Publications by authors named "Thomas Perneger"

232 Publications

Physicians' Views and Agreement about Patient- and Context-Related Factors Influencing ICU Admission Decisions: A Prospective Study.

J Clin Med 2021 Jul 11;10(14). Epub 2021 Jul 11.

Division of Palliative Medicine, Department of Readaptation and Geriatrics, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland.

Background: Single patient- and context-related factors have been associated with admission decisions to intensive care. How physicians weigh various factors and integrate them into the decision-making process is not well known.

Objectives: First, to determine which patient- and context-related factors influence admission decisions according to physicians, and their agreement about these determinants; and second, to examine whether there are differences for patients with and without advanced disease.

Method: This study was conducted in one tertiary hospital. Consecutive ICU consultations for medical inpatients were prospectively included. Involved physicians, i.e., internists and intensivists, rated the importance of 13 factors for each decision on a Likert scale (1 = negligible to 5 = predominant). We cross-tabulated these factors by presence or absence of advanced disease and examined the degree of agreement between internists and intensivists using the kappa statistic.

Results: Of 201 evaluated patients, 105 (52.2%) had an advanced disease, and 140 (69.7%) were admitted to intensive care. The mean number of important factors per decision was 3.5 (SD 2.4) for intensivists and 4.4 (SD 2.1) for internists. Patient's comorbidities, quality of life, preferences, and code status were most often mentioned. Inter-rater agreement was low for the whole population and after stratifying for patients with and without advanced disease. Kappa values ranged from 0.02 to 0.34 for all the patients, from -0.05 to 0.42 for patients with advanced disease, and from -0.08 to 0.32 for patients without advanced disease. The best agreement was found for family preferences.

Conclusion: Poor agreement between physicians about patient- and context-related determinants of ICU admission suggests a lack of explicitness during the decision-making process. The potential consequences are increased variability and inequity regarding which patients are admitted. Timely advance care planning involving families could help physicians make the decision most concordant with patient preferences.
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http://dx.doi.org/10.3390/jcm10143068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305175PMC
July 2021

Systemic Fairness for Sharing Health Data: Perspectives From Swiss Stakeholders.

Front Public Health 2021 5;9:669463. Epub 2021 May 5.

Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.

Health research is gradually embracing a more collectivist approach, fueled by a new movement of open science, data sharing and collaborative partnerships. However, the existence of systemic contradictions hinders the sharing of health data and such collectivist endeavor. Therefore, this qualitative study explores these systemic barriers to a fair sharing of health data from the perspectives of Swiss stakeholders. Purposive and snowball sampling were used to recruit 48 experts active in the Swiss healthcare domain, from the research/policy-making field and those having a high position in a health data enterprise (e.g., health register, hospital IT data infrastructure or a national health data initiative). Semi-structured interviews were then conducted, audio-recorded, verbatim transcribed with identifying information removed to guarantee the anonymity of participants. A theoretical thematic analysis was then carried out to identify themes and subthemes related to the topic of systemic fairness for sharing health data. Two themes related to the topic of systemic fairness for sharing health data were identified, namely (i) the hypercompetitive environment and (ii) the legal uncertainty blocking data sharing. The theme, hypercompetitive environment was further divided into two subthemes, (i) systemic contradictions to fair data sharing and the (ii) need of fair systemic attribution mechanisms. From the perspectives of Swiss stakeholders, hypercompetition in the Swiss academic system is hindering the sharing of health data for secondary research purposes, with the downside effect of influencing researchers to embrace individualism for career opportunities, thereby opposing the data sharing movement. In addition, there was a perceived sense of legal uncertainty from legislations governing the sharing of health data, which adds unreasonable burdens on individual researchers, who are often unequipped to deal with such facets of their data sharing activities.
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http://dx.doi.org/10.3389/fpubh.2021.669463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131670PMC
May 2021

How to use likelihood ratios to interpret evidence from randomized trials.

J Clin Epidemiol 2021 Aug 27;136:235-242. Epub 2021 Apr 27.

Division of Clinical Epidemiology, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Geneva 1211, Switzerland. Electronic address:

Objective: The likelihood ratio is a method for assessing evidence regarding two simple statistical hypotheses. Its interpretation is simple - for example, a value of 10 means that the first hypothesis is 10 times as strongly supported by the data as the second. A method is shown for deriving likelihood ratios from published trial reports.

Study Design: The likelihood ratio compares two hypotheses in light of data: that a new treatment is effective, at a specified level (alternate hypothesis: for instance, the hazard ratio equals 0.7), and that it is not (null hypothesis: the hazard ratio equals 1). The result of the trial is summarised by the test statistic z (ie, the estimated treatment effect divided by its standard error). The expected value of z is 0 under the null hypothesis, and A under the alternate hypothesis. The logarithm of the likelihood ratio is given by z·A - A/2. The values of A and z can be derived from the alternate hypothesis used for sample size computation, and from the observed treatment effect and its standard error or confidence interval.

Results: Examples are given of trials that yielded strong or moderate evidence in favor of the alternate hypothesis, and of a trial that favored the null hypothesis. The resulting likelihood ratios are applied to initial beliefs about the hypotheses to obtain posterior beliefs.

Conclusions: The likelihood ratio is a simple and easily understandable method for assessing evidence in data about two competing a priori hypotheses.
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http://dx.doi.org/10.1016/j.jclinepi.2021.04.010DOI Listing
August 2021

Serum NGAL, BNP, PTH, and albumin do not improve glomerular filtration rate estimating formulas in children.

Eur J Pediatr 2021 Jul 10;180(7):2223-2228. Epub 2021 Mar 10.

Women-Mother-Child Department, Pediatric Nephrology Division, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.

Glomerular filtration rate (GFR) is difficult to measure, and estimating formulas are notorious for lacking precision. This study aims to assess if the inclusion of additional biomarkers improves the performance of eGFR formulas. A hundred and sixteen children with renal diseases were enrolled. Data for age, weight, height, inulin clearance (iGFR), serum creatinine, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), parathyroid hormone (PTH), albumin, and brain natriuretic peptide (BNP) were collected. These variables were added to the revised and combined (serum creatinine and cystatin C) Schwartz formulas, and the quadratic and combined quadratic formulas. We calculated the adjusted r-square (r) in relation to iGFR and tested the improvement in variance explained by means of the likelihood ratio test. The combined Schwartz and the combined quadratic formulas yielded best results with an r of 0.676 and 0.730, respectively. The addition of BNP and PTH to the combined Schwartz and quadratic formulas improved the variance slightly. NGAL and albumin failed to improve the prediction of GFR further. These study results also confirm that the addition of cystatin C improves the performance of estimating GFR formulas, in particular the Schwartz formula.Conclusion: The addition of serum NGAL, BNP, PTH, and albumin to the combined Schwartz and quadratic formulas for estimating GFR did not improve GFR prediction in our population. What is Known: • Estimating glomerular filtration rate (GFR) formulas include serum creatinine and/or cystatin C but lack precision when compared to measured GFR. • The serum concentrations of some biological parameters such as neutrophil gelatinase-associated lipocalin (NGAL), parathyroid hormone (PTH), albumin, and brain natriuretic peptide (BNP) vary with the level of renal function. What is New: • The addition of BNP and PTH to the combined quadratic formula improved its performance only slightly. NGAL and albumin failed to improve the prediction of GFR further.
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http://dx.doi.org/10.1007/s00431-021-04019-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195898PMC
July 2021

Emergency Computed Tomography: How Misinterpretations Vary According to the Periods of the Nightshift?

