Swiss medical weekly最新文献

A recent hypothesis states that Menière's disease is caused by inappropriate expression, i.e. enhanced release of the neurotransmitter calcitonin gene-related peptide. Here, we tested this hypothesis by administering rimegepant, a new calcitonin gene-related peptide antagonist approved for the acute treatment of migraine and for the prevention of episodic migraine, to six patients with both Menière's disease and migraine. Two patients received the first dose of 75 mg rimegepant to treat an acute attack of Menière's disease. One of these two plus the remaining four patients were treated with 75 mg rimegepant every other day for secondary prevention. One patient developed an allergic reaction after the first administration and was excluded from further treatment. In the two patients treated during acute Menière's disease, symptoms were relieved and resolved about 30 min earlier than migraine symptoms. While all five patients had reduced migraine, all completely resolved Menière's symptoms on preventive therapy with rimegepant for up to eight months. These results support the idea that calcitonin gene-related peptide is linked to the pathogenesis of Menière's disease and suggest that inhibition of calcitonin gene-related peptide signalling may represent a promising therapeutic option for Menière's disease patients.

Background: Electronic medical records (EMRs) in general practice provide various methods for identifying patients with specific diagnoses. While several studies have focused on case identification via structured EMR components, diagnoses in general practice are frequently documented as unstructured free-text entries, making their use for research challenging. Furthermore, diagnoses may remain undocumented even when evidence of the underlying disease exists within structured EMR data.

Objective: This study aimed to quantify the extent to which free-text diagnoses contribute to identifying additional cases of diabetes mellitus, obesity and dyslipidaemia (target diseases) and assess the cases missed when relying exclusively on free-text entries.

Methods: This cross-sectional study utilised EMR data from all consultations up to 2019 for 6,000 patients across 10 general practices in Switzerland. Diagnoses documented in a free-text entry field for diagnoses were manually coded for target diseases. Cases were defined as patients with a corresponding coded free-text diagnosis or meeting predefined criteria in structured EMR components (medication data or clinical and laboratory parameters). For each target disease, prevalence was calculated along with the proportion of cases identified exclusively via free-text diagnoses and the proportion missed when using free-text diagnoses alone.

Results: The prevalence estimates for diabetes mellitus, obesity and dyslipidaemia were 8.8%, 16.2% and 38.9%, respectively. Few cases relied exclusively on free-text diagnoses for identification, but a substantial proportion of cases were missed when relying solely on free-text diagnoses, particularly for obesity (19.5% exclusively identified; 50.7% missed) and dyslipidaemia (8.7% exclusively identified; 53.3% missed).

Conclusion: Free-text diagnoses were of limited utility for case identification of diabetes mellitus, obesity or dyslipidaemia, suggesting that manual coding of free-text diagnoses may not always be justified. Relying solely on free-text diagnoses for case identification is not recommended, as substantial proportions of cases may remain undetected, leading to biased prevalence estimates.

Bacillus cereus, a gram-positive, rod-shaped bacterium known for both its environmental resilience and its pathogenic potential, has been increasingly recognised as a serious health threat outside the traditional contexts of food poisoning. This narrative review, anchored by a detailed case study, highlights the pathogen's role in rare but severe infections like endocarditis, especially among intravenous drug users, who are particularly vulnerable, among other identified risk factors. The case of a 62-year-old female with a history of intravenous cocaine use who developed Bacillus cereus endocarditis underscores the complexities of diagnosing and managing such infections. Despite the challenges posed by the patient's adverse reactions to vancomycin, the mainstay treatment, successful management was achieved through persistent administration adjusted for tolerance and side effects. This review meticulously compiles all known cases of Bacillus cereus endocarditis from the past decades, beginning with the first identified case fifty years ago in 1974. It provides a thorough analysis, identifying various risk factors and outlining the evolution of treatment protocols. This comprehensive approach not only enhances understanding of the pathogen's clinical impact but also clarifies the progression of therapeutic strategies, highlighting the individual adaptations necessary to address this challenging infection effectively.

No abstract available.

