Revue médicale suisse
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Every day, hospital doctors spend time at conducting ward rounds. Rounds are a core clinical activity during which doctors interact with patients, synthetise a whole set of informations and make many decisions. In addition, rounds can become a crucial teaching moment, when a trainee gets supervised by an attending physician. ⋯ This paper summarizes the results of the few key studies focusing on ward rounds. The results are presented in four sections, each one being dedicated to one of the round stakeholders: the trainee or resident, the trainer, the patient and the nurse. An emphasis is put on ward rounds involving both a trainee and a trainer, since such rounds always mean striking a balance between care and teaching.
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Procalcitonin (PCT) is a biomarker that is increasingly being used to help in decision making when managing febrile patients. This is a non exhaustive review of the literature regarding the use of PCT in deciding to begin or discontinue antibiotic treatment. ⋯ For other indications there is however insufficient evidence to support the systematic measurement of PCT in all febrile patients. In particular, in patients with autoimmune disease or in the postoperative setting, PCT is insufficiently sensitive or specific to rule out or confirm a bacterial infection requiring antibiotic treatment.
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Revue médicale suisse · Oct 2013
[Electrocardiogram for diagnosing myocardial infarction in patients with left bundle branch block or a pacemaker].
Effective management of myocardial infarction with ST segment elevation depends on rapid diagnosis. The presence of a left bundle branch block or of an electrically driven rhythm limits the interpretation of the initial electrocardiogram, potentially causing damaging delays. The Sgarbossa's score is well fit for those situations allowing when positive to opt for an immediate reperfusion strategy. However, its low sensitivity requires that it be combined with other diagnostic tools when negative.
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Revue médicale suisse · Oct 2013
[Threshold for allogeneic red cell transfusions in adult patients].
Red cell concentrate is a life-saving but expensive and sometimes limited resource. Its use is associated with a wide range of rare but potentially severe complications. ⋯ Transfusion thresholds have been widely debated and recent evidence suggest that a restrictive transfusion strategy may allow safely reducing the use of red cell concentrates and even improving clinical outcomes in some situations. The aim of this article is to review the physiologic adaptive responses to anemia and to discuss the clinical evidence about erythrocyte transfusion strategies in adult patients in order to provide evidence-based transfusion recommendations.