J Comput Assist Tomogr 2021 Mar-Apr 01;45(2):248-252

Service of Radiology, Geneva University Hospital, Geneva, Switzerland.

Objective: To evaluate the accuracy of initial computed tomography (CT) interpretations made by radiology residents during nightshifts in the emergency department.

Methods: Preliminary CT reports performed by radiology residents during 120 consecutive nightshifts (08:30 pm to 08:30 am) were reviewed, attendings' final interpretation being the reference standard. Nightshifts were divided into four consecutive periods of 3 hours. Major misinterpretations were related to potentially life-threatening conditions if not treated immediately after CT. The rate of misinterpretations was calculated for all CT examinations, separately for nightshift's periods and for residents' training years.

Results: Misinterpretations were recorded in 155 (7.4%) of 2102 CT examinations, 0.6% (13/2102) were major. There were 2.2% (4/186) major misinterpretations that occurred during the last period of the nightshift versus 0.4% (9/1916) during the first periods of the night (P < 0.05). Of all misinterpretations, 8.5% (130/1526) were made by third- and fourth-year residents and 4.3% (25/576) by fifth-year residents (P < 0.005).

Conclusions: Major misinterpretations occur at the end of the nightshift, which may be explained by the fatigue effect. The rate of misinterpretations is lower among fifth-year residents, which may be related to their prior experience in reading emergency cases.
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http://dx.doi.org/10.1097/RCT.0000000000001128DOI Listing
April 2021

Prevalence of childhood exposure to intimate partner violence and associations with mental distress in Cambodia, Malawi and Nigeria: A cross-sectional study.

Child Abuse Negl 2021 01 23;111:104807. Epub 2020 Nov 23.

Division of Clinical Epidemiology, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Background: Research from high-income countries shows that witnessing intimate partner violence (IPV) between caregivers is experienced by up to a third of all children and is related to poor mental health outcomes. Much less is known about the burden of witnessing IPV in low- and middle-income countries.

Objectives: This study seeks to explore the magnitude of witnessing IPV between caregivers, its association with other types of violence and the relationship between witnessing IPV in the past and current mental distress.

Participants And Setting: Representative data from the Violence against Children Surveys (VACS) from Cambodia (N = 2373), Malawi (N = 2147) and Nigeria (N = 4098) are employed.

Methods: Logistic regression was applied to assess the association between witnessing IPV in childhood and mental distress in adulthood.

Results: Between 22.4 % and 34.3 % of participants witnessed IPV between their caregivers during childhood. Respondents who witnessed IPV had higher odds of mental distress, compared to those who did not witness IPV in Cambodia (OR 2.73 [2.02, 3.72] for females, OR 2.38 [1.67, 3.41] for males) and Malawi (OR 2.48 [1.43, 4.28] for females, OR 1.66 [1.11, 2.48] for males). In Nigeria only male respondents who witnessed IPV had higher odds of mental distress (OR 2.12 [1.60, 2.80]), but females had no significant association (OR 0.91 [0.68, 1.20]).

Conclusions: The findings highlight the association of negative mental health consequences faced by children living in households with intimate partner violence for selected low- and middle-income countries. Children's exposure to IPV should be considered when providing support to survivors of IPV. Special considerations should be made to provide culturally and resource-appropriate support.
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http://dx.doi.org/10.1016/j.chiabu.2020.104807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885728PMC
January 2021

Efficacy of pragmatic same-day ring prophylaxis for adult individuals exposed to SARS-CoV-2 in Switzerland (COPEP): protocol of an open-label cluster randomised trial.

BMJ Open 2020 11 12;10(11):e040110. Epub 2020 Nov 12.

HIV Unit, Geneva University Hospitals, Geneva, Switzerland.

Introduction: Lopinavir/ritonavir (LPV/r) has been proposed as repurposed drugs for pre-exposure and postexposure prophylaxis as well as therapy of COVID-19. Coronavirus postexposure prophylaxis (COPEP) trial aims at assessing their efficacy as postexposure ring-prophylaxis among adults exposed to SARS-CoV-2.

Methods And Analysis: COPEP is a two-arm open-label cluster-randomised trial conducted in three cantons of Switzerland. Asymptomatic contacts (≥16 years) of individuals diagnosed with COVID-19 will be randomised (2:1) to either LPV/r (400 mg/100 mg two times per day) for 5 days, or a standard of care arm (no treatment). Asymptomatic individuals may be either SARS-CoV-2 positive or negative. Contacts living in the single household will form a cluster and will be randomised into the same arm. All participants will be followed-up for 21 days and undergo daily monitoring for COVID-19 symptoms. The primary endpoint is 21-day incidence of laboratory-confirmed COVID-19 with ≥1 compatible symptom, analysed in an intention-to-treat (ITT) analysis. The secondary endpoints include the 21-day incidence of COVID-19 as well as SARS-CoV-2 infection in a modified ITT analysis, excluding participants who had a positive SARS-CoV-2 RT-PCR from oropharyngeal swab and/or a positive SARS-CoV-2 IgG serology at baseline. Assuming a 21-day incidence for COVID-19 of 20% among contacts without postexposure chemoprophylaxis, to detect a relative risk reduction of 60% (ie, translating in an absolute reduction from 20% to 8%), with a power of 80%, an alpha of 5%. Accounting for design effect of cluster design of circa 1.1, we plan to enrol 200 participants to the LPV/r arm and 100 to the standard of care arm, 300 participants in total.

Ethics And Dissemination: Ethics approval has been granted by the Commission Cantonale d'Ethique de la Recherche, Ethikkommission Nordwest- und Zentralschweiz and Comitato Etico Cantonale (ref 2020-00864) and Swissmedic (2020DR3056). Results from this trial will be disseminated via journal articles and presentations at national and international conferences.

Trial Registration Number: Clinicaltrials.gov Registry (NCT04364022); Swiss National Clinical Trial Portal Registry (SNCTP 000003732).

Registered Report Identifier: CCER 2020-0864.
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http://dx.doi.org/10.1136/bmjopen-2020-040110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662450PMC
November 2020

Correction to: Alternative graphical displays for the monitoring of epidemic outbreaks, with application to COVID-19 mortality.

