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Article ; Online: Weekly Internal Ethical Case Discussions in an ICU-Results Based on 9 Years of Experience With a Highly Structured Approach.

Meyer-Zehnder, Barbara / Barandun Schäfer, Ursi / Wesch, Conrad / Reiter-Theil, Stella / Pargger, Hans

Critical care explorations

2021 Volume 3, Issue 3, Page(s) e0352

Abstract: Objectives: Various ethical challenges are prevalent in ICUs. In order to handle these problems, a highly structured internal ethical case discussion within the multiprofessional team was implemented in 2011 in a Swiss ICU and has been regularly ... ...

Abstract	Objectives: Various ethical challenges are prevalent in ICUs. In order to handle these problems, a highly structured internal ethical case discussion within the multiprofessional team was implemented in 2011 in a Swiss ICU and has been regularly practiced almost weekly until present. To explore the results of all ethical case discussions taking place in a general ICU and to discuss the outcomes of the patients. To identify the conditions facilitating the implementation of regular ethical case discussions. Design: Retrospective case series analysis. Setting: Mixed academic ICU. Patients and intervention: All patients who had an ethical case discussion between January 2011 and December 2019 following the approach called Modular, Ethical, Treatment decisions, Allocation of resources at the micro-level, and Process. Measurements and main results: Weekly ethical case discussions held regularly on a fixed date were found to be practical for the observed ICU. A total of 314 ethical case discussions were realized in 281 patients. Median patient age was 70 years (interquartile range, 62-77 yr); two thirds were men. The results were categorized into the following groups: established therapy continues, complications to be treated ( Conclusions: Regular ethical case discussions can be successfully implemented, enabling careful review of the patient's will and balancing it with the prognosis of the disease. This facilitates a necessary change of the therapeutic goal whenever appropriate.
Language	English
Publishing date	2021-03-15
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000352
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Article ; Online: Advance Directives in the Neurocritically Ill: A Systematic Review.

Sutter, Raoul / Meyer-Zehnder, Barbara / Baumann, Sira M / Marsch, Stephan / Pargger, Hans

Critical care medicine

2020 Volume 48, Issue 8, Page(s) 1188–1195

Abstract: Objectives: To determine the frequency of advance directives or directives disclosed by healthcare agents and their influence on decisions to withdraw/withhold life-sustaining care in neurocritically ill adults.: Data sources: PubMed, Embase, and ... ...

Abstract	Objectives: To determine the frequency of advance directives or directives disclosed by healthcare agents and their influence on decisions to withdraw/withhold life-sustaining care in neurocritically ill adults. Data sources: PubMed, Embase, and Cochrane databases. Study selection: Screening was performed using predefined search terms to identify studies describing directives of neurocritically ill patients from 2000 to 2019. The review was registered prior to the screening process (International Prospective Register of Systematic Reviews identification number 149185). Data extraction: Data were collected using standardized forms. Primary outcomes were the frequency of directives and associated withholding/withdrawal of life-sustaining care. Data synthesis: Out of 721 articles, 25 studies were included representing 35,717 patients. The number of studies and cohort sizes increased over time. A median of 39% (interquartile range, 14-72%) of patients had directives and/or healthcare agents. The presence of directives was described in patients with stroke, status epilepticus, neurodegenerative disorders, neurotrauma, and neoplasms, with stroke patients representing the largest subgroup. Directives were more frequent among patients with neurodegenerative disorders compared with patients with other illnesses (p = 0.043). In reference to directives, care was adapted in 71% of European, 50% of Asian, and 42% of American studies, and was withheld or withdrawn more frequently over time with a median of 58% (interquartile range, 39-89%). Physicians withheld resuscitation in reference to directives in a median of 24% (interquartile range, 22-70%). Conclusions: Studies regarding the use and translation of directives in neurocritically ill patients are increasing. In reference to directives, care was adapted in up to 71%, withheld or withdrawn in 58%, and resuscitation was withheld in every fourth patient, but the quality of evidence regarding their effects on critical care remains weak and the risk of bias high. The limited number of patients having directives is worrisome and studies aiming to increase the use and translation of directives are scarce. Efforts need to be made to increase the perception, use, and translation of directives of the neurocritically ill.
MeSH term(s)	Advance Directives ; Critical Illness/therapy ; Humans ; Nervous System Diseases/therapy ; Withholding Treatment
Language	English
Publishing date	2020-07-13
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000004388
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Article: Control of Raw Pork Liver Sausage Production Can Reduce the Prevalence of HEV Infection.

