Gender-based differential management of acute low back pain in the emergency department: A survey based on a clinical vignette.

BACKGROUND: Women may receive suboptimal pain management compared with men, and this disparity might be related to gender stereotypes. OBJECTIVES: To assess the influence of patient gender on the management of acute low back pain. DESIGN: We assessed pain management by 231 physicians using an online clinical vignette describing a consultation for acute low back pain in a female or male patient. The vignette was followed by a questionnaire that assessed physicians' management decisions and their gender stereotypes. METHODS: We created an online clinical vignette presenting a patient with acute low back pain and assessed the influence of a patient's gender on pain management. We investigated gender-related stereotyping regarding pain care by emergency physicians using the Gender Role Expectation of Pain questionnaire. RESULTS: Both male and female physicians tended to consider that a typical man was more sensitive to pain, had less pain endurance, and was more willing to report pain than a typical woman. These stereotypes did not translate into significant differences in pain management between men and women. However, women tended to be referred less often for imaging examinations than men and were also prescribed lower doses of ibuprofen and opioids. The physician's gender had a modest influence on management decisions, female physicians being more likely to prescribe ancillary examinations. CONCLUSION: We observed gender stereotypes among physicians. Our findings support the hypothesis that social characteristics attributed to men and women influence pain management. Prospective clinical studies are needed to provide a deeper understanding of gender stereotypes and their impact on clinical management.

[Intensive care unit treatment for patients suffering from COVID-19: The second wave Neuchâtel experience]. / Traitement des patients souffrant de Covid-19 aux soins intensifs†: l'expérience neuchâteloise de la deuxième vague.

Between mid-October 2020 and mid-January 2021, during the second wave of COVID-19 pandemia, 125 patients have been admitted in the intensive care units of Neuchâtel network hospitals. To manage this flow, the bed capacity of intensive care unit increased by 240%. Each patient received corticosteroids, an increased prophylactic anticoagulation and an antibiotic. Similarly to the first wave, 51% patients received mechanical ventilation, 55% of which in prone position. Concerning the drug treatments, 16 patients were treated with tocilizumab and 4 with remdesivir. Despite an unprecedented rise in the number of ventilated beds, 15 patients were transferred out of the region of Neuchâtel in order to prevent a saturation point of the system. The mortality rate in the intensive care unit reached 16% of the admitted and non-transported patients.

Entre mi-octobre 2020 et mi-janvier 2021, durant la deuxième vague de pandémie de Covid-19, 125 patients ont séjourné aux soins intensifs du Réseau hospitalier neuchâtelois. Pour pouvoir recevoir cet afflux, la capacité d'accueil a augmenté de 240 %. Tous les patients ont bénéficié d'un traitement par glucocorticoïdes ainsi que d'une anticoagulation prophylactique majorée et d'une antibiothérapie. Similairement à la première vague, 51 % des patients ont nécessité une ventilation mécanique, dont 55 % ont bénéficié d'une ventilation en décubitus ventral. Par ailleurs, 16 patients ont bénéficié du tocilizumab et 4 du remdésivir. Malgré une augmentation hors norme du nombre de lits ventilés, 15 patients ont dû être transférés hors canton afin de prévenir une saturation du système. Le taux de mortalité des patients non transférés admis aux soins intensifs s'est élevé à 16 %.

[Place of the respiratory physiotherapist in the Covid-19 crisis: Neuchâtel experience]. / Place du physiothérapeute respiratoire dans la crise Covid-19 : expérience neuchâteloise.

The physiotherapy service became an important player in the care of patients with COVID-19 at Pourtalès hospital (Neuchâtel, Switzerland), illustrating its important role in the organization of acute care units. The workforce was increased, and the diaries extended (7/7d, 24/24h). Respiratory physiotherapists were largely involved in the initiation and the adaptation of the respiratory therapy in the units dedicated to Covid-19 patients (emergency, intensive care and pulmonology units), such as oxygen therapy and both invasive and non-invasive ventilation. Rehabilitation was also early initiated in order to limit the risk of intensive care unit-acquired polyneuromyopathy and to prevent physical deconditioning.

