Revue médicale suisse
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Specialized and multidisciplinary care is needed for patients with amyotrophic lateral sclerosis (ALS). Respiratory failure secondary to respiratory muscle dysfunction, ineffective cough, weight loss and progressive loss of autonomy should always be sought and explored. ⋯ Patients should be informed clearly as to the nature and evolution of ALS, and as to the potential benefits and disadvantages associated with each treatment modality in order to be involved in therapeutic decisions. This evidence-based review focuses on respiratory care of patients with ALS.
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Medical use of chronic opioids has recently increased in Switzerland. Even though their effect on daytime vigilance tends to disappear after some time, 70% of chronic opioid users will suffer from sleep disordered breathing. ⋯ More sophisticated ventilatory modes such as bilevel ventilation with backup respiratory rate or adaptive servoventilation are often required. Older patients with concomitant COPD or obstructive sleep apnea are at higher risk of developing nocturnal breathing disorders.
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Medical fee schedules are controversial. In this paper we examine the reasons that justify the imposition of fee schedules in the presence of a socially financed health insurance system, and examine the ways of constructing a medical fee schedule. ⋯ Current solutions to this problem--audit of doctors' average cost per case, freeze on new medical practices, or the insurers' discretion in choosing the doctors they reimburse--have multiple drawbacks. Alternatives to fee-for-service payment--such as flat fees, or payment based on the quality of medical services--are discussed.