Swiss medical weekly最新文献

  BACKGROUND: Community mental health nursing has gained importance in Switzerland as part of a broader shift towards community-based psychiatric care. While community mental health nursing services are increasingly implemented, empirical evidence on their effectiveness in reducing psychiatric hospitalisations remains limited. This study aims to evaluate the effect of community mental health nursing on psychiatric hospitalisations and to identify risk factors for hospitalisation during community mental health nursing care.

Methods: We conducted a naturalistic observational study using data from two linked national databases: the HomeCareData register and the Medical Statistics of Hospitals. The study included adults who were admitted to community mental health nursing services between January 2020 and December 2022 and whose data was documented in HomeCareData. With mirror-image methods, we compared psychiatric hospitalisation rates in equally long pre-index and post-index periods, defined by each individual's duration of community mental health nursing care, with each participant serving as their own control. The start of community mental health nursing care was defined as the index date. For a sensitivity analysis, individuals hospitalised within 60 days before the start of community mental health nursing were excluded to address potential regression to the mean effects. Uni- and multivariable logistic regression were used to identify risk factors of hospitalisation during community mental health nursing care.

Results: The study sample comprised 5252 individuals with a mean age of 52 years; 66% were female. The primary mirror-image analysis revealed a significant reduction in psychiatric hospitalisations following the start of community mental health nursing (unadjusted Incidence Rate Ratio: 0.60; 95% confidence interval: 0.55-0.65). No significant effect was observed in the sensitivity analysis (unadjusted Incidence Rate Ratio: 0.97; 95% confidence interval: 0.87-1.09). Multivariable logistic regression identified previous psychiatric hospitalisations and compulsory admissions as significant risk factors of hospitalisation during community mental health nursing care. Sociodemographic and diagnostic variables showed no significant associations.

Conclusions: This is the first study to show a reduction in psychiatric hospitalisations after participation in community mental health nursing services in Switzerland. However, this effect was not confirmed in the sensitivity analysis which may suggest a regression to the mean effect. The study demonstrates the feasibility of using linked routine data to evaluate real-world mental health interventions and underscores the need for broader data coverage and improved documentation to strengthen future research.

Background and aims: Respiratory syncytial virus (RSV) infection is one of the leading causes of hospitalisation in infants, the elderly and immunocompromised patients, with significant morbidity and mortality rates. Despite its global impact, epidemiological surveillance of RSV in Switzerland has historically been limited compared to the USA and European countries. A significant surge in RSV activity and hospitalisations after the COVID-19 pandemic, along with the introduction of new monoclonal antibodies and RSV vaccines, has led to an increased interest in the molecular epidemiology of RSV. To ensure continued efficacy of the new preventive options, monitoring of the genetic diversity of circulating RSV strains, their evolutionary dynamics and the potential emergence of resistance mutations is of central importance. The present study aimed to characterise the genetic diversity and seasonal trends of RSV dynamics in Switzerland from 2019 to 2024, mainly over the last two post-pandemic winter seasons (2022/23 and 2023/24).

Methods: A total of 48,897 respiratory clinical specimens from 30,782 patients with respiratory tract infections were tested for RSV at a tertiary care centre in Northwestern Switzerland between July 2019 and June 2024. RSV activity over these seasons was investigated. Amplicon-based whole-genome sequencing was performed on 182 selected samples, with 125 high-quality consensus genomes and phylogenies reconstructed. Lineage distribution and seasonal subtype prevalence were compared to European data.

Results: RSV activity was absent during the 2020/21 pandemic season, but surged with an off-season peak in summer 2021. RSV B predominated during the 2022/23 season, while a shift to RSV A occurred in the 2023/24 winter season, which is in line with neighbouring European countries. Lineage subtype distribution showed high concordance with circulating European strains. RSV A exhibited greater diversity (mean pairwise Hamming distance 0.015, SD 0.006) than RSV B (mean 0.006, 0.003), with all current strains falling within G protein duplication clades A.D.1, 2, 3 and 5 for RSV A, and B.D.E.1 and B.D.4.1.1 for RSV B.

