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

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

Group sequential procedures for multiple comparison of rates of change

Group sequential methods find a particular field of application in clinical trials because patient recruitment is by nature sequential. It is important to minimize the number of patients exposed to an inferior treatment. Moreover, the experimenter is required to monitor the data on a few occasions during the trial to check for toxicity or other unsuspected harmful side-effects. These intermediate analyses may reveal a significant superiority of one treatment, resulting in an early termination of the trial, but only a sequential design allows for such early termination. The availability of fast and efficient algorithms for estimating parameters of multivariate distributions (e.g. Expectation Maximization or Newton-Raphson algorithms) and for computing multivariate normal probabilities opens new frontiers by allowing complex but very flexible experimental designs for the comparison of several treatments. Using these powerful tools, together with the concept of spending function, flexible procedures for multiple comparison of treatments have been designed. In 1991, Lee and DeMets (Journal of the American Statistical Association 86, 757-62) proposed a group sequential procedure for comparing the rates of change of two treatments. Our work generalizes their model, a linear mixed effects model with repeated measurements, to several treatments. We derive group sequential procedures for comparing the rates of change of several treatments to a control while controlling the overall significance level, or more generally, comparing general contrasts of changes of several treatments while controlling the overall significance level, and studying and comparing data-dependent allocation rules and strategies for assigning patients to treatments. These procedures and algorithms are applied to real and simulated data. The importance of this work lies in the fact that quite often in clinical trials, we compare the effects of more than one treatment or the effects of different doses of the same treatment. Here we provide flexible procedures for multiple comparisons to the medical experimenter. With these procedures, the number and times of interim analyses need not be specified in advance, missing observations can be handled, and the experimenter can freely choose which treatment effects to test at any time he wishes. The overall significance level of the tests is controlled. Moreover algorithms for the execution of these procedures are provided. This study tries to open avenues of further theoretical and numerical studies in multiple comparisons, a field which has a long history in theoretical and applied statistics and which recently has seen vigorous new developments to which the above-described research contributes

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

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

Canicola, mortalità e interventi di pronto soccorso durante l'estate

L'estate del 2003 è stata caratterizzata da temperature eccezionalmente elevate durante periodi insolitamente lunghi. Questo fenomeno non ha risparmiato né il Ticino, né la Svizzera in generale, con il riscontro di diversi primati meteorologici. Le ondate di calore hanno provocato un aumento significativo della mortalità in numerosi paesi europei, in particolar modo nei grandi centri urbani in Francia, in Germania e in Spagna. L'analisi dei dati per quanto concerne il Ticino, non evidenzia un aumento importante e persistente nel tempo della mortalità in occasione delle ondate di calore dell'estate 2003. A livello di popolazione con 65 anni e più e con 75 anni e più, non è stata osservata alcuna mortalità significativamente superiore ai valori attesi, né per quanto riguarda il bilancio delle tre ondate di calore, né per quanto riguarda la mortalità totale dal 1° giugno al 31 agosto 2003. Si osserva in compenso un aumento degli interventi in urgenza con autoambulanza sia durante il mese di giugno, sia durante le tre ondate di calore di giugno, luglio e agosto considerate insieme, così come sul bilancio globale del periodo dal 1° giugno al 31 agosto. Visto che la mortalità non è aumentata, si può ipotizzare una reazione efficace dei servizi sanitari presenti sul territorio nel nostro Cantone. [Autori]]]> Heat ; Climate ; Aged ; Mortality ita oai:serval.unil.ch:BIB_184 2022-05-07T01:11:28Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_184 Notes on African Lepidoptera - foodplant relationships as phyletic clues. Spichiger, R Vuattoux, R Savolainen, V info:eu-repo/semantics/article article 1997 Candollea, vol. 52, pp. 113-117 oai:serval.unil.ch:BIB_184074146752 2022-05-07T01:11:28Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_184074146752 Caractéristiques des participants à l'étude comparative des programmes de méthadone en Suisse romande Dauwalder, J. P. Cattaneo, A. Poncioni-Derigo, R. info:eu-repo/semantics/article article 1997 Recherches de l'OFSP en matière de dépendances, 1993-1996, pp. 235-240 oai:serval.unil.ch:BIB_18408 2022-05-07T01:11:28Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_18408 Des différences de traitement fiscal entre des personnes juridiques sont déclarées contraires à la Convention européenne des droits de l'homme. Flauss, JF info:eu-repo/semantics/article article 2001 Actualité juridique de droit administratif, vol. 7-8, pp. 658-662 oai:serval.unil.ch:BIB_1840808F2B60 2022-05-07T01:11:28Z openaire documents <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_1840808F2B60 The Interdisciplinary Centre for Mountain Research (CIRM): Fostering Transdisciplinarity for Transformation Research in Mountains info:doi:10.1659/mrd-journal-d-20-00051.1 info:eu-repo/semantics/altIdentifier/doi/10.1659/mrd-journal-d-20-00051.1 Reynard, Emmanuel Otero, Iago Clivaz, Mélanie info:eu-repo/semantics/article article 2020-11-20 Mountain Research and Development, vol. 40, no. 2 info:eu-repo/semantics/altIdentifier/pissn/0276-4741 Development; General Environmental Science; Environmental Chemistry eng https://serval.unil.ch/resource/serval:BIB_1840808F2B60.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_1840808F2B608 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_1840808F2B608 info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/openAccess CC BY 4.0 https://creativecommons.org/licenses/by/4.0/ application/pdf oai:serval.unil.ch:BIB_18409 2022-05-07T01:11:28Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_18409 Partenariat enregistré. La situation en Suisse de lege ferenda: tendances et options. Sandoz, S. info:eu-repo/semantics/article article 2001 RSDIE, vol. 25.7.2001 fre oai:serval.unil.ch:BIB_1840A5FD6859 2022-05-07T01:11:28Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_1840A5FD6859 [ Compte-rendu de ] Un cartel parfait. Réseaux, R&amp;D, profits dans l'industrie suisse des câbles / Cortat Alain, Neuchâtel : Editions Alphil - Presses universitaires suisses, 2009 https://www.revue-traverse.ch/ausgabe/2010/2/les-intellectuels-en-suisse-au-20e-siecle-milieux-postures-engagements Humair, C info:eu-repo/semantics/article article 2010 Traverse : Revue d'histoire, no. 2, pp. 179-180 info:eu-repo/semantics/altIdentifier/pissn/978-3-905315-50-9 fre oai:serval.unil.ch:BIB_1840E4FACA48 2022-05-07T01:11:28Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_1840E4FACA48 Retrospective Analysis of the Production of the Revue d’Anthropologie des Connaissances https://www.cairn.info/revue-anthropologie-des-connaissances-2017-2-page-cy.htm The editorial board info:eu-repo/semantics/article article 2017-06-30 Revue d'Anthropologie des Connaissances, vol. 11, no. 2, pp. cy-du info:eu-repo/semantics/altIdentifier/pissn/1760-5393 <![CDATA[Based on the corpus of all articles published during the ten-year existence of the Revue d’Anthropologie des Connaissances, this article offers a retrospective analysis of the status of authors, of the categories of published items, of contents of abstracts and keywords, and of references enlisted in the contributions. This analysis makes it possible to understand what the editorial project has generated during the 10 years of publication of the journal with regard to its editorial project and its willingness to foster an open science. This retrospective analysis leads to a synthesis of the way in which the Revue d’Anthropologie des Connaissances contributes to the landscape of scientific publishing today

