Bernard Cerutti

Influence of Steroids on Procalcitonin and C-reactive Protein in Patients with COPD and Community-acquired Pneumonia

Background:The induction of C-reactive Protein (CRP) may be attenuated by corticosteroids, whereas Procalcitonin (PCT) appears to be unaltered. We investigated, whether in community-acquired pneumonia (CAP) a combined antibiotic-corticosteroid therapy may actually lead to different slopes of decline of these inflammatory markers.Patients and Methods:We studied the slopes of decline of PCT and CRP serum levels during 7 consecutive days as well as clinical parameters in a group of patients with CAP on or off corticosteroids. Patients with underlying COPD received systemic corticosteroids (n = 10), while non-COPD patients (n = 10) presenting with CAP alone formed the control group. All patients were treated with antibiotics.Results:At baseline, relevant clinical and laboratory characteristics of the two groups were similar. Regarding the decreasing shapes of the curves from PCT and CRP, no significant differences were found (p-value = 0.48 for the groups for CRP, respectively 0.64 for PCT). All patients showed an uneventful recovery.Conclusion:In patients with COPD and CAP, the time courses over 7 days of PCT and CRP showed a nearly parallel decline compared to non-COPD patients with CAP. Contrary to the induction phase, corticosteroids do not modify the time-dependent decay of PCT and CRP when the underlying infectious disease (CAP) is adequately treated.

Omitted and unjustified medications in the discharge summary

Background: Limited information exists in regard to drug omissions and unjustified medications in the hospital discharge summary (DS). Objective: To evaluate the incidence and types of drug omissions and unjustified medications in the DS, and to assess their potential impact on patient health. Methods: A prospective observational review of the DSs of all patients discharged from our Internal Medicine Department over a 3-month period. Data assessment was made by internists using a structured form. Results: Of the 577 evaluated DSs, 66% contained at least one inconsistency accounting for a total of 1012 irregularities. There were 393 drug omissions affecting 251 patients, 32% of which were potentially harmful. Seventeen per cent of all medications (619/3691) were unjustified, affecting 318 patients. The unjustified medication was potentially harmful in 16% of cases, occurred significantly more frequent in women than in men (61% vs 50%; p = 0.008) and increased linearly with the number of drugs prescribed (p<0.001). Drug omission had a twofold higher potential to cause harm than unjustified medication. Conclusions: Drug omissions and unjustified medications are frequent, and systemic changes are required to substantially reduce these inconsistencies.

Temperature related mortality and ambulance service interventions during the heat waves of 2003 in Ticino (Switzerland).

Summary.ObjectivesThis study investigates a potential increase in mortality and in the demand for ambulance emergency services among the elderly in particular, in Ticino in the summer of 2003.MethodsMortality rates and emergency ambulance interventions rates were compared with records from the previous years. We considered the whole population, aged 65 and over, as well as 75 and over.ResultsThe 2003 mortality in the population was not signifi cantly different from the previous years. The number of deaths among the elderly showed a small but significant deviation from the expected values during the first heat wave in June 2003, with no significant impact on the seasonal results. The number of ambulance service interventions was larger than during the previous years.ConclusionThese results are consistent with findings in other studies. The heat waves (especially in June), were correlated with a higher number of ambulance callouts. In addition to some geographic, climatic, and social factors that had a protective impact, the response of the emergency services is likely to have contributed to a certain reduction in mortality.Zusammenfassung.Temperaturabhängige Sterblichkeit und Notfalleinsätze während der Hitzewellen im Jahr 2003 im Kanton Tessin (Schweiz)ZielDie Studie untersucht, ob im Kanton Tessin während der Sommermonate 2003 ein Anstieg der Sterblichkeit und der Anzahl Notfalleinsätze, besonders unter der älteren Bevölkerung, zu verzeichnen war.MethodenDie Sterblichkeitsraten und Notfalleinsätze wurden mit den Angaben des Vorjahres verglichen. Dabei wurde die Gesamtbevölkerung in Betracht gezogen sowie die Altersgruppe der über 65-Jährigen und der über 75-Jährigen.ErgebnisseDie Sterblichkeit im Jahr 2003 variierte nicht signi fikant gegenüber den Vorjahren. Bei der Gesamtbevölkerung wurde eine bedeutend höhere Sterblichkeit während der ersten Hitzewelle vom Juni 2003 beobachtet, ohne bedeutende Auswirkungen auf die Monats- und Saisonergebnisse. Die Anzahl der Notfalleinsätze war höher als in den Vorjahren.SchlussfolgerungDie vorliegenden Ergebnisse stimmen mit anderen Studien überein. Während der Hitzewellen (besonders derjenigen vom Juni) wurde ein Anstieg der Notfalleinsätze verzeichnet. Neben geographischen, meteorologischen und sozialen Aspekten, die eine schützende Wirkung hatten, war vermutlich auch der Einsatz der Notfalldienste für den Rückgang der Sterbefälle mit verantwortlich.Résumé.Mortalité liée à la température et interventions des services d’ambulances durant les vagues de chaleur de 2003 dans le canton du Tessin (Suisse)ObjectifsEnquêter sur une possible augmentation de la mortalité et de l’utilisation des services d’ambulances, en particulier pour les personnes âgées, durant l’été 2003 dans le canton du Tessin.MéthodesLes taux de mortalité et le nombre d’intervention des services d’ambulances ont été comparés avec les chiffres des années précédentes. L’étude a porté sur la population totale, sur les 65 ans et plus, ainsi que sur les 75 ans et plus.RésultatsLa mortalité de la population n’est pas significativement supérieure à celle des années précédentes. Les décès des personnes âgées mettent en évidence une déviation légère mais significative par rapport aux valeurs attendues durant la première vague de chaleur (juin 2003), mais sans impact sur les résultats saisonniers. Le nombre d’interventions des services d’ambulances a été supérieur à celui des années précédentes.ConclusionCes résultats corroborent les conclusions d’autres travaux. Les vagues de chaleur (surtout celle de juin), sont en lien avec un nombre plus élevé d’interventions des services d’ambulances. Outre certains facteurs géographiques, météorologiques et sociaux qui ont sans doute eu un effet protecteur, la réponse des systèmes d’interventions d’urgence a probablement aussi contribué à une certaine réduction de la mortalité.

