Swiss medical weekly
-
Swiss medical weekly · Jan 2013
Randomized Controlled TrialEffects of dexmedetomidine on performance of bispectral index as an indicator of loss of consciousness during propofol administration.
The performance of bispectral index (BIS) for the measurement of the sedative depth when dexmedetomidine is administered in propofol anaesthesia and sedation has not yet been established. This study evaluated the effects of adjunctive dexmedetomidine on the accuracy of BIS to predict loss of consciousness (LOC) and BIS values predicting LOC during propofol administration. ⋯ The ability of BIS to predict LOC is not influenced by dexmedetomidine during propofol administration, but BIS values are enhanced at the time of LOC.
-
Chronic obstructive pulmonary disease (COPD) is a global health challenge and a leading cause of death worldwide. Several risk factors have been identified, with cigarette smoking being the most important. Diagnostic assessment is based on symptoms, risk of exacerbations and results of lung function testing. ⋯ Oxygen therapy, noninvasive nocturnal ventilation and surgical treatment options only apply to a highly selected group of patients. Disease management programmes and guideline adherence are briefly discussed. In conclusion, although there is debate as to the extent with which pharmacological therapies influence mortality, adherence to the GOLD strategy is recommended.
-
Swiss medical weekly · Jan 2013
ReviewIs tracheostomy still an option in amyotrophic lateral sclerosis? Reflections of a multidisciplinary work group.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a poor prognosis. Survival and quality of life of ALS patients have improved through the implementation of multidisciplinary approaches, the use of percutaneous gastrostomy and of noninvasive (NIV) or invasive ventilation. The question of whether or not to propose invasive ventilation (by tracheostomy: TPPV) to ALS patients remains a matter of debate. ⋯ Current practice in Switzerland and France tends to discourage the use of TPPV in ALS. Fear of a "locked-in syndrome", the high burden placed on caregivers, and unmasking cognitive disorders occurring in the evolution of ALS are some of the caveats when considering TPPV. Most decisions about TPPV are taken in emergency situations in the absence of advance directives. One exception is that of young motivated patients with predominantly bulbar disease who "fail" NIV.
-
Swiss medical weekly · Jan 2013
Randomized Controlled TrialCulturally sensitive group therapy for Turkish patients suffering from chronic pain: a randomised controlled intervention trial.
The incidence of chronic pain is higher among immigrants in Europe than among the native European population. Therapeutic interventions in this population are far less effective than in patients for whom these programmes were originally developed. ⋯ Cognitive behavioural intervention is feasible with immigrants with chronic disabling pain, but the evidence-based CBT programme, as well as exercise therapy supplemented with culturally sensitive aspects, showed no improvement.
-
Swiss medical weekly · Jan 2013
Randomized Controlled TrialABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial.
After years of advocating ABC (Airway-Breathing-Circulation), current guidelines of cardiopulmonary resuscitation (CPR) recommend CAB (Circulation-Airway-Breathing). This trial compared ABC with CAB as initial approach to CPR from the arrival of rescuers until the completion of the first resuscitation cycle. ⋯ This randomized controlled trial found CAB superior to ABC with an earlier start of CPR and a shorter time to completion of the first 30:2 resuscitation cycle. These findings endorse the change from ABC to CAB in international resuscitation guidelines.