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Aim of the study: Poor safety culture, bad teamwork, non-functional inter-departmental working relationships and increased cognitive demands are associated with higher amounts of adverse events in hospitals. To improve patient safety, one of the first steps is to assess safety culture among health care providers in an institution. Considering the sparsity of studies addressing patient safety culture in Europe and Switzerland, the aim of the present study was to assess patient safety culture in the emergency department of a University Hospital in Switzerland. Methods: We employed the Hospital Survey On Patient Safety Culture, developed by the U.S. Agency for Healthcare Research and Quality. 140 questionnaires were distributed to nurses and physicians. Two weeks after the first questionnaire, we performed a sensitization campaign addressed to health care providers, and then repeated the survey. We calculated composite scores for each question category and percentages of positive responses for each dimension. For group comparisons such as possible differences relating to education and duration of employment and to compare results of the first and second survey we used T-tests. The results were compared to other published surveys outside of Switzerland. Results: Particularly positive assessments were found for the categories “nonpunitive response to errors”, “teamwork within units”, “supervisor/manager expectations and actions promoting patient safety” and, compared to other hospitals, also “staffing”. The lowest average percent positive responses were found in the categories “frequencies of reported event”, “teamwork across units” and “handoffs and transitions”. Nurses and health care personnel with a longer employment history had an overall more negative assessment of patient safety culture, when compared to physicians and personnel with a shorter duration of employment, respectively. Conclusions: The present study has identified strengths and potential weaknesses in the safety culture of a large university hospital emergency department in Switzerland. The results provide opportunities for improvement of patient safety in particular in the reporting of adverse events, in interaction across units and patient transitions. Furthermore, as we employed a standardized self-assessment tool similar to previously published studies, the work contributes to the establishment of a benchmark for hospital safety culture at the national, European and international level., Ziel der Studie: Schlechte Sicherheitskultur, schlecht abgestimmte Zusammenarbeit, nicht-funktionierende Übergänge zwischen verschiedenen Abteilungen und verstärkte kognitive Herausforderungen gehen einher mit häufigeren fehlerhaften Behandlungen in Spitälern. Einer der ersten Schritte um die Patientensicherheit zu steigern, ist die Sicherheitskultur der Gesundheitsfachleute innerhalb einer Institution zu verbessern. Wegen der spärlich vorhandenen Studien über Patientensicherheit in Europa und der Schweiz war das Ziel dieser Studie die Patientensicherheitskultur in einem universitären Notfallzentrum in der Schweiz zu untersuchen. Methoden: Wir haben die deutsche Übersetzung (PASKI) des Fragenbogens zur Patientensicherheitskultur „Hospital Survey On Patient Safety Culture“, den die amerikanische „Agency for Healthcare Research and Quality“ etabliert hat, benutzt. 140 Fragebögen wurden unter Pflege- und Arztpersonal verteilt. Zwei Wochen nach der Verteilung der ersten Fragebögen haben wir unter den Gesundheitsfachpersonen eine Informationskampagne gestartet und danach die Umfrage wiederholt. Wir haben die Werte für jede Fragen-Gruppe berechnet und auch die prozentualen positiven Anteile der einzelnen Fragen. Zum Vergleich von Gruppen, wie zum Beispiel Unterschiede zwischen verschiedenen Ausbildungen, oder unterschiedlich langen Anstellungsverhältnissen und auch zum Vergleich des erstens und des zweiten Fragebogens habend wir einen T-Test benutzt. Die Resultate haben wir mit anderen, publizierten Daten von ausserhalb der Schweiz verglichen. Resultate: In den Gruppen „nicht strafende Reaktion auf Fehler“, „Zusammenarbeit innerhalb der Abteilung“, „Erwartungen von Vorgesetzten und Massnahmen, die Patientensicherheit fördern“ und vor allem im Vergleich zu anderen Spitälern „Personalbestand“ wurden vor allem positive Antworten gefunden. Die tiefsten Antworten wurden bei den Kategorien „Anzahl gemeldeter unerwünschter Ereignisse“, „Abteilungsübergreifende Zusammenarbeit“ und „Übergabe und Schichtwechsel“ gefunden. Pflegende und Personen, mit bereits längerem Anstellungsverhältnis gaben eine schlechtere Beurteilung zur Patientensicherheit ab im Vergleich zu Arztpersonal und Gesundheitsfachleuten, die noch nicht so lange hier angestellt waren. Schlussfolgerungen: Diese Studie hat einige Stärken und potentielle Schwächen in der Patientensicherheitskultur in einem grossen universitären Notfallzentrum in der Schweiz aufgedeckt. Die Resultate bieten die Möglichkeit, die Patientensicherheitskultur zu verbessern, insbesondere im Melden von unerwünschten Ereignissen, der Interaktion zwischen Abteilungen und der Patientenübergabe. Da wir einen standardisierten Fragebogen benutzt haben, den die Befragten selber ausfüllen, wie er in anderen Studien auch schon benutzt wurde, hilft diese Studie eine Benchmark für eine nationale, europäische und internationale Patientensicherheitskultur in Spitälern zu etablieren., GMS Journal for Medical Education; 36(2):Doc14