Le marché domestique du sciage artisanal en République démocratique du Congo : Etat des lieux, opportunités, défis

International audienceAu-delà de l’utilisation illégale des permis de coupe artisanale pour des entreprises dans la province du Bandundu, il existe à l’échelle de la RDC un secteur du sciage artisanal individuel qui alimente en produits sciés les marchés domestiques et de certains pays limitrophes. Ce secteur demeure essentiellement dans l’informalité. Notre suivi annuel des marchés et des points de passage des sciages artisanaux montre une augmentation substantielle de cette activité sur les quinze dernières années. C’est aujourd’hui plus d’un million de mètres cube de sciages artisanaux qui est produit en RDC, dont 85 % alimentent la demande intérieure. La production Équivalent Bois Rond de sciages artisanaux est treize fois supérieure à toute la production formelle des produits bois en RDC.Les marchés domestiques de Kinshasa et de l’Est de la RDC génèrent un chiffre d’affaires dépassant 100 millions $par an et dégagent un profit estimé à 25 millions$. Les populations locales sont des bénéficiaires majeurs du sciage artisanal, en captant autour de 50 millions de $ de revenu par an. Au total, en regroupant les activités rurales et urbaines, le secteur du sciage artisanal offre au moins 25 000 emplois directs en RDC.Le sciage artisanal se focalise sur cinq essences – mais qui diffèrent selon les provinces - et sur les arbres de gros diamètre. Le faible nombre d’espèces exploitées par chaque scieur artisanal met a priori peu en cause l’intégrité de la forêt, même si cette pratique peut contribuer à une diminution de la valeur économique du massif par la dégradation de la forêt et la raréfaction des essences nobles.Par son ampleur physique et économique, le secteur du sciage artisanal est central si la RDC souhaite assurer la gestion durable et la légalité de l’exploitation de ses ressources forestières. Quatre pistes sont explorées pour améliorer et sécuriser le fonctionnement de ce secteur d’activité : (1) améliorer à court terme la mise en œuvre de la réglementation, en cherchant à modifier les comportements actuels des acteurs ; (2) proposer un appui multiforme aux exploitants artisanaux légaux ; (3) valoriser davantage les bois d’origine légale sur les marchés nationaux ; (4) réformer le cadre juridique et réglementaire. Ces quatre stratégies d’action sont déclinées en options techniques et politiques

