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99 results on '"Louis-Simonet M"'

6. Relationship between hospital length of stay and quality of care in patients with congestive heart failure. (Original Article)

Author

Kossovsky, M.P., Sarasin, F.P., Chopard, P., Louis-Simonet, M., Sigaud, P., Perneger, T.V., and Gaspoz, J-M

Subjects
Hospital care -- Evaluation, Congestive heart failure -- Care and treatment, Cardiac patients -- Care and treatment, Medical care -- Evaluation -- Switzerland, Health, Health care industry
Abstract

Objective: To determine the relationship between hospital length of stay (LOS) and quality of care in patients admitted for congestive heart failure (CHF). Methods: This observational study was conducted in [...]

Published
2002

7. Targeted education improves the very low recognition of vertebral fractures and osteoporosis management by general internists

Author

Casez, P., Uebelhart, B., Gaspoz, J.-M, Ferrari, S., Louis-Simonet, M., Rizzoli, R., Casez, P., Uebelhart, B., Gaspoz, J.-M, Ferrari, S., Louis-Simonet, M., and Rizzoli, R.

Abstract

Introduction: Vertebral fractures in older persons are strong predictors of subsequent fracture risk but remain largely under-recognized. To evaluate the impact of an educational intervention on the recognition of vertebral fractures and the prescription of anti-osteoporosis treatment among general internists, we conducted a prospective study in a service of general internal medicine of a large university teaching hospital in Geneva, Switzerland. During a 3.5-month observation period (phase1), all lateral spinal or chest radiographs performed on consecutive inpatients over 60 years were reviewed by two independent investigators, and vertebral fractures were graded according to their severity. Methods: Results were compared with radiology reports and general internists' discharge summaries. During the following 2-month intervention period (phase2), internists were actively educated about vertebral fracture identification by means of lectures, posters and flyers. Radiologists did not receive this educational strategy and served as controls. Results: Among 292 consecutive patients (54% men; range: 60-97 years) included in phase1, 85 (29%) were identified by investigators as having at least one vertebral fracture; radiologists detected 29 (34%), and internists detected 19 (22%). During the intervention phase, 58 (34%) of 172 patients were identified with vertebral fractures by investigators; radiologists detected 13 patients (22%) whereas among internists the detection rate almost doubled (25/58 patients, 43%; p=0.008 compared to phase1). The percentage of patients with vertebral fracture who benefitted from an osteoporosis medical management increased from 11% (phase1) to 40% (phase2, p<0.03). Conclusions: Our findings confirm the large under-recognition of vertebral fractures, irrespective of their severity, and demonstrate that a simple educational strategy can significantly improve their detection on routine radiographs and, consequently, improve osteoporosis manage

Published
2018

8. Impact d’une réconciliation médicamenteuse par un pharmacien lors de l’admission dans un service de médecine interne

Author

Skalafouris, C., primary, Guignard, B., additional, Ing-Lorenzini, K., additional, Rollason, V., additional, Desnoyer, A., additional, Blondon, K., additional, Louis-Simonet, M., additional, Choupay-Dessard, G., additional, Chopard, P., additional, Samer, C., additional, Desmeules, J., additional, and Bonnabry, P., additional

Published
2017
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9. [Can antiplatelet therapy be continued in upper gastrointestinal bleeding?]

Author

Restellini S, jean louis Frossard, and Louis Simonet M

Subjects
Stroke, Contraindications, Myocardial Infarction, Humans, Gastrointestinal Hemorrhage, Platelet Aggregation Inhibitors
Abstract

During a gastro-intestinal bleeding, treatment options regarding antiplatelet agents depend on the indication. In primary prevention, treatment can reasonably be stopped regarding the low expected benefit. In secondary prevention, experts recommend resuming treatment after a five-day interruption. In patients with a coronary stent, the decision is made on a case by case basis and requires close multidisciplinary collaboration between internists, cardiologists and gastroenterologists.

Published
2012

10. Nutrition entérale : sonde nasogastrique ou gastrostomie percutanée endoscopique?

Author

Rendall, K, Pichard, Claude, Louis, Simonet M, and Reny, J-L

Subjects
ddc:616, Gastrostomy/methods, Meta-Analysis as Topic, technology, industry, and agriculture, Humans, Enteral Nutrition/methods, macromolecular substances, Intubation, Gastrointestinal
Abstract

When enteral nutrition is indicated to prevent or to treat a patient with denutrition choosing between a nasogastric tube (NGT) and a percutaneous endoscopic gastrostomy (PEG) is not always an easy decision. In neurological patients with swallowing disturbances or in patients with head and neck tumors, PEG is associated with lower rates of feeding tube dislodgement, while NGT has lower rates or morbidity. A meta-analysis showed that the interruption of nutrition is less frequent with PEG but there is no difference in terms of mortality and aspiration pneumonia between PEG and NGT. The European Society for Clinical Nutrition and Metabolism recommends PEG when enteral nutrition is expected to last more than 3 weeks.

Published
2012

11. Toscana virus meningitis case in Switzerland: an example of the ezVIR bioinformatics pipeline utility for the identification of emerging viruses

Author

Cordey, S., primary, Bel, M., additional, Petty, T.J., additional, Docquier, M., additional, Sacco, L., additional, Turin, L., additional, Cherpillod, P., additional, Emonet, S., additional, Louis-Simonet, M., additional, Zdobnov, E.M., additional, Ambrosioni, J., additional, and Kaiser, L., additional

Published
2015
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13. Impact of postgraduate training on communication skills teaching: a controlled study

Author

Junod Perron, N., Nendaz, M., Louis-Simonet, M., Sommer, J., Gut, A., Cerutti, B., Vleuten, C.P.M. van der, Dolmans, D., Junod Perron, N., Nendaz, M., Louis-Simonet, M., Sommer, J., Gut, A., Cerutti, B., Vleuten, C.P.M. van der, and Dolmans, D.

Abstract

Contains fulltext : 138239.pdf (publisher's version ) (Open Access), BACKGROUND: Observation of performance followed by feedback is the key to good teaching of communication skills in clinical practice. The fact that it occurs rarely is probably due to clinical supervisors' perceived lack of competence to identify communication skills and give effective feedback. We evaluated the impact of a faculty development programme on communication skills teaching on clinical supervisors' ability to identify residents' good and poor communication skills and to discuss them interactively during feedback. METHODS: We conducted a pre-post controlled study in which clinical supervisors took part to a faculty development program on teaching communication skills in clinical practice. Outcome measures were the number and type of residents' communication skills identified by supervisors in three videotaped simulated resident-patient encounters and the number and type of communication skills discussed interactively with residents during three feedback sessions. RESULTS: 48 clinical supervisors (28 intervention group; 20 control group) participated. After the intervention, the number and type of communication skills identified did not differ between both groups. There was substantial heterogeneity in the number and type of communication skills identified. However, trained participants engaged in interactive discussions with residents on a significantly higher number of communication items (effect sizes 0.53 to 1.77); communication skills items discussed interactively included both structural and patient-centered elements that were considered important to be observed by expert teachers. CONCLUSIONS: The faculty development programme did not increase the number of communication skills recognised by supervisors but was effective in increasing the number of communication issues discussed interactively in feedback sessions. Further research should explore the respective impact of accurate identification of communication skills and effective teaching skills on

Published
2014

14. Effectiveness of a training program in supervisors' ability to provide feedback on residents' communication skills

Author

Junod Perron, N., Nendaz, M., Louis-Simonet, M., Sommer, J., Gut, A., Baroffio, A., Dolmans, D., Vleuten, C.P.M. van der, Junod Perron, N., Nendaz, M., Louis-Simonet, M., Sommer, J., Gut, A., Baroffio, A., Dolmans, D., and Vleuten, C.P.M. van der

