Swiss medical weekly
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Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease with poor survival. Recent studies have improved understanding of IPF and new discoveries have led to novel treatment options, which now have become available for patients. In face of the newly available therapies we present an update on the pathophysiology and epidemiology of IPF. ⋯ The role of biomarkers will briefly be outlined. Finally, we discuss novel antifibrotic treatment options for IPF (pirfenidone, nintedanib) and the management of patients regarding to comorbidities and complications. Both pirfenidone and nintedanib were shown to reduce the progression of IPF and therefore represent novel therapeutic strategies in this so far untreatable chronic lung disease.
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Swiss medical weekly · Jan 2015
Acute kidney injury KDIGO stage 2 to 3 in HIV-positive patients treated with cART--a case series over 11 years in a cohort of 1,153 patients.
We aimed to explore acute kidney injury (AKI) Kidney Disease Improving Global Guidelines (KDIGO) stage 2 to 3 in a cohort of antiretroviral treated HIV-infected individuals. ⋯ AKI KDIGO stage 2 to 3 demonstrates complex associations at the individual level and can occur without early signs. Although treatment with TDF and presence of cardiovascular risk factors were found frequently, predicting AKI seems very difficult.
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Swiss medical weekly · Jan 2015
Comparative StudyEfficacy of continuous catheter analgesia of the sciatic nerve after total knee arthroplasty.
This study investigated and compared the outcomes after continuous femoral nerve block alone, continuous femoral nerve analgesia combined with single-shot sciatic nerve analgesia, and continuous femoral and sciatic nerve analgesia in patients with total knee replacement. ⋯ On the basis of these results, which correspond well to other studies of a topic that is under discussion in the literature, we adapted our postoperative pain regimen to continuous sciatic and femoral nerve analgesia for at least 24 hours after hemi- and total knee replacement.
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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.
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Swiss medical weekly · Jan 2015
The role of Clinical Trial Units in investigator- and industry-initiated research projects.
Six multidisciplinary competence centres (Clinical Trial Units, CTUs) in Basel, Berne, Geneva, Lausanne, St. Gallen and Zurich provide professional support to clinical researchers in the planning, implementation, conduct and evaluation of clinical studies. ⋯ Taking the CTU Basel as an example, we show that a considerable number (25%) of the studies submitted for regulatory approval in 2013 were supported by the CTU, decreasing the number of findings in ethics reviews by about one-third. We conclude that these achievements, together with a Swiss national funding model for clinical research, and improved national coordination, will be critical factors to successfully position Swiss clinical research at the international forefront.