate the initial management and outcome of patients presenting to their general practitioner (GP) with severe high blood pressure. ⋯ The majority of 164 patients who presented with acutely and severely elevated blood pressure (BP >180 +/or >110 mm Hg) to their GPs was asymptomatic, had pre-existing hypertension and was managed in GP's office unless a hypertensive emergency was present. At three month follow-up mean systolic BP was still above target values.
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Swiss medical weekly · Jan 2012
Meta AnalysisMortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trials.
Hydroxyethyl starch (HES) is in widespread clinical use for volume therapy with colloids. According to the most recent meta-analysis performed in 2010, published studies are of poor quality and report too few events to reliably estimate the benefits or risks of administering 6% HES 130/0.4. As results from new trials, reporting on a large number of events became available in 2011 and 2012, an updated meta-analysis was performed. ⋯ Large-scale trials should help more precisely to determine the effect of HES 130/0.4 on mortality. In the interim, best current evidence suggests a trend toward higher mortality among HES 130/0.4 recipients.