Swiss University Hospital Research Articles

Emergency Room Admission of On-Duty Police at a Swiss University Hospital

Background. Police and law enforcement officers may face physical violence and multiple occupational hazards in the line of duty. There is no nationwide statistical reporting of police officers’ injuries in Switzerland. The aim of this study was to describe the epidemiological features of emergency room admissions of on-duty police officers. Methods. The retrospective analysis was based on the prospective database of the Emergency Department of Bern University Hospital. Fifty-seven (57) police officers presenting to our department were included and analysed. Results. Minor blunt trauma (32/57) associated with extremity trauma was the leading cause of admission to our emergency department. 16 body fluid born exposures with a possible risk of viral transmission were reported, with 12/16 cases during summer; serological testing for HBV, HCV, and HIV was negative in all cases. No police death was reported. Conclusions. Police officers are exposed to occupational hazards. In comparison to other countries the number of severely injured or killed officers is very low. In the light of the daily reports in the lay media about assaulted police officers, it may be assumed that the majority of injured police officers were treated by general practitioners outside the hospital or treated by themselves. An adequate injury prevention strategy is desirable, combined with more meticulous nationwide reporting of police officers’ injuries.

Malnutrition und Gewichtsverlust - Erfassen des Ernährungsstatus und Beratung durch Pflegende: Das Erleben von Patienten mit einer neu diagnostizierten oder rezidivierten Tumorerkrankung

Due to the anorexia-cachexia syndrome, cancer patients are already suffering from nutritional problems and weight loss by the time they receive their diagnosis and start chemotherapy. In the oncology outpatient clinic of a Swiss university hospital, patients currently undergo a nutritional assessment and receive individual counselling at the beginning of cancer treatment. This qualitative study explored cancer patients' experiences with weight loss and nutritional problems as well as how they experienced the assessment and the consecutive counselling by nurses. Interviews were conducted with 12 patients and qualitative content analysis was used for data analysis. Results showed that patients barely registered the weight loss and did not interpret it as an early warning signal. Nevertheless, they attempted to improve their nutritional habits soon after diagnosis, prior to receiving any counselling. The patients did not experience the assessment as troublesome. They appreciated the nurses' advice and implemented the suggestions they found appropriate. This study highlights the importance of patient education regarding weight loss and nutritional problems early in the course of an illness. Patients may not be aware of nutritional problems at this early stage and may lack the necessary specialised knowledge. Assessment and counselling provided by nurses offer targeted measures for prevention of malnutrition and weight loss.

Underreporting of needlestick and sharps injuries among healthcare workers in a Swiss University Hospital

To determine 1) rates of needlestick and sharps injuries (NSSIs) not reported to occupational health services, 2) reasons for underreporting and 3) awareness of reporting procedures in a Swiss university hospital. We surveyed 6,367 employees having close clinical contact with patients or patient specimens. The questionnaire covered age, sex, occupation, years spent in occupation, history of NSSI during the preceding twelve months, NSSI reporting, barriers to reporting and knowledge of reporting procedures. 2,778 questionnaires were returned (43.6%) of which 2,691 were suitable for analysis. 260/2,691 employees (9.7%) had sustained at least one NSSI during the preceding twelve months. NSSIs were more frequent among nurses (49.2%) and doctors performing invasive procedures (IPs) (36.9%). NSSI rate by occupation was 8.6% for nurses, 19% for doctors and 1.3% for domestic staff. Of the injured respondents, 73.1% reported all events, 12.3% some and 14.6% none. 42.7% of doctors performing invasive procedures (IPs) underreported NSSIs and represented 58.6% of underreported events. Estimation that transmission risk was low (87.1%) and perceived lack of time (34.3%) were the most common reasons for non-reporting. Regarding reporting procedures, 80.1% of respondents knew to contact occupational health services. Doctors performing IPs have high rates of NSSI and, through self-assessment that infection transmission risk is low or perceived lack of time, high rates of underreporting. If individual risk analyses underestimate the real risk, such underreporting represents a missed opportunity for post-exposure prophylaxis and identification of hazardous procedures. Doctors' training in NSSI reporting merits re-evaluation.

