Navigating Communication in Nursing Homes During COVID-19: Perspectives From Families, Healthcare Professionals, and Managers in Southern Switzerland-A Qualitative Study.

Objectives: This study aims to understand the effectiveness and challenges of communication strategies implemented to maintain contact between nursing home (NH) residents and their families during the COVID-19 pandemic, by considering the perspectives of families, healthcare professionals, and NH managers.

Methods: Using a qualitative research design, the study analyzed in-depth semi-structured interviews with key stakeholders (N = 34), including family members, NH staff, and managers.

Results: The study found that communication strategies like video calls, telephone calls, and window visits were generally appreciated and facilitated contact between residents and their families.

Physician-reported characteristics, representations, and ethical justifications of shared decision-making practices in the care of paediatric patients with prolonged disorders of consciousness.

Background: Despite consensus about the importance of implementing shared decision-making (SDM) in clinical practice, this ideal is inconsistently enacted today. Evidence shows that SDM practices differ in the degree of involvement of patients or family members, or in the amount of medical information disclosed to patients in order to "share" meaningfully in treatment decisions. Little is known on which representations and moral justifications physicians hold when realizing SDM.

Physicians' decision-making when managing pediatric patients with prolonged disorders of consciousness: A qualitative study.

Background And Purpose: Advances in medicine have resulted in treatments that can extend the survival of patients with prolonged disorders of consciousness (PDOC) for several years. However, several diagnostic and prognostic uncertainties remain, particularly in the care of pediatric patients. In the absence of international guidelines, we aimed to explore physicians' decision-making when managing pediatric patients with PDOC.

Physicians' Acceptance of Triage Guidelines in the Context of the COVID-19 Pandemic: A Qualitative Study.

One of the major ethical challenges posed by the Covid-19 pandemic comes in the form of fair triage decisions for critically ill patients in situations where life-saving resources are limited. In Spring 2020, the Swiss Academy of Medical Sciences (SAMS) issued specific guidelines on triage for intensive-care treatment in the context of the Covid-19 pandemic. While evidence has shown that the capacities of intensive care medicine throughout Switzerland were sufficient to take care of all critically ill patients during the first wave of the outbreak, no evidence is available regarding the acceptance of these guidelines by ICU staff.

Affective empathy predicts self-isolation behaviour acceptance during coronavirus risk exposure.

Health risk exposure during the global COVID-19 pandemic has required people to adopt self-isolation. Public authorities have therefore had the difficult task of sustaining such protective but stressful behaviour. Evidence shows that besides egoistic drives, the motivation for self-isolation behaviour could be altruistic.

Influence of Empathy Disposition and Risk Perception on the Psychological Impact of Lockdown During the Coronavirus Disease Pandemic Outbreak.

During the current COVID-19 pandemic, and especially in the absence of availability of an effective treatment or a vaccine, the main health measure is neither chemical nor biological, but behavioral. To reduce the exponential growth of infections due to the new coronavirus (SARS-CoV-2) and the resulting overburdening of the healthcare system, many European Countries, parts of the US and Switzerland gradually implemented measures of quarantine and isolation defined as lockdown. This consideration leads to the need to understand how individuals are motivated to protect themselves and others.

Hope and therapeutic privilege: time for shared prognosis communication.

Communicating an unfavourable prognosis while maintaining patient hope represents a critical challenge for healthcare professionals (HPs). Duty requires respect for the right to patient autonomy while at the same time not doing harm by causing hopelessness and demoralisation. In some cases, the need for therapeutic privilege is discussed.

New perspectives on substituted relational autonomy for shared decision-making in critical care.

In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives. Whereas patient-centred approaches are widely discussed and fostered, managing communication in complex, especially end-of-life, situations in open intensive care units is still a point of debate and a possible source of conflict and moral distress. In particular, healthcare teams are often sceptical about the growing role of families in shared decision-making and their ability to represent patients' preferences.

Sharing intimacy in "open" intensive care units.

Purpose: Opening intensive care units (ICUs) is particularly relevant because of a new Swiss law granting the relatives of patients without decision-making capability a central role in medical decisions. The main objectives of the study were to assess how the presence of relatives is viewed by patients, health care providers, and relatives themselves and to evaluate the perception of the level of intrusiveness into the personal sphere during admission.

Material And Methods: In a longitudinal and prospective design, qualitative questionnaires were submitted concomitantly to patients, relatives, and health care providers consecutively over a 6-month period.

Beneficial effects of a semi-intensive stroke unit are beyond the monitor.

Background And Purpose: Precise mechanisms underlying the effectiveness of the stroke unit (SU) are not fully established. Studies that compare monitored stroke units (semi-intensive type, SI-SU) versus an intensive care unit (ICU)-based mobile stroke team (MST-ICU) are lacking. Although inequalities in access to stroke unit care are globally improving, acute stroke patients may be admitted to Intensive Care Units for monitoring and followed by a mobile stroke team in hospital's lacking an SU with continuous cardiovascular monitoring.

Physical restraint in the ICU: does it prevent device removal?

Background: Physical restraint is frequently used in the intensive care setting but little is known regarding its clinical scenario and effectiveness in preventing adverse events (AEs), defined as device removal.

