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Care projects
Development of a cardiovascular prevention service
Dr Nicolas Rodondi and Prof Jacques Cornuz, University Medical Polyclinic
Context and unexpected results
Numerous studies have shown that the quality of secondary prevention of cardiovascular diseases is far from being optimal, in spite of its obvious benefits. Treatments with proven results are under-used and patient information is insufficient to encourage healthy lifestyle behaviour.
The treatment of risk factors are often not initiated during hospitalisation although it is known that this is the opportune moment to assist patients in changing behaviour, such as giving up smoking. This situation is mainly due to the priority given to intensive care and to lack of time for the nursing staff. Studies of the implementation of cardiovascular prevention in hospitals have shown a significant reduction in secondary heart attacks, re-hospitalisation and mortality.
Objectives
The objective is to supply cardiovascular prevention consultations to all the CHUV services for patients hospitalised with acute or chronic cardiovascular diseases or multiple risk factors. The proposed interventions are health consultations and awareness information about the disease, patient education and medical advice.
Units concerned
All units involved in the care of these hospitalised patients are concerned. The consultation is carried out in collaboration with the services involved with cardiovascular prevention and the staff caring for these patients.
Planning
A one-year pilot phase was carried out. The evaluation by 50 doctors showed that the results were extremely satisfactory. The availability of the cardiovascular prevention consultation is therefore going to be extended to all services. An evaluation protocol of the satisfaction of the patients and their evolution after leaving hospital will also be established.
Early mobilisation after infarctus myocardic with ST segment elevation
Dresse Christel Moret, Dr Olivier Lamy, Prof Gérard Waeber, Internal Medical Service with the collaboration of adult Intensive Care the Cardiology Service (Project co-financed by the CardioMet Centre and the Quality Office of the CHUV)
Objectives
The early post-infarctus mobilsation as well as surveillance methods have rarely been randomly studied. Several studies (Cadillac, PAMI II, Gusto) have identified a category of patients with infarctus with low risk of complications who could benefit from an early mobilisation scheme and modified surveillance with a return to their home within 4 days. The aim of our study is to rapidly identify this category of patient and to implement the new mobilisation and surveillance protocol. This should improve the use of hospital resources and consequentially decrease costs and the length of hospitalisation.
Methods
Patients hospitalised with a myocardic infarctus ST segment elevation and a low risk of complications will be identified within 24 hours according to these criteria: age < 76 years, the absence of any clinical sign of cardiac insufficiency and / or an ejection fraction > 45%, mono coronary disease/bitronculaire, successful angioplasty ? de l’angioplastie, persistant absence of arrhythmia for 24 hours.. They will benefit from a new physiotherapy scheme with early mobilisation. The evaluation will have an effect on the length and cost of their stay and will systematically evaluate the development of any complications. With the agreement of the patient, follow-up will be carried out with their doctor three months after leaving hospital.
Planning
12 months, from 8 January 2007 to 7 January 2008
Information
Dr. C. Moret, Head of the Clinic MIA, pager 740490
Dr. O. Lamy, Senior Physician MIA, pager 740876
Obesity and comportmental eating disorder consultations
Dr Vittorio Giusti, Endocrinology diabetology and metabolism service
At the moment in Switzerland, 1 person in 5 is concerned by excess weight and 85% of obese patients have eating disorders, i.e. eating compulsions linked to psychological stress situations.
To deal with this increasing demand, the obesity and eating disorder consultations propose a multidisciplinary approach. The team is composed of endocrinologists, psychologists, dieticians and surgeons trained to deal with the requirements of the obese patient, depending on the severity of the excess weight or the behavioural disorders.
Various training courses have been put in place, of which two dietary courses are held over 4 sessions of 2 hours each. These allow the analysis of eating habits of patients and offer useful quantitative and qualitative changes.
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