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Swiss Emergency Research collection

2021

  • Nestelberger, T., Boeddinghaus, J., Gimenez, M. R., Lopez-Ayala, P., Ratmann, P. D., Badertscher, P., Wildi, K., et al. “Direct Comparison Of High-Sensitivity Cardiac Troponin T And I In The Early Differentiation Of Type 1 Vs. Type 2 Myocardial Infarction”. Eur Heart J Acute Cardiovasc Care 11, no. 1: 62-74. doi:10.1093/ehjacc/zuab039.
    Abstract: AIMS: To directly compare the diagnostic accuracy of high-sensitivity cardiac troponin (hs-cTn) T vs. hs-cTnI in the early non-invasive differentiation of Type 1 myocardial infarction (T1MI) due to plaque rupture and atherothrombosis from Type 2 myocardial infarction (T2MI) due to supply-demand mismatch. METHODS AND RESULTS: In a prospective multicentre diagnostic study, two independent cardiologists centrally adjudicated the final diagnosis of T1MI vs. T2MI according to the fourth universal definition of myocardial infarction (MI), using all available clinical information including cardiac imaging in patients presenting with acute chest pain. Diagnostic accuracy was quantified by the area under the receiver operating characteristics curve (AUC). The most extensively validated hs-cTnT-Elecsys and hs-cTnI-Architect assays were measured at presentation, 1 h, and 2 h. Among 5887 patients, 1106 (19%) had a final diagnosis of MI, including 860 (78%) T1MI and 246 (22%) T2MI. The AUC of hs-cTnT-Elecsys to differentiate T1MI from T2MI was moderate and comparable to that provided by hs-cTnI-Architect: hs-cTnT-Elecsys AUC-presentation 0.67 [95% confidence interval (CI) 0.64-0.71], AUC-1 h 0.70 (95% CI 0.66-0.74), and AUC-2 h 0.71 (95% CI 0.66-0.75) vs. hs-cTnI-Architect AUC-presentation 0.71 (95% CI 0.67-0.74), AUC-1 h 0.72 (95% CI 0.68-0.76), and AUC-2 h 0.74 (95% CI 0.69-0.78), all P = not significant (NS). Similarly, the AUC of absolute changes was moderate and comparable for hs-cTnT-Elecsys and hs-cTnI-Architect (all P = NS). Cut-off concentrations achieving at least 90% specificity for the differentiation of T1MI vs. T2MI were >114 ng/L for hs-cTnT-Elecsys [odds ratio (OR) 4.2, 95% CI 2.7-6.6] and >371 ng/L for hs-cTnI-Architect (OR 4.0, 95% CI 2.6-6.2). CONCLUSION: hs-cTnT-Elecsys and hs-cTnI-Architect provided comparable, albeit only moderate, diagnostic accuracy for the early differentiation of T1MI vs. T2MI. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00470587, https://clinicaltrials.gov/ct2/show/NCT00470587.
    Tags: *Myocardial Infarction/diagnosis, *Troponin T, Biomarkers, Differentiation, Early Diagnosis, High-sensitivity cardiac troponin, Humans, Prospective Studies, Type 1 myocardial infarction, Type 2 myocardial infarction.
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  • Morrison, M., Korda, A., Zamaro, E., Wagner, F., Caversaccio, M. D., Sauter, T. C., Kalla, R., and Mantokoudis, G. “Paradigm Shift In Acute Dizziness: Is Caloric Testing Obsolete?”. J Neurol 269, no. 2: 853-860. doi:10.1007/s00415-021-10667-7.
    Abstract: OBJECTIVE: Cold and warm water ear irrigation, also known as bithermal caloric testing, has been considered for over 100 years the 'Gold Standard' for the detection of peripheral vestibular hypofunction. Its discovery was awarded a Nobel Prize. We aimed to investigate the diagnostic accuracy of Caloric Testing when compared to the video head impulse test (vHIT) in differentiating between vestibular neuritis and vestibular strokes in acute dizziness. DESIGN: Prospective cross-sectional study (convenience sample). SETTING: All patients presenting with signs of an acute vestibular syndrome at the emergency department of a tertiary referral center. PARTICIPANTS: One thousand, six hundred seventy-seven patients were screened between February 2015 and May 2020 for Acute Vestibular Syndrome (AVS), of which 152 met the inclusion criteria and were enrolled. Inclusion criteria consisted of a state of continuous dizziness, associated with nausea or vomiting, head-motion intolerance, new gait or balance disturbance and nystagmus. Patients were excluded if they were younger than 18 years, if symptoms lasted < 24 h or if the index ED visit was > 72 h after symptom onset. Of the 152 included patients 85 completed testing. We assessed 58 vestibular neuritis and 27 stroke patients. MAIN OUTCOME MEASURES: All patients underwent calorics and vHIT followed by a delayed MRI which served as a gold standard for vestibular stroke confirmation. RESULTS: The overall sensitivity and specificity for detecting stroke with a caloric asymmetry cut-off of 30.9% was 75% and 86.8%, respectively [negative likelihood ratio (NLR) 0.29] compared to 91.7% and 88.7% for vHIT (NLR 0.094). Best VOR gain cut-off was 0.685. Twenty-five percent of vestibular strokes were misclassified by calorics, 8% by vHIT. CONCLUSIONS: Caloric testing proved to be less accurate than vHIT in discriminating stroke from vestibular neuritis in acute dizziness. Contrary to classic teaching, asymmetric caloric responses can also occur with vestibular strokes and might put the patient at risk for misdiagnosis. We, therefore, recommend to abandon caloric testing in current practice and to replace it with vHIT in the acute setting. Caloric testing has still its place as a diagnostic tool in an outpatient setting.
    Tags: *Dizziness/diagnosis, *Vestibular Neuronitis/complications/diagnosis, Acute stroke, Caloric testing, Caloric Tests, Cross-Sectional Studies, Dizziness, Head Impulse Test, Head-impulse test, Humans, interest with respect to the conduct or analysis of this study. Eyeseetec company, loaned the VOG goggles., Neuritis, Prospective Studies, Reflex, Vestibulo-Ocular, relationships, or affiliations that represent a relevant financial conflict of, Vertigo.
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  • Mockel, M., Nickel, C. H., Behringer, W., and Backus, B. “Status Of Physician Education In Emergency Medicine In Four European Countries: No Primary Specialty Yet”. Eur J Emerg Med 28, no. 4: 257-259. doi:10.1097/MEJ.0000000000000837.
    Tags: *Emergency Medicine, *Physicians, Europe, Humans.
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  • L'Huillier, A. G., Lacour, M., Sadiku, D., Gadiri, M. A., De Siebenthal, L., Schibler, M., Eckerle, I., et al. “Diagnostic Accuracy Of Sars-Cov-2 Rapid Antigen Detection Testing In Symptomatic And Asymptomatic Children In The Clinical Setting”. J Clin Microbiol 59, no. 9: e0099121. doi:10.1128/JCM.00991-21.
    Abstract: Antigen-based rapid diagnostic tests (RDTs) are used in children despite the lack of data. We evaluated the diagnostic performance of the Panbio-COVID-19 Ag Rapid Test Device (P-RDT) in children. Symptomatic and asymptomatic participants 0 to 16 years old had two nasopharyngeal swabs (NPS) for both reverse transcription-PCR (RT-PCR) and P-RDT. A total of 822 participants completed the study, of which 533 (64.9%) were symptomatic. Among the 119 (14.5%) RT-PCR-positive patients, the P-RDT sensitivity was 0.66 (95% confidence interval [CI] 0.57 to 0.74). Mean viral load (VL) was higher among P-RDT-positive patients than negative ones (P < 0.001). Sensitivity was 0.91 in specimens with VL of >1.0E6 IU/ml (95% CI 0.83 to 0.99) and decreased to 0.75 (95% CI 0.66 to 0.83) for specimens >1.0E3 IU/ml. Among symptomatic participants, the P-RDT displayed a sensitivity of 0.73 (95% CI 0.64 to 0.82), which peaked at 1.00 at 2 days post-onset of symptoms (DPOS) (95% CI 1.00 to 1.00), then decreased to 0.56 (95% CI 0.23 to 0.88) at 5 DPOS. There was a trend toward lower P-RDT sensitivity in symptomatic children <12 years (0.62 [95% CI 0.45 to 0.78]) versus >/=12 years (0.80 [95% CI 0.69 to 0.91]; P = 0.09). In asymptomatic participants, the P-RDT displayed a sensitivity of 0.43 (95% CI 0.26 to 0.61). Specificity was 1.00 in symptomatic and asymptomatic children (95% CI 0.99 to 1.00). The overall 73% and 43% sensitivities of P-RDT in symptomatic and asymptomatic children, respectively, was below the 80% cutoff recommended by the World Health Organization. We observed a correlation between VL and P-RDT sensitivity, as well as variation of sensitivity according to DPOS, a major determinant of VL. These data highlight the limitations of RDTs in children, with the potential exception in early symptomatic children >/=12yrs.
    Tags: *covid-19, *SARS-CoV-2, Adolescent, antigen-based rapid diagnostic tests, Antigens, Viral, Child, Child, Preschool, children, Covid-19, COVID-19 Serological Testing, diagnostics, Humans, Infant, Infant, Newborn, pediatric infectious disease, rapid diagnostic tests, SARS-CoV-2, Sensitivity and Specificity.
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  • Dunand, A., Beysard, N., Maudet, L., Carron, P. N., Dami, F., Piquilloud, L., Caillet-Bois, D., and Pasquier, M. “Management Of Respiratory Distress Following Prehospital Implementation Of Noninvasive Ventilation In A Physician-Staffed Emergency Medical Service: A Single-Center Retrospective Study”. Scand J Trauma Resusc Emerg Med 29, no. 1: 85. doi:10.1186/s13049-021-00900-7.
    Abstract: BACKGROUND: Noninvasive ventilation (NIV) is recognized as first line ventilatory support for the management of acute pulmonary edema (APE) and chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to study the prehospital management of patients in acute respiratory distress with an indication for NIV and whether they received it or not. METHODS: This retrospective study included patients >/=18 years old who were cared for acute respiratory distress in a prehospital setting. Indications for NIV were oxygen saturation (SpO(2)) <90% and/or respiratory rate (RR) >25/min with a presumptive diagnosis of APE or COPD exacerbation. Study population characteristics, initial and at hospital vital signs, presumptive and definitive diagnosis were analyzed. For patients who received NIV, dyspnea level was evaluated with a dyspnea verbal ordinal scale (D-VOS, 0-10) and arterial blood gas (ABG) values were obtained at hospital arrival. RESULTS: Among the 187 consecutive patients included in the study, most (n = 105, 56%) had experienced APE or COPD exacerbation, and 56 (30%) received NIV. In comparison with patients without NIV, those treated with NIV had a higher initial RR (35 +/- 8/min vs 29 +/- 10/min, p < 0.0001) and a lower SpO(2) (79 +/- 10 vs 88 +/- 11, p < 0.0001). The level of dyspnea was significantly reduced for patients treated with NIV (on-scene D-VOS 8.4 +/- 1.7 vs 4.4 +/- 1.8 at admission, p < 0.0001). Among the 131 patients not treated with NIV, 41 (31%) had an indication. In the latter group, initial SpO(2) was 80 +/- 10% in the NIV group versus 86 +/- 11% in the non-NIV group (p = 0.0006). NIV was interrupted in 9 (16%) patients due to either discomfort (n = 5), technical problem (n = 2), persistent desaturation (n = 1), or vomiting (n = 1). CONCLUSIONS: The results of this study contribute to a better understanding of the prehospital management of patients who present with acute respiratory distress and an indication for NIV. NIV was started on clinically more severe patients, even if predefined criteria to start NIV were present. NIV allows to improve vital signs and D-VOS in those patients. A prospective study could further elucidate why patients with a suspected diagnosis of APE and COPD are not treated with NIV, as well as the clinical impact of the different strategies. TRIAL REGISTRATION: The study was approved by our institutional ethical committee ( CER-VD 2020-01363 ).
    Tags: Acute pulmonary edema, Acute respiratory failure, Adolescent, Aged, Chronic obstructive pulmonary disease exacerbation, Emergency medical services, Emergency Medical Services/*methods, Female, Hospitals/*statistics & numerical data, Humans, Male, Noninvasive ventilation, Noninvasive Ventilation/*methods, Prehospital, Respiratory distress, Respiratory Distress Syndrome/*therapy, Retrospective Studies.
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  • Stoffel, L., Agyeman, P. K. A., Keitel, K., Barbani, M. T., Duppenthaler, A., Kopp, M. V., and Aebi, C. “Striking Decrease Of Enteroviral Meningitis In Children During The Covid-19 Pandemic”. Open Forum Infect Dis 8, no. 6: ofab115. doi:10.1093/ofid/ofab115.