Abstract

Item does not contain fulltext, Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are scarce as well as studies that go beyond self-reported data. The aim of the study was to develop and assess the effectiveness of a training program for clinical supervisors on how to give feedback on residents' CS in clinical practice. The authors designed a pretest-posttest controlled study in which clinical supervisors working in two different medical services were invited to attend a sequenced and multifaceted program in teaching CS over a period of 6-9 months. Outcome measures were self-perceived and observed feedback skills collected during questionnaires and three videotaped objective structured teaching encounters. The videotaped feedbacks made by the supervisors were analysed using a 20-item feedback rating instrument. Forty-eight clinical supervisors participated (28 in the intervention, 20 in the control group). After training, a higher percentage of trained participants self-reported and demonstrated statistically significant improvement in making residents more active by exploring residents' needs, stimulating self-assessment, and using role playing to test strategies and checking understanding, with effect sizes ranging from 0.93 to 4.94. A training program on how to give feedback on residents' communication skills was successful in improving clinical supervisors' feedback skills and in helping them operate a shift from a teacher-centered to a more learner-centered approach.

Published
2013

15. Relationship between hospital length of stay and quality of care in patients with congestive heart failure

Author

Thomas V. Perneger, Louis-Simonet M, Chopard P, Michel P. Kossovsky, Sigaud P, Jean-Michel Gaspoz, and F. P. Sarasin

Subjects
medicine.medical_specialty, Leadership and Management, Length of hospitalization, Discharged alive, State Medicine, medicine, Humans, In patient, cardiovascular diseases, Quality of care, Intensive care medicine, General Nursing, Quality of Health Care, Heart Failure, business.industry, Health Policy, Confounding, Public Health, Environmental and Occupational Health, Health services research, Length of Stay, medicine.disease, United Kingdom, Heart failure, Emergency medicine, Observational study, Original Article, business
Abstract

Objective: To determine the relationship between hospital length of stay (LOS) and quality of care in patients admitted for congestive heart failure (CHF). Methods: This observational study was conducted in the medical wards of the Geneva University Hospitals, Geneva, Switzerland. A random sample of 371 patients was drawn from the 1084 patients discharged alive with a principal diagnosis of CHF between January 1997 and December 1998. Explicit criteria grouped into three scores were used to assess the quality of processes of care: admission work-up (admission score); evaluation and treatment during the stay (treatment score); and readiness for discharge (discharge score). The association between LOS and quality of care was analysed using linear regression with adjustment for clinical characteristics. Results: The mean proportion of criteria met were 80% for the admission score, 66% for the treatment score, and 76% for the discharge score. Mean (SD) LOS was 13.2 (8.8) days. The admission score was not associated with LOS, but the treatment score increased by 0.5% (95% CI 0.3 to 0.7; p

