Hopital du Valais

Sion, Switzerland

Hopital du Valais

Sion, Switzerland
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Ehlinger M.,University of Strasbourg | Brinkert D.,University of Strasbourg | Besse J.,University of Strasbourg | Adam P.,University of Strasbourg | And 2 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2011

The incidence of femoral fracture on hip prosthesis is increasing. Plate fixation is the method of choice when the prosthesis is stable. In fracture with proximal extension, the quality of the bone fixation is critical and, despite the development of anatomic plates, may be endangered when there are too few proximal screws. To resolve this issue, we recommend using a reversed LCP™ anatomic distal femoral Less Invasive Stabilization System (LISS™) locking plate: e.g., a left distal femoral plate for femoral fracture on right-hip implant. This presents several advantages: minimally invasive surgery, the introduction of the plate being facilitated by the LISS™ ancillary; ease of locking, also thanks to the ancillary; and, above all, multiple proximal trochanteric fixation thanks to the form of this anatomic distal LISS™ plate, improving proximal bone fixation. The present technical note seeks to illustrate the interest of using a " reversed" plate, in terms of simplicity of fitting and quality of reduction and consolidation, while also specifying the associated limitations and tolerance. © 2011 Elsevier Masson SAS.

Pasquier M.,University of Lausanne | Zurron N.,Intensive Care Medicine and Emergency Medicine | Weith B.,Intensive Care Medicine and Emergency Medicine | Turini P.,Hopital du Valais | And 3 more authors.
High Altitude Medicine and Biology | Year: 2014

Background: According to the Swiss hypothermia clinical staging, patients with stage III are unconscious with preserved vital signs, with core temperature usually between 24° and 28°C. With stage IV, vital signs are absent with core temperature <24°C. Aims: To describe a patient presenting with HT stage III with vital signs but a core temperature of <24°C, and to search for similar patients in the medical literature. Materials and methods: MEDLINE was used to search for cases of deep accidental hypothermia (<24°C) and preserved vital signs. Results: We found 22 cases in addition to our case (n=23). Median age was 44 years (IQR 36; range 4-83) and median core temperature 22°C (IQR 1.7; 17-23.8). Vital signs were often minimal. Seven patients developed ventricular fibrillation (VF). Twenty patients survived with excellent neurological outcome. Conclusions: Vital signs can be present in hypothermic patients with core temperature <24°C. In deeply hypothermic patients, a careful check and prolonged check of vital functions should be made, as vital signs may be minimal. The clinical Swiss staging remains valuable in the prehospital evaluation of hypothermic patients; its correlation with core temperature should be better defined. © Copyright 2014, Mary Ann Liebert, Inc. 2014.

Garin N.,University of Geneva | Genne D.,Hopital Neuchatelois La Chaux de Fonds | Carballo S.,University of Geneva | Chuard C.,Hopital Cantonal | And 10 more authors.
JAMA Internal Medicine | Year: 2014

