Perspective des patients et des médecins à l'égard du dépistage VIH aux urgences: Une étude prospective transversale

Background At our emergency department (ED), 1% of all patients seen are tested for HIV. This study explored patient- and physician-led barriers and acceptability of rapid HIV testing. Methods Between October 2014 and May 2015, 100 patient-physician pairs were interviewed in the ED of Lausanne University Hospital, Lausanne, Switzerland. Patients completed a questionnaire on HIV risk factors and were offered free rapid HIV testing (INSTITM). For every patient included, the treating physician was asked if HIV testing had been indicated according to the national testing recommendations, mentioned, or offered during the consultation. Results: Of 100 patients, 30 had indications for HIV testing through risk factors or a suggestive presenting complaint. Although 17 patients wished to be tested during their ED consultation, none raised the subject with their physician. Fifty patients accepted rapid testing; no test was reactive. Of 50 patients declining testing, 82% considered themselves not at risk or had recently tested negative and 16% wished to focus on their presenting complaint (PC). Twenty physicians identified patients with testing indications and six offered testing. The main reason for not mentioning or offering testing was the wish to focus on the PC. Conclusion: Patients and physicians at our ED share the barrier of wishing to focus on the PC. Rapid HIV testing offered in parallel to the patient-physician consultation increased the testing rate from 6% (offered by physicians) to 50%. Introducing this service would enable testing of patients not offered tested by their physicians and optimise early HIV diagnoses

Patient and doctor perspectives on HIV screening in the emergency department: A prospective cross-sectional study.

The emergency department (ED) is mentioned specifically in the Swiss HIV testing recommendations as a site at which patients can benefit from expanded HIV testing to optimise early HIV diagnosis. At our centre, where local HIV seroprevalence is 0.2-0.4%, 1% of all patients presenting to the ED are tested for HIV. Barriers to HIV testing, from the patient and doctor perspective, and patient acceptability of rapid HIV testing were examined in this study. Between October 2014 and May 2015, 100 discrete patient-doctor encounter pairs undertook a survey in the ED of Lausanne University Hospital, Switzerland. Patients completed a questionnaire on HIV risk factors and were offered free rapid HIV testing (INSTI™). For every patient included, the treating doctor was asked if HIV testing had 1) been indicated according to the national testing recommendations, 2) mentioned, and 3) offered during the consultation. Of 100 patients, 30 had indications for HIV testing through risk factors or a suggestive presenting complaint (PC). Fifty patients accepted rapid testing; no test was reactive. Of 50 patients declining testing, 82% considered themselves not at risk or had recently tested negative and 16% wished to focus on their PC. ED doctors identified 20 patients with testing indications, mentioned testing to nine and offered testing to six. The main reason for doctors not mentioning or not offering testing was the wish to focus on the PC. Patients and doctors at our ED share the testing barrier of wishing to focus on the PC. Rapid HIV testing offered in parallel to the patient-doctor consultation increased the testing rate from 6% (offered by doctors) to 50%. Introducing this service would enable testing of patients not offered tests by their doctors and reduce missed opportunities for early HIV diagnosis

Spontaneous non-traumatic splenic artery aneurysm rupture: a case report and review of the literature.

The current case report is about spontaneous non-traumatic rupture of a splenic artery aneurysm (SAA) in a 53-year-old woman with no particular medical history. An emergent laparotomy with splenectomy was required, unfortunately without success as the patient died. SAA is the most common visceral artery aneurysm. Most of SAA remain asymptomatic and are discovered incidentally on imaging. The overall risk of rupture increases with the size of SAA, especially when above 2 cm. Initial presentation of SAA has been associated with acute rupture and hemodynamic instability leading to substantial perioperative morbidity and mortality