How to improve automated external defibrillator placement for out-of-hospital cardiac arrests: A case study.

INTRODUCTION: In out-of-hospital cardiac arrests (OHCAs), the use of an automatic external defibrillator (AED) by a bystander remains low, as AEDs may be misplaced with respect to the locations of OHCAs. As the distribution of historical OHCAs is potentially predictive of future OHCA locations, the purpose of this study is to assess AED positioning with regard to past locations of OHCAs, in order to improve the efficiency of public access defibrillation programs. METHODS: This is a retrospective observational study from 2014 to 2018. The locations of historical OHCAs and AEDs were loaded into a geodata processing tool. Median distances between AEDs were collected, as well as the number and rates of OHCAs covered (distance of <100 meters from the nearest AED). Areas with high densities of uncovered OHCAs (hotspots) were identified in order to propose the placement of additional AEDs. Areas over-covered by AEDs (overlays) were also identified in order to propose the relocation of overlapping AEDs. RESULTS: There were 2,971 OHCA, 79.3% of which occurred at home, and 633 AEDs included in the study. The global coverage rate was 7.5%. OHCAs occurring at home had a coverage rate of 4.5%. Forty hotspots were identified, requiring the same number of additional AEDs. The addition of these would increase the coverage from 7.5% to 17.6%. Regarding AED overlays, 17 AEDs were found to be relocatable without reducing the AED coverage of historical OHCAs. DISCUSSION: This study confirms that geodata tools can assess AED locations and increase the efficiency of their placement. Historical hotspots and AED overlays should be considered, with the aim of efficiently relocating or adding AEDs. At-home OHCAs should become a priority target for future public access defibrillation programs as they represent the majority of OHCAs but have the lowest AED coverage rates.

Impact of a telephone triage service for non-critical emergencies in Switzerland: A cross-sectional study.

INTRODUCTION: Telephone triage services (TTS) play an increasing role in the delivery of healthcare. The objective of this study was to characterize the adult users of a TTS for non-critical emergencies, describe the types of advice given and their subsequent observation, and assess the influence of TTS on the use of the healthcare system in a sanitary region of Switzerland. METHODS: Data from a TTS based in the French part of Switzerland were analyzed. This service consists of a medical contact center for non-critical emergencies, with trained nurses available 24/7. A random selection of 2,034 adult calls was performed between July and December 2018. Research students contacted users 2 to 4 weeks after the initial call and assessed sociodemographic and clinical data, as well as the impact of the advice received on the use of the healthcare system. RESULTS: A sample of 412 users was included in the analyses. The average age was 49.0 (SD 20.4) years; 68.5% were women and 72.8% of Swiss origin. The two main recommendations provided by nurses were to consult the emergency department (ED) (44.6%, n = 184) and to contact a physician on duty (33.2%, n = 137). The majority of users followed the advice given by the nurses (substantial agreement [k = 0.79] with consulting the ED and perfect agreement [k = 0.87] with contacting a physician on duty). We calculated that calling the TTS could decrease the intention to visit the ED by 28.1%. CONCLUSION: TTS for non-critical emergencies have the potential to decrease the use of ED services.

[Detection and treatment of burnout by physicians of Unisanté]. / Repérage et prise en charge des patients en burnout par les médecins d'Unisanté.

Lacking diagnostic standards, the prevalence of Occupational Burnout (OB) remains uncertain. Unisanté aimed to evaluate its magnitude in its patients and to evaluate the medical practices related to OB in two of its departments, the Department of the Policlinics (DDP) and the Department of Occupational and Environmental Health (DSTE). An online survey has shown that 43/55 of the physicians participating in the survey have already diagnosed patients with OB in their practice. Two focus groups allowed to evaluate the interest and usefulness of a standardized diagnostic tool for physicians of the DDP and the DSTE. The tool turned out not to be appropriate in its present form, but this work allowed to sensitize physicians to OB and to clarify the recommendations for the screening and treatment of OB patients at Unisanté.

Faute de standard diagnostique, la prévalence de burnout professionnel (BP) reste incertaine. Unisanté a souhaité évaluer son ampleur dans sa patientèle et décrire les pratiques médicales en rapport au BP dans 2 de ses départements, le Département des policliniques (DDP) et le Département santé, travail et environnement (DSTE). Une enquête en ligne a montré que 43/55 médecins participant à l'étude ont déjà diagnostiqué des patients en BP dans leur pratique. Deux focus groups ont permis d'évaluer l'intérêt et l'utilité d'un outil diagnostique standardisé pour les médecins du DDP et du DSTE. L'outil s'est avéré peu adapté sous sa forme actuelle, mais ce travail a permis de sensibiliser les médecins au BP et de clarifier les recommandations de dépistage et de prise en charge des patients en BP à Unisanté.

[Myofascial approach in tension-type headache management: a scientific assessment]. / Approche myofasciale dans la prise en charge des céphalées de tension†: ce que dit la science.