IMPORTANCE: The clinical benefit of adding a macrolide to a β-lactam for empirical treatment of moderately severe community-acquired pneumonia remains controversial. OBJECTIVE: To test noninferiority of a β-lactam alone compared with a β-lactam and macrolide combination in moderately severe community-acquired pneumonia. DESIGN, SETTING, AND PARTICIPANTS: Open-label, multicenter, noninferiority, randomized trial conducted from January 13, 2009, through January 31, 2013, in 580 immunocompetent adult patients hospitalized in 6 acute care hospitals in Switzerland for moderately severe community-acquired pneumonia. Follow-up extended to 90 days. Outcome assessors were masked to treatment allocation. INTERVENTIONS: Patients were treated with a β-lactam and a macrolide (combination arm) or with a β-lactam alone (monotherapy arm). Legionella pneumophila infection was systematically searched and treated by addition of a macrolide to the monotherapy arm. MAIN OUTCOMES AND MEASURES: Proportion of patients not reaching clinical stability (heart rate <100/min, systolic blood pressure >90mmHg, temperature <38.0° C, respiratory rate <24/min, and oxygen saturation >90% on room air) at day 7. RESULTS After 7 days of treatment, 120 of 291 patients (41.2%) in the monotherapy arm vs 97 of 289 (33.6%) in the combination arm had not reached clinical stability (7.6%difference, P = .07). The upper limit of the 1-sided 90% CI was 13.0%, exceeding the predefined noninferiority boundary of 8%. Patients infected with atypical pathogens (hazard ratio [HR], 0.33; 95%CI, 0.13-0.85) or with Pneumonia Severity Index (PSI) category IV pneumonia (HR, 0.81; 95%CI, 0.59-1.10) were less likely to reach clinical stability with monotherapy, whereas patients not infected with atypical pathogens (HR, 0.99; 95%CI, 0.80-1.22) or with PSI category I to III pneumonia (HR, 1.06; 95%CI, 0.82-1.36) had equivalent outcomes in the 2 arms. There were more 30-day readmissions in the monotherapy arm (7.9%vs 3.1%, P = .01). Mortality, intensive care unit admission, complications, length of stay, and recurrence of pneumonia within 90 days did not differ between the 2 arms. CONCLUSIONS AND RELEVANCE: We did not find noninferiority of β-lactam monotherapy in patients hospitalized for moderately severe community-acquired pneumonia. Patients infected with atypical pathogens or with PSI category IV pneumonia had delayed clinical stability with monotherapy. Copyright 2014 American Medical Association. All rights reserved.

Moor B.K.,Hopital du Valais | Ehlinger M.,Hopital Hautepierre | Arlettaz Y.,Hopital du Valais
Orthopaedics and Traumatology: Surgery and Research | Year: 2012

Background: During the last decades, intramedullary nailing has become the standard treatment for diaphyseal fractures of long bones. Numerous innovative techniques and devices have been proposed to simplify distal locking. Each has its own limitations and, as a result, the fluoroscopy-dependent " free-hand technique" remains the most popular method. However, radiation exposure to the patient and operating room staff remains a concern. Methods: Before the development of a new radiation-independent, nail-mounted targeting system, we mathematically analyzed the aiming accuracy that such a system has to achieve. The correctness of this mathematical model was evaluated using a mechanical testing apparatus. Findings: We found a quite large targeting range for the unimpeded passage of the drill bit through the locking hole of a given nail. Important degrees of nail bending can thereby be compensated. As predicted by the mathematical formula, a 4-mm drill bit passed the distal locking hole of a 320/11. mm femoral nail up to a deflection of ±13. mm in the coronal plane. Interpretation: This mathematical model can be considered to be an additional tool for the development of new targeting devices. Combining our mathematical model with data previously published, not only torsional deformation along the longitudinal axis of the nail but also bending in the coronal plane can approximately be neglected. Hence, the three-dimensional aiming process can be simplified to the determination of the interlocking hole of the nail in the sagittal plane provided that the insertion-induced nail deformation in vivo stays in the range of that observed in vitro. Level of evidence: Level III. Basic sciences control study. © 2011 Elsevier Masson SAS.

Meier P.,University of Lausanne | Bonfils R.M.,Hopital du Valais | Vogt B.,University of Lausanne | Burnand B.,University of Lausanne | Burnier M.,University of Lausanne
Clinical Journal of the American Society of Nephrology | Year: 2011

Background and objectives: Despite modern treatment, the case fatality rate of hospital-acquired acute kidney injury (HA-AKI) is still high. We retrospectively described the prevalence and the outcome of HA-AKI without nephrology referral (nrHA-AKI) and late referred HA-AKI patients to nephrologists (lrHA-AKI) compared with early referral patients (erHA-AKI) with respect to renal function recovery, renal replacement therapy (RRT) requirement, and in-hospital mortality of HA-AKI. Design, setting, participants, & measurements: Noncritically ill patients admitted to the tertiary care academic center of Lausanne, Switzerland, between 2004 and 2008 in the medical and surgical services were included. Acute kidney injury was defined using the Acute Kidney Injury Network (AKIN) classification. Results: During 5 years, 4296 patients (4.12% of admissions) experienced 4727 episodes of HA-AKI during their hospital stay. The mean ± SD age of the patients was 61 ± 15 years with a 55% male predominance. There were 958 patients with nrHA-AKI (22.3%) and 2504 patients with lrHA-AKI (58.3%). RRT was required in 31% of the patients with lrHA-AKI compared with 24% of the patients with erHA-AKI. In the multiple risk factor analysis, compared with erHA-AKI, nrHA-AKI and lrHA-AKI were significantly associated with worse renal outcome and higher in-hospital mortality. Conclusions: These data suggest that HA-AKI is frequent and the patients with nrHA-AKI or lrHA-AKI are at increased risk for in-hospital morbidity and mortality. © 2011 by the American Society of Nephrology.

