Swiss medical weekly
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Swiss medical weekly · Jan 2013
Reasons for the persistence of adverse events in the era of safer surgery--a qualitative approach.
We sought to evaluate potential reasons given by board-certified doctors for the persistence of adverse events despite efforts to improve patient safety in Switzerland. ⋯ This qualitative study revealed the individual as the main player in the persistence of adverse events. Working conditions should be optimised to minimise interface problems in the case of cross-covering of patients, to assure support for students, residents and interns, and to reduce strain. Checklists are helpful on an "organisational level" (e.g., financial benefits, quality assurance) and to clarify responsibilities.
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Swiss medical weekly · Jan 2013
Randomized Controlled TrialEffects of dexmedetomidine on performance of bispectral index as an indicator of loss of consciousness during propofol administration.
The performance of bispectral index (BIS) for the measurement of the sedative depth when dexmedetomidine is administered in propofol anaesthesia and sedation has not yet been established. This study evaluated the effects of adjunctive dexmedetomidine on the accuracy of BIS to predict loss of consciousness (LOC) and BIS values predicting LOC during propofol administration. ⋯ The ability of BIS to predict LOC is not influenced by dexmedetomidine during propofol administration, but BIS values are enhanced at the time of LOC.
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To measure the workload of residents in a paediatric intensive care unit (PICU) and to compare this value with the possible explanatory variables "nine equivalents of nursing manpower use score" (NEMS), length of stay (LOS), patient age and severity of illness at admission. ⋯ NEMS, a therapeutic intervention score, and LOS are both independent predictors of clinical workload of residents in PICU. The correlation with LOS means that workload depends mainly on routine procedures (rounds, discussions with parents, administrative tasks) unrelated to the severity of illness. After calibration, LOS or NEMS, two widely used measures, may be used to calculate resident workload.
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Swiss medical weekly · Jan 2013
ReviewThe impact of emotion on perception, attention, memory, and decision-making.
Reason and emotion have long been considered opposing forces. However, recent psychological and neuroscientific research has revealed that emotion and cognition are closely intertwined. Cognitive processing is needed to elicit emotional responses. ⋯ We describe how psychological theories of emotion conceptualise the interactions of cognitive and emotional processes. We then review recent research investigating how emotion impacts our perception, attention, memory, and decision-making. Drawing on studies with both healthy participants and clinical populations, we illustrate the mechanisms and neural substrates underlying the interactions of cognition and emotion.
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Swiss medical weekly · Jan 2013
ReviewUptake of guidelines on prevention of mother-to-child transmission of HIV in rural Tanzania: time for change.
Guidelines on prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) are inconsistently implemented in low-income countries. Strategies are needed to improve the uptake of these guidelines to prevent avoidable new HIV infections of infants. In 2010 the World Health Organisation presented its new PMTCT guidelines, offering two options for short courses of antiretroviral prophylaxis: Option A and Option B. ⋯ The continuously changing recommendations on PMTCT stress the need for a much simpler and effective approach. We argue in favour of implementing Option B+ in Tanzania. Financial challenges need to be faced, but Option B+ would help to overcome many barriers that prevent guidelines to be implemented in order to increase coverage and ultimately achieve the goal of 'virtual elimination' of mother-to-child transmission in sub-Saharan Africa.