    Abstract: We report the unprecedented complete absence of pediatric enteroviral meningitis in 2020 in the area of Bern, Switzerland. Presumably an unintended effect of coronavirus disease 2019 public health measures, this finding highlights the potential of community-wide nonpharmaceutical interventions for controlling the circulation of a major pediatric pathogen, which is mainly transmitted by the fecal-oral route.
    Tags: child, Covid-19, Enterovirus, epidemiology, meningitis, SARS-CoV-2.
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  • Douillet, D., Riou, J., Thoma, M., Moumneh, T., Darsonval, A., Trinh-Duc, A., Hugli, O., Chauvin, A., Penaloza, A., and Roy, P. M. “Thromboembolic Risk Stratification By Trip(Cast) Score To Rationalise Thromboprophylaxis In Patients With Lower Leg Trauma Requiring Immobilisation: A Study Protocol Of The Casting Stepped-Wedge Cluster Randomised Trial”. Bmj Open 11, no. 6: e045905. doi:10.1136/bmjopen-2020-045905.
    Abstract: INTRODUCTION: Patients with lower limb trauma requiring orthopaedic immobilisation may be at risk of venous thromboembolism but opinions differ about who may benefit from thromboprophylactic anticoagulant treatment.The aim of this CASTING study is to demonstrate the safety of thromboprophylaxis based on the Thrombosis Risk Prediction for patients with cast immobilisation (TRiP(cast) score with regards to the 3-month incidence of symptomatic venous thromboembolism events in low-risk patients not receiving thromboprophylaxis, as well as the usefulness of this strategy on the rate of patients receiving anticoagulant treatment in comparison to current practice. METHODS AND ANALYSIS: CASTING will be a stepped-wedge cluster randomised controlled clinical trial, performed in 15 emergency departments in France and Belgium. With their informed consent, outpatients admitted to one of the participating emergency departments for a lower limb trauma requiring orthopaedic immobilisation without surgery will be included. All centres will begin the trial with the 'observational period' and, every 2 weeks, 1 centre will be randomly assigned to switch to the 'interventional period' and to apply the TRiP(cast) score, in which only patients with a score >/=7 will receive thromboprophylactic anticoagulant treatment. The primary endpoint is the rate of clinical thromboembolic events within 90 days following the inclusion of low-risk patients not receiving thromboprophylaxis. ETHICS AND DISSEMINATION: The protocol has been approved by the Comite de Protection des Personnes Sud I (Ethics Review ID-RCB: 2019-A01829-48) for France and the Comite d'ethique hopital-facultaire Saint Luc (N degrees B403201941338) for Belgium. It is carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. The findings of this study will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER: NCT04064489.
    Tags: *Anticoagulants/therapeutic use, *Venous Thromboembolism/prevention & control, accident & emergency medicine, adult orthopaedics, Belgium, foot & ankle, France, Humans, Leg, Randomized Controlled Trials as Topic, Risk Assessment, vascular medicine.
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  • Brunner, L., Canepa Allen, M., Malebranche, M., Hudon, C., Senn, N., Hugli, O., Vu, F., Akre, C., and Bodenmann, P. “Qualitative Evaluation Of Primary Care Providers' Experiences Caring For Frequent Users Of The Emergency Department”. Bmj Open 11, no. 6: e044326. doi:10.1136/bmjopen-2020-044326.
    Abstract: OBJECTIVES: Many interventions have been developed over the years to offer frequent users of the emergency department (FUEDs) better access to quality coordinated healthcare. Despite recognising the role primary care physicians (PCPs) play in FUEDs' care, to date their perceptions of case management, the most studied intervention, have rarely been assessed. Furthermore, a gap regarding PCPs' experience of caring for FUEDs persists. Thus, this study aimed to explore PCPs' perceptions of the care provided to FUEDs in emergency and primary care settings, their views on the local case management team (CMT), and their suggestions to improve FUEDs' care. DESIGN: Qualitative study using in-depth semistructured interviews and inductive thematic analysis. SETTING: Canton of Vaud, Switzerland. PARTICIPANTS: Thirty PCPs participated, 16 in private practice (PP-PCPs) and 14 based at the Lausanne University Centre of General Medicine and Public Health (Unisante-U-PCPs). RESULTS: U-PCPs and PP-PCPs thought that most FUEDs' emergency department (ED) visits were legitimate, but questioned ED adequacy to meet FUEDs' needs. Yet, both PCP groups reported encountering many challenges in FUEDs' care themselves. In this context, PP-PCPs seemed more satisfied of the care they provided to FUEDs than U-PCPs. Generally, U-PCPs seemed to find more value in the CMT to help them care for FUEDs than PP-PCPs. To enhance FUEDs' care, U-PCPs and PP-PCPs suggested enhancing collaboration with other healthcare providers. U-PCPs also wished to increase their availability, and some PP-PCPs considered outpatient clinics, larger group practices or medical centres most appropriate to handle FUEDs' needs. CONCLUSIONS: This study highlights the many challenges PCPs face in caring for FUEDs, that a CM intervention has the potential to mitigate, and provides ways forward in improving FUEDs' care, including reinforced communication with the CMT and ED physicians, and structural changes to their own way of delivering care to FUEDs.
    Tags: *Physicians, Primary Care, Attitude of Health Personnel, Emergency Service, Hospital, general medicine (see internal medicine), Humans, primary care, Primary Health Care, Qualitative Research, Switzerland.
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  • Schmuelling, L., Franzeck, F. C., Nickel, C. H., Mansella, G., Bingisser, R., Schmidt, N., Stieltjes, B., et al. “Deep Learning-Based Automated Detection Of Pulmonary Embolism On Ct Pulmonary Angiograms: No Significant Effects On Report Communication Times And Patient Turnaround In The Emergency Department Nine Months After Technical Implementation”. Eur J Radiol 141: 109816. doi:10.1016/j.ejrad.2021.109816.
    Abstract: OBJECTIVES: Rapid communication of CT exams positive for pulmonary embolism (PE) is crucial for timely initiation of anticoagulation and patient outcome. It is unknown if deep learning automated detection of PE on CT Pulmonary Angiograms (CTPA) in combination with worklist prioritization and an electronic notification system (ENS) can improve communication times and patient turnaround in the Emergency Department (ED). METHODS: In 01/2019, an ENS allowing direct communication between radiology and ED was installed. Starting in 10/2019, CTPAs were processed by a deep learning (DL)-powered algorithm for detection of PE. CTPAs acquired between 04/2018 and 06/2020 (n = 1808) were analysed. To assess the impact of the ENS and the DL-algorithm, radiology report reading times (RRT), radiology report communication time (RCT), time to anticoagulation (TTA), and patient turnaround times (TAT) in the ED were compared for three consecutive time periods. Performance measures of the algorithm were calculated on a per exam level (sensitivity, specificity, PPV, NPV, F1-score), with written reports and exam review as ground truth. RESULTS: Sensitivity of the algorithm was 79.6 % (95 %CI:70.8-87.2%), specificity 95.0 % (95 %CI:92.0-97.1%), PPV 82.2 % (95 %CI:73.9-88.3), and NPV 94.1 % (95 %CI:91.4-96 %). There was no statistically significant reduction of any of the observed times (RRT, RCT, TTA, TAT). CONCLUSION: DL-assisted detection of PE in CTPAs and ENS-assisted communication of results to referring physicians technically work. However, the mere clinical introduction of these tools, even if they exhibit a good performance, is not sufficient to achieve significant effects on clinical performance measures.
    Tags: *Deep Learning, *Pulmonary Embolism/diagnostic imaging, Angiography, Artificial intelligence, Clinical workflow, Communication, Computed tomography pulmonary angiograms, Emergency department, Emergency Service, Hospital, Humans, Pulmonary embolism, Tomography, X-Ray Computed.
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  • Nieves-Ortega, R., Brabrand, M., Dutilh, G., Kellett, J., Bingisser, R., and Nickel, C. H. “Assessment Of Patient Mobility Improves The Risk Stratification Of Triage With The Emergency Severity Index: A Prospective Cohort Study”. Eur J Emerg Med 28, no. 6: 456-462. doi:10.1097/MEJ.0000000000000845.
    Abstract: BACKGROUND AND IMPORTANCE: Formal triage may assign a low acuity to patients at high risk of deterioration and mortality. A patient's mobility can be easily assessed at triage. OBJECTIVE: To investigate if a simple assessment of mobility at triage can improve the Emergency Severity Index's (ESI) prediction of adverse outcomes. DESIGN, SETTING AND PARTICIPANTS: Prospective observational study of all patients attending the emergency department (ED) of a single academic hospital in Switzerland over a period of 3 weeks. OUTCOME MEASURES AND ANALYSIS: Triage clinicians classified participants as having normal or impaired mobility at triage. Impaired mobility was defined as the lack of a stable independent gait, regardless of its cause or duration (e.g. any patient who needed help to walk). The primary outcome was 30-day mortality. We performed a survival analysis stratified by mobility and ESI level. We compared the performance of regression models including the ESI alone or in combination with mobility as predictors of mortality using the Bayesian information criterion (BIC). MAIN RESULTS: 2523 patients were included in the study and 880 (34.9%) had impaired mobility. Patients with impaired mobility had a lower median 30-day survival in ESI levels 1-3. Survival of patients with normal mobility was similar regardless of their ESI level. CONCLUSION: The assessment of mobility at triage improves the ESI algorithm's risk stratification.
    Tags: *Emergency Service, Hospital, *Triage, Bayes Theorem, Humans, Prospective Studies, Risk Assessment.
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  • Leidi, A., Saudan, A., Soret, G., Rouyer, F., Marti, C., Stirnemann, J., Reny, J. L., and Grosgurin, O. “Confidence And Use Of Physical Examination And Point-Of-Care Ultrasonography For Detection Of Abdominal Or Pleural Free Fluid. A Cross-Sectional Survey”. Intern Emerg Med 17, no. 1: 113-122. doi:10.1007/s11739-021-02781-1.
    Abstract: Physical examination (PE) has always been a corner stone of medical practice. The recent advances in imaging and fading of doctors' ability in performing it, however, raised doubts on PE usefulness. Point-of-care ultrasonography (POCUS) is gaining ground in medicine with the detection of free fluids being one of its main applications. To estimate physicians' confidence and use of PE and POCUS for the detection of abdominal or pleural free fluid, we conducted a cross-sectional survey. In all, 246 internal and emergency medicine physicians answered to the survey (197 in-hospital physicians and 49 general practitioners; response rate 28.5%). Almost all declared to perform PE in case of suspected ascites or pleural effusion (88% and 90%, respectively). The highest rates of confidence were observed in conventional PE signs (91% for diminished breath sounds, 80% for dullness to thorax percussion, and 66% for abdominal flank dullness). For the remaining signs, rates of confidence were less than 53%. Physicians with > 15 years of experience and POCUS-naive doctors reported higher confidence in PE. Most of emergency and almost half of internal medicine physicians (78% and 44%, respectively) attended a structured POCUS course. POCUS use was higher among trained physicians for both ascites (84% vs 50%, p < 0.001) and pleural effusion (80% vs 34%, p < 0.001). Similarly, higher POCUS use was observed in younger physicians. In conclusion, PE is frequently performed and rates of confidence are low for most PE signs, especially among young doctors and POCUS users. This detailed inventory suggests an ongoing shift towards POCUS integration in clinical practice.
    Tags: *Pleural Effusion/diagnostic imaging, *Point-of-Care Systems, Ascites, Ascites/diagnostic imaging, Cross-Sectional Studies, Emergency Service, Hospital, Free fluid, Humans, Physical Examination, Pleural effusion, Pocus, Ultrasonography, Ultrasonography/methods.
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  • van den Ende, E. S., Schouten, B., Kremers, M. N. T., Cooksley, T., Subbe, C. P., Weichert, I., van Galen, L. S., et al. “Correction To: Understanding What Matters Most To Patients In Acute Care In Seven Countries, Using The Flash Mob Study Design”. Bmc Health Serv Res 21, no. 1: 586. doi:10.1186/s12913-021-06580-4.
    Abstract: Following publication of the original article [1], the authors identified an error in the author name of Ling Yan LEUNG. The incorrect author name is: L. E. U. N. G. Ling Yan The correct author name is: Ling Yan LEUNG The author group has been updated above and the original article [1] has been corrected. © The Author(s). 2021
    Tags: erratum.
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  • Bibert, S., Guex, N., Lourenco, J., Brahier, T., Papadimitriou-Olivgeris, M., Damonti, L., Manuel, O., et al. “Transcriptomic Signature Differences Between Sars-Cov-2 And Influenza Virus Infected Patients”. Front Immunol 12: 666163. doi:10.3389/fimmu.2021.666163.
