Background Smoking cessation represents one of the best means of preventing smoking-related complications. In recent years, a majority of hospitals have implemented smoke-free policies, making support for smoker patients a necessary and... more
Background Smoking cessation represents one of the best means of preventing smoking-related complications. In recent years, a majority of hospitals have implemented smoke-free policies, making support for smoker patients a necessary and indispensable task. The clinical pharmacist is well-positioned to provide this kind of support, given a good understanding of the medical condition and pharmacotherapy of hospitalized patients and the possibility to acquire specific smoking cessation training. Objectives This study aimed to evaluate the impact of a smoking cessation intervention for hospitalized patients by a clinical pharmacist previously trained for smoking cessation counselling. Setting Internal medicine department of a Swiss regional hospital. Method Smoker patients hospitalized in this department were included in the study from mid-September 2012 to mid-January 2013, according to the inclusion criteria. Moderate-intensity smoking cessation interventions based on smoking counsell...
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Type 2 diabetes is a frequent condition in humans with about 350 million affected people. One of the complications is blindness caused by damage of the blood vessels in retina, cataract or glaucoma. But in an acute developing... more
Type 2 diabetes is a frequent condition in humans with about 350 million affected people. One of the complications is blindness caused by damage of the blood vessels in retina, cataract or glaucoma. But in an acute developing hyperglycaemia, changes in sugar level in blood modify the refraction in the eye. Thus people complain of blurred vision. We present a case of a patient with hypermetropia who reported quick amelioration of his vision as hyperglycaemia developed, because of myopisation.
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Den Ultraschall in der taglichen Praxis zu nutzen, wird von Intensiv- und Notfallmedizinern nicht mehr in Frage gestellt. Es gilt als unentbehrliches Werkzeug fur die Intensiv- und Notfallmedizin. Nach Uberwindung der technologischen und... more
Den Ultraschall in der taglichen Praxis zu nutzen, wird von Intensiv- und Notfallmedizinern nicht mehr in Frage gestellt. Es gilt als unentbehrliches Werkzeug fur die Intensiv- und Notfallmedizin. Nach Uberwindung der technologischen und politischen Hindernisse ist jetzt die Herausforderung, die Technik in Intensiv- und Notfallstationen zu implementieren. Hier geben wir einige Empfehlungen auf der Grundlage unserer Erfahrungen der letzten funfzehn Jahre.
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POCUS is a valuable tool for the internist. Its field of application in internal medicine is multisystemic and requires rigorous training. This training includes an initiation phase, followed by a practical training phase for the... more
POCUS is a valuable tool for the internist. Its field of application in internal medicine is multisystemic and requires rigorous training. This training includes an initiation phase, followed by a practical training phase for the acquisition of images from patients or simulators. Supervision by experts is vital for mastering the necessary skills for the safe use of POCUS. Although, supervisors are available in French speaking Switzerland, there are too few to meet training needs. Several associations provide training courses to obtain POCUS certification, the content of which has been established since 2018 in Switzerland. In order to maintain a high level of proficiency and to identify tomorrow's supervisors, it is essential to provide the necessary means to allow more internists to obtain POCUS certification.
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Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the... more
Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the transition of care. This study took place in the internal medicine ward and in surrounding community pharmacies. The intervention group's patients underwent a set of pharmaceutical interventions during their hospital stay: medication reconciliation at admission, medication review, and discharge planning. The two groups were compared with regards to: number of community pharmacist interventions, time spent on discharge prescriptions, and number of treatment changes. Comparison between the groups showed a much lower (77% lower) number of community pharmacist interventions per discharge prescription in the intervention (n=54 patients) compared to the control group (n=64 patients): 6.9 versus 1.6 interventions, respectively (p<0.0001); less time worki...
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Lors de bronchopneumopathie chronique obstructive decompensee, la ventilation mecanique (VM) a pour but d'ameliorer l'oxygenation, de corriger l'hypoventilation alveolaire et l'acidose, de mettre les musdes «au repos» et... more
Lors de bronchopneumopathie chronique obstructive decompensee, la ventilation mecanique (VM) a pour but d'ameliorer l'oxygenation, de corriger l'hypoventilation alveolaire et l'acidose, de mettre les musdes «au repos» et d'assurer la fonction respiratoire jusqu'a resolution de la crise. Dans cette premiere phase, la VM peut s'effectuer a travers un tube endotrecheal (VM invasive) ou un masque facial ou nasal (VM non invasive). Les indications de ces deux approches et des modes ventilatoires sont passees en revue. La VM non invasive instauree precocement - quand faire se peut et en l'absence de contre-indications - permet de diminuer la duree de sejour hospitalier et la mortalite.
