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Ravioli S, Jina R, Risk O, Cantle F. Impact of junior doctor strikes on patient flow in the emergency department: a cross-sectional analysis. Eur J Emerg Med 2024; 31:53-58. [PMID: 37851520 DOI: 10.1097/mej.0000000000001093] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND IMPORTANCE Healthcare worker strikes are a global phenomenon. Mortality and morbidity seem to be unaffected by doctor strikes, but there is little evidence on the impact on emergency department (ED) flow and patient characteristics. In March and April 2023, two consecutive UK junior doctor strikes occurred. OBJECTIVES This study investigated the impact of junior doctor strikes on ED patient flow. Additionally, variation in patient presentations was compared between non-strike and strike days. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study was conducted at King's College Hospital ED, a university hospital in London. All ED attendances during the 72- and 96-hour strike actions were compared with the corresponding non-strike days of the previous week. OUTCOME MEASURES AND ANALYSIS National key performance indicators (KPIs) were analysed and compared between non-strike and strike days. Patients' demographics, acuity and diagnoses were compared. Outcome measures included number of 4-hour breaches, number of patients admitted or discharged and ED mortality. Staff seniority was categorised into levels for analysis. MAIN RESULTS There was increased ED patient flow during strike days with a significantly shorter total time in department in March [240 min (IQR 155-469) vs. 286 min (IQR 198.5-523.5), P < 0.001] and in April [222.5 min (IQR 147-351) vs. 251.5 min (IQR 174-443), P < 0.001]. Time to first clinician, treatment, and decision to admit were all shorter during both strike actions. Number of attendances, acuity, diagnoses, admission, discharge, and mortality rates were similar during strike and non-strike days. Staffing numbers were lower or equivalent on strike days but level of seniority was higher ( P < 0.001). CONCLUSION The improved KPIs and increased patient flow during strike days, while multifactorial, seem largely attributed to the higher number of senior staff. Patient presentations and outcomes were unaffected by junior doctor strike action.
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Affiliation(s)
- Svenja Ravioli
- Emergency Department, King's College Hospital NHS Foundation Trust
| | - Raeesa Jina
- Emergency Department, King's College Hospital NHS Foundation Trust
| | - Omar Risk
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Fleur Cantle
- Emergency Department, King's College Hospital NHS Foundation Trust
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Haidinger M, Wechsler P, Ravioli S, Exadaktylos A, Lindner G. Gender equality in palliative medicine editorial boards, authorships and national societies. BMJ Support Palliat Care 2024:spcare-2023-004293. [PMID: 38272655 DOI: 10.1136/spcare-2023-004293] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Michael Haidinger
- Department of Internal Medicine, Bülach Hospital, Bülach, Switzerland
| | - Patrick Wechsler
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Svenja Ravioli
- Department of Emergency Medicine, King's College London, London, UK
| | | | - Gregor Lindner
- Department of Emergency Medicine, Inselspital Universitatsspital Bern, Bern, Switzerland
- Department of Emergency Medicine, Johannes Kepler Universität Linz, Linz, Austria
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Ravioli S, Lafranchi A, Exadaktylos AK, Haidinger M, Lindner G. Characteristics and outcome of severe hypercalcemia on admission to the emergency department: a retrospective cohort study. Swiss Med Wkly 2023; 153:40069. [PMID: 37191138 DOI: 10.57187/smw.2023.40069] [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: 05/17/2023] Open
Abstract
AIMS OF THE STUDY To investigate the prevalence of hypercalcemia (>2.60 mmol/l) and severe hypercalcemia (≥2.80 mmol/l) on admission. Symptoms, causes, course of serum calcium, treatment and outcome of severe hypercalcemia were evaluated and compared to historical data from previous studies. METHODS In this retrospective cohort study, all patients presenting to the interdisciplinary emergency department of the Buergerspital Solothurn between 01 January 2017 and 31 December 2020 with measurements of serum calcium were included. Chart reviews were performed for patients with calcium ≥2.80 mmol/l to assess clinical presentation, course of disease and treatment for severe hypercalcemia. RESULTS Of 31,963 tested patients, 869 patients (2.7%) had hypercalcemia on the admission, of which 161 had severe hypercalcemia. Non-albumin corrected calcium was 3.07 (0.32) while albumin corrected calcium was 3.34 (0.44). Calcium was higher in patients with malignancy-related hypercalcemia (3.18 [0.34] versus 3.00 [0.3], p <0.001). Neuropsychiatric (35%) and gastrointestinal (24%) were the leading symptoms. Malignancy was the most common identifiable cause of hypercalcemia (40%), with lung cancer (20%), multiple myeloma (14%) and renal cell carcinoma (11%) being the main cancer types. 