Assisted suicide in an acute care hospital: 18 months' experience

QUESTION UNDER STUDY: In 2006 the University Hospital of Lausanne (CHUV) introduced an institutional directive specifying the conditions for assisted suicide, in accordance with professional guidelines and the recommendation of the Swiss National Advisory Commission on Biomedical Ethics that every acute care hospital take up a position on this subject. METHODS: 18-months follow-up analysis of patient requests and application of the directive by hospital staff. RESULTS: Of the 54,000 patients hospitalised between January 1, 2006, and June 30, 2007, six requests were recorded, all within the first 7 months after introduction of the directive and in the context of severe and life-threatening diseases. However, only one of the six patients, living in a nursing home belonging to the hospital, died by assisted suicide. Two patients died from their diseases, one during the assessment procedure and the other shortly after. One patient withdrew his request after pain control, returned home and died several weeks later. Another patient, although she was severely ill and died several months later, was denied the procedure because her condition was improving. Only one patient was declared incompetent and his request refused. The time distribution of requests seems to be associated with initial media coverage of the assisted-suicide directive's introduction. Only minor amendments to the directive were needed. CONCLUSIONS: The recommendations of the Swiss National Advisory Commission on Biomedical Ethics are applicable in an acute care hospital

Comparison of HIV-infected patients' characteristics, healthcare resources use and cost between native and migrant patients

Objectives:: To assess whether patients' characteristics and healthcare resources consumption and costs were different between native and migrant populations in Switzerland. Methods:: All adult patients followed-up in the Swiss HIV-cohort study in our institution during 2000-2003 were considered. Patients' characteristics were retrieved from the cohort database. Hospital and outpatient resource use were extracted from individual charts and valued with 2002 tariffs. Results:: The 66 migrants were younger (29 ± 8years versus 37±11, p < 0.001), less often of male gender (38 % versus 70 %, p < 0.001), predominantly infected via heterosexual contact (87 % versus 52 %, p < 0.01), with lower mean CD4 level at enrolment (326 ± 235 versus 437± 305, p = 0.002) than their 200 native counterparts. Migrants had fewer hospitalizations, more frequent outpatient visits, laboratory tests, and lower total cost of care per year of follow-up (€ 2′215 ± 4′206 versus 4′155 ± 12′304, p = 0.037). Resource use and costs were significantly higher in people with < 200 CD4 cell counts in both groups. Conclusions:: Migrant population had more advanced disease, more outpatient visits but less hospitalizations, resulting in lower costs of care when compared with native populatio

Planification hospitalière cantonale orientée sur les prestations : application à l'orthopédie - traumatologie dans le canton de Vaud

