Revue médicale suisse
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Revue médicale suisse · Nov 2006
Review[Hemorrhage and transfusion: the case of Jehovah's witnesses].
For Jehovah Witness patients the additional responsibilities of surgeon, anesthetist and intensivist represent a particular challenge. A "therapeutic" contract needs to be established at the very outset specifying the commitment and undertaking of each party. ⋯ Above all, the entire medical team must respect the personal values of the patient despite any contradiction with their own values. This means that judgements based on values must be avoided in order to allow for the freedom of thought.
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In the past, red blood cells were given in case of acute anemia, the decision being often based on the hemoglobin concentration alone. The clinical situation and the comorbidities of the patient as well as the secondary were given only a little, if any, consideration. Presently, the evidence shows that red blood cells transfusion has to be individualized in every single patient, taking into consideration the risks of the transfusion, the coexisting medical problems and the patient's tolerance to acute anemia. Experimental and clinical research confirms that a much lower hemoglobin concentration can be tolerated than previously admitted if normovolemia is preserved, the most important transfusion trigger being a sign of insufficient oxygen consumption and signs of an inadequate circulation.
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Revue médicale suisse · Nov 2006
Review[Dyspnea: is medical history still useful for its evaluation?].
Dyspnea is a common symptom and a major cause of medical consultation. Fast and reliable diagnostic work-up warrants minimization of the risks, sometimes vital, incurred by the patient. ⋯ Verbal expressions used by dyspneic patients have been analyzed and progressively linked to given pathophysiological situations. Becoming more fluent with the language of dyspnea would allow physicians to break down any communication barriers and provide the best care possible to patients with dyspnea.
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In Switzerland, environmental tobacco smoke (ETS) is widespread and affects 25% of the never smokers. The risk of having lung carcinoma is increased by 23% for never smokers who report exposure to ETS, and women are particularly at risk. ⋯ In children, however, there is increased incidence of asthma when the mother (+36%) or both parents (+50%) are smokers. All-cause mortality (+ 15%) and disease-specific mortality for lung cancer (+65% to + 79%) are increased among ETS exposed never-smokers.
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Revue médicale suisse · Oct 2006
Review[Alternative to hospitalization for patients diagnosed with acute congestive heart failure].
Heart failure is the first cause of hospital admission in patients above 65 years of age and represents a major health problem given demographic projections. Rapid admission of selected patients in specialized heart failure observation units in the emergency departments providing therapeutic monitoring and multiple educative interventions may obviate the need for hospitalization. This strategy may reduce the overall incidence of hospitalization and subsequent readmissions as well as save costs. Outcome studies are needed before a widespread implementation of such strategies.