36% of patients with severe hypercalcemia took calcium supplements. Bisphosphonate treatment was an independent predictor of a fall in calcium until day 5 (regression coefficient: -0.404, standard error 0.11, p <0.001). Hypercalcemia was not mentioned in the final discharge report in 38% of cases. CONCLUSION Severe hypercalcemia is common and malignancy-related in almost half of the cases. Neuropsychiatric and gastrointestinal symptoms were most prevalent. Awareness of hypercalcemia, particularly in cancer patients and those with known triggering factors, should be raised in order to identify and treat this harmful disorder early.
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Affiliation(s)
- Svenja Ravioli
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Anne Lafranchi
- Department of Nephrology, Bürgerspital Solothurn, Switzerland
| | | | - Michael Haidinger
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Switzerland
| | - Gregor Lindner
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland
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Ravioli S, Oberle J, Haidinger M, Lindner G. Gender equality in national cardiology societies: a cross-sectional study. Am J Med 2023; 136:585-591. [PMID: 36906170 DOI: 10.1016/j.amjmed.2023.02.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Higher productivity and team stability has been shown for gender diverse teams. However, there is a relevant and well-known gender gap in clinical and academic cardiovascular medicine. So far, no data concerning gender distribution in presidents and executive boards of national cardiology societies exist. METHODS In this cross-sectional analysis, gender equality in presidents and representatives of all national cardiology societies, which are members of or affiliated with the European Society of Cardiology (ESC) in 2022 was analyzed. In addition, representatives of the American Heart Association (AHA) were evaluated. RESULTS A total of 106 national societies were screened of which 104 were included in the final analysis. Overall, in these 104 societies, 90 out of 106 (85%) presidents were men while 14 (13%) were women. In the analysis of board members and executives, a total of 1128 individuals were included. Overall, 809 (72%) board members were men, 258 (23%) women and 61 (5%) of unknown gender. Except for society presidents in Australia, women were relevantly outnumbered by men in all world regions. CONCLUSION Women were globally underrepresented in leading positions of national cardiology societies in all world regions. As national societies are important regional stakeholders, improving gender equality in executive boards might create women role models, help foster careers and narrow the global cardiology gender gap.
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Affiliation(s)
- Svenja Ravioli
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jolanda Oberle
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Michael Haidinger
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Gregor Lindner
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Switzerland.
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Meier-Irmer S, Ravioli S, Pluess E. Ultrasound-Guided Conservative Treatment of Pyomyositis Due to Metamizole-Induced Agranulocytosis. Journal of Diagnostic Medical Sonography 2022. [DOI: 10.1177/87564793221134250] [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: 11/08/2022]
Abstract
Metamizole-induced agranulocytosis is a rare adverse drug reaction with common infectious complications. In this context, pyomyositis of the extremities has not yet been described. Usually, pyomyositis is treated with a combination of antibiotics and surgical intervention. Sonography is described as diagnostic tool for pyomyositis but without defined concrete characteristics for follow-up. This case report describes a widespread pyomyositis due to a metamizole-induced agranulocytosis, which was treated conservatively, using sonography for surveillance.