BMC Med Res Methodol 2020 Oct 26;20(1):265. Epub 2020 Oct 26.

Division of clinical epidemiology, Geneva University Hospitals, and Faculty of medicine, University of Geneva, Geneva, Switzerland.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12874-020-01147-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587165PMC
October 2020

Physicians' predictions of long-term survival and functional outcomes do not influence the decision to admit patients with advanced disease to intensive care: A prospective study.

Palliat Med 2021 01 16;35(1):161-168. Epub 2020 Oct 16.

Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland.

Background: Long-term survival and functional outcomes should influence admission decisions to intensive care, especially for patients with advanced disease.

Aim: To determine whether physicians' predictions of long-term prognosis influenced admission decisions for patients with and without advanced disease.

Design: A prospective study was conducted. Physicians estimated patient survival with intensive care and with care on the ward, and the probability of 4 long-term outcomes: leaving hospital alive, survival at 6 months, recovery of functional status, and recovery of cognitive status. Patient mortality at 28 days was recorded. We built multivariate logistic regression models using admission to the intensive care unit (ICU) as the dependent variable.

Setting/participants: ICU consultations for medical inpatients at a Swiss tertiary care hospital were included.

Results: Of 201 evaluated patients, 105 (52.2%) had an advanced disease and 140 (69.7%) were admitted to the ICU. The probability of admission was strongly associated with the expected short-term survival benefit for patients with or without advanced disease. In contrast, the predicted likelihood that the patient would leave the hospital alive, would be alive 6 months later, would recover functional status, and would recover initial cognitive capacity was not associated with the decision to admit a patient to the ICU. Even for patients with advanced disease, none of these estimated outcomes influenced the admission decision.

Conclusions: ICU admissions of patients with advanced disease were determined by short-term survival benefit, and not by long-term prognosis. Advance care planning and developing decision-aid tools for triage could help limit potentially inappropriate admissions to intensive care.
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http://dx.doi.org/10.1177/0269216320963931DOI Listing
January 2021

Alternative graphical displays for the monitoring of epidemic outbreaks, with application to COVID-19 mortality.

BMC Med Res Methodol 2020 10 6;20(1):248. Epub 2020 Oct 6.

Division of clinical epidemiology, Geneva University Hospitals, and Faculty of medicine, University of Geneva, Geneva, Switzerland.

Background: Classic epidemic curves - counts of daily events or cumulative events over time -emphasise temporal changes in the growth or size of epidemic outbreaks. Like any graph, these curves have limitations: they are impractical for comparisons of large and small outbreaks or of asynchronous outbreaks, and they do not display the relative growth rate of the epidemic. Our aim was to propose two additional graphical displays for the monitoring of epidemic outbreaks that overcome these limitations.

Methods: The first graph shows the growth of the epidemic as a function of its size; specifically, the logarithm of new cases on a given day, N(t), is plotted against the logarithm of cumulative cases C(t). Logarithm transformations facilitate comparisons of outbreaks of different sizes, and the lack of a time scale overcomes the need to establish a starting time for each outbreak. Notably, on this graph, exponential growth corresponds to a straight line with a slope equal to one. The second graph represents the logarithm of the relative rate of growth of the epidemic over time; specifically, log(N(t)/C(t-1)) is plotted against time (t) since the 25th event. We applied these methods to daily death counts attributed to COVID-19 in selected countries, reported up to June 5, 2020.

Results: In most countries, the log(N) over log(C) plots showed initially a near-linear increase in COVID-19 deaths, followed by a sharp downturn. They enabled comparisons of small and large outbreaks (e.g., Switzerland vs UK), and identified outbreaks that were still growing at near-exponential rates (e.g., Brazil or India). The plots of log(N(t)/C(t-1)) over time showed a near-linear decrease (on a log scale) of the relative growth rate of most COVID-19 epidemics, and identified countries in which this decrease failed to set in in the early weeks (e.g., USA) or abated late in the outbreak (e.g., Portugal or Russia).

Conclusions: The plot of log(N) over log(C) displays simultaneously the growth and size of an epidemic, and allows easy identification of exponential growth. The plot of the logarithm of the relative growth rate over time highlights an essential parameter of epidemic outbreaks.
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http://dx.doi.org/10.1186/s12874-020-01122-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537983PMC
October 2020

Evidence of survival benefit was often ambiguous in randomized trials of cancer treatments.

J Clin Epidemiol 2020 11 3;127:1-8. Epub 2020 Jul 3.

Division of Clinical Epidemiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.

Objectives: The objective of the study is to estimate the proportion of statistically significant survival improvements reported in randomized trials of cancer treatments that are also compatible with a clinically negligible benefit.

Study Design And Setting: This is a cross-sectional study of reports of randomized clinical trials of cancer treatments that reported a statistically significant increase in overall survival, published in leading journals between 2009 and 2019. The main outcome variable was the hazard ratio (HR) for overall survival and its upper 95% confidence limit. An HR of 0.95 implies an absolute survival gain ≤1.9%, and an HR of 0.90 implies an absolute survival gain ≤3.8%; we reasoned that such survival gains can be considered clinically negligible, given the potential toxicity of oncologic treatments.

Results: Among 234 trial results, the mean point estimate of the HR was 0.664, and all HRs were below 0.90. The mean upper 95% confidence limit for the HR was 0.897, but 37.6% of the values were ≥0.95, and 59.0% were ≥0.90. These proportions were lower when overall survival was the primary outcome of the trial (29.9% ≥ 0.95 and 51.3% ≥ 0.90).

Conclusions: Considering only point estimates of HRs, all trials reported clinically meaningful improvements in overall survival. However, the upper confidence limits of a large proportion of HRs were also compatible with clinically negligible survival gains. Acknowledging the uncertainty regarding treatment benefits presents a challenge for the reporting of trial results and for clinical decision-making.
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http://dx.doi.org/10.1016/j.jclinepi.2020.06.026DOI Listing
November 2020

Study design factors influencing patients' willingness to participate in clinical research: a randomised vignette-based study.

BMC Med Res Methodol 2020 04 26;20(1):93. Epub 2020 Apr 26.

Division of Clinical Epidemiology and Department of health and community medicine, Geneva University Hospitals and Faculty of Medicine, 6 Rue Gabrielle Perret-Gentil, 1211, 14, Geneva, Switzerland.

Background: High patient participation in clinical research reduces selection bias and ensures the generalizability of study findings. We explored study-related factors that may influence patients' willingness to participate in research.

Methods: We submitted by mail two vignettes that described clinical research studies - a drug trial and a diagnostic study - to patients recently discharged from hospital and assessed their willingness to participate. We used a factorial design to randomly allocate three study attributes per vignette: in the drug trial, presumed superiority of new drug versus equipoise, public versus industry funding, and random versus non-random treatment allocation; in the diagnostic study, common versus rare disease, genetic versus protein analysis, and automatic reporting of results versus reporting on request.

