Joseph Osterwalder - Academia.edu (original) (raw)
Papers by Joseph Osterwalder
Forum médical suisse =, Mar 15, 2016
Bulletin des médecins suisses, Jun 28, 2023
Ultraschall in Der Medizin, Mar 30, 2023
Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept. It has spread rapi... more Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept. It has spread rapidly because of its intuitive, simple applicability and low equipment costs. The speed of its emerging growth frequently outpaces the development of quality assurance and education. Indeed, education standards vary worldwide, and in some cases seem to neglect the principles of modern competence-based education. Additional challenges are encountered such as remote or low resource medical practice. Here, EMPoCUS might be the only ad-hoc imaging modality available. Once mastery of EMPoCUS is achieved, emergency physicians should be able to independently and efficiently care for their patients using a variety of PoCUS skills. However, most curricula only define these tasks as non-binding and in general terms or use outdated measures, such as length of training and self-reporting of achieved examinations with variable oversight, or administrative measures to create educational milestones. This threatens to take quality assurance down the wrong path. It created a scenario in which concrete EMPoCUS skill outcome measures that would realistically reflect the training objectives and simultaneously would be easily observable and verifiable are lacking. In view of the dangers of poorly controlled EMPoCUS dissemination and the current lack of European guidelines, we would like to set central standards for European EMPoCUS stewardship based on a critical review of the current situation. This position paper, which was jointly developed by EuSEM and EF-SUMB and endorsed by IFEM and WFUMB, is also intended to accompany the EFSUMB/EuSEM guidelines on PoCUS currently being prepared for publication. ZUSAMMENFASSUNG Der notfallmedizinische Point-of-Care-Ultraschall (EMPoCUS) ist ein überzeugendes Konzept. Es hat sich aufgrund seiner intuitiven, einfachen Anwendbarkeit und der geringen Gerätekosten rasch verbreitet. Die Geschwindigkeit des sich abzeichnenden Wachstums übertrifft häufig die Entwicklung der Qualitätssicherung oder der Ausbildung. In der Tat variieren die Ausbildungsstandards weltweit und scheinen in einigen Fällen die Grundsätze einer modernen kompetenzbasierten Ausbildung zu vernachlässigen. Hinzu kommen weitere Her-Guidelines & Recommendations
Georg Thieme Verlag eBooks, 2014
Blood, Nov 5, 2021
Introduction: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary e... more Introduction: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), constitutes a worldwide major health issue, and a leading cause of death. VTE incidence increases exponentially with age mainly due to the accumulation of risk factors and comorbidities predisposing to thrombosis. This leads to greater morbidity impact of VTE on elderly patients, who are also at higher risk of bleeding. Consequently, identification of older patients who might benefit from indefinite anticoagulation treatment is paramount. In order to facilitate the identification of these patients, the benefit/risk ratio should be carefully evaluated by considering clinical and laboratory information. Thrombin activity can be recorded by continuously measuring cleavage of a fluorescent substrate, resulting in a thrombin generation (TG) curve. Recent association studies show promising data of thrombin generation parameters predicting first VTE in elderly (Wang H et. al. RPTH 2021, 5:e12536). However, the predictive ability of thrombin generation for recurrent VTE, major bleeding and mortality in the elderly is unknown. The goal of this study was to prospectively investigate the performance of the TG assay one year after index VTE in predicting the risk of VTE, recurrence, major bleeding and mortality up to 2 years in elderly