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Affiliation(s)
- Sandra Meier-Irmer
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Svenja Ravioli
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Emanuel Pluess
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
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Ravioli S, Rohn V, Lindner G. Hypernatremia at presentation to the emergency department: a case series. Intern Emerg Med 2022; 17:2323-2328. [PMID: 36114318 PMCID: PMC9483287 DOI: 10.1007/s11739-022-03097-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022]
Abstract
Disorders of serum sodium are common findings in patients presenting to the emergency department (ED). The aim of this study was to systematically investigate the prevalence, symptoms, etiology, treatment as well as the course of hypernatremia present on admission to the ED. All adult patients with measurements of serum sodium presenting to the ED between 01 January 2017 and 31 December 2020 were included in this retrospective cohort study. Chart reviews were performed for all patients with hypernatremia defined as serum sodium > 147 mmol/L. 376 patients (0.7%) had a serum sodium > 145 mmol/L on admission and 109 patients (0.2%) had clinically relevant hypernatremia > 147 mmol/L. Main symptoms included somnolence (42%) followed by disorientation (30%) and recent falls (17%). An impaired sense of thirst was the main cause of hypernatremia as present in 76 patients (70%), followed by a lack of free access to water in 50 patients (46%). Regarding treatment, only one patient received targeted oral hydration and 38 patients (35%) experienced inadequate correction of hypernatremia as defined as either a correction of < 2 mmol/L or further increasing sodium during the first 24 h. 25% of patients with hypernatremia died during the course of their hospital stay. Patients who died had significantly lower correction rates of serum sodium (0 mmol/L (-3 - 1.5) versus - 6 mmol/L (-10 - 0), p < 0.001). Hypernatremia is regularly encountered in the ED and patients present with unspecific neurologic symptoms. Initial treatment and correction of hypernatremia are frequently inadequate with no decrease or even increase in serum sodium during the first 24 h.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland.
| | - Vanessa Rohn
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
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7
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Haidinger M, Ravioli S, Lindner G. Equality in Recipients of Nephrology Awards from International Societies. Kidney Med 2022; 4:100505. [PMID: 36061367 PMCID: PMC9437596 DOI: 10.1016/j.xkme.2022.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Marti F, Lindner G, Ravioli S. Resistance to local anaesthetics: a literature review. Br J Anaesth 2022; 129:e43-e45. [PMID: 35718562 DOI: 10.1016/j.bja.2022.05.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Florian Marti
- Department of Anaesthesiology and Intensive Care Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland; Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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9
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Lindner G, Ravioli S. The Reply. Am J Med 2022; 135:e110. [PMID: 35525565 DOI: 10.1016/j.amjmed.2022.01.027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
| | - Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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10
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Ryser B, Rudenko A, Haidinger M, Exadaktylos AK, Ravioli S, Lindner G. Gender distribution in speakers at emergency medicine conferences. Am J Emerg Med 2022; 53:161-162. [DOI: 10.1016/j.ajem.2022.01.023] [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: 01/07/2022] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022] Open
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11
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Lindner G, Ravioli S. The Reply. Am J Med 2022; 135:e84. [PMID: 35249637 DOI: 10.1016/j.amjmed.2021.10.039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
| | - Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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12
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Ravioli S, Lindner G, Haidinger M. Gender Distribution in Presidents and Board Members of European Nephrology Societies. Clin Kidney J 2021; 15:1017-1018. [PMID: 35498892 PMCID: PMC9050545 DOI: 10.1093/ckj/sfab259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Michael Haidinger
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
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13
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Ravioli S, Moser N, Ryser B, Pfortmueller CA, Lindner G. Gender distribution in boards of intensive care medicine societies. J Crit Care 2021; 68:157-162. [PMID: 34836749 DOI: 10.1016/j.jcrc.2021.11.006] [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: 10/19/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The established gender gap in intensive care medicine is larger compared to other medical specialties. The aim of this study was to evaluate gender distribution in boards of intensive care medicine societies worldwide. METHODS In this cross-sectional analysis, board members and presidents of all intensive care medicine societies associated with the European Society of Intensive Care Medicine were eligible for study inclusion. Exclusion criteria were: A) society without focus on intensive care and B) online information unavailable. RESULTS In 2021, 65 presidents and 820 board members were analyzed. Ten presidents (15%) and 231 board members (28%) were women. The proportion of women presidents reached from 0% in Africa to 20% in Europe and South America. The proportion of women board members was highest in North and South America with 42% and 46% respectively and lowest in Africa (21%) and Asia (10%). In Europe, 31% of board members were women and 35% in Australia/New Zealand. Among presidents, women were underrepresented in all continents while gender distribution among board members varied significantly between countries (p < 0.0001). CONCLUSION Our analysis reveals an inequality in gender distribution in the boards of national intensive care medicine societies which varies but persists for all global regions.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland.
