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  • 1
    Online Resource
    Online Resource
    Switching COPD patients from the disposable to the new reusable Respimat soft mist inhaler: a real-world study from Switzerland
    Informa UK Limited ; 2021
    In:  Current Medical Research and Opinion Vol. 37, No. 11 ( 2021-11-02), p. 2019-2033
    Details
    In: Current Medical Research and Opinion, Informa UK Limited, Vol. 37, No. 11 ( 2021-11-02), p. 2019-2033
    Type of Medium: Online Resource
    ISSN: 0300-7995 , 1473-4877
    URL: Article
    DOI: 10.1080/03007995.2021.1969354
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2021
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    detail.hit.zdb_id: 2034331-0
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  • 2
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    High Incidence of New-Onset Joint Pain in Patients on Fluoroquinolones as Antituberculous Treatment
    S. Karger AG ; 2020
    In:  Respiration Vol. 99, No. 2 ( 2020), p. 125-131
    Details
    In: Respiration, S. Karger AG, Vol. 99, No. 2 ( 2020), p. 125-131
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Joint pain is frequently observed in patients on antituberculous treatment, and pyrazinamide is known to be associated with joint pain in patients receiving antituberculous treatment. Fluoroquinolone-associated joint pain and tendon injury have been reported in long-term corticosteroid and transplant recipients, but data are lacking in patients with tuberculosis. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The objective of this study was to examine the incidence of joint pain manifested during administration of antituberculous therapy and their association with fluoroquinolones. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Patients diagnosed with tuberculosis attending the outpatient clinic over a period of 1 year were reviewed and divided into 3 groups: group A receiving pyrazinamide, group B receiving a fluoroquinolone, and group C receiving both pyrazinamide and a fluoroquinolone. Latency to onset of joint pain was noted in all 3 groups. Joint pain was initially managed with analgesics, and associated hyperuricemia was treated with allopurinol/febuxostat. Causative drugs were stopped in case of intolerable joint pain. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 260 patients (47% females, aged 38 ± 18 years; mean ± SD) were included [group A ( 〈 i 〉 n 〈 /i 〉 = 140), group B ( 〈 i 〉 n 〈 /i 〉 = 81), and group C ( 〈 i 〉 n 〈 /i 〉 = 39)]. Overall, 76/260 (29%) patients developed joint pain: group A – 24/140 patients (17%), group B – 32/81 patients (40%), and group C – 20/39 patients (51%). The median latency to the onset of joint pain was 83 days (interquartile range, IQR 40–167): 55 days (IQR 32–66) in group A, 138 days (IQR 74–278) in group B, and 88 days (IQR 34–183) in group C. Hyperuricemia was present in 12/24 (50%) patients in group A and 11/20 (55%) patients in group C. Pyrazinamide was stopped in 7/140 (5%) patients in group A, fluoroquinolones in 6/81 (7%) patients in group B, and both pyrazinamide and fluoroquinolones were stopped in 5/39 (13%) patients in group C because of intolerable joint pain. Major joints affected were knees and ankles. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 There is a high incidence of joint pain in patients receiving antituberculous treatment, which is higher when fluoroquinolones or the pyrazinamide-fluoroquinolone combination are administered as compared to pyrazinamide alone.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000505102
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1464419-8
    detail.hit.zdb_id: 206674-9
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  • 3
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    The Correct Indication to Induce Labour in a Swiss Cantonal Hospital
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 20 ( 2023-10-14), p. 6515-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 20 ( 2023-10-14), p. 6515-