population. Methods: The study was conducted as part of the Swiss Cohort of Elderly Patients with VTE (SWITCO65+), a prospective multicenter cohort study to assess medical outcomes and quality of life in elderly patients with acute VTE in Switzerland. For the present study, the clinical outcomes were VTE recurrence, major bleeding and mortality, which were assessed parallel to clinical data of thrombosis and other general laboratory parameters including thrombophilia testing in over a 3-year period. Blood samples for assessment of TG parameters were drawn 12 month after the index VTE. Venous blood was drawn after minimal venostasis and processed by double centrifugation according to the recommendation of the subcommittee of the Scientific and Standardization Committee of ISTH. TG measurements were performed with the calibrated automated thrombogramm assay (Stago, Asnières-sur-Seine, France) in two experimental settings: 1pM tissue factor (TF) with/without thrombomodulin (TM) and 13.6 pM TF with/without activated protein C (APC). In addition, reference plasma (Cryocheck Reference Control Normal, PrecisionBiologic, Dartmouth, Canada) was tested in all experiments in order to correct day-to-day variations. Lag time, velocity index, time to peak, peak height, endogenous thrombin potential (ETP) were measured and peak and ETP ratio obtained in presence/absence of TM or APC were calculated. Results from the reference plasma were used to calculate the normalized ETP and peak ratio in 1 pM setting and peak ratio in 13.6 pM TF setting. Results: TG was assessed in 565 patients 12 months after the index VTE. At this time, 59% of patients were still anticoagulated. Eleven percent of them had cancer-related VTE, 20% provoked VTE and 68% unprovoked VTE. The prevalence of inherited risk factors for VTE was in line with previous reports on European patients with VTE. Patients still anticoagulated 12 months after the index VTE were less likely to develop recurrent VTE in the next 24 months than patients without anticoagulation. However, the incidence of major bleeding and mortality was comparable in anticoagulated and non-anticoagulated patients. TG was faster and lower in anticoagulated than in non-anticoagulated patients. Some thrombin generation parameters measured 12 months after the index VTE (Figure 1) were discriminatory for VTE recurrence, major bleeding and mortality (Table 1). In addition, several thrombin generation parameters measured in patients not under anticoagulation 12 months after the index VTE were associated with an increased risk of VTE recurrence, major bleeding and mortality up to 24 months. These associations remained after adjustment for potential confounding factors for the risk of VTE recurrence, major bleeding and mortality (Table 2). Conclusion: In elderly patients, several parameters of thrombin generation were associated with VTE recurrence, major bleeding and/or mortality. These findings may serve as the basis for validation in a prospective interventional outcome trial. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
Das Thoraxtrauma und die schwere, nicht traumatische bedingte Dyspnoe stellen eine besondere Hera... more Das Thoraxtrauma und die schwere, nicht traumatische bedingte Dyspnoe stellen eine besondere Herausforderung an die Thoraxsonographie dar, indem einige lebensbedrohliche Situationen sofort erkannt und auch interventionell behandelt werden konnen. Dabei gehen wir nach dem international anerkannten ABC-Standard vor. Behinderungen der Atemwege und Atmung haben Vorrang vor Storungen von Herz und Zirkulation. Haufige und wichtige Ursachen der Dyspnoe konnen gut mittels Ultraschall erkannt und dargestellt werden. Allerdings ist die Methode nicht 100 % sensitiv sowie spezifisch, und einige wenige Pathologien oder deren Lokalisation sind dem Thoraxultraschall nicht zuganglich. Zudem wird das Verfahren immer wichtiger, da vermehrt relative Kontraindikationen fur die CT-Untersuchung vorkommen.
