Swiss medical weekly
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Swiss medical weekly · Oct 1999
Review[Quality assurance in intensive care: the situation in Switzerland].
The movement for quality in medicine is starting to take on the dimensions of a crusade. Quite logically it has also reached the intensive care community. Due to their complex multidisciplinary functioning and because of the high costs involved, ICUs are model services reflecting the overall situation in our hospitals. ⋯ Statistics on admissions, length of stay and length of mechanical ventilation, as well as severity data based on a simple classification system, are collected nationwide and allow some limited insight into the overall process of care. Results of intensive care are not systematically assessed. In response to the constant threat of cost containment, Swiss ICUs should increasingly focus on process quality and results, while maintaining their existing good structures.
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The article describes the evolution of high frequency oscillation since its first use by Lunkenheimer through the initial failed NIH trial and subsequent more successful trials to its current widespread use in the neonatal population. The importance of oscillating at an optimal lung volume, achieved through a volume recruitment manoeuvre, is emphasised as is the efficacy with which oscillation clears CO2. The lack of adequate control of these two factors in the initial NIH trial is suggested as a possible cause of the trial's failure. ⋯ Given the difficulty of recruiting lung volume in late RDS, a suggestion is made to combine high frequency oscillation with perfluorocarbon. The former as a mechanism for maintaining lung volume which has been recruited by the perfluorocarbon. The authors speculate that the use of high frequency oscillation will increase in both the paediatric and adult population.
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Swiss medical weekly · Oct 1999
[Complementary and conventional medicine: prejudices against and demands placed on natural care and conventional doctors].
In Switzerland some 40% of the population use complementary healing methods, whereby 28% also make use of the services of alternative therapists. Are different demands made upon these alternative therapists in terms of their time, the respective perception of authority, understanding and trust, from those made upon conventional medical practitioners? ⋯ The demands placed in terms of communication skills are high for both conventional and alternative medical practitioners, and call for a situation-sensitive approach to changing patient needs. General practitioners must accept that their traditional performance is as appreciated as ever but that in certain situations there are more significant explanation patterns concerning health and illness for patients than conventional medicine can offer. The (poor) level of compliance in the case of conventional medication should also be viewed in terms of the cost factor. In general, questions raised during consultations concerning medication should be seen as significant, as both users and non-users of complementary medicine pay close critical attention to them.
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Swiss medical weekly · Oct 1999
[High-risk PTCA assisted by the Hemopump 14F: the Geneva experience].
The hemopump is a transvalvular, catheter-mounted, left ventricular assist device, intended for surgical placement via the femoral artery (hemopump 21 Fr. outer diameter). This device has demonstrated its ability to unload the left ventricle, leading to myocardial protection and haemodynamic stabilisation in patients with cardiogenic shock and those undergoing high-risk coronary angioplasty (PTCA). Since 1994, a new hemopump system (14 Fr. in external diameter, flow rates of 1.5-2.2 l/min) has been developed for percutaneous insertion. The aim of this study is to describe the immediate and mid-term results obtained during Hemopump 14 Fr. assisted high-risk PTCA. ⋯ The 14 Fr. Hemopump device may constitute a useful percutaneous mode of haemodynamic support for patients undergoing high-risk PTCA. The haemolysis it causes is mild and not clinically significant, but the hemopump is associated with a significant rate of local vascular complications. Recent improvements in interventional techniques and hardware have decreased the necessity for circulatory assistance during elective PTCA, even for very ill patients. Nevertheless, indications such as cardiogenic shock, the "bridge" period prior to heart transplantation and video-assisted minimally invasive cardiac surgery, or haemodynamic support of the right ventricle are the new applications of the hemopump.
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Swiss medical weekly · Oct 1999
Comparative Study Clinical Trial Controlled Clinical Trial[Water precautions after insertion of a tympanostomy tube: necessary or obsolete?].
Since the introduction of tympanostomy tubes by Armstrong in 1952, physicians and patients alike have been concerned about the possible harm associated with water entering the middle ear via tubes. It is the current practice of many physicians to advise patients to avoid water entering the middle ear by using water precautions when swimming. However, the potential harmful effect of water in causing otorrhoea and otalgia still remains controversial. ⋯ In patients with tympanostomy tubes swimming without water precaution does not predispose to otorrhoea. On the basis of this study, previous investigations using in vitro models, and the literature, it is currently our practice to permit children to swim without water precautions two weeks after insertion of a tympanostomy tube.