Wrongly Prescribed Half Tablets in a Swiss University Hospital

Background: Prescription of 1/2 tablets is a widespread practice, mainly to achieve dose flexibility and to facilitate swallowing. However, tablet splitting includes several disadvantages, like destruction of galenic formulation, stability problems, and unequal amount of active ingredient that may reduce effectiveness or result in a greater risk of toxicity. Objective: To assess the rate of wrongly prescribed 1/2 tablets in discharge prescriptions at the University Hospital in Basel (UHBS, 600 beds) and to evaluate its consequences for community pharmacists. Setting: Discharge prescriptions written between January 1st and December 31st 2011 and containing the term “1/2” were extracted from the electronic patients’ data management system of the UHBS. Presence of a score line and suitability for splitting were retrieved from two official sources of drug information. Main Outcome Measure: Wrong prescription was assigned for tablets with no score line or not suitable for dose splitting. Results: Of the 36,751 discharge prescriptions that were recorded in 2011 at the UHBS, 3724 (10.1%) contained at least one prescription item with the term “1/2”. The recipient patients were on average 72.9 ± 14.8 years old (median 76 years), 50.9% were women. Of the 4517 analysed items, 49% had a corresponding lower dosage strength available on the market, making splitting unnecessary. Rate of wrongly prescribed 1/2 tablets reached 16.4% (2.8% of all prescriptions) and concerned predominantly unscored tablets. When the lack of information on splitting suitability (5.6%) and on score lines (0.5%) was taken into account, the rate reached 22.4%. Half of all wrong prescriptions could be assigned to 14 different products that were prescribed with an overall rate between 3.1 and 0.2%. Quetiapine (Seroquel?) at all strengths was the most often wrongly prescribed tablet to split (3.1%; no score line), followed by atorvastatin (Sortis?) at all strengths (1.3%; no score line) and oxazepam (Seresta?) 15 mg (1.2%; with decorative score line). Conclusion: Prescribing of 1/2 tablets is common and concerns every 10th discharge prescriptions. It represents a pharmaceutical care issue, since in almost every second case, an identical drug with half the dosage strength is commercially available and a substitution could be offered by the community pharmacist. Further, one out of 5 prescribed 1/2 tablets is wrong or untraceable in the official sources of drug information and represents a safety issue. In all cases, time consuming and costly clarifications must be undertaken, ultimately the physician must be consulted, in order to modify the prescription or to dispense the prescribed 1/2 tablets as off-label use. If splitting is allowed, the patient’s cognitive and physical capacities have to be clarified and appropriate aids have to be offered, e.g. a pill splitter, in order to insure the safe use of the drug.

Initial management of and outcome in patients with pneumococcal bacteremia: a retrospective study at a Swiss university hospital, 2003–2009