Le Service de physiothérapie s'est inscrit comme un acteur important dans la prise en charge des patients Covid-19 à l'Hôpital Pourtalès (Neuchâtel, Suisse), illustrant son rôle important dans l'organigramme des unités de soins aigus. L'effectif a été augmenté et les horaires étendus (7 j/7, 24 h/24). Les physiothérapeutes spécialisés dans le domaine respiratoire ont activement participé à la mise en route des traitements respiratoires et à leur adaptation dans les unités dédiées aux patients Covid-19 (urgences, soins intensifs et pneumologie), tels que l'oxygénothérapie et l'assistance ventilatoire invasive et non invasive. Une réhabilitation a par ailleurs été initiée précocement afin de limiter le risque de polyneuromyopathie acquise aux soins intensifs et de prévenir le déconditionnement physique.

Timing of VV-ECMO therapy implementation influences prognosis of COVID-19 patients.

INTRODUCTION: Current knowledge on the use of extracorporeal membrane oxygenation (ECMO) in COVID-19 remains limited to small series and registry data. In the present retrospective monocentric study, we report on our experience, our basic principles, and our results in establishing and managing ECMO in critically ill COVID-19 patients. METHODS: A cohort study was conducted in patients with severe acute respiratory distress syndrome (ARDS) related to COVID-19 pneumonia admitted to the ICU of the Geneva University Hospitals and supported by VV-ECMO from March 14 to May 31. The VV-ECMO implementation criteria were defined according to an institutional algorithm validated by the local crisis unit and the Swiss Society of Intensive Care Medicine. RESULTS: Out of 137 ARDS patients admitted to our ICU, 10 patients (age 57 ± 4 years, BMI 31.5 ± 5 kg/m2 , and SAPS II score 56 ± 3) were put on VV-ECMO. The mean duration of mechanical ventilation before ECMO and mean time under ECMO were 7 ± 3 days and 19 ± 11 days, respectively. The ICU and hospital length of stay were 26 ± 11 and 35 ± 10 days, respectively. The survival rate for patients on ECMO was 40%. The comparative analysis between survivors and non-survivors highlighted that survivors had a significantly shorter mechanical ventilation duration before ECMO (4 ± 2 days vs. 9 ± 2 days, p = 0.01). All the patients who had more than 150 h of mechanical ventilation before the application of ECMO ultimately died. CONCLUSION: The present results suggest that VV-ECMO can be safely utilized in appropriately selected COVID-19 patients with refractory hypoxemia. The main information for clinicians is that late VV-ECMO therapy (i.e., beyond the seventh day of mechanical ventilation) seems futile.

[Physical activity and cardiovascular mortality: epidemiology, screening and secondary prevention]. / Activité sportive et mortalité cardiovasculaire†: épidémiologie, screening et prévention secondaire.

Sudden cardiac death in young athletes has become a highly visible public health issue and it has been studied for the last twenty years. In this article, we analyse the most recent literature about epidemiology and aetiology of sudden cardiac death in Switzerland in comparison to international data. We cover last recommendations for pre-participation screening in athletes and we briefly describe the strategies of secondary prevention.

Le décès par mort subite d'origine cardiovasculaire chez le jeune sportif est depuis tout temps un sujet brûlant de société et a largement été étudié durant ces vingt dernières années. Dans cet article de synthèse, nous analyserons la littérature récente sur l'épidémiologie et l'étiologie de la mort subite en Suisse en comparaison à la littérature internationale. Les dernières recommandations en matière d'examen médical de préparticipation (EMPP) des athlètes seront abordées et des stratégies de prévention secondaire seront énumérées.

[Syncope or palpitations during pregnancy]. / Syncope et palpitations chez la femme enceinte.

Syncope and palpitations are common symptoms during pregnancy ; they are elicited by physiological changes. Although they are often benign, careful management is essential to eliminate a serious aetiology requiring specialized care. Syncope is often of vasovagal origin, but trauma with possible secondary lesions that compromise the life-threatening of the mother and foetus must be researched. Some palpitations are the manifestation of serious rhythm disorders whose therapeutic management depends on their severity and must consider the potential side effects on the foetus.