Coutaz M.,Hopital du Valais | Morisod J.,Hopital du Valais
Revue Medicale Suisse | Year: 2012

One hundred seventy patients (average age 79.9 years) with preserved cognitive faculties agreed to complete a questionnaire on the costs caused by their health conditions, the guilt they feel due to these costs, and their eventual resort to the Exit association. 48% answered that health care cost too much to the community, 10% reported feeling guilty about the potential costs generated by a consultation with their physician. 98 patients knew about the Exit association : 26% considered that resorting to Exit was a way to reduce health costs, 30% a way to avoid being an economic burden to their family and 34% a way to die with dignity. Our results indicate that economic pressure on medical costs is a source of guilt for older citizens, so much so that one in 10 patients considers resorting to assisted sucide for fear of costing too much to the community.

Coutaz M.,Hopital du Valais
Revue Medicale Suisse | Year: 2014

Hip fracture management by the geriatrician demands a close cooperation with orthopedic surgeons and a interdisciplinary approach with the implementation of protocole-driven care to standardize the care of most patients. From admission to discharge this orthogeriatric management is based on the comprehensive geriatric assessment to reduce the delays in surgery, the occurence of delirium or the most postoperative complications. This collaborative model of care seems to have the potential to improve function, admissions to nursing homes and mortality outcomes compared with usual care of geriatric patient with hip fracture.

Caring for a patient with dementia who lives at home, sometimes alone, presents a constant challenge for general practitioners. This article uses a clinical vignette to explore the initiation of medical care and treatment in an elderly patient with dementia. We specifically address how to inform the patient and family of the initial diagnosis and important issues to discuss from the start. We also examine issues such as delirium, medication adjustments, behavioral difficulties, feeding, and treatment of associated pathologies such as hypertension and diabetes.

Therapeutic hypnosis: a relational art using attention with the intention to treat. The definition of hypnosis most commonly formulated nowadays by practitioners does not adequately meet the threefold demands of the patient's nformed consent, express formulation of the caregiver's intentions, and demonstration of the therapy's efficacy. This common definition of therapeutic hypnosis needs updating, to enable the therapists who offer it to their p atients to adjust their relational aptitudes to the scientific, deontological and ethical needs of the contemporary therapeutic relationship. On the basis of semantic, comparative and ethical considerations, this article concludes on a definition of medical and therapeutic hypnosis founded on current knowledge of attention and therapy, adapted to the demands of the psychothera-peutic context specific to contemporary society.

Coutaz M.,Hopital du Valais
European Geriatric Medicine | Year: 2014

Increased life expectancy, which reflects progress in living conditions, medical knowledge and technology, has given rise to an aging of the population. Thus, the number of older subjects requiring care has increased. As a result, the resources that modern state must devote to healthcare are increasing, directly affecting the cost of health insurance premiums to taxpayers. This has resulted in a certain social stigma surrounding medical costs of older persons, causing them to feel insecure and guilty, sometimes to the point where they forgo care or even envisage assisted suicide, lest they become an economic burden on their loved ones. Explicit rationing of access to care or reimbursement of medical services does not seem to globally reduce healthcare costs (reduction of outpatient costs, but a strong increase in hospital costs). Therefore, an ethical approach established equitably and knowingly through shared decision-making by clinicians and patients could consent to omitting certain diagnostic procedures or onerous and futile care, thereby, contributing, in parallel, to restricting increases in health costs. © 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society.

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