Background: The aim of our study was to assess utilization patterns of psychiatric services by asylum seekers. Methods: We included 119 adults who presented themselves at the University Emergency Department between 1 March 2012 and 1 January 2017 for psychiatric consultation. Descriptive data were compared with a control group of non-Swiss individuals with warranted residence permits using Mann-Whitney-U and chi square (&chi, 2) tests. Results: Patients were mainly single, male, residing in reception centers, and presented themselves most frequently due to suicidal ideation. Almost 60% of the patients were assigned to inpatient treatments, with 28 involuntary cases. Compared to the control group, asylum seekers were younger and more often men (p &lt, 0.001 for both). Further, they less often had family in Switzerland (&chi, 2 = 9.91, p = 0.007). The proportion of patients coming in as walk-ins was significantly higher in the control group than in asylum seekers (&chi, 2 = 37.0, p &lt, 0.001). Asylum seekers were more frequently referred due to suicidal ideation and aggressive behavior than participants in the control group (&chi, 2 = 80.07, p &lt, 0.001). Diagnoses for asylum seekers infrequently included mood, as they often reported stress-related disorders (&chi, 2 = 19.6, p = 0.021) and they were infrequently released home (&chi, 2 = 9.19, p = 0.027). Conclusion: Asylum seekers more frequently demonstrated severe symptoms such as suicidal ideation and aggressive behavior and they were mainly treated as inpatients, potentially due to minimal social resources.

Background. Immediate reversal of anticoagulation is essential when facing severe bleeding or emergency surgery. Although idarucizumab is approved for the reversal of dabigatran in many countries, clinical experiences are lacking, particularly in special patient-populations such as sepsis and impaired renal function. Case Presentation. We present the case of a 67-year-old male septic patient with a multilocular facial abscess and chronic kidney disease (GFR 36.5 mL/min). Thrombin time (TT) and activated partial thromboplastin time (aPTT) 15 hours after the last intake of 150 mg dabigatran were both prolonged (>120 sec, resp., 61 sec), as well as unbound dabigatran concentration (119.05 ng/mL). Before immediate emergency surgery dabigatran was antagonised using idarucizumab 2 × 2.5 g. Dabigatran concentration was not detectable 10 min after idarucizumab administration (

Several mosquito-borne Flaviviruses such as Japanese encephalitis virus (JEV), West Nile virus (WNV), Dengue Virus (DENV), and Zika virus (ZIKV) can cause severe clinical disease. Being zoonotic, Flaviviruses infect a wide variety of terrestrial vertebrates, which dependent of the virus-host interactions, can enhance ongoing epidemics and maintain the virus in the environment for prolonged periods. Targeted species can vary from amphibians, birds to various mammals, dependent on the virus. For many mosquito-borne flaviviruses the spectrum of targeted species is incompletely understood, in particular with respect to their contribution to the maintenance of virus in certain geographical regions. Furthermore, little is known about virus and host factors contributing to species tropism. The present study utilized human and porcine monocyte-derived dendritic cells (MoDC) as a cell culture model to better understand Flavivirus species tropism and innate immune responses. MoDC were selected based on their presence in the skin and their role as an early target cell for several Flaviviruses and their role as immune sentinels. While differences in viral infectivity and replication were minor when comparing porcine with human MoDC for some of the tested Flaviviruses, a particularly strong replication in human MoDC was found with USUV, while JEV appeared to have a stronger tropism for porcine MoDC. With respect to innate immune responses we found high induction of TNF and IFN-β in both human and porcine MoDC after infection with JEV, WNV, and USUV, but not with DENV, ZIKV, and Wesselsbron virus. Spondweni virus induced these cytokine responses only in porcine MoDC. Overall, innate immune responses correlated with early infectivity and cytokine production. In conclusion, we demonstrate Flavivirus-dependent differences in the interaction with MoDC. These may play a role in pathogenesis but appear to only partially reflect the expected species tropism.