Georg Thieme Verlag eBooks, 2014
Journal of Thrombosis and Haemostasis, Nov 1, 2017
Article type : Original Article-Clinical Haemostasis and Thrombosis Long-term outcomes of elderly... more Article type : Original Article-Clinical Haemostasis and Thrombosis Long-term outcomes of elderly patients with CYP2C9 and VKORC1 variants treated with vitamin K antagonists
It is currently unknown whether thrombin generation is associated with venous thromboembolism (VT... more It is currently unknown whether thrombin generation is associated with venous thromboembolism (VTE) recurrence, major bleeding, and mortality in the elderly. Therefore, our aim was to prospectively study the association between thrombin generation and VTE recurrence, major bleeding and mortality in elderly patients with acute VTE. Consecutive patients aged ≥65years with acute VTE were followed for 2 years starting from 1 year after the index VTE. Primary outcomes were VTE recurrence, major bleeding and mortality. Thrombin generation was assessed in 565 patients 1 year after the index VTE. At this time, 59% of patients were still anticoagulated. Thrombin generation was discriminatory for VTE recurrence, but not for major bleeding and mortality in non-anticoagulated patients. Moreover, peak ratio (adjusted subhazard ratio 4.09, 95% CI, 1.12-14.92) and normalized peak ratio (adjusted subhazard ratio 2.18, 95% CI, 1.28-3.73) in presence/absence of thrombomodulin were associated with VTE recurrence, but not with major bleeding and mortality after adjustment for potential confounding factors. In elderly patients, thrombin generation was associated with VTE recurrence, but not with major bleeding and/or mortality. Therefore, our study suggests the potential usefulness of thrombin generation measurement after anticoagulation completion for VTE to help identifying among elderly patients those at higher risk of VTE recurrence.
Schweizerische Medizinische Wochenschrift, Aug 3, 2021
Medicina
Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and ... more Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and mortality. Hence, early diagnosis and management of both conditions is of paramount importance. Point-of-care ultrasound (POCUS) is a cost-effective and safe imaging modality performed at the bedside, which has rapidly emerged as an excellent multimodal tool and has been gradually incorporated as an adjunct to physical examination in order to facilitate evaluation, diagnosis and management. In sepsis, POCUS can assist in the evaluation of undifferentiated sepsis, while, in cases of shock, it can contribute to the differential diagnosis of other types of shock, thus facilitating the decision-making process. Other potential benefits of POCUS include prompt identification and control of the source of infection, as well as close haemodynamic and treatment monitoring. The aim of this review is to determine and highlight the role of POCUS in the evaluation, diagnosis, treatment and monitoring ...
Ultraschall in der Medizin - European Journal of Ultrasound
Purpose This prospective two-centre study investigated localisation-dependent lesion patterns in ... more Purpose This prospective two-centre study investigated localisation-dependent lesion patterns in COVID-19 with standard lung ultrasonography (LUS) and their relationship with thoracic computed tomography (CT) and clinical parameters. Materials and Methods Between April 2020 and April 2021, 52 SARS-CoV-2-positive patients in two hospitals were examined by means of LUS for “B-lines”, fragmented pleura, consolidation and air bronchogram in 12 lung regions and for pleural effusions. A newly developed LUS score based on the number of features present was correlated with clinical parameters (respiration, laboratory parameters) and the CT and analysed with respect to the 30- and 60-day outcome. All patients were offered an outpatient LUS follow-up. Results The LUS and CT showed a bilateral, partially posteriorly accentuated lesion distribution pattern. 294/323 (91%) of CT-detected lesions were pleural. The LUS score showed an association with respiratory status and C-reactive protein; the ...
European Journal of Clinical Investigation, 2019
BackgroundCombining high‐sensitivity cardiac Troponin T (hs‐cTnT), NT‐pro‐B‐type natriuretic pept... more BackgroundCombining high‐sensitivity cardiac Troponin T (hs‐cTnT), NT‐pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity C‐reactive protein (hs‐CRP) may improve risk stratification of patients with pulmonary embolism (PE) beyond the PESI risk score.MethodsIn the prospective multicentre SWITCO65+ study, we analysed 214 patients ≥ 65 years with a new submassive PE. Biomarkers and clinical information for the PESI risk score were ascertained within 1 day after diagnosis. Associations of hs‐TnT, NT‐proBNP, hs‐CRP and the PESI risk score with the primary endpoint defined as 6‐month mortality were assessed. The discriminative power of the PESI risk score and its combination with hs‐cTnT, NT‐proBNP and hs‐CRP for 6‐month mortality was compared using integrated discrimination improvement (IDI) index and net reclassification improvement (NRI).ResultsCompared with the lowest quartile, patients in the highest quartile had a higher risk of death during the first 6 months for hs‐cTn...
