1
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Ouk V, Heng LS, Virak M, Deng S, Lahra MM, Frankson R, Kreisel K, McDonald R, Escher M, Unemo M, Wi T, Maatouk I. High prevalence of ceftriaxone-resistant and XDR Neisseria gonorrhoeae in several cities of Cambodia, 2022-23: WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP). JAC Antimicrob Resist 2024; 6:dlae053. [PMID: 38577702 PMCID: PMC10993901 DOI: 10.1093/jacamr/dlae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
Objectives Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern. Ceftriaxone is the last effective and recommended option for empirical gonorrhoea therapy worldwide, but several ceftriaxone-resistant cases linked to Asia have been reported internationally. During January 2022-June 2023, the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) investigated N. gonorrhoeae AMR and epidemiological factors in patients from 10 clinical sentinel sites in Cambodia. Methods Urethral swabs from males with urethral discharge were cultured. ETEST determined the MIC of five antimicrobials, and EGASP MIC alert values and EUCAST breakpoints were used. EGASP demographic, behavioural and clinical variables were collected using a standardized questionnaire. Results From 437 male patients, 306 had positive N. gonorrhoeae cultures, AMR testing and complete epidemiological data. Resistance to ceftriaxone, cefixime, azithromycin and ciprofloxacin was 15.4%, 43.1%, 14.4% and 97.1%, respectively. Nineteen (6.2%) isolates were resistant to all four antimicrobials and, accordingly, categorized as XDR N. gonorrhoeae. These XDR isolates were collected from 7 of the 10 sentinel sites. No EGASP MIC alert values for gentamicin were reported. The nationally recommended cefixime 400 mg plus azithromycin 1 g (65.4%) or ceftriaxone 1 g plus azithromycin 1 g (34.6%) was used for treatment. Conclusions A high prevalence of ceftriaxone-resistant, MDR and XDR N. gonorrhoeae in several cities of Cambodia were found during 2022-23 in WHO EGASP. This necessitates expanded N. gonorrhoeae AMR surveillance, revision of the nationally recommended gonorrhoea treatment, mandatory test of cure, enhanced sexual contact notification, and ultimately novel antimicrobials for the treatment of gonorrhoea.
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Affiliation(s)
- V Ouk
- National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | - L Say Heng
- National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | - M Virak
- Laboratory of the National Institute of Public Health, Phnom Penh, Cambodia
| | - S Deng
- WHO, Office of Cambodia, Phnom Penh, Cambodia
| | - M M Lahra
- WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia
| | - R Frankson
- Division of STD Prevention, CDC, Atlanta, GA, USA
| | - K Kreisel
- Division of STD Prevention, CDC, Atlanta, GA, USA
| | - R McDonald
- Division of STD Prevention, CDC, Atlanta, GA, USA
| | - M Escher
- AMR Division, WHO, Geneva, Switzerland
| | - M Unemo
- Department of Laboratory Medicine, Faculty of Medicine and Health, WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London, London, UK
| | - T Wi
- Department of the Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
| | - I Maatouk
- Department of the Global HIV, Hepatitis and STI Programmes, WHO, Geneva, Switzerland
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2
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Magagnin G, Lubin C, Escher M, Weber N, Tortech L, Barrett N. Ferroelastic Twin Angles at the Surface of CaTiO_{3} Quantified by Photoemission Electron Microscopy. Phys Rev Lett 2024; 132:056201. [PMID: 38364151 DOI: 10.1103/physrevlett.132.056201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/30/2023] [Indexed: 02/18/2024]
Abstract
We use photoemission electron microscopy to measure the ferroelastic twin wall angles at the surface of CaTiO_{3} (001) and deduce the strain ordering. We analyze the angular dependence of the photoelectron emission from different domain surfaces, each with its own characteristic tilt angle in the factory rooflike topography. By considering the surface topography as a field perturbation, the offset in the photoemission threshold can be directly related to the tilt angles. With knowledge of the symmetry allowed twin walls we quantify the twin angles between 179.1° to 180.8°.
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Affiliation(s)
- G Magagnin
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay, 91191 Gif-sur-Yvette, France
| | - C Lubin
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay, 91191 Gif-sur-Yvette, France
| | - M Escher
- Focus GmbH, Neukirchner Straße 2, D-65510 Hünstetten-Kesselbach, Germany
| | - N Weber
- Focus GmbH, Neukirchner Straße 2, D-65510 Hünstetten-Kesselbach, Germany
| | - L Tortech
- NIMBE, CEA, CNRS, Université Paris-Saclay, CEA Saclay, 91191 Gif-sur-Yvette, France
| | - N Barrett
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay, 91191 Gif-sur-Yvette, France
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3
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Escher M, Weber NB, Kühn TJ, Patt M. 2D imaging spin-filter for NanoESCA based on Au/Ir(001) or Fe(001)-p(1×1)O. Ultramicroscopy 2023; 253:113814. [PMID: 37515931 DOI: 10.1016/j.ultramic.2023.113814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Abstract
A two-dimensional imaging spin-filter for photo-emission electron microscopy is described. The spin-filter is capable of imaging the electron spin polarization of either real space or momentum space electron distributions. As a scattering target either Au/Ir(001) comes into use, where spin sensitivity results from using spin-orbit scattering or Fe(001)-p(1×1)O that exploits exchange interaction. Both scattering targets were characterized with respect to their working points and Sherman function in a separate setup. Spin-polarization images of secondary electrons from the magnetic domains of a poly-crystalline iron sample are shown using both scattering targets. Images with a spin-filter using Au/Ir(001) show more than 104 discrete detection channels which increases the effective two-dimensional figure-of-merit (FoM) of this spin-filter by four orders of magnitude compared to single-channel spin detectors. Using the exchange scattering target two spin-components have been imaged for the first time. A method to detect all three spin-components is also outlined.
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Affiliation(s)
- M Escher
- Focus GmbH, 65510 Hünstetten-Kesselbach, Germany.
| | - N B Weber
- Focus GmbH, 65510 Hünstetten-Kesselbach, Germany
| | - T-J Kühn
- Focus GmbH, 65510 Hünstetten-Kesselbach, Germany
| | - M Patt
- Focus GmbH, 65510 Hünstetten-Kesselbach, Germany
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4
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Silhadi S, Hentsch L, Singovski S, Escher M. [Palliative sedation in a hospital unit]. Rev Med Suisse 2023; 19:1986-1990. [PMID: 37878098 DOI: 10.53738/revmed.2023.19.847.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
A person at the end of life may present uncomfortable symptoms becoming refractory to an adequate treatment. In this case, the initiation of palliative sedation is indicated. Most sedated inpatients die outside a specialized palliative care unit. Palliative sedation must be initiated and adapted according to the best clinical practices. This article describes the processes associated with palliative sedation in a hospital unit.
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Affiliation(s)
- Sabrina Silhadi
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Lisa Hentsch
- Service de médecine palliative, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Simon Singovski
- Service de médecine palliative, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Monica Escher
- Service de médecine palliative, Hôpitaux universitaires de Genève, 1211 Genève 14
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5
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Lavallard V, Cerutti B, Audétat-Voirol MC, Broers B, Sader J, Galetto-Lacour A, Hausmann S, Savoldelli GL, Nendaz M, Escher M. Formative assessments during COVID-19 pandemic: an observational study on performance and experiences of medical students. MedEdPublish (2016) 2023; 13:7. [PMID: 37942501 PMCID: PMC10628360 DOI: 10.12688/mep.19428.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
Background: Because of COVID-19, the 2020 written medical examinations were replaced by mandatory formative online assessments. This study aimed to determine students' performance, self-assessment of performance, and perception about the switch from a summative to a formative approach. Methods: Medical students from year 2 to 5 (n=648) were included. They could repeat each test once or twice. They rated their performance after each attempt and were then given their score. Detailed feedback was given at the end of the session. An online survey determined medical students' perception about the reorganization of education. Two items concerned the switch from summative to formative assessments Results: Formative assessments involved 2385 examinees totaling 3197 attempts. Among examinees, 30.8% made at least 2 attempts. Scores increased significantly at the second attempt (median 9.4, IQR 10.8), and duration decreased (median -31.0, IQR 48.0). More than half of examinees (54.6%) underestimated their score, female students more often than male. Low performers overestimated, while high performers underestimated their scores. Students approved of the switch to formative assessments. Stress was lessened but motivation for learning decreased. Conclusions: Medical students' better scores at a second attempt support a benefit of detailed feedback, learning time and re-test opportunity on performance. Decreased learning motivation and a minority of students repeating the formative assessments point to the positive influence of summative assessment on learning.
