Swiss medical weekly
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Swiss medical weekly · Mar 2021
Randomized Controlled Trial Multicenter StudyContinuous versus routine EEG in critically ill adults: reimbursement analysis of a randomised trial.
Continuous EEG (cEEG) is increasingly used in critically ill patients, but it is more resource-intensive than routine EEG (rEEG). In the US, cEEG generates increased hospitalisation charges. This study analysed hospital-related reimbursement for participants in a Swiss multicentre randomised controlled trial that assessed the relationship of cEEG versus repeated rEEG with outcome. ⋯ In a Swiss Diagnosis Related Groups billing system applied to critically ill adults, reimbursement largely depends on duration of acute hospital stay, whereas cEEG and lack of seizure/ status epilepticus detection also contribute to the bill. This differs from the USA, where charges are directly increased by cEEG.
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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
Randomized Controlled TrialEarly biomarker response and patient preferences to oral and intramuscular vitamin B12 substitution in primary care: a randomised parallel-group trial.
Vitamin B12 (VB12) deficiency can be treated with oral high-dose substitution or intramuscular (i.m.) injection of VB12. Whenever alternative routes of administration exist, patient preferences should be considered when choosing the treatment. We aimed to assess outpatient preferences towards oral or IM VB12 substitution and confirm noninferiority of early biomarker response with oral treatment, in a typical primary care population. ⋯ Differences in VB12 levels between groups were higher than expected. Therefore, noninferiority of oral treat-ment had to be rejected. However, normalisation of HoloTc and MMA was reached by all patients after a 1-month treatment period. The clinical benefit of the exaggerated biomarker re-sponse after IM treatment within a typical primary care popula-tion is questionable. Midterm biomarker effects and patient preferences should be considered when a therapeutic scheme is chosen. Initial rating in favour of either IM or oral therapy can change over time and justifies repeated re-evaluation of patient preferences. (ClinicalTrials.gov ID NCT01832129).
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Swiss medical weekly · Jan 2014
Randomized Controlled TrialButorphanol pre-treatment prevents myoclonus induced by etomidate: a randomised, double-blind, controlled clinical trial.
Myoclonic movements are common problems during induction of anaesthesia with etomidate. The myoclonus occurring after etomidate administration may represent a form of seizure. Agonistic modulation of the κ opiate receptor may reduce seizures, and butorphanol acts in such a manner. The aim of this randomised, double-blind, placebo-controlled clinical trial was to test our hypothesis that pre-treatment with butorphanol might reduce the incidence and severity of myoclonus induced by etomidate. ⋯ Infusion of 0.015 mg/kg butorphanol 2 minutes before etomidate administration is effective for suppressing myoclonus induced by etomidate during induction of general anaesthesia.
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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.