Ripellino, Paolo / Pianezzi, Enea / Martinetti, Gladys / Zehnder, Cinzia / Mathis, Barbara / Giannini, Petra / Forrer, Nicola / Merlani, Giorgio / Dalton, Harry R / Petrini, Orlando / Bihl, Florian / Fontana, Stefano / Gobbi, Claudio

Pathogens (Basel, Switzerland)

2021 Volume 10, Issue 2

Abstract: After an acute hepatitis E (HEV) outbreak in Southern Switzerland, in January 2017 the local public health authorities started an active program of food chain control and public education. In this retrospective study, we analysed all laboratory-confirmed ...

Abstract	After an acute hepatitis E (HEV) outbreak in Southern Switzerland, in January 2017 the local public health authorities started an active program of food chain control and public education. In this retrospective study, we analysed all laboratory-confirmed acute cases of HEV infection diagnosed between 2014 and 2020. In the period before the public health intervention, the number of cases increased steadily from 2014 (4 of 40 tests, 10%) reaching a peak in the last quarter of 2016 (42 of 285 tests, 14.7 %). Afterwards, the number of positive cases decreased steadily, reaching its lowest value (0.3%) in the second quarter of 2019. There was a statistically significant difference between the frequency of positive cases and period of testing, i.e., before and after the introduction of the public health interventions. Our study shows that active public health measures to control sausages containing raw pork liver can reduce the prevalence of HEV infection.
Language	English
Publishing date	2021-01-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens10020107
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Article: Dermatologische Klinik des Universitätsspitals Basel

Hartmann, Karin / Brenner, Maja / Brandt, Oliver / Contassot, Emmanuel / Cvijetic, Ivana / Erni, Barbara / Geiges, Michael / Izakovic, Jan / Kunz, Michael / Merkel, Tamara / Müller, Alina / Mühleisen, Beda / Müller, Simon / Schmidt, Veronika / Sonntag, Anne-Katharina / Vasconcelos, Roberta / Zehnder, Mara / Navarini, Alexander A.

Aktuelle Dermatologie

2023 Volume 49, Issue 10, Page(s) 422–434

Abstract: Die Dermatologische Klinik des Universitätsspitals Basel vereint die Disziplinen Dermatologie, Venerologie und Allergologie inkl. klinischer Immunologie. Sie zeichnet sich durch Patientenversorgung, Forschung und Weiterbildung auf universitärem Niveau ... ...

Abstract	Die Dermatologische Klinik des Universitätsspitals Basel vereint die Disziplinen Dermatologie, Venerologie und Allergologie inkl. klinischer Immunologie. Sie zeichnet sich durch Patientenversorgung, Forschung und Weiterbildung auf universitärem Niveau aus. Mit ihrer 109-jährigen Geschichte bietet die Klinik ein breites Spektrum an evidenzbasierten Möglichkeiten in Diagnostik und Therapie. Unser Team erforscht und integriert kontinuierlich die neuesten Möglichkeiten der medizinischen und ästhetischen Dermatologie, der Allergologie, der 3D-Hautkrebsvorsorge und der Mohs-Chirurgie. Neben der Dermatologischen Poliklinik mit allgemeiner Sprechstunde und Notfalldienst verfügt die Klinik über eine wachsende Allergologische Poliklinik und eine stationäre Dermatologie mit 12 Betten, die ein breites Spektrum moderner dermatologischer Behandlungen anbietet. Hinzu kommt die 2019 gegründete Margarethenklinik als Zentrum für Ästhetik und Rekonstruktion. Verschiedene Spezialsprechstunden, eine Abteilung für Dermatopathologie, 2 Operationssäle sowie Bereiche für Lehre und Forschung runden das umfassende Angebot ab. Schwerpunkte der klinischen Forschung sind entzündliche Hauterkrankungen, allergologische Erkrankungen und Dermatoonkologie. Die Klinik forscht intensiv im Bereich der Biomedizin und der digitalen Dermatologie, insbesondere unter Verwendung von KI-Techniken zur Analyse von Hautbildern. Sie ist bestrebt, klinische Innovationen in der Dermatologie und Allergologie voranzutreiben mit Schwerpunkt auf digitalen Lösungen und der Verbindung von medizinischer und ästhetischer Dermatologie.
Language	German
Publishing date	2023-10-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2072318-0
ISSN	1438-938X ; 0340-2541
ISSN (online)	1438-938X
ISSN	0340-2541
DOI	10.1055/a-2122-7078
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Article ; Online: Alpine and lowland grazing differentially alter the reproductive tract redox milieu and amino acid composition in cattle.

