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Erni P.,Swiss Association of Pharmacists | von Overbeck J.,Bern Medical | Reich O.,Helsana Group | Ruggli M.,Swiss Association of Pharmacists
Research in Social and Administrative Pharmacy | Year: 2016

Background: The Swiss Pharmacists Association has launched a new collaborative project, netCare. Community pharmacists provide a standard form with structured triage based on decision trees and document findings. As a backup, they can collaborate with physicians via video consultation. Objective: The aim of the study was to evaluate the impact of this service on the Swiss health care system. Method: All pharmacists offering netCare completed two training courses, a course covering the most common medical conditions observed in primary health care and a specific course on all of the decision trees. The pharmacists were free to decide whether they would provide the usual care or offer netCare triage. The patient was also free to accept or refuse netCare. Pharmacists reported the type of ailment, procedure of the consultation, treatment, patient information and outcomes of the follow-up call on a standardized form submitted to the study center. Results: Pharmacists from 162 pharmacies performed 4118 triages over a period of 21 months. A backup consultation was needed for 17% of the cases. In follow-up calls, 84% of the patients who were seen only by pharmacists reported complete relief or symptom reduction. Conclusions: netCare is a low-threshold service by which pharmacists can manage common medical conditions with physician backup, if needed. This study showed that a pharmacist could resolve a large proportion of the cases. However, to be efficient and sustainable, this service must be fully integrated into the health care system. © 2015 Elsevier Inc.

Bonadonna P.,Allergy Unit | Zanotti R.,Azienda Ospedaliera Universitaria Integrata of Verona | Muller U.,Bern Medical
Current Opinion in Allergy and Clinical Immunology | Year: 2010

Purpose of Review: To analyse the association of systemic allergic hymenoptera sting reactions with mastocytosis and elevated baseline serum tryptase and to discuss diagnosis and treatment in patients with both diseases. Recent findings: In recent large studies on patients with mastocytosis a much higher incidence of severe anaphylaxis following hymenoptera stings than in the normal population was documented. In patients with hymenoptera venom allergy, elevated baseline tryptase is strongly associated with severe anaphylaxis. Fatal sting reactions were reported in patients with mastocytosis, notably after stopping venom immunotherapy. During venom immunotherapy most patients with mastocytosis are protected from further sting reactions. Based on these observations immunotherapy for life is recommended for patients with mastocytosis and venom allergy. The incidence of allergic side-effects is increased in patients with mastocytosis and elevated baseline tryptase, especially in those allergic to Vespula venom. Premedication with antihistamines, or omalizumab in cases with recurrent severe side-effects, can be helpful. Summary: In all patients with anaphylaxis following hymenoptera stings, baseline serum tryptase should be determined. A value above 11.4 μg/l is often due to mastocytosis and indicates a high risk of very severe anaphylaxis following re-stings. Venom immunotherapy is safe and effective in this situation. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Michailov M.L.,National Sports Academy | Morrison A.,Bern Medical | Ketenliev M.M.,Directorate of Control and Management of Sports Preparation | Pentcheva B.P.,Directorate of Control and Management of Sports Preparation
International Journal of Sports Physiology and Performance | Year: 2015

Traditional treadmill or bicycle ergometry neglects the upper-body musculature that predominantly limits or terminates rock-climbing performance (ie, the inability to continually pull up one's body mass or "hang on"). Purpose: To develop an incremental maximal upper-body ergometer test (UBT) to evaluate climbers' aerobic fitness and sport-specific work capacity and to compare these results with a traditional treadmill protocol. Methods: Eleven elite sport climbers (best redpoint grade Fr.8b) performed a UBT on a vertically mounted rowing ergometer and, on a separate occasion, performed a maximal incremental treadmill test (TMT). Cardiorespiratory parameters were measured continuously. Lactate (La) samples were collected. Results: Peak oxygen consumption (VO2peak) and heart rate in UBT and TMT were 34.1 ± 4.1 vs 58.3 ± 2.6 mL · min-1 · kg-1 and 185 ± 8 vs 197 ± 8 beats/min, respectively, and both variables were of significantly lower magnitude during UBT (P < .001). End-of-test La levels for UBT (11.9 ± 1.7 mmol/L) and TMT (12.3 ± 2.5 mmol/L) were similar (P = .554). Treadmill VO2peak was not correlated with either upper-body (UB) VO2peak (P = .854) or redpoint and on-sight climbing grade ability (P > .05). UB VO2peak and peak power output per kg body mass were both strongly correlated (P < .05) with climbing grade ability. The highest correlation coefficient was calculated between current on-sight grade and UB VO2peak (r = .85, P = .001). Conclusion: UBT aerobic- and work-capacity results were strongly correlated to climbing-performance variables and reflected sport-specific fatigue, and TMT results were not. UBT is preferred to TMT to test and monitor dedicated and elite rock climbers' training status. © 2015 Human Kinetics, Inc.

