[HCV, HBV and HIV infections: risk for surgeon and staff. Results and consequences of routine screening in emergency patients]. / HCV-, HBV- und HIV-Infektionen -- Gefahren für Arzt und Pflegepersonal. Konsequenzen aus dem Routinescreening von unfallchirurgischen Notfallpatienten.

BACKGROUND: Trauma and emergency surgeons (S) are in contact with high-risk patients (P) infected with HBV, HCV, and HIV without knowing which P is and which is not infected. The aim of this paper was to analyze routine screening (SCR) in trauma care. METHOD: Microparticle enzyme immunoassays (MEIA) (Abbott Axym system) were analyzed from routine blood samples: HBsAg (V2), HCV version 3.0, HIV 1/2gO. All positive or uncertain samples were confirmed with ELISA/PCR. RESULTS: From January 2002 to October 2002 a total of 1074 emergency P were examined. The results were available within 50 min after admittance to the emergency room. In 53 of 1074 (4.9%) the MEIA was positive or in threshold margins (LV): HBV 15 P plus 3 LV (9 secured by ELISA/PCR), prevalence (PV) 0.84%. HCV 34 P plus 1 LV (31 secured with ELISA/PCR), PV 2.9%. HIV 2 P, PV 1.86 per thousand, 1 in co-infection with HCV, 1 with HBV. Of 42 infections, 21 were unknown before screening, and in 5 P the S suspected an infection. After screening, nine surgical procedures were changed to safer procedures. CONCLUSION: MEIA is a good tool for quick SCR of HCV, HBV, and HIV in emergency surgery (ES). When the infection is known the S is more aware to perform only safe procedures during surgery (no touch technique) or to use more protective devices (e.g., fluid shield, double gloves). Our results indicate that surgeons and nurses in ES are exposed four to six times more often to infection with HCV, HBV, and HIV than represented by officially published data. We recommend routine SCR of HBV, HCV, and HIV for all P in ES. Prevention procedures are discussed.

[Can empowerment of elderly with chronic disease be achieved in Switzerland? First results of the ALLFIT program in Zurich]. / Ist Empowerment chronisch kranker Betagter in der Schweiz möglich? Erste Resultate des Zürcher ALLFIT-Programms.

Self management courses can efficiently empower elderly with chronic disease. ALLFIT, a Swiss self management and fitness programme for seniors with chronic heart, lung, musculoskeletal or diabetic disease, consists of individual contracting and coaching by a Nurse, a weekly Fitness Training and 8 self management courses for 2 hours a week. Of the first 100 Participants, 99 defined contracts of goals and 80 achieved at least partially, 21% improved their physical fitness in walking and 25% in climbing stairs. Empowerment of elderly with chronic diseases can be achieved in Switzerland by a combination of fitness, self management training and individual coaching.