    Abstract: Background: Induction of labour (IOL) is a way to stimulate the onset of labour using mechanical and pharmacological methods. IOL is one of the most frequently performed obstetric procedures worldwide. We aimed to determine compliance with guidelines and to investigate factors associated with the success of labour. Methods: In this retrospective, observational study, we analysed all induced deliveries in a Swiss hospital between January 2020 and December 2022. Results: Out of 1705 deliveries, 349 women underwent IOL, and 278 were included in this study, with an average age of 32 years (range 19–44 years). Most of the women were induced for missed deadlines (20.1%), the premature rupture of membranes (16.5%), and gestational diabetes mellitus (9.3%), and there was a good adherence to the guideline, especially with the indication and IOL monitoring (100%). However, an improvement needs to be made in measuring and documenting the Bishop score (41%). The success of labour was associated with multiparity (81.8% vs. 62.4% p = 0.001) and maternal non-obesity (73.4 vs. 54.1% p = 0.026). Conclusions: An improvement is needed in the measurement and documentation of the Bishop score. Further research is needed to confirm the found associations between parity, obesity, and the success of IOL.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12206515
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662592-1
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  • 4
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    Inhaled aviptadil for the possible treatment of COVID-19 in patients at high risk for ARDS: study protocol for a randomized, placebo-controlled, and multicenter trial
    Springer Science and Business Media LLC ; 2022
    In:  Trials Vol. 23, No. 1 ( 2022-09-20)
    Details
    In: Trials, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2022-09-20)
    Abstract: Despite the fast establishment of new therapeutic agents in the management of COVID-19 and large-scale vaccination campaigns since the beginning of the SARS-CoV-2 pandemic in early 2020, severe disease courses still represent a threat, especially to patients with risk factors. This indicates the need for alternative strategies to prevent respiratory complications like acute respiratory distress syndrome (ARDS) associated with COVID-19. Aviptadil, a synthetic form of human vasoactive intestinal peptide, might be beneficial for COVID-19 patients at high risk of developing ARDS because of its ability to influence the regulation of exaggerated pro-inflammatory proteins and orchestrate the lung homeostasis. Aviptadil has recently been shown to considerably improve the prognosis of ARDS in COVID-19 when applied intravenously. An inhaled application of aviptadil has the advantages of achieving a higher concentration in the lung tissue, fast onset of activity, avoiding the hepatic first-pass metabolism, and the reduction of adverse effects. The overall objective of this project is to assess the efficacy and safety of inhaled aviptadil in patients hospitalized for COVID-19 at high risk of developing ARDS. Methods This multicenter, placebo-controlled, double-blinded, randomized trial with 132 adult patients hospitalized for COVID-19 and at high risk for ARDS (adapted early acute lung injury score ≥ 2 points) is conducted in five public hospitals in Europe. Key exclusion criteria are mechanical ventilation at baseline, need for intensive care at baseline, and severe hemodynamic instability. Patients are randomly allocated to either inhale 67 μg aviptadil or normal saline (three times a day for 10 days), in addition to standard care, stratified by center. The primary endpoint is time from hospitalization to clinical improvement, defined as either hospital discharge, or improvement of at least two levels on the nine-level scale for clinical status suggested by the World Health Organization. Discussion Treatment strategies for COVID-19 are still limited. In the context of upcoming new variants of SARS-CoV-2 and possible inefficacy of the available vaccines and antibody therapies, the investigation of alternative therapy options plays a crucial role in decreasing associated mortality and improving prognosis. Due to its unique immunomodulating properties also targeting the SARS-CoV-2 pathways, inhaled aviptadil may have the potential to prevent ARDS in COVID-19. Trial registration ClinicalTrials.gov, NCT04536350 . Registered 02 September 2020.