Psychiatric symptoms, psychological distress and somatic comorbidity among remand prisoners in Switzerland

OBJECTIVE The aims of this study were to determine the prevalence of psychiatric symptoms and complaints among remand prisoners in Switzerland and to analyze the relationships between psychiatric symptoms, physical health and substance abuse problems in this population. METHOD The medical files of all detainees attending the prison health service in 2007 were reviewed. Identified health problems were coded using the International Classification of Primary Care (ICPC-2). Descriptive statistics and measures of association were computed. RESULTS A total of 1510 files were analyzed. Several associations between psychological symptoms (anxiety and insomnia) and physical health problems (skin, respiratory and circulatory) were observed. Substance abuse was also frequently associated with somatic health problems. CONCLUSIONS These data provide the first comprehensive description of the mental health of detainees in Switzerlands largest remand prison. Our findings emphasize the need for coordinated health care services in detention settings.

Health problems among detainees in Switzerland: a study using the ICPC-2 classification

BackgroundLittle is known about the health status of prisoners in Switzerland. The aim of this study was to provide a detailed description of the health problems presented by detainees in Switzerlands largest remand prison.MethodsIn this retrospective cross-sectional study we reviewed the health records of all detainees leaving Switzerlands largest remand prison in 2007. The health problems were coded using the International Classification for Primary Care (ICPC-2). Analyses were descriptive, stratified by gender.ResultsA total of 2195 health records were reviewed. Mean age was 29.5 years (SD 9.5); 95% were male; 87.8% were migrants. Mean length of stay was 80 days (SD 160). Illicit drug use (40.2%) and mental health problems (32.6%) were frequent, but most of these detainees (57.6%) had more generic primary care problems, such as skin (27.0%), infectious diseases (23.5%), musculoskeletal (19.2%), injury related (18.3%), digestive (15.0%) or respiratory problems (14.0%). Furthermore, 7.9% reported exposure to violence during arrest by the police.ConclusionMorbidity is high in this young, predominantly male population of detainees, in particular in relation to substance abuse. Other health problems more commonly seen in general practice are also frequent. These findings support the further development of coordinated primary care and mental health services within detention centers.

Predictors of positive blood cultures in critically ill patients: a retrospective evaluation.

Aim To identify predictors of bacteremia in critically ill patients, to evaluate the impact of blood cultures on the outcome, and to define conditions for breakthrough bacteremia despite concurrent antibiotic treatment. Methods A descriptive retrospective study was performed over a two-year period (2007-2008) in the medico-surgical Intensive Care Unit (ICU) of the San Giovanni Hospital in Bellinzona, Switzerland. Results Forty-five out of 231 patients (19.5%) had positive blood cultures. Predictors of positive blood cultures were elevated procalcitonin levels (>2 µg/L, P < 0.001), higher severity scores (Simplified Acute Physiology Score II>43, P = 0.014; Sequential Organ Failure Assessment >4.0, P < 0.001), and liver failure (P = 0.028). Patients with bacteremia had longer hospital stays (31 vs 21 days, P = 0.058), but their mortality was not different from patients without bacteremia. Fever (t > 38.5°C) only showed a trend toward a higher rate of blood culture positivity (P = 0.053). The rate of positive blood cultures was not affected by concurrent antibiotic therapy. Conclusions The prediction of positive blood culture results still remains a very difficult task. In our analysis, blood cultures were positive in 20% of ICU patients whose blood was cultured, and positive findings increased with elevated procalcitonin levels, liver failure, and higher severity scores. Blood cultures drawn >4 days after the start of antibiotic therapy and >5 days after surgery could detect pathogens responsible for a new infection complication.