Forum médical suisse =, Mar 15, 2016
Bulletin des médecins suisses, Jun 28, 2023
Ultraschall in Der Medizin, Mar 30, 2023
Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept. It has spread rapi... more Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept. It has spread rapidly because of its intuitive, simple applicability and low equipment costs. The speed of its emerging growth frequently outpaces the development of quality assurance and education. Indeed, education standards vary worldwide, and in some cases seem to neglect the principles of modern competence-based education. Additional challenges are encountered such as remote or low resource medical practice. Here, EMPoCUS might be the only ad-hoc imaging modality available. Once mastery of EMPoCUS is achieved, emergency physicians should be able to independently and efficiently care for their patients using a variety of PoCUS skills. However, most curricula only define these tasks as non-binding and in general terms or use outdated measures, such as length of training and self-reporting of achieved examinations with variable oversight, or administrative measures to create educational milestones. This threatens to take quality assurance down the wrong path. It created a scenario in which concrete EMPoCUS skill outcome measures that would realistically reflect the training objectives and simultaneously would be easily observable and verifiable are lacking. In view of the dangers of poorly controlled EMPoCUS dissemination and the current lack of European guidelines, we would like to set central standards for European EMPoCUS stewardship based on a critical review of the current situation. This position paper, which was jointly developed by EuSEM and EF-SUMB and endorsed by IFEM and WFUMB, is also intended to accompany the EFSUMB/EuSEM guidelines on PoCUS currently being prepared for publication. ZUSAMMENFASSUNG Der notfallmedizinische Point-of-Care-Ultraschall (EMPoCUS) ist ein überzeugendes Konzept. Es hat sich aufgrund seiner intuitiven, einfachen Anwendbarkeit und der geringen Gerätekosten rasch verbreitet. Die Geschwindigkeit des sich abzeichnenden Wachstums übertrifft häufig die Entwicklung der Qualitätssicherung oder der Ausbildung. In der Tat variieren die Ausbildungsstandards weltweit und scheinen in einigen Fällen die Grundsätze einer modernen kompetenzbasierten Ausbildung zu vernachlässigen. Hinzu kommen weitere Her-Guidelines & Recommendations
Georg Thieme Verlag eBooks, 2014
Blood, Nov 5, 2021
Introduction: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary e... more Introduction: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), constitutes a worldwide major health issue, and a leading cause of death. VTE incidence increases exponentially with age mainly due to the accumulation of risk factors and comorbidities predisposing to thrombosis. This leads to greater morbidity impact of VTE on elderly patients, who are also at higher risk of bleeding. Consequently, identification of older patients who might benefit from indefinite anticoagulation treatment is paramount. In order to facilitate the identification of these patients, the benefit/risk ratio should be carefully evaluated by considering clinical and laboratory information. Thrombin activity can be recorded by continuously measuring cleavage of a fluorescent substrate, resulting in a thrombin generation (TG) curve. Recent association studies show promising data of thrombin generation parameters predicting first VTE in elderly (Wang H et. al. RPTH 2021, 5:e12536). However, the predictive ability of thrombin generation for recurrent VTE, major bleeding and mortality in the elderly is unknown. The goal of this study was to prospectively investigate the performance of the TG assay one year after index VTE in predicting the risk of VTE, recurrence, major bleeding and mortality up to 2 years in elderly population. Methods: The study was conducted