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J J Osterwalder

Publications and source records attributed to J J Osterwalder.

17 recordsLinked to original sources
PubMed2001

A randomised prospective study to evaluate a rapid HIV-antibody assay in the management of cases of percutaneous exposure amongst health care workers.

A rapid start of post-exposure prophylaxis with an antiretroviral regime is recommended after percutaneous exposure to blood from an HIV-positive source. Since the HIV-antibody status of the source is usually not known at the time of injury, antiretroviral treatment is started pending the results of HIV testing of the source. A randomised prospective study was designed to compare the use of a rapid-screening assay in the management of cases of percutaneous exposure with the conventional procedure. Prior to the comparative study, the accuracy of a rapid-screening assay performed by non-laboratory trained personnel was evaluated. 123 blinded HIV-positive and HIV-negative samples were correctly identified. In a randomised comparison with the conventional procedure, the application of the rapid-screening assay resulted in a significant reduction of psychological stress, drug use and cost. The estimated net benefit per case was CHF 93.-(62 US$). This study strongly supports the use of the rapid-screening assay in the management of post-exposure prophylaxis for HIV after percutaneous exposure in health care workers.

Anti-HIV Agents↗
PubMed2000

[Quality assessment of multiple trauma management bu ISS, TRISS or ASCOT?].

OBJECTIVES: Scores have been developed to assess the quality of trauma treatment. Our objective was to investigate prospectively whether there is a significant difference between the predicted survival and mortality rates with ISS, TRISS and ASCOT and observed rates in our patients. If the answer is affirmative, we also wished to evaluate whether the difference is significant enough to justify the greater data collection effort required for ASCOT as opposed to TRISS, and for TRISS as opposed to ISS. PATIENTS AND METHODS: Charts from 470 of 484 blunt multiple trauma patients with an ISS of 8 or more documented as part of a National Fund Study between June 1990 and June 1996 were reviewed. We compared the survival and mortality rates calculated by ISS, TRISS and ASCOT with the observed survival and death rates. RESULTS: Only the predicted survival and death rates calculated by ISS differed significantly from the observed rates. There were also significant differences between ISS and TRISS, and ISS and ASCOT, with regard to the predicted rates. CONCLUSIONS: In our unit ISS, which is simple to use, is not suitable for quality assessment. TRISS and ASCOT are of equal value. We prefer TRISS until a better, internationally recognised score is available, since it involves less effort and is less error-prone. General recommendations for Switzerland cannot be made until further results from other national accident and emergency units are available.

Adolescent↗
PubMed1998

Emergency medicine in Switzerland.

Situated in the heart of Europe, Switzerland's 7 million inhabitants, including 1 million foreigners, live in an area of 41,000 km2. German, French, Italian, and Rhaeto-Romanic are the official languages. The Swiss health service stands out because of the high quality and efficiency of its ambulatory and hospitalized health care management.

Ambulatory Care↗
PubMed1998

Effectiveness of mask ventilation in a training mannikin. A comparison between the Oxylator EM100 and the bag-valve device.

The demands for an optimal ventilation apparatus are that it can be easily handled, achieves a sufficiently high ventilation volume, and minimizes gastric inflation. Our aim was therefore to carry out a study in a training mannikin to find out whether the Oxylator EM100, compared with the bag, obtains improved ventilation and a decrease in gastric inflation. In a randomized crossover study, 72 subjects were selected (24 physicians, 44 nurses and 4 auxiliary nurses), chosen from the operating theatre, emergency department and intensive care unit of two hospitals. We used the Ambu-Bag Mark III with mask No. 4, the Oxylator EM100 with a pressure setting of 35 cm H2O run in the manual setting, the Ambu-Man C mannikin as well as the Ambu-CPR computer program. The resuscitation cycles of the standard two-rescuer's adult procedure lasted 3 min each, with a 3-min pause between the crossover procedure. The participants could improve their ventilatory volume with the Oxylator EM100 by 635 ml (95% confidence interval 578-692 ml) compared with the bag ventilation. The number of subjects who could attain a mean ventilatory volume of 800 ml or more increased from 15% to 98.6% (P < 0.001). Compared with the bag, the increase of adequate respirations (> or = 800 ml) obtained by the Oxylator EM100 for the individual participants amounted to a median of 91% (P < 0.001). Moreover, conventional ventilation caused in 42% one or several instances of gastric inflation, whereas no such reactions occurred with the Oxylator EM100. The Oxylator EM100 showed significantly better results in the mannikin than the bag. Of most importance is a significant lowering of gastric inflation and less so a marked increase in ventilatory volume. Our trial procedure with a relatively high lung compliance and a high oesophageal sphincter opening simulated favorable conditions. Owing to a large in vivo variability of these magnitudes, a direct testing in real patients with circulatory arrest is indicated.

Adult↗
PubMed1997

Diagnostic validity of ultrasound in patients with persistent wrist pain and suspected occult ganglion.