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Affiliation(s)
| | - Bernard Cerutti
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marie-Claude Audétat-Voirol
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Barbara Broers
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julia Sader
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | | | - Georges L. Savoldelli
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Anesthesia, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Nendaz
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Monica Escher
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
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6
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Tesoro R, Escher M. Patients' death: "Everybody hurts… sometimes"**Everybody Hurts, R.E.M. 1992. Ann Palliat Med 2023; 12:673-675. [PMID: 37164969 DOI: 10.21037/apm-23-257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/30/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Rosa Tesoro
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Monica Escher
- Department of Rehabilitation and Geriatrics, Division of Palliative Medicine, University Hospitals of Geneva, Geneva, Switzerland
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7
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Xausa G, Escher M, Singovski S, Hentsch L. Recurrent Persistent Hiccups on Opioid Treatment: A Case Report and Literature Review. J Pain Palliat Care Pharmacother 2023; 37:82-90. [PMID: 36520149 DOI: 10.1080/15360288.2022.2157070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hiccups are a rare but potentially debilitating side effect of opioid treatment, with only a handful of reported cases in the medical literature. The pathophysiological mechanism linking opioids and hiccups is unknown, and a lack of evidence exists concerning the optimal management of the condition. We report on a 64-year-old man diagnosed with advanced renal cancer and painful osteolytic metastases, presenting persistent hiccups while on opioid treatment. Hiccups recurred after multiple challenges with codeine, morphine and hydromorphone on separate occasions. Hiccups ceased only after opioid discontinuation, although various pharmacological treatments were tried to shorten the duration of hiccups. Eventually, fentanyl was introduced and was well tolerated by the patient, without any recurrence of hiccups. The chronological correlation between opioid initiation and the onset of hiccups, as well as opioid discontinuation and the termination of hiccups leads to the conclusion that a causal role of codeine, morphine and hydromorphone in this occurrence is likely. Individual susceptibility probably plays a central role in the development of opioid-related hiccups. Opioid rotation is a promising strategy in the management of opioid-related hiccups, particularly when the mere discontinuation of the opioid is not a viable option, such as in the oncology and palliative care field.
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8
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Lavallard V, Cerutti B, Audétat-Voirol MC, Broers B, Sader J, Galetto-Lacour A, Hausmann S, Savoldelli GL, Nendaz M, Escher M. Formative assessments during COVID-19 pandemic: an observational study on performance and experiences of medical students. MedEdPublish 2023. [DOI: 10.12688/mep.19428.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: Because of COVID-19, the 2020 written medical examinations were replaced by mandatory formative online assessments. This study aimed to determine students’ performance, self-assessment of performance, and perception about the switch from a summative to a formative approach. Methods: Medical students from year 2 to 5 (n=648) were included. They could repeat each test once or twice. They rated their performance after each attempt and were then given their score. Detailed feedback was given at the end of the session. An online survey determined medical students’ perception about the reorganization of education. Two items concerned the switch from summative to formative assessments Results: Formative assessments involved 2385 examinees totaling 3197 attempts. Among examinees, 30.8% made at least 2 attempts. Scores increased significantly at the second attempt (median 9.4, IQR 10.8), and duration decreased (median -31.0, IQR 48.0). More than half of examinees (54.6%) underestimated their score, female students more often than male. Low performers overestimated, while high performers underestimated their scores. Students approved of the switch to formative assessments. Stress was lessened but motivation for learning decreased. Conclusions: Medical students’ better scores at a second attempt support a benefit of detailed feedback, learning time and re-test opportunity on performance. Decreased learning motivation and a minority of students repeating the formative assessments point to the positive influence of summative assessment on learning.
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9
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Schurter T, Escher M, Gachoud D, Bednarski P, Hug B, Kropf R, Meng-Hentschel J, König B, Beyeler C, Guttormsen S, Huwendiek S. Essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss federal licensing examination for human medicine. GMS J Med Educ 2022; 39:Doc43. [PMID: 36310888 PMCID: PMC9585413 DOI: 10.3205/zma001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This report describes the essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss Federal Licensing Examination for Human Medicine (FLE) and the insights gained since its introduction in 2011. METHODS Based on existing scientific evidence, international expertise, and experience gained from previous examinations, the FLE is developed by experts from all five medical faculties in Switzerland with the support of the Institute for Medical Education and is held simultaneously at five locations. The exam organisers document and review every examination held and continuously optimise the processes; they have summarised the results in this report. RESULTS The essential steps comprise the development, revision and translation of questions; construction of the exam and production of materials; candidate preparation; implementation and analysis. The quality assurance measures consist of guideline coherence in the development of the questions and implementation of the exam, revision processes, construction of the exam based on the national blueprint, multiphase review of the translations and exam material, and statistical analysis of the exam and the comments from candidates. The intensive collaboration, especially on the part of representatives from all the participating faculties and a central coordination unit, which provides methodological support throughout and oversees the analysis of the exam, has proven successful. Successfully completed examinations and reliable results in the eleven examinations so far implemented represent the outcomes of the quality assurance measures. Significant insights in recent years are the importance of appreciating the work of those involved and the central organisation of exam development, thus ensuring the long-term success of the process. CONCLUSION Common guidelines and workshops, quality assurance measures accompanied by the continuous improvement of all processes, and appreciation of everyone involved, are essential to carrying out such an examination at a high-quality level in the long term.
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Affiliation(s)
- Tina Schurter
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Monica Escher
- University of Geneva, Medical Faculty, Geneva, Switzerland
| | - David Gachoud
- University of Lausanne, Medical Faculty, Lausanne, Switzerland
| | - Piotr Bednarski
- University of Fribourg, Medical Faculty, Fribourg, Switzerland
- University of Bern, Medical Faculty, Bern, Switzerland
| | - Balthasar Hug
- University of Basel, Medical Faculty, Basel, Switzerland
- University of Lucerne, Medical Faculty, Lucerne, Switzerland
| | - Roger Kropf
- University of Basel, Medical Faculty, Basel, Switzerland
- University of Zurich, Medical Faculty, Zurich, Switzerland
| | - Juliane Meng-Hentschel
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Benjamin König
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Christine Beyeler
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sissel Guttormsen
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
| | - Sören Huwendiek
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
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10
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Hentsch L, Sobanski PZ, Escher M, Pautex S, Meyer P. Palliative care provision for people living with heart failure: The Geneva model. Front Cardiovasc Med 2022; 9:933977. [PMID: 36093153 PMCID: PMC9452732 DOI: 10.3389/fcvm.2022.933977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
As life expectancy rises and the survival rate after acute cardiovascular events improves, the number of people living and dying with chronic heart failure is increasing. People suffering from chronic ischemic and non-ischemic heart disease may experience a significant limitation of their quality of life which can be addressed by palliative care. Although international guidelines recommend the implementation of integrated palliative care for patients with heart failure, models of care are scarce and are often limited to patients at the end of life. In this paper, we describe the implementation of a model designed to improve the early integration of palliative care for patients with heart failure. This model has enabled patients to access palliative care when they normally would not have and given them the opportunity to plan their care in line with their values and preferences. However, the effectiveness of this interdisciplinary model of care on patients' quality of life and symptom burden still requires evaluation.
