Swiss medical weekly
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Swiss medical weekly · Jan 2012
Randomized Controlled TrialEffect of bispectral index monitoring on extubation time and analgesic consumption in abdominal surgery: a randomised clinical trial.
The aim of this study was to investigate the effect of bispectral index (BIS) monitoring on intra-operative anaesthesia consumption and extubation time. ⋯ Guiding anaesthesia according to BIS level will result in significantly faster recovery after anaesthesia. The investigation was registered on ClinicalTrials.gov (NCT01470898).
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Swiss medical weekly · Jan 2012
Cerebral MRI and EEG studies in the initial management of pediatric headaches.
High resolution imaging modalities and electroencephalographic studies (EEG) are used in the assessment of children with headaches. We evaluated the role of cerebral MRI (cMRI) and EEG in the initial assessment of children with headache as the chief complaint of initial presentation. ⋯ Despite abnormal findings on neurological/physical examination in a substantial number of children with headaches, the yield of pathological cMRIs was low. The use of EEG recordings was not contributory to the diagnostic and therapeutic approach. More research is needed to better define those patients who are likely to have an intracranial pathology.
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Swiss medical weekly · Jan 2012
Multicenter Study Comparative StudyNurse-reported patient safety climate in Swiss hospitals: a descriptive-explorative substudy of the Swiss RN4CAST study.
Measuring the patient safety climate in the organisation of healthcare can help to identify problematic issues with a view to improving patient safety. We aimed (1) to describe the nurse-reported engagement in safety behaviours, (2) to describe the prevailing nurse-reported patient safety climate of general medical, surgical and mixed medical-surgical units in Swiss acute-care hospitals and (3) to explore differences between hospital type, unit type and language regions. ⋯ The findings of this study suggest a need to improve the patient safety climate on many units in Swiss hospitals. Leaders in hospitals should strengthen the patient safety climate at unit level by implementing methods, such as root cause analysis or patient safety leadership walk rounds, to improve individual and team skills and redesign work processes. The impact of these efforts should be measured by periodically assessing the patient safety climate with the SOS.
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Swiss medical weekly · Jan 2012
Clinical TrialPrevention and control of surgical site infections: review of the Basel Cohort Study.
Surgical site infections (SSI) are the most common hospital-acquired infections among surgical patients, with significant impact on patient morbidity and health care costs. The Basel SSI Cohort Study was performed to evaluate risk factors and validate current preventive measures for SSI. The objective of the present article was to review the main results of this study and its implications for clinical practice and future research. ⋯ The Basel SSI Cohort Study suggested that SAP should be administered between 74 and 30 minutes before surgery. Due to the observational nature of these data, corroboration is planned in a randomized controlled trial, which is supported by the Swiss National Science Foundation. Routine change of gloves or double gloving is recommended in the absence of SAP. Anaemia, transfusion and tutorial assistance do not increase the risk of SSI. The substantial economic burden of in-hospital SSI has been confirmed. SSI surveillance by the surgical staff detected only half of all in-hospital SSI, which prompted the introduction of an electronic SSI surveillance system at the University Hospital of Basel and the Cantonal Hospital of Aarau. Due to the absence of multiresistant SSI-causing pathogens, the continuous use of single-shot single-drug SAP with cefuroxime (plus metronidazole in colorectal surgery) has been validated.
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Although safety and efficacy of TAVI was improved with next-generation equipment, experience, and careful patient selection, some worrisome complications associated with the procedure remain. Current hot topics in transcatheter aortic valve implantation include patient selection, valve sizing, paravalvular regurgitation, cerebrovascular accidents, vascular complications and need for a permanent pacemaker. In this article we review the pathophysiology, avoidance and treatment options for these complications.