Results: Of 2600 patients contacted, 1140 (44%) participated. Globally, willingness to participate in a drug trial was lower than in a diagnostic study (44.8% vs. 76.2%; P < 0.001). In the drug trial, participation was significantly higher when the new drug was presented as presumably better than the old (vs. equipoise) and when the study was funded by public sources (vs. industry), but was not affected by the allocation method. None of the factors tested in the diagnostic study was associated with participation.

Conclusions: Patients were more likely to participate in a hypothetical observational diagnostic study than in a hypothetical drug trial. Participation in the trial was lower when clinical equipoise was expressed and when the trial was funded by industry. These results suggest that some features of study design can influence participation.
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http://dx.doi.org/10.1186/s12874-020-00979-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183682PMC
April 2020

Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial.

BMC Nephrol 2020 04 9;21(1):128. Epub 2020 Apr 9.

Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.

Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCPs) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge.

Methods: Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years.

Results: From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups. Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival.

Conclusion: These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD.

Trial Registration: This study was registered on June 29, 2009 in clinicaltrials.gov (NCT00929760) and adheres to CONSORT 2010 guidelines.
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http://dx.doi.org/10.1186/s12882-020-01747-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147051PMC
April 2020

Patient satisfaction and survey response in 717 hospital surveys in Switzerland: a cross-sectional study.

BMC Health Serv Res 2020 Mar 2;20(1):158. Epub 2020 Mar 2.

Division of clinical epidemiology, Geneva University Hospitals, and Faculty of medicine, University of Geneva, Geneva, Switzerland.

Background: The association between patient satisfaction and survey response is only partly understood. In this study, we describe the association between average satisfaction and survey response rate across hospital surveys, and model the association between satisfaction and propensity to respond for individual patients.

Methods: Secondary analysis of patient responses (166'014 respondents) and of average satisfaction scores and response rates obtained in 717 annual patient satisfaction surveys conducted between 2011 and 2015 at 164 Swiss hospitals. The satisfaction score was the average of 5 items scored between 0 and 10. The association between satisfaction and response propensity in individuals was modeled as the function that predicted best the observed response rates across surveys.

Results: Among the 717 surveys, response rates ranged from 16.1 to 80.0% (pooled average 49.8%), and average satisfaction scores ranged from 8.36 to 9.79 (pooled mean 9.15). At the survey level, the mean satisfaction score and response rate were correlated (r = 0.61). This correlation held for all subgroups of surveys, except for the 5 large university hospitals. The estimated individual response propensity function was "J-shaped": the probability of responding was lowest (around 20%) for satisfaction scores between 3 and 7, increased sharply to about 70% for those maximally satisfied, and increased slightly for the least satisfied. Average satisfaction scores projected for 100% participation were lower than observed average scores.

Conclusions: The most satisfied patients were the most likely to participate in a post-hospitalization satisfaction survey. This tendency produces an upward bias in observed satisfaction scores, and a positive correlation between average satisfaction and response rate across surveys.
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http://dx.doi.org/10.1186/s12913-020-5012-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052977PMC
March 2020

Development and psychometric performance of the French language version of the Manchester-Oxford Foot Questionnaire (MOXFQ).

Foot Ankle Surg 2020 Dec 20;26(8):902-906. Epub 2019 Dec 20.

Division of Epidemiology, Geneva University Hospitals, Geneva, Switzerland.

Background: The Manchester-Oxford Foot Questionnaire (MOXFQ) is a 16-item patient-reported outcome measure (PROM) validated for use in patients with foot and ankle pathologies. It contains three sub-scores for pain, walking/standing and social interaction dimensions. The aim of this study was to develop a French language version of the MOXFQ and to assess its psychometric properties in patients affected by foot and ankle pathologies.

Methods: According to guidelines, forward and backward independent translations were performed. The final French version was pre-tested in 45 patients. The French MOXFQ and the Short-form 36 Health Survey (SF-36) were filled in by 149 patients. A retest was performed in 39 patients. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed by factor analysis, and through correlations of MOXFQ scales with SF-36 scales.

Results: Internal consistency coefficients were high with Cronbach's alpha ranging from 0.79 and 0.94. Test-retest ICCs were between 0.74 and 0.93. No floor or ceiling effects were observed. The correlations between French MOXFQ and French SF-36 subscales were moderate ranging from -0.33 to -0.71.

Conclusions: The French translation of the MOXFQ revealed good psychometric properties. Our French version proved to be a reliable instrument which can be used for evaluation of patients with foot and ankle disorders.

Level Of Evidence: II.
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http://dx.doi.org/10.1016/j.fas.2019.12.002DOI Listing
December 2020

Accommodating an Uninvited Guest: Perspectives of Researchers in Switzerland on 'Honorary' Authorship.

Sci Eng Ethics 2020 04 29;26(2):947-967. Epub 2019 Nov 29.

Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.

The aim of this paper is to analyze the attitudes and reactions of researchers towards an authorship claim made by a researcher in a position of authority who has not made any scientific contribution to a manuscript or helped to write it. This paper draws on semi-structured interviews conducted with 33 researchers at three seniority levels working in biomedicine and the life sciences in Switzerland. This manuscript focuses on the analysis of participants' responses when presented with a vignette describing an authorship assignment dilemma within a research group. The analysis indicates that researchers use a variety of explanations and arguments to justify inclusion of what guidelines would describe as honorary or guest authorship. Fuzzy parameters such as "substantial contribution" lead to varied interpretation and consequently convenient application of authorship guidelines in practice. Factors such as the culture of the research group, the values and practice shaped by the research leaders, the hierarchy and relative (perceived) positions of power within research institutions, and the importance given to publications as the currency for academic success and growth tend to have a strong influence on authorship practice. Unjustified authorship assignment practices can be reduced to some extent by creating empowering research cultures where each researcher irrespective of his/her career stage feels empowered to confidently raise concerns without fearing adverse impact on their professional lives. However, individual researchers and research institutions currently have limited influence on established methods for evaluating academic success, which is primarily based on the number of high impact publications.
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http://dx.doi.org/10.1007/s11948-019-00162-8DOI Listing
April 2020

Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study.

J Cardiothorac Surg 2019 Nov 7;14(1):189. Epub 2019 Nov 7.

Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Background: Compared to lobectomy by video-assisted thoracic surgery (VATS), segmentectomy by VATS has a potential higher risk of postoperative atelectasis and air leakage. We compared postoperative complications between these two procedures, and analyzed their risk factors.

Methods: We reviewed the records of all patients who underwent anatomical pulmonary resections by VATS from January 2014 to March 2018 in two Swiss university hospitals. All complications were reported. A logistic regression model was used to compare the risks of complications for the two interventions. Adjustment for patient characteristics was performed using a propensity score, and by including risk factors separately.

