Swiss medical weekly
-
Swiss medical weekly · Jan 2014
Clinical TrialEffects of different modes of ventilation and head position on the size of the vena jugularis interna.
Right internal jugular vein (RIJV) catheterisation is a common procedure in patients undergoing surgery. We aimed to compare diameters and the cross-sectional area (CSA) of the RIJV when the head is in a neutral or 30-degree rotated position during mechanical ventilation in various modes and spontaneous ventilation. ⋯ We conclude that both pressure-controlled and volume-controlled mechanical ventilation have similar effects on the CSA and diameters of the RIJV. Positioning of the head with a 30-degree rotation laterally has different effects on CSA depending on the ventilation mode used. A neutral position should be preferred with spontaneous ventilation whereas 30 degree rotation should be preferred in patients under pressure-controlled and volume-controlled ventilation.
-
Swiss medical weekly · Jan 2014
ReviewNovel concepts in the epidemiology, diagnosis and prevention of childhood tuberculosis.
Tuberculosis (TB) is one of the oldest diseases known to mankind, yet it is the second leading cause of death from an infection worldwide today. In the absence of epidemiological data, TB in children was not considered significant and research efforts did not prioritise this group. ⋯ This review discusses the most relevant advances in the understanding of epidemiology, diagnosis and prevention of children with TB. It also highlights challenges and research priorities in childhood TB, which include better diagnostic tests, accurate correlates of protection and an improved vaccine.
-
Swiss medical weekly · Jan 2014
Advance directives and the impact of timing. A qualitative study with Swiss general practitioners.
Advance directives are seen as an important tool for documenting the wishes of patients who are no longer competent to make decisions in regards to their medical care. Due to their nature, approaching the subject of advance directives with a patient can be difficult for both the medical care provider and the patient. This paper focuses on general practitioners' perspectives regarding the timing at which this discussion should take place, as well as the advantages and disadvantages of the different moments. ⋯ The distinct approaches, perspectives and rationales show that there is no well-defined or "right" moment. However, participants often associated advance directives with death. This link caused discomfort and uncertainty, which led to hesitation and delay on the part of general practitioners. Therefore we recommend further training on how to professionally initiate a conversation about advance directives. Furthermore, based on our results and experience, we recommend an early approach with healthy patients paired with later regular updates as it seems to be the most effective way to inform patients about their end-of-life care options.
-
Swiss medical weekly · Jan 2014
Reduction in the use of diagnostic tests in infants with risk factors for early-onset neonatal sepsis does not delay antibiotic treatment.
Despite a low positive predictive value, diagnostic tests such as complete blood count (CBC) and C-reactive protein (CRP) are commonly used to evaluate whether infants with risk factors for early-onset neonatal sepsis (EOS) should be treated with antibiotics. ⋯ Reduction of diagnostic tests such as CBC and CRP does not delay initiation of antibiotic treatment in infants with suspected EOS. The importance of clinical examination in infants with risk factors for EOS should be emphasised.
-
Swiss medical weekly · Jan 2014
Case ReportsGastrointestinal bleeding associated with rivaroxaban administration in a treated patient infected with human immunodeficiency virus.
The use of rivaroxaban in fixed dosing regimens without need for routine coagulation monitoring may lead to the misconception that there is a minimal risk of drug-drug interactions. We describe the case of a patient infected with human immunodeficiency virus (HIV) on salvage therapy who developed gastrointestinal bleeding while receiving the standard dose of rivaroxaban for the prevention of venous thromboembolism after surgery. This case clearly sends a warning that protease inhibitors should not be co-administered with rivaroxaban. Furthermore, it highlights the importance of clinicians' caution about potential drug-drug interactions.