    Abstract: The reason why most individuals with COVID-19 have relatively limited symptoms while other develop respiratory distress with life-threatening complications remains unknown. Increasing evidence suggests that COVID-19 associated adverse outcomes mainly rely on dysregulated immunity. Here, we compared transcriptomic profiles of blood cells from 103 patients with different severity levels of COVID-19 with that of 27 healthy and 22 influenza-infected individuals. Data provided a complete overview of SARS-CoV-2-induced immune signature, including a dramatic defect in IFN responses, a reduction of toxicity-related molecules in NK cells, an increased degranulation of neutrophils, a dysregulation of T cells, a dramatic increase in B cell function and immunoglobulin production, as well as an important over-expression of genes involved in metabolism and cell cycle in patients infected with SARS-CoV-2 compared to those infected with influenza viruses. These features also differed according to COVID-19 severity. Overall and specific gene expression patterns across groups can be visualized on an interactive website (https://bix.unil.ch/covid/). Collectively, these transcriptomic host responses to SARS-CoV-2 infection are discussed in the context of current studies, thereby improving our understanding of COVID-19 pathogenesis and shaping the severity level of COVID-19.
    Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., Covid-19, COVID-19/*immunology, Humans, immune profiling, influenza, Influenza, Human/*immunology, RNA-sequencing, SARS-CoV-2, SARS-CoV-2/immunology, Transcriptome, whole blood transcriptome.
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  • van de Maat, J., De Santis, O., Luwanda, L., Tan, R., and Keitel, K. “Primary Care Case Management Of Febrile Children: Insights From The Epoct Routine Care Cohort In Dar Es Salaam, Tanzania”. Front Pediatr 9: 626386. doi:10.3389/fped.2021.626386.
    Abstract: Aim: To provide insight in the primary health care (PHC) case management of febrile children under-five in Dar es Salaam, and to identify areas for improving quality of care. Methods: We used data from the routine care arm of the ePOCT trial, including children aged 2-59 months who presented with an acute febrile illness to two health centers in Dar es Salaam (2014-2016). The presenting complaint, anthropometrics, vital signs, test results, final diagnosis, and treatment were prospectively collected in all children. We used descriptive statistics to analyze the frequencies of diagnoses, adherence to diagnostics, and prescribed treatments. Results: We included 547 children (47% male, median age 14 months). Most diagnoses were viral: upper respiratory tract infection (60%) and/or gastro-enteritis (18%). Vital signs and anthropometric measurements taken by research staff and urinary testing failed to influence treatment decisions. In total, 518/547 (95%) children received antibiotics, while 119/547 (22%) had an indication for antibiotics based on local guidelines. Antibiotic dosing was frequently out of range. Non-recommended treatments were common (29%), most often cough syrup and vitamins. Conclusion: Our study points to challenges in using diagnostic test results, concerns regarding quality of antibiotic prescriptions, and frequent use of non-evidence-based complementary medicines in PHC in Tanzania. Larger studies on diagnostic and treatments processes in PHC in Tanzania are needed to inform effective solutions to support PHC workers in case management of children.
    Tags: commercial or financial relationships that could be construed as a potential, conflict of interest., decision-support, fever, infectious diseases, low-resource setting, pediatrics, primary care, quality of care.
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  • Ravioli, S., Rupp, A., Exadaktylos, A. K., and Lindner, G. “Gender Distribution In Emergency Medicine Journals: Editorial Board Memberships In Top-Ranked Academic Journals”. Eur J Emerg Med 28, no. 5: 380-385. doi:10.1097/MEJ.0000000000000842.
    Abstract: OBJECTIVE: Despite an established gender gap in academic medicine, evidence on gender diversity in emergency medicine is scarce. In the present study, gender distribution of editorial boards and among editors-in-chief of 31 emergency medicine journals was investigated in 2020/2021 and compared to 2015 and 2010. Additionally, gender distribution in editorial boards of emergency medicine journals was compared to editorial boards in five different medical specialties. METHODS: In this cross-sectional analysis, gender of editorial board members and editors-in-chief of journals ranked in the Clarivate Analytics 'Journal Citation Report' (JCR) of 2019 in the sections 'Emergency Medicine', 'Medicine General and Internal', 'Surgery', 'Obstetrics and Gynecology', 'Pediatrics' and 'Orthopedics' were analyzed. RESULTS: In the investigated 31 emergency medicine journals, three out of 35 editors-in-chief (9%) and 299 out of 1810 editorial board members (17%) were women in 2020/2021. In 2015 and 2010, two editors-in-chief were women (13% vs. 15%). In 2015, 19% of editorial board members were women and in 2010 it was 18%, respectively. There was no significant difference in gender distribution among editors-in-chief and editorial board members comparing 2020/2021 with 2015 and 2010 (P = 0.76 vs. P = 0.40, respectively). There was a lower percentage of women in editorial boards of emergency medicine journals compared to the top five JCR-ranked journals in the categories 'Medicine General and Internal', 'Surgery', 'Gynecology and Obstetrics' and 'Pediatrics'. CONCLUSION: The gender gap in editorial boards and among editors-in-chief of emergency medicine journals seems to be consistent for the last 10 years. Gender disparity appears to be substantial in academic emergency medicine: The percentage of women in emergency medicine editorial boards was lower compared to editorial boards of four other medical specialties.
    Tags: *Emergency Medicine, *Periodicals as Topic, Child, Cross-Sectional Studies, Female, Humans.
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  • Eidenbenz, D., Techel, F., Kottmann, A., Rousson, V., Carron, P. N., Albrecht, R., and Pasquier, M. “Survival Probability In Avalanche Victims With Long Burial (≫/=60 Min): A Retrospective Study”. Resuscitation 166: 93-100. doi:10.1016/j.resuscitation.2021.05.030.
    Abstract: BACKGROUND: The survival of completely buried victims in an avalanche mainly depends on burial duration. Knowledge is limited about survival probability after 60 min of complete burial. AIM: We aimed to study the survival probability and prehospital characteristics of avalanche victims with long burial durations. METHODS: We retrospectively included all completely buried avalanche victims with a burial duration of >/=60 min between 1997 and 2018 in Switzerland. Data were extracted from the registry of the Swiss Institute for Snow and Avalanche Research and the prehospital medical records of the physician-staffed helicopter emergency medical services. Avalanche victims buried for >/=24 h or with an unknown survival status were excluded. Survival probability was estimated by using the non-parametric Ayer-Turnbull method and logistic regression. The primary outcome was survival probability. RESULTS: We identified 140 avalanche victims with a burial duration of >/=60 min, of whom 27 (19%) survived. Survival probability shows a slight decrease with increasing burial duration (23% after 60 min, to <6% after 1400 min, p = 0.13). Burial depth was deeper for those who died (100 cm vs 70 cm, p = 0.008). None of the survivors sustained CA during the prehospital phase. CONCLUSIONS: The overall survival rate of 19% for completely buried avalanche victims with a long burial duration illustrates the importance of continuing rescue efforts. Avalanche victims in CA after long burial duration without obstructed airway, frozen body or obvious lethal trauma should be considered to be in hypothermic CA, with initiation of cardiopulmonary resuscitation and an evaluation for rewarming with extracorporeal life support.
    Tags: *Avalanches, *Cardiopulmonary Resuscitation, *Hypothermia, Accidental, Avalanche, Burial, Cardiac arrest, Ecmo, Ecpr, Humans, Hypothermia, Logistic Models, Resuscitation, Retrospective Studies, Triage.
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  • Luedi, M. M., Schober, P., Stauffer, V. K., Diekmann, M., Andereggen, L., and Doll, D. “Gender-Specific Prevalence Of Pilonidal Sinus Disease Over Time: A Systematic Review And Meta-Analysis”. Anz J Surg 91, no. 7-8: 1582-1587. doi:10.1111/ans.16990.
    Abstract: BACKGROUND: Gender-specific risk factors have been suggested to promote a fourfold higher incidence of pilonidal sinus disease (PSD) in male as compared to female patients. However, in recent decades there has been an apparent shift towards an increasing prevalence of PSD in women, as body weight and other risk factors influence the disease. We aimed at determining whether PSD prevalence actually changed in men and women over time. METHODS: Following PRISMA guidelines (PROSPERO ID: 42016051588), databases were systematically searched. Papers reporting on PSD published between 1833 and 2018 in English, French, German, Italian and Spanish containing precise numbers of male and female participants were selected for analysis. Gender-specific prevalence of PSD over several decades was the main outcome measure. RESULTS: We screened 679 studies reporting on 104 055 patients and found that the male/female ratio in patients with PSD has remained constant over time, with women being affected in about 20% of all PSD cases (I(2) = 96.18%; meta-regression p < 0.001). CONCLUSION: While the prevalence of PSD has risen over the past decades, the ratio between affected males and affected females has remained constant, with women invariably representing about 20% of patients despite wide ranging socioeconomic and behavioural changes.
    Tags: *Pilonidal Sinus/epidemiology, *Skin Diseases, Female, gender medicine, hair, Humans, Incidence, Male, meta-analysis, pilonidal sinus disease, Prevalence, Risk Factors.
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  • Ryser, B., Ravioli, S., and Lindner, G. “Gender Distribution In Boards Of Internal Medicine Societies”. Eur J Intern Med 90: 122-124. doi:10.1016/j.ejim.2021.05.019.
    Tags: *Internal Medicine, *Physicians, Women, Gender, Gender disparities, Gender distribution, Gender Identity, Humans, Internal medicine societies, Societies.
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  • Pasquier, M., and Paal, P. “Rescue Collapse - A Hitherto Unclassified Killer In Accidental Hypothermia”. Resuscitation 164: 142-143. doi:10.1016/j.resuscitation.2021.05.011.
    Tags: *Hypothermia/complications/therapy, *Shock/therapy, Humans, Matched-Pair Analysis, Rewarming.
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  • Musi, M. E., Sheets, A., Brugger, H., Paal, P., Zafren, K., and Pasquier, M. “Reply To: Revised Swiss System For Clinical Staging Of Accidental Hypothermia - At Which Core Temperatures Are Patients At High Risk Of Cardiac Arrest?”. Resuscitation 165: 186-187. doi:10.1016/j.resuscitation.2021.05.014.
    Tags: *Heart Arrest/therapy, *Hypothermia/complications/therapy, Humans, Rewarming, Switzerland, Temperature.
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  • Lu, H., Lu, H., Kosinski, C., Wojtusciszyn, A., Zanchi, A., Carron, P. N., Muller, M., et al. “Sglt2 Inhibitors, What The Emergency Physician Needs To Know: A Narrative Review”. J Clin Med 10, no. 9. doi:10.3390/jcm10092036.
    Abstract: Canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin belong to a class of antidiabetic treatments referred to as sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors, or SGLT2is). SGLT2is are currently indicated in North America and in Europe in type 2 diabetes mellitus, especially in patients with cardiovascular (CV) disease, high CV risk, heart failure, or renal disease. In Europe, dapagliflozin is also approved as an adjunct to insulin in patients with type 1 diabetes mellitus. New data provide evidence for benefits in heart failure with reduced ejection fraction and chronic kidney disease, including in patients without diabetes. The use of SGLT2is is expected to increase, suggesting that a growing number of patients will present to the emergency departments with these drugs. Most common adverse events are easily treatable, including mild genitourinary infections and conditions related to volume depletion. However, attention must be paid to some potentially serious adverse events, such as hypoglycemia (when combined with insulin or insulin secretagogues), lower limb ischemia, and diabetic ketoacidosis. We provide an up-to-date practical guide highlighting important elements on the adverse effects of SGLT2is and their handling in some frequently encountered clinical situations such as acute heart failure and decompensated diabetes.
    Tags: Cardiology Service of the University Hospitals of Geneva (GeCor foundation). The, consulting honoraria from Boehringer Ingelheim, Astra Zeneca and Janssen. A.Z., diabetes, funders had no role in the writing or in the decision to publish the manuscript., guidelines, heart failure, honoraria have been entirely paid to a private research foundation of the, Mundipharma. A.Z. also participated in clinical trials for Boehringer Ingelheim., not have any conflict of interest in relation with this article. A.W. reports, P.M. has participated to meetings organized by Boehringer Ingelheim, whose, renal, reports consulting honoraria from Boehringer Ingelheim, Astra Zeneca and.
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  • Diebold, M., Zimmermann, T., Dickenmann, M., Schaub, S., Bassetti, S., Tschudin-Sutter, S., Bingisser, R., et al. “Comparison Of Acute Kidney Injury In Patients With Covid-19 And Other Respiratory Infections: A Prospective Cohort Study”. J Clin Med 10, no. 11. doi:10.3390/jcm10112288.