Results: Among 690 patients reviewed, the major indication for lung resection was primary lung cancer (86.4%) followed by metastasis resection (5.8%), benign lesion (3.9%), infection (3.2%) and emphysema (0.7%). Postoperatively, there were 80 instances (33.3%) of complications in 240 segmentectomies, and 171 instances (38.0%) of complications in 450 lobectomies (P = 0.73). After adjustment for the patient's propensity to be treated by segmentectomy rather than lobectomy, the risks of a complication remained comparable for the two techniques (odds ratio for segmentectomy 0.91 (0.61-1.30), p = 0.59). Length of hospital stay and drainage duration were shorter after segmentectomy. On multivariate analysis, an American Society of Anesthesiologists score above 2 and a forced expiratory volume in one second below 80% of predicted value were significantly associated with the occurrence of complications.

Conclusions: The rate of complications and their grade were similar between segmentectomy and lobectomy by VATS.
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http://dx.doi.org/10.1186/s13019-019-1021-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836384PMC
November 2019

Improvement in mental health following total hip arthroplasty: the role of pain and function.

BMC Musculoskelet Disord 2019 Jun 29;20(1):307. Epub 2019 Jun 29.

Department of Orthopaedic Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland.

Background: Mental health has been shown to improve after total hip arthroplasty (THA). Little is known about the role of pain and function in this context. We assessed whether change in mental health was associated with improvement in pain and function 1 year post-surgery.

Methods: This prospective study included patients enrolled in a THA registry from 2010 to 2014. We examined the mental component score (MCS) before and 1 year post-surgery, and 1-year change, in association with Western Ontario McMaster Universities (WOMAC) pain and function scores. All scores were normalized, ranging from 0 to 100 (larger score indicating better outcome). Analyses were adjusted for potential confounders.

Results: Our study included 610 participants, of which 53% were women. Descriptive statistics are as follows: the average (SD) for age (years) was 68.5 (11.8), and for BMI was 26.9 (4.9). In addition, the MCS average (SD) at baseline was 44.7 (11.2), and at 1-year after THA was 47.5 (10.5). The average change from baseline to 1-year post-THA in MCS was 2.8 (95% CI: 1.9, 3.6), for an effect size of 0.26. As for the WOMAC pain score, the average change from baseline to 1-year post-THA was 44.2 (95%CI: 42.4, 46.0), for an effect size of 2.5. The equivalent change in WOMAC function was 38.1 (95% CI: 36.2, 40.0), for an effect size of 2.0. Results from multivariable analysis controlling for covariates showed that an improvement of 10 points in the 1-year change in pain score resulted in a 0.78 point (95%: CI 0.40, 1.26) increase in the 1-year change in MCS, whereas a 10-point improvement in the 1-year change in function was associated with a 0.94 point (95% CI: 0.56, 1.32) increase.

Conclusions: Mental health significantly improved from baseline to 1-year post-THA. Greater improvement in pain and function was associated with greater improvement in mental health 1 year post-THA.
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http://dx.doi.org/10.1186/s12891-019-2669-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599341PMC
June 2019

Symptoms of osteoarthritis influence mental and physical health differently before and after joint replacement surgery: A prospective study.

PLoS One 2019 6;14(6):e0217912. Epub 2019 Jun 6.

Division of Orthopedic Surgery and Traumatology, Geneva University Hospitals, Geneva, Switzerland.

Background: Patient-reported outcomes are increasingly used in evaluations of joint replacement surgery, but it is unclear if symptoms of osteoarthritis (i.e., pain and dysfunction) influence health perceptions similarly before and after surgery.

Methods: In this prospective study based on a hospital-based arthroplasty registry, patients with primary total hip or knee arthroplasty (THA, N = 990, and TKA, N = 907) completed the WOMAC Pain and Function scales, and the SF12 Physical and Mental Component Scores (PCS and MCS), before surgery and one year later. Associations between WOMAC and SF12 scales were examined using mixed linear regression models.

Results: All patient-reported outcomes improved following total joint arthroplasty, but the associations between symptom scales and global health perceptions were altered. Mental health scores at a given level of pain or function were lower after surgery than before, by about 4-5 points, a clinically meaningful and statistically significant difference. In contrast, the associations between WOMAC scales and the PCS remained stable. These findings were observed in both cohorts of patients.

Conclusions: After total joint arthroplasty, mental health scores were lower than would have been expected given the symptomatic improvement. This suggests that relationships between patient-reported outcomes are context-dependent, and that care should be exerted when interpreting changes in patient-reported outcomes over time.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217912PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553858PMC
February 2020

Comparison of the contributions of female and male authors to medical research in 2000 and 2015: a cross-sectional study.

BMJ Open 2019 02 13;9(2):e024436. Epub 2019 Feb 13.

Medical Directorate / Division of Clinical Epidemiology, Hopitaux Universitaires de Geneve, Geneva, GE, Switzerland.

Objectives: The proportion of women engaged in clinical research has increased over time. However, it is unclear if women and men contribute to the same extent during the conduct of research and, if so, if they are equally rewarded by a strategic first or last author position. We aim to describe the prevalence of women authors of original articles published 15 years apart and to compare the research contributions and author positions according to gender.

Design: Repeated cross-sectional study.

Setting: Published original articles.

Participants: 1910 authors of 223 original articles published in the in 2000 and 2015.

Primary And Secondary Outcomes Measures: Self-reported contributions to 10 aspects of the article (primary) and author position on the byline.

Results: The proportion of women authors increased from 32% (n=243) to 41% (n=469) between 2000 and 2015 (p<0.0001). In 2000, women authors were less frequently involved than men in the conception and design (134 (55%) vs 323 (61%); p=0.0256), critical revision (171 (70%) vs 426 (81%); p=0.0009), final approval (196 (81%) vs 453 (86%); p=0.0381) and obtaining of funding (39 (16%) vs 114 (22%); p=0.0245). Women were more frequently involved than men in administration and logistics (85 (35%) vs 137 (26%); p=0.0188) and data collection (121 (50%) vs 242 (46%); p=0.0532), but they were similarly involved in the analysis and interpretation of data, drafting of the manuscript, provision of materials/patients and statistical expertise. Women were less often last authors than men (22 (9%) vs 82 (16%); p=0.0102). These gender differences persisted in 2015.

Conclusions: The representation of women among authors of medical articles increased notably between 2000 and 2015, but still remained below 50%. Women's roles differed from those of men with no change over time.
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http://dx.doi.org/10.1136/bmjopen-2018-024436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398775PMC
February 2019

Concomitant leukocytosis and lymphopenia predict significant pathology at CT of acute abdomen: a case-control study.

BMC Emerg Med 2019 01 18;19(1):10. Epub 2019 Jan 18.

Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.

