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Background: Although bedside case presentation contributes to patient-centered care through active patient participation in medical discussions, the complexity of medical information and jargon-induced confusion may cause misunderstandings and patient discomfort.Objective: To compare bedside versus outside the room patient case presentation regarding patients' knowledge about their medical care.Design: Randomized, controlled, parallel-group trial. (ClinicalTrials.gov: NCT03210987).Setting: 3 Swiss teaching hospitals.Patients: Adult medical patients who were hospitalized.Intervention: Patients were randomly assigned to bedside or outside the room case presentation.Measurements: The primary endpoint was patients' average knowledge of 3 dimensions of their medical care (each rated on a visual analogue scale from 0 to 100): understanding their disease, the therapeutic approach being used, and further plans for care.Results: Compared with patients in the outside the room group (n = 443), those in the bedside presentation group (n = 476) reported similar knowledge about their medical care (mean, 79.5 points [SD, 21.6] vs. 79.4 points [SD, 19.8]; adjusted difference, 0.09 points [95% CI, -2.58 to 2.76 points]; P = 0.95). Also, an objective rating of patient knowledge by the study team was similar for the 2 groups, but the bedside presentation group had higher ratings of confusion about medical jargon and uncertainty caused by team discussions. Bedside ward rounds were more efficient (mean, 11.89 minutes per patient [SD, 4.92] vs. 14.14 minutes per patient [SD, 5.65]; adjusted difference, -2.31 minutes [CI, -2.98 to -1.63 minutes]; P < 0.001).Limitation: Only Swiss hospitals and medical patients were included.Conclusion: Compared with outside the room case presentation, bedside case presentation was shorter and resulted in similar patient knowledge, but sensitive topics were more often avoided and patient confusion was higher. Physicians presenting at the bedside need to be skilled in the use of medical language to avoid confusion and misunderstandings.Primary Funding Source: Swiss National Foundation (10531C_ 182422). [ABSTRACT FROM AUTHOR]

Abstract Background Interferon-gamma release assays (IGRA) are more specific than the tuberculin skin test (TST) for the diagnosis of Mycobacterium tuberculosis infection. Data on sensitivity are controversial in HIV infection. Methods IGRA (T-SPOT.TB) was performed using lymphocytes stored within 6 months before culture-confirmed tuberculosis was diagnosed in HIV-infected individuals in the Swiss HIV Cohort Study. Results 64 individuals (69% males, 45% of non-white ethnicity, median age 35 years (interquartile range [IQR] 31-42), 28% with prior AIDS) were analysed. Median CD4 cell count was 223 cells/μl (IQR 103-339), HIV-RNA was 4.7 log10 copies/mL (IQR 4.3-5.2). T-SPOT.TB resulted positive in 25 patients (39%), negative in 18 (28%) and indeterminate in 21 (33%), corresponding to a sensitivity of 39% (95% CI 27-51%) if all test results were considered, and 58% (95% CI 43-74%) if indeterminate results were excluded. Sensitivity of IGRA was independent of CD4 cell count (p = 0.698). Among 44 individuals with available TST, 22 (50%) had a positive TST. Agreement between TST and IGRA was 57% (kappa = 0.14, p = 0.177), and in 34% (10/29) both tests were positive. Combining TST and IGRA (at least one test positive) resulted in an improved sensitivity of 67% (95% CI 52-81%). In multivariate analysis, older age was associated with negative results of TST and T-SPOT.TB (OR 3.07, 95% CI 1,22-7.74, p = 0.017, per 10 years older). Conclusions T-SPOT.TB and TST have similar sensitivity to detect latent TB in HIV-infected individuals. Combining TST and IGRA may help clinicians to better select HIV-infected individuals with latent tuberculosis who qualify for preventive treatment.

