Swiss medical weekly最新文献

Aims of the study: Opioid prescriptions have increased in Switzerland, even though current guidelines warn of their harms. If opioids for postoperative analgesia are not tapered before hospital discharge, patients are at risk of adverse events such as constipation, drowsiness, dependence, tolerance and withdrawal. The aim of this study was to investigate and quantify the potential association between opioids prescribed at discharge from hospital and rehospitalisation.

Methods: We conducted a nested case-control study using routinely collected electronic health records from a Swiss public acute hospital. Cases were patients aged 65 years or older admitted between November 2014 and December 2018, with documented opioid administration on the day of discharge and rehospitalisation within 18 or 30 days after discharge. Each case was matched to five controls for age, sex, year of hospitalisation and Charlson Comorbidity Index. We calculated odds ratios for 18-day and 30-day rehospitalisation based on exposure to opioids using a conditional logistic regression adjusted for potential confounders. Secondary analyses included stratifications into morphine-equivalent doses of <50 mg, 50-89 mg and ≥90 mg, and co-prescriptions of gabapentinoids and benzodiazepines.

Results: Of 22,471 included patients, 3144 rehospitalisations were identified, of which 1698 were 18-day rehospitalisations and 1446 were 30-day rehospitalisations. Documented opioid administration on the day of discharge was associated with 30-day rehospitalisation after adjustment for confounders (adjusted odds ratio 1.48; 95% CI 1.25-1.75, p <0.001), while no difference was observed in the likelihood of 18-day rehospitalisation. The combined prescription of opioids with benzodiazepines or gabapentinoids and morphine-equivalent doses >50 mg were rare.

Conclusions: Patients receiving opioids on the day of discharge were 48% more likely to be readmitted to hospital within 30 days. Clinicians should aim to discontinue opioids started in hospital before discharge if possible. Patients receiving an opioid prescription should be educated and monitored as part of opioid stewardship programmes.

No abstract available.

No abstract available.

Aim of the study: We aimed to evaluate the utilisation of all prescribed drugs during pregnancy dispensed in outpatient care in Switzerland between 2015 and 2021.

Methods: We conducted a descriptive study using the Swiss Helsana claims database (2015-2021). We established a cohort of pregnancies by identifying deliveries and estimating the date of the last menstrual period. We analysed the drug burden during a 270-day pre-pregnancy period, during pregnancy (overall and by trimester), and during a 270-day postpartum period. Subsequently, we quantified 1) the median number of drug dispensations (total vs. unique drug claims); and 2) the prevalence of exposure to at least one dispensed drug and the number of dispensed drugs (0, 1, 2, 3, 4, and ≥5); and 3) the 15 most frequently dispensed drugs were identified during each period, overall and stratified by maternal age.

Results: Among 34,584 pregnant women (5.6% of all successful pregnancies in Switzerland), 87.5% claimed at least one drug (not including vitamins, supplements, and vaccines), and 33.3% claimed at least five drugs during pregnancy. During trimester 1 alone, 8.2% of women claimed at least five distinct drugs. The proportion of women who claimed prescribed drugs was lower pre-pregnancy (69.1%) and similar postpartum (85.6%) when compared to during pregnancy (87.5%). The most frequently claimed drugs during pregnancy were meaningfully different during pregnancy than before and after.

Conclusions: This study suggests that 8 of 10 women in Switzerland are exposed to prescribed drugs during pregnancy. Most drugs dispensed during pregnancy are comparatively well investigated and are considered safe. However, the high drug burden in this vulnerable patient population underlines the importance of evidence on the benefit-risk profile of individual drugs taken during pregnancy.

The term lymphadenopathy refers to an abnormality in size, consistency or morphological aspect of one or several lymph nodes. Although lymphadenopathies are commonly observed in everyday clinical practice, the difficulty of differentiating benign and malignant disease may delay therapeutic approaches. The present review aims to update diagnostic algorithms in different clinical situations based on the currently available literature. A literature review was performed to assess current knowledge of and to update the diagnostic approach. A short clinical vignette was used as an example of a typical clinical presentation. This case of metastatic lymphadenopathy with incomplete patient history demonstrates how misleading such lymphadenopathy may be, leading to a delayed diagnosis and even a fatal outcome. Any lymphadenopathy persisting for more than 2 weeks should be considered suspicious and deserves further investigation. Precise clinical examination, meticulous history-taking and a search for associated symptomatology are still cornerstones for diagnosing the origin of the condition. The next diagnostic step depends on the anatomical region and the specific patient's situation. Imaging starts with ultrasound, while computed tomography (CT) and magnetic resonance imaging (MRI) allow assessment of the surrounding structures. If the diagnosis remains uncertain, tissue sampling and histological analyses should be performed. Except for head and neck loco-regional lymphadenopathy, there are no methodical guidelines for persistent lymphadenopathy. The present review clarifies several confusing and complex situations. The accuracy of fine needle aspiration cytology could be increased by using core needle biopsy with immunocytologic and flow cytometric methods. Notably, except in the head and neck area, open biopsy remains the best option when lymphoma is suspected or when inconclusive results of previous fine needle aspiration cytology or core needle biopsy are obtained. The incidence of malignant lymphadenopathy varies with its location and the various diagnostic strategies. In metastatic lymphadenopathy of unknown primary origin, European Society for Medical Oncology (ESMO) guidelines and modern methods like next-generation sequencing (NGS) may help to manage such complex cases.