Contexte : Le monde sanitaire est en profonde mutation : les exigences légales la raréfaction des moyens financiers à disposition, et les meilleurs résultats cliniques observés en corrélation avec le volume des prestations incitent à regrouper les plateaux techniques des hôpitaux. D'un autre côté, le vieillissement de la population augmente le nombre de maladies dégénératives et les besoins en prothèses de hanche ou de genou. L'ensemble de ces facteurs incite à passer d'une planification par lits à une planification par prestations, qu'il faut valider. Matériel et méthode : L'ensemble des prestations orthopédiques fournies dans le canton de Vaud en 2000 a servi de base pour planifier le nombre de lits nécessaires à cette discipline dans le cadre du projet de nouvelle planification hospitalière vaudoise sur 4 sites, avec et sans l'ensemble des cliniques privées. Ces données ont été ensuite validées sur la base de l'activité enregistrée en 2001 et 2002. Résultats : L'implantation de prothèses totales de hanche (PTH) et de genou (PTG) représente 30% de l'activité orthopédique, mais 60% des journées d'hospitalisation, actuellement disséminée sur 19 sites, dont 8 privés. Cette activité est relativement stable au cours du temps (+5% PTH, 24% PTG, 5% journées d'hospitalisation). En tenant compte des complications liées à cette activité opératoire, de l'activité d'urgence et des autres interventions orthopédiques (supposées constantes), l'impact d'une augmentation du nombre de PTH et PTG de 5,10 et 20% dans les années à venir impliquerait une augmentation des lits existants de 4,7 et 14 lits respectivement, sur l'ensemble des 4 sites, sans tenir compte de l'activité du secteur privé, et de 4, 8 et 16 lits respectivement avec l'activité du secteur privé. Conclusion : La planification hospitalière par prestations plutôt que par nombre de lits semble possible Elle devrait être appliquée dans l'ensemble des disciplines médicales et chirurgicales, et tenir compte d'une activité d'urgence, non planifiable par définition, pour définir les structures et ressources nécessaires pour faire face aux besoins de la population. [Auteurs]]]> Hospital Planning ; Orthopedics ; Traumatology ; Aging oai:serval.unil.ch:BIB_4059 2022-05-07T01:16:14Z <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_4059 Martingale Approach to Pricing Perpeetual American Options on Two Stocks. Gerber, HU Shiu, E info:eu-repo/semantics/article article 1996 Mathematical Finance, vol. 6, pp. 302-322 oai:serval.unil.ch:BIB_405A82989897 2022-05-07T01:16:14Z <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_405A82989897 Les allergies médicamenteuses, une hydre à neuf têtes.. [Drug allergies]. info:eu-repo/semantics/altIdentifier/pmid/22594005 Spertini, F. Seebach, J.D. info:eu-repo/semantics/article article 2012 Revue Médicale Suisse, vol. 8, no. 337, pp. 827-828 info:eu-repo/semantics/altIdentifier/pissn/1660-9379 urn:issn:1660-9379 Anaphylaxis/chemically induced; Drug Hypersensitivity/complications; Drug Hypersensitivity/diagnosis; Humans; Iatrogenic Disease fre oai:serval.unil.ch:BIB_4055 2022-05-07T01:16:14Z 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_4055 La codification du vote en Suisse (1848-1918): fédéralisme et construction du citoyen Voutat, B info:eu-repo/semantics/article article 1996 Genèses, vol. 23, pp. 76-99 fre https://serval.unil.ch/resource/serval:BIB_4055.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_40557 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_40557 info:eu-repo/semantics/submittedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_40550 2022-05-07T01:16:14Z <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_40550 Des vertus de l'efficience à la puissance des marchés financiers Merrone, G. info:eu-repo/semantics/article article 1995 Le Trimestre du monde, vol. N°31 fre oai:serval.unil.ch:BIB_40551 2022-05-07T01:16:14Z <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_40551 Beauté, sécurité, travail, vertu... La Suisse a les plus beaux billets du monde! Graz, J.-Ch. Merrone, G. info:eu-repo/semantics/article article 1999 Le Temps stratégique, vol. N°90, pp. 8-13 fre oai:serval.unil.ch:BIB_40552 2022-05-07T01:16:14Z <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_40552 Ce qui donne sens à l'interdisciplinarité Freymond, N. Meier, D. Merrone, G. info:eu-repo/semantics/article article 2003 A contrario, vol. 1, no. 1, pp. 3-9 fre oai:serval.unil.ch:BIB_40553 2022-05-07T01:16:14Z <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_40553 La misère d'un monde lointain: Muriel Jolivet et la socio-analyse de l'homo japonicus Merrone, G. Watanabe, A. info:eu-repo/semantics/article article 2003 A contrario, vol. 1, no. 2, pp. 123-129 fre oai:serval.unil.ch:BIB_40554 2022-05-07T01:16:14Z <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_40554 Pratiquer l'interdisciplinarité Meier, D. Merrone, G. info:eu-repo/semantics/article article 2005 A contrario, vol. 3, no. 1, pp. 3-4 fre oai:serval.unil.ch:BIB_40555 2022-05-07T01:16:14Z <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_40555 Ecriture et récit en sciences sociales Meier, D. Merrone, G. Parchet, R. info:eu-repo/semantics/article article 2006 A contrario, vol. 4, no. 1, pp. 3-5 fre oai:serval.unil.ch:BIB_40555C722DE0 2022-05-07T01:16:14Z 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_40555C722DE0 Single breath-hold 3D measurement of left atrial volume using compressed sensing cardiovascular magnetic resonance and a non-model-based reconstruction approach. info:doi:10.1186/s12968-015-0147-8 info:eu-repo/semantics/altIdentifier/doi/10.1186/s12968-015-0147-8 info:eu-repo/semantics/altIdentifier/pmid/26062814 Vardoulis, O. Monney, P. Bermano, A. Vaxman, A. Gotsman, C. Schwitter, J. Stuber, M. Stergiopulos, N. Schwitter, J. info:eu-repo/semantics/article article 2015 Journal of Cardiovascular Magnetic Resonance, vol. 17, pp. 47 info:eu-repo/semantics/altIdentifier/eissn/1532-429X urn:issn:1097-6647 <![CDATA[BACKGROUND: Left atrial (LA) dilatation is associated with a large variety of cardiac diseases. Current cardiovascular magnetic resonance (CMR) strategies to measure LA volumes are based on multi-breath-hold multi-slice acquisitions, which are time-consuming and susceptible to misregistration. AIM: To develop a time-efficient single breath-hold 3D CMR acquisition and reconstruction method to precisely measure LA volumes and function. METHODS: A highly accelerated compressed-sensing multi-slice cine sequence (CS-cineCMR) was combined with a non-model-based 3D reconstruction method to measure LA volumes with high temporal and spatial resolution during a single breath-hold. This approach was validated in LA phantoms of different shapes and applied in 3 patients. In addition, the influence of slice orientations on accuracy was evaluated in the LA phantoms for the new approach in comparison with a conventional model-based biplane area-length reconstruction. As a reference in patients, a self-navigated high-resolution whole-heart 3D dataset (3D-HR-CMR) was acquired during mid-diastole to yield accurate LA volumes. RESULTS: Phantom studies. LA volumes were accurately measured by CS-cineCMR with a mean difference of -4.73 ± 1.75 ml (-8.67 ± 3.54%, r2 = 0.94). For the new method the calculated volumes were not significantly different when different orientations of the CS-cineCMR slices were applied to cover the LA phantoms. Long-axis "aligned" vs "not aligned" with the phantom long-axis yielded similar differences vs the reference volume (-4.87 ± 1.73 ml vs. -4.45 ± 1.97 ml, p = 0.67) and short-axis "perpendicular" vs. "not-perpendicular" with the LA long-axis (-4.72 ± 1.66 ml vs. -4.75 ± 2.13 ml; p = 0.98). The conventional bi-plane area-length method was susceptible for slice orientations (p = 0.0085 for the interaction of "slice orientation" and "reconstruction technique", 2-way ANOVA for repeated measures). To use the 3D-HR-CMR as the reference for LA volumes in patients, it was validated in the LA phantoms (mean difference: -1.37 ± 1.35 ml, -2.38 ± 2.44%, r2 = 0.97). Patient study: The CS-cineCMR LA volumes of the mid-diastolic frame matched closely with the reference LA volume (measured by 3D-HR-CMR) with a difference of -2.66 ± 6.5 ml (3.0% underestimation; true LA volumes: 63 ml, 62 ml, and 395 ml). Finally, a high intra- and inter-observer agreement for maximal and minimal LA volume measurement is also shown. CONCLUSIONS: The proposed method combines a highly accelerated single-breathhold compressed-sensing multi-slice CMR technique with a non-model-based 3D reconstruction to accurately and reproducibly measure LA volumes and function