Published
2002

16. Poster Session 3

Author

Fabbri, G. M. T., primary, Baldasseroni, S., additional, Panuccio, D., additional, Zoni Berisso, M., additional, Scherillo, M., additional, Lucci, D., additional, Di Pasquale, G., additional, Mathieu, G., additional, Burazor, I., additional, Burazor, M., additional, Perisic, Z., additional, Atanaskovic, V., additional, Erakovic, V., additional, Stojkovic, A., additional, Vogtmann, T., additional, Schoebel, C., additional, Sogorski, S., additional, Sebert, M., additional, Schaarschmidt, J., additional, Fietze, I., additional, Baumann, G., additional, Penzel, T., additional, Mornos, C., additional, Ionac, A., additional, Cozma, D., additional, Dragulescu, D., additional, Mornos, A., additional, Petrescu, L., additional, Pescariu, L., additional, Brembilla-Perrot, B., additional, Khachab, H., additional, Lamberti, F., additional, Bellini, C., additional, Remoli, R., additional, Cogliandro, T., additional, Nardo, R., additional, Bellusci, F., additional, Mazzuca, V., additional, Gaspardone, A., additional, Aguinaga Arrascue, L. E., additional, Bravo, A., additional, Garcia Freire, P., additional, Gallardo, P., additional, Hasbani, E., additional, Quintana, R., additional, Dantur, J., additional, Inoue, K., additional, Ueoka, A., additional, Tsubakimoto, Y., additional, Sakatani, T., additional, Matsuo, A., additional, Fujita, H., additional, Kitamura, M., additional, Wegrzynowska, M., additional, Konduracka, E., additional, Pietrucha, A. Z., additional, Mroczek-Czernecka, D., additional, Paradowski, A., additional, Bzukala, I., additional, Nessler, J., additional, Igawa, O., additional, Adachi, M., additional, Atarashi, H., additional, Kusama, Y., additional, Kodani, E., additional, Okazaki, R., additional, Nakagomi, A., additional, Endoh, Y., additional, Baez-Escudero, J. L., additional, Dave, A. S., additional, Sasaridis, C. M., additional, Valderrabano, M., additional, Tilz, R., additional, Bai, R., additional, Di Biase, L., additional, Gallinghouse, G. J., additional, Gibson, D., additional, Pisapia, A., additional, Wazni, O., additional, Natale, A., additional, Arujuna, A., additional, Karim, R., additional, Rinaldi, A., additional, Cooklin, M., additional, Rhode, K., additional, Razavi, R., additional, O'neill, M., additional, Gill, J., additional, Kusa, S., additional, Komatsu, Y., additional, Kakita, K., additional, Takayama, K., additional, Taniguchi, H., additional, Otomo, K., additional, Iesaka, Y., additional, Ammar, S., additional, Reents, T., additional, Fichtner, S., additional, Wu, J., additional, Zhu, P., additional, Kolb, C., additional, Hessling, G., additional, Deisenhofer, I., additional, Gilbert, G., additional, Mohanty, P., additional, Cunningham, J., additional, Metz, T., additional, Horton, R., additional, Tao, S., additional, Yamauchi, Y., additional, Okada, H., additional, Maeda, S., additional, Obayashi, T., additional, Isobe, M., additional, Chan, J., additional, Johar, S., additional, Wong, T., additional, Markides, V., additional, Hussain, W., additional, Konstantinidou, M., additional, Wissner, E., additional, Fuernkranz, A., additional, Yoshiga, Y., additional, Metzner, A., additional, Kuck, K.- H., additional, Ouyang, F., additional, Kettering, K., additional, Gramley, F., additional, Mollnau, H., additional, Weiss, C., additional, Bardeleben, S., additional, Biasco, L., additional, Scaglione, M., additional, Caponi, D., additional, Di Donna, P., additional, Sergi, D., additional, Cerrato, N., additional, Blandino, A., additional, Gaita, F., additional, Fiala, M., additional, Wichterle, D., additional, Sknouril, L., additional, Bulkova, V., additional, Chovancik, J., additional, Nevralova, R., additional, Pindor, J., additional, Januska, J., additional, Choi, J. I., additional, Ban, J. E., additional, Yasutsugu, N., additional, Park, J. S., additional, Jung, J. S., additional, Lim, H. E., additional, Park, S. W., additional, Kim, Y. H., additional, Kuhne, M., additional, Reichlin, T., additional, Ammann, P., additional, Schaer, B., additional, Osswald, S., additional, Sticherling, C., additional, Ohe, M., additional, Goya, M., additional, Hiroshima, K., additional, Hayashi, K., additional, Makihara, Y., additional, Nagashima, M., additional, Fukunaga, M., additional, An, Y., additional, Dorwarth, U., additional, Schmidt, M., additional, Wankerl, M., additional, Krieg, J., additional, Straube, F., additional, Hoffmann, E., additional, Kathan, S., additional, Defaye, P., additional, Mbaye, A., additional, Cassagneau, R., additional, Gagniere, V., additional, Jacon, P., additional, Pokushalov, E., additional, Romanov, A., additional, Artemenko, S., additional, Shabanov, V., additional, Elesin, D., additional, Stenin, I., additional, Turov, A., additional, Losik, D., additional, Kondo, K., additional, Miake, J., additional, Yano, A., additional, Ogura, K., additional, Kato, M., additional, Shigemasa, C., additional, Sekiguchi, Y., additional, Tada, H., additional, Yoshida, K., additional, Naruse, Y., additional, Yamasaki, H., additional, Igarashi, M., additional, Machino, T., additional, Aonuma, K., additional, Chen, S., additional, Liu, S., additional, Chen, G., additional, Meng, W., additional, Zhang, F., additional, Yan, Y., additional, Sciarra, L., additional, Dottori, S., additional, Lanzillo, C., additional, De Ruvo, E., additional, De Luca, L., additional, Minati, M., additional, Lioy, E., additional, Calo', L., additional, Lin, J., additional, Nie, Z., additional, Zhu, M., additional, Wang, X., additional, Zhao, J., additional, Hu, W., additional, Tao, H., additional, Ge, J., additional, Johansson, B., additional, Houltz, B., additional, Edvardsson, N., additional, Schersten, H., additional, Karlsson, T., additional, Wandt, B., additional, Berglin, E., additional, Hoyt, R. H., additional, Jenson, B. P., additional, Trines, S. A. I. P., additional, Braun, J., additional, Tjon Joek Tjien, A., additional, Zeppenfeld, K., additional, Tavilla, G., additional, Klautz, R. J. M., additional, Schalij, M. J., additional, Krausova, R., additional, Cihak, R., additional, Peichl, P., additional, Kautzner, J., additional, Pirk, J., additional, Skalsky, I., additional, Maly, J., additional, Imai, K., additional, Sueda, T., additional, Orihashi, K., additional, Picarra, B. C., additional, Santos, A. R., additional, Dionisio, P., additional, Semedo, P., additional, Matos, R., additional, Leitao, M., additional, Banha, M., additional, Trinca, M., additional, Elder, D. H. J., additional, George, J., additional, Jain, R., additional, Lang, C. C., additional, Choy, A. M., additional, Konert, M., additional, Loescher, S., additional, Hartmann, A., additional, Aversa, E., additional, Chirife, R., additional, Sztyglic, E., additional, Mazzetti, H., additional, Mascheroni, O., additional, Tentori, M. C., additional, Pop, R. M., additional, Margulescu, A. D., additional, Dulgheru, R., additional, Enescu, O., additional, Siliste, C., additional, Vinereanu, D., additional, Menezes Junior, A., additional, Castro Carneiro, A. R., additional, De Oliveira, B. L., additional, Shah, A. N., additional, Kantharia, B., additional, De Lucia, R., additional, Soldati, E., additional, Segreti, L., additional, Di Cori, A., additional, Zucchelli, G., additional, Viani, S., additional, Paperini, L., additional, Bongiorni, M. G., additional, Kutarski, A., additional, Czajkowski, M., additional, Pietura, R., additional, Malecka, B., additional, Heintze, J., additional, Eckardt, L., additional, Bauer, A., additional, Meine, M., additional, Van Erven, L., additional, Bloch Thomsen, P. E., additional, Lopez Chicharro, M. P., additional, Merhi, O., additional, Soga, Y., additional, Andou, K., additional, Nobuyoshi, M., additional, Gonzalez-Mansilla, A., additional, Martin-Asenjo, R., additional, Unzue, L., additional, Torres, J., additional, Garralda, E., additional, Coma, R. R., additional, Rodriguez Garcia, J. E., additional, Yaegashi, T., additional, Furusho, H., additional, Kato, T., additional, Chikata, A., additional, Takashima, S., additional, Usui, S., additional, Takamura, M., additional, Kaneko, S., additional, Chudzik, M., additional, Mitkowski, P., additional, Przybylski, A., additional, Lewek, J., additional, Smukowski, T., additional, Maciag, A., additional, Castrejon Castrejon, S., additional, Perez-Silva, A., additional, Estrada, A., additional, Doiny, D., additional, Ortega, M., additional, Lopez-Sendon, J. L., additional, Merino, J. L., additional, O'mahony, C., additional, Coats, C., additional, Cardona, M., additional, Garcia, A., additional, Calcagnino, M., additional, Lachmann, R., additional, Hughes, D., additional, Elliott, P. M., additional, Conti, S., additional, Pruiti, G. P., additional, Puzzangara, E., additional, Romano, S. A., additional, Di Grazia, A., additional, Ussia, G. P., additional, Tamburino, C., additional, Calvi, V., additional, Radinovic, A., additional, Sala, S., additional, Latib, A., additional, Mussardo, M., additional, Sora, S., additional, Paglino, G., additional, Gullace, M., additional, Colombo, A., additional, Ohlow, M.