    Abstract: Previous studies have indicated an association between coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) but lacked a control group. The prospective observational COronaVIrus-surviVAl (COVIVA) study performed at the University Hospital, Basel, Switzerland consecutively enrolled patients with symptoms suggestive of COVID-19. We compared patients who tested positive for SARS-CoV-2 with patients who tested negative but with an adjudicated diagnosis of a respiratory tract infection, including pneumonia. The primary outcome measure was death at 30 days, and the secondary outcomes were AKI incidence and a composite endpoint of death, intensive care treatment or rehospitalization at 30 days. Five hundred and seven patients were diagnosed with respiratory tract infections, and of those, 183 (36%) had a positive PCR swab test for SARS-CoV-2. The incidence of AKI was higher in patients with COVID-19 (30% versus 12%, p < 0.001), more severe (KDIGO stage 3, 22% versus 13%, p = 0.009) and more often required renal replacement therapy (4.4% versus 0.93%; p = 0.03). The risk of 30-day mortality and a composite endpoint was higher in patients with COVID-19-associated AKI (adjusted hazard ratio (aHR) mortality 3.98, 95% confidence interval (CI) 1.10-14.46, p = 0.036; composite endpoint aHR 1.84, 95% CI 1.02-3.31, p = 0.042). The mortality risk was attenuated when adjusting for disease severity (aHR 3.60, 95% CI 0.93-13.96, p = 0.062). AKI occurs more frequently and with a higher severity in patients with COVID-19 and is associated with worse outcomes.
    Tags: (Grant No P300PB_167803), Abbott, Amgen, Astra Zeneca, Roche, Siemens, Singulex and Thermo Scientific, acute kidney injury, Akademische Gesellschaft Basel outside of this work. S. Tschudin-Sutter is a, and (320030_197901), the Gottfried und Julia Bangerter-Rhyner Stiftung, the Fonds, and the University Hospital Basel and speaker honoraria/consulting honoraria from, Anti-infectives Advisory Board and the Menarini Scientific Advisory Board. She, Basel and the Jubilaumsstiftung from Swiss Life. Kuster reports research support, BRAHMS. Zimmermann reports a personal research grant by the Freiwillige, Cardiology, Cardiovascular Research Foundation Basel that are unrelated to this work and, consultant fees from Janssen. Breidthardt received research grants from the Swiss, Covid-19, Department of Internal Medicine University Hospital Basel, Abbott and Roche, as, from the Swiss National Science Foundation (Grant No IZCOZ0_189877) and the, member of the Astellas and MSD Advisory Boards for C. difficile of the Pfizer, mortality, National Science Foundation (PASMP3-134362), the University of Basel, the, pneumonia, reports grants from the Swiss National Science Foundation NRP72 (407240_167060), respiratory tract infection, SARS-CoV-2, the Cardiovascular Research Foundation Basel, the Swiss Heart Foundation, the Swiss Society of, the University of Basel, well as speakers honoraria from Roche., zur Forderung von Lehre und Forschung der Freiwilligen Akademischen Gesellschaft.
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  • Vincent, A., Beck, K., Becker, C., Zumbrunn, S., Ramin-Wright, M., Urben, T., Quinto, A., et al. “Psychological Burden In Patients With Covid-19 And Their Relatives 90 Days After Hospitalization: A Prospective Observational Cohort Study”. J Psychosom Res 147: 110526. doi:10.1016/j.jpsychores.2021.110526.
    Abstract: OBJECTIVE: COVID-19 causes psychological distress for patients and their relatives at short term. However, little research addressed the longer-term psychological outcomes in this population. Therefore, we aimed to prospectively assess clinically relevant psychological distress in hospitalized patients with COVID-19 and their relatives 90 days after hospital discharge. METHODS: This exploratory, prospective, observational cohort study included consecutive adult patients hospitalized in two Swiss tertiary-care hospitals between March and June 2020 for confirmed COVID-19 and their relatives. The primary outcome was psychological distress defined as clinically relevant symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS) 90 days after discharge. RESULTS: Clinically relevant psychological distress 90 days after hospital discharge was present in 23/108 patients (21.3%) and 22/120 relatives (18.3%). For patients, risk and protective factors associated with clinically relevant psychological distress included sociodemographic, illness-related, psychosocial, and hospital-related factors. A model including these factors showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.84. For relatives, relevant risk factors were illness-related, psychosocial, and hospital-related factors. Resilience was negatively associated with anxiety and depression in both patients and relatives and regarding PTSD in relatives only. CONCLUSION: COVID-19 is linked to clinically relevant psychological distress in a subgroup of patients and their relatives 90 days after hospitalization. If confirmed in an independent and larger patient cohort, knowledge about these potential risk and protective factors might help to develop preventive strategies.
    Tags: *Hospitalization, Adult, Anxiety, Cohort Studies, Covid-19, COVID-19/*psychology/therapy, Depression, Humans, Male, Middle Aged, Prospective Studies, Psychological distress, Ptsd, SARS-CoV-2, Stress, Psychological/psychology.
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  • Purnat, T. D., Wilson, H., Nguyen, T., and Briand, S. “Ears - A Who Platform For Ai-Supported Real-Time Online Social Listening Of Covid-19 Conversations”. Stud Health Technol Inform 281: 1009-1010. doi:10.3233/SHTI210330.
    Abstract: As the COVID-19 pandemic evolves, the accompanying infodemic is being amplified through social media and has challenged effective response. The WHO Early AI-supported Response with Social Listening (EARS) is a platform that summarizes real-time information about how people are talking about COVID-19 in public spaces online in 20 pilot countries and in four languages. The aim of the platform is to better integrate social listening with other data sources and analyses that can inform infodemic response.
    Tags: *covid-19, *Social Media, Artificial Intelligence, Humans, infodemic, infodemic management, pandemic preparedness, pandemic response, Pandemics, SARS-CoV-2, social listening, social media, World Health Organization.
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  • Purnat, T. D., Vacca, P., Burzo, S., Zecchin, T., Wright, A., Briand, S., and Nguyen, T. “Who Digital Intelligence Analysis For Tracking Narratives And Information Voids In The Covid-19 Infodemic”. Stud Health Technol Inform 281: 989-993. doi:10.3233/SHTI210326.
    Abstract: The COVID-19 pandemic is the first to unfold in the highly digitalized society of the 21st century and is therefore the first pandemic to benefit from and be threatened by a thriving real-time digital information ecosystem. For this reason, the response to the infodemic required development of a public health social listening taxonomy, a structure that can simplify the chaotic information ecosystem to enable an adaptable monitoring infrastructure that detects signals of fertile ground for misinformation and guides trusted sources of verified information to fill in information voids in a timely manner. A weekly analysis of public online conversations since 23 March 2020 has enabled the quantification of running shifts of public interest in public health-related topics concerning the pandemic and has demonstrated the frequent resumption of information voids relevant for public health interventions and risk communication in an emergency response setting.
    Tags: *covid-19, *Social Media, Communication, Ecosystem, Humans, Infodemic, infodemic management, Intelligence, pandemic preparedness, pandemic response, Pandemics, risk communication, SARS-CoV-2, social listening, social media, social monitoring, World Health Organization.
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  • Raess, N., Schuetz, P., Cesana-Nigro, N., Winzeler, B., Urwyler, S. A., Schaedelin, S., Rodondi, N., et al. “Influence Of Prednisone On Inflammatory Biomarkers In Community-Acquired Pneumonia: Secondary Analysis Of A Randomized Trial”. J Clin Pharmacol 61, no. 11: 1406-1414. doi:10.1002/jcph.1914.
    Abstract: Glucocorticoids are frequently prescribed in inflammatory diseases and have recently experienced a boom in the treatment of COVID-19. Small studies have shown an effect of glucocorticoids on inflammatory marker levels, but definitive proof is lacking. We investigated the influence of prednisone on inflammatory biomarkers in a previous multicenter, randomized, placebo-controlled trial that compared a 7-day treatment course of 50-mg prednisone to placebo in patients hospitalized with community-acquired pneumonia. We compared levels of C-reactive protein (CRP), procalcitonin (PCT), leukocyte and neutrophil count between patients with and without glucocorticoid treatment at baseline and on days 3, 5, and 7 and at discharge by Wilcoxon tests and analysis of variance. A total of 356 patient data sets in the prednisone group and 355 in the placebo group were available for analysis. Compared to placebo, use of prednisone was associated with reductions in levels of CRP on days 3, 5, and 7 (mean difference of 46%, P < .001 for each time point). For PCT, no such difference was observed. Leukocyte and neutrophil count were higher in the prednisone group at all time points (mean difference of 27% for leukocytes and 33% for neutrophils, P <.001 for all time points). We conclude that after administration of glucocorticoids in community-acquired pneumonia, patients had lower CRP levels and increased leukocyte and neutrophil count as compared to the placebo group. PCT levels were not different between treatment groups. PCT levels thus may more appropriately mirror the resolution of infection compared to more traditional inflammatory markers.
    Tags: *Community-Acquired Infections/drug therapy/epidemiology, *COVID-19 Drug Treatment, *COVID-19/epidemiology, *Pneumonia/blood/drug therapy/epidemiology/etiology, Abbott, outside the submitted work., Aged, 80 and over, Analysis of Variance, biomarkers, Biomarkers, Pharmacological/blood, C-reactive protein, C-Reactive Protein/*analysis, Drug Monitoring/methods, Female, glucocorticoids, Glucocorticoids/administration & dosage, Humans, Leukocyte Count/*methods, Male, Prednisone/*administration & dosage, procalcitonin, Procalcitonin/*blood, reports grants from ThermoFisher, bioMerieux, Roche Diagnostics, Nestle, and, respiratory tract infections, SARS-CoV-2, Statistics, Nonparametric.
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  • Meier, S. M., Kottwitz, J., Keller, D. I., and Albini, S. “Erysipelothrix Rhusiopathiae Infection By Geese To Human Transmission”. Bmj Case Rep 14, no. 5. doi:10.1136/bcr-2020-240073.
    Abstract: Erysipelothrix rhusiopathiae transmission to human is often occupation-related, but in most cases, a detailed case history is missing. This case report is based on an interdisciplinary approach and includes a thorough medical record. A 58-year-old laboratory technician working on geese necropsy cut open her glove at a rib fragment of a goose and subsequently noticed a slowly progressive, reddish skin alteration in the particular region of the hand. Bacteriological investigations on the geese revealed septicaemia due to E. rhusiopathiae and therefore substantiated the diagnosis of the patient. The infectious agent could not be cultured from the patient; however, antibiotic susceptibility testing was performed using the goose isolate. An entire follow-up until full recovery of the patient was conducted. Zoonotic infections possibly have a significant impact on certain occupations. This case report analyses a rare but important zoonotic infection to create awareness of this in physicians caring for human patients.
    Tags: *Erysipelothrix, *Erysipelothrix Infections/diagnosis, accidents, Animals, dermatological, disease and health outcomes, Female, Geese, Humans, infectious diseases, injuries, Middle Aged, occupational and environmental medicine, Zoonoses.
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  • Bargetzi, L., Brack, C., Herrmann, J., Bargetzi, A., Hersberger, L., Bargetzi, M., Kaegi-Braun, N., et al. “Nutritional Support During The Hospital Stay Reduces Mortality In Patients With Different Types Of Cancers: Secondary Analysis Of A Prospective Randomized Trial”. Ann Oncol 32, no. 8: 1025-1033. doi:10.1016/j.annonc.2021.05.793.
    Abstract: BACKGROUND: Nutritional support in patients with cancer aims at improving quality of life. Whether use of nutritional support is also effective in improving clinical outcomes requires further study. PATIENTS AND METHODS: In this preplanned secondary analysis of patients with cancer included in a prospective, randomized-controlled, Swiss, multicenter trial (EFFORT), we compared protocol-guided individualized nutritional support (intervention group) to standard hospital food (control group) regarding mortality at 30-day (primary endpoint) and other clinical outcomes. RESULTS: We analyzed 506 patients with a main admission diagnosis of cancer, including lung cancer (n = 113), gastrointestinal tumors (n = 84), hematological malignancies (n = 108) and other types of cancer (n = 201). Nutritional risk based on Nutritional Risk Screening (NRS 2002) was an independent predictor for mortality over 180 days with an (age-, sex-, center-, type of cancer-, tumor activity- and treatment-) adjusted hazard ratio of 1.29 (95% CI 1.09-1.54; P = 0.004) per point increase in NRS. In the 30-day follow-up period, 50 patients (19.9%) died in the control group compared to 36 (14.1%) in the intervention group resulting in an adjusted odds ratio of 0.57 (95% CI 0.35-0.94; P = 0.027). Interaction tests did not show significant differences in mortality across the cancer type subgroups. Nutritional support also significantly improved functional outcomes and quality of life measures. CONCLUSIONS: Compared to usual hospital nutrition without nutrition support, individualized nutritional support reduced the risk of mortality and improved functional and quality of life outcomes in cancer patients with increased nutritional risk. These data further support the inclusion of nutritional care in cancer management guidelines.