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Affiliation(s)
- Lisa Hentsch
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
- *Correspondence: Lisa Hentsch
| | - Piotr Z. Sobanski
- Palliative Care Unit and Competence Center, Department of Internal Disease, Schwyz Hospital, Schwyz, Switzerland
| | - Monica Escher
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Pautex
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Meyer
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
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Lefuel P, Bollondi Pauly C, Dufey Teso A, Martin PY, Escher M, Séchaud L, Da Rocha G. « Jeux sérieux », une nouvelle approche pour aborder le projet de soins anticipé avec les patients dialysés. Nephrol Ther 2022; 18:263-269. [DOI: 10.1016/j.nephro.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
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12
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Singovski S, Pautex S, Escher M. [Opiod prescription in primary care: the case of chronic non cancer pain]. Rev Med Suisse 2022; 18:1238-1241. [PMID: 35735146 DOI: 10.53738/revmed.2022.18.787.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pain, including chronic non-cancer pain (CNCP), is a common reason for primary care consultation. CNCP encompasses a heterogeneous group of patients, whose care is often complex. The increase in opioid prescription in Switzerland and worldwide is associated with CNCP, while opioid use for this indication is debated. Several studies suggest a limited effect on pain and function, while adverse effects are frequent. This article aims to summarize what is known about opioid prescription for CNCP and international guidelines and highlight important aspects for the general practitioner.
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Affiliation(s)
- Simon Singovski
- Service de médecine palliative, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Sophie Pautex
- Service de médecine palliative, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Monica Escher
- Service de médecine palliative, Hôpitaux universitaires de Genève, 1211 Genève 14
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Hentsch L, Escher M, Pautex S, Meyer P. [Improving access to palliative care for patients with heart failure: advances and challenges]. Rev Med Suisse 2022; 18:1052-1056. [PMID: 35612478 DOI: 10.53738/revmed.2022.18.783.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following the therapeutic progress of the last decades, patients suffering from chronic heart failure (HF) are living longer than ever before. However, recovery from a HF syndrome remains rare and patients more often have to live with chronic HF which considerably impacts their quality of life. For several years, national and international cardiology societies have recommended the early integration of palliative care for HF patients. Although the impact of palliative care on the quality of life, depression and general symptom management of patients with HF has now been clearly established, its implementation is still scarce. The objective of this review is to highlight recommendations and models of care for the implementation of palliative care for patients with HF.
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Affiliation(s)
- Lisa Hentsch
- Service de médecine palliative, Département de réadaptation et de gériatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Monica Escher
- Service de médecine palliative, Département de réadaptation et de gériatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Sophie Pautex
- Service de médecine palliative, Département de réadaptation et de gériatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Philippe Meyer
- Service de cardiologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
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14
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Tesoro R, Suppan M, Dupuis A, Escher M, Haller G. Futility of end-of-life and emergency surgery in extreme high-risk patients: anesthetists’ versus surgeons’ perspective. Brazilian Journal of Anesthesiology (English Edition) 2022; 72:434-436. [PMID: 35469850 PMCID: PMC9373684 DOI: 10.1016/j.bjane.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Rosa Tesoro
- University Hospitals of Geneva, Intensive Care and Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Division of Anaesthesiology, Geneva, Switzerland.
| | - Mélanie Suppan
- University Hospitals of Geneva, Intensive Care and Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Division of Anaesthesiology, Geneva, Switzerland
| | - Arnaud Dupuis
- University Hospitals of Geneva, Department of Visceral Surgery, Geneva, Switzerland
| | - Monica Escher
- University Hospitals of Geneva, Department of Rehabilitation and Geriatrics, Division of Palliative Care, Geneva, Switzerland
| | - Guy Haller
- University Hospitals of Geneva, Intensive Care and Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Division of Anaesthesiology, Geneva, Switzerland
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Wurth S, Sader J, Cerutti B, Broers B, Nadia Bajwa M, Carballo S, Escher M, Galetto-Lacour A, Grosgurin O, Lavallard V, Savoldelli G, Serratrice J, Nendaz M, Audétat-Voiro MC. Correction to: Medical students' perceptions and coping strategies during the first wave of the COVID-19 pandemic: studies, clinical implication, and professional identity. BMC Med Educ 2022; 22:232. [PMID: 35365127 PMCID: PMC8972896 DOI: 10.1186/s12909-022-03307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Sophie Wurth
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julia Sader
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bernard Cerutti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Barbara Broers
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - M Nadia Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Monica Escher
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Grosgurin
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Georges Savoldelli
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Anaesthesia, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Serratrice
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Claude Audétat-Voiro
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Nendaz M, Audétat Voirol MC, Fassier T, Lavallard V, Broers B, Chanson M, Savoldelli G, Escher M. [COVID-19 pandemics and medical training : supporting and trusting students]. Rev Med Suisse 2022; 18:131-133. [PMID: 35084140 DOI: 10.53738/revmed.2022.18.766.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemics has deeply impacted academic teaching and forced a complete shift to distance learning formats during the first and second waves. Medical education, among other professional training programs, relies also on practical and clinical immersion, while some of these clinical activities had to be postponed. This article analyzes how one medical school was able to maintain its teaching while ensuring clinical training and taking into account the psychological impact imputed to the lockdown. It also highlights the learning opportunities and unprecedented life experiences contributing to the training of tomorrow's physicians.
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Affiliation(s)
- Mathieu Nendaz
- Unité de développement et de recherche en éducation médicale, Département de médecine, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Marie-Claude Audétat Voirol
- Unité de développement et de recherche en éducation médicale, Département de santé et médecine communautaires, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Thomas Fassier
- Centre interprofessionnel de simulation, Département de réadaptation et gériatrie, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Vanessa Lavallard
- Dicastère enseignement, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Barbara Broers
- Dicastère enseignement, Département de santé et médecine communautaires, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Marc Chanson
- Département de physiologie cellulaire et métabolisme, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Georges Savoldelli
- Unité de développement et de recherche en éducation médicale, Département d'anesthésiologie, pharmacologie, soins intensifs et urgences, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Monica Escher
- Dicastère enseignement, Département de réadaptation et gériatrie, Faculté de médecine, Université de Genève, 1211 Genève 4
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Wurth S, Sader J, Cerutti B, Broers B, Bajwa NM, Carballo S, Escher M, Galetto-Lacour A, Grosgurin O, Lavallard V, Savoldelli G, Serratrice J, Nendaz M, Audétat-Voirol MC. Medical students' perceptions and coping strategies during the first wave of the COVID-19 pandemic: studies, clinical implication, and professional identity. BMC Med Educ 2021; 21:620. [PMID: 34915888 PMCID: PMC8674407 DOI: 10.1186/s12909-021-03053-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 12/01/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND The unfolding of the COVID-19 pandemic during spring 2020 has disrupted medical education worldwide. The University of Geneva decided to shift on-site classwork to online learning; many exams were transformed from summative to formative evaluations and most clinical activities were suspended. We aimed to investigate the perceived impact of those adaptations by the students at the Faculty of Medicine. METHODS We sent an online self-administered survey to medical students from years 2 to 6 of the University of Geneva, three months after the beginning of the pandemic. The survey explored students' main activities during the first three months of the pandemic, the impact of the crisis on their personal life, on their training and on their professional identity, the level of stress they experienced and which coping strategies they developed. The survey consisted of open-ended and closed questions and was administered in French. RESULTS A total of 58.8% of students responded (n = 467) and were homogeneously distributed across gender. At the time of the survey, two thirds of the participants were involved in COVID-19-related activities; 72.5% voluntarily participated, mainly fueled by a desire to help and feel useful. Many participants (58.8%) reported a feeling of isolation encountered since the start of the pandemic. Main coping strategies reported were physical activity and increased telecommunications with their loved ones. Most students described a negative impact of the imposed restrictions on their training, reporting decreased motivation and concentration in an unusual or distraction-prone study environment at home and missing interactions with peers and teachers. Students recruited to help at the hospital in the context of increasing staff needs reported a positive impact due to the enriched clinical exposure. Perceived stress levels were manageable across the surveyed population. If changed, the crisis had a largely positive impact on students' professional identity; most highlighted the importance of the health care profession for society and confirmed their career choice. CONCLUSION Through this comprehensive picture, our study describes the perceived impact of the pandemic on University of Geneva medical students, their training and their professional identity three months after the start of the pandemic. These results allowed us to gain valuable insight that reinforced the relevance of assessing the evolution of the situation in the long run and the importance of developing institutional support tools for medical students throughout their studies.