- A. G., additional, Lauer, B., additional, Wagner, A., additional, Schreiber, M., additional, Buchter, B., additional, Farah, A., additional, Fuhrmann, J. T., additional, Geller, J. C., additional, Nascimento Cardoso, R. M., additional, Batista Sa, L. A., additional, Campos Filho, L. F. C., additional, Rodrigues, S. V., additional, Dutra, M. V. F., additional, Borges, T. R. S. A., additional, Portilho, D. R., additional, Deering, T., additional, Bernardes, A., additional, Veiga, A., additional, Gartenlaub, O., additional, Goncalves, A., additional, Jimenez, A., additional, Rousseauplasse, A., additional, Deharo, J. C., additional, Striekwold, H., additional, Gosselin, G., additional, Sitbon, H., additional, Martins, V., additional, Molon, G., additional, Ayala-Paredes, F., additional, Sancho-Tello, M. J., additional, Fazal, I. A., additional, Brady, S., additional, Cronin, J., additional, Mcnally, S., additional, Tynan, M., additional, Plummer, C. J., additional, Mccomb, J. M., additional, Val-Mejias, J. E., additional, Oliveira, R. M., additional, Costa, R., additional, Martinelli Filho, M., additional, Silva, K. R., additional, Menezes, L. M., additional, Tamaki, W. T., additional, Mathias, W., additional, Stolf, N. A. G., additional, Misawa, T., additional, Ohta, I., additional, Shishido, T., additional, Miyasita, T., additional, Miyamoto, T., additional, Nitobe, J., additional, Watanabe, T., additional, Kubota, I., additional, Thibault, B., additional, Ducharme, A., additional, Simpson, C., additional, Stuglin, C., additional, Gagne, C. E., additional, Williams, R., additional, Mcnicoll, S., additional, Silvetti, M. S., additional, Drago, F., additional, Penela, D., additional, Bijnens, B., additional, Doltra, A., additional, Silva, E., additional, Berruezo, A., additional, Mont, L., additional, Sitges, M., additional, Mcintosh, R., additional, Baumann, O., additional, Raju, P., additional, Gurunathan, S., additional, Furniss, S., additional, Patel, N., additional, Sulke, N., additional, Lloyd, G., additional, Mor, M., additional, Dror, S., additional, Tsadok, Y., additional, Bachner-Hinenzon, N., additional, Katz, A., additional, Liel-Cohen, N., additional, Etzion, Y., additional, Mlynarski, R., additional, Mlynarska, A., additional, Wilczek, J., additional, Sosnowski, M., additional, Sinha, A. M., additional, Sinha, D., additional, Noelker, G., additional, Brachmann, J., additional, Weidemann, F., additional, Ertl, G., additional, Jones, M., additional, Searle, N., additional, Cocker, M., additional, Ilsley, E., additional, Foley, P., additional, Khiani, R., additional, Nelson, K. E., additional, Turley, A. J., additional, Owens, W. A., additional, James, S. A., additional, Linker, N. J., additional, Velagic, V., additional, Cikes, M., additional, Pezo Nikolic, B., additional, Puljevic, D., additional, Separovic-Hanzevacki, J., additional, Lovric-Bencic, M., additional, Biocina, B., additional, Milicic, D., additional, Kawata, H., additional, Chen, L., additional, Phan, H., additional, Anand, K., additional, Feld, G., additional, Birgesdotter-Green, U., additional, Fernandez Lozano, I., additional, Mitroi, C., additional, Toquero Ramos, J., additional, Castro Urda, V., additional, Monivas Palomero, V., additional, Corona Figueroa, A., additional, Hernandez Reina, L., additional, Alonso Pulpon, L., additional, Gate-Martinet, A., additional, Da Costa, A., additional, Rouffiange, P., additional, Cerisier, A., additional, Bisch, L., additional, Romeyer-Bouchard, C., additional, Isaaz, K., additional, Morales, M.- A., additional, Bianchini, E., additional, Startari, U., additional, Faita, F., additional, Bombardini, T., additional, Gemignani, V., additional, Piacenti, M., additional, Adhya, S., additional, Kamdar, R. H., additional, Millar, L. M., additional, Burchardt, C., additional, Murgatroyd, F. D., additional, Klug, D., additional, Kouakam, C., additional, Guedon-Moreau, L., additional, Marquie, C., additional, Benard, S., additional, Kacet, S., additional, Cortez-Dias, N., additional, Carrilho-Ferreira, P., additional, Silva, D., additional, Goncalves, S., additional, Valente, M., additional, Marques, P., additional, Carpinteiro, L., additional, Sousa, J., additional, Keida, T., additional, Nishikido, T., additional, Fujita, M., additional, Chinen, T., additional, Kikuchi, T., additional, Nakamura, K., additional, Ohira, H., additional, Takami, M., additional, Anjo, D., additional, Meireles, A., additional, Gomes, C., additional, Roque, C., additional, Pinheiro Vieira, A., additional, Lagarto, V., additional, Reis, H., additional, Torres, S., additional, Ortega, D. F., additional, Barja, L. D., additional, Montes, J. P., additional, Logarzo, E., additional, Bonomini, P., additional, Mangani, N., additional, Paladino, C., additional, Chwyczko, T., additional, Smolis-Bak, E., additional, Sterlinski, M., additional, Pytkowski, M., additional, Firek, B., additional, Jankowska, A., additional, Szwed, H., additional, Nakajima, I., additional, Noda, T., additional, Okamura, H., additional, Satomi, K., additional, Aiba, T., additional, Shimizu, W., additional, Aihara, N., additional, Kamakura, S., additional, Brzozowski, W., additional, Tomaszewski, A., additional, Wysokinski, A., additional, Bertoldi, E. G., additional, Rohde, L. E., additional, Zimerman, L. I., additional, Pimentel, M., additional, Polanczyk, C. A., additional, Boriani, G., additional, Lunati, M., additional, Gasparini, M., additional, Landolina, M., additional, Lonardi, G., additional, Pecora, D., additional, Santini, M., additional, Valsecchi, S., additional, Rubinstein, B. J., additional, Wang, D. Y., additional, Cabreriza, S. E., additional, Richmond, M. E., additional, Rusanov, A., additional, Quinn, T. A., additional, Cheng, B., additional, Spotnitz, H. M., additional, Kristiansen, H. M., additional, Vollan, G., additional, Hovstad, T., additional, Keilegavlen, H., additional, Faerestrand, S., additional, Brigesdotter-Green, U., additional, Nawar, A. M. R., additional, Ragab, D. A. L. I. A., additional, Eluhsseiny, R. A. N. I. A., additional, Abdelaziz, A. H. M. E. D., additional, Nof, E., additional, Abu Shama, R., additional, Buber, J., additional, Kuperstein, R., additional, Feinberg, M. S., additional, Barlev, D., additional, Eldar, M., additional, Glikson, M., additional, Badran, H., additional, Samir, R., additional, Tawfik, M., additional, Amin, M., additional, Eldamnhoury, H., additional, Khaled, S., additional, Tolosana, J. M., additional, Martin, A. M., additional, Hernandez-Madrid, A., additional, Macias, A., additional, Fernandez-Lozano, I., additional, Osca, J., additional, Quesada, A., additional, Padeletti, L., additional, Botto, G. L., additional, De Santo, T., additional, Szwed, A., additional, Martinez, J. G., additional, Degand, B., additional, Villani, G. Q., additional, Leclercq, C., additional, Ritter, P., additional, Watanabe, I., additional, Nagashima, K., additional, Okumura, Y., additional, Kofune, M., additional, Ohkubo, K., additional, Nakai, T., additional, Hirayama, A., additional, Mikhaylov, E., additional, Vander, M., additional, Lebedev, D., additional, Zarse, M., additional, Suleimann, H., additional, Bogossian, H., additional, Stegelmeyer, J., additional, Ninios, I., additional, Karosienne, Z., additional, Kloppe, A., additional, Lemke, B., additional, John, S., additional, Gaspar, T., additional, Rolf, S., additional, Sommer, P., additional, Hindricks, G., additional, Piorkowski, C., additional, Fernandez-Armenta, J., additional, Mont, L. 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P., additional, Kuroki, K., additional, Igawa, M., additional, Kuga, K., additional, Ferreira Santos, L., additional, Dionisio, T., additional, Nunes, L., additional, Machado, J., additional, Castedo, S., additional, Henriques, C., additional, Matos, A., additional, Oliveira Santos, J., additional, Kraaier, K., additional, Olimulder, M. A. G. M., additional, Galjee, M. A., additional, Van Dessel, P. F. H. M., additional, Van Der Palen, J., additional, Wilde, A. A. M., additional, Scholten, M. F., additional, Chouchou, F., additional, Poupard, L., additional, Philippe, C., additional, Court-Fortune, I., additional, Barthelemy, J.- C., additional, Roche, F., additional, Dolgoshey, T. S., additional, Madekina, G. A., additional, Sugiura, S., additional, Fujii, E., additional, Senga, M., additional, Dohi, K., additional, Sugiura, E., additional, Nakamura, M., additional, Ito, M., additional, Eitel, C., additional, Mendell, J., additional, Lasseter, K., additional, Shi, M., additional, Urban, L., additional, Hatala, R., additional, Hlivak, P., additional, De Melis, M., additional, Garutti, C., additional, Corbucci, G., additional, Mlcochova, H., additional, Maxian, R., additional, Arbelo, E., additional, Dogac, A., additional, Luepkes, C., additional, Ploessnig, M., additional, Chronaki, C., additional, Hinterbuchner, L., additional, Guillen, A., additional, Bun, S. S., additional, Latcu, D. G., additional, Franceschi, F., additional, Prevot, S., additional, Koutbi, L., additional, Ricard, P., additional, Saoudi, N., additional, Nazari, N., additional, Alizadeh, A., additional, Sayah, S., additional, Hekmat, M., additional, Assadian, M., additional, Ahmadzadeh, A., additional, Wnuk, M., additional, Jedrzejczyk-Spaho, J., additional, Kruszelnicka, O., additional, Piwowarska, W., additional, Fedorowski, A., additional, Burri, P., additional, Juul-Moller, S., additional, Melander, O., additional, Mitro, P., additional, Murin, P., additional, Kirsch, P., additional, Habalova, V., additional, Slaba, E., additional, Matyasova, E., additional, Barlow, M. A., additional, Blake, R. J., additional, Rostoff, P., additional, Wojewodka Zak, E., additional, Froidevaux, L., additional, Sarasin, F. P., additional, Louis-Simonet, M., additional, Hugli, O., additional, Yersin, B., additional, Schlaepfer, J., additional, Mischler, C., additional, Pruvot, E., additional, Occhetta, E., additional, Frascarelli, F., additional, Burali, A., additional, and Dovellini, E., additional