Methods: We carried out a prospective observational study in three Intensive Care Units on 120 adult high-risk patients. The effectiveness of physical restraint was evaluated using the propensity score methodology in order to obtain comparable groups.

Medical Humanities: a question of style.

The Medical Humanities go beyond bioethics, cross over multiple disciplines and represent a new way of perceiving, seeing and thinking about illness. They represent a different view that gives value to the human side of treatment, that recognizes in self-narration an authentic and living foundation. Today, the technical aspects of medicine need more than ever to be accompanied by content derived from the arts and social or human sciences that focus on other, but not less important, aspects of being sick or in health.

Adverse event reporting in adult intensive care units and the impact of a multifaceted intervention on drug-related adverse events.

Background: Adverse events (AEs) frequently occur in intensive care units (ICUs) and affect negatively patient outcomes. Targeted improvement strategies for patient safety are difficult to evaluate because of the intrinsic limitations of reporting crude AE rates. Single interventions influence positively the quality of care, but a multifaceted approach has been tested only in selected cases.

[Latin organ donation programme (LODP): an effective initiative to increase organ donation in Switzerland].

The 1st federal transplant law was enforced in July 2007 with the obligation to promote quality and efficiency in the procedures for organ and tissue donation for transplantation. The Latin organ donation programme (LODP) created in 2008 aims to develop organ donation in 17 public hospitals in 7 Latin cantons, covering 2.2 million people; 29% of the Swiss population.

Attitudes and behavior of young European adults towards the donation of organs--a call for better information.

Public perception of organ donation critically affects the availability of organ transplantation in the Western world. To assess the attitude of young adults towards the donation of organs and to investigate potential factors influencing their knowledge and actual behavior regarding organ transplantation, we evaluated a handout questionnaire survey of all Swiss-Italian recruits during six of the years 1989-98 (n = 7272). The attitude of recruits towards organ donation did not change significantly within the 10-year survey period: 61% of young men would personally donate their organs in the case of brain death, 13% would refuse, and 26% had not made up their mind.

The abdominal compartment syndrome. Clinical relevance.

Increased intra-abdominal pressure (IAP) may occur in a number of different situations encountered by intensivists, such as tense ascites, abdominal hemorrhage, use of military antishock trousers, abdominal obstruction, during laparoscopy, large abdominal tumors and peritoneal dialysis.1-3 Both clinical and experimental evidence indicate that increased IAP may adversely affect cardiac, renal, respiratory and metabolic functions.1-5 Despite this, increased IAP is rarely recognized and treated in Intensive Care Unit (ICU) settings.

Effect of prone positioning on the survival of patients with acute respiratory failure.

Background: Although placing patients with acute respiratory failure in a prone (face down) position improves their oxygenation 60 to 70 percent of the time, the effect on survival is not known.

Methods: In a multicenter, randomized trial, we compared conventional treatment (in the supine position) of patients with acute lung injury or the acute respiratory distress syndrome with a predefined strategy of placing patients in a prone position for six or more hours daily for 10 days. We enrolled 304 patients, 152 in each group.

Long-term safety of an early ACE-inhibitor treatment of patients with acute myocardial infarction: results of the 3 year follow-up period on 696 Swiss patients randomized to the ISIS-4 trial. ISIS-Switzerland Study Group.

Several large scale clinical trials showed that early ACE inhibitor treatment in patients with acute myocardial infarction reduced 30-day mortality. While the short-term evidence of benefit and risks appears to be consistent among trials, scarce data are available with respect to the long-term effects of short-term treatments. This study shows that the early reduction in mortality rate observed among patients treated with captopril persists for up to 3 years.

[Anxiety and stress in the nursing staff. A comparative study between intensive care and general wards].

We studied a population of 463 nurses working in intensive care units--ICUs--(distributed in 51 italian hospitals), and 216 nurses working in general medicine units (distributed in 17 italian hospitals). They we asked to fill in a form including: 1) general data and his/her work environment, and 2) some standardized scales (HAD A and D, STAI Y-1 and Y-2, MBI) for estimation of anxiety, depression and "burnout" syndrome. We used also the "P questions", evaluating the different situations of work environment causing anxiety.

[Medicine and humanism: clinical ethics and the community dimension of geriatrics].

Clinical ethics is generally related to the clinical bedside activity. Clinical ethics constitutes one aspect of bioethics. In particular, its aim consists in facilitating the solving of conflicts of values in practical care.

[Therapy of acute myocardial infarct (1994-1996) at non-university hospitals in Switzerland (CHAMI Study)].

The CHAMI study (Confederatio Helvetica Acute Myocardial Infarction) recorded the therapies administered for acute myocardial infarction in 520 consecutive patients between October 1994 and February 1996 at 10 non-academic hospitals in Switzerland. The patients in this group consisted of 363 men and 157 women with an average age of 63.2 years.

Determination of cardiac output during mechanical ventilation by electrical bioimpedance or thermodilution in patients with acute lung injury: effects of positive end-expiratory pressure.

Objective: To evaluate the usefulness of transthoracic electrical bioimpedance in sedated and paralyzed patients with acute lung injury during mechanical ventilation with and without early application of positive end-expiratory pressure (PEEP).

Design: Prospective, repeated-measures study.

Setting: University-affiliated intensive care center.