Swiss medical weekly
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Chronic obstructive pulmonary disease (COPD) is a global health challenge and a leading cause of death worldwide. Several risk factors have been identified, with cigarette smoking being the most important. Diagnostic assessment is based on symptoms, risk of exacerbations and results of lung function testing. ⋯ Oxygen therapy, noninvasive nocturnal ventilation and surgical treatment options only apply to a highly selected group of patients. Disease management programmes and guideline adherence are briefly discussed. In conclusion, although there is debate as to the extent with which pharmacological therapies influence mortality, adherence to the GOLD strategy is recommended.
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In chronic cardiomyopathy, mechanical circulatory support plays an increasingly important role for children as the shortage of suitable donor hearts increases times on the transplant waiting list. Ventricular assist devices (VADs) for adults have evolved dramatically over the last decade, both as a bridge to transplantation and for permanent support. ⋯ Increased experience with existing paediatric VADs and the introduction of third-generation VADs for the paediatric age group offer new possibilities for children suffering from end-stage heart failure. We review the literature on this topic, summarise the indications and contraindications for long-term support VADs and describe the decision-making algorithm used at our institution for use of long-term VADs in children.
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Swiss medical weekly · Jan 2013
ReviewIs tracheostomy still an option in amyotrophic lateral sclerosis? Reflections of a multidisciplinary work group.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a poor prognosis. Survival and quality of life of ALS patients have improved through the implementation of multidisciplinary approaches, the use of percutaneous gastrostomy and of noninvasive (NIV) or invasive ventilation. The question of whether or not to propose invasive ventilation (by tracheostomy: TPPV) to ALS patients remains a matter of debate. ⋯ Current practice in Switzerland and France tends to discourage the use of TPPV in ALS. Fear of a "locked-in syndrome", the high burden placed on caregivers, and unmasking cognitive disorders occurring in the evolution of ALS are some of the caveats when considering TPPV. Most decisions about TPPV are taken in emergency situations in the absence of advance directives. One exception is that of young motivated patients with predominantly bulbar disease who "fail" NIV.
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Swiss medical weekly · Jan 2013
Comparative StudyRisk factors and outcome of expanded-criteria donor kidney transplants in patients with low immunological risk.
The aim of this study was to evaluate risk factors and outcome of expanded-criteria donor (ECD) kidney transplants in patients with low immunological risk. ⋯ Tac-based immunosuppression seems to improve graft survival and to preserve graft function in ECD kidneys with low immunological risk.
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Swiss medical weekly · Jan 2013
ReviewImportance of leadership in cardiac arrest situations: from simulation to real life and back.
The 2010 American Heart Association guidelines now recommend leadership training in Advanced Cardiac Life Support courses. In this review we provide a comprehensive summary of data derived from clinical studies that investigated the importance of leadership in cardiopulmonary resuscitation (CPR). Only a few, mostly observational, studies have been conducted under real-life conditions because of the high heterogeneity of the situations, difficulties in capturing the initial phase of CPR, and ethical issues. ⋯ In addition, randomised controlled studies have provided evidence that medical students receiving leadership training subsequently showed improved CPR performance, which was sustained after a follow up of 4 months. In addition, leadership is influenced by gender and other factors such as emotional stress. Future studies are needed to investigate cultural differences and how findings from the simulator can be transferred to real-life situations.