as part of the Swiss Cohort of Elderly Patients with VTE (SWITCO65+), a prospective multicenter cohort study to assess medical outcomes and quality of life in elderly patients with acute VTE in Switzerland. For the present study, the clinical outcomes were VTE recurrence, major bleeding and mortality, which were assessed parallel to clinical data of thrombosis and other general laboratory parameters including thrombophilia testing in over a 3-year period. Blood samples for assessment of TG parameters were drawn 12 month after the index VTE. Venous blood was drawn after minimal venostasis and processed by double centrifugation according to the recommendation of the subcommittee of the Scientific and Standardization Committee of ISTH. TG measurements were performed with the calibrated automated thrombogramm assay (Stago, Asnières-sur-Seine, France) in two experimental settings: 1pM tissue factor (TF) with/without thrombomodulin (TM) and 13.6 pM TF with/without activated protein C (APC). In addition, reference plasma (Cryocheck Reference Control Normal, PrecisionBiologic, Dartmouth, Canada) was tested in all experiments in order to correct day-to-day variations. Lag time, velocity index, time to peak, peak height, endogenous thrombin potential (ETP) were measured and peak and ETP ratio obtained in presence/absence of TM or APC were calculated. Results from the reference plasma were used to calculate the normalized ETP and peak ratio in 1 pM setting and peak ratio in 13.6 pM TF setting. Results: TG was assessed in 565 patients 12 months after the index VTE. At this time, 59% of patients were still anticoagulated. Eleven percent of them had cancer-related VTE, 20% provoked VTE and 68% unprovoked VTE. The prevalence of inherited risk factors for VTE was in line with previous reports on European patients with VTE. Patients still anticoagulated 12 months after the index VTE were less likely to develop recurrent VTE in the next 24 months than patients without anticoagulation. However, the incidence of major bleeding and mortality was comparable in anticoagulated and non-anticoagulated patients. TG was faster and lower in anticoagulated than in non-anticoagulated patients. Some thrombin generation parameters measured 12 months after the index VTE (Figure 1) were discriminatory for VTE recurrence, major bleeding and mortality (Table 1). In addition, several thrombin generation parameters measured in patients not under anticoagulation 12 months after the index VTE were associated with an increased risk of VTE recurrence, major bleeding and mortality up to 24 months. These associations remained after adjustment for potential confounding factors for the risk of VTE recurrence, major bleeding and mortality (Table 2). Conclusion: In elderly patients, several parameters of thrombin generation were associated with VTE recurrence, major bleeding and/or mortality. These findings may serve as the basis for validation in a prospective interventional outcome trial. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
Das Thoraxtrauma und die schwere, nicht traumatische bedingte Dyspnoe stellen eine besondere Hera... more Das Thoraxtrauma und die schwere, nicht traumatische bedingte Dyspnoe stellen eine besondere Herausforderung an die Thoraxsonographie dar, indem einige lebensbedrohliche Situationen sofort erkannt und auch interventionell behandelt werden konnen. Dabei gehen wir nach dem international anerkannten ABC-Standard vor. Behinderungen der Atemwege und Atmung haben Vorrang vor Storungen von Herz und Zirkulation. Haufige und wichtige Ursachen der Dyspnoe konnen gut mittels Ultraschall erkannt und dargestellt werden. Allerdings ist die Methode nicht 100 % sensitiv sowie spezifisch, und einige wenige Pathologien oder deren Lokalisation sind dem Thoraxultraschall nicht zuganglich. Zudem wird das Verfahren immer wichtiger, da vermehrt relative Kontraindikationen fur die CT-Untersuchung vorkommen.
