Swiss medical weekly
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Respiratory care is universally recognised as useful, but its indications and practice vary markedly. In order to improve the appropriateness of respiratory care in our hospital, we developed evidence-based local guidelines in a collaborative effort involving physiotherapists, physicians and health service researchers. ⋯ Despite a marked heterogeneity of scientific evidence, the method used allowed us to develop commonly agreed local guidelines for respiratory care. In addition, this work fostered a closer relationship between physiotherapists and physicians in our institution.
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The functional capacity of the human lung as gas exchanger is to a large extent determined by structural design. Quantitative structure-function correlations can be established by morphometry. ⋯ However, these design features also pose problems, such as how to ventilate and perfuse this large surface evenly and efficiently, or how to ensure mechanical stability against surface forces with a minimum of supporting tissue. The discussion focuses on the extent to which novel design principles are used to overcome such problems by designing the airways as a fractal tree and the fibre support system as a tensegrity structure.
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Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. Unfortunately, current treatment strategies aiming at the elimination of atrial fibrillation have limited long term success rates and significant risks. In this context, recent publications have provided many insights on potentially treatable risk factors for the occurrence of atrial fibrillation, such as alcohol, blood pressure, obesity, inflammation and nutritional factors. ⋯ The current evidence shows that blood pressure, hypertension and obesity seem to play a key role in the pathogenesis of atrial fibrillation. Preliminary evidence also suggests that inflammation is an important mediator of these associations. Knowledge of these interrelationships may eventually help to develop new treatment strategies and decrease the burden of atrial fibrillation in the general population.
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Swiss medical weekly · Jun 2009
ReviewProcalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections--hope for hype?
This review aims to provide physicians with an overview of the potential of procalcitonin to guide antibiotic therapy in respiratory tract infections and in sepsis. Knowledge of the strengths and weaknesses of procalcitonin are prerequisites for a rational and safe use in clinical routine. In most infections a true gold standard for diagnosis does not exist, therefore physicians must remain sceptical towards observational studies evaluating procalcitonin. ⋯ Other biomarkers including cortisol, human growth hormone and prohormones from adrenomedullin and vasopressin ("copeptin") have a superior predictive potential to estimate the risk for short and long term mortality and other adverse outcomes in different diseases. An accurate prognostic assessment has the potential to optimise the management of patients and the allocation of our limited health care resources by lowering unnecessary hospitalisations and associated cost. Future intervention studies must prove if these biomarkers indeed improve clinical decision making and thus the overall medical management of patients.
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Swiss medical weekly · May 2009
Randomized Controlled Trial Comparative StudyRandomised comparison of complications from three different permanent central venous access systems.
We present a prospective randomised trial comparing complications from three different permanent central venous access systems (PCVAS). ⋯ The polyurethane catheters that ruptured more often had a larger diameter and a thicker wall than the other polyurethane catheters, and were probably subjected to greater shearing between the clavicle and the first rib. Silicone catheters, although thicker and of larger diameter than the two other catheters, seemed more resistant to shearing.