[Nutritional deficiency after gastric bypass surgery: a review of the literature and guidelines for follow-up]. / Carence nutritionnelle apràs bypass gastrique: revue de la littérature, recommandations et suivi.

Roux-en-Y gastric bypass (RYGB) is the most frequently performed bariatric surgical procedure in Switzerland. The incidence of postoperative nutritional deficiencies is high. Therefore, guidelines have been established for patient follow-up and prophylactic treatment of such complications. This article makes use of a case report and a review of the literature to emphasize the importance of such measures.

[Needs and expectations of general physicians exposed to emergency medicine: a study in Neuchâtel]. / Attentes et besoins des médecins de premier recours face à l'urgence: une enquête neuchâteloise.

The emergency ward constitutes the main extra/intra-hospital interface most in demand by general physicians (GP). In order to evaluate the needs and the expectations of GP and, thus, to improve the cooperation between different partners, we underwent a study over 150 GP in Neuchâtel, Switzerland. The rate of participation within the time limit was 61.3%. The results showed that only 49% of GP find an interest in emergency medicine and less than a half (43%) feel not at ease when facing to vital emergencies. However 67% of GP confirmed being highly interested to attend special training in emergency field. The cooperation with medical emergency team (SMUR) and paramedics came out to be satisfactory. Facilities to access to the medico-technical platform of the emergency ward is also highly requested.

[Access to thrombolysis in stroke: place of the rescue system and of the primary care physician]. / Accès à la thrombolyse lors d'AVC: rôle des secours préhospitaliers et des médecins de premier recours.

Thrombolysis is the most effective treatment improving the outcome of patients suffering from acute stroke. Moreover, its effectiveness increases when administrated as quick as possible after the onset of the first symptoms. Prehospital selection of patients and their immediate transfer to stroke center are the principal factors allowing the practice of thrombolysis within the authorized time frame. On the basis of regional Swiss French data, it seems that patients evaluated by emergency physician and their direct transfer in an acute stroke unit reduces delays and allows for a higher thrombolysis rate.

[Screening of community malnutrition by homecare staff in Neuchâtel--Switzerland]. / Dépistage de la dénutrition communautaire par les services de soins à domicile à Neuchâtel.

Malnutrition is unidentified in about 60% of malnourished people until their hospital admission. The screening of malnutrition and the institution of a nutritional therapy at home may decrease the mortality and the arise of in-hospital complications. In collaboration with NOMAD (General homecare organ in Neuchâtel - Switzerland), a pilot study was performed in order to evaluate the incidence of the community malnutrition. 129 homecare customers of NOMAD, mostly >70 years old, were screened by a trained staff using a score tool (SRNS) based on 5 simple criteria 39,5% of them were malnourished or at risk of malnutrition. The relevance of SRNS assessments was confirmed by a nutritional dietician in 81,85% of cases, corresponding to 28% of the whole cohort. This incidence is comparable to other studies.

Safety and outcome of patients with an acute ST-elevation myocardial infarction transferred for primary coronary intervention: the Neuchâtel experience.

BACKGROUND: Transferring patients with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI) from a community hospital to a PCI centre has been evaluated in randomised trials and shown to be safe and effective. A prolonged transfer time may restrict the benefit of this strategy. AIM: We sought to assess 1) safety of transfer from Neuchâtel to Berne, 2) time intervals of patients transferred either directly from on-site or after evaluation in the local emergency room, and 3) clinical long-term outcome. METHODS AND RESULTS: 42 patients with STEMI eligible for reperfusion therapy were prospectively included between January 2003 and June 2004. Twenty patients (48%, group 1) were directly transferred to the PCI centre from on-site. Twenty-two were transferred after initial treatment in the local emergency room: 11 patients (26%, group 2) presented spontaneously at the hospital and 11 patients (26%, group 3) were admitted by the rescue team. No major complication occurred during transport. Median transport time was 33 minutes. Median time from first healthcare contact to balloon consisted of 131 minutes in group 1, 158 minutes in group 2 and 174 minutes in group 3. The overall rate of Major Adverse Cardiac Events (MACE) at 6 months amounted to 9.5%. CONCLUSIONS: Transfer for primary PCI of our patients with acute STEMI was safe. Direct transfer from on-site to the PCI centre reduced the time of ischaemia. The overall MACE rate was low.

Individual value of each of the Duke criteria for the diagnosis of infective endocarditis.

OBJECTIVES: To assess the value of each of the Duke criteria for the diagnosis of infective endocarditis (IE). METHODS: Detailed review was done of charts of all cases discharged with the diagnosis of IE, and classification as 'definite', 'possible' and 'rejected' cases was made according to the Duke criteria. The diagnostic impact of each criterion was assessed by reclassifying each 'definite' case after subtraction of each individual criterion and by reclassifying each 'possible' and 'rejected' case after addition of each individual criterion. RESULTS: From 1983 to 1993, 179 cases were identified in the databases of two hospitals. When the Duke criteria were applied, 124 (6967%) were classed as 'definite', 43 (2466%) as 'possible' and 12 (763%) as 'rejected' cases. Of the 67 pathologically proven cases, 52 (78610%) were 'definite' cases when the criteria were applied before pathology. If the major microbiological criterion is subtracted, 53% (69%) of the 'definite' cases become 'possible' or 'rejected'. When the echocardiographic criterion is subtracted, 34% (68%) of the 'definite' cases become possible or rejected. Among minor criteria, fever and predisposition, contributing to the classification of respectively 31% (68%) and 27% (68%) of the 'definite' cases, were the most powerful. On the other hand, the minor microbiological criterion and immunologic phenomena were responsible for the classification of only 2% (62%) and 6% (64%) respectively, of the 'definite' cases. CONCLUSIONS: Depending on the criterion examined, 47-98% of the 'definite' cases of IE would remain 'definite' if this particular criterion were absent. The major microbiological criterion had the highest relative importance. In this retrospective study, in which only 32 (18%) patients had a transesophageal echocardiogram, the echocardiogram contributed to 15% (66%) of the 'definite' cases according to the major criterion and to 19% (66%) according to the minor criterion. This study illustrates that the degree of certainty of the diagnosis of IE often depends on the presence/absence of only one criterion.

Cerebral thromboembolism after direct current cardioversion for pure atrial flutter.

The need for prophylactic anticoagulation before electrical cardioversion for atrial arrhythmias is clearly established in the case of atrial fibrillation. By contrast, such prophylaxis is not a current standard of care before cardioversion for pure atrial flutter, since this arrhythmia seems not to increase the risk of postcardioversion embolism. We present a patient who developed two cerebral embolisms 24 h after electrical cardioversion for pure atrial flutter. To our knowledge, this observation has not been previously reported.