The aim of this quality control study was to assess the time to initial diagnostic procedures and the time to the first dose of antibiotics in patients with pneumococcal bacteremia, and to investigate whether the timeliness of these interventions influenced outcome. We retrospectively studied patient characteristics, chronological sequence of diagnostic and therapeutic steps, and the course of disease of all patients with pneumococcal bacteremia at a Swiss university hospital between 2003 and 2009, and we analyzed associations between these factors and the length of hospital stay (LOS) and mortality. A total of 102 episodes of pneumococcal bacteremia in 98 patients were analyzed, of whom 15.7% died during hospitalization. The median time (interquartile range [IQR]) to the first antibiotic dose was 4.0 (2.0-5.9)h, and the median times (IQR]) to blood cultures, chest radiograph, lumbar puncture, and brain computed tomography (CT) scan or magnetic resonance imaging (MRI) were 1.4 (0.5-3.3), 2.5 (1.2-4.2), 4.2 (2.7-7.2), and 2.3 (0.6-6.2)h, respectively. The time to diagnostic procedures and therapy were not associated with LOS or death. Risk factors for death in the univariable analysis were: Charlson comorbidity index [odds ratio [OR] (95% confidence interval) per unit increase, 1.3 (1.1-1.6)], neutropenia [OR 10.1 (2.0-51.0)], human immunodeficiency virus (HIV) infection [OR 3.9 (1.1-13.8)], chronic respiratory disease [OR 4.4 (1.2-16.0)], chronic liver disease [OR 3.2 (1.0-9.7)], smoking [OR 3.8 (1.1-13.5)], injection drug use [OR 9.7 (1.5-63.7)], and antibiotic therapy within 6months before admission [OR 4.0 (1.3-12.5)]. The multivariable analysis revealed age >60years (P=0.048) and alcoholism (P=0.009) as risks for prolonged LOS. The outcome of pneumococcal bacteremia may be more influenced by patient characteristics than by minor differences in the timeliness of initial diagnostic and therapeutic measures within the first several hours after hospital admission.

Plasma Copeptin in Preterm Infants - a Highly Sensitive Marker of Fetal and Neonatal Stress

Background: Copeptin is a stable by-product of arginine-vasopressin (AVP) synthesis and reflects its secretion by the pituitary. We investigated perinatal factors affecting copeptin concentrations in preterm infants at birth and at 3 days of life. Methods: A prospective cross-sectional study at two Swiss university hospitals was performed. 167 preterm infants were enrolled, 59 infants born between 24 and 31 weeks gestational age, 50 infants between 32 and 34 weeks, and 58 between 35 and 36 weeks. Plasma copeptin concentrations were determined by a CT-proAVP-Luminescence-immunoassay in umbilical cord blood at birth and in blood samples obtained at 2-3 days of life. Results: Copeptin at birth was significantly higher in preterm infants born vaginally (median [range] 366 [1-2900] pmol/L, n=43) than those born by caesarean section (6.9 [2-1580], n=124). In infants born after caesarean without prior labour (n=66), small for gestational age (< 5th percentile), suspect fetal heart rate, compromised placental perfusion, and chorioamnionitis were each associated with significantly elevated cord copeptin. Copeptin at 3 days of life was not associated with cord blood copeptin but inversely related to gestational age (Rs -0.6, p< 0.001) and birth weight (Rs -0.612, p< 0.001). Day 3 copeptin increased alongside the level of mechanical respiratory support. Conclusion: Copeptin is a highly sensitive marker of fetal and neonatal stress.

Effect of age on intraoperative cerebrovascular autoregulation and near-infrared spectroscopy-derived cerebral oxygenation

Age is an important risk factor for perioperative cerebral complications such as stroke, postoperative cognitive dysfunction, and delirium. We explored the hypothesis that intraoperative cerebrovascular autoregulation is less efficient and brain tissue oxygenation lower in elderly patients, thus, increasing the vulnerability of elderly brains to systemic insults such as hypotension. We monitored intraoperative cerebral perfusion in 50 patients aged 18-40 and 77 patients >65 yr at two Swiss university hospitals. Mean arterial pressure (MAP) was measured continuously using a plethysmographic method. An index of cerebrovascular autoregulation (Mx) was calculated based on changes in transcranial Doppler flow velocity due to changes in MAP. Cerebral oxygenation was assessed by the tissue oxygenation index (TOI) using near-infrared spectroscopy. End-tidal CO₂, O₂, and sevoflurane concentrations and peripheral oxygen saturation were recorded continuously. Standardized anaesthesia was administered in all patients (thiopental, sevoflurane, fentanyl, atracurium). Autoregulation was less efficient in patients aged >65 yr [by 0.10 (se 0.04; P=0.020)] in a multivariable linear regression analysis. This difference was not attributable to differences in MAP, end-tidal CO₂, or higher doses of sevoflurane. TOI was not significantly associated with age, sevoflurane dose, or Mx but increased with increasing flow velocity [by 0.09 (se 0.04; P=0.028)] and increasing MAP [by 0.11 (se 0.05; P=0.043)]. Our results do not support the hypothesis that older patients' brains are more vulnerable to systemic insults. The difference of autoregulation between the two groups was small and most likely clinically insignificant.