| | - Nathalie Moser
- Department of Anesthesiology, Buergerspital Solothurn, Switzerland
| | - Basil Ryser
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | | | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
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Ravioli S, Rupp A, Exadaktylos AK, Lindner G. Gender distribution in emergency medicine journals: editorial board memberships in top-ranked academic journals. Eur J Emerg Med 2021; 28:380-385. [PMID: 34115712 DOI: 10.1097/mej.0000000000000842] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite an established gender gap in academic medicine, evidence on gender diversity in emergency medicine is scarce. In the present study, gender distribution of editorial boards and among editors-in-chief of 31 emergency medicine journals was investigated in 2020/2021 and compared to 2015 and 2010. Additionally, gender distribution in editorial boards of emergency medicine journals was compared to editorial boards in five different medical specialties. METHODS In this cross-sectional analysis, gender of editorial board members and editors-in-chief of journals ranked in the Clarivate Analytics 'Journal Citation Report' (JCR) of 2019 in the sections 'Emergency Medicine', 'Medicine General and Internal', 'Surgery', 'Obstetrics and Gynecology', 'Pediatrics' and 'Orthopedics' were analyzed. RESULTS In the investigated 31 emergency medicine journals, three out of 35 editors-in-chief (9%) and 299 out of 1810 editorial board members (17%) were women in 2020/2021. In 2015 and 2010, two editors-in-chief were women (13% vs. 15%). In 2015, 19% of editorial board members were women and in 2010 it was 18%, respectively. There was no significant difference in gender distribution among editors-in-chief and editorial board members comparing 2020/2021 with 2015 and 2010 (P = 0.76 vs. P = 0.40, respectively). There was a lower percentage of women in editorial boards of emergency medicine journals compared to the top five JCR-ranked journals in the categories 'Medicine General and Internal', 'Surgery', 'Gynecology and Obstetrics' and 'Pediatrics'. CONCLUSION The gender gap in editorial boards and among editors-in-chief of emergency medicine journals seems to be consistent for the last 10 years. Gender disparity appears to be substantial in academic emergency medicine: The percentage of women in emergency medicine editorial boards was lower compared to editorial boards of four other medical specialties.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn
| | - Adrienne Rupp
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn
| | | | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn
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Ravioli S, Gygli R, Lindner G. The possibility of heart failure in patients with "Pneumonia" -Author's reply. Eur J Intern Med 2021; 91:84. [PMID: 34289954 DOI: 10.1016/j.ejim.2021.06.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland.
| | - Rebecca Gygli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
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16
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Affiliation(s)
- Basil Ryser
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500 Solothurn, Switzerland
| | - Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500 Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500 Solothurn, Switzerland.
