Swiss medical weekly
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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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Swiss medical weekly · Jan 2013
Randomized Controlled Trial Comparative StudyCost-effectiveness of ticagrelor and generic clopidogrel in patients with acute coronary syndrome in Switzerland.
The aim of this study was to evaluate the cost-effectiveness of ticagrelor and generic clopidogrel as add-on therapy to acetylsalicylic acid (ASA) in patients with acute coronary syndrome (ACS), from a Swiss perspective. ⋯ During the first five years after ACS, treatment with ticagrelor dominates generic clopidogrel in Switzerland. Over a patient's lifetime, ticagrelor is highly cost-effective compared with generic clopidogrel, proven by ICERs significantly below commonly accepted willingness-to-pay thresholds.
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Swiss medical weekly · Jan 2013
Randomized Controlled TrialABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial.
After years of advocating ABC (Airway-Breathing-Circulation), current guidelines of cardiopulmonary resuscitation (CPR) recommend CAB (Circulation-Airway-Breathing). This trial compared ABC with CAB as initial approach to CPR from the arrival of rescuers until the completion of the first resuscitation cycle. ⋯ This randomized controlled trial found CAB superior to ABC with an earlier start of CPR and a shorter time to completion of the first 30:2 resuscitation cycle. These findings endorse the change from ABC to CAB in international resuscitation guidelines.
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Swiss medical weekly · Jan 2013
ReviewPractical approach to early postoperative management of lung transplant recipients.
Meticulous attention to detail during the early postoperative period after lung transplantation is crucial for the overall success of the procedure. It starts in the intensive care unit with the initiation of immunosuppression, implementation of anti-infective strategies and stabilisation of respiratory function. The subsequent days and weeks on the regular ward focus on titration of immunosuppressive drugs, vigilant fluid management, early mobilisation and initiation of physiotherapy. ⋯ This article intends to communicate the practical aspects and principles of the patient management used at the authors' centre on a daily basis by a multi-disciplinary transplant team, having at its core both a transplant pulmonologist and a thoracic surgeon. It focuses on the first month after lung transplantation, but does not cover surgical techniques, rare complications or long-term management issues of lung transplant recipients. The target audience of this practical guide are advanced trainees of pulmonology, thoracic surgery, intensive care, anaesthesiology and other clinicians involved in the early postoperative care of lung transplant recipients either in the intensive care unit or on the peripheral ward.
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Swiss medical weekly · Jan 2013
ReviewImproving patient safety in medicine: is the model of anaesthesia care enough?
Avoiding iatrogenic adverse outcomes and providing safe care to patients is a priority in modern healthcare systems. Because anaesthetic practice is inherently risky, the specialty has developed a broad range of strategies to minimise human error and risk for patients. These are part of a hierarchical model developed by industrial safety experts to minimise risk. ⋯ This review will describe the use of this model in anaesthesia and show why the specialty is often cited as a role model for patient safety improvement. It will also explore the extension of the model to other specialties and analyse its intrinsic limitations due to new challenges to patient safety: teamwork and communication issues. These will conclude the review.