Tension-type headaches (TTH) are a very common condition. The most recent theories on TTH occurrences suggest that a myofascial component, through trigger points (TP), gives rise to pain signals from the periphery to the central nervous system (CNS). These nociception could lead to CNS sensitization and headaches. Studies show that identification and treatment of TP is a valid therapeutic option for TTH. Amongst the treatment techniques, dry needling (DN) and ischemic compression (IC) seem to be the most effective. These technics can be easily acquired and applied by any doctor.

Les céphalées de tension (CT) sont très fréquentes dans notre société. Les théories les plus récentes sur la génération des CT suggèrent que la composante myofasciale, via les points gâchette, ou trigger points (TP), soit à l'origine de signaux nociceptifs de la périphérie vers le système nerveux central (SNC). Cette nociception pourrait provoquer une sensibilisation du SNC et des céphalées. Les études montrent que pour les CT, l'identification et le traitement des TP sont des options thérapeutiques valables. Parmi les techniques de traitement, le dry needling (DN) et la compression ischémique (CI) semblent être les plus efficaces. Ces techniques peuvent être acquises rapidement et appliquées par tout médecin.

[Interprofessional physicians-pharmacists collaboration in ambulatory care†: a potential to be exploited]. / L'interprofessionnalité médecins-pharmaciens dans les soins ambulatoires†: un potentiel à exploiter.

In ambulatory care, the community pharmacist and the general practitioner most often interact through the dispensing of medicines in pharmacies following a prescription from the physician. However, this interaction can be reinforced by other practices that can increase the quality and safety of care. Interprofessional collaboration is possible through the development of increasing interrelationships, particularly in the sharing of information through dialogue on common objectives that integrate the perspectives of patients and professionals, and through joint decision-making. In this article, interprofessional collaboration between pharmacists and general practitioners is described, as well as data from the literature and some concrete examples from the regular practice of pharmacists and physicians in Unisanté.

Dans les soins ambulatoires, le pharmacien communautaire et le médecin généraliste interagissent le plus souvent par la remise de médicaments en pharmacie suite à une ordonnance rédigée par le médecin. Cette interaction peut néanmoins être renforcée par d'autres pratiques qui peuvent augmenter la qualité et la sécurité des soins. La collaboration interprofessionnelle est possible par le développement d'interrelations croissantes comme le partage d'informations, la concertation sur des objectifs intégrant l'avis du patient et des professionnels, ou encore la prise de décision conjointe. Dans cet article, nous décrivons la collaboration interprofessionnelle entre pharmaciens et médecins généralistes telle que présentée dans la littérature, et quelques exemples concrets issus de la pratique régulière des pharmaciens et médecins d'Unisanté.

Difficult patient-doctor encounters in a Swiss university outpatient clinic: cross-sectional study.

INTRODUCTION: Previous research has shown that multiple factors contribute to healthcare providers perceiving encounters as difficult, and are related to both medical and non-medical demands. AIM: To measure the prevalence and to identify predictors of encounters perceived as difficult by medical residents. DESIGN AND SETTING: Cross-sectional study at the Department of Ambulatory Care and Community Medicine (DACCM), a university outpatient clinic with a long tradition of caring for vulnerable patients. METHOD: We identified difficult doctor-patient encounters using the validated Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10), and characterised patients using the patient's vulnerability grid, a validated questionnaire measuring five domains of vulnerability, both completed by medical residents after each encounter. We used a multiple linear regression model with the outcome variable as the DDPRQ-10 score, controlling for resident characteristics. PARTICIPANTS: We analysed 527 patient encounters performed by all 27 DACCM residents (17 women and 10 men). We asked each medical resident to evaluate 20 consecutive consultations starting on the same date. OUTCOME: One hundred and fifty-seven encounters (29.8%) were perceived as difficult. RESULTS: After adjusting for differences among residents, all five domains of the patient vulnerability grid were independently associated with a difficult encounter: frequent healthcare user; psychological comorbidity; health comorbidity; risky behaviours and a precarious social situation. CONCLUSION: Nearly a third of encounters were perceived as difficult by medical residents in our university outpatient clinic that cares for a high proportion of vulnerable patients. This represents twice the average ratio of difficult encounters in general practice. All five domains of patient vulnerability appear to have partial explanatory power on medical residents' perception of difficult patient encounters.

[Transitional care between hospital and ambulatory care: risks, interventions and new perspectives]. / Soins de transition entre l'hôpital et l'ambulatoire : risques, interventions et nouvelles perspectives.

Transitional care interventions aim to ensure continuity of care during the transfer of patients from one care setting to another. Hospital readmission is a potentially preventable consequence in 5,5 % of patients leaving a hospital medical service, often resulting from poor coordination between health care providers. In this article, we describe the risks associated with hospital discharge, and how to identify patients at high risk of readmission by using the HOSPITAL score. New transitional care approaches are currently being developed, such as the extensivist doctor or the possibility of being hospitalized in a hotel, and may provide new perspectives in this area.