Dissemination of patient blood management practices in Swiss intensive care units: a cross-sectional survey

BACKGROUND Patient blood management (PBM) promotes the routine detection and treatment of anaemia before surgery, optimising the management of bleeding disorders, thus minimising iatrogenic blood loss and pre-empting allogeneic blood utilisation. PBM programmes have expanded from the elective surgical setting to nonsurgical patients, including those in intensive care units (ICUs), but their dissemination in a whole country is unknown. METHODS We performed a cross-sectional, anonymous survey (10 October 2018 to 13 March 2019) of all ordinary medical members of the Swiss Society of Intensive Care Medicine and the registered ICU nurses from the 77 certified adult Swiss ICUs. We analysed PBM-related interventions adopted in Swiss ICUs and related them to the spread of PBM in Swiss hospitals. We explored blood test ordering policies, blood-sparing strategies and red blood cell-related transfusion practices in ICUs. RESULTS A total of 115 medical doctors and 624 nurses (response rates 27% and 30%, respectively) completed the surveys. Hospitals had implemented a PBM programme according to 42% of physicians, more commonly in Switzerland's German-speaking regions (Odds Ratio [OR] 3.39, 95% confidence interval [CI] 1.23-9.35; p = 0.018) and in hospitals with more than 500 beds (OR 3.91, 95% CI 1.48-10.4; p = 0.006). The PBM programmes targeted the detection and correction of anaemia before surgery (79%), minimising perioperative blood loss (94%) and optimising anaemia tolerance (98%). Laboratory tests were ordered in 70.4% by the intensivist during morning rounds; the nurses performed arterial blood gas analyses autonomously in 48.4%. Blood-sparing techniques were used by only 42.1% of nurses (263 of 624, missing: 6) and 47.0% of physicians (54 of 115). Approximately 60% of respondents used an ICU-specific transfusion guideline. The reported haemoglobin threshold for the nonbleeding ICU population was 70 g/l and, therefore, was at the lower limit of current guidelines. CONCLUSIONS Based on this survey, the estimated proportion of the intensivists working in hospitals with a PBM initiative is 42%, with significant variability between regions and hospitals of various sizes. The risk of iatrogenic anaemia is relevant due to liberal blood sample collection practices and the underuse of blood-sparing techniques. The reported transfusion threshold suggests excellent adherence to current international ICU-specific transfusion guidelines

Long-menu questions in computer-based assessments: a retrospective observational study

Background: Computer based assessments of paediatrics in our institution use series of clinical cases, where information is progressively delivered to the students in a sequential order. Three types of formats are mainly used: Type A (single answer), Pick N, and Long-menu. Long-menu questions require a long, hidden list of possible answers: based on the student's initial free text response, the program narrows the list, allowing the student to select the answer. This study analyses the psychometric properties of Long-menu questions compared with the two other commonly used formats: Type A and Pick N. Methods: We reviewed the difficulty level and discrimination index of the items in the paediatric exams from 2009 to 2015, and compared the Long-menu questions with the Type A and Pick N questions, using multiple-way analyses of variances. Results: Our dataset included 13 exam sessions with 855 students and 558 items included in the analysis, 212 (38 %) Long-menu, 201 (36 %) Pick N, and 140 Type A (25 %) items. There was a significant format effect associated with both level of difficulty (p = .005) and discrimination index (p < .001). Long-menu questions were easier than Type A questions(+5.2 %; 95 % CI 1.1–9.4 %), and more discriminative than both Type A (+0.07; 95 % CI 0.01–0.14), and Pick N (+0.10; 95 % CI 0.05–0.16) questions. Conclusions: Long-menu questions show good psychometric properties when compared with more common formats such as Type A or Pick N, though confirmatory studies are needed. They provide more variety, reduce the cueing effect, and thus may more closely reflect real life practice than the other item formats inherited from paper-based examination that are used during computer-based assessments

Alexander I of Molossia and the creation of Apeiros

Epeiros, sometimes ‹Apeiros› in the sources, was a region in the northwest of the ancient Balkan peninsula. It ran roughly from the Gulf of Ambrakia in the south to Apollonia in the north, and as far inland as the Pindos mountain range. Epeiros was a region of substantial political and ethnic variety. For instance, Thucydides (2. 80. 5–6), when relating the local forces campaigning with the Spartan admiral Knemos in Akarnania in the summer of 429, describes a variety of ‹barbarian› contingents from Epeiros, some coming from communities with kings (Molossians, Atintanians, Parauaians, Orestians) and others kingless (Chaonians, Thesprotians). Three of these ethne came to dominate the region in the fourth, third, and second centuries: the Molossians, the Thesprotians, and the Chaonians. The Molossians and their ruling house, the Aiakids, appear most frequently in our standard narratives: Olympias, mother of Alexander the Great, and Pyrrhos, enemy of Rome, were both Aiakids