Swiss medical weekly
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To evaluate the patient characteristics and natural history of pubic rami fractures in geriatric patients, with a special focus on the frequency of concomitant posterior pelvic ring lesions and the percentage of secondarily operated patients as a result of conservative treatment failure. ⋯ Pubic rami fractures are frequently associated with concomitant posterior pelvic ring injuries, making these injuries more unstable than generally assumed. Based on this fact and the long duration of hospital stay, more aggressive management of these injuries may be considered. The principle aims in this patient population are satisfying pain management, early mobilisation, conservation of independence and return to previous place of residence.
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Emergency department crowding is a growing international problem. One possible reason for crowding might be the rising number of "walk-in" patients presenting with "non-urgent" health complaints. ⋯ In the emergency unit of the University Hospital Zurich, the prevalence of "non-urgent" medical encounters was substantial with one out three patients presenting with minor health complaints. Young age and non-Swiss origin were associated with increased use of the emergency unit for "non-urgent" conditions. A simple triage tool did not effectively divert "non-urgent" cases to alternates sites of primary care.
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Swiss medical weekly · Jan 2013
Patients leaving the emergency department without being seen by a physician: a retrospective database analysis.
To describe characteristics of patients leaving the emergency department (ED) before being seen by a physician and to identify factors associated with a greater risk of leaving the ED too early. ⋯ LWBS patients share some characteristics and a better understanding of these characteristics as well as time and logistic issues could ease to implement strategies to reduce premature leaving from the ED.
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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.