Published
2011
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27. Detecting Acute Thoracic Aortic Dissection in the Emergency Department: Time Constraints and Choice of the Optimal Diagnostic Test

Author

Sarasin, F.P., Louis-Simonet, M., Gaspoz, J.M., and Junod, A.F.

Abstract

Study objectives: To compare diagnostic strategies for the emergency assessment of patients with suspected acute thoracic aortic dissection and to measure the effect of delays related to the availability of these tests on the selection of the most appropriate one. Methods: We carried out a decision analysis representing the risks of performing one or two sequential tests, the tests' accuracy, the risks and benefits of treatment, and the time-dependent mortality rate in untreated patients with dissection (1%/hour). Data were drawn from a Medline search. Our subjects were patients who presented to the emergency department with chest pain in whom acute thoracic aortic dissection was suspected. For different clinical probabilities of aortic dissection, we compared the risks and benefits of testing using the following procedures (alone and in combinations): aortography, computed tomography (CT), magnetic resonance imaging (MRI), and both transesophageal (TEE) and transthoracic echocardiography (TTE). We then measured the effect of delays in these tests on the selection of the appropriate procedure. The outcome studied was 30-day survival. Results: We determined that the ''threshold'' clinical probability of aortic dissection above which the benefits of testing outweigh its risks is low. It ranges from 2% with the most reliable procedure (MRI) to 9% with the least (TTE). At low probability of dissection (<15%), the accuracy of all tests except TTE is sufficient to rule out dissection. Delays have negligible effect on these results. When the likelihood of dissection is higher, the preferred option is to order a second diagnostic test if the results of the first are negative. The threshold probabilities above which to order a second test range from 15% (CT, then aortography) to 35% (MRI, then aortography). Excessive delays may affect the selection of tests when the likelihood of dissection is high (eg, 50%). Thus, although it is less accurate, a CT scan obtained within 2 hours or a TEE obtained within 6 hours of presentation to the ED yields a higher survival rate than an MRI obtained within 9 hours. Similarly, the benefits of ordering a second test, if the result of the first are negative, outweigh the risks only if the delay in obtaining the test does not exceed 10 hours. Conclusion: All patients in whom aortic dissection is suspected, even if the index of suspicion is very low, should undergo one of the available diagnostic procedures (except TTE). A patient with a moderate to high probability of disease should undergo a second investigation if the findings of the first are negative. When the probability of dissection is high, the physician must consider delays in obtaining specific diagnostic tests and order those that will be the most quickly available. [Sarasin FP, Louis-Simonet M, Gaspoz J-M, Junod AF: Detecting acute aortic dissection in the emergency department: Time constraints and choice of the optimal diagnostic test. Ann Emerg Med September 1996;28:278-288.] See related editorial, Thoracic Aortic Dissection: Ruling In and Ruling Out

Published
1996
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29. Targeted education improves the very low recognition of vertebral fractures and osteoporosis management by general internists

Author

Casez, P., Uebelhart, B., Gaspoz, J.-M, Ferrari, S., Louis-Simonet, M., Rizzoli, R., Casez, P., Uebelhart, B., Gaspoz, J.-M, Ferrari, S., Louis-Simonet, M., and Rizzoli, R.

Abstract

Introduction: Vertebral fractures in older persons are strong predictors of subsequent fracture risk but remain largely under-recognized. To evaluate the impact of an educational intervention on the recognition of vertebral fractures and the prescription of anti-osteoporosis treatment among general internists, we conducted a prospective study in a service of general internal medicine of a large university teaching hospital in Geneva, Switzerland. During a 3.5-month observation period (phase1), all lateral spinal or chest radiographs performed on consecutive inpatients over 60 years were reviewed by two independent investigators, and vertebral fractures were graded according to their severity. Methods: Results were compared with radiology reports and general internists' discharge summaries. During the following 2-month intervention period (phase2), internists were actively educated about vertebral fracture identification by means of lectures, posters and flyers. Radiologists did not receive this educational strategy and served as controls. Results: Among 292 consecutive patients (54% men; range: 60-97 years) included in phase1, 85 (29%) were identified by investigators as having at least one vertebral fracture; radiologists detected 29 (34%), and internists detected 19 (22%). During the intervention phase, 58 (34%) of 172 patients were identified with vertebral fractures by investigators; radiologists detected 13 patients (22%) whereas among internists the detection rate almost doubled (25/58 patients, 43%; p=0.008 compared to phase1). The percentage of patients with vertebral fracture who benefitted from an osteoporosis medical management increased from 11% (phase1) to 40% (phase2, p<0.03). Conclusions: Our findings confirm the large under-recognition of vertebral fractures, irrespective of their severity, and demonstrate that a simple educational strategy can significantly improve their detection on routine radiographs and, consequently, improve osteoporosis manage

30. Residents' perceived needs in communication skills training across in- and outpatient clinical settings.

Author

Perron NJ, Sommer J, Hudelson P, Demaurex F, Luthy C, Louis-Simonet M, Nendaz M, De Grave W, Dolmans D, and Van der Vleuten C

Abstract

Context: Residents' perceived needs in communication skills training are important to identify before designing context-specific training programmes, since learrners' perceived needs can influence the effectiveness of training. Objectives: To explore residents' perceptions of their training needs and training experiences around communication skills, and whether these differ between residents training in inpatient and outpatient clinical settings. Methods: Four focus groups (FG) and a self-administered questionnaire were conducted with residents working in in- and outpatient medical service settings at a Swiss University Hospital. Focus groups explored residents' perceptions of their communication needs, their past training experiences and suggestions for future training programmes in communication skills. Transcripts were analysed in a thematic way using qualitative analytic approaches. All residents from both settings were asked to complete a questionnaire that queried their sociodemographics and amount of prior training in communication skills. Findings: In focus groups, outpatient residents felt that communication skills were especially useful in addressing chronic diseases and social issues. In contrast, inpatient residents emphasized the importance of good communication skills for dealing with family conflicts and end-of-life issues. Felt needs reflected residents' differing service priorities: outpatient residents saw the need for skills to structure the consultation and explore patients' perspectives in order to build therapeutic alliances, whereas inpatient residents wanted techniques to help them break bad news, provide information and increase their own well-being. The survey's overall response rate was 56%. Its data showed that outpatient residents received more training in communication skills and more of them than inpatient residents considered communication skills training to be useful (100% vs 74%). Discussion: Outpatient residents' perceived needs in communication skills were more patient-centered than the needs perceived by inpatient residents. Residents' perceived needs for communication skills may differ not only because of their differing service priorities but also because of differences in their previous experiences with communication skills training. These factors should be taken into account when designing a training programme in communication skills. [ABSTRACT FROM AUTHOR]

