Self-Reported Violence Experienced by Swiss Prehospital Emergency Care Providers.

Workplace violence is a serious and increasing problem in health care. Nevertheless, only few studies were carried out concerning this topic and then mainly in English-speaking countries. The objectives were to describe the acts of violence experienced by prehospital emergency care providers (PECPs) in the western part of Switzerland between January and December 2016 and to assess the consequences for subsequent PECPs behaviors. An observational cross-sectional study, carried out using an online survey, has been sent to all 416 PECPs in the Canton of Vaud, in the western, French-speaking, part of Switzerland. The survey contained items of demographic data and items to assess the type and consequence of violence sustained. This was classified as five types: verbal assault, intimidation, physical assault, sexual harassment, and sexual assault. 273 (65.6%) PECPs participated in the survey. During 2016, workplace violence was reported by 229 survey participants (83.9%). Most declared to be the victim of such violence between one and three times during the year. In all cases of violence described, the patient and/or a relative initiated aggressive behavior in 96% of cases. Verbal assaults were the most common (99.2% of all acts), followed by intimidation (72.8%), physical assault (69.6%), and sexual harassment (16.3%). Concerning physical assault, PECPs were predominantly victims of spitting and/or jostling (50%). After a violent event, in 50% of cases, the PECPs modified their behavior owing to the experience of workplace violence; 82% now wear protective vests, and 16% carry weapons for self-defense, such as pepper sprays. Seventy-five percent changed their intervention strategies, acting more carefully and using verbal de-escalation techniques or physical restraints for violent patients. Workplace violence is frequent and has significant consequences for PECPs. In order to increase their own security, they increased their protection. These results illustrate their feelings of insecurity, which may have deleterious effects on work satisfaction and motivation. Trial Registration. Our article does not report the results of a health care intervention on human participants

Involuntary admissions to the emergency department: a retrospective observational study.

The main objective of this study was to describe patients who were involuntarily admitted to the emergency department of Lausanne University Hospital on involuntary admission in 2018 in terms of age, gender, emergency department length of stay, the motive for involuntary admission, use of psychoactive substances, diagnosis, and destination at emergency department discharge, with or without discontinuation of involuntary admission. This retrospective, observational, and monocentric study included patients 18 years and older admitted to the emergency department of Lausanne University Hospital on involuntary admission from January 1, 2018, to December 31, 2018. Patients were identified by the Cantonal Medical Office of Vaud. The emergency department length of stay and patient destination on discharge from the emergency department were extracted from the patient flow database, and discharge letters and involuntary admission were extracted from the electronic archiving software. Descriptive statistics were processed by using means and standard deviations for quantitative variables with a normal distribution and median and interquartile range for non-normally distributed data. During the study period, 83 patients were admitted on involuntary admission to the emergency department. The majority of the patients were male (58%) with a mean age of 55 (±20) years. The median emergency department length of stay of patients with an involuntary admission was between 9 and 16 hours, depending on whether the involuntary admission was confirmed or discontinued after patient assessment in the emergency department. In comparison, the median emergency department length of stay was 6 hours for patients overall. The two principal diagnoses described were psychiatric (schizophrenia) and mental and behavioural disorders due to psychoactive substance use. Half of the patients on involuntary admission consumed psychoactive substances, primarily alcohol, and had a mean ethanolaemia of 53 (±32) mmol/l. Only a third of patients admitted on involuntary admission saw this measure confirmed after their assessment in the emergency department. Involuntary admissions with admission to the emergency department is used to force patients to be examined by an emergency physician or even a psychiatrist. On-call and primary care physicians seemed to lack the time or resources to set up alternatives to emergency department admissions on involuntary admission, especially in situations in which the involuntary admission was discontinued after an emergency department assessment. This demonstrates the inappropriate use of this measure because a patient cannot be involuntarily hospitalised in an emergency department

Contrasting and congruent patterns of genetic structuring in two Microtus vole species using museum specimens

The common vole (Microtus arvalis) and the field vole (Microtus agrestis) are morphologically similar species but are ecological distinctive and differ in the details of their evolutionary history as revealed by mitochondrial DNA (mtDNA). The aim of this study is to describe patterns of genetic variability using microsatellite markers in populations of the common and field vole in Poland using museum specimens, to assess the degree of congruence with mtDNA variation and thereby determine the factors that influence current patterns of gene flow. We genotyped 190 individuals of the common vole at 11 loci and 190 individuals of the field vole at 13 loci. Overall differentiation based on F ST was higher for the common vole than in the field vole. We detected a significant isolation by distance pattern for both species. Bayesian analysis in STRUCTURE identified Eastern and Western geographic groups in Poland based on microsatellites for both species. The location of river barriers is likely to be the main factor in these partitions. The eastern-western subdivision with microsatellites does not coincide with the distribution of mtDNA lineages for either species. Unlike previous studies in the common and field vole elsewhere in Europe, we found no evidence of reproductive isolation between the mtDNA lineages of these species at their contact zones in Poland. This study highlights the different roles of evolutionary history and landscape in shaping contemporary genetic structure in voles in Poland

Phylogeography of Aegean green toads (Bufo viridis subgroup): continental hybrid swarm vs. insular diversification with discovery of a new island endemic

BACKGROUND: Debated aspects in speciation research concern the amount of gene flow between incipient species under secondary contact and the modes by which post-zygotic isolation accumulates. Secondary contact zones of allopatric lineages, involving varying levels of divergence, provide natural settings for comparative studies, for which the Aegean (Eastern Mediterranean) geography offers unique scenarios. In Palearctic green toads (Bufo viridis subgroup or Bufotes), Plio-Pleistocene (~ 2.6 Mya) diverged species show a sharp transition without contemporary gene flow, while younger lineages, diverged in the Lower-Pleistocene (~ 1.9 Mya), admix over tens of kilometers. Here, we conducted a fine-scale multilocus phylogeographic analysis of continental and insular green toads from the Aegean, where a third pair of taxa, involving Mid-Pleistocene diverged (~ 1.5 Mya) mitochondrial lineages, earlier tentatively named viridis and variabilis, (co-)occurs. RESULTS: We discovered a new lineage, endemic to Naxos (Central Cyclades), while coastal islands and Crete feature weak genetic differentiation from the continent. In continental Greece, both lineages, viridis and variabilis, form a hybrid swarm, involving massive mitochondrial and nuclear admixture over hundreds of kilometers, without obvious selection against hybrids. CONCLUSIONS: The genetic signatures of insular Aegean toads appear governed by bathymetry and Quaternary sea level changes, resulting in long-term isolation (Central Cyclades: Naxos) and recent land-bridges (coastal islands). Conversely, Crete has been isolated since the end of the Messinian salinity crisis (5.3 My) and Cretan populations thus likely result from human-mediated colonization, at least since Antiquity, from Peloponnese and Anatolia. Comparisons of green toad hybrid zones support the idea that post-zygotic hybrid incompatibilities accumulate gradually over the genome. In this radiation, only one million years of divergence separate a scenario of complete reproductive isolation, from a secondary contact resulting in near panmixia

Mythes en médecine d’urgence : prises en charge intrahospitalières [Emergency medecine : myths in hospital care]

Many of our medical procedures are conditioned by beliefs or experiences by our mentors, which we pass on to the younger, for example: gradually emptying a full bladder to avoid hypotension or haemorrhage, hydrating the alcoholic so that the blood alcohol level decreases faster, always obtaining an arterial blood gas instead of a venous one and not injecting iodinated intravenous contrast in patients allergic to shellfish