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Affiliation(s)
- Sophie Wurth
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julia Sader
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bernard Cerutti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Barbara Broers
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia M Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Monica Escher
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Grosgurin
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Georges Savoldelli
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Anaesthesia, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Serratrice
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Claude Audétat-Voirol
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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18
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Escher M, Nendaz MR, Cullati S, Hudelson P. Physicians' perspective on potentially non-beneficial treatment when assessing patients with advanced disease for ICU admission: a qualitative study. BMJ Open 2021; 11:e046268. [PMID: 34020978 PMCID: PMC8144032 DOI: 10.1136/bmjopen-2020-046268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The use of intensive care at the end of life can be high, leading to inappropriate healthcare utilisation, and prolonged suffering for patients and families. The objective of the study was to determine which factors influence physicians' admission decisions in situations of potentially non-beneficial intensive care. DESIGN This is a secondary analysis of a qualitative study exploring the triage process. In-depth interviews were analysed using an inductive approach to thematic content analysis. SETTING Data were collected in a Swiss tertiary care centre between March and June 2013. PARTICIPANTS 12 intensive care unit (ICU) physicians and 12 internists routinely involved in ICU admission decisions. RESULTS Physicians struggled to understand the request for intensive care for patients with advanced disease and full code status. Physicians considered patients' long-term vital and functional prognosis, but they also resorted to shortcuts, that is, a priori consensus about reasons for admitting a patient. Family pressure and unexpected critical events were determinants of admission to the ICU. Patient preferences, ICU physician's expertise and collaborative decision making facilitated refusal. Physicians were willing to admit a patient with advanced disease for a limited amount of time to fulfil a personal need. CONCLUSIONS In situations of potentially non-beneficial intensive care, the influence of shortcuts or context-related factors suggests that practice variations and inappropriate admission decisions are likely to occur. Institutional guidelines and timely goals of care discussions with patients with advanced disease and their families could contribute to ensuring appropriate levels of care.
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Affiliation(s)
- Monica Escher
- Division of Palliative Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathieu R Nendaz
- Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland
- Population Health Laboratory, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Patricia Hudelson
- Department of Primary Care, University Hospitals of Geneva, Geneva, Switzerland
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Sukockienė E, Iancu Ferfoglia R, Boegli M, Lefranc Barranco C, Truffert A, Héritier Barras AC, Genton L, Leuchter I, Adler D, Janssens JP, Escher M. Early advance care planning in amyotrophic lateral sclerosis patients: results of a systematic intervention by a palliative care team in a multidisciplinary management programme - a 4-year cohort study. Swiss Med Wkly 2021; 151:w20484. [PMID: 33872379 DOI: 10.4414/smw.2021.20484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Although recommended, the implementation of early advance care planning is suboptimal in amyotrophic lateral sclerosis (ALS) patients. Barriers to advance care planning include healthcare professionals’ and patients’ reluctance, and uncertainty about the right time to initiate a discussion. AIM OF THE STUDY To determine how often advance care planning was initiated, and the content of the discussion in a first routine palliative care consultation integrated within a multidisciplinary management programme. METHODS Between June 2012 and September 2016, a prospective cohort study was conducted in Geneva University Hospitals. Sixty-eight patients were seen every 3 months for a 1-day clinical evaluation in a day care centre. RESULTS The patients’ mean ± standard deviation age was 68.6 ± 11.9 years, 50% were women. Four patients were excluded because of dementia. Advance care planning was initiated with 49 (77%) patients in the first palliative care consultation. Interventions most often addressed were cardiopulmonary resuscitation (49%), intubation and tracheostomy (47%) and palliative sedation (36.7%). Assisted suicide was discussed with 16 patients (36.6%). Functional disability was the only factor associated with initiation of advance care planning. Nearly half of the patients wrote advance directives (45%) or designated a healthcare surrogate (41%). Bulbar onset, functional disability and noninvasive ventilation were not associated with the completion of advance directives. CONCLUSION Early initiation of advance care planning is feasible in most ALS patients during a routine consultation, and relevant treatment issues can be discussed. All ALS patients should be offered the opportunity to write advance directives as completion was not associated with disease severity. .
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Affiliation(s)
- Eglė Sukockienė
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Switzerland
| | - Ruxandra Iancu Ferfoglia
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Switzerland
| | - Monique Boegli
- Pain Consultation, Division of Clinical Pharmacology and Toxicology, Department of Acute Medicine, Geneva University Hospitals, Switzerland
| | - Catherine Lefranc Barranco
- Pain Consultation, Division of Clinical Pharmacology and Toxicology, Department of Acute Medicine, Geneva University Hospitals, Switzerland
| | - André Truffert
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Switzerland
| | | | - Laurence Genton
- Division of Nutrition, Department of Medical Specialties, Geneva University Hospitals, Switzerland
| | - Igor Leuchter
- Division of ENT, Department of Clinical Neurosciences, Geneva University Hospitals, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Switzerland
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Switzerland
| | - Monica Escher
- Palliative Care Consultation, Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Switzerland / Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Switzerland
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20
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Escher M, Nendaz M, Scherer F, Cullati S, Perneger T. Physicians' predictions of long-term survival and functional outcomes do not influence the decision to admit patients with advanced disease to intensive care: A prospective study. Palliat Med 2021; 35:161-168. [PMID: 33063607 DOI: 10.1177/0269216320963931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term survival and functional outcomes should influence admission decisions to intensive care, especially for patients with advanced disease. AIM To determine whether physicians' predictions of long-term prognosis influenced admission decisions for patients with and without advanced disease. DESIGN A prospective study was conducted. Physicians estimated patient survival with intensive care and with care on the ward, and the probability of 4 long-term outcomes: leaving hospital alive, survival at 6 months, recovery of functional status, and recovery of cognitive status. Patient mortality at 28 days was recorded. We built multivariate logistic regression models using admission to the intensive care unit (ICU) as the dependent variable. SETTING/PARTICIPANTS ICU consultations for medical inpatients at a Swiss tertiary care hospital were included. RESULTS Of 201 evaluated patients, 105 (52.2%) had an advanced disease and 140 (69.7%) were admitted to the ICU. The probability of admission was strongly associated with the expected short-term survival benefit for patients with or without advanced disease. In contrast, the predicted likelihood that the patient would leave the hospital alive, would be alive 6 months later, would recover functional status, and would recover initial cognitive capacity was not associated with the decision to admit a patient to the ICU. Even for patients with advanced disease, none of these estimated outcomes influenced the admission decision. CONCLUSIONS ICU admissions of patients with advanced disease were determined by short-term survival benefit, and not by long-term prognosis. Advance care planning and developing decision-aid tools for triage could help limit potentially inappropriate admissions to intensive care.