Published
2009

31. A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility.

Author

Louis Simonet M, Kossovsky MP, Chopard P, Sigaud P, Perneger TV, Gaspoz JM, Louis Simonet, Martine, Kossovsky, Michel P, Chopard, Pierre, Sigaud, Philippe, Perneger, Thomas V, and Gaspoz, Jean-Michel

Abstract

Background: Early identification of patients who need post-acute care (PAC) may improve discharge planning. The purposes of the study were to develop and validate a score predicting discharge to a post-acute care (PAC) facility and to determine its best assessment time.Methods: We conducted a prospective study including 349 (derivation cohort) and 161 (validation cohort) consecutive patients in a general internal medicine service of a teaching hospital. We developed logistic regression models predicting discharge to a PAC facility, based on patient variables measured on admission (day 1) and on day 3. The value of each model was assessed by its area under the receiver operating characteristics curve (AUC). A simple numerical score was derived from the best model, and was validated in a separate cohort.Results: Prediction of discharge to a PAC facility was as accurate on day 1 (AUC: 0.81) as on day 3 (AUC: 0.82). The day-3 model was more parsimonious, with 5 variables: patient's partner inability to provide home help (4 pts); inability to self-manage drug regimen (4 pts); number of active medical problems on admission (1 pt per problem); dependency in bathing (4 pts) and in transfers from bed to chair (4 pts) on day 3. A score > or = 8 points predicted discharge to a PAC facility with a sensitivity of 87% and a specificity of 63%, and was significantly associated with inappropriate hospital days due to discharge delays. Internal and external validations confirmed these results.Conclusion: A simple score computed on the 3rd hospital day predicted discharge to a PAC facility with good accuracy. A score > 8 points should prompt early discharge planning. [ABSTRACT FROM AUTHOR]

Published
2008
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32. Associations between early handoffs, length of stay and complications in internal medicine wards: A retrospective study.

Author

Fehlmann C, Louis Simonet M, Reny JL, Stirnemann J, and Blondon K

Subjects
Aged, Aged, 80 and over, Cohort Studies, Female, Hospital Departments, Humans, Internal Medicine, Male, Middle Aged, Retrospective Studies, Time Factors, Length of Stay statistics & numerical data, Medical Errors statistics & numerical data, Patient Handoff statistics & numerical data
Abstract

Background: In US healthcare system, handoffs are associated with an increase in medical error and in hospital length of stay. In non-US healthcare systems, this phenomenon has not been well studied. We studied the association between early handoffs (EH) in a non-US internal medicine ward with length of stay (LOS), use of resources, major complication (MC) and discharge to post-acute care (PAC) facility., Methods: We conducted a retrospective cohort study on patients admitted to the general internal medicine division. Patients with EH (defined as a transfer of responsibility between primary teams within the first 72 h) were compared with patients without EH. The primary outcome was LOS in the general internal medicine division. Secondary outcomes were the use of resources, the incidence of MC (transfer to intensive care, to intermediate care or death) and discharge to a PAC facility., Results: We included 11,869 patients, 38% of whom were in the EH group. Patients were 67.7±16.6 years old and 53% were males. EH was independently associated with an increase of LOS (+6.4% [95% CI, 3.5%-9.5%], P < .001) and with an increased rate of MC (OR 1.3 [95% CI, 1.1-1.7], P = .012). In our subgroup analysis, the association between early handoff and LOS and MC rate were not statistically significant when the admission occurred on public holidays and weekends., Conclusions: Among patients admitted in our general internal medicine division, early handoffs were associated with significantly higher length of stay and major complication rate, but not in patients admitted during week-ends., (Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Published
2019
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33. Prediction of post-acute care demand in medical and neurological inpatients: diagnostic assessment of the post-acute discharge score - a prospective cohort study.

Author

Conca A, Gabele A, Reutlinger B, Schuetz P, Kutz A, Haubitz S, Faessler L, Batschwaroff M, Schild U, Caldara Z, Regez K, Schirlo S, Vossler G, Kahles T, Nedeltchev K, Keller A, Huber A, De Geest S, Buergi U, Tobias P, Louis Simonet M, Mueller B, and Schäfer-Keller P

Subjects
Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Patient Discharge, Prospective Studies, ROC Curve, Risk Assessment, Health Services Needs and Demand statistics & numerical data, Inpatients, Nervous System Diseases, Subacute Care
Abstract

Background: Early identification of patients requiring transfer to post-acute care (PAC) facilities shortens hospital stays. With a focus on interprofessional assessment of biopsychosocial risk, this study's aim was to assess medical and neurological patients' post-acute care discharge (PACD) scores on days 1 and 3 after hospital admission regarding diagnostic accuracy and effectiveness as an early screening tool. The transfer to PAC facilities served as the outcome ("gold standard")., Methods: In this prospective cohort study, registered at ClinicalTrial.gov (NCT01768494) on January 2013, 1432 medical and 464 neurological patients (total n = 1896) were included consecutively between February and October 2013. PACD scores and other relevant data were extracted from electronic records of patient admissions, hospital stays, and interviews at day 30 post-hospital admission. To gauge the scores' accuracy, we plotted receiver operating characteristic (ROC) curves, calculated area under the curve (AUC), and determined sensitivity and specificity at various cut-off levels., Results: Medical patients' day 1 and day 3 PACD scores accurately predicted discharge to PAC facilities, with respective discriminating powers (AUC) of 0.77 and 0.82. With a PACD cut-off of ≥8 points, day 1 and 3 sensitivities were respectively 72.6% and 83.6%, with respective specificities of 66.5% and 70.0%. Neurological patients' scores showed lower accuracy both days: using the same cut-off, respective day 1 and day 3 AUCs were 0.68 and 0.78, sensitivities 41.4% and 68.7% and specificities 81.4% and 83.4%., Conclusion: PACD scores at days 1 and 3 accurately predicted transfer to PAC facilities, especially in medical patients on day 3. To confirm and refine these results, PACD scores' value to guide discharge planning interventions and subsequent impact on hospital stay warrants further investigation., Trial Registration: ClinialTrials.gov Identifier, NCT01768494 .

Published
2018
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35. [Recent advances in internal medicine].

Author

Von Düring S, Mavrakanas T, Muller H, Primmaz S, Grosgurin O, Louis Simonet M, Marti C, Nendaz M, Serratrice J, Stirnemann J, Carballo S, and Darbellay Farhoumand P

Subjects
Hospitalists, Humans, Internal Medicine trends
Abstract

In medicine, there are progresses which radically transform practices, change recommendations and win unanimous support in the medical community. There are some which divide, questioning principles that seemed established. There are also small advances, which can answer the questions that internists ask themselves in the daily care of their patients. Here are several articles published in 2017, read and commented for you by hospitalists, selected according to their impact on the medical world., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Published
2018

37. [Paracentesis and cirrhotic patients: should we fear hemorrhages ?]