Survey of aspergillosis in non-neutropenic patients in Swiss teaching hospitals

Invasive aspergillosis (IA) is a live-threatening opportunistic infection that is best described in haematological patients with prolonged neutropenia or graft-versus-host disease. Data on IA in non-neutropenic patients are limited. The aim of this study was to establish the incidence, disease manifestations and outcome of IA in non-neutropenic patients diagnosed in five Swiss university hospitals during a 2-year period. Case identification was based on a comprehensive screening of hospital records. All cases of proven and probable IA were retrospectively analysed. Sixty-seven patients were analysed (median age 60 years; 76% male). Sixty-three per cent of cases were invasive pulmonary aspergillosis (IPA), and 17% of these were disseminated aspergillosis. The incidence of IPA was 1.2/10 000 admissions. Six of ten cases of extrapulmonary IA affected the brain. There were six cases of invasive rhinosinusitis, six cases of chronic pulmonary aspergillosis, and cases three of subacute pulmonary aspergillosis. The most frequent underlying condition of IA was corticosteroid treatment (57%), followed by chronic lung disease (48%), and intensive-care unit stays (43%). In 38% of patients with IPA, the diagnosis was established at autopsy. Old age was the only risk factor for post-mortem diagnosis, whereas previous solid organ transplantation and chronic lung disease were associated with lower odds of post-mortem diagnosis. The mortality rate was 57%.

High incidence of medication documentation errors in a Swiss university hospital due to the handwritten prescription process

BackgroundMedication errors have been reported to be a leading cause of death in hospitalized patients. In this study we focused on identifying and quantifying errors in the handwritten drug ordering and dispensing documentation processes which could possibly lead to adverse drug events.MethodsWe studied 1,934 ordered agents (165 consecutive patients) retrospectively for medication documentation errors. Errors were categorized into: Prescribing errors, transcription errors and administration documentation errors on the nurses' medication lists. The legibility of prescriptions was analyzed to explore its possible influence on the error rate in the documentation process.ResultsDocumentation errors occurred in 65 of 1,934 prescribed agents (3.5%). The incidence of patient charts showing at least one error was 43%. Prescribing errors were found 39 times (37%), transcription errors 56 times (53%), and administration documentation errors 10 times (10%). The handwriting readability was rated as good in 2%, moderate in 42%, bad in 52%, and unreadable in 4%.ConclusionsThis study revealed a high incidence of documentation errors in the traditional handwritten prescription process. Most errors occurred when prescriptions were transcribed into the patients' chart. The readability of the handwritten prescriptions was generally bad. Replacing the traditional handwritten documentation process with information technology could potentially improve the safety in the medication process.

Regrets Associated with Providing Healthcare: Qualitative Study of Experiences of Hospital-Based Physicians and Nurses

BackgroundRegret is an unavoidable corollary of clinical practice. Physicians and nurses perform countless clinical decisions and actions, in a context characterised by time pressure, information overload, complexity and uncertainty.ObjectiveTo explore feelings associated with regretted clinical decisions or interventions of hospital-based physicians and nurses and to examine how these regrets are coped with.MethodQualitative study of a volunteer sample of 12 physicians and 13 nurses from Swiss University Hospitals using semi-structured interviews and thematic analysisResultsAll interviewees reported at least one intense regret, which sometimes led to sleep problems, or taking sickness leave. Respondents also reported an accumulation effect of small and large regrets, which sometimes led to quitting one's unit or choosing another specialty. Respondents used diverse ways of coping with regrets, including changing their practices and seeking support from peers and family but also suppression of thoughts related to the situation and ruminations on the situation. Another coping strategy was acceptance of one's limits and of medicine's limits. Physicians reported that they avoided sharing with close colleagues because they felt they could lose their credibility.ConclusionsSince regret seems related to both positive and negative consequences, it is important to learn more about regret coping among healthcare providers and to determine whether training in coping strategies could help reduce negative consequences such as sleep problems, absenteeism, or turnover.