Chiumia, Daniel / Hankele, Anna-Katharina / Drews, Barbara / Zehnder, Tobias / Berard, Joel / Giesbertz, Pieter / Ulbrich, Susanne E / Giller, Katrin

Animal reproduction science

2019 Volume 213, Page(s) 106268

Abstract: ... glutathione S-transferase alpha 2, glutathione synthetase (GSS)) and the endometrium (catalase ...

Abstract	An alpine environment is unique due to pasture biodiversity, with an abundant content of natural antioxidant polyphenols. The present study investigated the effects of lowland and alpine grazing on the oviduct and uterine tissue redox status and amino acid concentrations in plasma and reproductive fluids. In the first experiment, heifers grazed on lowland (H-LOW: n = 13) and on alpine (H-ALP: n = 15) pastures. In the second experiment, heifers grazed on the same lowland (HS-LOW: n = 6) and on a different alpine (HS-ALP: n = 6) pasture. The abundance of mRNA transcripts for antioxidant enzymes in the oviduct (glutathione S-transferase alpha 2, glutathione synthetase (GSS)) and the endometrium (catalase, glutathione-disulfide reductase, GSS) was less (P <  0.05), and for glutathione peroxidase 4 in the endometrium greater (P =  0.006) in the H-LOW than in the H-ALP group. The abundance of mRNA transcript for catalase was less in the endometrium in the H-LOW than in the H-ALP (P =  0.001) group. Catalase and NAD(P)H quinone dehydrogenase 1 concentrations in the oviduct were greater in the HS-LOW than in the HS-ALP group (P <  0.05). Of 32 amino acids analysed, there were differences in concentrations in the H-LOW and H-ALP group of 13, seven and 15 in plasma, oviduct and uterine fluids, respectively (P <  0.05). Comparing the HS-LOW to the HS-ALP groups, there were 13, one and three amino acids in the plasma, oviduct and uterine fluids, respectively, that were differentially abundant (P <  0.05). The grazing systems had some effect on the redox status and amino acid patterns in reproductive tissues.
MeSH term(s)	Altitude ; Amino Acids/chemistry ; Amino Acids/metabolism ; Animal Husbandry ; Animals ; Cattle/physiology ; Female ; Genitalia, Female/chemistry ; Genitalia, Female/metabolism ; Oxidation-Reduction
Chemical Substances	Amino Acids
Language	English
Publishing date	2019-12-23
Publishing country	Netherlands
Document type	Clinical Trial, Veterinary ; Journal Article
ZDB-ID	429674-6
ISSN	1873-2232 ; 0378-4320
ISSN (online)	1873-2232
ISSN	0378-4320
DOI	10.1016/j.anireprosci.2019.106268
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Article ; Online: How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model.

Meyer-Zehnder, Barbara / Albisser Schleger, Heidi / Tanner, Sabine / Schnurrer, Valentin / Vogt, Deborah R / Reiter-Theil, Stella / Pargger, Hans

BMC medical ethics

2017 Volume 18, Issue 1, Page(s) 16

Abstract: Background: As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which ... ...