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This book provides in condensed form all the theoretical and practical knowledge necessary for the safe and effective use of the Swan-Ganz catheter in pulmonary artery catheterisation. It covers in detail the technical and practical... more
This book provides in condensed form all the theoretical and practical knowledge necessary for the safe and effective use of the Swan-Ganz catheter in pulmonary artery catheterisation. It covers in detail the technical and practical aspects of insertion of the catheter, its withdrawal and the procedures for the various measurements of pressure, blood gases, cardiac output and blood cytology. There is also a section on the pathophysiologial background, a compendium of characteristic haemodynamic profiles in specific conditions and a discussion of the strategy for interpretation of the results
Quatre molécules sont à l’origine de la plupart des intoxications domestiques à base de dérivés alcooliques: l’éthanol, l’isopropanol, le méthanol et l’éthylène glycol. Ces deux dernières sont potentiellement plus dangereuses par... more
Quatre molécules sont à l’origine de la plupart des intoxications domestiques à base de dérivés alcooliques: l’éthanol, l’isopropanol, le méthanol et l’éthylène glycol. Ces deux dernières sont potentiellement plus dangereuses par accumulation de leurs métabolites causant une acidose métabolique avec trou anionique augmenté. Les symptômes et les signes les plus fréquents d’une intoxication à l’alcool isopropylique sont une dépression du système nerveux central (somnolence, ataxie, confusion, coma), une dépression respiratoire et des symptômes digestifs (douleur abdominale, irritation gastrique, nausées, vomissements). Le trou osmolaire plasmatique permet une estimation de la concentration sanguine d’alcool isopropylique. Le traitement est basé sur une hydratation agressive, une prise en charge symptomatique des complications neurologiques et métaboliques ainsi qu’un soutien des fonctions vitales. L’hémodialyse est indiquée pour les patients avec une concentration d’alcool isopropyliq...
Point of care ultrasonography (POCU) has changed the practice of emergency and critical care medicine. Until recently, the emphasis has mainly been on using POCU to assist with percutaneous procedures and/or with the diagnosis and... more
Point of care ultrasonography (POCU) has changed the practice of emergency and critical care medicine. Until recently, the emphasis has mainly been on using POCU to assist with percutaneous procedures and/or with the diagnosis and management of life threatening conditions such as trauma, shock, pulmonary edema or pneumothorax. More recently, new but not widely embraced ICU applications for POCU have emerged and allowed bedside assessment of important ICU clinical questions such lung recruitability or diaphragmatic function.
In 2009, the Critical Care Network of the American College of Chest Physicians (ACCP) in partnership with La Sociéte de Reanimation de Langue Française selected a panel of experts to characterize competence in critical care... more
In 2009, the Critical Care Network of the American College of Chest Physicians (ACCP) in partnership with La Sociéte de Reanimation de Langue Française selected a panel of experts to characterize competence in critical care ultrasonography. The task force developed a consensus and made recommendations concerning the qualifications in ultrasonography. Experts have identified specific skills that intensivit should acquire, by setting a minimum standard for the realisation and control of ultrasound. Last year, we published in the present journal the results of this consensus conference concerning the "basic echocardiography" for intensivit. This year, we summarize here the results of the consensus conference and its conclusions on the assessment of advanced level skills to practice echocardiography in intensive care.
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In 2009, the Critical Care NetWork of the American College of Chest Physicians (ACCP) in partnership with La Société de réanimation de langue française (SRLF) selected a panel of experts to characterize competence in critical care... more
In 2009, the Critical Care NetWork of the American College of Chest Physicians (ACCP) in partnership with La Société de réanimation de langue française (SRLF) selected a panel of experts to characterize competence in critical care ultrasonography (CCUS) and suggest a consensus statement on competence in CCUS. CCUS may be divided into general CCUS (thoracic, abdominal, and vascular), and echocardiography (basic and advanced). For each component, the experts defined the specific skills that the intensivist should acquire to be competent in that aspect of CCUS. They, also, defined a reasonable minimum standard statement to serve as a guide for the intensivist in achieving proficiency in the field. The present article focuses on the consensus statement concerning the evaluation of the competences (basic level) in critical care echocardiography.