Les itinéraires cliniques sont-ils efficaces ? : revue Cochrane pour le praticien

Cet article présente les résultats de la revue systématique: Rotter T, Kinsman L, James E, et al. Clinical pathways : Effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No:CD006632. DOI:10.1002/14651858.CD006632.pub2. PMID: 20238347

Can the impact of bed closure in intensive care units be reliably monitored?

Objective: To assess the properties of various indicators aimed at monitoring the impact on the activity and patient outcome of a bed closure in a surgical intensive care unit (ICU). Design: Comparison before and after the intervention. Setting: A surgical ICU at a university hospital. Patients: All patients admitted to the unit over two periods of 10months. Intervention: Closure of one bed out of 17. Measurements and results: Activity and outcome indicators in the ICU and the structures upstream from it (emergency department, operative theater, recovery room) and downstream from it (intermediate care units). After the bed closure, the monthly medians of admitted patients and ICU hospital days increased from 107 (interquartile range 94-112) to 113 (106-121, P=0.07) and from 360 (325-443) to 395 (345-436, P=0.48), respectively, along with the linear trend observed in our institution. All indicators of workload, patient severity, and outcome remained stable except for SAPS II score, emergency admissions, and ICU readmissions, which increased not only transiently but also on a mid-term basis (10months), indicating that the process of patient care delivery was no longer predictable. Conclusions: Health care systems, including ICUs, are extraordinary flexible, and can adapt to multiple external constraints without altering commonly used activity and outcome indicators. It is therefore necessary to set up multiple indicators to be able to reliably monitor the impact of external interventions and intervene rapidly when the system is no longer under contro