Analytical validation of a lymphocytic choriomeningitis virus real-time RT-PCR assay

Lymphocytic choriomeningitis virus (LCMV) is a rare cause of central nervous system disease in humans. Screening by real-time RT-PCR assay is of interest in the case of aseptic meningitis of unknown etiology.A specific LCMV real-time RT-PCR assay, based on the detection of genomic sequences of the viral nucleoprotein (NP), was developed to assess the presence of LCMV in cerebrospinal fluids (CSF) sent for viral screening to a Swiss university hospital laboratory.A 10-fold dilution series assay using a plasmid containing the cDNA of the viral NP of the LCMV isolate Armstrong (Arm) 53b demonstrated the high sensitivity of the assay with a lowest detection limit of ≤50 copies per reaction. High sensitivity was confirmed by dilution series assays in a pool of human CSF using four different LCMV isolates (Arm53b, WE54, Traub and E350) with observed detection limits of ≤10PFU/ml (Arm53b and WE54) and 1PFU/ml (Traub and E350).Analysis of 130 CSF showed no cases of acute infection. The absence of positive cases was confirmed by a published PCR assay detecting all Old World arenaviruses.This study validates a specific and sensitive real-time RT-PCR assay for the diagnosis of LCMV infections. Results showed that LCMV infections are extremely rare in hospitalized patients western in Switzerland.

Understanding accountability in midwifery practice: Key concepts

British Journal of MidwiferyVol. 19, No. 5 LegalUnderstanding accountability in midwifery practice: Key conceptsRichard GriffithRichard GriffithSearch for more papers by this authorRichard GriffithPublished Online:16 Aug 2013https://doi.org/10.12968/bjom.2011.19.5.327AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Batey MV, Lewis FM (1982) Clarifying autonomy and accountability in nursing services. J Nurs Adm 12(9): 13–18 Crossref, Google ScholarCrook A (2009) Midwife struck off. Manchester Evening News. 7 March. http://tinyurl.com/43t5sgt (accessed 18 April 2011) Google ScholarKent Messenger (2010) Midwife's errors led to emergency caesarean. 19 March: 4 Google ScholarMitchell G (2009) Midwife supervisor jailed for theft and fraud. Maidenhead Advertiser. 25 June. http://tinyurl.com/6korlfy (accessed 18 April 2011) Google ScholarNursing and Midwifery Council (2004) Midwives rules and standards. NMC, London Google ScholarNursing and Midwifery Council (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives. NMC, London Google ScholarSavage J, Moore L (2004) Interpreting accountability: An ethnographic study of practice nurses, accountability and multidisciplinary team decision-making in the context of clinical governance. RCN, London Google Scholar FiguresReferencesRelatedDetailsCited byDecision-making in midwifery: A tripartite clinical decision4 August 2016 | British Journal of Midwifery, Vol. 24, No. 8Women and healthcare providers’ perceptions of a midwife-led unit in a Swiss university hospital: a qualitative study11 March 2015 | BMC Pregnancy and Childbirth, Vol. 15, No. 1Accountability and the dental nurse: key issues16 August 2013 | Dental Nursing, Vol. 7, No. 10British Politics, the Welfare State, and Tort Liability of Public AuthoritiesSSRN Electronic Journal 1 May 2011Volume 19Issue 5ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 16 August 2013 Published in print 1 May 2011 Information© MA Healthcare LimitedPDF download