Background: Acute abdominal pain accounts for about 10% of emergency department visits and has progressively become the primary indication for CT scanning in most centers. The goal of our study is to identify biological or clinical variables able to predict or rule out significant pathology (conditions requiring urgent medical or surgical treatment) on abdominal CT in patients presenting to an emergency department with acute abdominal pain.

Methods: This was a retrospective cohort study performed in the emergency department of an academic center with an annual census of 60'000 patients. One hundred and-nine consecutive patients presenting with an acute non-traumatic abdominal pain, not suspected of appendicitis or renal colic, during the first semester of 2013, who underwent an abdominal CT were included. Two medical students, completing their last year of medical school, extracted the data from patients' electronic health record. Ambiguities in the formulations of clinical symptoms and signs in the patients' records were solved by consulting a board certified emergency physician. Nine clinical and biological variables were extracted: shock index, peritonism, abnormal bowel sounds, fever (> 38 °C), intensity and duration of the pain, leukocytosis (white blood cell count >11G/L), relative lymphopenia (< 15% of total leukocytes), and C-reactive Protein (CRP). These variables were compared to the CT results (reference standard) to determine their ability to predict a significant pathology.

Results: Significant pathology was detected on CT in 71 (65%) patients. Only leukocytosis (odds ratio 3.3, p = 0.008) and relative lymphopenia (odds ratio 3.8, p = 0.002) were associated with significant pathology on CT. The joint presence of these two anomalies was strongly associated with significant pathology on CT (odds ratio 8.2, p = 0.033). Leukocytosis with relative lymphopenia had a specificity of 89% (33/37) and sensitivity of 48% (33/69) for the detection of significant pathology on CT.

Conclusion: The high specificity of the association between leukocytosis and relative lymphopenia amongst the study population suggests that these parameters would be sufficient to justify an emergency CT. However, none of the parameters could be used to rule out a significant pathology.
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http://dx.doi.org/10.1186/s12873-019-0227-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339375PMC
January 2019

Epidemiology of Strongyloides stercoralis infection in Bolivian patients at high risk of complications.

PLoS Negl Trop Dis 2019 01 17;13(1):e0007028. Epub 2019 Jan 17.

Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.

Background: Strongyloidiasis can be fatal in immunocompromised patients, but few epidemiological studies investigated the burden of this neglected tropical disease among these populations, particularly in low- and middle-income countries such as Bolivia. This study aimed to fill in this gap by estimating prevalence rate and risk factors associated with strongyloidiasis among patients at high risk of complications.

Methods: A cross-sectional study was carried out in Santa Cruz (elevation 400 meters, tropical climate) and Cochabamba (elevation 2,500 meters, temperate climate), among patients with cancer, HIV infection and rheumatic or hematologic disease, using four coproparasitological techniques and one serological (ELISA) test.

Results: In total, 1,151 patients participated in this study, including individuals who were HIV-positive (30%) or with rheumatic (29%), oncologic (32%) or hematologic (9%) diseases. The serological and coproparasitological prevalence was 23.0% (95% confidence interval [CI], 20.7-25.5; n = 265/1151) and 7.6% (95% CI, 6.2-9.3; n = 88/1151), respectively, with an estimated actual prevalence of 20.2% (95% CI, 17.9-22.5). Positive serology and positive coproparasitology were associated with younger age and lower education levels. There was no significant difference in prevalence between Cochabamba and Santa Cruz as defined by coproparasitology (6.4% vs. 8.9%; p = 0.11) or serology (24.0% vs. 22.0%; p = 0.4). Among 64 patients in Cochabamba who had never travelled to the tropical lowlands, 5 (7.8%) had a positive coproparasitology.

Conclusions: Strongyloidiasis is widely prevalent in Bolivia among vulnerable patients at increased risk of life-threatening complications. Transmission of the parasite occurs both in tropical lowlands and temperate elevation (≥ 2,500 m). Control strategies to prevent transmission and complications of this serious parasitic disease should be urgently reinforced.
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http://dx.doi.org/10.1371/journal.pntd.0007028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353209PMC
January 2019

Edentulous jaw impression techniques: An in vivo comparison of trueness.

J Prosthet Dent 2019 Apr 21;121(4):623-630. Epub 2018 Dec 21.

Professor, Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.

Statement Of Problem: Simplified edentulous jaw impression techniques have gained popularity, while their validity has not yet been evaluated.

Purpose: The purpose of this clinical study was to compare the trueness of maxillary edentulous jaw impressions made with irreversible hydrocolloid (ALG), polyvinyl siloxane (PVS), PVS modified with zinc oxide eugenol (ZOE) (PVSM), and an intraoral scanner (TRI) with a conventionally border-molded ZOE impression (control).

Material And Methods: Twelve edentulous maxillary impressions were made with the impression techniques. The analog impressions were scanned using a laboratory scanner, imported into 3-dimensional comparison software, and superimposed against the corresponding control. Trueness was evaluated by calculating the effective deviation known as root mean square (RMS) for the entire surface (ES) and for specific regions of interest such as peripheral border, inner seal, midpalatal suture, ridge, and posterior palatal seal. The secondary outcomes for this study were the patients' perception of the impression techniques. Statistical analyses with the Wilcoxon tests were carried out (α=.05).

Results: For ES, significant differences were found when comparing ALG (1.21 ±0.35 mm) with PVS (0.75 ±0.17 mm; P=.008), PVSM (0.75 ±0.19 mm; P=.012), and TRI (0.70 ±0.18 mm; P=.006) but not among the other groups. Significant differences were found for peripheral border when comparing ALG (2.03 ±0.55 mm) with PVS (1.12 ±0.32 mm; P=.006), PVSM (1.05 ±0.29 mm; P=.003), and TRI (1.38 ±0.25 mm; P=.008), as well as TRI and PVSM (P=.028). Significant differences were also found for inner seal when comparing ALG (0.74 ±0.36 mm) with PVSM (0.52 ±0.13 mm; P=.041), as well as TRI (0.8 ±0.25 mm) versus PVS (0.56 ±0.14 mm; P=.005) and PVSM (P=.005). The difference at the ridge was significant when comparing PVS (0.18 ±0.07 mm) with PVSM (0.28 ±0.19 mm; P=.015) but not among the other groups. A significant difference was also found for posterior palatal seal when comparing PVS (0.55 ±0.41 mm) with PVSM (0.60 ±0.43 mm; P=.034). Patient perceptions showed significantly better satisfaction scores for ALG (1.83 ±2.03) and PVS (3.17 ±2.40) than for TRI (4.08 ±2.71), PVSM (4.58 ±2.35), and ZOE (6.83 ±1.75).

Conclusions: Edentulous impressions made with PVS, PVSM, and TRI had similar deviations and may yield clinically acceptable results. Irreversible hydrocolloids are contraindicated for definitive impression making in completely edentulous jaws.
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http://dx.doi.org/10.1016/j.prosdent.2018.08.016DOI Listing
April 2019

Effect of implant-supported mandibular overdentures versus reline on masticatory performance and salivary flow rates in very old adults-A randomized clinical trial.