    Type of Medium: Online Resource
    ISSN: 1745-6215
    URL: Article
    DOI: 10.1186/s13063-022-06723-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2040523-6
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  • 5
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    Online Resource
    High-dose vitamin D substitution in patients with COVID-19: study protocol for a randomized, double-blind, placebo-controlled, multi-center study—VitCov Trial
    Springer Science and Business Media LLC ; 2022
    In:  Trials Vol. 23, No. 1 ( 2022-02-04)
    Details
    In: Trials, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2022-02-04)
    Abstract: The coronavirus disease 19 (COVID-19) pandemic has caused millions of deaths, and new treatments are urgently needed. Factors associated with a worse COVID-19 prognosis include old age ( 〉  65 years), ethnicity, male sex, obesity, and people with comorbidities. Furthermore, vitamin D deficiency was reported as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. According to a recent clinical case series, vitamin D deficiency is a modifiable risk factor, which has the prospect of reducing hospital stay, intensive care, and fatal outcomes. Vitamin D has potent immunomodulatory properties, and its supplementation might improve important outcomes in critically ill and vitamin D-deficient COVID-19 patients. Despite the evidence that supports an association between vitamin D deficiency and COVID-19 severity, there is uncertainty about the direct link. Therefore, the aim of the trial is to assess if high-dose vitamin D supplementation has a therapeutic effect in vitamin D-deficient patients with COVID-19. Methods As the trial design, a randomized, placebo-controlled, double-blind, multi-center approach was chosen to compare a high single dose of vitamin D (140,000 IU) followed by treatment as usual (TAU) (VitD + TAU) with treatment as usual only (placebo + TAU) in patients with COVID-19 and vitamin D deficiency. Discussion Vitamin D substitution in patients with COVID-19 and vitamin D deficiency should be investigated for efficacy and safety. The study aim is to test the hypothesis that patients with vitamin D deficiency suffering from COVID-19 treated under standardized conditions in hospital will recover faster when additionally treated with high-dose vitamin D supplementation. Latest studies suggest that vitamin D supplementation in patients with COVID-19 is highly recommended to positively influence the course of the disease. With this randomized controlled trial, a contribution to new treatment guidelines shall be made. Trial registration ClinicalTrials.gov NCT04525820 and SNCTP 2020-01401
    Type of Medium: Online Resource
    ISSN: 1745-6215
    URL: Article
    DOI: 10.1186/s13063-022-06016-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2040523-6
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  • 6
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    Is Serum 25-Hydroxyvitamin D Level Associated with Severity of COVID-19? A Retrospective Study
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 17 ( 2023-08-25), p. 5520-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 17 ( 2023-08-25), p. 5520-
    Abstract: (1) Background: SARS-COV2 infection has a clinical spectrum ranging from asymptomatic infection to COVID-19 with acute respiratory distress syndrome (ARDS). Although vitamin D deficiency is often found in patients with ARDS, its role in COVID-19 is not clear. The aim of this study was to explore a possible association between serum 25-hydroxyvitamin D levels and the severity of COVID-19 in hospitalised patients. (2) Methods: In this retrospective observational study, we analysed data from 763 patients hospitalised for COVID-19 in 2020 and 2021. Patients were included in the study if serum 25-hydroxyvitamin D was assessed 30 days before or after hospital admission. Vitamin D deficiency was defined as 〈 50 nmol/L ( 〈 20 ng/mL). The primary outcome was COVID-19 severity. (3) Results: The overall median serum 25-hydroxyvitamin D level was 54 nmol/L (IQR 35–76); 47% of the patients were vitamin D deficient. Most patients had mild to moderate COVID-19 and no differences were observed between vitamin D deficient and non-deficient patients (81% vs. 84% of patients, respectively p = 0.829). (4) Conclusion: No association was found between serum 25-hydroxyvitamin D levels and COVID-19 severity in this large observational study conducted over 2 years of the pandemic.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12175520
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662592-1
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  • 7
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    Prädiktoren für frühe ungeplante Rehospitalisationen
    Hogrefe Publishing Group ; 2023
    In:  Praxis Vol. 112, No. 2 ( 2023-02), p. 75-81
    Details
    In: Praxis, Hogrefe Publishing Group, Vol. 112, No. 2 ( 2023-02), p. 75-81
    Abstract: Zusammenfassung. Ungeplante Rehospitalisationen stellen eine grosse Belastung für Patientinnen und Patienten, deren Angehörige und das Gesundheitssystem dar. Vor allem seit der Einführung der SwissDRG im Jahr 2012 wurden finanzielle Anreize für Spitäler geschaffen, Wiederaufnahmen zu verhindern. Nicht alle Patientinnen und Patienten haben dasselbe Risiko für eine Rehospitalisation. Mittels Prädiktoren aus verschiedenen Bereichen können Risikopatientinnen und -patienten erkannt werden, um bereits frühzeitig adäquate Interventionen zur Vermeidung einer Wiederaufnahme zu implementieren. Prädiktoren lassen sich bei den Patientinnen und Patienten finden, beispielsweise Polypharmazie und viele Komorbiditäten, oder beim Geschlecht, aber auch behandler- und systembezogene Prädiktoren spielen eine Rolle. Als wirksame Interventionen werden in der Literatur frühe Nachkontrollen und Medikationsüberprüfungen vor Austritt genannt.