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Affiliation(s)
- Monica Escher
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland.,Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fabienne Scherer
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Cullati
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
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Sukockienė E, Iancu Ferfoglia R, Truffert A, Héritier Barras AC, Genton L, Viatte V, Leuchter I, Escher M, Horie N, Poncet A, Pasquina P, Adler D, Janssens JP. Multidisciplinary care in amyotrophic lateral sclerosis: a 4-year longitudinal observational study. Swiss Med Wkly 2020; 150:w20258. [PMID: 32579697 DOI: 10.4414/smw.2020.20258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Over a four-year period, ALS patients complied with the modalities of the multidisciplinary management follow-up without any drop-outs. The multidisciplinary management structure also contributes to increasing the experience and knowledge of the clinicians involved in managing patients suffering from this rare disease.
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Affiliation(s)
- Eglė Sukockienė
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Ruxandra Iancu Ferfoglia
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland / Faculty of Medicine, University of Geneva, Switzerland
| | - André Truffert
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland / Faculty of Medicine, University of Geneva, Switzerland
| | - Anne-Chantal Héritier Barras
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland /Faculty of Medicine, University of Geneva, Switzerland
| | - Laurence Genton
- Clinical Nutrition, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland / Faculty of Medicine, University of Geneva, Switzerland
| | - Valérie Viatte
- Clinical Nutrition, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Igor Leuchter
- Division of ENT, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland / Faculty of Medicine, University of Geneva, Switzerland
| | - Monica Escher
- Division of Palliative Care, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland / Faculty of Medicine, University of Geneva, Switzerland
| | - Ninon Horie
- Centre for Clinical Research, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Poncet
- Centre for Clinical Research and Division of Clinical Epidemiology, Department of Health and Community medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Patrick Pasquina
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland / Faculty of Medicine, University of Geneva, Switzerland
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland / Faculty of Medicine, University of Geneva, Switzerland
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22
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Cerutti B, Stollar F, Escher M, Blondon K, Aujesky S, Nendaz M, Galetto-Lacour A. Comparison of long-menu and single-best-answer multiple choice questions in computer-based summative assessments: a randomised controlled trial. BMC Med Educ 2019; 19:219. [PMID: 31215430 PMCID: PMC6582573 DOI: 10.1186/s12909-019-1651-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Little is known regarding the psychometric properties of computerized long-menu formats in comparison to classic formats. We compared single-best-answer (Type A) and long-menu formats using identical question stems during the computer-based, summative, intermediate clinical-clerkship exams for nine disciplines. METHODS In this randomised sequential trial, we assigned the examinees for every summative exam to either the Type A or long-menu format (four different experimental questions, otherwise identical). The primary outcome was the power of discrimination. The study was carried out at the Faculty of Medicine, University of Geneva, Switzerland, and included all the students enrolled for the exams that were part of the study. Examinees were surveyed about the long-menu format at the end of the trial. RESULTS The trial was stopped for futility (p = 0.7948) after 22 exams including 88 experimental items. The long-menu format had a similar discriminatory power but was more difficult than the Type A format (71.45% vs 77.80%; p = 0.0001). Over half of the options (54.4%) chosen by the examinees in long-menu formats were not proposed as distractors in the Type A formats. Most examinees agreed that their reasoning strategy was different. CONCLUSIONS In a non-selected population of examinees taking summative exams, long-menu questions have the same discriminatory power as classic Type A questions, but they are slightly more difficult. They are perceived to be closer to real practice, which could have a positive educational impact. We would recommend their use in the final years of the curriculum, within realistic key-feature problems, to assess clinical reasoning and patient management skills.
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Affiliation(s)
- Bernard Cerutti
- Unit of Development and Research in Medical Education, Faculty of medicine, Faculty of medicine, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland
| | - Fabiola Stollar
- Department of Paediatrics, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Monica Escher
- Unit of Development and Research in Medical Education, Faculty of medicine, Faculty of medicine, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland
- Division of Palliative Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Katherine Blondon
- Medical Directorate of the University Hospitals of Geneva, Geneva, Switzerland
| | - Susanne Aujesky
- Department of Paediatrics, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of medicine, Faculty of medicine, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland
| | - Annick Galetto-Lacour
- Department of Paediatrics, Children’s Hospital, University Hospitals of Geneva, Geneva, Switzerland
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Escher M, Ricou B, Nendaz M, Scherer F, Cullati S, Hudelson P, Perneger T. ICU physicians' and internists' survival predictions for patients evaluated for admission to the intensive care unit. Ann Intensive Care 2018; 8:108. [PMID: 30430269 PMCID: PMC6236006 DOI: 10.1186/s13613-018-0456-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/09/2018] [Indexed: 11/29/2022] Open
Abstract
Background A higher chance of survival is a key justification for admission to the intensive care unit (ICU). This implies that physicians should be able to accurately estimate a patient’s prognosis, whether cared for on the ward or in the ICU. We aimed to determine whether physicians’ survival predictions correlate with the admission decisions and with patients’ observed survival. Consecutive ICU consultations for internal medicine patients were included. The ICU physician and the internist were asked to predict patient survival with intensive care and with care on the ward using 5 categories of probabilities (< 10%, 10–40%, 41–60%, 61–90%, > 90%). Patient mortality at 28 days was recorded. Results Thirty ICU physicians and 97 internists assessed 201 patients for intensive care. Among the patients, 140 (69.7%) were admitted to the ICU. Fifty-eight (28.9%) died within 28 days. Admission to intensive care was associated with predicted survival gain in the ICU, particularly for survival estimates made by ICU physicians. Observed survival was associated with predicted survival, for both groups of physicians. The discrimination of the predictions for survival with intensive care, measured by the area under the ROC curve, was 0.63 for ICU physicians and 0.76 for internists; for survival on the ward the areas under the ROC curves were 0.69 and 0.74, respectively. Conclusions Physicians are able to predict survival probabilities when they assess patients for intensive care, albeit imperfectly. Internists are more accurate than ICU physicians. However, ICU physicians’ estimates more strongly influence the admission decision. Closer collaboration between ICU physicians and internists is needed. Electronic supplementary material The online version of this article (10.1186/s13613-018-0456-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monica Escher
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland. .,Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Bara Ricou
- Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fabienne Scherer
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Stéphane Cullati
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Patricia Hudelson
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
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Abstract
A 20-year-old woman presented with acute exacerbation of ulcerative colitis. After treatment with infliximab, she developed a fulminant liver failure. Under supportive therapy and steroid medication, recovery of symptoms and transaminases occurred. A few case reports about hepatic side effects of anti-TNF-α antibodies in patients with inflammatory bowel disease have been published. These side effects ranged from asymptomatic increase of transaminases to fulminant liver failure necessitating transplantation. The pathomechanism is not fully understood; in some case reports autoimmune phenomena have been described.
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Affiliation(s)
- R Forker
- Gastroenterologie, Rems-Murr-Klinik-Schorndorf, Schlichtener Str. 105, 73614, Schorndorf, Deutschland.
| | - M Escher
- Gastroenterologische Schwerpunktpraxis, Leonberg, Deutschland
| | - E F Stange
- Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland
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25
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Escher M, Cullati S, Hudelson P, Nendaz M, Ricou B, Perneger T, Dayer P. Admission to intensive care: A qualitative study of triage and its determinants. Health Serv Res 2018; 54:474-483. [PMID: 30362106 DOI: 10.1111/1475-6773.13076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine physicians' decision making and its determinants about admission to intensive care. DATA SOURCES/STUDY SETTING ICU physicians (n = 12) and internists (n = 12) working in a Swiss tertiary care hospital. STUDY DESIGN We conducted in-depth interviews. DATA COLLECTION/EXTRACTION METHODS Interviews were analyzed using an inductive thematic approach. PRINCIPAL FINDINGS Admission decisions regarding seriously ill or elderly patients with comorbidities are complex. Nonmedical factors such as ICU beds availability, health care resources on the ward, information about patient preferences, and family behavior determine the decision. Code status and the quality of interaction between physicians are key determinants. The absence of code status or poor documentation of code status discussions makes decisions more difficult and laden emotionally, as physicians feel they are making a life-death decision. Mutual respect and collaborative decision making facilitate the decision. Tensions arise due to ICU physicians' postponing the decision because of lack of beds, ICU physicians' dismissive attitudes, perceived shortcomings in the other physician's completion of expected tasks, and preconceptions about the other physician. CONCLUSIONS Systematic documentation of code status, and fostering collaboration between ICU physicians and internists would facilitate ICU admission decisions in complex clinical situations.