Georg Thieme Verlag eBooks, 2014
Journal of Thrombosis and Haemostasis, Nov 1, 2017
Article type : Original Article-Clinical Haemostasis and Thrombosis Long-term outcomes of elderly... more Article type : Original Article-Clinical Haemostasis and Thrombosis Long-term outcomes of elderly patients with CYP2C9 and VKORC1 variants treated with vitamin K antagonists
It is currently unknown whether thrombin generation is associated with venous thromboembolism (VT... more It is currently unknown whether thrombin generation is associated with venous thromboembolism (VTE) recurrence, major bleeding, and mortality in the elderly. Therefore, our aim was to prospectively study the association between thrombin generation and VTE recurrence, major bleeding and mortality in elderly patients with acute VTE. Consecutive patients aged ≥65years with acute VTE were followed for 2 years starting from 1 year after the index VTE. Primary outcomes were VTE recurrence, major bleeding and mortality. Thrombin generation was assessed in 565 patients 1 year after the index VTE. At this time, 59% of patients were still anticoagulated. Thrombin generation was discriminatory for VTE recurrence, but not for major bleeding and mortality in non-anticoagulated patients. Moreover, peak ratio (adjusted subhazard ratio 4.09, 95% CI, 1.12-14.92) and normalized peak ratio (adjusted subhazard ratio 2.18, 95% CI, 1.28-3.73) in presence/absence of thrombomodulin were associated with VTE recurrence, but not with major bleeding and mortality after adjustment for potential confounding factors. In elderly patients, thrombin generation was associated with VTE recurrence, but not with major bleeding and/or mortality. Therefore, our study suggests the potential usefulness of thrombin generation measurement after anticoagulation completion for VTE to help identifying among elderly patients those at higher risk of VTE recurrence.
Schweizerische Medizinische Wochenschrift, Aug 3, 2021
Medicina
Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and ... more Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and mortality. Hence, early diagnosis and management of both conditions is of paramount importance. Point-of-care ultrasound (POCUS) is a cost-effective and safe imaging modality performed at the bedside, which has rapidly emerged as an excellent multimodal tool and has been gradually incorporated as an adjunct to physical examination in order to facilitate evaluation, diagnosis and management. In sepsis, POCUS can assist in the evaluation of undifferentiated sepsis, while, in cases of shock, it can contribute to the differential diagnosis of other types of shock, thus facilitating the decision-making process. Other potential benefits of POCUS include prompt identification and control of the source of infection, as well as close haemodynamic and treatment monitoring. The aim of this review is to determine and highlight the role of POCUS in the evaluation, diagnosis, treatment and monitoring ...
Ultraschall in der Medizin - European Journal of Ultrasound
Purpose This prospective two-centre study investigated localisation-dependent lesion patterns in ... more Purpose This prospective two-centre study investigated localisation-dependent lesion patterns in COVID-19 with standard lung ultrasonography (LUS) and their relationship with thoracic computed tomography (CT) and clinical parameters. Materials and Methods Between April 2020 and April 2021, 52 SARS-CoV-2-positive patients in two hospitals were examined by means of LUS for “B-lines”, fragmented pleura, consolidation and air bronchogram in 12 lung regions and for pleural effusions. A newly developed LUS score based on the number of features present was correlated with clinical parameters (respiration, laboratory parameters) and the CT and analysed with respect to the 30- and 60-day outcome. All patients were offered an outpatient LUS follow-up. Results The LUS and CT showed a bilateral, partially posteriorly accentuated lesion distribution pattern. 294/323 (91%) of CT-detected lesions were pleural. The LUS score showed an association with respiratory status and C-reactive protein; the ...
European Journal of Clinical Investigation, 2019
BackgroundCombining high‐sensitivity cardiac Troponin T (hs‐cTnT), NT‐pro‐B‐type natriuretic pept... more BackgroundCombining high‐sensitivity cardiac Troponin T (hs‐cTnT), NT‐pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity C‐reactive protein (hs‐CRP) may improve risk stratification of patients with pulmonary embolism (PE) beyond the PESI risk score.MethodsIn the prospective multicentre SWITCO65+ study, we analysed 214 patients ≥ 65 years with a new submassive PE. Biomarkers and clinical information for the PESI risk score were ascertained within 1 day after diagnosis. Associations of hs‐TnT, NT‐proBNP, hs‐CRP and the PESI risk score with the primary endpoint defined as 6‐month mortality were assessed. The discriminative power of the PESI risk score and its combination with hs‐cTnT, NT‐proBNP and hs‐CRP for 6‐month mortality was compared using integrated discrimination improvement (IDI) index and net reclassification improvement (NRI).ResultsCompared with the lowest quartile, patients in the highest quartile had a higher risk of death during the first 6 months for hs‐cTn...