Les soins de transition ont pour objectif d'assurer la continuité des soins durant le passage des patients d'un milieu de soins à un autre. La réadmission hospitalière est une conséquence potentiellement évitable chez 5,5 % des patients sortant d'un service de médecine hospitalier, souvent résultante d'une mauvaise coordination entre les prestataires de soins. Dans cet article, nous décrivons comment identifier les risques liés à la sortie de l'hôpital et les patients à haut risque de réadmission par l'utilisation du score HOSPITAL. Des nouvelles approches dans les soins de transition se développent actuellement, comme le profil du médecin extensiviste ou les structures des soins intermédiaires. Ces développements pourraient apporter de nouvelles perspectives dans ce domaine.

Associations between perceived discrimination and health status among frequent Emergency Department users.

OBJECTIVE: Frequent Emergency Department (ED) users are vulnerable individuals and discrimination is usually associated with increased vulnerability. The aim of this study was to investigate frequent ED users' perceptions of discrimination and to test whether they were associated with increased vulnerability. METHODS: In total, 250 adult frequent ED users were interviewed in Lausanne University Hospital. From a previously published questionnaire, we assessed 15 dichotomous sources of perceived discrimination. Vulnerability was assessed using health status: objective health status (evaluation by a healthcare practitioner including somatic, mental health, behavioral, and social issues - dichotomous variables) and subjective health status [self-evaluation including health-related quality of life (WHOQOL) and quality of life (EUROQOL) - mean-scores]. We computed the prevalence rates of perceived discrimination and tested associations between perceived discrimination and health status (Fischer's exact tests, Mann-Whitney U-tests). RESULTS: A total of 35.2% of the frequent ED users surveyed reported at least one source of perceived discrimination. Objective health status was not significantly related to perceived discrimination. In contrast, experiencing perceived discrimination was associated with worse subjective health status (P<0.001). CONCLUSION: Frequent ED users are highly likely to report perceived discrimination during ED use, and this was linked to a decrease in their own rating of their health. Hence, discrimination should be taken into account when providing care to such users as it may constitute an additional risk factor for this vulnerable population. Perceived discrimination may also be of concern to professionals seeking to improve practices and provide optimal care to frequent ED users.

[Examination of the abdomen, let's train again ?] / Examen de l'abdomen : et si nous refaisions nos gammes ?

This article describes the main clinical gestures to perform when a patient complains of acute abdominal pain. It summarizes the knowledge in general medicine by integrating whenever possible clinical reasoning with likelihood ratios. This chapter does not address complex situations.

Cet article décrit les principaux gestes cliniques à effectuer lors de plaintes abdominales aiguës. Il résume les connaissances de la littérature en médecine générale en intégrant lorsque cela est possible le raisonnement clinique à l'aide des rapports de vraisemblance. Ce chapitre n'aborde pas les situations complexes.

Emergency department visits for non-life-threatening conditions: evolution over 13 years in a Swiss urban teaching hospital.

INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients' characteristics and reasons for consultation had changed over 13 years. METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP). RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p=0.128). Of these patients, 54.0% vs 57.0% were male (p=0.329), 55.5% vs 58.7% were Swiss (p=0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p<0.001); 57.7% vs., 58.3% consulted during out-of- hours (p=0.821). Trauma-related visits decreased from 34.2% to 23.7% (p<0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p<0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP's treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p<0.001). CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.

Patients satisfaction in an academic walk-in centre: a new model of residents training achieved by family doctors.

BACKGROUND: Walk-in centres may improve access to healthcare for some patients, due to their convenient location and extensive opening hours, with no need for an appointment. Herein, we describe and assess a new model of walk-in centre, characterised by care provided by residents and supervision achieved by experienced family doctors. The main aim of the study was to assess patients' satisfaction about the care they received from residents and their supervision by family doctors. The secondary aim was to describe walk-in patients' demographic characteristics and to identify potential associations with satisfaction. METHODS: The study was conducted in the walk-in centre of Lausanne. Patients who consulted between 11th and 31st April were automatically included and received a questionnaire in French. We used a five-point Likert scale, ranging from "not at all satisfied" to "very satisfied", converted from values of 1 to 5. We focused on the satisfaction regarding residents' care and supervision by a family doctor. The former was divided in three categories: "Skills", "Treatment" and "Behaviour". A mean satisfaction score was calculated for each category and a multivariable logistic model was applied in order to identify associations with patients' demographics. RESULTS: The overall response rate was 47% [184/395]. Walk-in patients were more likely to be women (62%), young (median age 31), with a high education level (40% of University degree or equivalent). Patients were "very satisfied" with residents' care, with a median satisfaction score between 4.5 and 5, for each category. Over 90% of patients were "satisfied" or "very satisfied" that a family doctor was involved in the consultation. Age showed the greatest association with satisfaction. CONCLUSION: Patients were highly satisfied with care provided by residents and with the involvement of a family doctor in the consultation. Older age showed the greatest positive association with satisfaction with a positive impact. The high level satisfaction reported by walk-in patients supports this new model of walk-in centre.