Swiss Interdisciplinary Management Programme for Heart Failure (SWIM-HF): A randomised controlled trial study of an outpatient inter-professional management programme for heart failure patients in Switzerland

International guidelines for heart failure (HF) care recommend the implementation of inter-professional disease management programmes. To date, no such programme has been tested in Switzerland. The aim of this randomised controlled trial (RCT) was to test the effect on hospitalisation, mortality and quality of life of an adult ambulatory disease management programme for patients with HF in Switzerland. Consecutive patients admitted to internal medicine in a Swiss university hospital were screened for decompensated HF. A total of 42 eligible patients were randomised to an intervention (n = 22) or usual care group (n = 20). Medical treatment was optimised and lifestyle recommendations were given to all patients. Intervention patients additionally received a home visit by a HF-nurse, followed by 17 telephone calls of decreasing frequency over 12 months, focusing on self-care. Calls from the HF nurse to primary care physicians communicated health concerns and identified goals of care. Data were collected at baseline, 3, 6, 9 and 12 months. Mixed regression analysis (quality of life) was used. Outcome assessment was conducted by researchers blinded to group assignment. After 12 months, 22 (52%) patients had an all-cause re-admission or died. Only 3 patients were hospitalised with HF decompensation. No significant effect of the intervention was found on HF related to quality of life. An inter-professional disease management programme is possible in the Swiss healthcare setting but effects on outcomes need to be confirmed in larger studies.

Spectrum of pathogens in surgical site infections at a Swiss university hospital

The type of surgical antimicrobial prophylaxis (SAP) is determined by the spectrum and antimicrobial resistance of pathogens causing surgical site infections (SSI). The aim of this study was to define the microbiological features of SSI in general surgery patients at Basel University Hospital in order to validate our current strategy of single-shot SAP with 1.5 g cefuroxime (plus 500 mg metronidazole in colorectal surgery). A prospective observational cohort of consecutive vascular, visceral and trauma procedures was analysed to evaluate the incidence of SSI. Surgical wounds and resulting infections were assessed to centres for disease control standards. Microbiological evaluation was performed by microscopic direct preparation, cultures and testing for antibiotic resistance. A total of 293 instances of SSI were detected in this cohort of 6283 surgical procedures (4.7%). Microbiological species were identified in 129 of 293 SSI (44%). Staphylococcus aureus (29.5%) was the most common pathogen causing SSI in trauma and vascular surgery, whereas Escherichia coli (20.9%) was more frequently responsible for SSI in visceral surgery. Importantly, not a single case of SSI was caused by antimicrobial-resistant pathogens in this series. The spectrum of pathogens causing SSI identified and the very low incidence of antimicrobial resistance at Basel University Hospital validate the continuous use of single-shot single-drug SAP with cefuroxime (plus metronidazole in colorectal surgery).

Description of a Tertiary Swiss University Hospital Palliative Population Based on the International Classification of Disease (ICD): A Retrospective Pilot Study

The factors for assessing the utilization rate of a palliative care service are various and complex. Several authors have described different methods to address this problem. McNamara and colleagues have proposed criteria to determine "minimal," "mid-range," and "maximal" palliative population estimates. In order to evaluate the utilization of our intrahospital palliative care consult team (PCT), it appeared necessary to better describe and define the population who dies in our institution, a Swiss university hospital. The goal of this pilot study was to determine what percentage of patients who died in our hospital over a 4-month period in 2007 was seen by the palliative care consult team (PCT), using "minimal" and "maximal" population estimates. The hospital database was searched for all adult patients who died during that period and the "maximal" and "minimal" populations determined. The PCT's database was searched to identify those patients who had been seen by the PCT. The charts of a random sample of patients who did not initially meet the "minimal" criteria were hand searched. A total of 294 adult deaths were reported: 263 (89%) met the "maximal" criteria and 83 (28%) met the "minimal" criteria initially. The random search of 56 charts of the 180 patients who did not meet the "minimal" criteria revealed that 21 (38%) should have been included in the "minimal" population. The PCT saw 67/263 (25.5%) of the "maximal" palliative patient population and 56/151 (37.1%) of the "minimal" palliative population. This study highlights the usefulness of the method proposed by McNamara and colleagues to determine palliative populations. However, it also illustrates an important limitation of the "minimal" estimate and reliance on the accuracy of the cause of death as noted on the death certificate. A strategy to address this limitation is suggested. The "maximal" estimate suggests that the PCT is being underutilized.