Clin Oral Implants Res 2019 Jan 30;30(1):59-67. Epub 2018 Dec 30.

Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.

Purpose: To compare the masticatory efficiency (ME), maximum voluntary bite force (MBF), masseter muscle thickness (MMT), and salivary flow rates (SFR) in completely edentulous dependent elders treated either with a conversion of their existing mandibular complete removable dental prostheses (CRDPs) into a two-implant overdenture (IOD) or a conventional reline of the CRDP.

Material And Methods: Participants were randomly allocated into intervention (IG) and control (CG) groups. The IG received two implants in the mandibular canine regions, and their CRDPs were transformed into IODs. The CG received a conventional reline of their mandibular CRDPs. Outcomes were recorded at each recall visit (baseline, immediately, 3 months, 12 months after intervention, and subsequently on an annual basis). Statistical analyses used mixed linear regression models (level of significance: p < 0.05).

Results: The IG comprised 16 participants (age = 85.0 ± 6.2 years), while the CG comprised 16 (age = 84.8 ± 5.4 years), with a mean follow-up of 2.7 ± 2.2 years (range: 3 months-7 years). A significant increase of MBF in the IG was observed with an overall gain of 80 N (p < 0.001) compared with the reline group. There were no significant long-term changes in SFR, MMT, or ME within/between groups.

Conclusion: Since dependent elders with mandibular IODs present a significant gain in MBF, but no relative increase in SFR, MMT, and ME, it seems that this increased capacity of MBF is not exploited by the elders during their habitual chewing.
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http://dx.doi.org/10.1111/clr.13392DOI Listing
January 2019

ICU physicians' and internists' survival predictions for patients evaluated for admission to the intensive care unit.

Ann Intensive Care 2018 Nov 14;8(1):108. Epub 2018 Nov 14.

Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland.

Background: A higher chance of survival is a key justification for admission to the intensive care unit (ICU). This implies that physicians should be able to accurately estimate a patient's prognosis, whether cared for on the ward or in the ICU. We aimed to determine whether physicians' survival predictions correlate with the admission decisions and with patients' observed survival. Consecutive ICU consultations for internal medicine patients were included. The ICU physician and the internist were asked to predict patient survival with intensive care and with care on the ward using 5 categories of probabilities (< 10%, 10-40%, 41-60%, 61-90%, > 90%). Patient mortality at 28 days was recorded.

Results: Thirty ICU physicians and 97 internists assessed 201 patients for intensive care. Among the patients, 140 (69.7%) were admitted to the ICU. Fifty-eight (28.9%) died within 28 days. Admission to intensive care was associated with predicted survival gain in the ICU, particularly for survival estimates made by ICU physicians. Observed survival was associated with predicted survival, for both groups of physicians. The discrimination of the predictions for survival with intensive care, measured by the area under the ROC curve, was 0.63 for ICU physicians and 0.76 for internists; for survival on the ward the areas under the ROC curves were 0.69 and 0.74, respectively.

Conclusions: Physicians are able to predict survival probabilities when they assess patients for intensive care, albeit imperfectly. Internists are more accurate than ICU physicians. However, ICU physicians' estimates more strongly influence the admission decision. Closer collaboration between ICU physicians and internists is needed.
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http://dx.doi.org/10.1186/s13613-018-0456-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236006PMC
November 2018

Admission to intensive care: A qualitative study of triage and its determinants.

Health Serv Res 2019 04 25;54(2):474-483. Epub 2018 Oct 25.

Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.

Objective: To examine physicians' decision making and its determinants about admission to intensive care.

Data Sources/study Setting: ICU physicians (n = 12) and internists (n = 12) working in a Swiss tertiary care hospital.

Study Design: We conducted in-depth interviews.

Data Collection/extraction Methods: Interviews were analyzed using an inductive thematic approach.

Principal Findings: Admission decisions regarding seriously ill or elderly patients with comorbidities are complex. Nonmedical factors such as ICU beds availability, health care resources on the ward, information about patient preferences, and family behavior determine the decision. Code status and the quality of interaction between physicians are key determinants. The absence of code status or poor documentation of code status discussions makes decisions more difficult and laden emotionally, as physicians feel they are making a life-death decision. Mutual respect and collaborative decision making facilitate the decision. Tensions arise due to ICU physicians' postponing the decision because of lack of beds, ICU physicians' dismissive attitudes, perceived shortcomings in the other physician's completion of expected tasks, and preconceptions about the other physician.

Conclusions: Systematic documentation of code status, and fostering collaboration between ICU physicians and internists would facilitate ICU admission decisions in complex clinical situations.
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http://dx.doi.org/10.1111/1475-6773.13076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407353PMC
April 2019

The paradox of self-rated health following joint replacement surgery.

Qual Life Res 2019 Feb 15;28(2):503-508. Epub 2018 Oct 15.

University of Geneva, Geneva, Switzerland.

Purpose: Self-rated health is a commonly used patient-reported outcome, but its responsiveness to is not well documented. We examined the ability of self-rated health to capture health changes attributable to a highly effective surgical intervention.

Methods: Prospective study of patients with severe osteoarthritis of the hip (N = 990) or knee (N = 907) who underwent total hip replacement (THA) or total knee replacement (TKA). Self-rated health was assessed pre-operatively and 1 year after surgery on a scale between "excellent" and "poor," along with other health items (other 11 items of the SF12 questionnaire) and multi-item Pain and Function scales.

Results: On average, self-rated health was unchanged by surgery. In both THA and TKA cohorts, of 10 patients, 6 rated their health the same after surgery as before, 2 gave a higher rating, and 2 gave a lower rating. In contrast, major improvements were observed for all other SF12 items, and for the Pain and Function scales, in both cohorts of patients. Nevertheless, both before and after surgery, self-rated health was associated with the other SF12 items and with Pain and Function scores. These associations were stronger after surgery than before.

Conclusions: Self-rated health was not responsive to major improvements in health, documented by other instruments, attributable to joint replacement surgery. However, self-rated health was even more strongly associated with concurrent assessments of more specific health problems after surgery than before. Caution is advised in interpreting changes in self-rated health following health-altering interventions.
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http://dx.doi.org/10.1007/s11136-018-2018-xDOI Listing
February 2019

Utility of Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Malignant and Nonmalignant Disease.

Acta Cytol 2018 21;62(5-6):380-385. Epub 2018 Sep 21.

Department of Pulmonology, Geneva University Hospitals, Geneva, Switzerland.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate procedure to sample mediastinal tissue. Rapid on-site cytologic evaluation (ROSE) has been advocated to improve the performance of this procedure, but its benefit remains controversial. Our objective is to assess the utility of ROSE for EBUS-TBNA diagnostic accuracy among unselected patients.

