Laparoscopic incisional hernia repair is feasible and safe after liver transplantation

Incisional hernia is a common complication after liver transplantation. The current study evaluated incidence and risk factors for incisional hernia and compared laparoscopic and open hernia repair in terms of feasibility and outcome.

Am I (un)safe here? Chemotherapy patients' perspectives towards engaging in their safety

To assess chemotherapy patients' perceptions of safety and their attitudes towards participating in error-prevention strategies.

Is computer-assisted telephone triage safe? A prospective surveillance study in walk-in patients with non-life-threatening medical conditions

Background Patients often establish initial contact with healthcare institutions by telephone. During this process they are frequently medically triaged. Purpose To investigate the safety of computer-assisted telephone triage for walk-in patients with non-life-threatening medical conditions at an emergency unit of a Swiss university hospital. Methods This prospective surveillance study compared the urgency assessments of three different types of personnel (call centre nurses, hospital physicians, primary care physicians) who were involved in the patients' care process. Based on the urgency recommendations of the hospital and primary care physicians, cases which could potentially have resulted in an avoidable hazardous situation (AHS) were identified. Subsequently, the records of patients with a potential AHS were assessed for risk to health or life by an expert panel. Results 208 patients were enrolled in the study, of whom 153 were assessed by all three types of personnel. Congruence between the three assessments was low. The weighted κ values were 0.115 (95% CI 0.038 to 0.192) (hospital physicians vs call centre), 0.159 (95% CI 0.073 to 0.242) (primary care physicians vs call centre) and 0.377 (95% CI 0.279 to 0.480) (hospital vs primary care physicians). Seven of 153 cases (4.57%; 95% CI 1.85% to 9.20%) were classified as a potentially AHS. A risk to health or life was adjudged in one case (0.65%; 95% CI 0.02% to 3.58%). Conclusion Medical telephone counselling is a demanding task requiring competent specialists with dedicated training in communication supported by suitable computer technology. Provided these conditions are in place, computer-assisted telephone triage can be considered to be a safe method of assessing the potential clinical risks of patients' medical conditions.

Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count <200 cells/microL?

Current guidelines suggest that primary prophylaxis for Pneumocystis jiroveci pneumonia (PcP) can be safely stopped in human immunodeficiency virus (HIV)-infected patients who are receiving combined antiretroviral therapy (cART) and who have a CD4 cell count >200 cells/microL. There are few data regarding the incidence of PcP or safety of stopping prophylaxis in virologically suppressed patients with CD4 cell counts of 101-200 cells/microL.

Partnership Actions for Mitigating Syndromes (PAMS): Experience with a transdisciplinary tool in the NCCR North-South programme

Partnership Actions for Mitigating Syndromes (PAMS) are small transdisciplinary projects which bring scientific research insights from the NCCR North-South into policy and practice. They are implemented by researchers from different disciplines in collaboration with non-scientific actors. PAMS aim to implement and test approaches, methods and tools developed in research, in order to identify promising strategies and potentials for sustainable development. In this sense, they are solution-oriented. This paper will provide insights into our experience with PAMS, with a special focus on the implementation of transdisciplinarity and its outcomes. From 2001 to 2010, 77 PAMS were implemented in Africa, Asia and Latin America. An internal evaluation of the first 55 projects was conducted in 2006. Results of this evaluation led to a refinement and improvement of the tool. A second internal evaluation is currently underway in the NCCR North-South. This evaluation will provide an overview of 22 new PAMS. We will look at partners involved, project beneficiaries, activities implemented, outcomes achieved, and lessons learnt. In the first evaluation, transdisciplinarity was considered as “a form of collaboration within scientific fields … and as a form of continuous dialogue between research and society” (Messerli et al., 2007). The evaluation report concluded that this understanding of transdisciplinarity was not satisfactorily applied in the 55 projects. Only about half of the PAMS addressed mutual exchange between researchers and society. Some involved only one specific field of research and clearly lacked interdisciplinary co-operation, and most often knowledge was transferred mainly unilaterally from the scientific community to society, without society having any effect on science. It was therefore recommended to address transdisciplinarity more carefully in Phase 2 PAMS. The second evaluation, which is currently under way, is analysing whether and how this recommendation has been met, based on criteria defined in the NCCR North-South’s Outcome Monitoring Strategy. The analysis is focusing on partners with whom researchers interact and investigating whether practices have changed both in research and society. We are also exploring the role of researchers in PAMS. Preliminary results show that researchers can assume different roles, from direct implementation, mediation, and promotion of social learning between different actors, to giving advice as neutral outsiders.

Irrigation of continent catheterizable ileal pouches: tap water can replace sterile solutions because it is safe, easy, and economical

Continent catheterizable ileal pouches require regular irrigations to reduce the risk of bacteriuria and urinary tract infections (UTIs).

Unsecured intracranial aneurysms and induced hypertension in cerebral vasospasm: is induced hypertension safe?

Induced hypertension is an established therapy to treat cerebral vasospasm (CVS) following subarachnoid hemorrhage (SAH) to prevent delayed ischemic deficits. Currently, there is minimal evidence available assessing the risk of induced hypertension in the presence of unsecured aneurysms. The aim of this study was to investigate the impact of induced hypertension on the rupturing of unsecured aneurysms in treating CVS.