    Type of Medium: Online Resource
    ISSN: 1661-8157 , 1661-8165
    URL: Article
    DOI: 10.1024/1661-8157/a003992
    Language: German
    Publisher: Hogrefe Publishing Group
    Publication Date: 2023
    detail.hit.zdb_id: 2041040-2
    detail.hit.zdb_id: 209026-0
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  • 8
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    Diagnosis and Therapy of Community-Acquired Pneumonia in the Emergency Department: A Retrospective Observational Study and Medical Audit
    MDPI AG ; 2024
    In:  Journal of Clinical Medicine Vol. 13, No. 2 ( 2024-01-19), p. 574-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 13, No. 2 ( 2024-01-19), p. 574-
    Abstract: Background: Despite advances in therapy, community-acquired pneumonia (CAP) is still associated with significant morbidity and mortality. Several studies conducted in different countries have reported suboptimal adherence to the guidelines. However, there are currently no available data on adherence to CAP guidelines specifically in Switzerland. Objectives: The aim of this study was to audit the quality of diagnosis and therapy of CAP at a Swiss general hospital. Methods: A retrospective, observational, single-center cohort study was conducted, including patients older than 18 years diagnosed with CAP and admitted to a medical ward throughout 2019 without prior antibiotic therapy prescribed by their general practitioner (GP). The baseline characteristics of the patients were analyzed, and the diagnostic workup and treatment were compared to the Swiss guidelines for CAP. Results: A total of 254 patients diagnosed with CAP were included in this study (median age 78 years, 51.6% males). Atypical pneumonia was diagnosed in 4% of patients, while an organism was identified in 33% of cases, with Streptococcus pneumoniae being the most frequently detected pathogen (57%). A chest image was taken in almost all patients. Documentation of respiratory rate was missing in 23% of cases. Procalcitonin was measured in 23.2% of cases. Pneumococcal and legionella urinary antigen testing was performed on approximately 90% of all patients and blood cultures were drawn in approximately 80% of patients. In 39% of cases, arterial blood gas analysis was performed. Guideline adherence for the administration of empiric antibiotics was documented/recorded in 75% of cases. Twelve different antibiotic regimens were administered, and they were mostly amoxicillin/clavulanate with or without macrolides, as suggested by the guidelines. In particular, the use of ceftriaxone was higher (19.7%) compared to the Swiss guidelines. The average length of antibiotic therapy was longer (8.2 days) compared to the guidelines (5–7 days). Oral steroid therapy was administered to 29.1% of patients, including to 75% of those diagnosed with COPD. Conclusion: Overall, guideline adherence was moderately low, especially with regards to the assessment of respiratory rate, performance of arterial blood gas analysis, and sputum collection. Regarding antibiotic therapy, the use of ceftriaxone and the length of antibiotic therapy should be reduced. Further research is needed to identify the reasons for guideline non-adherence, and to find effective measures for the improvement of guideline adherence.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm13020574
    Language: English
    Publisher: MDPI AG
    Publication Date: 2024
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  • 9
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    Diagnostic Workup and Outcome in Patients with Profound Hyponatremia
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 10 ( 2023-05-19), p. 3567-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 10 ( 2023-05-19), p. 3567-
