Moving the Lausanne medical library to a new location: shaping spaces, tailoring services

Moving the Lausanne medical library to a new location was the opportunity to investigate how to best support the educational, training, clinical and research needs of both the Medical Faculty and the medical community across all disciplines. Our analysis is based on a tridimensional approach. First, we examine the role of the library as space provider, especially for the students and educational staff. Second, we reflect to what extent we could improve as an online resources provider and trim the print collection. Finally, we underline the importance to position the library as solution provider geared towards clinicians and researchers

Major malformations risk following early pregnancy exposure to metformin: a systematic review and meta-analysis.

Metformin is considered as first-line treatment for type 2 diabetes and an effective treatment for polycystic ovary syndrome (PCOS). However, evidence regarding its safety in pregnancy is limited. We conducted a systematic review and meta-analysis of major congenital malformations (MCMs) risk after first-trimester exposure to metformin in women with PCOS and pregestational diabetes mellitus (PGDM). Randomized controlled trials (RCTs) and observational cohort studies with a control group investigating risk of MCM after first-trimester pregnancy exposure to metformin were searched until December 2021. ORs and 95% CIs were calculated separately according to indications and study type using Mantel-Haenszel method; outcome data were combined using random-effects model. Eleven studies (two RCTs; nine observational cohorts) met the inclusion criteria: four included pregnant women with PCOS, four included those with PGDM and three evaluated both indications separately and were considered in both indication groups. In PCOS group, there were two RCTs (57 exposed, 52 control infants) and five observational studies (472 exposed, 1892 control infants); point estimates for MCM rates in RCTs and observational studies were OR 0.93 (95% CI 0.09 to 9.21) (I2=0%; Q test=0.31; p value=0.58) and OR 1.35 (95% CI 0.37 to 4.90) (I2=65%; Q test=9.43; p value=0.05), respectively. In PGDM group, all seven studies were observational (1122 exposed, 1851 control infants); the point estimate for MCM rates was OR 1.05 (95% CI 0.50 to 2.18) (I2=59%; Q test=16.34; p value=0.01). Metformin use in first-trimester pregnancy in women with PCOS or PGDM do not meaningfully increase the MCM risk overall. However, further studies are needed to characterize residual safety concerns

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Patients souffrant de lésions cérébrales ::les soins à la famille

Une revue de la littérature concernant les patients souffrant d’une lésion cérébrale montre l’importance de tenir compte des répercussions de cet accident sur tous les membres de la famille. Les interventions infirmières s’attachent en particulier à les soutenir sur le plan émotionnel et à leur apporter des informations ciblées

Planification anticipée concernant la santé chez des personnes avec une capacité de discernement limitée ::revue de la littérature et état des lieux en Suisse

En dépit des nombreuses recommandations, un grand nombre des décisions sont encore prises sans impliquer le patient, plus particulièrement lorsque celui-ci a une capacité de discernement limitée. L’Office fédéral de la santé publique recommande de définir le plus rapidement possible les objectifs de la prise en charge du patient dans le cadre d’une planification des soins (c’est-à-dire la gestion quotidienne des soins, care planning) et d’un projet de soins anticipé (c’est-à-dire les soins en prévision d’une perte de la capacité de discernement, advance care planning). Ces planifications peuvent être faites de manière indépendante ou associée mais elles sont étroitement liées dans la prise en charge de personnes avec une capacité de discernement limitée. Ce projet vise à développer une image actuelle de la planification anticipée concernant la santé pour les personnes avec une capacité de discernement limitée. Nous avons dans ce contexte fait un bref état de lieux juridique et une revue de portée de la littérature des outils qui, en Suisse, permettent la planification anticipée concernant la santé chez des personnes avec une capacité de discernement limitée. La revue de la littérature et des sources complémentaires a mis en évidence un nombre important de plaidoyers en faveur de la planification anticipée en matière de santé des personnes avec une capacité de discernement limitée. En comparaison, le nombre d’outils permettant de soutenir l’autonomie des personnes en situation de handicap intellectuel ou avec des troubles neurocognitifs semble restreint et de fait nous avons pu identifier seulement dix outils s’adressant explicitement à des personnes avec une capacité de discernement limitée. Les lacunes suivantes ont été notamment soulignées : 1) La personne avec une capacité de discernement limitée n’est pas systématiquement impliquée dans sa planification anticipée concernant la santé malgré le fait que celle-ci se compose de nombreuses décisions et que la capacité de discernement devrait être évaluée pour chacune de celles-ci. 2) Il apparaît que les outils identifiés sont créés en fonction des besoins et cela engendre une grande hétérogénéité des approches et documents. 3) Les ressources investies dans la planification anticipées concernant la santé de personnes avec une capacité de discernement limitée et l’efficacité de la démarche ne sont pas discutées par les auteurs des outils. 4) La réception de ces documents et leur utilisation dans le cadre de la mise en œuvre de la planification anticipée concernant la santé de personnes avec une capacité de discernement limitée n’est pas discutée par les auteurs des outils répertoriés. Cet aspect est particulièrement important en ce qui concerne les décisions en cas d’urgence vitale. La situation actuelle est à même de diminuer le potentiel de la planification anticipée concernant la santé de personnes avec une capacité de discernement limitée. Nos recommandations découlent des constats de lacunes et s’organisent autour de 3 axes : 1. Développer des processus adaptés aux personnes avec une capacité de discernement limitée, en évaluer les coûts et les gains et élaborer des critères de qualité et d’efficacité ; 2. Améliorer l’implication des personnes avec une capacité de discernement limitée et les compétences des professionnels qui encadrent la planification anticipée concernant la santé ; 3. Préparer les représentants thérapeutiques et les curateurs à assumer leur rôle de représentants dans le domaine de la santé

