Swiss medical weekly
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Swiss medical weekly · Jan 2012
ReviewContinuous flow left ventricular assist devices: a valid option for heart failure patients.
Recent outstanding clinical advances with new mechanical circulatory systems (MCS) have led to additional strategies in the treatment of end stage heart failure (HF). Heart transplantation (HTx) can be postponed and for certain patients even replaced by smaller implantable left ventricular assist devices (LVAD). Mechanical support of the failing left ventricle enables appropriate hemodynamic stabilisation and recovery of secondary organ failure, often seen in these severely ill patients. ⋯ The review is also based on the institutional experience at Berne University Hospital between 2000 and 2012. Apart from short-term devices (Impella, Cardiac Assist, Deltastream and ECMO) which were used in approximately 150 cases, 85 pulsatile long-term LVAD, RVAD or bi-VAD and 44 non-pulsatile LVAD (mainly HeartMateII and HeartWare) were implanted. After an initial learning curve, one-year mortality dropped to 10.4% in the last 58 patients.
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Swiss medical weekly · Jan 2012
Multicenter Study Clinical TrialEvaluation of a novel in-vitro diagnostic device for the detection of urinary tract infections in diaper wearing children.
Is the novel in-vitro diagnostic device U-Test(®) reliable and secure for urine collection in diaper-wearing children and simultaneous evaluation of the urine collected for the presence of leucocytes and nitrite? ⋯ The evaluation shows that U-Test(®) is a safe and reliable device of high functionality and diagnostic performance for the detection of leucocytes and nitrite directly and without time delay in a child's diaper. This statement is based on a comprehensive comparison of the novel device with accepted diagnostic test systems and procedures based on the same dry chemistry technology. Due to its simplicity of use, U-Test(®) can be considered an alternative to the cumbersome procedures of urine collection by the bag-method or clean-catch followed by dipstick analysis for the presence of leucocytes and nitrite.
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Swiss medical weekly · Jan 2012
Comparative StudyPrognostic value of proadrenomedullin in severe sepsis and septic shock patients with community-acquired pneumonia.
Midregional proadrenomedullin (proADM) is a novel biomarker with potential prognostic utility in patients with community-acquired pneumonia. The aim of this study was to investigate the value of proADM levels for severity assessment and outcome prediction in severe sepsis and septic shock due to CAP. ⋯ In our study MR-proADM levels correlate with increasing severity of illness and death. High MR-proADM levels offer additional risk stratification in high-risk CAP patients.
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Swiss medical weekly · Jan 2012
ReviewPrognosis and quality of life of elderly patients after intensive care.
Ageing of the world's population raises important questions about the utilisation of the health care system. It is not clear how much should be invested in the last years of life whereas the costs are known to increase in parallel. Since intensive care units (ICU) are costly with highly specialised personnel, it seems of paramount importance that they would be used efficiently. ⋯ The fundamental questions are actually "Do they go back to life?" "What is life for elderly people?" These questions lead to more basic questions such as "Are they able to go back home or are they institutionalised? How is their quality of life and functional status after ICU?". We tried to address these questions through the existing literature and our experience while caring for these particular patients. Some clues on the prognostic factors related to their outcome are reported.
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Swiss medical weekly · Jan 2012
Comparative StudyIdentification of older patients at risk of unplanned readmission after discharge from the emergency department - comparison of two screening tools.
The Identification of Senior At Risk (ISAR) and the Triage Risk Stratification Tool (TRST) are the two most studied screening tools to detect high-risk patients for unplanned readmission after an emergency department (ED)-visit. Since their performance was unclear among ED-patients over 75 years, we evaluated their capacities to predict readmission at 1, 3, 6 and 12 months as well as their usefulness in avoiding unnecessary further comprehensive geriatric assessment (CGA) in negative screened patients. ⋯ Both ISAR and TRST tools predicted modestly unplanned readmission after an ED-visit among patients over 75 years. Nevertheless, due to their low specificity and high NPV these screening tools are useful to select elderly ED-patients who can safely return home without any further CGA.