Swiss medical weekly
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Swiss medical weekly · Jan 2017
Randomized Controlled TrialPredictors of re-exacerbation after an index exacerbation of chronic obstructive pulmonary disease in the REDUCE randomised clinical trial.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) compromise physical activity and quality of life and contribute significantly to health care costs. Systemic glucocorticoids benefit clinical outcome in AECOPD, and the REDUCE trial demonstrated noninferiority of a 5-day treatment course with prednisone compared with 14 days therapy regarding clinical outcome over 6 months of follow-up. Unexpectedly, we found an inverse correlation between circulating cortisol levels and exacerbation risk during a 6-month follow-up period. ⋯ In addition to biochemical suppression of the adrenal glands, other standard clinical parameters predict re-exacerbation in patients admitted to the emergency department with AECOPD. (REDUCE trial registration: ISRCTN29646069).
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Swiss medical weekly · Jan 2017
Informal caregiving, work-privacy conflict and burnout among health professionals in Switzerland - a cross-sectional study.
Health professionals were found to have an elevated burnout risk compared to the general population. Some studies also reported more emotional exhaustion - a component of burnout - for health professionals with informal caregiving responsibilities for children (double-duty child caregivers) or adults (double-duty adult caregivers) or a combination of both (triple-duty caregivers) compared to health professionals without informal caregiving roles (formal caregivers). However, the potential mediating effect of the work-privacy conflict in this relationship as well as differences between occupational groups have not yet been studied in healthcare settings. ⋯ Additional and large-scale studies focusing on the combination of formal and informal caregiving roles are needed to better understand its effect on burnout among healthcare professionals and to evaluate the role of work-privacy conflict.
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Swiss medical weekly · Jan 2017
Meta AnalysisEarly versus late initiation of renal replacement therapy in patients with acute kidney injury: a meta-analysis of randomised clinical trials.
The optimal timing of renal replacement therapy (RRT) initiation in acute kidney injury (AKI) remains a matter of debate. A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to better estimate the effects of early initiation of RRT compared with late initiation of RRT among patients with AKI and in patients at risk for AKI. ⋯ Early RRT in patients with AKI (or at risk for AKI) does not appear to provide a significant reduction in mortality rates compared with late RRT. The data did not suggest any apparent impact on renal recovery with early dialysis.
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Swiss medical weekly · Jan 2017
ReviewDizziness in the emergency department: an update on diagnosis.
This review aims to assist emergency physicians in finding the underlying aetiology when a patient presents with dizziness to the emergency department. After reading this review, the emergency physician will be able to consider the most relevant differential diagnoses and have an idea about dangerous aetiologies that require immediate action. The emergency physician will also know what diagnostic steps need to be taken at what time, such as the three-component HINTS Test (Head Impulse, Nystagmus, and Test-of-Skew), which helps with distinguishing central from peripheral causes of the acute vestibular syndrome. ⋯ Given that it would neither be economical nor practical to send all patients to specialists from the start, we present general guidelines for the diagnostic workup of patients presenting with dizziness to the emergency department. This review will focus on epidemiology, aetiologies, differential diagnoses and diagnostics. Treatment is described in a separate article.
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Swiss medical weekly · Jan 2017
ReviewThe search for atrial fibrillation and its impact on public health.
Atrial fibrillation may be clearly symptomatic and is easily amenable to state-of-the-art treatment, most importantly oral anticoagulation therapy for the prevention of thromboembolism. However, atrial fibrillation may also go unnoticed for long periods in many patients. ⋯ Early detection of atrial fibrillation in patients at increased thromboembolic risk and consequent oral anticoagulation therapy may have a significant impact on public health. This review focuses on screening recommendations for atrial fibrillation and on the impact of silent atrial fibrillation in various clinical scenarios.