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Purpose: Patients diagnosed with ductal carcinoma in situ (DCIS) face trade-offs when deciding among different treatments, including surgery, radiation, and endocrine therapy. A less chosen option is active monitoring. While evidence from clinical trials is not yet available, observational studies show comparable results for active monitoring and immediate treatment on cancer outcomes in select subgroups of patients. We developed and tested a web-based decision support tool (DST) to help patients explore current knowledge about DCIS and make an informed choice., Methods: The DST, an interactive web application, was informed by literature reviews and formative work with patients, breast surgeons, and health communication experts. We conducted iterative interviews to evaluate the DST content among women with and without a history of breast cancer, as well as breast cancer experts. For usability testing, we conducted an online survey among women with and without a history of breast cancer., Results: For content evaluation, 5 women with and 10 women without a history of DCIS were interviewed. The sample included 11 White and 4 non-White women, with a mean age of 64 years. The expert sample consisted of 5 attendings and a physician assistant. The feedback was used to add, clarify, or reorganize information in the DST. For usability testing, 22 participants with a mean age of 61 years were recruited including 15 White and 7 Black women and 6 women with a history of DCIS. The mean usability score was 3.7 out of 5. Most participants (86%) found that the DST provided unbiased information about treatments. To improve usability, we reduced the per-page content and added navigation cues., Conclusion: Content and usability evaluation showed that the DST helps patients explore trade-offs of active monitoring and immediate treatment. By adopting a personalized approach, the tool will enable informed decisions aligned with patients' values and expectations., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To compare the recently developed "nine equivalents of nursing manpower use score" (NEMS) with the simplified Therapeutic Intervention Scoring System (TISS-28)., Design: Prospective single centre study., Setting: Adult 30-bed medical-surgical intensive care unit (ICU) in a tertiary care university hospital., Patients: Data from all patients admitted in 1997 to the ICU were included in the study., Methods and Results: NEMS and TISS-28 items were recorded prospectively for each nursing shift. There were three shifts per day. The Simplified Acute Physiology Score (SAPS) II was calculated for the first 24 h of ICU stay and each patient's basic demographic data were collected. The agreement between NEMS and TISS-28 was assessed by calculating the mean difference and the standard deviation of the differences between the two measures. Further, regression techniques and Pearson's correlation were used. Altogether, 2743 patients with a total of 28,220 nursing shifts were included; 62% of the shifts were used for postoperative/trauma patients and 38% for medical patients. Mean NEMS was 26.0 +/- 8.1 and mean TISS-28 was 26.5 +/- 7.9. The scores differed by < or = 3 points in 49 % of all shifts. The bias was -0.5 +/- 5.3 (95% confidence interval -0.47 to -0.60) and the limits of agreement were -11.1 to +10.1. The relation between the two systems was NEMS = 4.7 +/- 0.8 x TISS-28 (r = 0.78, r2 = 0.62, p < 0.001). Including postoperative/trauma patients only: NEMS = 1.9 +/- 0.9 x TISS-28, for medical patients this equation was: NEMS = 6.0 + 0.8 x TISS-28. First-day SAPS II explained 11% of the variability in first-shift NEMS and 5% of the variability in first-shift TISS-28., Conclusions: This study confirms a good agreement between TISS-28 and NEMS in a large, independent sample. However, as shown by the differences between medical and postoperative/trauma patients, a change in case mix may result in different regression equations. Further, wide limits of agreement indicate that there may be a rather large variability between the two measures at the individual level.

Acute drug intoxication is a medical emergency considering its potential interference with vital functions. All 157 cases with drug overdose admitted to the emergency department of the "Inselspital" in Berne over 183 days between July 1989 and June 1990 were analyzed retrospectively. In the vast majority of cases heroin overdose was involved. In mixed poisonings with heroin mostly flunitrazepam and alcohol contributed to the clinical picture, less commonly cocaine. There were very few intoxications with cocaine alone. A practical approach to the management of patients with certain or suspected drug intoxication presenting with coma and depressed respiration is proposed. In the therapy of acute intoxications with opiates and benzodiazepines there are specific antagonists available. In contrast, therapy of cocaine overdose remains symptomatic. The medical complications of acute heroin and cocaine intoxications are discussed separately.

Malignant pericardial effusion (MPE) resulting in cardiac tamponade is a rare complication in neoplastic disease. From January 1975 to December 1984 the authors observed 22 patients with cytologically verified malignant pericardial effusion. The most frequent primary tumors were non-small cell lung cancer (6), breast cancer (5), non-Hodgkin lymphoma (4) and mesothelioma (4). 50% of the patients presented with MPE as the initial manifestation of the tumor. In the other group of patients MPE appeared after an average of 11 months following the diagnosis of malignant disease. The most frequent symptoms and clinical findings were dyspnea (100%), jugular venous distention (91%), and tachycardia (82%). During the first 24 hours after pericardiocentesis a median volume of 675 ml of predominantly serosanguinous effusion was drained. Besides intrapericardial drug instillation, patients also received local radiotherapy and systemic chemotherapy. At the time when MPE was diagnosed 77% of the patients exhibited advanced malignant disease. Mean survival time was 140 days. Malignant pericardial effusion is therefore regarded as an unfavorable prognostic factor.

In a clinical study the tolerance and efficacy of a gamma-globulin, treated at pH 4, has been studied. This preparation manufactured by the "Zentrallaboratorium des Blutspendedienstes SRK" can be given intravenously without any risk of untoward reactions. It has been applied in high dosages up to 99 g per week. In 15 cases with primary humoral immunodeficiency, the frequency and the severity of acute bacterial infections were markedly reduced or completely absent. In 16 patients without antibody deficiency but suffering from severe septic-toxic infections, results with Immunglobulin SRK were encouraging and warrant further controlled studies.