Until recently, the presence of occult ganglions could be determined only by surgical exploration. This prospective study investigated the reliability of ultrasound in the diagnosis of occult ganglions in a patient series over 4 years. The sensitivity, specificity, and accuracy of ultrasound, as well as its positive and negative predictive values, were determined in 83 patients suspected of having an occult wrist ganglion and who had persistent pain and consented to an operation. Examinations were carried out with a 7.5-MHz linear probe and spacer. Outcome of surgery and histologic examination served as the gold standard in 168 patients who had undergone ultrasound; 89 underwent surgery. In 83 patients for whom enough information was available to allow statistical assessment, sensitivity, specificity, and accuracy rates of 88%, 85%, and 87% were respectively obtained. In dorsal wrist ganglions (75%), better results were obtained: a sensitivity rate of 93%, a specificity rate of 86%, and an accuracy rate of 91%. It was concluded that ultrasound of the wrist can be used as a first-line imaging procedure in clinically inconclusive situations and that ultrasound evidence of an occult dorsal ganglion is a reliable indicator for surgery.

Adult↗
PubMed1996

[The comatose patient: initial considerations and measures].

The aim of assessing the emergency patient's threshold of consciousness is to diagnose and manage reversible and treatable conditions fast and effectively. Diagnosis and treatment procedures can be summarized on three levels. First assessment and treatment of hypoxia and shock, second: differentiation of types of coma, in order to decide further treatment measures and the choice of hospital admittance, and third: initiation of antidotes and other appropriate preclinical therapies.

Algorithms↗
PubMed1996

Naloxone--for intoxications with intravenous heroin and heroin mixtures--harmless or hazardous? A prospective clinical study.

BACKGROUND: Naloxone is standard medication for the treatment of heroin intoxications. No large-scale studies have yet been carried out to determine its toxicity in heroin intoxications. METHODS: We have undertaken an investigation as to the frequency, type and degree of severity of complications attributable to naloxone administration. Subjects treated between 1991 and 1993 with naloxone for intravenous drug intoxications were prospectively evaluated. MAIN OUTCOME MEASUREMENTS: Development of ventricular tachycardia or fibrillation; atrial fibrillation; asystole; pulmonary edema; convulsions; vomiting; and violent behavior within ten minutes after parenteral administration of naloxone. RESULTS: Six of 453 intoxicated subjects (1.3%; 95% confidence interval 0.4%-3%) suffered severe adverse effects within ten minutes after naloxone administration (one asystole; three generalized convulsions; one pulmonary edema; and one violent behavior). After the ten minute period, no further complications were observed. CONCLUSIONS: The short time between naloxone administration and the occurrence of complications, as well as the type of complications, are strong evidence of a causal link. In 1000 clinically diagnosed intoxications with heroin or heroin mixtures, from 4 to 30 serious complications can be expected. Such a high incidence of complications is unacceptable and could theoretically be reduced by artificial respiration with a bag valve device (hyperventilation) as well as by administering naloxone in minimal divided doses, injected slowly.

Adolescent↗
PubMed1996

[The ABCD of resuscitation].

Reanimation is divided into two phases. The first phase, primary ABCD, consists of verifying the patient's responsiveness, activating the emergency system, requesting a defibrillator, establishing and maintaining the airway's patency, checking respiration, initiating artificial respiration when necessary, checking the circulation, in the absence of a pulse beginning with chest compressions, and identifying the heart rhythm on the monitor. In particular, one should determine if the rhythm is ventricular fibrillation. Ventricular fibrillation is the most frequent cause of sudden cardiac arrest, estimated to occur in 70 to 80% of cases. The basic measures should not delay the earliest possible use of defibrillation. Only then follows the second phase, secondary ABCD, consisting of intubation, adequate ventilation, intravenous infusion, medications, further defibrillation when appropriate and the determination of treatable causes.

Algorithms↗
PubMed1995

[Is textbook knowledge of ultrasonography also valid in emergency admission?].

Textbook knowledge of sonography is not immediately applicable in emergencies where the favourable prerequisites characterizing the standard case are often lacking. The question therefore arises of what textbook knowledge is also viable in the average emergency unit, under what circumstances and for which clinical questions. The answer to this differentiated question is a graded concept with "primary emergency sonography", "extended" and "standard sonography". The indications and advantages of "primary emergency sonography" in contrast to standard procedure are discussed in detail. The key to success depends on meticulous introduction and training, strict compliance with indications and principle, and rigorous surveillance by an experienced ultrasonic specialist. In addition further scientific examination of the concept is necessary.

Emergencies↗
PubMed1995

Patients intoxicated with heroin or heroin mixtures: how long should they be monitored?