Seiffert S.N.,University of Bern | Perreten V.,University of Bern | Johannes S.,Rehaklinik Bellikon | Droz S.,University of Bern | And 2 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2014

Here, we report a case of OXA-48-producing Salmonella enterica serovar Kentucky of sequence type 198 (ST198) from perianal screening cultures of a patient transferred from Libya to Switzerland. The blaOXA-48 gene was carried by Tn1999.2 and located on an ∼60-kb IncL/M plasmid. This Salmonella strain also possessed the blaVEB-8, aac(6)-Ib, tet(A), sul1, and mphA resistance genes and substitutions in GyrA (Ser83Phe and Asp87Asn) and ParC (Ser80Ile). This finding emphasizes that prompt screening strategies are essential to prevent the dissemination of carbapenemase producers imported from countries where they are endemic. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Claus C.,University of Bern | Riether C.,University of Bern | Schurch C.,University of Bern | Matter M.S.,University of Bern | And 3 more authors.
Cancer Research | Year: 2012

Signaling of the TNF receptor superfamily member CD27 activates costimulatory pathways to elicit T- and B-cell responses. CD27 signaling is regulated by the expression of its ligand CD70 on subsets of dendritic cells and lymphocytes. Here, we analyzed the role of the CD27-CD70 interaction in the immunologic control of solid tumors in Cd27-deficient mice. In tumor-bearing wild-type mice, the CD27-CD70 interaction increased the frequency of regulatory T cells (Tregs), reduced tumor-specific T-cell responses, increased angiogenesis, and promoted tumor growth. CD27 signaling reduced apoptosis of Tregs in vivo and induced CD4+ effector T cells (Teffs) to produce interleukin-2, a key survival factor for Tregs. Consequently, the frequency of Tregs and growth of solid tumors were reduced in Cd27-deficient mice or in wild-type mice treated with monoclonal antibody to block CD27 signaling. Our findings, therefore, provide a novel mechanism by which the adaptive immune system enhances tumor growth and may offer an attractive strategy to treat solid tumors. ©2012 AACR.

Bernhard H.,Bern Medical | Stieger C.,University of Bern | Perriard Y.,Ecole Polytechnique Federale de Lausanne
IEEE Transactions on Biomedical Engineering | Year: 2011

A new hearing therapy based on direct acoustic cochlear stimulation was developed for the treatment of severe to profound mixed hearing loss. The device efficacy was validated in an initial clinical trial with four patients. This semi-implantable investigational device consists of an externally worn audio processor, a percutaneous connector, and an implantable microactuator. The actuator is placed in the mastoid bone, right behind the external auditory canal. It generates vibrations that are directly coupled to the inner ear fluids and that, therefore, bypass the external and the middle ear. The system is able to provide an equivalent sound pressure level of 125 dB over the frequency range between 125 and 8000Hz. The hermetically sealed actuator is designed to provide maximal output power by keeping its dimensions small enough to enable implantation. A network model is used to simulate the dynamic characteristics of the actuator to adjust its transfer function to the characteristics of the middle ear. The geometry of the different actuator components is optimized using finite-element modeling. © 2010 IEEE.

Seiler J.P.,Bern Medical
Therapeutic Innovation & Regulatory Science | Year: 2013

User-friendliness is one of those terms that take on different meanings when used by different people. Even from the point of view of a single group of users, for example, regulatory agency assessors, there are many facets to be looked at. The public, on the one hand, expects rapid, but also thorough, cautious, and reliable assessment and registration procedures from regulatory agencies in order to ensure its fast access to new, safe, and effective medicines. The pharmaceutical industry, on the other hand, expects rapid, reliable, and unbureaucratic assessment and registration procedures from regulatory agencies in order to gain fast access to the markets for their products. To ensure an optimal outcome of the regulatory process several components have to be taken care of by the submitter, which can be summarized under the terms of “user-friendliness,” or alternatively “ease of use.” The ease with which an evaluation can be performed is first dependent on the format. The introduction of the future Common Technical Document will certainly lead to a major improvement over the present situation. Second, the material, scientific content of the dossier has to be presented in a logical and convincing way, making it easy for the assessor to follow the reasonings in the development of the various quality, safety, and efficacy issues and the conclusions drawn therefrom. Third, the dossier should be carefully controlled for its formal quality, that is, for clarity of print and pictures, for completeness of copies, for clarity and intelligibility of the language, and so forth. In this context, it must be remembered that, although it can be assumed that most assessors worldwide understand the English language, in most cases this will be only their second language, leaving them vulnerable to slips of spelling, grammar, or other linguistic or textual errors that will hamper the easy understanding and readability of the text, and user-friendliness must, therefore, also be seen under the aspect of possible problems of language barriers. © 1999, Drug Information Association. All rights reserved.

Guttormsen S.,Bern Medical
Swiss medical weekly | Year: 2013

A new Swiss federal licencing examination for human medicine (FLE) was developed and released in 2011. This paper describes the process from concept design to the first results obtained on implementation of the new examination. The development process was based on the Federal Act on University Medical Professions and involved all national stakeholders in this venture. During this process questions relating to the assessment aims, the assessment formats, the assessment dimensions, the examination content and necessary trade-offs were clarified. The aims were to create a feasible, fair, valid and psychometrically sound examination in accordance with international standards, thereby indicating the expected knowledge and skills level at the end of undergraduate medical education. Finally, a centrally managed and locally administered examination comprising a written multiple-choice element and a practical " clinical skills" test in the objective structured clinical examination (OSCE) format was developed. The first two administrations of the new FLE show that the examination concept could be implemented as intended. The anticipated psychometric indices were achieved and the results support the validity of the examination. Possible changes to the format or content in the future are discussed.

L'Italien A.J.,Bern Medical | L'Italien A.J.,University of North Carolina at Chapel Hill
Emergency Medicine Clinics of North America | Year: 2013

The management of cardiovascular emergencies is a fundamental component of the practice of an emergency practitioner. Delays in the evaluations and management can lead to significant morbidity or mortality. It is of vital importance to be familiar with procedures such as pericardiocentesis, cardioversion, defibrillation, temporary pacing, and options for the management of tachyarrhythmias. This article discusses the most common cardiovascular procedures encountered in an emergency setting, including the indications, contraindications, equipment, technique, and complications for each procedure. © 2013 Elsevier Inc.

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