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Lindner G, Rupp A, Exadaktylos AK, Ravioli S. Gender distribution in board memberships of emergency medicine societies. Am J Emerg Med 2021; 47:176-179. [PMID: 33892332 DOI: 10.1016/j.ajem.2021.04.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/08/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Gender gaps have been described regarding the chairpersons in academic emergency departments, the composition of editorial boards and publications in emergency medicine. The objective of this study was to determine the gender distribution of chairpersons and board members of emergency medicine societies worldwide. MATERIALS AND METHODS In this cross-sectional analysis, websites of national emergency medicine societies worldwide were screened for the composition of executive boards and the respective chairpersons. The gender of the board members and chairpersons was obtained either by the profile on the respective web site and/or by internet search and gender identification software. Descriptive statistics were performed and results for national societies were stratified by continent. RESULTS A total of 61 boards of national emergency medicine societies were analyzed. Detailed information on the board composition was available for 50 societies, of which 27 were from Europe, 10 from Asia, five from Africa, four from North America, three from South America and one from Australasia. A total of 603 persons were included in the analysis. 45 (82%) of the listed societies' presidents were male, while 10 (18%) were female. 385 (70%) of the non-president board members were male. The highest proportion of female board members was seen in Australia/New Zealand with five out of eight persons (62%) followed by South America with 13 out of 29 (45%). CONCLUSIONS A marked gender disparity was found for emergency medicine societies worldwide in terms of chair functions as well as board composition. Wide regional differences were found between world regions.
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Affiliation(s)
- Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland.
| | - Adrienne Rupp
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | | | - Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
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Ravioli S, Woitok BK, Lindner G. BRASH syndrome - fact or fiction? A first analysis of the prevalence and relevance of a newly described syndrome. Eur J Emerg Med 2021; 28:153-155. [PMID: 33674517 DOI: 10.1097/mej.0000000000000762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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Ravioli S, Gygli R, Funk GC, Exadaktylos A, Lindner G. Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis. Eur J Intern Med 2021; 85:63-67. [PMID: 33358686 DOI: 10.1016/j.ejim.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/29/2020] [Revised: 11/05/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Disorders of sodium and potassium are common and predictors of adverse outcome. Prevalence and impact on outcome of hypokalemia, hyperkalemia, hyponatremia and hypernatremia were investigated in emergency patients with community-acquired pneumonia (CAP). METHODS Patients ≥18 years presenting to our emergency department between January 1st 2017 and December 31st 2018 with on-admission electrolyte measurements were included. Chart reviews were performed to identify patients with CAP. RESULTS 19.948 cases had measurements of sodium and potassium of which 469 had CAP (2.4%). Prevalence of hypo- and hypernatremia was significantly increased in patients with compared to those without CAP (hyponatremia: 28.8% vs. 10.5% respectively, p<0.0001; hypernatremia: 1.9% vs. 0.6% respectively, p=0.002). The prevalence of hypo- and hyperkalemia was significantly higher in patients with than without CAP (hypokalemia 15.6% vs. 11.4% respectively, p=0.004; hyperkalemia: 4.5% vs. 2.0% respectively, p=0.001). Hyponatremia was significantly associated with longer hospital stay in patients with CAP (regression coefficient 0.194, standard error 0.079, p=0.015). None of the investigated electrolyte disorders were predictive of 30-day re-admission and 180-day pneumonia recurrence rates. Use of loop diuretics was an independent predictor for 30-day re-admission (OR 2.351 (1.099-5.03). p=0.028). Pneumonia Severity Index (PSI) risk class was an independent predictor of 180-day pneumonia recurrence (OR 1.494 (1.022-2.184), p=0.038). CONCLUSION Dysnatremias and dyskalemias are common findings complicating CAP in emergency patients. Prevalence of hyponatremia was highest followed by hypokalemia. Hyponatremia was an independent predictor of prolonged length of hospital stay. Loop diuretic use was associated with 30-day readmission and PSI risk class with 180-day pneumonia recurrence.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland.