Aim of the study: The purpose of the present study was to evaluate demographic characteristics of inmates in the Canton of Zurich (exposure), and investigate the changes in diseases and drug use between 2015 and 2020 (outcome).

Methods: The study prospectively evaluated 51,989 inmates admitted to the Police Prison Zurich in Switzerland between 1 April 2015 and 31 August 2020 and who were systematically medically assessed. A total of 19,027 (37%) inmates had one or more health conditions, which the authors recorded according to the International Classification of Diseases-10 (ICD-10), in addition to demographic data (country of origin, sex, age, year of imprisonment), as well as details of any drugs used (type and dosage).

Results: The 19,027 inmates with medical conditions had a mean age of 35.4±12.5 years (range 10-89) and comprised 16,489 males (87%). The inmates originated from 170 countries, including 4606 from Switzerland (24.2%), 4227 from Eastern Europe (22%) and 3432 from the Middle East & North Africa (18%). A total of 1631 inmates (9%) were enrolled in the medication-assisted treatment (MAT) programme, and 672 patients (4%) received a psychiatric evaluation. The proportions of foreign prisoners did not increase during the study period. There was a significant increase in the use of antipsychotics from year 1 to 5 (y = 0.866x; R2 = 0.902; p = 0.01) and anticonvulsants from year 1 to 4 (y = 1.27x; R2 = 0.823; p = 0.01), and a significant decrease in the use of analgesics from year 2 to 5 (y = -4.42x; R2 = 0.947; p = 0.03) and antianxiety drugs from year 1 to 4 (y = -3.31x; R2 = 0.989; p = 0.005). Inmates from Switzerland were most likely to use antianxiety drugs, while inmates from the Middle East & North Africa were most likely to use antipsychotics (OR 2.09; CI 1.88-2.34) and anticonvulsants (OR 3.52; CI 2.90-4.29), whereas inmates from Latin and North America were most likely to use herbal medicine (OR 1.50; CI 1.05-2.10).

Conclusions: The findings of this study could help anticipate needs of prisons as well as improve treatment of disease and assist with substance use or abuse, particularly in the context of migration.

Introduction: There is limited understanding of the pathomechanistic relationship between leptomeningeal collateral formation and ischaemic stroke aetiology. We aimed to assess the association of leptomeningeal collateral status and ischaemic stroke aetiology, using the widely recognised "Trial of Org 10172 in Acute Stroke Treatment" (TOAST) classification categorising strokes into five distinct aetiologies.

Methods: Retrospective study of consecutively admitted adult ischaemic stroke patients at a Swiss stroke centre. Leptomeningeal collateral status was assessed on admission with single-phase CT-angiographies using a validated 4-point score. Patients were categorised into large-artery atherosclerosis (LAA), cardioembolic (CE), small-vessel disease (SVD) and cryptogenic (CG) according to the TOAST classification. We performed ordinal and binary (poor [collaterals filling ≤50% of the occluded territory] vs good [collaterals filling >50% of the occluded territory] collateralisation) logistic regression to evaluate the impact of TOAST aetiology on collateral status.

Results: Among 191 patients, LAA patients had better collateral status compared to non-LAA aetiology (LAA: 2 vs CE: 2 vs SVD: 3 vs CG: 2, pLAA vs non-LAA = 0.04). In weighted multivariate logistic regression, LAA and SVD independently predicted better collateral status (binary models [adjusted odds ratio; aOR]: LAA: 3.72 [1.21-11.44] and SVD: 4.19 [1.21-14.52]; ordinal models [adjusted common odds ratio; acOR]: LAA: 2.26 [95% CI: 1.23-4.15] and SVD: 1.94 [1.03-3.66]), while CE predicted worse collateral status (binary models [aOR]: CE: 0.17 [0.07-0.41]; ordinal models [acOR]: CE: 0.24 [0.11-0.51]).

Conclusion: The aetiology of ischaemic stroke is associated with leptomeningeal collateral status on single-phase CT-angiography, with LAA and SVD predicting better and CE predicting worse collateral status.