Work related characteristics of back and neck pain among employees of a Swiss University Hospital

Objectives 1) To explore the staff- and work-related risk factors for spinal pain among hospital employees, 2) to investigate the effect of staff- and work-related variables on the consequences of spinal pain, such as doctor visits and sick leave. Methods A mailed survey was carried out in a random sample of 2700 employees stratified for occupational categories (administration staff, nurses, nurse assistants, physicians, support staff and allied health professionals). The questionnaire measured self-reported spinal pain, consequences of pain, and work characteristics. Results The response rate was 48.1% (1298/2700). The one-year prevalence of spinal pain was 67.3%, highest among nurses (75.6%) and lowest among support staff (54.9%). Reported work characteristics associated with spinal pain included frequent work at a poorly adapted work station (odds ratio (OR) 1.90 [1.24–2.93]) and having to maintain a position for a long time (OR 1.71 [1.25–2.34]). No significant correlations were observed with lifting, patient handling, material handling, or working on nightshift. Sickness leave due to spinal pain was significantly associated with duration of pain episode (OR 4.08 for > 3 months compared to less than 10 days), and with work categories (OR 2.58 for nurse assistants compared to nurses). Conclusion In this population of hospital employees, being a nurse, working at a poorly adapted work place, and having to maintain positions for a long time were related independently to spinal pain. Nurse assistants had a higher risk of work absenteeism.

Anatomy and physiology of pain and the management of breakthrough pain in palliative care

The aim of the study was to explore terminally ill patients’ and their families’ experiences of hospital end-of-life care. The study design was a qualitative approach using interpretive phenomenology, which was applied prospectively. Ten patients and their closest family members were recruited in one Swiss university hospital. Data collection included repeated observations, conversations with patients, and interviews with family members. It was found that people led unique lives; when a terminal illness intruded and during hospital stays, they continued to live their particular life. The hospital was experienced differently, as prison, heaven, or necessary sojourn. A caring stance of the professionals was crucial to patients’ and families’ sense of being well cared for. When care providers lacked skills or did not recognize patients and family members as persons, they suffered. In contrast, adequate care interventions improved their quality of life. The experience of being in the hospital cannot be separated from patients’ and families’ life stories.

Period Prevalence and Risk Factors for Postoperative Short-Term Wound Complications in Vulvar Cancer

Although clinicians recognize that postoperative wound management in patients with vulvar cancer (VC) is challenging, the prevalence and risk factors for different types of short-term wound complications (WCs) remain unclear. The aims of this study were: (1) to determine the period prevalence of postoperative short-term WCs and (2) to identify risk factors associated with short-term WCs in patients with VC. In a cross-sectional study in a Swiss University Hospital, a sample of 108 patients with VC treated surgically (and free of WCs at the time of admission) was included. Data were collected retrospectively from 2007 to 1997 from medical records using an investigator-developed data collection instrument to assess risk factors preoperatively and perioperatively and WCs that occurred within the first 30 postoperative hospital days. The period prevalence of WCs was calculated, and logistic regression was used to identify risk factors for WCs. The median age was 69 years (interquartile range [IQR], 21 years). The period prevalence of WCs was 45.4% (49/108), showing at least 1 of 8 assessed WCs per patient within the median hospital duration of 11 days (IQR, 12 days). The period prevalence for each type of WC was 31.5% for dehiscence, 12% for hematoma, 6.5% for necrosis, 5.6% for infections, 4.6% for seroma, 1.9% for lymph cysts, 1.9% for malignant wounds, and 0% for disturbed tissue formation. Two significant predictors of WCs were identified out of 14 risk factors examined (P < 0.05). The odds ratio (OR) for WC increased with the extent of surgical therapy, ie, from excision to hemivulvectomy and to radical vulvectomy, by a factor of 2.6 (OR, 2.6; 95% confidence interval [CI], 1.34-5.14), and, in the case of inguinofemoral lymphadenectomy, by a factor of 3 (OR, 3.0; 95% CI, 1.03-8.76). The high prevalence of short-term WCs (45.4%) indicates a need for systematic wound assessment and early risk management--especially after hemivulvectomy, radical vulvectomy, and inguinal lymphadenectomy.