Conclusion: By contributing 125 newly assembled RSV genome sequences, we have significantly increased the number of publicly available whole-genome sequences from Switzerland. Our study provides a genomic surveillance of RSV in Switzerland, analysing seasonal patterns, alternating subtype dominance, and consistency with broader European trends. A comprehensive understanding of the molecular epidemiology of RSV enables healthcare providers and public health authorities to monitor the effectiveness of current vaccines and monoclonal antibodies, associate lineages and serotypes with disease severity, implement timely interventions and detect emerging variants, ultimately reducing the burden of RSV-related illnesses.

  INTRODUCTION: Most European transplant centres require patients to abstain from alcohol consumption for at least 6 months to be listed for liver transplantation, even though delayed transplantation is associated with increased mortality. This study examined the effects of a shorter duration of alcohol abstinence before placement on the waiting list for liver transplantation on post-transplant survival and quality of life. This article contributes to the ongoing debate on whether patients with less than 6 months of alcohol abstinence should be categorically excluded from transplantation.

Methods:  This retrospective cohort study analysed patients at the University Hospital Zurich who underwent liver transplantation for any indication between 2011 and 2019. Patients younger than 18 years and those with acute liver failure were excluded. The follow-up period was 3 years. The outcomes were post-transplant survival and quality of life in patients with less than (group 1) or more than (group 2) 6 months of abstinence before being listed for liver transplantation. Survival was compared using log-rank tests, and quality of life (scored from 0 to 100) was compared using multivariate ANOVA with repeated measures.

Results:  Of the 206 included patients, 50 (24%) had abstained from alcohol for less than 6 months before being listed for liver transplantation (group 1). The cohort had a median (IQR) age at transplantation of 59 (53-64) years, and 155 (75%) were men. Three-year survival was similar in patients with less than or more than 6 months of alcohol abstinence before listing (76% [95% CI, 62%; 86%] vs 78% [95% CI, 70%; 83%]). No significant differences in quality-of-life scores were observed between groups (F(2,244) = 0.814, p = 0.435), and no significant changes in quality of life over time were found within each group (F(1,133) = 0.346, p = 0.557). The median (IQR) quality of life score at 36 months after transplantation was 80 (56-92) in patients with less than 6 months of abstinence before listing versus 78 (63-90) in those with more than 6 months of abstinence.

Conclusion:  Post-transplant survival and quality of life did not differ between patients with less than 6 months and those with more than 6 months of alcohol abstinence before being listed for liver transplantation. These findings suggest that the strict 6-month abstinence requirement for inclusion on the waiting list should be reconsidered to prevent patients from being denied access to life-saving transplantation solely because of a shorter abstinence duration.

Background: Respiratory syncytial virus (RSV) infection is a major cause of severe lower respiratory tract infections in newborns and young infants, especially during the winter season from October to March. In Switzerland, RSV infection represents a leading cause of hospital admissions among newborns. Since October 2024, a long-acting monoclonal antibody, nirsevimab (Beyfortus®), has been available in Switzerland for standard care in newborns.

Objectives: This paper presents a multidisciplinary, standardised protocol for the administration of nirsevimab, as well as immunisation data from the first season of application in 2024/25 at a tertiary centre in Switzerland.

Methods: A protocol for implementing the RSV immunisation strategy was developed at University Hospital Zurich by a multidisciplinary team of obstetricians, neonatologists, nurses, from in- and outpatient services. The focus was on prenatal counselling during outpatient consultations as well as inpatient procedures on maternity and neonatology wards. The goal was to provide expectant parents with consistent information by different healthcare professionals. Neonatal immunisation data from the first season in 2024/25 (25 October to 31 March ) were retrieved from patient charts (Yes/No) in a retrospective, quality control, observational cohort study. All newborns discharged from the maternity ward or the neonatology unit of our centre were included in the analysis.