Aims: The literature from Canada, the UK and the USA reports health inequities among people experiencing homelessness; however little is known about this population's health in Switzerland. Our study is the first to comprehensively assess health needs, expectations and experiences of people experiencing homelessness in Switzerland.

Methods: We describe the health needs, expectations and experiences of people experiencing homelessness in French-speaking Switzerland, using both quantitative and qualitative methods. From May to August 2022, 123 people experiencing homelessness completed quantitative questionnaires about health needs, expectations and experiences. Recruitment took place in 10 homeless-serving institutions across four cities in the Canton of Vaud. A total of 18 people experiencing homelessness and 13 professionals involved in the homeless-serving sector completed qualitative interviews. For the qualitative strand, we selected people experiencing homelessness using quota sampling based on health insurance, residency status and sex representativeness according to the study population. For homeless-serving sector professionals, we used quota sampling by professions (i.e. night watcher in shelters; social/healthcare workers) ensuring balance. In addition, we aimed to recruit at least one homeless-serving sector professional from each of the ten institutions included in the parent research project.

Results: The most common health issues reported were musculoskeletal, dental and psychiatric. Thirty-one percent of people experiencing homelessness had visited emergency rooms and 27% a community health centre in the prior 6 months. People experiencing homelessness reported low quality of life according to the WHOQOL, especially in social and environmental domains; 33% reported moderate and 17% high grade of psychological distress. Findings indicated that up to 32% of participants reported facing difficulties in reaching out to the healthcare system. In qualitative interviews, people experiencing homelessness described positive perceptions about the Swiss healthcare system. However, people experiencing homelessness reported various barriers encountered while seeking healthcare (e.g., health insurance, financial barriers, appointment delays, hesitancy in accessing care, prioritising other needs). Both groups commonly reported that social situations impacted the health and healthcare use of people experiencing homelessness.

Conclusion: People experiencing homelessness in Switzerland are not spared by the common health inequities reported in Canada, the USA and the UK. Our results provide interesting foundations on which to build public health actions towards health equity for people experiencing homelessness in Switzerland and suggest that they could benefit from additional medical follow-up and tailored interventions.

Background: Alveolar echinococcosis is a rare but potentially severe parasitic disease caused by the larval stage of Echinococcus multilocularis, endemic in many countries in the northern hemisphere, including Switzerland. While the liver is most commonly affected, other organs can also be involved either by contiguity or haematogenous spread. To date, there is no epidemiological or clinical data on alveolar echinococcosis in the canton of Geneva.

Objectives: To describe the demographic, epidemiological, clinical and therapeutic characteristics of alveolar echinococcosis in the canton of Geneva between 2010 and 2021.

Methods: An investigation was conducted among physicians from Geneva University Hospitals (HUG) and the private sector likely to encounter patients diagnosed with alveolar echinococcosis between 2010 and 2021. All patients being treated in the canton of Geneva were included. After obtaining their consent, an epidemiological questionnaire was completed by patients, and a clinical questionnaire by their referring physicians. Demographic, epidemiological and clinical data were entered into REDCap, then extracted and analysed.

Results: Of a total of 27 patients diagnosed with alveolar echinococcosis, 25 were included in the study; one patient did not provide his consent and one patient could not be contacted. The annual incidence of alveolar echinococcosis in the canton of Geneva was calculated at 0.24 cases per 100,000 inhabitants based on the subset (n = 14) domiciled in Geneva. The vast majority of patients (n = 24; 96%) were followed at HUG. The median age of patients was 55 years (range: 17-79) with a slight predominance of women (56%). Reported risk factors for alveolar echinococcosis included owning a vegetable garden (70.8%), often unfenced, practicing composting (69.6%), and owning a dog (58.3%) or a cat (58.3%). Four patients (16%) had an immunosuppressive condition. Only 52% of patients were symptomatic at the time of diagnosis. The liver was affected in most cases (n = 24; 96%), but one patient had a primary splenic location. Surgical resection for curative purposes was performed in 13 patients (52%). All patients received parasitostatic treatment with albendazole, discontinued in 5 patients (20%) due to drug-induced hepatitis. Three patients died (12%), of which two directly related to alveolar echinococcosis.

