Swiss medical weekly
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Unilateral chronic maxillary sinusitis is frequently attributed to dental origin. The goal of this retrospective study is to determine the frequency of maxillary sinusitis due to a foreign body of dental origin and its characteristics. ⋯ Chronic maxillary sinusitis attributable to a dental foreign body is rare and overestimated. There exists an important disproportion between the number of intra-sinusal dental foreign bodies and the number of patients who are symptomatic. Treatment is surgical by oral antrotomy and/or endonasal meatotomy. Only a prospective study could give a real estimation of the proportion of symptomatic cases and determine the predisposing factors.
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Swiss medical weekly · Dec 1999
Subspecialty internal medicine in the United States: in and outside the hospital.
In the U. S. the subspecialties of internal medicine are well integrated in the overall discipline of internal medicine and each one is also unique. The American Board of Internal Medicine at present certifies 16 unique subdisciplines, which are, in order from the largest to the smallest: cardiology (14,000 certified cardiologists), gastroenterology (10,000 certified), pulmonary disease (9000 certified), critical care medicine (6500 certified), hematology, oncology, nephrology, infectious diseases, allergy and immunology, endocrinology, rheumatology, geriatrics, sport medicine, adolescent medicine. ⋯ These disciplines require an additional, fourth year of cardiac training and prior certification in cardiology. Between the departments of internal medicine and the subspecialty divisions there is often a "healthy tension" stemming from unavoidable inequities in the financial contributions of the subspecialties to the department. Currently, there is a decline in specialization rate due to a variety of converging factors, among them restricted direct access to specialists in HMOs, and the developing hospitalist movement: full-time hospitalists are less likely to need subspecialist consultation than other generalists.
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Swiss medical weekly · Oct 1999
Review[Quality assurance in intensive care: the situation in Switzerland].
The movement for quality in medicine is starting to take on the dimensions of a crusade. Quite logically it has also reached the intensive care community. Due to their complex multidisciplinary functioning and because of the high costs involved, ICUs are model services reflecting the overall situation in our hospitals. ⋯ Statistics on admissions, length of stay and length of mechanical ventilation, as well as severity data based on a simple classification system, are collected nationwide and allow some limited insight into the overall process of care. Results of intensive care are not systematically assessed. In response to the constant threat of cost containment, Swiss ICUs should increasingly focus on process quality and results, while maintaining their existing good structures.
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The article describes the evolution of high frequency oscillation since its first use by Lunkenheimer through the initial failed NIH trial and subsequent more successful trials to its current widespread use in the neonatal population. The importance of oscillating at an optimal lung volume, achieved through a volume recruitment manoeuvre, is emphasised as is the efficacy with which oscillation clears CO2. The lack of adequate control of these two factors in the initial NIH trial is suggested as a possible cause of the trial's failure. ⋯ Given the difficulty of recruiting lung volume in late RDS, a suggestion is made to combine high frequency oscillation with perfluorocarbon. The former as a mechanism for maintaining lung volume which has been recruited by the perfluorocarbon. The authors speculate that the use of high frequency oscillation will increase in both the paediatric and adult population.
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Swiss medical weekly · Oct 1999
[Complementary and conventional medicine: prejudices against and demands placed on natural care and conventional doctors].
In Switzerland some 40% of the population use complementary healing methods, whereby 28% also make use of the services of alternative therapists. Are different demands made upon these alternative therapists in terms of their time, the respective perception of authority, understanding and trust, from those made upon conventional medical practitioners? ⋯ The demands placed in terms of communication skills are high for both conventional and alternative medical practitioners, and call for a situation-sensitive approach to changing patient needs. General practitioners must accept that their traditional performance is as appreciated as ever but that in certain situations there are more significant explanation patterns concerning health and illness for patients than conventional medicine can offer. The (poor) level of compliance in the case of conventional medication should also be viewed in terms of the cost factor. In general, questions raised during consultations concerning medication should be seen as significant, as both users and non-users of complementary medicine pay close critical attention to them.