Swiss medical weekly
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Swiss medical weekly · Jul 2019
Observational StudyDysphagia in the intensive care unit in Switzerland (DICE) - results of a national survey on the current standard of care.
Oropharyngeal dysphagia (OD) is often observed in critically ill patients. In most affected patients OD persists throughout hospital stay and negatively impacts on clinical outcomes. Here we systematically explore routine clinical practice standards for recognition/screening, diagnosis and treatment of OD in accredited Swiss ICUs. ⋯ Many Swiss ICUs have established standard operating procedures, with most using sequential clinical approaches to assess ICU patients at risk of dysphagia. OD confirmation is mostly performed using non-instrumental techniques. In general, it appears that awareness of OD and ICU educational curricula can be further optimised.
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Swiss medical weekly · Jun 2019
Multicenter StudyPatterns of multimorbidity in internal medicine patients in Swiss university hospitals: a multicentre cohort study.
Despite the high prevalence of multimorbidity, we lack detailed descriptive data on the most prevalent combinations of chronic comorbidities in Switzerland. We aimed to describe and quantify the most prevalent combinations of comorbidities in internal medicine multimorbid inpatients. ⋯ The vast majority of patients fulfilled the criteria for multimorbidity. Chronic heart disease, chronic kidney disease, solid malignancy and substance-related disorders were each present in at least one tenth of the patients. This in-depth description of the most frequent comorbidities and of their frequent associations in a multicentre population may advise healthcare providers to improve preventive care and develop appropriate guidelines for multimorbid patients. .
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Swiss medical weekly · Apr 2019
Impact of co-amoxicillin-resistant Escherichia coli and Pseudomonas aeruginosa on the rate of infectious complications in paediatric complicated appendicitis.
Choice of antibiotics for complicated appendicitis should address local antibiotic resistance patterns. As our local data showed a less than 15% resistance of Escherichia coli to co-amoxicillin (amoxicillin + clavulanic acid), we opted for this antibiotic in 2013. Subsequently, the increasing prevalence of Pseudomonas aeruginosa challenged this choice. ⋯ Results of the multivariable analysis of this small, retrospective study revealed a statistically significant increase in the risk of postoperative complications in the presence of co-amoxicillin-resistant E. coli. The choice of antibiotic should be adapted accordingly. More data are needed to justify the systematic coverage of P. aeruginosa in children with complicated appendicitis. .
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Swiss medical weekly · Apr 2019
Outcome of inter-hospital transfer of patients on extracorporeal membrane oxygenation in Switzerland.
An extracorporeal membrane oxygenation system (ECMO), as a bridge to either recovery, a ventricular assist device (VAD), or heart or lung transplantation, may be the only lifesaving option for critically ill patients suffering from refractory cardiac, respiratory or combined cardiopulmonary failure. As peripheral hospitals may not offer ECMO treatment, tertiary care centres provide specialised ECMO teams for on-site implantation and subsequent patient transfer on ECMO to the tertiary hospital. This study reports the results of the largest ECMO transportation programme in Switzerland and describes its feasibility and safety. ⋯ The first results of our ECMO transportation programme show its feasibility, safety and efficacy without on-site implant or on-transport complications or mortality. The favourable early survival may justify the large effort with respect to logistics, costs and manpower. With rising awareness, referring centres may increasingly consider this lifesaving option at an early stage, which may further improve outcomes.
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Swiss medical weekly · Mar 2019
Teamwork and clinician burnout in Swiss intensive care: the predictive role of workload, and demographic and unit characteristics.
The levels of teamwork and clinician burnout in healthcare differ depending on demographic and unit characteristics. However, the impact of these characteristics varies between clinical settings. In addition, the impact of objectively measured workload in such settings is largely unknown. The aim of this study was to analyse the predictive role of demographic (e.g., professional experience) and unit (e.g., unit size) characteristics, and workload (e.g., nursing interventions) in explaining teamwork and clinician burnout in Swiss intensive care units (ICUs). ⋯ We identified several demographic and unit-based factors in Swiss ICUs that were associated with lower perceptions of the quality of teamwork and higher self-reported burnout. Discrepant experiences regarding the quality of teamwork based on professional role, professional status and experience might affect team effectiveness. Furthermore, this study showed the importance of workload management, as objectively measured workload was associated with higher self-reported burnout. Results suggested that certain clinician groups (e.g., working predominantly night shifts) were at higher risk for burnout, thus highlighting the importance of providing additional support to these groups. Lastly, special attention should be paid to medical and surgical ICUs, which reported the highest level of burnout. Because this is a cross-sectional study, no conclusions can be drawn regarding causal relationships.