Swiss medical weekly
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Swiss medical weekly · Mar 2009
ReviewTherapeutical options for the treatment of Cheyne-Stokes respiration.
The awareness of Cheyne-Stokes respiration (CSR) and of the co-existence of the obstructive sleep apnoea syndrome and central breathing disturbances has rapidly grown in recent years. CSR is defined by a waxing and waning pattern of the breathing amplitude. Sleep related breathing disorders in patients with heart failure are associated with impaired clinical outcome and survival. ⋯ There is a lack of evidence on the use of bilevel devices in CSR. However, ASV has proven both to effectively treat CSR and to be superior to CPAP in respiratory and sleep parameters in short term and medium term studies. Nevertheless, data on the long term use and the influence on cardiac parameters are necessary.
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Swiss medical weekly · Jan 2009
ReviewThe emotional impact of medical error involvement on physicians: a call for leadership and organisational accountability.
Involvement in errors often results in serious health effects, emotional distress, as well as performance and work-related consequences in staff members, in particular physicians. The aim of this systematic review was to evaluate current evidence on a) the impact of involvement in medical errors on physicians, b) needs and experiences in coping with the experience of error, and c) interventions to support physicians involved in errors. ⋯ Many professionals respond to error with serious emotional distress, and these emotions can imprint a permanent emotional scar. Given the significant burden on physicians' health, well-being and performance associated with medical errors, health care institutions and clinical leaders have to take accountability and provide staff with formal and informal systems of support.
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Sepsis, the systemic inflammatory response to an infection, is an increasingly common condition. It represents a major healthcare problem as affected patients have a high morbidity and mortality leading to high direct and indirect costs. This article describes the progression from a simple infection to septic shock and multi-organ failure, with a special emphasis on the body's response at the cellular level. ⋯ This underlines the assumption that organ dysfunction during sepsis is predominantly a functional problem which appears to relate to the creation of a new balance between energy generation and expenditure. Hence, organ dysfunction could be viewed as a protective mechanism for the patient and may represent a state analogous to hibernation, which can be reversed once the infection is overcome and inflammation has abated. More research is needed to develop better directed and timed therapeutic interventions that can reduce the high morbidity and mortality of this common condition.
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Swiss medical weekly · Oct 2008
Randomized Controlled TrialThe efficacy of non-pharmacological methods of pain management in school-age children receiving venepuncture in a paediatric department: a randomized controlled trial of audiovisual distraction and routine psychological intervention.
Non-pharmacologic analgesia has been demonstrated to alleviate pain and distress in invasive procedures. Nevertheless, the practice has not been adopted widely in paediatric departments because nurses are often too busy to perform a time consuming procedure. ⋯ Audiovisual distraction was demonstrated to be effective in reducing self-reported pain, improving patient cooperation and increasing success rate in venepuncture procedures and was as successful as routine psychological intervention. It is highly recommended as an effective, labour saving and easy to administer analgesia and should be used to help prevent pain from venepuncture in school age children.
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Swiss medical weekly · Oct 2008
Clinical TrialSafety and feasibility of percutaneous closure of patent foramen ovale without intra-procedural echocardiography in 825 patients.
Percutaneous closure of patent foramen ovale (PFO) is generally performed using intra-procedural guidance by transoesophageal (TEE) or intracardiac (ICE) echocardiography. While TEE requires sedation or general anaesthesia, ICE is costly and adds incremental risk, and both imaging modalities lengthen the procedure. ⋯ This study confirms the safety and feasibility of percutaneous PFO closure without intra-procedural echocardiographic guidance in a large cohort of consecutive patients.