    Tags: *Hematologic Neoplasms, *Quality of Life, cancer, declared no conflicts of interest., Health Science, Abbott Nutrition and Fresenius Kabi. All other authors have, Humans, institution of ZS received speaking honoraria and research support from Nestle, Length of Stay, malnutrition, nutrition, Nutritional Support, outcomes, Prospective Studies, randomized trial, unrelated to this project from Nestle Health Science and Abbott Nutrition. The.
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  • De Hond, A., Raven, W., Schinkelshoek, L., Gaakeer, M., Ter Avest, E., Sir, O., Lameijer, H., et al. “Machine Learning For Developing A Prediction Model Of Hospital Admission Of Emergency Department Patients: Hype Or Hope?”. Int J Med Inform 152: 104496. doi:10.1016/j.ijmedinf.2021.104496.
    Abstract: OBJECTIVE: Early identification of emergency department (ED) patients who need hospitalization is essential for quality of care and patient safety. We aimed to compare machine learning (ML) models predicting the hospitalization of ED patients and conventional regression techniques at three points in time after ED registration. METHODS: We analyzed consecutive ED patients of three hospitals using the Netherlands Emergency Department Evaluation Database (NEED). We developed prediction models for hospitalization using an increasing number of data available at triage, approximately 30 min (including vital signs) and approximately 2 h (including laboratory tests) after ED registration, using ML (random forest, gradient boosted decision trees, deep neural networks) and multivariable logistic regression analysis (including spline transformations for continuous predictors). Demographics, urgency, presenting complaints, disease severity and proxies for comorbidity, and complexity were used as covariates. We compared the performance using the area under the ROC curve in independent validation sets from each hospital. RESULTS: We included 172,104 ED patients of whom 66,782 (39 %) were hospitalized. The AUC of the multivariable logistic regression model was 0.82 (0.78-0.86) at triage, 0.84 (0.81-0.86) at approximately 30 min and 0.83 (0.75-0.92) after approximately 2 h. The best performing ML model over time was the gradient boosted decision trees model with an AUC of 0.84 (0.77-0.88) at triage, 0.86 (0.82-0.89) at approximately 30 min and 0.86 (0.74-0.93) after approximately 2 h. CONCLUSIONS: Our study showed that machine learning models had an excellent but similar predictive performance as the logistic regression model for predicting hospital admission. In comparison to the 30-min model, the 2-h model did not show a performance improvement. After further validation, these prediction models could support management decisions by real-time feedback to medical personal.
    Tags: *Emergency Service, Hospital, *Triage, Emergency medicine, Hospital admission, Hospitalization, Hospitals, Humans, Machine Learning, Prediction, Prognosis, Triage.
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  • van den Ende, E. S., Schouten, B., Kremers, M. N. T., Cooksley, T., Subbe, C. P., Weichert, I., van Galen, L. S., et al. “Understanding What Matters Most To Patients In Acute Care In Seven Countries, Using The Flash Mob Study Design”. Bmc Health Serv Res 21, no. 1: 474. doi:10.1186/s12913-021-06459-4.
    Abstract: BACKGROUND: Truly patient-centred care needs to be aligned with what patients consider important, and is highly desirable in the first 24 h of an acute admission, as many decisions are made during this period. However, there is limited knowledge on what matters most to patients in this phase of their hospital stay. The objective of this study was to identify what mattered most to patients in acute care and to assess the patient perspective as to whether their treating doctors were aware of this. METHODS: This was a large-scale, qualitative, flash mob study, conducted simultaneously in sixty-six hospitals in seven countries, starting November 14th 2018, ending 50 h later. One thousand eight hundred fifty adults in the first 24 h of an acute medical admission were interviewed on what mattered most to them, why this mattered and whether they felt the treating doctor was aware of this. RESULTS: The most reported answers to "what matters most (and why)?" were 'getting better or being in good health' (why: to be with family/friends or pick-up life again), 'getting home' (why: more comfortable at home or to take care of someone) and 'having a diagnosis' (why: to feel less anxious or insecure). Of all patients, 51.9% felt the treating doctor did not know what mattered most to them. CONCLUSIONS: The priorities for acutely admitted patients were ostensibly disease- and care-oriented and thus in line with the hospitals' own priorities. However, answers to why these were important were diverse, more personal, and often related to psychological well-being and relations. A large group of patients felt their treating doctor did not know what mattered most to them. Explicitly asking patients what is important and why, could help healthcare professionals to get to know the person behind the patient, which is essential in delivering patient-centred care. TRIAL REGISTRATION: NTR (Netherlands Trial Register) NTR7538 .
    Tags: *Hospitalization, *Research Design, Acute care, Adult, author) and declare: no support from any organization for the submitted work, no, could appear to have influenced the submitted work., Emergency medicine, financial relationships with any organizations that might have an interest in the, Humans, Length of Stay, Netherlands, Patient-centred care, Patient-physician communication, Qualitative Research, Quality of care, Research methods, submitted work in the previous 3 years, no other relationships or activities that, What matters most, www.icmje.org/coi_disclosure.pdf (available on request from the corresponding.
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  • Aeby, D., Staeger, P., and Dami, F. “How To Improve Automated External Defibrillator Placement For Out-Of-Hospital Cardiac Arrests: A Case Study”. Plos One 16, no. 5: e0250591. doi:10.1371/journal.pone.0250591.
    Abstract: INTRODUCTION: In out-of-hospital cardiac arrests (OHCAs), the use of an automatic external defibrillator (AED) by a bystander remains low, as AEDs may be misplaced with respect to the locations of OHCAs. As the distribution of historical OHCAs is potentially predictive of future OHCA locations, the purpose of this study is to assess AED positioning with regard to past locations of OHCAs, in order to improve the efficiency of public access defibrillation programs. METHODS: This is a retrospective observational study from 2014 to 2018. The locations of historical OHCAs and AEDs were loaded into a geodata processing tool. Median distances between AEDs were collected, as well as the number and rates of OHCAs covered (distance of <100 meters from the nearest AED). Areas with high densities of uncovered OHCAs (hotspots) were identified in order to propose the placement of additional AEDs. Areas over-covered by AEDs (overlays) were also identified in order to propose the relocation of overlapping AEDs. RESULTS: There were 2,971 OHCA, 79.3% of which occurred at home, and 633 AEDs included in the study. The global coverage rate was 7.5%. OHCAs occurring at home had a coverage rate of 4.5%. Forty hotspots were identified, requiring the same number of additional AEDs. The addition of these would increase the coverage from 7.5% to 17.6%. Regarding AED overlays, 17 AEDs were found to be relocatable without reducing the AED coverage of historical OHCAs. DISCUSSION: This study confirms that geodata tools can assess AED locations and increase the efficiency of their placement. Historical hotspots and AED overlays should be considered, with the aim of efficiently relocating or adding AEDs. At-home OHCAs should become a priority target for future public access defibrillation programs as they represent the majority of OHCAs but have the lowest AED coverage rates.
    Tags: Cardiopulmonary Resuscitation/*methods, Defibrillators/*statistics & numerical data, Emergency Medical Services/*methods, Geographic Information Systems/*instrumentation, Humans, Out-of-Hospital Cardiac Arrest/*therapy, Retrospective Studies.
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  • Seiler, M., Goldman, R. D., Staubli, G., Hoeffe, J., Gualco, G., Manzano, S., and Part Of The International Covid-Parental Attitude Study Covipas, Group. “Parents' Intent To Vaccinate Against Influenza During The Covid-19 Pandemic In Two Regions In Switzerland”. Swiss Med Wkly 151, no. 19: w20508. doi:10.4414/smw.2021.20508.
    Abstract: AIMS OF THE STUDY: The COVID-19 pandemic is likely to overlap with the seasonal influenza epidemic, increasing the risk of overextending the health system capacity in Switzerland. Influenza vaccine uptake has remained low in most countries, including Switzerland. The aim of the study was to determine parents&rsquo; intentions towards influenza vaccination of their children, as well as themselves, and to assess regional differences. METHODS: Parents presenting to four paediatric emergency departments (Zurich, Bern, Bellinzona, Geneva) were asked to complete an online survey during and after the first lockdown of the COVID-19 pandemic (April to June 2020). The anonymised survey included demographic information, vaccination history and intentions to vaccinate against influenza, as well as attitudes towards future vaccination against COVID-19. RESULTS: The majority of children (92%; 602/654) were up-to-date on their vaccination schedule. In 2019/2020, 7.2% (47/654) were vaccinated against influenza. Children with chronic illnesses were more frequently vaccinated than healthy children (19.2% vs 5.6%; p = 0.002). For the coming winter season, 111 (17%) parents stated they plan to vaccinate their children against influenza, more than double the rate from last year, and 383 (59.2%) parents suggested they will vaccinate against COVID-19 once a vaccine is available. Regional differences between &ldquo;German&rdquo; and &ldquo;Latin&rdquo; Switzerland were found for parents&rsquo; intent to have their children vaccinated against influenza next season (Zurich and Bern 14.3%, Bellinzona and Geneva 27.2%, p &lt;0.001), but not for a hypothetical vaccination against COVID-19 (Zurich and Bern 59.1%, Bellinzona and Geneva 59.7%, p = 0.894). CONCLUSIONS: The COVID-19 pandemic resulted in a substantial increase of parents&rsquo; intention to vaccinate their children against influenza, especially in hard-hit &ldquo;Latin&rdquo; Switzerland. The Swiss government and public health organisations can leverage these regional results to promote influenza vaccination among children for the coming seasons.
    Tags: Adult, Child, COVID-19 Vaccines/therapeutic use, COVID-19/*prevention & control, Female, Health Knowledge, Attitudes, Practice, Humans, Influenza Vaccines/*therapeutic use, Influenza, Human/*prevention & control, Intention, Male, Parents/*psychology, SARS-CoV-2, Seasons, Switzerland, Vaccination/*psychology.
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  • Doppmann, P., Meuli, L., Sollid, S. J. M., Filipovic, M., Knapp, J., Exadaktylos, A., Albrecht, R., and Pietsch, U. “End-Tidal To Arterial Carbon Dioxide Gradient Is Associated With Increased Mortality In Patients With Traumatic Brain Injury: A Retrospective Observational Study”. Sci Rep 11, no. 1: 10391. doi:10.1038/s41598-021-89913-x.
    Abstract: Early definitive airway protection and normoventilation are key principles in the treatment of severe traumatic brain injury. These are currently guided by end tidal CO(2) as a proxy for PaCO(2). We assessed whether the difference between end tidal CO(2) and PaCO(2) at hospital admission is associated with in-hospital mortality. We conducted a retrospective observational cohort study of consecutive patients with traumatic brain injury who were intubated and transported by Helicopter Emergency Medical Services to a Level 1 trauma center between January 2014 and December 2019. We assessed the association between the CO(2) gap-defined as the difference between end tidal CO(2) and PaCO(2)-and in-hospital mortality using multivariate logistic regression models. 105 patients were included in this study. The mean +/- SD CO(2) gap at admission was 1.64 +/- 1.09 kPa and significantly greater in non-survivors than survivors (2.26 +/- 1.30 kPa vs. 1.42 +/- 0.92 kPa, p < .001). The correlation between EtCO(2) and PaCO(2) at admission was low (Pearson's r = .287). The mean CO(2) gap after 24 h was only 0.64 +/- 0.82 kPa, and no longer significantly different between non-survivors and survivors. The multivariate logistic regression model showed that the CO(2) gap was independently associated with increased mortality in this cohort and associated with a 2.7-fold increased mortality for every 1 kPa increase in the CO(2) gap (OR 2.692, 95% CI 1.293 to 5.646, p = .009). This study demonstrates that the difference between EtCO(2) and PaCO(2) is significantly associated with in-hospital mortality in patients with traumatic brain injury. EtCO(2) was significantly lower than PaCO(2), making it an unreliable proxy for PaCO(2) when aiming for normocapnic ventilation. The CO2 gap can lead to iatrogenic hypoventilation when normocapnic ventilation is aimed and might thereby increase in-hospital mortality.
    Tags: *Respiration, Adult, Aged, Brain Injuries, Traumatic/metabolism/*mortality/pathology, Carbon Dioxide/isolation & purification/*metabolism, Emergency Medical Services, Female, Hospital Mortality, Humans, Male, Middle Aged, Respiration, Artificial/adverse effects, Retrospective Studies, Tidal Volume/physiology.