    Abstract: Hyponatremia is the most common electrolyte disorder. A proper diagnosis is important for its successful management, especially in profound hyponatremia. The European hyponatremia guidelines point at sodium and osmolality measurement in plasma and urine, and the clinical evaluation of volume status as the minimum diagnostic workup for the diagnosis of hyponatremia. We aimed to determine compliance with guidelines and to investigate possible associations with patient outcomes. In this retrospective study, we analysed the management of 263 patients hospitalised with profound hyponatremia at a Swiss teaching hospital between October 2019 and March 2021. We compared patients with a complete minimum diagnostic workup (D-Group) to patients without (N-Group). A minimum diagnostic workup was performed in 65.5% of patients and 13.7% did not receive any treatment for hyponatremia or an underlying cause. The twelve-month survival did not show statistically significant differences between the groups (HR 1.1, 95%-CI: 0.58–2.12, p-value 0.680). The chance of receiving treatment for hyponatremia was higher in the D-group vs. N-Group (91.9% vs. 75.8%, p-value 〈 0.001). A multivariate analysis showed significantly better survival for treated patients compared to not treated (HR 0.37, 95%-CI: 0.17–0.78, p-value 0.009). More efforts should be made to ensure treatment of profound hyponatremia in hospitalised patients.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12103567
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662592-1
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  • 10
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    Risk factors for hospital outcomes in pulmonary embolism: A retrospective cohort study
    Frontiers Media SA ; 2023
    In:  Frontiers in Medicine Vol. 10 ( 2023-4-11)
    Details
    In: Frontiers in Medicine, Frontiers Media SA, Vol. 10 ( 2023-4-11)
    Abstract: Pulmonary embolism (PE) is not only a life-threatening disease but also a public health issue with significant economic burden. The aim of the study was to identify factors—including the role of primary care—that predict length of hospital stay (LOHS), mortality and re-hospitalization within 6 months of patients admitted for PE. Method A retrospective cohort study was conducted with patients presenting to a Swiss public hospital with PE diagnosed at the hospital between November 2018 and October 2020. Multivariable logistic and zero-truncated negative binomial regression analyses were performed to assess risk factors for mortality, re-hospitalization and LOHS. Primary care variables encompassed whether patients were sent by their general practitioner (GP) to the emergency department and whether a GP follow-up assessment after discharge was recommended. Further analyzed variables were pulmonary embolism severity index (PESI) score, laboratory values, comorbidities, and medical history. Results A total of 248 patients were analyzed (median 73 years and 51.6% females). On average patients were hospitalized for 5 days (IQR 3–8). Altogether, 5.6% of these patients died in hospital, and 1.6% died within 30 days (all-cause mortality), 21.8% were re-hospitalized within 6 months. In addition to high PESI scores, we detected that, patients with an elevated serum troponin, as well as with diabetes had a significantly longer hospital stay. Significant risk factors for mortality were elevated NT-proBNP and PESI scores. Further, high PESI score and LOHS were associated with re-hospitalization within 6 months. PE patients who were sent to the emergency department by their GPs did not show improved outcomes. Follow-up with GPs did not have a significant effect on re-hospitalization. Conclusion Defining the factors that are associated with LOHS in patients with PE has clinical implications and may help clinicians to allocate adequate resources in the management of these patients. Serum troponin and diabetes in addition to PESI score might be of prognostic use for LOHS. In this single-center cohort study, PESI score was not only a valid predictive tool for mortality but also for long-term outcomes such as re-hospitalization within 6 months.
    Type of Medium: Online Resource
    ISSN: 2296-858X
    URL: Article
    DOI: 10.3389/fmed.2023.1120977
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2775999-4
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