Our investigation was carried out in subjects intoxicated with heroin or heroin mixtures to find out the time interval during which delayed life-threatening complications become manifest, such as pulmonary oedema or relapse into respiratory depression or coma after naloxone treatment. We studied prospectively all drug intoxications between 1991 and 1992. Of the 538 intoxications, we assessed in detail 160 outpatients who lived within the catchment area of our hospital. The outcome variables studied were (1) rehospitalization for pulmonary oedema, (2) relapse into coma, and/or (3) death and cause within 24 h after release from hospital. Deaths occurring outside our hospital have to be reported, as decreed by law, to the Institute for Forensic Medicine. The results of our investigation showed no rehospitalization owing to pulmonary oedema or coma, but one death, outside the hospital, owing to delayed pulmonary oedema. This delayed complication had an incidence of 0.6% (95% confidence interval 0-3.8%). A reintoxication could be excluded in this patient. Based on reliable report, the pulmonary oedema occurred between approximately 2 1/4 and 8 1/4 hours after intoxication. In the literature, only two cases of delayed pulmonary oedema have been reported with reliable time statements (4 and 6 h after hospitalization). We therefore conclude that surveillance for at least 8 h is essential after successful treatment to exclude delayed pulmonary oedema in patients intoxicated with heroin or heroin mixtures.

Adolescent↗
PubMed1992

[The effect of first aid and care times on the clinical course and treatment results in multiple trauma. Initial interim results of an interdisciplinary trauma registry in the St. Gallen district hospital].

QUESTION: To date little is known about the influence of variable rescue (i.e. transportation/preclinical care) and clinical care times on the clinical progress and outcome of patients suffering injuries ranging from average to severe. Having examined this question within the framework of an ongoing study of trauma, we present the first provisional results and compare them with existing documentation. METHOD: Since 15 June 1990, all cases of multiple injury have been recorded in a trauma register. The present interim investigation of 143 patients covers a period of 13.5 months. We have recorded the rescue and clinical care times and compared them with survival, disability, complications and length of stay in hospital or intensive care unit. RESULTS: 106 (74%) of the total of 143 patients were operated on an average of 5.5 hours after the accident. In cases of intracranial or intraabdominal bleeding, there was an average time lag of 220 minutes after the accident before the patient could undergo surgery. Overall, 70% of the total rescue time was spent on medical attention and waiting time in the emergency unit. The secondary transfer rate is 46%. In the case of 4 patients, it is possible that the delays involved contributed appreciably to mortality (19%. i.e. 4/21). Generally, however, no coherent and conclusive correlation could be established between prolonged rescue and clinical care times and a worsened outcome. False negative results cannot be totally excluded, since the classification of the individual degree of injury by means of ISS and TRISS is unreliable, the variable quality of medical care prior to arrival at our emergency unit has not been taken into account, and the case figures are low (possibly of a large-scale beta error). CONCLUSIONS: The database for the assessment of standard times is still inadequate. For a reliable analysis, a total number of at least 500 patients is necessary (beta error acceptable). Our own data and the meagre results of other studies support the supposition that it is not the absolute time-lapse which has prognostic significance but the qualified medical assistance provided within a critical, individual, but extremely variable time-span. The increased employment of highly qualified emergency staff and a more efficient "triage", in the sense of a clearly directed trauma regionalization, could thus lead to optimization of trauma care.

Adolescent↗
PubMed1992

[Quality assurance in traumatology--initial experiences with a computer program for the selection of trauma patients for morbidity and mortality conferences].

Trauma is the leading cause of death in the under thirties age group in Switzerland and the third leading cause in the 30-64 age group. In addition to efforts in the area of prevention, optimization must also be attained in individual medical care in order to reduce mortality and morbidity. Improvements are only possible, however, when based on precise knowledge of accident epidemiology and possible weak spots in the rescue chain, which begins at the scene of the accident and ends with discharge from hospital. This information should be complied for our region with the aid of a trauma register on the basis of internationally recognized elements. The following comments describe in a shortened form the CDC-Register (Centers for Disease Control, USA). Using our own initial experiences, the practical application and use of the corresponding Register-Software ("Trauma registry", Version 2.0, 1990) for conferences on mortality and morbidity, the basic guarantee of quality, are demonstrated.

Cause of Death↗
PubMed1991

[Randomized and controlled single-case study--a scientific method for individual and difficult therapy decisions in clinical practice exemplified with methotrexate use in asthma].

For various reasons, optimal individual therapies cannot always be derived from monitored, large-scale random studies. This applies particularly to delicate decisions on the treatment of chronically ill patients. In such situations, random, controlled and "double-blind" individual case studies with "cross-over" can be a solution. The procedure is adjusted to suit the individual patient. In many two-part treatment phases, the patient receives the active medication and an alternative/placebo. The sequence is adapted to the randomization. Neither patient nor doctor knows what the preparations are. The aims of the study are primarily oriented towards the wellbeing of the individual patient. The problems of individual optimization of therapy in practice are presented, as are the individual case study methods. Their potential application and limits and their value are discussed and illustrated by means of an actual case study.

Adult↗