Patients' and healthcare workers' perceptions of a patient safety advisory

Objective To assess patients' and healthcare workers' (hcw) attitudes and experiences with a patient safety advisory, to investigate predictors for patients' safety-related behaviors and determinants for staff support for the advisory. Design Cross-sectional surveys of patients (n= 1053) and hcw (n= 275). Setting Three Swiss hospitals. Participants Patients who received the safety advisory and hcw caring for these patients. Intervention Patient safety advisory disseminated to patients at the study hospitals. Main Outcome Measures Attitudes towards and experiences with the advisory. Hcw support for the intervention and patients' intentions to apply the recommendations were modelled using regression analyses. Results Patients (95%) and hcw (78%) agreed that hospitals should educate patients how to prevent errors. Hcw and patients' evaluations of the safety advisory were positive and followed a similar pattern. Patients' intentions to engage in safety were significantly predicted by behavioral control, subjective norms, attitudes, safety behaviors during hospitalization and experiences with taking action. Hcw support for the campaign was predicted by rating of the advisory (Odds ratio (OR) 3.4, confidence interval (CI) 1.8-6.1, P< 0.001), the belief that it prevents errors (OR 1.7, CI 1.2-2.5, P= 0.007), perceived increased vigilance of patients (OR 1.9, CI 1.1-3.3, P= 0.034) and experience of unpleasant situations (OR 0.6, CI 0.4-1.0, P= 0.035). Conclusions The safety advisory was well accepted by patients and hcw. To be successful, the advisory should be accompanied by measures that target norms and barriers in patients, and support staff in dealing with difficult situation

Quality of life on chronic dialysis: comparison between haemodialysis and peritoneal dialysis

Background. Quality of life (QOL) assessment in patients on chronic haemodialysis (HD) or peritoneal dialysis (PD) has only rarely been carried out with the generic Euroqol-5D® questionnaire. Methods. All chronic HD and PD patients in the 19 centres of western Switzerland were requested to fill in the validated Euroqol-5D® generic QOL questionnaire, assessing health status in five dimensions and on a visual analogue scale, allowing computation of a predicted QOL value, to be compared with the value measured on the visual analogue scale. Results. Of the 558 questionnaires distributed to chronic HD patients, 455 were returned (response rate 82%). Fifty of 64 PD patients (78%) returned the questionnaire. The two groups were similar in age, gender and duration of dialysis treatment. Mean QOL was rated at 60±18% for HD and 61±19% for PD, for a mean predicted QOL value of 62±30 and 58±32% respectively. Results of the five dimensions were similar in both groups, except for a greater restriction in usual activities for PD patients (P = 0.007). The highest scores were recorded for self-care, with 71% HD and 74% PD patients reporting no limitation, and the lowest scores for usual activities, with 14% HD and 23% PD patients reporting severe limitation. Experiencing pain/discomfort (for HD and PD) or anxiety/depression (for PD) had the highest impact on QOL. Conclusions. QOL was equally diminished in HD and PD patients. The questionnaire was well accepted and performed well. Improvement could be achievable in both groups if pain/discomfort and anxiety/depression could be more effectively treate

Variability in quality of care among dialysis units in western Switzerland

Background. Quality indicators for dialysis care vary across countries and regions, but regional variability across centres has received little attention. We analysed variations in quality indicators among dialysis facilities in western Switzerland to identify opportunities for improving care for patients with end-stage kidney disease. Methods. A cross-sectional study of 617 dialysis patients treated at 19 facilities examined the distribution of indicators of quality of care addressing: adequacy of dialysis (Kt/V ≥1.2 for haemodialysis, Kt/V ≥2 for peritoneal dialysis), anaemia control (haemoglobin ≥110 g/l), calcium and phosphate control (product ≤4.4 mmol2/l2), adequate nutrition (serum albumin >35 g/l), hypertension control (pre-dialysis blood pressure 40 patients better fulfilled quality targets than university-based centres. Adjustment for patient characteristics did not modify these results. Conclusions. Substantial variations in quality indicators existed between dialysis centres in western Switzerland, which could not be attributed to different centre policies, or to differences in available measures of patient case mix. These findings indicate opportunities for improvement in dialysis practice which may translate into improved clinical outcome