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  • Vincent, A., Urben, T., Becker, C., Beck, K., Daetwyler, C., Wilde, M., Gaab, J., Langewitz, W., and Hunziker, S. “Breaking Bad News: A Randomized Controlled Trial To Test A Novel Interactive Course For Medical Students Using Blended Learning”. Patient Educ Couns 105, no. 1: 105-113. doi:10.1016/j.pec.2021.05.002.
    Abstract: OBJECTIVE: Breaking bad news (BBN) is challenging for physicians and patients and specific communication strategies aim to improve these situations. This study evaluates whether an E-learning assignment could improve medical students' accurate recognition of BBN communication techniques. METHODS: This randomized controlled trial was conducted at the University of Basel. After a lecture on BBN, 4th year medical students were randomized to an intervention receiving an E-learning assignment on BBN or to a control group. Both groups then worked on an examination video and identified previously taught BBN elements shown in a physician-patient interaction. The number of correctly, misclassified and incorrectly identified BBN communication elements as well as missed opportunities were assessed in the examination video. RESULTS: We included 160 medical students (55% female). The number of correctly identified BBN elements did not differ between control and intervention group (mean [SD] 3.51 [2.50] versus 3.72 [2.34], p = 0.58). However, the mean number of inappropriate BBN elements was significantly lower in the intervention than in the control group (2.33 [2.57] versus 3.33 [3.39], p = 0.037). CONCLUSIONS: Use of an E-learning tool reduced inappropriate annotations regarding BBN communication techniques. PRACTICE IMPLICATIONS: This E-learning might help to further advance communication skills in medical students.
    Tags: *Education, Medical, Undergraduate/methods, *Students, Medical, Blended learning, Breaking bad news, Clinical Competence, Communication, Communication strategy, E-learning, Female, Humans, Learning, Male, Physician-Patient Relations, Truth Disclosure.
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  • Ladoy, A., Opota, O., Carron, P. N., Guessous, I., Vuilleumier, S., Joost, S., and Greub, G. “Size And Duration Of Covid-19 Clusters Go Along With A High Sars-Cov-2 Viral Load: A Spatio-Temporal Investigation In Vaud State, Switzerland”. Sci Total Environ 787: 147483. doi:10.1016/j.scitotenv.2021.147483.
    Abstract: To understand the geographical and temporal spread of SARS-CoV-2 during the first documented wave of infection in the state of Vaud, Switzerland, we analyzed clusters of positive cases using the precise residential location of 33,651 individuals tested (RT-PCR) between January 10 and June 30, 2020. We used a prospective Poisson space-time scan statistic (SaTScan) and a Modified Space-Time Density-Based Spatial Clustering of Application with Noise (MST-DBSCAN) to identify both space-time and transmission clusters, and estimated cluster duration, transmission behavior (emergence, growth, reduction, etc.) and relative risk. For each cluster, we computed the number of individuals, the median age of individuals and their viral load. Among the 1684 space-time clusters identified, 457 (27.1%) were significant (p </= 0.05), such that they harbored a higher relative risk of infection within the cluster than compared to regions outside the cluster. Clusters lasted a median of 11 days (IQR 7-13) and included a median of 12 individuals per cluster (IQR 5-20). The majority of significant clusters (n = 260; 56.9%) had at least one person with an extremely high viral load (>1 billion copies/ml). Those clusters were considerably larger (median of 17 infected individuals, p < 0.001) than clusters with individuals showing a viral load below 1 million copies/ml (median of three infected individuals). The highest viral loads were found in clusters with the lowest average age group considered in the investigation, while clusters with the highest average age had low to middle viral load. In 20 significant clusters, the viral load of the three first cases was below 100,000 copies/ml, suggesting that subjects with fewer than 100,000 copies/ml may still be contagious. Notably, the dynamics of transmission clusters made it possible to identify three diffusion zones, which predominantly differentiated between rural and urban areas, the latter being more prone to persistence and expansion, which may result in the emergence of new clusters nearby. The use of geographic information is key for public health decision makers in mitigating the spread of the SARS-CoV-2 virus. This study suggests that early localization of clusters may help implement targeted protective measures limiting the spread of the virus.
    Tags: *covid-19, *SARS-CoV-2, competing financial interests or personal relationships that could have appeared, Contagiousness, Coronavirus, Gis, Health geography, Humans, Infectious disease, Prospective Studies, Spacetime scan statistic, Switzerland/epidemiology, to influence the work reported in this paper., Viral Load.
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  • Mantokoudis, G., Wyss, T., Zamaro, E., Korda, A., Wagner, F., Sauter, T. C., Kerkeni, H., Kalla, R., Morrison, M., and Caversaccio, M. D. “Stroke Prediction Based On The Spontaneous Nystagmus Suppression Test In Dizzy Patients: A Diagnostic Accuracy Study”. Neurology 97, no. 1: e42-e51. doi:10.1212/WNL.0000000000012176.
    Abstract: OBJECTIVE: Failure of fixation suppression of spontaneous nystagmus is sometimes seen in patients with vestibular strokes involving the cerebellum or brainstem; however, the accuracy of this test for the discrimination between peripheral and central causes in patients with an acute vestibular syndrome (AVS) is unknown. METHODS: Patients with AVS were screened and recruited (convenience sample) as part of a prospective cross-sectional study in the emergency department between 2015 and 2020. All patients received neuroimaging, which served as a reference standard. We recorded fixation suppression with video-oculography (VOG) for forward, right, and left gaze. The ocular fixation index (OFI) and the spontaneous nystagmus slow velocity reduction was calculated. RESULTS: We screened 1,646 patients reporting dizziness in the emergency department and tested for spontaneous nystagmus in 148 patients with AVS. We analyzed 56 patients with a diagnosed acute unilateral vestibulopathy (vestibular neuritis) and 28 patients with a confirmed stroke. There was a complete nystagmus fixation suppression in 49.5% of patients with AVS, in 40% of patients with vestibular neuritis, and in 62.5% of patients with vestibular strokes. OFI scores had no predictive value for detecting strokes; however, a nystagmus reduction of less than 2 degrees /s showed a high accuracy of 76.9% (confidence interval 0.59-0.89) with a sensitivity of 62.2% and specificity of 84.8% in detecting strokes. CONCLUSIONS: The presence of fixation suppression does not rule out a central lesion. The magnitude of suppression was lower compared to patients with vestibular neuritis. The nystagmus suppression test predicts vestibular strokes accurately provided that eye movements are recorded with VOG. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with an AVS, decreased fixation suppression recorded with VOG occurred more often in stroke (76.9%) than in vestibular neuritis (37.8%).
    Tags: Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Dizziness/diagnostic imaging/*physiopathology, Female, Fixation, Ocular, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Nystagmus, Pathologic/diagnostic imaging/*physiopathology, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Stroke/*diagnosis/diagnostic imaging/*etiology, Vestibular Diseases/physiopathology, Vestibular Neuronitis/physiopathology, Young Adult.
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  • Aurora, L., McCord, J., Nowak, R., Giannitsis, E., Christenson, R., DeFilippi, C., Lindahl, B., et al. “Prognostic Utility Of A Modified Heart Score When Different Troponin Cut Points Are Used”. Crit Pathw Cardiol 20, no. 3: 134-139. doi:10.1097/HPC.0000000000000262.
    Abstract: BACKGROUND: Although the recommended cut point for cardiac troponin (cTn) is the 99th percentile, many institutions use cut points that are multiples higher than the 99th percentile for diagnosing acute myocardial infarction (AMI). Prior studies have shown that patients with a HEART score (HS) </= 3 and normal serial cTn values (modified HS) are at low risk for adverse events. This study aimed to evaluate the prognostic utility of the HS when various cTn cut points are used. METHODS: This was a substudy of High Sensitivity Cardiac Troponin T assay for RAPID Rule-out of Acute Myocardial Infarction (TRAPID-AMI), a multicenter, international trial evaluating a rapid rule-out AMI study using high-sensitivity cardiac troponin T (hs-cTnT). One-thousand two-hundred eighty-two patients were evaluated for AMI from 12 centers in Europe, United States, and Australia from 2011 to 2013. Blood samples of hs-cTnT were collected at presentation and 2 hours, and each patient had a HS calculated. The US Food and Drug Administration approved 99th percentile for hs-cTnT (19 ng/L) was used. RESULTS: There were 213 (17%) AMIs. Within 30 days, there were an additional 2 AMIs and 8 deaths. The adverse event rates at 30 days (death/AMI) for a HS </= 3 and nonelevated hs-cTnT over 2 hours using increasing hs-cTnT cut points ranged from 0.6% to 5.1%. CONCLUSIONS: Using the recommended 99th percentile cut point for hs-cTnT, the combination of a HS </= 3 with nonelevated hs-cTnT values over 2 hours identifies a low-risk cohort who can be considered for discharge from the emergency department without further testing. The prognostic utility of this strategy is greatly lessened as higher hs-cTnT cut points are used.
    Tags: *Troponin, *Troponin T, Biomarkers, Humans, Prognosis, Prospective Studies.
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  • Tshering Vogel, D. W., Kiss, B., Heverhagen, J. T., Benackova, K., Burkhard, F., Muller, M., Uehlinger, D., and Arampatzis, S. “Prospective Comparison Of Contrast-Enhanced Ultrasound And Magnetic Resonance Imaging To Computer Tomography For The Evaluation Of Complex Cystic Renal Lesions”. Urology 154: 320-325. doi:10.1016/j.urology.2021.04.032.
    Abstract: OBJECTIVE: To prospectively evaluate the diagnostic accuracy of contrast enhanced ultrasound (CEUS) and MRI compared to computed tomography (CT) as the current gold standard for the characterization of cystic renal lesions using the Bosniak classification. METHODS: Between July 2014 and October 2017 we prospectively enrolled patients with cystic renal lesions. Based on the Bosniak classification of complex renal lesions (>/=BII-F) we evaluated the accuracy of observed agreement by Cohen's Kappa coefficient and calculated sensitivity, specificity, positive and negative predictive values (PPV/NPV) between the three imaging modalities CT, MRI and CEUS. RESULTS: We evaluated 65 cystic renal lesions in 48 patients (median age 63 years, range 36-91 years; 18 females, 30 males). According to CT 29 (47%) of the cystic renal lesions were classified as complex. The agreement between CEUS and CT in the classification of complex cystic lesions was fair (agreement 50.8%, Kappa 0.31), and was excellent between MRI and CT (agreement 93.9%, Kappa 0.88). Compared to CT, CEUS and MRI had a sensitivity of 100% and 96.6%, a specificity of 33.3% and 91.7%, a PPV of 54.7% and 90.3%, and a NPV of 100% and 97.1% with an accuracy of 63.1% and 93.8% respectively. CONCLUSION: CEUS has an excellent sensitivity and NPV and represents a promising non-invasive screening tool for renal cystic lesions. The classification of complex renal cysts based on MRI and CT scans correlated closely.
    Tags: *Contrast Media, *Magnetic Resonance Imaging/methods, *Tomography, X-Ray Computed/methods, Adult, Aged, Aged, 80 and over, Female, Humans, Kidney Diseases, Cystic/*diagnostic imaging, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Ultrasonography/methods.
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  • Douillet, D., Caillaud, A., Riou, J., Miroux, P., Thibaud, E., Noizet, M., Oberlin, M., et al. “Assessment Of Physicians' Resilience Level During The Covid-19 Pandemic”. Transl Psychiatry 11, no. 1: 283. doi:10.1038/s41398-021-01395-7.
    Abstract: We aim to assess physicians' level of resilience and define factors that improve or decrease the resilience level during the COVID-19 pandemic. Physicians from hospitals located in areas with different COVID-19 caseload levels, were invited to participate in a national e-survey between April and May 2020. Study participants were mainly emergency physicians, and anaesthesiologists, infectious disease consultants, and intensive care. The survey assessed participant's characteristics, factors potentially associated with resilience, and resilience using the Connor-Davidson Resilience Scale (RISC-25), with higher scores indicative of greater resilience. Factors associated with the resilience score were assessed using a multivariable linear regression. Of 451 responding physicians involved in the care of COVID-19 patients, 442 were included (98%). Age was 36.1 +/- 10.3 years and 51.8% were male; 63% worked in the emergency department (n = 282), 10.4% in anesthesiology (n = 46), 9.9% in infectious disease department (n = 44), 4.8% in intensive care unit (n = 21) or other specialties (n = 49). The median RISC-25 score was at 69 (IQR 62-75). Factors associated with higher RISC scores were anesthesia as a specialty, parenthood, no previous history of anxiety or depression and nor increased anxiety. To conclude, this study is the first to characterize levels of resilience among physicians involved in COVID-19 unit. Our data points to certain protective characteristics and some detrimental factors, such as anxiety or depression, that could be amenable to remediating or preventing strategies to promote resilience and support caregivers in a pandemic.
