Experiences of Frequent Users of Emergency Departments in Health Care Setting in French-Speaking Switzerland: A Qualitative Study.

AIMS: Frequent users of the emergency department (FUED; five ED visits or more per year) often have negative experiences in health care settings, potentially aggravating their health problems. Scarce research has explored FUED experiences in health care in Europe, none in Switzerland. Thus, this study aimed to conduct an in-depth exploration of FUED experiences in health care settings in Switzerland. METHODS: Semi-structured interviews were conducted among 20 FUED (75% female; mean age = 40.6, SD = 12.8). Qualitative data were subject to inductive content analysis. RESULTS: Five main themes emerged from the analysis. The main findings documented that FUED experiences in health care were mostly negative, leading to negative emotions, dissatisfaction and a loss of confidence in the system, although some positive experiences were reported as well. The relationship with health care workers was perceived as playing a key role in FUED experiences. CONCLUSION: The findings indicate that FUED often have negative experiences in the health care system in Switzerland. The relationship with the health care staff is reported as a decisive ingredient of the experience in health care. Future research is needed to develop awareness-raising interventions for health care staff to improve FUED experiences in health care.

Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study.

BACKGROUND: Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED's perception of CM outside of North America to further improve CM implementation. OBJECTIVES: Explore the FUED's perspectives about CM in Switzerland. DESIGN, SETTING & PARTICIPANTS: Semi-structured qualitative interviews eliciting FUED's experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED. OUTCOMES MEASURES & ANALYSIS: Inductive content analysis. MAIN RESULTS: Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM (ie, stigmatization, lack of concrete outcomes). Barriers identified were cm's lack of time, COVID-19's negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.

[Physiological respiratory changes and venous thromboembolic disease during pregnancy]. / Modifications respiratoires physiologiques et maladie thromboembolique veineuse lors de la grossesse.

During physiological pregnancy, changes in lung functions, ventilatory patterns and gas exchanges happen. Therefore, the dyspnea experienced by a majority of women is usually due to pregnancy itself and is very difficult to differentiate from a pathophysiological state. Anamnesis and clinical examination alone do not rule out dyspnea of ​​thromboembolic origin. Therefore, a structured approach, based on a thromboembolic risk assessment, the application of a specific management algorithm and the use of imaging exams is required for emergency management of dyspnea occurring during the pregnancy and in the postpartum.

Durant une grossesse physiologique, des modifications des fonctions pulmonaires, des paramètres ventilatoires et des échanges gazeux surviennent. Dès lors, la dyspnée ressentie par une majorité des femmes est généralement due à la grossesse elle-même et peut être difficile à différencier d'un état physiopathologique. L'anamnèse et l'examen clinique seuls ne permettent pas d'écarter une dyspnée d'origine thromboembolique. Par conséquent, lors de la prise en charge aux urgences d'une dyspnée survenant pendant la grossesse ou le postpartum, une approche structurée, basée sur une évaluation du risque thromboembolique, l'application d'un algorithme de prise en charge spécifique et des examens d'imagerie, est requise.

Refractory changes in hyperosmolar diabetic decompensation: when hyperglycaemia improves vision.

Type 2 diabetes is a frequent condition in humans with about 350 million affected people. One of the complications is blindness caused by damage of the blood vessels in retina, cataract or glaucoma. But in an acute developing hyperglycaemia, changes in sugar level in blood modify the refraction in the eye. Thus people complain of blurred vision. We present a case of a patient with hypermetropia who reported quick amelioration of his vision as hyperglycaemia developed, because of myopisation.