| | - Rebecca Gygli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | | | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Switzerland
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Ravioli S, Pluess E, Funk GC, Walter P, Schwarz C, Exadaktylos AK, Woitok BK, Lindner G. Dyskalemias in patients with acute kidney injury presenting to the emergency department are common and independent predictors of adverse outcome. Int J Clin Pract 2021; 75:e13653. [PMID: 32770846 DOI: 10.1111/ijcp.13653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND No data concerning the prevalence and risk factors of dyskalemia in acute kidney injury (AKI) exist. We investigated (a) prevalence rates, (b) risk factors and (c) outcome of hypo- and hyperkalemia in emergency patients. METHODS In this cross-sectional analysis, all patients admitted to the emergency department of a large public hospital in Switzerland between January 1st 2017 and December 31st 2018 with measurements of creatinine and potassium were included. Baseline characteristics, medication and laboratory data were extracted. Chart reviews were performed to identify patients with a diagnosis of chronic kidney disease (CKD) and to extract their baseline creatinine. For all other patients, the ADQI backformula was used in order to calculate baseline creatinine. AKI was graduated using creatinine criteria of the acute kidney injury network. Binary logistic regression analysis was used to identify risk factors for appearance of hyperkalemia and outcome. RESULTS AKI was found in 8% of patients. Hyperkalemia was present in 13% and hypokalemia in 11% of patients with AKI. AKI stage, potassium-sparing diuretics, ACE inhibitors and underlying CKD were the strongest risk factors for hyperkalemia. Hyperkalemia as well as profound hypokalemia were independently associated with prolonged length of stay and in-hospital mortality. The study is limited by its dependency on chart review data in order to identify patients with chronic kidney disease and by limitations of the ADQI backformula to calculate baseline creatinine. CONCLUSIONS Dyskalemias are common in emergency patients with AKI and are independent risk factors for adverse outcomes. Potassium-sparing diuretics, ACE-inhibitors, AKIN stage and CKD are predictors of hyperkalemia in AKI.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Emanuel Pluess
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | - Philipp Walter
- Department of Laboratory Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Christoph Schwarz
- Department of Internal Medicine 1, Landeskrankenhaus Steyr, Steyr, Austria
| | | | - Bertram K Woitok
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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Woitok BK, Funk GC, Walter P, Schwarz C, Ravioli S, Lindner G. Dysnatremias in emergency patients with acute kidney injury: A cross-sectional analysis. Am J Emerg Med 2020; 38:2602-2606. [DOI: 10.1016/j.ajem.2020.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/25/2019] [Accepted: 01/04/2020] [Indexed: 01/24/2023] Open
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Ravioli S, Stoeckli T, Lindner G. COVID-19 screening in outpatients with risk factors and healthcare workers. Wien Klin Wochenschr 2020; 132:693-694. [PMID: 32681359 PMCID: PMC7366464 DOI: 10.1007/s00508-020-01714-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/29/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500 Solothurn, Switzerland
| | - Thomas Stoeckli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500 Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500 Solothurn, Switzerland
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Woitok BK, Ravioli S, Funk GC, Lindner G. Characteristics of very elderly patients in the emergency department - A retrospective analysis. Am J Emerg Med 2020; 46:200-203. [PMID: 33069543 DOI: 10.1016/j.ajem.2020.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/06/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Elderly people, defined by age 65 years and older, made up 18.45% of the Swiss Population in 2018 and their number is projected to rise continuously. Data investigating specific characteristics of this patient subgroup, especially in the emergency setting, is scarce. METHODS Demographic data of admission records from all patients aged 65 years or older admitted to our emergency department (ED) between January 1st 2015 and December 31st 2018 were investigated. Retrospective chart reviews of patients admitted in 2018 were conducted. Comorbidity burden was assessed by Charlson Comorbidity Index. Risk factors for death, longer hospitalization and placement in a nursing facility were identified by multivariate regression. RESULTS The prevalence of elderly patients (≥65 years) admitted to the ED between 2015 and 2018 was rising from 33% in 2015 to 37.8% in 2018. In 2018 709 patients were 90 years and older (3.6%). Age above 90 years and high comorbidity burden were identified as independent risk factors for death. Polypharmacy, hyponatremia and high comorbidity burden were independent risk factors for longer hospitalizations. Advanced age and high comorbidity burden were independent risk factors for placement in a nursing facility. CONCLUSION The number of elderly patients admitted to our ED is continuously rising. There was no difference in overall disease burden, number of medications and hospital length of stay between octogenarians and nonagenarians. We identified risk factors for mortality, long hospitalizations and need of placement in a nursing facility.
