Swiss medical weekly
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Swiss medical weekly · Jan 2011
Catheter related blood stream infections in critically ill patients with continuous haemo(dia)filtration and temporary non-tunnelled vascular access.
This prospective, single centre, observational study analysed the rate of catheter related blood stream infections in critically ill patients in intensive care units treated with haemo(dia)filtration. The infection rate was 3.8 per 1000 patient days. All infections were caused by coagulase negative staphylococci. ⋯ The incidence of catheter related blood stream infection in critically ill patients on intensive care units treated with continuous veno-venous haemo(dia)filtration was 3.8 per 1000 catheter days. All catheter related blood stream infections were caused by coagulase negative staphylococci.
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Perinatal asphyxial encephalopathy occurs in 1 per 1000 live births and is associated with high mortality and morbidity. Therapeutic hypothermia increases intact survival and improves neurodevelopmental outcome in survivors. ⋯ In Switzerland, access to therapeutic hypothermia is widespread and Swiss neonatologists believe that therapeutic hypothermia for perinatal asphyxia is effective. National cooling protocols are needed for the management of infants with perinatal asphyxial encephalopathy in order to ensure safe cooling, appropriate monitoring, imaging and follow-up assessment. A national registry is needed to collect data on diagnosis, treatment, adverse events and outcome.
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Swiss medical weekly · Jan 2011
Lung cancer screening has the potential to safe lives, but shall we do it?
Almost three decades ago several controlled studies failed to show that lung cancer screening by chest x-ray (CXR) and sputum cytology improves survival in a screened population. A number of subsequent studies using chest computed tomography (CT) in smokers revealed lesions suspect for cancer in around 20% and had a lung cancer detection rate of approx. 1%. ⋯ Recently, the preliminary results of the randomised controlled National Lung Screening Trial (NLST), a study organised by the US National Cancer Institute, confirmed for the first time that lung cancer screening by CT is associated with a reduction in lung cancer mortality (20.3%) and in all-cause mortality (7%) compared with a control group undergoing CXR at the same time intervals. However, before lung cancer CT screening can be recommended, many open questions need to be answered with respect to costs and reimbursement, duration of an appropriate screening programme and its psychological impact.
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Swiss medical weekly · Jan 2011
Strengths and weaknesses of chest compression training: a preliminary retrospective study.
High quality chest compression is one of the key factors in successful resuscitation. A high standard of training is therefore decisive. We aimed to investigate the strengths and weaknesses of teaching chest compression in a study designed to highlight where targeted improvements in the quality of our chest compression training can and must be made. ⋯ Chest compression training showed weakness for four out of five variables. Only the end results for compression depth were satisfactory. The deficits observed in the training on chest compression were relevant and must be remedied. One possibility would be initial step-by-step training and assessment of each component of chest compression, concentrating in particular on hand positioning and compression/decompression ratio.
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Swiss medical weekly · Oct 2010
Randomized Controlled Trial Multicenter Study Comparative StudyShort versus conventional term glucocorticoid therapy in acute exacerbation of chronic obstructive pulmonary disease - the "REDUCE" trial.
International guidelines advocate a 10 to 14-day course of systemic glucocorticoid therapy in the management of COPD exacerbations. The optimal duration of therapy is unknown and glucocorticoids have serious adverse effects. The aim of this trial is to demonstrate non-inferiority of a five-day compared to a 14-day course of systemic glucocorticoids with respect to COPD outcome, thereby significantly reducing steroid exposure and side effects in patients with COPD exacerbations. ⋯ If the strategy of significantly reducing cumulative exposure to glucocorticoids while taking advantage of their beneficial short-term effects proves to be successful, it will warrant a change in common glucocorticoid prescription practice, thereby improving the management of COPD.