Author

De Carvalho Fernandes M, Giostra E, and Louis Simonet M

Subjects
Ascites, Child, Humans, Blood Coagulation Disorders, Hemorrhage etiology, Liver Cirrhosis therapy, Paracentesis adverse effects, Paracentesis methods
Abstract

Paracentesis is a frequent procedure, especially in patients with cirrhosis. In these patients, given the fears of severe bleeding associated with coagulation disorders as well as thrombocytopenia, we were interested to review the literature on this subject. Few studies are available and, for the moment, recommendations are of a low level of evidence. Paracentesis seems to be a safe procedure without severe haemorrhagic complications (< 1%), regardless of coagulation disorders and platelet count. Renal insufficiency, Child-Pugh C cirrhosis, thrombocytes < 50 G/L and cirrhosis of alcoholic origin may however increase the risk of bleeding. Caution should be observed in these patients., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Published
2017

38. The quality of feedback during formative OSCEs depends on the tutors' profile.

Author

Junod Perron N, Louis-Simonet M, Cerutti B, Pfarrwaller E, Sommer J, and Nendaz M

Subjects
Communication, Cooperative Behavior, Curriculum, Educational Measurement, Female, Humans, Male, Medical History Taking, Physical Examination, Program Evaluation, Prospective Studies, Surveys and Questionnaires, Switzerland, Clinical Competence standards, Education, Medical, Undergraduate standards, Formative Feedback, Problem-Based Learning methods, Professional Competence standards, Students, Medical, Teaching standards
Abstract

Background: During their pre-clinical years, medical students are given the opportunity to practice clinical skills with simulated patients. During these formative objective structured clinical encounters (OSCEs), tutors from various backgrounds give feedback on students' history taking, physical exam, and communication skills. The aim of the study was to evaluate whether the content and process of feedback varied according to the tutors' profile., Methods: During 2013, all 2 nd and 3 rd year medical students and tutors involved in three formative OSCEs were asked to fill in questionnaires, and their feedback sessions were audiotaped. Tutors were divided into two groups: 1) generalists: primary care, general internist and educationalist physicians 2) specialists involved in the OSCE related to their field of expertise. Outcome measures included the students' perceptions of feedback quality and utility and objective assessment of feedback quality., Results: Participants included 251 medical students and 38 tutors (22 generalists and 16 specialists). Students self-reported that feedback was useful to improve history taking, physical exam and communication skills. Objective assessment showed that feedback content essentially focused on history taking and physical exam skills, and that elaboration on clinical reasoning or communication/professionalism issues was uncommon. Multivariate analyses showed that generalist tutors used more learner-centered feedback skills than specialist tutors (stimulating student's self-assessment (p < .001; making the student active in finding solutions, p < .001; checking student's understanding, p < .001) and elaborated more on communication and professionalism issues (p < 0.001). Specialists reported less training in how to provide feedback than generalists., Conclusion: These findings suggest that generalist tutors are more learner-centered and pay more attention to communication and professionalism during feedback than specialist tutors. Such differences may be explained by differences in feedback training but also by differences in practice styles and frames of references that should be further explored.

Published
2016
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39. Feedback in formative OSCEs: comparison between direct observation and video-based formats.

Author

Junod Perron N, Louis-Simonet M, Cerutti B, Pfarrwaller E, Sommer J, and Nendaz M

Subjects
Adult, Communication, Female, Humans, Male, Middle Aged, Observation, Switzerland, Clinical Competence, Education, Medical, Undergraduate methods, Educational Measurement methods, Formative Feedback, Videotape Recording
Abstract

Introduction: Medical students at the Faculty of Medicine, University of Geneva, Switzerland, have the opportunity to practice clinical skills with simulated patients during formative sessions in preparation for clerkships. These sessions are given in two formats: 1) direct observation of an encounter followed by verbal feedback (direct feedback) and 2) subsequent review of the videotaped encounter by both student and supervisor (video-based feedback). The aim of the study was to evaluate whether content and process of feedback differed between both formats., Methods: In 2013, all second- and third-year medical students and clinical supervisors involved in formative sessions were asked to take part in the study. A sample of audiotaped feedback sessions involving supervisors who gave feedback in both formats were analyzed (content and process of the feedback) using a 21-item feedback scale., Results: Forty-eight audiotaped feedback sessions involving 12 supervisors were analyzed (2 direct and 2 video-based sessions per supervisor). When adjusted for the length of feedback, there were significant differences in terms of content and process between both formats; the number of communication skills and clinical reasoning items addressed were higher in the video-based format (11.29 vs. 7.71, p= 0.002 and 3.71 vs. 2.04, p= 0.010, respectively). Supervisors engaged students more actively during the video-based sessions than during direct feedback sessions (self-assessment: 4.00 vs. 3.17, p= 0.007; active problem-solving: 3.92 vs. 3.42, p= 0.009). Students made similar observations and tended to consider that the video feedback was more useful for improving some clinical skills., Conclusion: Video-based feedback facilitates discussion of clinical reasoning, communication, and professionalism issues while at the same time actively engaging students. Different time and conceptual frameworks may explain observed differences. The choice of feedback format should depend on the educational goal., Competing Interests: and funding The authors declare that they have no competing interests. The Edmond J. Safra Philanthropic Foundation supported the cost of the data collection.

Published
2016
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41. [Long term aspirin in stable coronary disease with an indication for anticoagulation: is it reasonable?].

Author

Lister K and Louis Simonet M

Subjects
Anticoagulants administration & dosage, Anticoagulants adverse effects, Aspirin administration & dosage, Aspirin adverse effects, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Drug Therapy, Combination, Hemorrhage chemically induced, Hemorrhage epidemiology, Humans, Platelet Aggregation Inhibitors administration & dosage, Platelet Aggregation Inhibitors adverse effects, Risk, Thromboembolism etiology, Thromboembolism prevention & control, Anticoagulants therapeutic use, Aspirin therapeutic use, Coronary Disease drug therapy, Platelet Aggregation Inhibitors therapeutic use
Abstract

In patients with both stable coronary disease and atrial fibrillation, a baseline treatment of aspirin and an oral anticoagulant is often prescribed due to the proven benefits of each therapy on cardiovascular and thromboembolic events and mortality. However, recent cohort studies in this population have shown that adding aspirin to an oral anticoagulant is not associated with a reduction in recurrence of coronary or thromboembolic events, but significantly increases the bleeding risk. In these patients, in particular when their bleeding risk is high, aspirin withdrawal may be considered.

Published
2015

42. Impact of postgraduate training on communication skills teaching: a controlled study.

Author

Junod Perron N, Nendaz M, Louis-Simonet M, Sommer J, Gut A, Cerutti B, van der Vleuten CP, and Dolmans D

Subjects
Adult, Faculty, Medical standards, Feedback, Female, Humans, Male, Middle Aged, Video Recording, Clinical Competence, Communication, Education, Medical, Graduate, Teaching methods
Abstract

Background: Observation of performance followed by feedback is the key to good teaching of communication skills in clinical practice. The fact that it occurs rarely is probably due to clinical supervisors' perceived lack of competence to identify communication skills and give effective feedback. We evaluated the impact of a faculty development programme on communication skills teaching on clinical supervisors' ability to identify residents' good and poor communication skills and to discuss them interactively during feedback., Methods: We conducted a pre-post controlled study in which clinical supervisors took part to a faculty development program on teaching communication skills in clinical practice. Outcome measures were the number and type of residents' communication skills identified by supervisors in three videotaped simulated resident-patient encounters and the number and type of communication skills discussed interactively with residents during three feedback sessions., Results: 48 clinical supervisors (28 intervention group; 20 control group) participated. After the intervention, the number and type of communication skills identified did not differ between both groups. There was substantial heterogeneity in the number and type of communication skills identified. However, trained participants engaged in interactive discussions with residents on a significantly higher number of communication items (effect sizes 0.53 to 1.77); communication skills items discussed interactively included both structural and patient-centered elements that were considered important to be observed by expert teachers., Conclusions: The faculty development programme did not increase the number of communication skills recognised by supervisors but was effective in increasing the number of communication issues discussed interactively in feedback sessions. Further research should explore the respective impact of accurate identification of communication skills and effective teaching skills on achieving more effective communication skills teaching in clinical practice.