Objectives: Detecting severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is key to the clinical and epidemiological assessment of CoVID‐19. We cross‐validated manual and automated high‐throughput testing for SARS‐CoV‐2‐RNA, evaluated SARS‐CoV‐2 loads in nasopharyngeal–oropharyngeal swabs (NOPS), lower respiratory fluids, and plasma, and analyzed detection rates after lockdown and relaxation measures. Methods: Basel‐S‐gene, Roche‐E‐gene, and Roche‐cobas®6800‐Target1 and Target2 were prospectively validated in 1344 NOPS submitted during the first pandemic peak (Week 13). Follow‐up cohort (FUP) 1, 2, and 3 comprised 10,999, 10,147, and 19,389 NOPS submitted during a 10‐week period until Weeks 23, 33, and 43, respectively. Results: Concordant results were obtained in 1308 cases (97%), including 97 (9%) SARS‐CoV‐2‐positives showing high quantitative correlations (Spearman's r >.95; p <.001) for all assays and high precision by Bland–Altman analysis. Discordant samples (N = 36, 3%) had significantly lower SARS‐CoV‐2 loads (p <.001). Following lockdown, detection rates declined to <1% in FUP‐1, reducing single‐test positive predictive values from 99.3% to 85.1%. Following relaxation, rates flared up to 4% and 12% in FUP‐2 and ‐3, but infected patients were younger than during lockdown (34 vs. 52 years, p <.001). In 261 patients providing 936 NOPS, SARS‐CoV‐2 loads declined by three orders of magnitude within 10 days postdiagnosis (p <.001). SARS‐CoV‐2 loads in NOPS correlated with those in time‐matched lower respiratory fluids or in plasma but remained detectable in some cases with negative follow‐up NOPS, respectively. Conclusion: Manual and automated assays significantly correlated qualitatively and quantitatively. Following a successful lockdown, declining positive predictive values require independent dual‐target confirmation for reliable assessment. Confirmatory and quantitative follow‐up testing should be obtained within <5 days and consider lower respiratory fluids in symptomatic patients with SARS‐CoV‐2‐negative NOPS. Highlights: SARS‐CoV‐2‐loads decline by 1000‐fold within 10 days post‐diagnosis.Low prevalence settings require concordant dual‐target detection of SARS‐CoV‐2‐RNA.SARS‐CoV‐2 confirmation and follow‐up testing be obtained in <5 days post‐diagnosis.In symptomatic patients with SARS‐CoV‐2‐negative swabs, lower respiratory tract sampling be considered. [ABSTRACT FROM AUTHOR]

Abstract Background Several strategies to optimise the use of antibiotics have been developed. Most of these interventions can be classified as educational or restrictive. Restrictive measures are considered to be more effective, but the enforcement of these measures may be difficult and lead to conflicts with prescribers. Any intervention should be aimed at targets with the highest impact on antibiotic prescribing. The aim of the present study was to assess the adequacy of empirical and adjusted antibiotic therapies in a Swiss university hospital where no antibiotic use restrictions are enforced, and to identify risk factors for inadequate treatment and targets for intervention. Methods A prospective observational study was performed during 9 months. All patients admitted through the emergency department who received an antibiotic therapy within 24 hours of admission were included. Data on demographic characteristics, diagnoses, comorbidities, systemic inflammatory response syndrome (SIRS) parameters, microbiological tests, and administered antibiotics were collected prospectively. Antibiotic therapy was considered adequate if spectrum, dose, application modus, and duration of therapy were appropriate according to local recommendations or published guidelines. Results 2943 admitted patients were evaluated. Of these, 572 (19.4%) received antibiotics within 24 hours and 539 (94%) were analysed in detail. Empirical antibiotic therapy was inadequate in 121 patients (22%). Initial therapy was adjusted in 168 patients (31%). This adjusted antibiotic therapy was inadequate in 46 patients (27%). The main reason for inadequacy was the use of antibiotics with unnecessarily broad spectrum (24% of inadequate empirical, and 52% of inadequate adjusted therapies). In 26% of patients with inadequate adjusted therapy, antibiotics used were either ineffective against isolated pathogenic bacteria or antibiotic therapy was continued despite negative results of microbiological investigations. Conclusion The rate of inadequate antibiotic therapies was similar to the rates reported from other institutions despite the absence of a restrictive antibiotic policy. Surprisingly, adjusted antibiotic therapies were more frequently inappropriate than empirical therapies. Interventions aiming at improving antibiotic prescribing should focus on both initial empirical therapy and streamlining and adjustment of therapy once microbiological results become available.

Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site [...]

To the Editor: The primary mode of transmission of severe acute respiratory syndrome (SARS) appears to be through exposure to respiratory droplets and direct contact with patients and their contaminated [...]

This abstract aims to summarize the procedure implemented by ITHACA S.R.L. for creating Reference Maps (Figure 1). The team, thanks to its strong competences in the field of management and processing of geographic and cartographic data and its GIS, Mapping and Data Analysis skills, is able to produce maps in different size and orientation and to satisfy the specific customers' requests. The process consists of automation phases combined with manual work by means of the operator. The starting point was an in-depth investigation of different free available and official datasets (e.g. Natural Earth, Geonames, vMap0) containing the main reference topographic geospatial data (e.g. boundaries, physiography, settlements, transportation, hydrography) used to create Reference Maps [1]. A preliminary analysis on the level of detail and accuracy of the data, as well as the completeness, the timeliness, the temporal coverage, the data policy was performed. Moreover, it is important to have a bulk of geospatial information that can be used in different scales and formats of maps. For this reason, a proper Geodatabase with a particular scheme, that maintains the same structure for any types of product, was realized to store and to uniform the data belonging from different sources (Figure 2). The checked and modified data can also be reused easily in future requests [2]. If the map scale requires it, Open Street Map (OSM) reference data can be used. There are different ways to manage and get data from there but all of them only allow the download of small size dataset. To overcome this annoying limitation, a QGIS tool was developed internally. This automatic tool allows the download of data from OSM from an Area of Interest (AOI) with big size and it exploits the "Quick OSM" tool of QGIS that allows the download of OSM data with the Overpass API. Since the limit in size of the downloadable data, the tool subdivides the AOI in smaller sub-areas from which Quick OSM performs the download of the only selected data, decided by means of a list of key and value that are easily chosen by the operator using the tool interface. After each sub-area is downloaded, the different datasets are merged in a unique shapefile for each feature class. Then, the tool allows to keep the final data as shapefile for a first manual refinement or to upload it automatically in the Geodatabase. ITHACA S.R.L. has also developed a set of map template prototypes in ArcGIS Pro environment, that ensure an homogeneous look-and-feel and a company branding while allowing to manage product specific requirements [3]. Regarding the Map Production (Figure 3), firstly, the team analyses in more detail the request of the customer, in order to achieve a complete understanding of the context and to identify the geospatial data necessary to correctly manage the related production activities. Subsequently, the appropriate map template prototype, in terms of format and orientation, is chosen. In the map template, there are three sections that correspond to three steps: - The first mainframe permits to focus on the Area Of Interest, to manage the extent, to set and fix the required scale and to select the appropriate map projection. - The second mainframe permits to see all the features contained in the GDB and to clip the data using a clip tool created ad-hoc. - The third mainframe includes the Table of Contents (TOC) with all the layers that can be visualized in the map. After that, the data are uploaded in a shared GDB and linked to the TOC of the template. Obviously, data from different sources to produce a map at a definite scale have to be checked by the operator. The first check concerns the geometry of the original data, that must adapt to the production scale of the map and, as consequence, an editing operation is required to generalize or to integrate the data. Another check concerns the data truthfulness and updating; for example, it happens to update the administrative boundaries (Regions or Municipalities) or to re-classify the types of roads (Highways, Primary Roads and so on). The particular scheme of the Dataset and the use of a shared GDB speed up the editing phase, also ensuring consistency and uniqueness of the topological content and standardizing the cartographic representation of different areas of the world. In order to produce a Reference Map of high level, the operator must verify carefully each element of the template which may require minor changes in order to better fit the type of product or rearrangements to improve visualization and readability. Finally, dedicated quality check tasks, led by a team of quality experts, are foreseen. The use of quality assurance protocols, automatic checklist procedures supported by official cartographic material and combined with technical guidelines will ensure the products' best quality. [ABSTRACT FROM AUTHOR]