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Clostridium septicum gas gangrene is a rare fulminant infectious disease for which signs and symptoms like extreme pain, subcutaneous crepitus and violaceous necrotic bullae must be recognised. Early diagnosis followed by large surgical... more
Clostridium septicum gas gangrene is a rare fulminant infectious disease for which signs and symptoms like extreme pain, subcutaneous crepitus and violaceous necrotic bullae must be recognised. Early diagnosis followed by large surgical debridement are the only ways to ameliorate the bad prognosis. Here we describe a case of cervico-thoracic spontaneous gas gangrene.
Research Interests: Humans, Male, Clinical Sciences, Aged, Prognosis, and 4 moreDebridement, Pneumothorax, Gas Gangrene, and Clostridium
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We report the case of two patients hospitalized within a few weeks of each other and both presenting with spontaneous rupture of the esophagus whose evolution proved fatal. We take the opportunity of drawing attention to this rare and... more
We report the case of two patients hospitalized within a few weeks of each other and both presenting with spontaneous rupture of the esophagus whose evolution proved fatal. We take the opportunity of drawing attention to this rare and challenging disease, which is often diagnosed too late.
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ABSTRACT Objective: The aims of the study were: i) to determine whether cardiogenic shock is associated with elevation of plasma nitrite (NO2-) and/or nitrate (NO3-) levels, ii) to determine whether NO2-/NO3- could be used as a predictor... more
ABSTRACT Objective: The aims of the study were: i) to determine whether cardiogenic shock is associated with elevation of plasma nitrite (NO2-) and/or nitrate (NO3-) levels, ii) to determine whether NO2-/NO3- could be used as a predictor of the septic or cardiogenic origin of shock, and iii) to compare NO2-/NO3- plasma levels to more routinely measured inflammatory markers. Design: Prospective study. Setting: Fourteen-bed medical intensive care unit in a university hospital. Patients: Twenty-eight patients with cardiogenic (n=15) or septic shock (n=13). Measurements and main results: In the 13 septic patients, plasma NO3- levels were markedly increased (median value 143 μmol/l) and significantly higher than in patients with cardiogenic shock (32 μmol/l, p=0.0001). In cardiogenic shock, plasma NO3- levels were always below 100 μmol/l but significantly higher than those measured in 15 normal subjects (16 μmol/l, p=0.015). The best predictive value for a septic origin was obtained at the cutoff of 100 μmol/l. At this threshold, the specificity was 100% and sensitivity 64%. A comparison of the receiver operator characteristic curves constructed for nitrate and C-reactive protein values showed that nitrate was a better indicator of a septic aetiology of shock. Conclusion: In patients with circulatory shock of unclear origin, a plasma nitrate level above 100 μmol/l appears to be a reliable indicator of a septic origin. Further studies are needed to evaluate the clinical value of this test.
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The legitimacy of intensivists and emergency physicians to use ultrasound in their daily practice is no longer questioned. This new tool is now considered essential in the acute care setting. After overcoming the technological and... more
The legitimacy of intensivists and emergency physicians to use ultrasound in their daily practice is no longer questioned. This new tool is now considered essential in the acute care setting. After overcoming the technological and political obstacles, the current challenge is to implement technology in units. Here we give some recommendations based on our experience of the last fifteen years.
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Type 2 diabetes is a frequent condition in humans with about 350 million affected people. One of the complications is blindness caused by damage of the blood vessels in retina, cataract or glaucoma. But in an acute developing... more
Type 2 diabetes is a frequent condition in humans with about 350 million affected people. One of the complications is blindness caused by damage of the blood vessels in retina, cataract or glaucoma. But in an acute developing hyperglycaemia, changes in sugar level in blood modify the refraction in the eye. Thus people complain of blurred vision. We present a case of a patient with hypermetropia who reported quick amelioration of his vision as hyperglycaemia developed, because of myopisation.
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ABSTRACT Clostridium septicum gas gangrene is a rare fulminant infectious disease for which signs and symptoms like extreme pain, subcutaneous crepitus and violaceous necrotic bullae must be recognised. Early diagnosis followed by large... more
ABSTRACT Clostridium septicum gas gangrene is a rare fulminant infectious disease for which signs and symptoms like extreme pain, subcutaneous crepitus and violaceous necrotic bullae must be recognised. Early diagnosis followed by large surgical debridement are the only ways to ameliorate the bad prognosis. Here we describe a case of cervico-thoracic spontaneous gas gangrene.