Methods: We prospectively collected data from all consecutive EBUS-TBNA procedures performed between 2008 and 2014. ROSE was introduced since 2011 in our daily practice. The accuracy of EBUS-TBNA with and without ROSE was compared in a univariate and multivariate model accounting for confounding factors. The impact of ROSE was then analyzed according to the etiology and size of the lesions.

Results: Among 348 EBUS-TBNA procedures analyzed, 213 were performed with ROSE. The overall accuracy tended to be better with ROSE than without (90.6 vs. 84.4%; p = 0.082). After adjustment in a multivariate model, the benefit of ROSE still did not reach statistical significance (adjusted odds ratio 1.86; 95% confidence interval 0.79-4.41). Similar results were obtained in subgroups of patients with malignant disease or sarcoidosis. The size of the lesion did not influence the impact of ROSE on accuracy.

Conclusions: ROSE was associated with a moderate increase in the accuracy of EBUS-TBNA, but the difference was not statistically significant. The same effect of ROSE was observed in malignant and nonmalignant lesions and this effect was not influenced by the lesion's size.
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http://dx.doi.org/10.1159/000493334DOI Listing
January 2019

Internists' and intensivists' roles in intensive care admission decisions: a qualitative study.

BMC Health Serv Res 2018 08 8;18(1):620. Epub 2018 Aug 8.

Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.

Background: Intensive care Unit (ICU) admission decisions involve collaboration between internists and intensivists. Clear perception of each other's roles is a prerequisite for good collaboration. The objective was to explore how internists and intensivists perceive their roles during admission decisions.

Methods: Individual in-depth interviews with 12 intensivists and 12 internists working at a Swiss teaching hospital. Interviews were analyzed using a thematic approach.

Results: Roles could be divided into practical roles and identity roles. Internist and intensivists had the same perception of each other's practical roles. Internists' practical roles were: recognizing signs of severity when the patient becomes acutely ill, calling the intensivist at the right moment, having the relevant information about the patient and having determined the goals of care. Intensivists' practical roles were: assessing the patient on the ward, giving expert advice, making quick decisions, managing access to the ICU, having the final decision power and, sometimes, deciding whether or not to limit treatment. In complex situations, perceived flaws in performing practical roles could create tensions between the doctors. Intensivists' identity roles included those of leader, gatekeeper, life-death decision maker, and supporting colleague doctors (consultant, senior and helper). These roles could be perceived as emotionally burdensome. Internists' identity roles were those of leader and partner.

Conclusions: Despite a common perception of each other's practical roles, tensions can arise between internists and intensivists in complex situations of ICU admission decisions. Training in communication skills and interprofessional education interventions aimed at a better understanding of each other roles would improve collaboration.
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http://dx.doi.org/10.1186/s12913-018-3438-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083517PMC
August 2018

European trends in epilepsy surgery.

Neurology 2018 07 13;91(2):e96-e106. Epub 2018 Jun 13.

From the Department of Neurology (M.O.B., S.V., F.P., M.S.), and Center for Clinical Research (T.P.), University Hospital Geneva; Department of Neurology (M.O.B.), University Hospital Bern; Wyss Center for Bio- and Neuro-Engineering (M.O.B.), Geneva, Switzerland; Klinik und Poliklinik für Epileptologie (A.R., M.C.P., C.E.), Universitätsklinikum Bonn, Germany; Sahlgrenska University Hospital and Sahlgrenska Academy at the University of Gothenburg (B.R., K. Malmgren), Sweden; UCL Great Ormond Street Hospital (J.H.C., G.M., M.T.), London, UK; Department of Child Neurology (H.J.L., K.P.J.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Department of Functional Neurology and Epileptology (S. Rheims, J.I., P.R., F.M.) and Department of Clinical Epileptology, Sleep Disorders, and Functional Neurology in Children (A.A., P.R.), Hospices Civils de Lyon and University of Lyon, France; Department of Neurology (P.R.), University Hospital Lausanne, Switzerland; Department of Neurology (S.A., K.D., C.O.), Cerrahpasa Medical Faculty, Istanbul University, Turkey; Clinic for Neuroscience (M.L.), National Center for Epilepsy, Oslo University Hospital, Norway; Epilepsy Centre, (I.R.), Masaryk University, Hospital Ste Anne, and CEITEC-Neuroscience Centre, Brno, Czech Republic; Kuopio University Hospital and University of Eastern Finland (R.K., L.-M.V.); St. Ivan Rilski University Hospital (P.D., K. Minkin), Bulgaria; Epilepsiezentrum Kork (A.M.S., B.J.S.), Germany; Second Faculty of Medicine (A.K., P.K.,, P.M.), Charles University, Motol University Hospital, Prague, Czech Republic; Juhász Pál Epilepsy Centrum (Z.J., D.F.), National Institute of Clinical Neurosciences, Hungary; Reference Center for Refractory Epilepsy (E.C., P.B.), Ghent University Hospital, Belgium; and Department of Neurology and Neurosurgery (S. Rocka, R.M.), Vilnius University, Lithuania.

Objective: Resective surgery is effective in treating drug-resistant focal epilepsy, but it remains unclear whether improved diagnostics influence postsurgical outcomes. Here, we compared practice and outcomes over 2 periods 15 years apart.

Methods: Sixteen European centers retrospectively identified 2 cohorts of children and adults who underwent epilepsy surgery in the period of 1997 to 1998 (n = 562) or 2012 to 2013 (n = 736). Data collected included patient (sex, age) and disease (duration, localization and diagnosis) characteristics, type of surgery, histopathology, Engel postsurgical outcome, and complications, as well as imaging and electrophysiologic tests performed for each case. Postsurgical outcome predictors were included in a multivariate logistic regression to assess the strength of date of surgery as an independent predictor.

Results: Over time, the number of operated cases per center increased from a median of 31 to 50 per 2-year period ( = 0.02). Mean disease duration at surgery decreased by 5.2 years ( < 0.001). Overall seizure freedom (Engel class 1) increased from 66.7% to 70.9% (adjusted = 0.04), despite an increase in complex surgeries (extratemporal and/or MRI negative). Surgeries performed during the later period were 1.34 times (adjusted odds ratio; 95% confidence interval 1.02-1.77) more likely to yield a favorable outcome (Engel class I) than earlier surgeries, and improvement was more marked in extratemporal and MRI-negative temporal epilepsy. The rate of persistent neurologic complications remained stable (4.6%-5.3%, = 0.7).

Conclusion: Improvements in European epilepsy surgery over time are modest but significant, including higher surgical volume, shorter disease duration, and improved postsurgical seizure outcomes. Early referral for evaluation is required to continue on this encouraging trend.
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http://dx.doi.org/10.1212/WNL.0000000000005776DOI Listing
July 2018
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