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Affiliation(s)
- Bertram K Woitok
- Dept. of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
| | - Svenja Ravioli
- Dept. of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | - Gregor Lindner
- Dept. of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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Woitok BK, Büttiker P, Ravioli S, Funk GC, Exadaktylos AK, Lindner G. Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis. BMJ Open 2020; 10:e038079. [PMID: 32978199 PMCID: PMC7520836 DOI: 10.1136/bmjopen-2020-038079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We aimed to clarify the prevalence, indications, analgesic comedications and complications of prescription opioid use in patients presenting to a large emergency department (ED). DESIGN Retrospective chart review. SETTING Large, interdisciplinary ED of a public hospital. PARTICIPANTS All patients aged ≥18 years presenting between 1 January 2017, and 31 December 2018, with documentation on medication were included. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence rates for prescription opioid use and its indication. Prevalence of analgesic comedications in prescription opioid users. Hospitalisation rate, 72 hours ED reconsultation rate, 30-day rehospitalisation rate, in-hospital mortality. RESULTS A total of 26 224 consultations were included in the analysis; 1906 (7.3%) patients had prescriptions for opioids on admission to the ED. The main indications for opioid prescriptions were musculoskeletal disease in 1145 (60.1%) patients, followed by neoplastic disease in 374 (19.6%) patients. One hundred fifty-four (8.2%) consultations were directly related to opioid intake, and 50.1% of patients on opioids also used other classes of analgesics. Patients on prescription opioids were older (76 vs 62 years, p<0.0001) and female individuals were over-represented (58 vs 48.9%, p<0.0001). Hospitalisation rate (78.3 vs 49%, p<0.0001), 72 hours ED reconsultation rate (0.8 vs 0.3%, p=0.004), 30-day rehospitalisation rate (6.2 vs 1.5%, p<0.0001) and in-hospital mortality (6.3 vs 1.6%, p<0.0001) were significantly higher in patients with opioid therapy than other patients. In 25 cases (1.3%), admission to the ED was due to opioid intoxication. CONCLUSIONS Daily prescription opioid use is common in patients presenting to the ED. The use of prescription opioids is associated with adverse outcomes, whereas intoxication is a minor issue in the studied population.
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Affiliation(s)
- Bertram K Woitok
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Petra Büttiker
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Svenja Ravioli
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilhelminenspital, Vienna, Austria
| | | | - Gregor Lindner
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
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Ravioli S, Niebuhr N, Ruchti C, Pluess E, Stoeckli T, Lindner G. The syndrome of inappropriate antidiuresis in COVID-19 pneumonia: report of two cases. Clin Kidney J 2020; 13:461-462. [PMID: 32695328 PMCID: PMC7239248 DOI: 10.1093/ckj/sfaa080] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/29/2020] [Revised: 04/21/2020] [Indexed: 01/08/2023] Open
Abstract
The emergence of the novel coronavirus or severe acute respiratory syndrome coronavirus 2 leads to a high number of cases of severe pneumonia. So far, little is known about the course of the disease and its symptoms, complications and treatment. We report the first two cases of the syndrome of inappropriate antidiuresis complicating COVID-19 pneumonia.
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Norbert Niebuhr
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Chantal Ruchti
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Emanuel Pluess
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Thomas Stoeckli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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Affiliation(s)
- Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
| | - Hannah Ochsner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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