Search

The COVID-19 pandemic has challenged the Swiss mental healthcare system. Many services were downsized or closed, and admission to treatment and care institutions was restricted during lockdown. These measures were necessary according to the general containment and mitigation strategies of federal and cantonal authorities, but this situation has had negative consequences for care and treatment of service users. This paper asks for a rethink of key aspects of the Swiss mental healthcare system that have been demonstrated not to be adaptable to the pandemic. In particular, the paper suggests diversifying care and treatment settings, and strengthening outpatient and outreach services. Finally, some proposals to foster social inclusion during and after the pandemic are outlined.

Neurology and neurosciences are becoming more and more specialised, and research in the field is creating an enormous amount of data. In our daily practice we need ofte n specialist and dedicated persons, with knowledge, and a clinical and academic approach, to summarise the data. This is why in the surveys you completed, a majority asked, among other points, for more reviews on current topics. This is why we propose, for the next issues of SANP, an orientation towards educational dossiers, particularly on topics that were proposed at the last SNG Congress in Interlaken, during the 190th Annual Meeting of the Swiss Neurological Society, in collaboration with other societies, particularly the Swiss Society of Intensive Care Medicine. The first dossier comes from some of our neurointensivist colleagues, who kindly agreed to write a report on what they presented. ICU Teachers were the fir st to send their manuscripts and we propose to present their refle ctions, which are also important for neurologists. Bernard Frey presents some arguments on how problems should be handled in the diffic ult case of Hypothermia in paediatric traumatic brain injury: cons . His paper does not question the importance of hypothermia in the intensive management aft er asphyxia or cardiac arrest where it has very interesting results, but aims to make doctors cautious on some points potentially related to issues when hypothermia is proposed afte r TBI, at least in children. The second paper is a minireview on Glucose control in the ICU, by Karin Amrein and Tadeja Urbanic Purkart; this is a very important topic also in neu rology – particularly aft er stroke – and the authors remind us that glucose should be ideally kept under 150 mg/dl in the ICU, although the margin is less strict in patients with preexisting diabetis. A third ICU paper will appear in the next issue. Finally a case report Malformation d’Arnold-Chiari et apnee centrale du sommeil by Guinhouya et al. reminds one that interesting case reports are welcome in our journal. Enjoy the reading.

Symbolizations of final parting. On the imagery of the dying Empirical studies show that those nearing death are commonly overtaken by intense imagery. They require appropriate spiritual support during this experience. This paper lays out results from the research project entitled “Hermeneutic of trust at the end of life” and sponsored by the Swiss National Science Foundation as part of the national research program “End of Life” (NFP 67). This project entailed surveying clinical pastoral caregivers in terms of their observations and assessments regarding such occurrences. Besides quantitative results, the study yielded an abundance of qualitative data. Example vignettes in this article demonstrate that near-death imagery is wildly diverse and by no means adheres to a single pattern. That said, it appears essential for spiritual caregivers to recognize certain recurrent themes.

The two large landmark single-centre randomised controlled trials in Leuven, Belgium, showed a substantial and signifi cant clinical benefit for intensive insulin therapy (IIT, target 80–110 mg/dl) in adult surgical and medical critically ill patients. Therefore, tight glycaemic control was implemented in guidelines and in clinical routine in intensive care units (ICUs) all around the world, ofte n at the cost of an increased incidence of moderate and severe hypoglycaemic episodes. Surprisingly, in sub sequent large multicenter trials the same effe ct could not be replicated. Currently, the debate on how best to implement glucose control in the ICU is lively and ongoing, but a recent consensus paper on glycaemic control in critically ill adults has clarifie d many aspects [1]. It is likely that the same rules apply to other severely ill patients who are not necessarily in ICU and to hospi