Swiss medical weekly
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Swiss medical weekly · Jan 2015
ReviewNovel psychoactive substances (designer drugs): overview and pharmacology of modulators of monoamine signaling.
Novel psychoactive substances are newly used designer drugs ("internet drugs", "research chemicals", "legal highs") potentially posing similar health risks to classic illicit substances. Chemically, many novel psychoactive substances can be classified as phenethylamines, amphetamines, synthetic cathinones, piperazines, pipradrols/piperidines, aminoindanes benzofurans, and tryptamines. Pharmacologically, these substances interact with various monoaminergic targets. ⋯ Dopaminergic drugs are highly addictive and acute toxicity includes prolonged stimulation, insomnia, agitation, and psychosis. Agitation, anxiety, paranoia, hypertension, and rarely myocardial infarction and renal failure are seen with synthetic cannabinoids. Treatment is supportive.
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Elevation of the mean pulmonary arterial pressure to ≥25 mm Hg within the low-pressure system of the pulmonary circulation is defined as pulmonary hypertension. Pulmonary hypertension may be the consequence of various clinical and pathophysiological entities. ⋯ Remodelling is arguably the most important factor: its complex pathogenesis is not completely understood and no specific treatment directly targets vascular remodelling. This article aims to review the current understanding of the pathogenesis of pulmonary hypertension and to give insights in future developments in this evolving field.
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Swiss medical weekly · Jan 2015
Observational StudyThe proportion of correct diagnoses is low in emergency patients with nonspecific complaints presenting to the emergency department.
To determine the proportion of correct emergency department (ED) diagnoses and of hospital discharge diagnoses, in comparison with final diagnoses at the end of a 30-day follow-up, in patients presenting with nonspecific complaints (NSCs) to the ED; to determine differences between male and female patients in the proportion of missed diagnoses. ⋯ Patients presenting to the ED with NSCs present a diagnostic challenge. New diagnostic tools are needed to help in the diagnosis of these patients.
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Swiss medical weekly · Jan 2015
Adherence to transfusion guidelines: are we prepared for the Smarter Medicine or Choosing Wisely initiative?
To determine, whether a restrictive transfusion strategy is followed in our hospital and to identify differences in activities within departments and patient groups. ⋯ All wards in our analysis are following the current guidelines based on restrictive transfusion strategies. At the same time, we were able to detect significant differences between different departments and patient characteristics.
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Swiss medical weekly · Jan 2015
ReviewSmarter medicine: do physicians need political pressure to eliminate useless interventions?
Echoing the "less is more" and "choosing wisely" campaigns in the USA, the "smarter medicine" campaign launched in 2014 by the Swiss Society of General Internal Medicine listed five tests or treatments that are often prescribed in ambulatory general internal medicine, but that may not provide any meaningful benefit and may carry the risk of generating harms and costs. In the United Kingdom, the National Institute for Health and Care Excellence (NICE) supported the National Health Services in identifying "low value" activities that should be stopped. ⋯ To obtain significant changes and promote the paradigm of reducing unnecessary waste of medical resources, opinion leaders and leading scientific or academic institutions, as well as medical societies, can make a difference, together with consumer associations and the lay press. Politicians can undoubtedly contribute to the success of these strategies, but rather than putting physicians alone under pressure and setting up stringent regulatory measures, they should network with all stakeholders and put emphasis on a broader agenda, the one of improving healthcare quality and efficiency.