Conclusion: Alveolar echinococcosis, a rare but severe disease, is endemic in the canton of Geneva. The establishment of mandatory reporting of this disease in Switzerland would allow monitoring of its epidemiological evolution. Primary and secondary prevention measures, currently non-existent, could potentially lower the incidence and severity of the disease.

Background: Physician wellbeing has a direct impact on patient care. Meta-analyses have concluded that interventions are moderately effective at reducing physician burnout, but new studies are needed to target populations at higher risk (e.g. young physicians) and determine which interventions might be most effective.   METHOD: Using matched questionnaires, we conducted a cross-sectional pre-post study of a multimodal intervention to promote physician wellbeing. The intervention involved a change in institutional culture, information on occupational wellbeing, and the organisation of undisturbed lunch breaks and short breaks during the day. The primary outcome was the proportion of physicians satisfied with their job (scoring >3 points  on the Work-Related Quality of Life [WRQoL] scale). Secondary outcomes were overall WRQoL score, WRQoL subscale scores, number of short breaks taken during the working day, number of lunch breaks taken, physicians' likeliness of recommending their job to peers, monthly overtime hours worked and monthly sick days. Subgroup analyses included women vs men, residents vs chief residents/senior physicians, and participants with vs without children. We also explored potential factors influencing WRQoL in the pre-intervention population.

Results: Pre- and post-intervention questionnaires were returned by 134 (63%) and 87 (42%) physicians, respectively, with 75 responding to both (matched). The intervention significantly increased the proportion of physicians satisfied with their job (from 49/75 [65%] to 58/75 [77%], p = 0.02), median overall WRQoL score (from 3.3 [IQR: 2.8-3.8] to 3.5 [IQR: 3.1-3.8], p <0.01), median Home-Work Interface subscale score (from 2.7 [IQR: 2.0-3.3] to 3.0 [IQR: 2.3-3.7], p = 0.01) and median General Well-Being subscale score (from 3.4 [IQR: 2.6-4.0] to 3.6 [IQR: 3.0-4.0], p <0.01). Residents showed a greater increase in overall WRQoL median score (from 3.2 [IQR: 2.7-3.6] to 3.5 [IQR: 3.3-3.8]) than chief residents/senior physicians (3.3 [IQR: 2.9-3.9] to 3.4 [IQR: 3.0-3.8], p <0.01 for group difference). No significant differences were seen in other subgroups or secondary outcomes in the matched population. Among the 134 participants in the pre-intervention period, those taking a daily lunch break, sleeping 7 hours or more or self-reporting doing sports activities on weekdays had higher overall WRQoL scores.

Conclusions: This wellbeing intervention increased physicians' WRQoL scores. However, the difference was small and its relevance remains uncertain.

Background: Digital tools are widely utilised to improve communication and information exchange among healthcare professionals. The cantonal hospital in Lucerne was the first to implement the Epic clinical information system in a German-speaking country, including information access for primary care physicians via an electronic health record portal.

Objectives: This study assessed how primary care physicians perceive the communication with hospitals in the canton of Lucerne, including their preferences for discharge summary contents and experiences and utilisation of a regionally implemented electronic health record portal.

Methods: We performed an online survey among primary care physicians and contacted all 323 primary care physicians enlisted as members of the cantonal medical society in Lucerne, Switzerland.

Results: A total of 109 primary care physicians completed the online survey (34% response rate). Half of the primary care physicians were satisfied with hospital communication. Three-quarters (n = 83) wanted to be informed of patients' emergency hospital admission within 48 hours, but only 30% (n = 33) reported being notified. In discharge summaries, primary care physicians expect information on the diagnosis, medication, therapies, and recommendations for follow-up care. A large portion of primary care physicians deemed the electronic health record portal beneficial for patient management. Most primary care physicians utilise the portal to retrieve patient data, but it is rarely used for patient referrals.

Conclusion: Half of primary care physicians were satisfied with communication with regional hospitals. Primary care physicians reported a lack of timely notifications or reports about emergency admissions, in-hospital deaths, and discharges of their patients. Primary care physicians value the electronic health record portal as a supporting tool for patient management.