Family-oriented interventions for adults with acquired brain injury and their families ::a scoping review

Objective: This scoping review sought to describe the literature on the different types of interventions to support families of patients with acquired brain injuries (ABIs) and their outcomes. Introduction: Acquired brain injuries are among the leading causes of disability in adults worldwide and have physical, cognitive or/and behavioral consequences not only for the patient, but also for the family. Several support interventions have been proposed in different contexts at different phases of recovery with various levels of evidence, yet no synthesis is available to date. Inclusion criteria: We included studies that focused on family members of patients suffering from ABI. The concept under review included any type of intervention or action oriented to support families of patients with ABI, in any care setting. We included all published qualitative and quantitative designs, including those in the gray literature. Methods: A three-step search strategy was performed. Searches were conducted in eight major databases, MEDLINE, PubMed, Embase, CINAHL, PsycINFO, Cochrane, JBI Database of Systematic Reviews and Implementation Reports, Web of Science in April 2017, and seven databases for unpublished studies in November 2017. This review was limited to studies published in English and French since January 2007. Additional studies were searched amongst reference lists of all included articles. Results: We included 89 studies, 19 secondary studies (systematic reviews n = 13, other type of reviews n = 6) and 70 primary studies (experimental studies n = 20, quasi-experimental studies n = 33, other designs n = 17). Even if heterogeneity was found in the characteristics of the 64 selected interventions, emotional support and education were highlighted as the main core components for family-oriented interventions. Mental health and burden were the two most prevalent outcomes found in this scoping review. Interventions targeted families and patients together in 56% of the cases or families alone. Conclusion: This scoping review provides an actual state of the current evidence available for families of patients with ABI. Extended and heterogeneous literature was found, showing the growing interest for considering ABI as a family issue in recent years. However, the overall level of evidence found indicates that more research is still needed to determine key components to intervene within this specific population

A systematic review of clinical practice guidelines for acute procedural pain on neonates

Objectives: During hospitalization in neonatal intensive care units, neonates are exposed to many painful procedures within a stressful environment. To date, many evidence-based guidelines are available. However, the quality of these guidelines and their clinical application remain unclear. This systematic review aimed to determinie the quality of existing guidelines on the management of procedural pain in neonates and to summarize the recommendations provided by these guidelines. Materials and Methods: A structured search was conducted in Embase, PubMed, CINAHL, JBI database, and gray literature resources in November 2018 to identify relevant guidelines published from 2007 onward. Published guidelines and guidelines from complementary searches were included in the treating assessment or management of procedural pain in neonates. The methodological quality was analyzed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Results: A total of 1154 records were identified. After screening for eligibility, 17 guidelines were included in this review. Among these, 11 were identified to be high-quality guidelines. Besides the usual recommendations for pharmacological and nonpharmacological treatments, the inclusion of parents, improving interprofessional collaboration, and considering the setting were identified as important elements. Discussion: The results of this review show that there is a need to improve the methodological quality of guidelines for procedural pain in newborns. The set of recommendations for procedural pain prevention needs to involve not only pharmacological and nonpharmacological pain treatment but also parents and interprofessional collaboration. It is also essential to take into account facilitators, barriers, and the context to improve pain management

Experience of hope in adult patients with advanced chronic disease and their informal caregivers ::a qualitative systematic review protocol

Objective: This systematic review will evaluate the experience of hope in adult patients with advanced chronic diseases other than cancer, transitioning toward end-of-life. The review will also evaluate the experience of hope in informal caregivers caring for adult patients with advanced chronic diseases other than cancer as they transition toward end-of-life. Introduction: Hope is an important resource that assists patients and informal caregivers to deal with difficult and complex situations, such as living with advanced chronic disease. Inclusion criteria: The review will include studies written in English, French, and Portuguese exploring hope. Qualitative studies focusing on adult patients with advanced chronic diseases other than cancer and/or informal caregivers will be considered. Studies with children as patients or parents as caregivers will be excluded. Methods: The review will search Embase, MEDLINE, CINAHL, PsycINFO, Web of Science, ProQuest Dissertations & Theses, DART-Europe E-theses Portal, and Google Scholar. The search will be conducted without date restrictions. Articles will be selected against the inclusion criteria by two independent reviewers and potentially relevant papers will be assessed in detail. Data will be extracted using a standard tool. The extracted findings will be synthesized using the meta-aggregation approach through assembling and categorizing data