Rates, Delays, and Completeness of General Practitioners’ Responses to a Postal Versus Web-Based Survey: A Randomized Trial

Background Web-based surveys have become a new and popular method for collecting data, but only a few studies have directly compared postal and Web-based surveys among physicians, and none to our knowledge among general practitioners (GPs). Objective Our aim is to compare two modes of survey delivery (postal and Web-based) in terms of participation rates, response times, and completeness of questionnaires in a study assessing GPs’ preventive practices. Methods This randomized study was conducted in Western Switzerland (Geneva and Vaud) and in France (Alsace and Pays de la Loire) in 2015. A random selection of community-based GPs (1000 GPs in Switzerland and 2400 GPs in France) were randomly allocated to receive a questionnaire about preventive care activities either by post (n=700 in Switzerland, n=400 in France) or by email (n=300 in Switzerland, n=2000 in France). Reminder messages were sent once in the postal group and twice in the Web-based group. Any GPs practicing only complementary and alternative medicine were excluded from the study. Results Among the 3400 contacted GPs, 764 (22.47%, 95% CI 21.07%-23.87%) returned the questionnaire. Compared to the postal group, the participation rate in the Web-based group was more than four times lower (246/2300, 10.70% vs 518/1100, 47.09%, P<.001), but median response time was much shorter (1 day vs 1-3 weeks, P<.001) and the number of GPs having fully completed the questionnaire was almost twice as high (157/246, 63.8% vs 179/518, 34.6%, P<.001). Conclusions Web-based surveys offer many advantages such as reduced response time, higher completeness of data, and large cost savings, but our findings suggest that postal surveys can be still considered for GP research. The use of mixed-mode approaches is probably a good strategy to increase GPs’ participation in surveys while reducing costs.

Effect of magnesium therapy on nocturnal leg cramps: a systematic review of randomized controlled trials with meta-analysis using simulations

BACKGROUND AND OBJECTIVE Nocturnal leg cramps (NLC) are common in primary care and may cause severe pain and sleep disturbance. We systematically reviewed the effectiveness of magnesium in treating NLC and the side-effect profile of magnesium compared to placebo. METHODS We searched Medline, Embase, Cochrane Library, ClinicalTrials.gov, the International Standard Randomised Controlled Trial Number and the International Clinical Trials Registry Platform registries until August 2012. All randomized controlled trials (RCTs) comparing magnesium therapy for NLC in adults with any other comparator were eligible. Two investigators independently selected, extracted data from and rated the risk of bias of relevant studies. To compensate for the heterogeneity in outcome measures, simulations were used to summarize the data. RESULTS Seven RCTs were included in the review (n = 361), all comparing magnesium to placebo. Three of these trials included only pregnant women. The difference in the median number of leg cramps per week between the placebo and the intervention groups was 0.345 (quantile 2.5%: -0.133, quantile 97.5%: 0.875). This difference was 0.807 (quantile 2.5%: 0.015, quantile 97.5%: 1.207) in the three studies involving only pregnant women and 0.362 (quantile 2.5%: -0.386, quantile 97.5%: 1.148) in the others. Overall gastrointestinal side effects were slightly more common with magnesium therapy than with placebo. The strength of this evidence was weak, mainly due to small study sizes and short follow-up. CONCLUSIONS Magnesium therapy does not appear to be effective in the treatment of NLC in the general population, but may have a small effect in pregnant women. Further research using better designed RCTs is necessary.

Needs assessment for training in interprofessional skills in Swiss primary care: a Delphi study

Abstract Despite the importance of appropriate interprofessional collaboration in health care, it is still insufficiently taught in health professions education. The aim of the study was to conduct a needs assessment among health professionals on the themes and skills to be taught during interprofessional education programs in the context of Swiss primary care. A three round Delphi electronic survey was carried out in order to identify priority themes and skills to be included in such a program. Participants comprised 12 categories of health professionals. Seventy-two participated in the first, 41 in the second and 43 in the third round. Patient communication, case management of chronic conditions, therapeutic patient education, health promotion and prevention, ethics and medication were the most important themes identified. The most important skill was regarded as “to define and then share tasks and responsibilities between professionals”. Sub-analysis revealed that both priority themes and skills chosen differed between health professional categories.

Mental health of young offenders in Switzerland: Recognizing psychiatric symptoms during detention

We reviewed the medical records of the 118 adolescent detainees which had at least one consultation by a psychiatrist at the prison health facility during 2007. General practitioners used the International Classification of Primary Care (ICPC-2) for recording health problems. Psychiatrists used the International Classification of Diseases (ICD-10) for making psychiatric diagnoses. The concordance between the mental health assessment done by general practitioners using the ICPC-2 and the diagnoses proposed by psychiatrists was globally satisfying. The five most frequent ICD categories (conduct disorder, drug abuse, alcohol abuse, personality disorder, adjustment disorder) encompassed the most frequently reported ICPC-2 psychological symptoms. Several associations between psychological symptoms and socio-demographic characteristics were observed. Apart from providing a description of the mental health of adolescent detainees in one of Switzerlands largest detention centre for minors, results suggest that general practitioners can adequately identify frequent mental disorders in such contexts.