Swiss medical weekly
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Swiss medical weekly · Jan 2011
Students' interest in becoming a general surgeon before and after a surgical clerkship in German-speaking Switzerland.
The proportion of medical graduates entering a surgical career in Switzerland, as well as in most Western countries, is declining. The purpose of the present study was to evaluate the factors influencing medical students when choosing a career in surgery and to identify the impact of a surgical clerkship. ⋯ A surgical clerkship might have a positive impact on the choice of a surgical career. As there might be a shortage of surgeons in the future, lifestyle as the main impediment for choosing a surgical career should be kept in mind.
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Swiss medical weekly · Jan 2011
Optimised patient transfer using an innovative multidisciplinary assessment in Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections.
Current medical scores have limited efficiency and safety profiles to enable assignment to the most appropriate treatment site in patients with lower respiratory tract infections (LRTIs). We describe our current triage practice and assess the potential of a combination of CURB65 with proadrenomedullin (ProADM) levels for triage decisions. ⋯ Current rates of hospitalisation are high in patients with LRTI and length of stay frequently extended beyond time of medical stabilization. The lower proportion of patients reclassified as low risk by adding ProADM to the CURB65 score might improve confidence in the triage algorithm.
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Swiss medical weekly · Jan 2011
High prevalence of hypovitaminosis D in a Swiss rheumatology outpatient population.
Vitamin D is important for bone metabolism and neuromuscular function. While a routine dosage is often proposed in osteoporotic patients, it is not so evident in rheumatology outpatients where it has been shown that the prevalence of hypovitaminosis D is high. The aim of the current study was to systematically evaluate the vitamin D status in our outpatient rheumatology population to define the severity of the problem according to rheumatologic diseases. ⋯ Insufficiency and deficiency were even seen in 38% of the patients who were taking supplements. These results confirm that hypovitaminosis D is highly prevalent in an outpatient population of rheumatology patients, affecting 86% of subjects. Despite oral supplementation (taken in 38% of our population), only a quarter of those on oral supplementation attained normal values of 25-OH vitamin D.
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Swiss medical weekly · Jan 2011
Computed tomography angiography (CTA) to prove circulatory arrest for the diagnosis of brain death in the context of organ transplantation.
For the determination of brain death (BD) in potential organ donors, confirmatory tests that show cessation of cerebral circulation are used in many countries. Conventional angiography is considered the golden standard among these ancillary examinations. In recent years other angiographic techniques such as CT angiography (CTA) have been increasingly employed to establish the diagnosis of BD. We report our experience with CTA in this setting. ⋯ CTA is a useful additional tool for the confirmation of the diagnosis of brain death. Pooling of contrast in the relevant cerebral vessels, however, can be detected in up to 25% of CTAs in clinically brain dead patients.
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Perinatal asphyxial encephalopathy occurs in 1 per 1000 live births and is associated with high mortality and morbidity. Therapeutic hypothermia increases intact survival and improves neurodevelopmental outcome in survivors. ⋯ In Switzerland, access to therapeutic hypothermia is widespread and Swiss neonatologists believe that therapeutic hypothermia for perinatal asphyxia is effective. National cooling protocols are needed for the management of infants with perinatal asphyxial encephalopathy in order to ensure safe cooling, appropriate monitoring, imaging and follow-up assessment. A national registry is needed to collect data on diagnosis, treatment, adverse events and outcome.