Abstract	Background: As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. Methods: A medical ethics decision-making model called METAP was introduced on three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Results: Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing (explicit) ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Conclusions: Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and staff can be overcome when people are convinced that the benefits justify the effort.
MeSH term(s)	Aged ; Attitude of Health Personnel ; Decision Making/ethics ; Ethics, Medical ; Female ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Models, Theoretical ; Personnel, Hospital/supply & distribution ; Surveys and Questionnaires ; Workload
Language	English
Publishing date	2017-02-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2041552-7
ISSN	1472-6939 ; 1472-6939
ISSN (online)	1472-6939
ISSN	1472-6939
DOI	10.1186/s12910-017-0174-0
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Article: Atrial fibrillation: estimated excess rate of stroke due to lacking adherence to guidelines.

Zehnder, Barbara S / Schaer, Beat A / Jeker, Urs / Cron, Thomas A / Osswald, Stefan

Swiss medical weekly

2006 Volume 136, Issue 47-48, Page(s) 757–760

Abstract: Questions under study: Many patients with atrial fibrillation (AF), risk factors for stroke and no obvious contraindications do not receive oral anticoagulation. Estimations of the increased rate of stroke due to neglected anticoagulation, particularly ... ...

Abstract	Questions under study: Many patients with atrial fibrillation (AF), risk factors for stroke and no obvious contraindications do not receive oral anticoagulation. Estimations of the increased rate of stroke due to neglected anticoagulation, particularly in an elderly, non-selected population, are unknown. Methods: Consecutive patients with paroxysmal or permanent atrial fibrillation admitted to the medical or surgical department of our hospital for any reason were studied. Risk factors for stroke and contraindications for anticoagulation were recorded. Estimations of the increased rate of cerebrovascular events due to neglected anticoagulation were based on data of a large meta-analysis. Patients were further stratified into different age and risk groups. Results: 484 patients with a mean age of 75 (12) years were studied, 45% were female. 237 patients had no oral anticoagulation at hospital discharge, despite guideline recommendations. Contraindications for anticoagulation were found in 85 (36%) of these patients, resulting in 152 patients with neglected anticoagulation (31% of all patients with AF). We estimated that, if all those patients would have been treated according to guidelines, 7.4 strokes per year could be prevented in the study population. The estimated rate of preventable events was 4.9%/year (7.4/152). Conclusions: With better adherence to guidelines for oral anticoagulation in patients with atrial fibrillation and risk factors for stroke, a significant number of strokes could be prevented.
MeSH term(s)	Administration, Oral ; Aged ; Aged, 80 and over ; Anticoagulants/adverse effects ; Anticoagulants/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Contraindications ; Drug Utilization Review ; Female ; Guideline Adherence/statistics & numerical data ; Hospitals, University/standards ; Humans ; Intracranial Hemorrhages/chemically induced ; Male ; Meta-Analysis as Topic ; Middle Aged ; Practice Guidelines as Topic ; Risk Assessment ; Risk Factors ; Stroke/epidemiology ; Stroke/etiology ; Stroke/prevention & control ; Switzerland
Chemical Substances	Anticoagulants
Language	English
Publishing date	2006-12-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2036179-8
ISSN	1424-3997 ; 1424-7860
ISSN (online)	1424-3997
ISSN	1424-7860
DOI	10.4414/smw.2006.11486
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Article: Ethische Reflexion von Pflegenden im Akutbereich--eine Thematische Analyse.

Barandun Schäfer, Ursi / Ulrich, Anja / Meyer-Zehnder, Barbara / Frei, Irena Anna

Pflege

2015 Volume 28, Issue 6, Page(s) 321–327

Abstract: ... rather than alleviating the patient’s suffering. These problematic aspects are often overlooked ...