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Affiliation(s)
- Monica Escher
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.,Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Bara Ricou
- Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Dayer
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
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Richtering SS, Darbellay Farhoumand P, Escher M. [Would you want to be resuscitated if you heart stops Code status discussions in the hospital setting]. Rev Med Suisse 2018; 14:1854-1858. [PMID: 30329232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Doctors are responsible for code status discussions with patients in the hospital setting. However, several barriers are associated with these discussions, relating to both doctors and patients. Inadequate or insufficient communication can lead to inappropriate care, contrary to patients' preferences and, subsequently, to a suboptimal use of health care resources. Ways to improve these discussions have been identified, such as doctor-targeted educational programs and inserting decisions about code status within a more general discussion of patients' goals of care. These interventions could allow a better understanding and consideration of patients' values and preferences, hence improving shared-decision making about cardiopulmonary resuscitation.
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Affiliation(s)
- Sarah Samantha Richtering
- Service de médecine interne générale, Département de médecine interne, de réhabilitation et de gériatrie, HUG, 1211 Genève 14
| | - Pauline Darbellay Farhoumand
- Service de médecine interne générale, Département de médecine interne, de réhabilitation et de gériatrie, HUG, 1211 Genève 14
| | - Monica Escher
- Equipe mobile douleur et soins palliatifs, Service de pharmacologie et toxicologie cliniques, Département d'anesthésiologie, pharmacologie et soins intensifs, HUG, 1211 Genève 14
- Unité de développement et recherche en éducation médicale (UDREM), Faculté de médecine, Université de Genève, 1211 Genève 4
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Cullati S, Hudelson P, Ricou B, Nendaz M, Perneger TV, Escher M. Internists' and intensivists' roles in intensive care admission decisions: a qualitative study. BMC Health Serv Res 2018; 18:620. [PMID: 30089526 PMCID: PMC6083517 DOI: 10.1186/s12913-018-3438-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive care Unit (ICU) admission decisions involve collaboration between internists and intensivists. Clear perception of each other's roles is a prerequisite for good collaboration. The objective was to explore how internists and intensivists perceive their roles during admission decisions. METHODS Individual in-depth interviews with 12 intensivists and 12 internists working at a Swiss teaching hospital. Interviews were analyzed using a thematic approach. RESULTS Roles could be divided into practical roles and identity roles. Internist and intensivists had the same perception of each other's practical roles. Internists' practical roles were: recognizing signs of severity when the patient becomes acutely ill, calling the intensivist at the right moment, having the relevant information about the patient and having determined the goals of care. Intensivists' practical roles were: assessing the patient on the ward, giving expert advice, making quick decisions, managing access to the ICU, having the final decision power and, sometimes, deciding whether or not to limit treatment. In complex situations, perceived flaws in performing practical roles could create tensions between the doctors. Intensivists' identity roles included those of leader, gatekeeper, life-death decision maker, and supporting colleague doctors (consultant, senior and helper). These roles could be perceived as emotionally burdensome. Internists' identity roles were those of leader and partner. CONCLUSIONS Despite a common perception of each other's practical roles, tensions can arise between internists and intensivists in complex situations of ICU admission decisions. Training in communication skills and interprofessional education interventions aimed at a better understanding of each other roles would improve collaboration.
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Affiliation(s)
- Stéphane Cullati
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Bara Ricou
- Intensive Care Unit, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Department of General Internal Medicine, Geriatrics and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas V. Perneger
- Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Monica Escher
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Luthy C, Chaves-Iselin I, Kupferschmid S, Bollondi-Pauly C, Pautex S, Escher M, Broers B, Rehberg-Klug B, Cedraschi C, Piguet V. [Pain management in adult medico-surgical wards : practical guidelines]. Rev Med Suisse 2018; 14:1296-1300. [PMID: 29944297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Guidelines for pain management in the medical and surgical departments of the Geneva University Hospitals (GUH) have been systematically developed using a multidisciplinary approach. These guidelines are aimed towards improving healthcare quality. We point to the ways the pain network of the GUH has elected to deal with the ever-increasing progression of concepts regarding pain management. This is of importance at a time when the risks related to the patients' transitions between the different departments, to the specificities of the clinical practices, and to the need for personalized care have never been so high.
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Affiliation(s)
- Christophe Luthy
- Service de médecine interne de réhabilitation de Beau-Séjour, Département de réhabilitation et gériatrie, HUG, 1211 Genève 14
| | | | | | | | - Sophie Pautex
- Service de médecine de premier recours, HUG, 1211 Genève 14
| | - Monica Escher
- Service de pharmacologie et toxicologie cliniques, HUG, 1211 Genève 14
| | - Barbara Broers
- Service de médecine de premier recours, HUG, 1211 Genève 14
| | | | - Christine Cedraschi
- Service de médecine interne de réhabilitation de Beau-Séjour, Département de réhabilitation et gériatrie, HUG, 1211 Genève 14
- Service de pharmacologie et toxicologie cliniques, HUG, 1211 Genève 14
| | - Valérie Piguet
- Service de pharmacologie et toxicologie cliniques, HUG, 1211 Genève 14
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Rakic M, Escher M, Elger BS, Eckstein S, Pacurari N, Zwahlen S, Wienand I. Feelings of Burden in Palliative Care: A Qualitative Analysis of Medical Records. J Palliat Care 2018; 33:32-38. [PMID: 29301449 DOI: 10.1177/0825859717750522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Care for palliative care patients is often provided by unpaid caregivers (eg, family members) who take care of the patient's daily needs (eg, bathing, dressing). Family members of palliative care patients are involved in numerous ways. These tasks and responsibilities can make them feel burdened and even overburdened. AIM We specifically looked at patients' medical records to determine what is being reported about burden and overburden and who seems to be mostly affected. Burden was understood as a weight or task that is difficult to accept or carry, whereas overburden indicates that this weight or task cannot be carried anymore. METHODS We looked at 300 medical records of palliative care patients written by health-care professionals. Written notes were analyzed using latent content analysis as it helps to analyze large amounts of textual data qualitatively and to understand the underlying concepts of what was said. RESULTS Most (73.5%) patients had a cancer diagnosis. Mean age was 67.6 years (range, 22-98 years). Burden and overburden were identified as main categories and further divided into the following subcategories: for patients and families. According to the written notes, patients often felt burdened by their disease, financial problems, situation at home, and families' reactions to their disease. By and large, patients felt overburdened by their own disease. Families often felt burdened because of issues related to patients' medical condition, providing home care, or financial and social aspects. Families mentioned home care and the decision-making process as being overburdening. CONCLUSION Findings in the palliative care patients' medical records are inasmuch important, as they point at the health-care staff's awareness of possible weights and tasks that might be burdensome for patients and their families. Attention should be drawn to the documentation of medical records in order to identify recurrent difficulties and to help discuss these.