Results: The protocol included early and multidisciplinary parental education, offering consistent oral and written information, as well as opportunities to discuss their questions regarding the new immunisation, ensured informed consent and enabled timely administration of nirsevimab by healthcare professionals in the obstetrics and neonatology units. Over the 2024/25 season, 78% of the newborns were immunised before leaving hospital care: 78% (588/758) of newborns discharged home from the maternity ward were immunised and 82% (125/153) of those discharged home from the neonatology unit were immunised.   CONCLUSION: The implementation of passive RSV immunisation was overall successful with an immunisation rate of around 80% for the first season in 2024/25.

  AIM: Antimicrobial stewardship (AMS) is essential to containing antimicrobial resistance. Under the Swiss Strategy on Antibiotic Resistance (StAR), a nationwide survey was conducted to assess antimicrobial stewardship implementation in acute care hospitals and inform future national stewardship strategies.

Methods: A total of 136 acute care hospitals in Switzerland were invited to complete a questionnaire adapted from a validated Dutch tool and modified for the Swiss context. The questionnaire gathered information on whether a formal antimicrobial stewardship programme was present (primary outcome), institutional characteristics, as well as key antimicrobial stewardship activities (secondary outcomes) such as guideline implementation, education, raising awareness, prescription restrictions, and audits. Descriptive statistics and analyses compared the implementation of antimicrobial stewardship activities by the presence of a formal antimicrobial stewardship programme.

Results: Sixty-nine hospitals completed the survey (response rate: 51%); these hospitals represent 67% of all patient discharges in Switzerland in 2023. Although 86% reported engaging in at least one antimicrobial stewardship activity, only 47% had a formal antimicrobial stewardship programme (primary outcome). Most institutions reported providing infectious diseases specialist consult services (93%), clinical pharmacy support (84%), and microbiology advice (78%). Treatment guidelines (90%) and monitoring antimicrobial use (85%) were widely implemented. However, critical stewardship measures such as prescription audits with feedback were underutilised (20%), and few hospitals (18%) had allocated dedicated staff resources for antimicrobial stewardship. Hospitals with formal antimicrobial stewardship programmes reported key activities such as guideline use, prescriber education, antimicrobial restrictions, and audits more frequently.

Conclusion: This nationwide survey demonstrates encouraging progress in antimicrobial stewardship implementation since 2017, with most hospitals reporting stewardship activities and half having established a formal antimicrobial stewardship programme. However, critical gaps remain, highlighting the need for strengthened coordination and national support for hospitals to establish formal antimicrobial stewardship programmes to ensure the implementation and a sustainable impact of key antimicrobial stewardship activities.

  Switzerland's Electronic Patient Record (EPR) system faces a critical adoption crisis: less than 2% of the population has opened an account despite years of investment. To understand this failure from the citizen's perspective, we launched the first "expedition" in which 120 volunteers ("salutonauts") systematically tested Switzerland's current digital health infrastructure by opening EPRs, requesting their health data and documenting their experiences. This represents the first real-world, citizen-led assessment of Switzerland's health data infrastructure. Our findings reveal three fundamental insights. First, citizens appreciate the concept of personally controlled health records governed by a trustworthy national framework. Second, the current EPR implementation is both impractical and economically untenable under existing conditions: opening an EPR nationwide would cost CHF 400 million (calculated from required man-hours alone), while uploading historic documents would cost CHF 1 billion, and obtaining insurance claims data would cost over CHF 5 billion in lost productivity. Third, the recently announced draft of the new Electronic Health Dossier Law (E-GD) comes at a critical moment, since evidence-based redesign of the EPR system is essential. 95% of participants valued comprehensive medical checkups producing structured data, demonstrating citizens' appetite for high-quality digital health records when they provide tangible benefits. Our expedition methodology, which is agile, citizen-centred and involves real-world testing, offers a replicable model for evaluating digital health initiatives before massive implementation costs are incurred. With the E-GD revision underway, Switzerland has a unique opportunity to develop an EPR system that serves patients and physicians above all. Successful implementation requires EPR opening at birth by default (with the ability to opt-out), the AI-powered automation of data collection and uploading, seamless healthcare professional interfaces, and using the EPR as the billing data gateway. The alternative - i.e. continuing the current approach - virtually guarantees failure based on economic factors alone.

