Revue médicale suisse
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Revue médicale suisse · Jun 2014
[Lung volume reduction (LVR) in severe emphysema: a multidisciplinary approach].
Most cases of emphysema are managed conservatively. However, in severe symptomatic emphysema associated with hyperinflation, lung volume reduction (LVR) may be proposed to improve dyspnea, exercice capacity, pulmonary functions, walk distance and to decrease long-term mortality. ⋯ Currently, the optimal approach is discussed in a multidisciplinary setting. The latter permits a personalized evaluation the patient's clinical status and allows the best possible therapeutic intervention to be proposed to the patient.
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Revue médicale suisse · Jun 2014
Review[Adolescents with chronic pain: practical assessment and management].
More than 20% of adolescents in the general population suffer of chronic pain mainly headaches, abdominal or musculoskeletal pain. Often, these complaints are self limited without impact on adolescent development but the cause of emergency consultations, unnecessary costs or inappropriate prescriptions. ⋯ Primary care phyisicians play a crucial role (private practice, adolescent clinic...). Efforts should be made to increase access to modern approaches of chronic pain taking into account family, development as well as aspects related to pain in itself.
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This article presents a critical review of the literature about the potential benefit of cardiac pacing in patients suffering from vasovagal or neurocardiogenic syncope. The manifestation of vasovagal syncope comprises some reflex bradycardia and vasoplegia resulting in cerebral hypoperfusion that ultimately leads to a loss of consciousness. ⋯ A detailed analysis of the inclusion criteria of these studies permits to clarify the discrepancy. Only patients older than 50 years with prolonged sinus pause at time of syncope benefit of the implantation of a cardiac pacemaker.
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Revue médicale suisse · May 2014
Review[Quality improvement initiatives in hospitals: which one to choose].
The number of quality improvement initiatives in hospitals has been steadily increasing in the last decades. Most of these initiatives are inspired by three quality control and improvement models developed in the manufacturing industry: the final inspection, the quality assurance and the total quality management. The purpose of this review is to describe how these methods have been implemented in healthcare organizations and to assess their effectiveness and acceptability by healthcare professionals. This review should help quality managers and healthcare professionals to choose a model that is best adapted to their needs and expected goals.