Swiss medical weekly
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Swiss medical weekly · Jan 2013
ReviewUptake of guidelines on prevention of mother-to-child transmission of HIV in rural Tanzania: time for change.
Guidelines on prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) are inconsistently implemented in low-income countries. Strategies are needed to improve the uptake of these guidelines to prevent avoidable new HIV infections of infants. In 2010 the World Health Organisation presented its new PMTCT guidelines, offering two options for short courses of antiretroviral prophylaxis: Option A and Option B. ⋯ The continuously changing recommendations on PMTCT stress the need for a much simpler and effective approach. We argue in favour of implementing Option B+ in Tanzania. Financial challenges need to be faced, but Option B+ would help to overcome many barriers that prevent guidelines to be implemented in order to increase coverage and ultimately achieve the goal of 'virtual elimination' of mother-to-child transmission in sub-Saharan Africa.
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To measure the workload of residents in a paediatric intensive care unit (PICU) and to compare this value with the possible explanatory variables "nine equivalents of nursing manpower use score" (NEMS), length of stay (LOS), patient age and severity of illness at admission. ⋯ NEMS, a therapeutic intervention score, and LOS are both independent predictors of clinical workload of residents in PICU. The correlation with LOS means that workload depends mainly on routine procedures (rounds, discussions with parents, administrative tasks) unrelated to the severity of illness. After calibration, LOS or NEMS, two widely used measures, may be used to calculate resident workload.
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Swiss medical weekly · Jan 2013
ReviewImproving patient safety in medicine: is the model of anaesthesia care enough?
Avoiding iatrogenic adverse outcomes and providing safe care to patients is a priority in modern healthcare systems. Because anaesthetic practice is inherently risky, the specialty has developed a broad range of strategies to minimise human error and risk for patients. These are part of a hierarchical model developed by industrial safety experts to minimise risk. ⋯ This review will describe the use of this model in anaesthesia and show why the specialty is often cited as a role model for patient safety improvement. It will also explore the extension of the model to other specialties and analyse its intrinsic limitations due to new challenges to patient safety: teamwork and communication issues. These will conclude the review.
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Swiss medical weekly · Jan 2013
Impact of family history of breast cancer on tumour characteristics, treatment, risk of second cancer and survival among men with breast cancer.
Male breast cancer patients have a higher risk of developing a second primary cancer, but whether this risk differs according to the family history of breast or ovarian cancers remains to be elucidated. We aimed to determine the effect of a positive family history among men diagnosed with breast cancer on tumour characteristics, treatment, second cancer occurrence and overall survival. ⋯ Prognosis was similar among patients with or without familial risk. Our results are however based on small numbers and larger registry-based cohorts of males with precise data on familial risk are still warranted.
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To evaluate the patient characteristics and natural history of pubic rami fractures in geriatric patients, with a special focus on the frequency of concomitant posterior pelvic ring lesions and the percentage of secondarily operated patients as a result of conservative treatment failure. ⋯ Pubic rami fractures are frequently associated with concomitant posterior pelvic ring injuries, making these injuries more unstable than generally assumed. Based on this fact and the long duration of hospital stay, more aggressive management of these injuries may be considered. The principle aims in this patient population are satisfying pain management, early mobilisation, conservation of independence and return to previous place of residence.