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Affiliation(s)
- Milenko Rakic
- 1 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Monica Escher
- 2 Division of Clinical Pharmacology and Toxicology, Pain and Palliative Care Consultation, Geneva University Hospitals, Geneva, Switzerland
| | - Bernice S Elger
- 1 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Sandra Eckstein
- 3 Palliative Care, University Hospital Basel, Basel, Switzerland
| | - Nadia Pacurari
- 1 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Susanne Zwahlen
- 4 Centre for Palliative Care, University Hospital Bern, Bern, Switzerland
| | - Isabelle Wienand
- 1 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Pautex S, Vayne-Bossert P, Bernard M, Beauverd M, Cantin B, Mazzocato C, Thollet C, Bollondi-Pauly C, Ducloux D, Herrmann F, Escher M. Validation of the French Version of the Edmonton Symptom Assessment System. J Pain Symptom Manage 2017; 54:721-726.e1. [PMID: 28751077 DOI: 10.1016/j.jpainsymman.2017.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 01/29/2023]
Abstract
CONTEXT The Edmonton Symptom Assessment System (ESAS) is a brief, widely adopted, multidimensional questionnaire to evaluate patient-reported symptoms. OBJECTIVES The objective of this study was to define a standard French version of the ESAS (F-ESAS) to determine the psychometric properties in French-speaking patients. METHODS In a first pilot study, health professionals (n = 20) and patients (n = 33) defined the most adapted terms in French (F-ESAS). In a prospective multicentric study, palliative care patients completed the three forms of F-ESAS (F-ESAS-VI, F-ESAS-VE, and F-ESAS-NU, where VI is visual, VE, verbal, and NU, numerical), the Hospital Anxiety and Depression Scale. All patients had a test-retest evaluation during the same half-day. Standardized distraction material was used between each scale. RESULTS One hundred twenty-four patients were included (mean age [±SD]: 68.3 ± 12; 70 women; 54 men). Test-retest reliability was high for all three F-ESAS, and the correlation between these scales was nearly perfect (Spearman rs = 0.66-0.91; P < 0.05). F-ESAS-VI, F-ESAS-VE, and F-ESAS-NU performed similarly and were equally reliable, although there was a trend toward lower reliability for F-ESAS-VI. Correlation between F-ESAS depression and anxiety and HADS depression and anxiety, respectively, were positive (Spearman rs = 0.38-0.41 for depression; Spearman rs = 0.48-0.57 for anxiety, P < 0.05). Among patients, 59 (48%), 45 (36%), and 20 (16%) preferred to assess their symptoms with F-ESAS-VE, F-ESAS-NU, and F-ESAS-VI, respectively. CONCLUSION The F-ESAS is a valid and reliable tool for measuring multidimensional symptoms in French-speaking patients with an advanced cancer. All forms of F-ESAS performed well with a trend for better psychometric performance for F-ESAS-NU, but patients preferred the F-ESAS-VE.
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Affiliation(s)
- Sophie Pautex
- Division of Primary Care, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
| | - Petra Vayne-Bossert
- Division of Palliative Medicine, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Mathieu Bernard
- Division of Supportive and Palliative Care, Lausanne, Switzerland
| | - Michel Beauverd
- Division of Supportive and Palliative Care, Lausanne, Switzerland
| | - Boris Cantin
- Division of palliative care, Hôpitaux Fribourgeois, Fribourg, Switzerland
| | | | | | | | - Dominique Ducloux
- Division of Palliative Medicine, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - François Herrmann
- Division of Geriatrics, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Monica Escher
- Pain and Palliative Care Consultation, Division of Pharmacology and Toxicology, University Hospital Geneva and Geneva University, Geneva, Switzerland
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Escher M, Lamuela-Naulin M, Bollondi C, Flores Menendez P, Hurst SA. Should gratitude be a requirement for access to live organ donation? J Med Ethics 2017; 43:762-765. [PMID: 28356491 DOI: 10.1136/medethics-2016-103698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 12/19/2016] [Accepted: 03/06/2017] [Indexed: 06/06/2023]
Abstract
Gratitude is both expected and problematic in live organ donation. Are there grounds to require it, and to forbid access to live donor transplantation to a recipient who fails to signal that he feels any form of gratitude? Recipient gratitude is not currently required for organ donation, but it is expected and may be a moral requirement. Despite this, we argue that making it a condition for live organ transplantation would be unjustified. It would constitute a problematic and disproportionate punishment for perceived immoral behaviour on the part of the recipient. It would also bar the donor from positive aspects of organ donation that remain even in the absence of recipient gratitude. A potential recipient's lack of gratitude should be explored as a possible symptom of other morally problematic issues and integrated into the information provided to the potential donor. Recognition of the donor's gift and gratitude for it may also need to be expressed in part by others. This last aspect is relevant even in cases where the recipient feels and expresses gratitude.
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Affiliation(s)
- Monica Escher
- Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Monique Lamuela-Naulin
- Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland
- Gynecology and obstetrics department, Geneva University Hospitals, Geneva, Switzerland
| | - Catherine Bollondi
- Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland
- Direction of care, Geneva University Hospitals, Geneva, Switzerland
| | - Paola Flores Menendez
- Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland
- External affairs directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Samia A Hurst
- Clinical Ethics Council, Geneva University Hospitals, Geneva, Switzerland
- Institute for Ethics, History, and the Humanities, Geneva University Medical School, Switzerland
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Escher M, Nendaz M, Ricou B. [Admission to intensive care of palliative care patients : the stakes and factors influencing the decision]. Rev Med Suisse 2017; 13:323-325. [PMID: 28708342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Palliative care patients have limited prospects of survival and the benefit of intensive care is uncertain. To make a decision there are considerations other than survival probabilities. Patients should receive appropriate care and be spared suffering. End of life in the intensive care unit has an impact on families, who may develop psychological problems or complicated grief. End of life care can be a source of conflicts and cause burnout in health providers. Finally, intensive care is an expensive resource, which must be fairly allocated. In these complex situations, patient preferences help make a decision. However, they have often not been discussed with the physicians. General practitioners have a role to play by promoting advance care planning with their patients.
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Affiliation(s)
- Monica Escher
- Equipe mobile douleur et soins palliatifs, Service de pharmacologie et toxicologie cliniques, HUG, 1211 Genève 14
| | - Mathieu Nendaz
- Service de médecine interne générale, HUG, 1211 Genève 4
- Unité de développement et de recherche en éducation médicale, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Bara Ricou
- Service des soins intensifs, HUG, 1211 Genève 14
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Rollason V, Spahr L, Escher M. Severe liver injury due to a homemade flower pollen preparation in a patient with high CYP3A enzyme activity: a case report. Eur J Clin Pharmacol 2016; 72:507-8. [DOI: 10.1007/s00228-015-1986-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
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Bosilkovska M, Ing Lorenzini K, Uppugunduri CRS, Desmeules J, Daali Y, Escher M. Severe Vincristine-induced Neuropathic Pain in a CYP3A5 Nonexpressor With Reduced CYP3A4/5 Activity: Case Study. Clin Ther 2015; 38:216-20. [PMID: 26565076 DOI: 10.1016/j.clinthera.2015.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE Peripheral neuropathy is a frequent vincristine-induced adverse effect. Vincristine is a substrate of P-glycoprotein and is metabolized by the cytochrome P-450 (CYP) 3A5 and 3A4 isoforms, with CYP3A5 contributing to 75% of the intrinsic clearance of vincristine. Alterations in the function of these proteins may lead to an increase in vincristine toxicity. CYP3A5 nonexpressor status has been associated with vincristine-induced peripheral neuropathy. The severity of neuropathy has been reported to be inversely correlated to vincristine metabolite concentrations. Recently, the presence of a mutation in the CEP72 gene, which encodes for a protein involved in microtubule formation, has also been associated with vincristine-induced peripheral neuropathy. However, a clear correlation between genetic polymorphisms and vincristine toxicity has not been established. METHODS Here we report the case of a 21-year old patient in whom severe neuropathic pain developed after vincristine treatment. FINDINGS The patient was a CYP3A5 nonexpressor and presented with reduced CYP3A4/5 functional activity, a likely reason for the occurrence of the adverse event, as genotyping showed that his status was wild type for the ABCB1 and CEP72 genes. IMPLICATIONS CYP phenotype and genotype may explain the occurrence of severe neuropathy in some patients treated with vincristine.
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Affiliation(s)
- Marija Bosilkovska
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Monica Escher
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.