Published
2014
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43. Effectiveness of a training program in supervisors' ability to provide feedback on residents' communication skills.

Author

Junod Perron N, Nendaz M, Louis-Simonet M, Sommer J, Gut A, Baroffio A, Dolmans D, and van der Vleuten C

Subjects
Adult, Educational Measurement, Female, Humans, Male, Middle Aged, Patient Simulation, Primary Health Care, Surveys and Questionnaires, Switzerland, Videotape Recording, Communication, Education, Medical, Graduate methods, Feedback, Internal Medicine education, Internship and Residency, Professional Competence, Teaching standards
Abstract

Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are scarce as well as studies that go beyond self-reported data. The aim of the study was to develop and assess the effectiveness of a training program for clinical supervisors on how to give feedback on residents' CS in clinical practice. The authors designed a pretest-posttest controlled study in which clinical supervisors working in two different medical services were invited to attend a sequenced and multifaceted program in teaching CS over a period of 6-9 months. Outcome measures were self-perceived and observed feedback skills collected during questionnaires and three videotaped objective structured teaching encounters. The videotaped feedbacks made by the supervisors were analysed using a 20-item feedback rating instrument. Forty-eight clinical supervisors participated (28 in the intervention, 20 in the control group). After training, a higher percentage of trained participants self-reported and demonstrated statistically significant improvement in making residents more active by exploring residents' needs, stimulating self-assessment, and using role playing to test strategies and checking understanding, with effect sizes ranging from 0.93 to 4.94. A training program on how to give feedback on residents' communication skills was successful in improving clinical supervisors' feedback skills and in helping them operate a shift from a teacher-centered to a more learner-centered approach.

Published
2013
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44. Acquisition of clinical competence: Added value of clerkship real-life contextual experience.

Author

Rudaz A, Gut AM, Louis-Simonet M, Perrier A, Vu NV, and Nendaz MR

Subjects
Adult, Female, Humans, Male, Problem-Based Learning, Prospective Studies, Clinical Clerkship organization & administration, Clinical Competence, Education, Medical, Undergraduate organization & administration, Internal Medicine education, Patients
Abstract

Background: Medical students' limited access to patients induces a shift of learning activities from clinical wards to classrooms., Aim: Identify clinical competencies specifically acquired during real-life contextual clerkship added to case-based tutorials, by a prospective, controlled study., Methods: Students entering our eight-week internal medicine (IM) clerkship attended paper case-based tutorials about 10 common presenting complaints and were assigned to an IM specialty ward. For each tutorial case, two groups of students were created: those assigned to a ward, the specialty of which was unrelated to the case (case-unrelated ward, CUW) and those assigned to a ward, the specialty of which was related to the case (case-related ward, CRW)., Results: Forty-one students (30 CUW and 11 CRW) volunteered for the study. Both groups had similar previous experiences and pre-clerkship exam scores. The CRW students collected more relevant clinical information from the patient (69% vs. 55% of expected items, p=0.001) and elaborated charts of better quality (47% vs. 39% of expected items, p=0.05). Clinical-knowledge mean score was similar (70%) in both groups (p=0.92)., Conclusions: While paper-case tutorials did provide students with clinical knowledge, real contextual experience brought additional, specific competencies. This supports the preservation of clinical exposure with supervision and feedback.

Published
2013
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45. [Enteral nutrition: nasogastric tube or percutaneous endoscopic gastrostomy?].

Author

Rendall K, Pichard C, Louis SM, and Reny JL

Subjects
Humans, Meta-Analysis as Topic, Enteral Nutrition methods, Gastrostomy methods, Intubation, Gastrointestinal
Abstract

When enteral nutrition is indicated to prevent or to treat a patient with denutrition choosing between a nasogastric tube (NGT) and a percutaneous endoscopic gastrostomy (PEG) is not always an easy decision. In neurological patients with swallowing disturbances or in patients with head and neck tumors, PEG is associated with lower rates of feeding tube dislodgement, while NGT has lower rates or morbidity. A meta-analysis showed that the interruption of nutrition is less frequent with PEG but there is no difference in terms of mortality and aspiration pneumonia between PEG and NGT. The European Society for Clinical Nutrition and Metabolism recommends PEG when enteral nutrition is expected to last more than 3 weeks.

Published
2012

47. [Monitoring of heparins and of anticoagulants].

Author

Beauverd Y, Boehlen F, Fontana P, and Louis-Simonet M

Subjects
Humans, Anticoagulants pharmacology, Drug Monitoring, Heparin pharmacology
Abstract

Anticoagulation with unfractionated heparin, low molecular weight heparin or fondaparinux is common practice in thromboembolic disease, atrial fibrillation and mechanical heart valves. Some of these molecules, with specific pharmacokinetic, requires specific monitoring. Unfractionated heparin requires close monitoring by aPTT and/or anti-FXa activity while LMWH and fondaparinux do not require biological surveillance except in a few specific situations.

Published
2011

48. [Hospital based internal medicine: a year in review].

Author

Carballo S, Nendaz M, Reny JL, Louis-Simonet M, Perrier A, and Garin N

Subjects
Hospitals, Humans, Internal Medicine
Abstract

Epidemiological studies and working hypotheses based on pathophysiology can lead to shortcuts and assumptions on which treatment may sometimes be based. As is often the case, prospective, randomized, controlled studies bring important insight into the actual benefits of various treatment options. This selective review describes some recent studies that provide insight in various areas such as cardiovascular disease, heart failure, renovascular disease, venous thromboembolic disease, pneumonia, as well as acute pancreatitis.

Published
2011

49. [The role of direct inhibitors of renin].

Author

Fernandez E and Louis Simonet M

Subjects
Amides pharmacology, Antihypertensive Agents pharmacology, Drug Therapy, Combination, Fumarates pharmacology, Humans, Hypertension drug therapy, Amides therapeutic use, Antihypertensive Agents therapeutic use, Fumarates therapeutic use, Renin antagonists & inhibitors
Abstract

Aliskiren is the first direct oral renin inhibitor approved for the treatment of hypertension. It acts by binding to the active site of renin and blocking its catalytic function, as a result preventing the formation of the angiotensin I and II. Used in monotherapy or in combination, this molecule proved its antihypertensive efficacy without showing, however, a clear superiority on the other antihypertensive drugs. Its benefit on cardiovascular morbidity and mortality and on target organ damage should be proved before aliskiren may be recommended as a first line therapy in essential hypertension. Data on cardiac insufficiency and diabetic nephropathy are preliminary.

Published
2010

50. [Aspirin as primary prevention for diabetic patients].

Author

Fumeaux D, Becerra ME, Philippe J, and Louis-Simonet M

Subjects
Cardiovascular Diseases etiology, Humans, Aspirin therapeutic use, Cardiovascular Diseases prevention & control, Diabetes Complications, Platelet Aggregation Inhibitors therapeutic use, Primary Prevention
Abstract

Several meta-analysis support the prescription of aspirin for primary prevention of cardiovascular events in patients at risk. Though diabetics are particularly prone to these complications, a review of the literature shows that they have fewer benefits from the protective effects of such treatment. In these patients, controlling dyslipidemia, blood pressure and glycemia remains the main aim. Prescription of aspirin, in combination with an already existing medication, should not be solely based on the presence of diabetes, but on the overall risk profile of the patient, as well as his motivation.

Published
2010

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