    Tags: *covid-19, *Physicians, *Resilience, Psychological, Adult, Anxiety, Female, Humans, Male, Middle Aged, Pandemics, SARS-CoV-2.
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  • Schauber, S. K., Hautz, S. C., Kammer, J. E., Stroben, F., and Hautz, W. E. “Do Different Response Formats Affect How Test Takers Approach A Clinical Reasoning Task? An Experimental Study On Antecedents Of Diagnostic Accuracy Using A Constructed Response And A Selected Response Format”. Adv Health Sci Educ Theory Pract 26, no. 4: 1339-1354. doi:10.1007/s10459-021-10052-z.
    Abstract: The use of response formats in assessments of medical knowledge and clinical reasoning continues to be the focus of both research and debate. In this article, we report on an experimental study in which we address the question of how much list-type selected response formats and short-essay type constructed response formats are related to differences in how test takers approach clinical reasoning tasks. The design of this study was informed by a framework developed within cognitive psychology which stresses the importance of the interplay between two components of reasoning-self-monitoring and response inhibition-while solving a task or case. The results presented support the argument that different response formats are related to different processing behavior. Importantly, the pattern of how different factors are related to a correct response in both situations seem to be well in line with contemporary accounts of reasoning. Consequently, we argue that when designing assessments of clinical reasoning, it is crucial to tap into the different facets of this complex and important medical process.
    Tags: *Clinical Reasoning, *Problem Solving, Clinical reasoning, Cognitive reflection, Humans, Processing fluency, Response format.
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  • Ratmann, P. D., Boeddinghaus, J., Nestelberger, T., Lopez-Ayala, P., Koechlin, L., Wildi, K., Miro, O., et al. “External Validation Of The No Objective Testing Rules In Acute Chest Pain”. J Am Heart Assoc 10, no. 10: e020031. doi:10.1161/JAHA.120.020031.
    Tags: *Emergency Service, Hospital, Acute Pain/*diagnosis, Chest Pain/blood/*diagnosis, Electrocardiography/*methods, Female, Humans, Male, Middle Aged, Pilot Projects, Troponin/*blood.
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  • Ravioli, S., Bahmad, S., Funk, G. C., Schwarz, C., Exadaktylos, A., and Lindner, G. “Risk Of Electrolyte Disorders, Syncope, And Falls In Patients Taking Thiazide Diuretics: Results Of A Cross-Sectional Study”. Am J Med 134, no. 9: 1148-1154. doi:10.1016/j.amjmed.2021.04.007.
    Abstract: BACKGROUND: Thiazide diuretics are a mainstay in the management of hypertension and often associated with dyselectrolytemias. We investigated the prevalence of and risk factors for hyponatremia and hypokalemia in thiazide users, substance-specific differences, and the association of thiazides with syncope and falls. METHODS: In this cross-sectional analysis all patients admitted to an interdisciplinary emergency department in Switzerland between January 1, 2017, and December 31, 2018, with measurements of serum sodium and potassium were included. Data regarding serum electrolytes and creatinine were analyzed to classify for dysnatremias, dyskalemias, and acute kidney injury. Chart reviews were performed to screen for syncope or falls. RESULTS: A total of 1604 patients (7.9%) took thiazides. Acute kidney injury was significantly more common in thiazide users (22.1 vs 7%, P < .0001). Hyponatremia (22.1 vs 9.8%, P < .0001) and hypokalemia (19 vs 11%, P < .0001) were more frequent with thiazides. Thiazide use together with higher age and female sex were independent predictors of hyponatremia and hypokalemia. A dose-dependent effect was found for electrolyte disorders, and there was a variance in risk between the investigated substances with chlorthalidone bearing the highest and hydrochlorothiazide the lowest risk. Patients taking thiazide diuretics had significantly more episodes of syncope and falls. CONCLUSIONS: Thiazide use is a clear risk factor for hyponatremia and hypokalemia. The effect appears to be dose-dependent and highly variable depending on the substance. Syncope and falls seem to be causally related to thiazide use. Especially in patients who are elderly, female, and prone to falls, the use of thiazide diuretics should be thoroughly questioned.
    Tags: *Accidental Falls/prevention & control/statistics & numerical data, *Hypertension/drug therapy/epidemiology, *Hypokalemia/chemically induced/diagnosis/epidemiology, *Hyponatremia/chemically induced/diagnosis/epidemiology, *Sodium Chloride Symporter Inhibitors/adverse effects/therapeutic use, *Syncope/blood/epidemiology/etiology, Aged, Antihypertensive Agents/therapeutic use, Chlorthalidone/therapeutic use, Cross-Sectional Studies, Electrolyte disorders, Falls, Female, Humans, Hypokalemia, Hyponatremia, Male, Middle Aged, Prevalence, Risk Assessment, Switzerland/epidemiology, Syncope, Thiazide diuretics, Water-Electrolyte Balance/*drug effects.
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  • Hersberger, L., Dietz, A., Burgler, H., Bargetzi, A., Bargetzi, L., Kagi-Braun, N., Tribolet, P., et al. “Individualized Nutritional Support For Hospitalized Patients With Chronic Heart Failure”. J Am Coll Cardiol 77, no. 18: 2307-2319. doi:10.1016/j.jacc.2021.03.232.
    Abstract: BACKGROUND: Deterioration of nutritional status during hospitalization in patients with chronic heart failure increases mortality. Whether nutritional support during hospitalization reduces these risks, or on the contrary, may be harmful due to an increase in salt and fluid intake, remains unclear. OBJECTIVES: The purpose of this trial was to study the effect of nutritional support on mortality in patients hospitalized with chronic heart failure who are at nutritional risk. METHODS: A total of 645 patients with chronic heart failure (36% [n = 234] with acute decompensation) participated in the investigator-initiated, open-label EFFORT (Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients) trial. Patients were randomized to protocol-guided individualized nutritional support to reach energy, protein, and micronutrient goals (intervention group) or standard hospital food (control group). The primary endpoint was all-cause mortality at 30 days. RESULTS: Mortality over 180 days increased with higher severity of malnutrition (odds ratio per 1-point increase in Nutritional Risk Screening 2002 score: 1.65; 95% confidence interval [CI]: 1.21 to 2.24; p = 0.001). By 30 days, 27 of 321 intervention group patients (8.4%) died, compared with 48 of 324 (14.8%) control group patients (odds ratio: 0.44; 95% CI: 0.26 to 0.75; p = 0.002). Patients at high nutritional risk showed the most benefit from nutritional support. Mortality effects remained significant at 180-day follow-up. Intervention group patients also had a lower risk for major cardiovascular events at 30 days (17.4% vs. 26.9%; odds ratio: 0.50; 95% CI: 0.34 to 0.75; p = 0.001). CONCLUSIONS: Among hospitalized patients with chronic heart failure at high nutritional risk, individualized nutritional support reduced the risk for mortality and major cardiovascular events compared with standard hospital food. These data support malnutrition screening upon hospital admission followed by an individualized nutritional support strategy in this vulnerable patient population. (Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial [EFFORT]; NCT02517476).
    Tags: (1410.000.058 and 1410.000.044) provided funding for the trial. The funders had, (SNSF) (PP00P3_150531) and the Research Council of the Kantonsspital Aarau, *Hospitalization, *Nutritional Support, Aged, Aged, 80 and over, and the decision to submit. Dr. Stanga's institution has received speaking, cardiology, cardiovascular, Chronic Disease, clinical outcomes, Female, Fresenius Kabi. Dr. Schuetz's institution has previously received unrestricted, grant money unrelated to this project from Nestle Health Science and Abbott, heart failure, Heart Failure/*mortality/therapy, honoraria and research support from Nestle Health Science, Abbott Nutrition, and, Humans, Male, malnutrition, Middle Aged, no role in data collection, analysis, interpretation, writing of the manuscript, Nutrition. All other authors have reported that they have no relationships, Nutritional Risk Screening, nutritional support, relevant to the contents of this paper to disclose..
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  • Willekens, G., Studt, J. D., Mendez, A., Alberio, L., Fontana, P., Wuillemin, W. A., Schmidt, A., et al. “A Universal Anti-Xa Assay For Rivaroxaban, Apixaban, And Edoxaban Measurements: Method Validation, Diagnostic Accuracy And External Validation”. Br J Haematol 193, no. 6: 1203-1212. doi:10.1111/bjh.17470.
    Abstract: A universal anti-Xa assay for the determination of rivaroxaban, apixaban and edoxaban drug concentrations would simplify laboratory procedures and facilitate widespread implementation. Following two pilot studies analysing spiked samples and material from 698 patients, we conducted a prospective multicentre cross-sectional study, including 867 patients treated with rivaroxaban, apixaban or edoxaban in clinical practice to comprehensively evaluate a simple, readily available anti-Xa assay that would accurately measure drug concentrations and correctly predict relevant levels in clinical practice. Anti-Xa activity was measured by an assay calibrated with low-molecular-weight heparin (LMWH) in addition to ultra-high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). As an external validation, LMWH-calibrated anti-Xa activity was also determined in nine external laboratories. The LMWH-calibrated anti-Xa activity correlated strongly with rivaroxaban, apixaban or edoxaban drug levels [r(s) = 0.98, 95% confidence interval (CI) 0.98-0.98]. The sensitivity for the clinically relevant cut-off levels of 30, 50 and 100 microg/l was 96.2% (95% CI 94.4-97.4), 96.4% (95% CI 94.4-97.7) and 96.7% (95% CI 94.3-98.1) respectively. Concordant results were obtained in the external validation study. In conclusion, a universal, LMWH-calibrated anti-Xa assay accurately measured rivaroxaban, apixaban and edoxaban concentrations and correctly predicted relevant drug concentrations in clinical practice.
    Tags: *Drug Monitoring, Adolescent, Adult, Aged, Aged, 80 and over, apixaban, Bangerter-Rhyner Stiftung (applicant Ursula Amstutz). We thank the following, Bristol-Myers Squibb, and Daiichi Sankyo. These companies had no role in study, Cantonal Hospital Lucerne. Michael Nagler is supported by a research grant of the, Chromatography, High Pressure Liquid, companies for the provision of pure substances: Bayer Healthcare AG,, Cross-Sectional Studies, Cyclophosphamide/*pharmacokinetics, Daiichi Sankyo. Lorenzo Alberio reports research grants from Bayer, CSL-Behring,, design, data collection and analysis, the decision to publish, or manuscript, drug monitoring, edoxaban, factor Xa inhibitors, Factor Xa Inhibitors/*blood, Female, from Alexion Pharma GmbH, all outside the submitted. Jan-Dirk Studt reports, grant of the Swiss National Science Foundation (#320030-197392). Implementation, heparin, honoraria for participating in scientific advisory boards from Bayer, Pfizer, and, Humans, lecture fees and advisory honoraria from Bayer Healthcare, Pfizer, Takeda,, low-molecular-weight, Male, Middle Aged, Novartis, Novo Nordisk, Roche, Sobi, and Takeda. Walter A. Wuillemin reports, of the LC-MS/MS measurements was supported by the Gottfried & Julia, outside of the submitted work, lecture honoraria from Bayer Healthcare, and, Pilot Projects, preparation. Michael Nagler reports research grants from Bayer Healthcare,, Pyrazoles/*pharmacokinetics, Pyridones/*pharmacokinetics, research grants from Bayer Healthcare, BMS-Pfizer, Daiichi Sankyo and Sanofi, and, Retrospective Studies, rivaroxaban, Rivaroxaban/*pharmacokinetics, Siemens, and Sanofi., Swiss National Science Foundation (#179334). Lorenzo Alberio is supported by a, Tandem Mass Spectrometry.
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  • Dorr, M., Riemer, U., Christ, M., Bauersachs, J., Bosch, R., Laufs, U., Neumann, A., Scherer, M., Stork, S., and Wachter, R. “Hospitalizations For Heart Failure: Still Major Differences Between East And West Germany 30 Years After Reunification”. Esc Heart Fail 8, no. 4: 2546-2555. doi:10.1002/ehf2.13407.