Title translation	Acute care nurses’ ethical reasoning: a thematic analysis.
Abstract	Background: In the day-to-day course of nursing, ethical issues are being openly articulated to a growing extent. However, nurses only rarely systematically address these issues. This subject was explored in interviews with professionals who have a particular focus on ethics. Objective: Gain input for further developing the skills of nursing staff in ethical reasoning. Method: In two focus groups and four individual interviews, we questioned 14 professionals, including nine nurses, who have a special interest in ethics. Results: Nurses find it ethically problematic when the wishes of patients are not respected or something is forced on them, creating the impression that the care being given is exacerbating rather than alleviating the patient’s suffering. These problematic aspects are often overlooked because the consequences of the action in question are not immediately apparent. Ethical issues in nursing are often addressed in informal, non-systematic discussions among nursing staff. Nurses actively and confidently engage in discussions on treatment goals, and the teamwork with doctors is usually experienced as being based on mutual respect and partnership. The inherent hierarchical role differences between nursing and medical staff nevertheless manifest in ethical issues. Conclusion: Through the practical application of ethical reasoning in day-to-day nursing, structured discussions of the ethical aspects of cases and dedicated further education, nurses should learn to better recognise ethical issues in nursing and effectively analyse them and find solutions.
MeSH term(s)	Acute Disease/nursing ; Attitude of Health Personnel ; Cooperative Behavior ; Ethics, Nursing ; Focus Groups ; Hierarchy, Social ; Humans ; Interdisciplinary Communication ; Nurse's Role ; Nurse-Patient Relations/ethics ; Nursing Care/ethics ; Physician-Nurse Relations ; Switzerland
Language	German
Publishing date	2015-12
Publishing country	Switzerland
Document type	English Abstract ; Journal Article
ZDB-ID	645005-2
ISSN	1664-283X ; 1012-5302
ISSN (online)	1664-283X
ISSN	1012-5302
DOI	10.1024/1012-5302/a000457
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Article: The complex roles of relatives in end-of-life decision-making: an ethical analysis.

Reiter-Theil, Stella / Mertz, Marcel / Meyer-Zehnder, Barbara

HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues

2007 Volume 19, Issue 4, Page(s) 341–364

MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Critical Care/ethics ; Decision Making/ethics ; Family ; Female ; Humans ; Male ; Middle Aged ; Organizational Case Studies ; Switzerland ; Terminal Care/ethics
Language	English
Publishing date	2007-12-19
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1042368-0
ISSN	0956-2737
ISSN	0956-2737
DOI	10.1007/s10730-007-9054-1
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Article ; Online: Burkholderia pseudomallei isolates in 2 pet iguanas, California, USA.

Zehnder, Ashley M / Hawkins, Michelle G / Koski, Marilyn A / Lifland, Barry / Byrne, Barbara A / Swanson, Alexandra A / Rood, Michael P / Gee, Jay E / Elrod, Mindy Glass / Beesley, Cari A / Blaney, David D / Ventura, Jean / Hoffmaster, Alex R / Beeler, Emily S

Emerging infectious diseases

2014 Volume 20, Issue 2, Page(s) 304–306

Abstract: Burkholderia pseudomallei, the causative agent of melioidosis, was isolated from abscesses of 2 pet green iguanas in California, USA. The international trade in iguanas may contribute to importation of this pathogen into countries where it is not endemic ...

Abstract	Burkholderia pseudomallei, the causative agent of melioidosis, was isolated from abscesses of 2 pet green iguanas in California, USA. The international trade in iguanas may contribute to importation of this pathogen into countries where it is not endemic and put persons exposed to these animals at risk for infection.
MeSH term(s)	Abscess/diagnosis ; Abscess/microbiology ; Animals ; Burkholderia pseudomallei/genetics ; Burkholderia pseudomallei/isolation & purification ; California ; DNA, Bacterial/genetics ; DNA, Bacterial/isolation & purification ; Female ; Humans ; Iguanas/microbiology ; Melioidosis/diagnosis ; Melioidosis/microbiology ; Pets ; Polymerase Chain Reaction
Chemical Substances	DNA, Bacterial
Language	English
Publishing date	2014-01-22
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2002.131314
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