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Bosilkovska M, Ing Lorenzini K, Desmeules J, Daali Y, Escher M. Vincristine-Induced Neuropathic Pain In A Cyp3a5 Non-Expresser With Reduced Cyp3a4 Activity. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Escher M, Perrier A, Rudaz S, Dayer P, Perneger TV. Doctors' decisions when faced with contradictory patient advance directives and health care proxy opinion: a randomized vignette-based study. J Pain Symptom Manage 2015; 49:637-45. [PMID: 25131892 DOI: 10.1016/j.jpainsymman.2014.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/27/2014] [Accepted: 07/06/2014] [Indexed: 11/18/2022]
Abstract
CONTEXT Sometimes a written advance directive contradicts the opinion of a health care proxy. How this affects doctors' decision making is unknown. OBJECTIVES To quantify the influence of contradictory instructions on doctors' decisions. METHODS All the generalists and internists in French-speaking Switzerland were mailed the questionnaire. Respondents (43.5%) evaluated three vignettes that described medical decisions for incapacitated patients. Each vignette was produced in four versions: one with an advance directive, one with a proxy opinion, one with both, and one with neither (control). In the first vignette, the directive and proxy agreed on the recommendation to forgo a medical intervention; in the second, the advance directive opposed, but the proxy favored the intervention; and in the third, the roles were reversed. Each doctor received one version of each vignette, attributed at random. The outcome variables were the doctor's decision to forgo the medical intervention and the rating of the decision as difficult. RESULTS Written advance directives and proxy opinions significantly influenced doctors' decision making. When both were available and concordant, they reinforced each other (odds ratio [OR] of forgoing intervention 35.7, P < 0.001 compared with no instruction). When the directive and proxy disagreed, the resulting effect was to forgo the intervention (ORs 2.1 and 2.2 for the two discordant vignettes, both P < 0.001). Discordance between instructions was associated with increased odds of doctors rating the decision as difficult (both ORs 2.0, P ≤ 0.001). CONCLUSION Contradictions between advance directives and proxy opinions result in a weak preference for abstention from treatment and increase the difficulty of the decision.
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Affiliation(s)
- Monica Escher
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Geneva, Switzerland.
| | - Arnaud Perrier
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Sandrine Rudaz
- Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Dayer
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas V Perneger
- Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
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Escher M. Dünndarm-Kapselendoskopie: Erythromcyin oder Domperidon? Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1390128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Escher M. Blockade des Nervus vagus: Effektiv gegen morbide Adipositas? Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1390117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Patt M, Wiemann C, Weber N, Escher M, Gloskovskii A, Drube W, Merkel M, Schneider CM. Bulk sensitive hard x-ray photoemission electron microscopy. Rev Sci Instrum 2014; 85:113704. [PMID: 25430117 DOI: 10.1063/1.4902141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hard x-ray photoelectron spectroscopy (HAXPES) has now matured into a well-established technique as a bulk sensitive probe of the electronic structure due to the larger escape depth of the highly energetic electrons. In order to enable HAXPES studies with high lateral resolution, we have set up a dedicated energy-filtered hard x-ray photoemission electron microscope (HAXPEEM) working with electron kinetic energies up to 10 keV. It is based on the NanoESCA design and also preserves the performance of the instrument in the low and medium energy range. In this way, spectromicroscopy can be performed from threshold to hard x-ray photoemission. The high potential of the HAXPEEM approach for the investigation of buried layers and structures has been shown already on a layered and structured SrTiO3 sample. Here, we present results of experiments with test structures to elaborate the imaging and spectroscopic performance of the instrument and show the capabilities of the method to image bulk properties. Additionally, we introduce a method to determine the effective attenuation length of photoelectrons in a direct photoemission experiment.
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Affiliation(s)
- M Patt
- Peter Grünberg Institute (PGI-6) and JARA-FIT, Research Center Jülich, D-52425 Jülich, Germany
| | - C Wiemann
- Peter Grünberg Institute (PGI-6) and JARA-FIT, Research Center Jülich, D-52425 Jülich, Germany
| | - N Weber
- Focus GmbH, Neukirchner Str. 2, D-65510 Hünstetten, Germany
| | - M Escher
- Focus GmbH, Neukirchner Str. 2, D-65510 Hünstetten, Germany
| | - A Gloskovskii
- DESY Photon Science, Deutsches Elektronen-Synchrotron, D-22603 Hamburg, Germany
| | - W Drube
- DESY Photon Science, Deutsches Elektronen-Synchrotron, D-22603 Hamburg, Germany
| | - M Merkel
- Focus GmbH, Neukirchner Str. 2, D-65510 Hünstetten, Germany
| | - C M Schneider
- Peter Grünberg Institute (PGI-6) and JARA-FIT, Research Center Jülich, D-52425 Jülich, Germany
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Escher M. Profitieren Patienten mit Herzinsuffizienz von Telemonitoring? Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1390099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Escher M. Ebola in Westafrika – Resümee der letzten 9 Monate. Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1390111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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De Medici D, Alfonsi V, Bruni R, Busani L, Ciccaglione AR, Di Pasquale S, Equestre M, Escher M, Ricotta L, Rizzo C, Scavia G, Taffon S, Tosti ME, Pompa MG, Martini V, Iannazzo S, Losio MN, Varisco G, Pavoni E, Massaro M, Cappelletti B, Noè P, Menghi A, Guizzardi S, Lena R, Plutino G, Monteleone D, Borrello S. Hepatitis A outbreak in Italy associated with frozen berries. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Escher M. Behandlungszentren für Patienten mit Ebolavirus-Infektion in Deutschland. Dtsch Med Wochenschr 2014; 139:2062-3. [DOI: 10.1055/s-0034-1374712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Escher M. Medikation senkt Rückfallrisiko bei Alkoholproblemen. Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1382115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bouatou Y, Samer C, Ing Lorenzini K, Daali Y, Daou S, Fathi M, Rebsamen M, Desmeules J, Calmy A, Escher M. Therapeutic drug monitoring of voriconazole: a case report of multiple drug interactions in a patient with an increased CYP2C19 activity. AIDS Res Ther 2014; 11:25. [PMID: 25120580 PMCID: PMC4130425 DOI: 10.1186/1742-6405-11-25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Voriconazole is metabolized by cytochrome P450 (CYP) 2C19 and CYP 3A4. Drug-drug interactions and genetic polymorphisms modulate their activities. Case presentation A 35-year old African female patient with resistant HIV and a cerebral mass of unknown origin was treated with voriconazole for a suspicion of disseminated Aspergillosis infection. Voriconazole trough concentrations (C0) were within target range while the patient was under esomeprazole, a CYP2C19 inhibitor. Phenotyping showed decreased CYP2C19 activity, whereas genotyping showed a variant allele associated with increased enzyme activity. The patient was switched to ranitidine because of the introduction of atazanavir. CYP3A4 inhibition by atazanavir combined with uninhibited CYP2C19 activity resulted in subtherapeutic voriconazole C0. The reintroduction of esomeprazole allowed restoring voriconazole C0 back to target range. Conclusion The integration of drug-drug interactions and pharmacogenetics data is crucial to interpret drug concentrations correctly, thus preventing suboptimal exposure to voriconazole.
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Escher M. Senkt natives Olivenöl das kardiovaskuläre Risiko? Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1382107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Escher M. Kolonkarzinom: Neuer Biomarker für Nutzen von ASS gefunden? Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1372298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Escher M. Ledipasvir-Sofosbuvir-Kombination bei chronischer Hepatitis C? Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1372287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Escher M. [Pump system for peritoneal-vesical ascitesdrainage: principle, implantation and studies]. Dtsch Med Wochenschr 2014; 139:1307-9. [PMID: 24892469 DOI: 10.1055/s-0034-1370098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M Escher
- Zentrum für Innere Medizin I, Robert-Bosch-Krankenhaus, Stuttgart
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