Mathieu Nendaz

Bio: Mathieu Nendaz is an academic researcher from University of Geneva. The author has contributed to research in topics: Medicine & Health care. The author has an hindex of 28, co-authored 153 publications receiving 2604 citations. Previous affiliations of Mathieu Nendaz include Geneva College & University of Illinois at Chicago.

β-Lactam monotherapy vs β-lactam-macrolide combination treatment in moderately severe community-acquired pneumonia: a randomized noninferiority trial.

Abstract: 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 pneumophilainfection 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 90 mm Hg, temperature 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. Trial Registration clinicaltrials.gov Identifier:NCT00818610

Assessment in Problem-Based Learning Medical Schools: A Literature Review

Abstract: Background: Despite widespread use of problem-based learning (PBL) in medical schools, no review currently exists on its assessment. Given the importance of assessment for any curriculum, a critical review of the literature was conducted to explore whether the assessment methods match the philosophical tenets of PBL. Summary: Articles from MEDLINE and other databases on the assessment of PBL were reviewed. The following areas require special attention by PBL medical schools: enhancement of formal continuous formative assessment; use of the context of a working problem to assess knowledge and problem-solving skills; prevention of negative steering effects by a judicious choice of assessment content, instruments, and timing; and implementation of a longitudinal and centralized student profile. Conclusion: Despite the existence of general practical recommendations on assessment in PBL settings, this review reveals a lack of uniformity and consensus on the practical application of general principles. Topics f...

Le raisonnement clinique : données issues de la recherche et implications pour l'enseignement

Abstract: • Il existe un vaste champ de connaissances en psychologie cognitive appliquee a l’education medicale. • Ces connaissances ont permis de mieux comprendre les processus du raisonnement, l’organisation des connaissances et le recueil de l’information clinique et de developper certaines strategies pedagogiques fondees sur des donnees probantes. • Les medecins font appel a des processus mixtes de raisonnement, associant des strategies analytiques, comme le raisonnement hypothetico-deductif, et des strategies non analytiques telle la reconnaissance spontanee d’une conjonction de signes cliniques. • L’organisation des connaissances peut prendre diverses formes dont les plus elaborees consistent en des reseaux richement interconnectes. • L’activation des connaissances passe par le plus souvent une etape de representation mentale de la teneur du probleme clinique. • L’acquisition des donnees cliniques est conditionnee par la generation precoce d’hypotheses diagnostiques. • L’apprentissage des seuls processus de raisonnement n’est pas efficace s’il ne s’accompagne pas de l’acquisition simultanee des connaissances specifiques necessaires pour resoudre un probleme clinique.

Thinking fast and slow.

Abstract: In 1974 an article appeared in Science magazine with the dry-sounding title “Judgment Under Uncertainty: Heuristics and Biases” by a pair of psychologists who were not well known outside their discipline of decision theory. In it Amos Tversky and Daniel Kahneman introduced the world to Prospect Theory, which mapped out how humans actually behave when faced with decisions about gains and losses, in contrast to how economists assumed that people behave. Prospect Theory turned Economics on its head by demonstrating through a series of ingenious experiments that people are much more concerned with losses than they are with gains, and that framing a choice from one perspective or the other will result in decisions that are exactly the opposite of each other, even if the outcomes are monetarily the same. Prospect Theory led cognitive psychology in a new direction that began to uncover other human biases in thinking that are probably not learned but are part of our brain’s wiring.

Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)

Abstract: Non-thrombotic PE does not represent a distinct clinical syndrome. It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity.

2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism

Abstract: ACS : acute coronary syndrome AMPLIFY : Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-line Therapy aPTT : activated partial thromboplastin time b.i.d. : bis in diem (twice daily) b.p.m. : beats per minute BNP : brain natriuretic peptide BP : blood pressure CI : confidence interval CO : cardiac output COPD : chronic obstructive pulmonary disease CPG : Committee for Practice Guidelines CRNM : clinically relevant non-major CT : computed tomographic/tomogram CTEPH : chronic thromboembolic pulmonary hypertension CUS : compression venous ultrasonography DSA : digital subtraction angiography DVT : deep vein thrombosis ELISA : enzyme-linked immunosorbent assay ESC : European Society of Cardiology H-FABP : heart-type fatty acid-binding protein HIT : heparin-induced thrombocytopenia HR : hazard ratio ICOPER : International Cooperative Pulmonary Embolism Registry ICRP : International Commission on Radiological Protection INR : international normalized ratio iPAH : idiopathic pulmonary arterial hypertension IVC : inferior vena cava LMWH : low molecular weight heparin LV : left ventricle/left ventricular MDCT : multi-detector computed tomographic (angiography) MRA : magnetic resonance angiography NGAL : neutrophil gelatinase-associated lipocalin NOAC(s) : Non-vitamin K-dependent new oral anticoagulant(s) NT-proBNP : N-terminal pro-brain natriuretic peptide o.d. : omni die (every day) OR : odds ratio PAH : pulmonary arterial hypertension PE : pulmonary embolism PEA : pulmonary endarterectomy PEITHO : Pulmonary EmbolIsm THrOmbolysis trial PESI : pulmonary embolism severity index PH : pulmonary hypertension PIOPED : Prospective Investigation On Pulmonary Embolism Diagnosis PVR : pulmonary vascular resistance RIETE : Registro Informatizado de la Enfermedad Thromboembolica venosa RR : relative risk rtPA : recombinant tissue plasminogen activator RV : right ventricle/ventricular SPECT : single photon emission computed tomography sPESI : simplified pulmonary embolism severity index TAPSE : tricuspid annulus plane systolic excursion Tc : technetium TOE : transoesophageal echocardiography TTR : time in therapeutic range TV : tricuspid valve UFH : unfractionated heparin V/Q scan : ventilation–perfusion scintigraphy VKA : vitamin K antagonist(s) VTE : venous thromboembolism Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate. A great number of Guidelines have …