In Switzerland, where individual self-determination and self-responsibility are strong values, coercive measures are still very present in the care of individuals with mental health conditions. In 2022, over 18,000 cases of compulsory care placements were recorded - one of the highest rates in Europe [1]. The Swiss Academy of Medical Sciences (SAMS) is reviewing its guidelines on coercion to better support practice. The present viewpoint aims to contribute to such efforts by focusing on the role of advance directives in preventing unwanted compulsory placement and coercive measures. Advance directives support individuals to document treatment preferences in anticipation of future incapacity. There is, though, differentiation between psychiatric and non-psychiatric cases: while treatment refusals for somatic conditions are typically considered binding, the preferences expressed in psychiatric advance directives can be overridden following compulsory placement. This creates a double standard that undermines self-determination for individuals with mental health conditions. The present article advocates for uniform legal standards that would grant psychiatric advance directives equal binding force. It explores the validity of common arguments against doing so, suggesting that objections often rely on inconsistent or ethically flawed reasoning. The piece lays out arguments in support of modifying policy on psychiatric advance directives, suggesting that comparably binding directives might enhance patient autonomy, reduce the harm of coercive interventions, promote goal-concordant care, strengthen oversight, and address discriminatory policy. As the Swiss Academy of Medical Sciences revisits guidelines on coercive practices, it is a good moment to consider the potential value of binding psychiatric advance directives as tools to uphold patient autonomy and contribute to broader efforts to reduce the harm of coercive practices.

Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems worldwide, leading to concerns about reduced access to routine childhood immunisations. However, comprehensive data on how the pandemic specifically impacted paediatric vaccination coverage in Switzerland remain limited across the country. The present study provides an analysis of the timeliness and coverage of routine childhood immunisations in Switzerland before and during the COVID-19 pandemic, offering insights into potential fluctuations in coverage.

Aims: To assess the impact of the COVID-19 pandemic on routine childhood immunisation in Switzerland by comparing vaccination coverage and timeliness for children under 35 months of age before and during the pandemic. Additionally, the study seeks to identify factors associated with the likelihood of children receiving vaccinations, considering demographic and geographic variables.

Methods: We used 2019-2023 data from the Swiss National Vaccination Coverage Survey (SNVCS), a cross-sectional survey that collected immunisation information of children under 35 months of age from a nationally representative sample of households. Children who were eligible for a vaccine from March 2020 to March 2021 were considered as the COVID-affected group and those eligible for a vaccine before this date were included in the pre-COVID-19 cohort. Coverage of the following vaccine doses was considered: diphtheria at one, two and three doses (Di1, Di2, Di3); pneumococcus at one, two and three doses (PCV1, PCV2, PCV3); and measles first and second dose (MCV1, MCV2). Vaccine timeliness was defined as receiving a dose on time with a tolerance period of 30 days. We used logistic regression models to identify and understand the factors that might influence vaccination rates.

Results: For the diphtheria vaccines (Di1, Di2, Di3), while coverage remained high, there was a slight decrease observed in timely vaccination rates for some doses, with reductions of around 1% to 3% compared to pre-COVID-19 levels. The impact on PCV1, PCV2 and PCV3 showed similar trends, with slight reductions in coverage during the pandemic, but these differences were not statistically significant. For measles-containing vaccines (MCV1 and MCV2), coverage during the pandemic was higher compared to pre-COVID-19 rates. Geographic and demographic factors, such as an urban setting, nationality and linguistic region, significantly influence childhood vaccination rates in Switzerland.

Conclusion: While minor declines in vaccine timeliness were observed (diphtheria vaccine, pneumococcal conjugate vaccine), the overall likelihood of vaccination was not significantly affected by the COVID-19 pandemic. However, changes in vaccination recommendations introduced in 2019 may have influenced these trends.