Dietary, Weight, and Psychological Changes among Patients with Obesity, 8 Years after Gastric Bypass

Background and objective Long-term data on patients with obesity outcome after bariatric surgery are lacking. The goal was to document dietary and anthropometric changes more than 5 years after surgery, as well as patients' eating behavior, psychological state, and quality of life. Methods A cohort of 80 women (mean age 40±10 years) who underwent a Roux-en-Y gastric bypass between 1997 and 2002 were followed in a Swiss University Hospital for an average of 8±1.2 years. The primary outcome was successful weight loss defined as excess weight loss ≥50%. Body composition was measured by bioelectrical analysis, and diet was assessed via a food diary. Eating disorders, psychological factors, and quality of life were evaluated by questionnaires. Patients' perceptions of difficulties and benefits were explored using semistructured interviewing. Results at baseline and last visit were compared using paired t test. Cofactors' means were compared between successful and unsuccessful patients with Student t tests and logistic regression. Results Average weight loss 8 years after surgery was 30.7±13.8 kg. Excess weight loss ≥50% was observed for 47 patients (59%). Between baseline and last visit, relative proportions of fat mass/total body weight decreased, and fat-free mass/total body weight increased. Mean energy intake was 2,355±775 kcal at baseline and 1,680±506 kcal at last visit, with 42% of energy from carbohydrates, 39% of energy from fats, and 19% of energy from protein (0.8 g/kg). At last visit, 41 patients (51%) described episodes of binge eating or night eating syndrome. Factors associated with excess weight loss ≥50% were: younger age at operation, greater number of psychological consultations before the operation, and higher scores on ineffectiveness and social insecurity scales at baseline. Conclusions More than half of the patients achieved successful weight loss, but disordered eating behavior was frequent. Periodic follow-up screenings and interdisciplinary care are advised. The definition of successful outcome should take into account problematic eating behaviors.

Determinants of Vaccine Immunity in the Cohort of Human Immunodeficiency Virus-Infected Children Living in Switzerland

Human immunodeficiency virus (HIV)-infected children are at increased risk of infections caused by vaccine preventable pathogens, and specific immunization recommendations have been issued. A prospective national multicenter study assessed how these recommendations are followed in Switzerland and how immunization history correlates with vaccine immunity. Among 87 HIV-infected children (mean age: 11.1 years) followed in the 5 Swiss university hospitals and 1 regional hospital, most (76%) had CD4 T cells >25%, were receiving highly active antiretroviral treatment (79%) and had undetectable viral load (60%). Immunization coverage was lower than in the general population and many lacked serum antibodies to vaccine-preventable pathogens, including measles (54%), varicella (39%), and hepatitis B (65%). The presence of vaccine antibodies correlated most significantly with having an up-to-date immunization history (P<0.05). An up-to-date immunization history was not related to age, immunologic stage, or viremia but to the referral medical center. All pediatricians in charge of HIV-infected children are urged to identify missing immunizations in this high-risk population.