    Abstract: AIMS: Heart failure (HF) is the most common primary inpatient diagnosis in Germany. We examined temporal trends of HF hospitalization within Germany focusing on regional differences. METHODS AND RESULTS: We analysed aggregated data of more than 320 million hospitalizations in Germany from 2000 to 2017. Temporal trends of HF-related parameters were analysed, focusing on regional differences between the federal states. The absolute number of HF-related hospitalizations throughout Germany increased continuously and almost doubled (from 239 694 to 464 724 cases, +94%) with the relative increase being higher in East Germany compared with West Germany (119% vs. 88%). These regional differences persisted after age standardization with 609 and 490 cases per 100 000 population, respectively. The length of stay decreased continuously across Germany (from 14.3 to 10.2 days; -29%), while the total number of HF-related hospital days increased by 51% in East Germany and 35% in West Germany. In 2017, HF remained the leading cause of in-hospital death (8.9% of all cases), with a markedly higher rate in East vs. West Germany (65 vs. 43 deaths per 100 000 population). CONCLUSIONS: Heart failure remains the most common cause of hospitalization and in-hospital death throughout Germany. The increase in HF-related morbidity and mortality was much higher in East Germany compared with West Germany during the observation period. A more detailed understanding of these striking disparities 30 years after the German reunification requires further investigations. There is an urgent need for action with regard to stronger control of risk factors and improvement of both chronic HF management and healthcare structures.
    Tags: *Heart Failure/epidemiology, *Hospitalization, consulting from Novartis, BMS, Pfizer, Vifor, Bayer, Servier, Daichii Sankyo,, CVRx, MSD, Boehringer Ingelheim, AstraZeneca, Abiomed, Abbott, and Medtronic and, Daichii Sankyo, Boehringer Ingelheim, and Amgen. R.W. has been a consultant for, Epidemiology, Germany, Germany, West, Germany/epidemiology, Heart failure, Hospital Mortality, Hospitalization, Humans, In-hospital mortality, Ingelheim, Bristol Myers Squibb, CVRx, Daiichi, Johnson & Johnson, Medtronic,, is an employee of Novartis Germany. J.B. reports honoraria for lectures and/or, lectures and/or consulting from Bayer, Daiichi Sankyo, Hexal, and Novartis. U.R., lectures and/or consulting from Novartis, BMS, Pfizer, Bayer, Biotronik, and, M.S., A.N., and S.S. report no conflicts of interest. M.D. reports honoraria for, Medtronic and research support from BMS, Pfizer, Biotronik, and Abbott. U.L. has, Novartis, Pfizer, Sanofi, and Servier., or received speaker's bureau honoraria from Bayer, Berlin Chemie, Boehringer, received honoraria for lectures and/or consulting from Novartis, Bayer, Servier,, Regional disparities, research support from Zoll, CVRx, Vifor, and Abiomed. R.B. reports honoraria for, to the research, authorship, and/or publication of this article: M.C., U.L.,.
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  • Beaulieu, K., Blundell, J. E., van Baak, M. A., Battista, F., Busetto, L., Carraca, E. V., Dicker, D., et al. “Effect Of Exercise Training Interventions On Energy Intake And Appetite Control In Adults With Overweight Or Obesity: A Systematic Review And Meta-Analysis”. Obes Rev 22 Suppl 4, no. Suppl 4: e13251. doi:10.1111/obr.13251.
    Abstract: This systematic review examined the impact of exercise training interventions on energy intake (EI) and appetite control in adults with overweight/obesity (>/=18 years including older adults). Articles were searched up to October 2019. Changes in EI, fasting appetite sensations, and eating behavior traits were examined with random effects meta-analysis, and other outcomes were synthesized qualitatively. Forty-eight articles were included (median [range] BMI = 30.6 [27.0-38.4] kg/m(2) ). Study quality was rated as poor, fair, and good in 39, seven, and two studies, respectively. Daily EI was assessed objectively (N = 4), by self-report (N = 22), with a combination of the two (N = 4) or calculated from doubly labeled water (N = 1). In studies rated fair/good, no significant changes in pre-post daily EI were found and a small but negligible (SMD < 0.20) postintervention difference when compared with no-exercise control groups was observed (five study arms; MD = 102 [1, 203] kcal). There were negligible-to-small pre-post increases in fasting hunger and dietary restraint, decrease in disinhibition, and some positive changes in satiety and food reward/preferences. Within the limitations imposed by the quality of the included studies, exercise training (median duration of 12 weeks) leads to a small increase in fasting hunger and a small change in average EI only in studies rated fair/good. Exercise training may also reduce the susceptibility to overconsumption (PROSPERO: CRD42019157823).
    Tags: *Appetite, *Energy Intake, Aged, appetite control, energy intake, Exercise, Humans, Obesity/therapy, Overweight/therapy, physical activity.
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  • Beck, K., Vincent, A., Becker, C., Keller, A., Cam, H., Schaefert, R., Reinhardt, T., et al. “Prevalence And Factors Associated With Psychological Burden In Covid-19 Patients And Their Relatives: A Prospective Observational Cohort Study”. Plos One 16, no. 5: e0250590. doi:10.1371/journal.pone.0250590.
    Abstract: BACKGROUND: Due to the dramatic measures accompanying isolation and the general uncertainty and fear associated with COVID-19, patients and relatives may be at high risk for adverse psychological outcomes. Until now there has been limited research focusing on the prevalence of psychological distress and associated factors in COVID-19 patients and their relatives. The objective of our study was to assess psychological distress in COVID-19 patients and their relatives 30 days after hospital discharge. METHODS: In this prospective observational cohort study at two Swiss tertiary-care hospitals we included consecutive adult patients hospitalized between March and June 2020 for a proven COVID-19 and their relatives. Psychological distress was defined as symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS), i.e., a score of >/=8 on the depression and/or anxiety subscale. We further evaluated symptoms of post-traumatic stress disorder (PTSD), defined as a score of >/=1.5 on the Impact of Event Scale-Revised (IES-R). RESULTS: Among 126 included patients, 24 (19.1%) had psychological distress and 10 (8.7%) had symptoms of PTSD 30 days after hospital discharge. In multivariate logistic regression analyses three factors were independently associated with psychological distress in patients: resilience (OR 0.82; 95%CI 0.71 to 0.94; p = 0.005), high levels of perceived stress (OR 1.21; 95%CI 1.06 to 1.38; p = 0.006) and low frequency of contact with relatives (OR 7.67; 95%CI 1.42 to 41.58; p = 0.018). The model showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.92. Among 153 relatives, 35 (22.9%) showed symptoms of psychological distress, and 3 (2%) of PTSD. For relatives, resilience was negatively associated (OR 0.85; 95%CI 0.75 to 0.96; p = 0.007), whereas perceived overall burden caused by COVID-19 was positively associated with psychological distress (OR 1.72; 95%CI 1.31 to 2.25; p<0.001). The overall model also had good discrimination, with an AUC of 0.87. CONCLUSION: A relevant number of COVID-19 patients as well as their relatives exhibited psychological distress 30 days after hospital discharge. These results might aid in development of strategies to prevent psychological distress in COVID-19 patients and their relatives.
    Tags: *Psychological Distress, Adult, Aged, Area Under Curve, Cohort Studies, COVID-19/pathology/*psychology/virology, Family/*psychology, Female, Humans, Male, Middle Aged, Patient Discharge, Prevalence, Prospective Studies, Resilience, Psychological, ROC Curve, SARS-CoV-2/isolation & purification, Socioeconomic Factors, Stress Disorders, Post-Traumatic/diagnosis/epidemiology, Stress, Psychological.
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  • Robert-Ebadi, H., Robin, P., Hugli, O., Verschuren, F., Trinh-Duc, A., Roy, P. M., Schmidt, J., et al. “Impact Of The Age-Adjusted D-Dimer Cutoff To Exclude Pulmonary Embolism: A Multinational Prospective Real-Life Study (The Relax-Pe Study)”. Circulation 143, no. 18: 1828-1830. doi:10.1161/CIRCULATIONAHA.120.052780.
    Tags: Age Factors, diagnosis, Fibrin Fibrinogen Degradation Products/pharmacology/*therapeutic use, fibrin fragment D, Humans, Prospective Studies, pulmonary embolism, Pulmonary Embolism/*drug therapy.
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  • Bargetzi, A., Emmenegger, N., Wildisen, S., Nickler, M., Bargetzi, L., Hersberger, L., Segerer, S., et al. “Admission Kidney Function Is A Strong Predictor For The Response To Nutritional Support In Patients At Nutritional Risk”. Clin Nutr 40, no. 5: 2762-2771. doi:10.1016/j.clnu.2021.03.013.
    Abstract: BACKGROUND: Patients with chronic kidney disease (CKD) are at substantial risk of malnutrition, which negatively affects clinical outcomes. We investigated the association of kidney function assessed at hospital admission and effectiveness of nutritional support in hospitalized medical patients at risk of malnutrition. METHODS: This is a secondary analysis of an investigator-initiated, randomized-controlled, Swiss multicenter trial (EFFORT) that compared individualised nutritional support with usual hospital food on clinical outcomes. We compared effects of nutritional support on mortality in subgroups of patients stratified according to kidney function at the time of hospital admission (estimated glomerular filtration rates [eGFR] <15, 15-29, 30-59, 60-89 and >/= 90 ml/min/1.73 m(2)). RESULTS: We included 1943 of 2028 patients (96%) from the original trial with known admission creatinine levels. Admission eGFR was a strong predictor for the beneficial effects of nutritional support in regard to lowering of 30-day mortality. Patients with an eGFR <15, 15-29 and 30-59 had the strongest mortality benefit (odds ratios [95%CI] of 0.24 [0.05 to 1.25], 0.37 [0.14 to 0.95] and 0.39 [0.21 to 0.75], respectively), while patients with less severe impairment in kidney function had a less pronounced mortality benefits (p for interaction 0.001). A similar stepwise association of kidney function and response to nutritional support was found also for other secondary outcomes. CONCLUSION: In medical inpatients at nutritional risk, admission kidney function was a strong predictor for the response to nutritional therapy. Initial kidney function may help to individualize nutritional support in the future by identification of patients with most clinical benefit. CLINICAL TRIAL REGISTRATION: Registered under ClinicalTrials.gov Identifier no. NCT02517476.
    Tags: *Nutrition Surveys, *Nutritional Status, Abbott Nutrition. The institution of Z.Stanga received speaking honoraria and, Aged, and 1410.000.044). The Institution of P.Schuetz has previously received, Chronic kidney disease, Clinical outcomes, Desenvolvimento Humanitario. All other authors report no conflicts of interest., Female, Glomerular Filtration Rate/physiology, grant from the Swiss National Foundation to P.Schuetz (SNSF Professorship,, Humans, Kidney function, Kidney/*physiology, Male, Malnutrition, Malnutrition/etiology, Middle Aged, Mr. St. Segerer was supported by a grant of the Fundacao Pesquisa e, Nutritional support, or part, except in abstract form., Outcome, PP00P3_150,531) and the Forschungsrat of the Kantonsspital Aarau (1410.000.058, Randomized trial, Renal function, Renal Insufficiency, Chronic/*physiopathology, research support from Neste Health Science, Abbott Nutrition and Fresenius Kabi., Risk Factors, The results presented in this paper have not been published previously in whole, unrestricted grant money unrelated to this project from Neste Health Science and.
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  • Afshar-Oromieh, A., Prosch, H., Schaefer-Prokop, C., Bohn, K. P., Alberts, I., Mingels, C., Thurnher, M., et al. “A Comprehensive Review Of Imaging Findings In Covid-19 - Status In Early 2021”. Eur J Nucl Med Mol Imaging 48, no. 8: 2500-2524. doi:10.1007/s00259-021-05375-3.
    Abstract: Medical imaging methods are assuming a greater role in the workup of patients with COVID-19, mainly in relation to the primary manifestation of pulmonary disease and the tissue distribution of the angiotensin-converting-enzyme 2 (ACE 2) receptor. However, the field is so new that no consensus view has emerged guiding clinical decisions to employ imaging procedures such as radiography, computer tomography (CT), positron emission tomography (PET), and magnetic resonance imaging, and in what measure the risk of exposure of staff to possible infection could be justified by the knowledge gained. The insensitivity of current RT-PCR methods for positive diagnosis is part of the rationale for resorting to imaging procedures. While CT is more sensitive than genetic testing in hospitalized patients, positive findings of ground glass opacities depend on the disease stage. There is sparse reporting on PET/CT with [(18)F]-FDG in COVID-19, but available results are congruent with the earlier literature on viral pneumonias. There is a high incidence of cerebral findings in COVID-19, and likewise evidence of gastrointestinal involvement. Artificial intelligence, notably machine learning is emerging as an effective method for diagnostic image analysis, with performance in the discriminative diagnosis of diagnosis of COVID-19 pneumonia comparable to that of human practitioners.
    Tags: *covid-19, *Pneumonia, Viral, Artificial Intelligence, Corona virus, Covid-19, Humans, Imaging, Positron Emission Tomography Computed Tomography, SARS-CoV-2.
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