Les syncopes ainsi que les palpitations sont des symptômes fréquents durant la grossesse ; elles sont favorisées par les modifications physiologiques. Si elles sont souvent bénignes, une prise en charge minutieuse est indispensable pour éliminer une étiologie grave nécessitant une prise en charge spécialisée. La syncope est dans la majorité des cas d'origine vasovagale, mais un traumatisme avec d'éventuelles lésions secondaires pouvant mettre en jeu le pronostic vital de la mère et du fœtus doit obligatoirement être recherché. Certaines palpitations sont la traduction de troubles du rythme graves dont la prise en charge thérapeutique dépend de la sévérité et doit tenir compte des potentiels effets secondaires sur le fœtus.

[Initial management of febrile neutropenia]. / Prise en chargede la neutropénie fébrile.

Despite major advances in prevention and treatment, febrile neutropenia remains one of the most concerning complications of cancer chemotherapy. Its prognosis depends directly on the quality of the initial management in the emergency department (ED). An initial assessment of circulatory and respiratory function, with vigorous resuscitation where necessary, should be followed by careful examination for potential source of infection. A broad-spectrum empirical antibacterial therapy should be given in a timespan < 1 hour. Multinational Association for Supportive Care in Cancer (MASCC) criteria were developed to help physicians make decisions about the site of care and overall management of these patients.

Malgré les progrès réalisés dans sa prévention et son traitement, la neutropénie fébrile reste une complication sérieuse et fréquente de la chimiothérapie anticancéreuse. Son pronostic dépend directement de la qualité de la prise en charge initiale. Les priorités pour l'urgentiste sont l'évaluation et le soutien des fonctions vitales, la recherche méticuleuse du foyer infectieux et une antibiothérapie empirique à large spectre administrée impérativement dans la première heure. Le choix de l'antibiotique et la décision d'hospitalisation sont guidés par les critères (MASCC) de la « Multinational association for supportive care in cancer ¼.

[Anaphylaxis and anaphylactic shock]. / Anaphylaxie et etat de choc anaphylactique.

The anaphylactic shock is an acute, multisystemic and potentially fatal circulatory insufficiency, secondary to an allergic reaction. The prevalence of anaphylaxis is underestimated in the general population. Many studies have reported a prevalence of 0.05-2%. Multiple etiologies are incriminated in the pathogenesis of anaphylaxis, and these etiologies vary depending on age and geographic zones. The clinical manifestations of anaphylaxis are multiple, owing to the multisystemic character of this pathology. The gold standard in management of anaphylaxis is thought to be the rapid and early administration of epinephrine by intra-muscular route. The prevention of anaphylaxis remains the treatment of choice. Educating the patient is an important aspect of anaphylaxis follow-up along with the prescription of epinephrine autoinjectors.

Postischemic forearm skin reactive hyperemia is related to cardovascular risk factors in a healthy female population.

OBJECTIVE: To examine whether forearm postischemic skin reactive hyperemia (SRH) measured by laser Doppler flowmetry (LDF) can be used to explore microvascular function and whether LDF response is related to cardiovascular (CV) risk in a population study. METHODS: SRH of the forearm defined as the percentage increase in cutaneous blood flow from resting conditions to peak dilation following a 2 min upper arm occlusion and CV risk factors were measured prospectively in 862 healthy females screened for cardiovascular risk factors in the context of a campaign designed to promote the 'control' of CV risk factors in women. RESULTS: The Framingham risk score was constructed from age, sex, systolic and diastolic blood pressure, diabetes, total and high-density lipoprotein-cholesterol and left ventricular hypertrophy (Cornell product. The Cornell product for women was calculated as the QRS duration (ms) (R aVL + S V3 + 6 mV)). Although the score was low in this female population (CV event risk at 10 years 7.89) (95% confidence interval, 7.49-8.30) aged 40 to 75 years, we observed an inverse correlation between SRH of the forearm and the CV risk score ( P<0.001). Hormonal replacement therapy (39.4% of the study population was on hormone replacement therapy) had no significant influence on forearm postischemic SRH in this particular population. CONCLUSIONS: This study shows that in a very low CV risk female population, a significant correlation can be observed between the weight of CV risks and the impairment of postischemic forearm SRH. Thus, skin laser Doppler flowmetry may represent a valuable, simple and non-invasive tool to assess and monitor microvascular function in future prospective observational and interventional studies.