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Purpose: To compare the costs of 25-fraction vs 5-fraction postoperative radiotherapy regimens in breast cancer patients. Several clinical trials have confirmed at least comparable safety and efficacy of short hypofractionated partial and whole breast radiation regimens. This study was focused on providing detailed cost data and analysing the advantages or disadvantages of either treatment strategy for patients.

Materials and methods: Calculations were performed based on patient and infra-structure data collected from the department of radiation oncology at Lucerne Cantonal Hospital (LUKS) in Switzerland from 1 July to 31 December 2020. The process maps were created to identify resources used for each radiation therapy option, from initial consultation to treatment completion. Cost comparisons represent the viewpoints of the hospital, insurance coverages and societal costs. To estimate hospital costs, time-driven activity-based costing was used, including equipment purchase and personnel costs. For insurers, estimates were based on the TARMED tariff system in Switzerland, which is used for billing ambulatory services and reflecting insurance coverage. The social cost was defined as productivity loss (e.g. absence from work) due to treatment appointments.

Results: The 5-fraction regimens resulted in a total of 53% (972 CHF) lower hospital costs, including personnel and equipment resources, a 42% (3153 CHF) reduction of charges to insurers and a 62% (372 CHF) lower social burden in terms of productivity losses due to the patient's absence from work. The major findings from studies using 5-fraction regimens have shown a comparable result in terms of local control and treatment tolerance.

Conclusion: A5-fraction radiotherapy regimen in breast cancer patients results in a lower cost than a conventional 25-fraction regimen.

Background and study aims: Is there a post-acute infection syndrome for Legionnaires' disease? Legionnaires' disease is a form of primarily community-acquired pneumonia caused by Legionella spp. bacteria. Legionnaires' disease and other forms of bacterial community-acquired pneumonia may lead to persistent health and wellbeing impairments. It remains unclear whether these are caused by the community-acquired pneumonia-causing pathogen or the pneumonia itself. We present the rationale and design of a matched cohort study to investigate the persistent health impacts of Legionnaires' disease and compare them with persistent manifestations of other bacterial (Legionella test-negative) community-acquired pneumonia. We also present baseline characteristics of the study cohorts.

Methods: Legionnaires' disease patients and Legionella test-negative community-acquired pneumonia patients with confirmed or clinically suspected bacterial aetiology were recruited from university and cantonal/regional hospitals and matched for sex, age, hospital type and date of diagnosis. Questionnaire-based interviews are conducted at baseline and 2, 6 and 12 months after the start of appropriate antibiotics. The questionnaires focus on patient-reported outcome measures and cover long-term symptoms, use of health services and health-related quality of life.

Results: Between June 2023 and June 2024, 59 patients with Legionnaires' disease (59.3% male, median age 69 years [interquartile range [IQR]: 57-80]) and 60 patients with other bacterial (Legionella test-negative) community-acquired pneumonia (63.3% male, median age 69 years [IQR: 60-79]) were enrolled. Admission to the intensive care unit was required for 13.6 % of Legionnaires' disease patients and 8.3 % of other bacterial community-acquired pneumonia patients. Chronic kidney failure was more prevalent among Legionnaires' disease patients (15.3% vs 10.0%), while chronic obstructive pulmonary disease (20.0% vs 11.9%), malignancies (33.3% vs 13.6%) and an immunocompromised status (25.0% vs 13.6%) were more common in Legionella test-negative community-acquired pneumonia patients. Furthermore, Legionella test-negative community-acquired pneumonia patients reported lower baseline quality of life scores than Legionnaires' disease patients. Differences in pneumonia severity, comorbidities and self-reported quality of life scores will be accounted for in future analyses.

Conclusions: The LongLEGIO study will contribute to research on post-acute infection syndromes and provide the data for a more holistic assessment of the disease burden of Legionnaires' disease.

Aims: This study aims to provide age-specific prevalence of time spent on-screen among children and adolescents, to identify its sociodemographic and family-related determinants and to assess its impact on physical and psychosocial health outcomes.

Methods: Data was drawn from the SEROCoV-KIDS prospective cohort study, which includes randomly selected children living in Geneva, Switzerland. Daily screen time, sociodemographic and family characteristics were collected at baseline (December 2021 to June 2022). Physical and psychosocial health outcomes were measured at one-year follow-up.

Results: Among 674 children (2-8 years old), 752 preadolescents (9-13 years old) and 434 adolescents (14-17 years old), median daily screen time was 0h29, 1h14 and 3h18, respectively. Lower parental education and poorer parenting practices were associated with higher screen time in all age groups. In children only, poor parental mental health (+14 minutes/day; 95% CI: 2-27) and work-family conflicts (+6 minutes/day; 95% CI: 2-10) were related to increased screen time. After adjustment, elevated screen time was associated with an increased likelihood of poor physical-, emotional- and school-related quality of life in preadolescents and adolescents and of social difficulties in adolescents one year later.

Conclusion: Almost all children engage with screens, but those from socially disadvantaged backgrounds and with strained families face a heightened risk of prolonged screen time. The health consequences we identified call for close monitoring.

Background: Approximately 20% of flap surgeries in people with spinal cord injury/disorder and stage III and IV pressure injury result in a major complication requiring re-surgery. Although several factors are associated with postoperative complications according to the literature, there is no risk prediction model for major postoperative complications in the treatment of stage III and IV pressure injuries in people with spinal cord injury/disorder.

Study aim: The study aims to predict the risk of major postoperative complications in people with spinal cord injury/disorder and stage III and IV pressure injury at hospital admission.

Setting: The study was conducted in a Swiss acute and rehabilitation hospital for people with spinal cord injury/disorder that specialises in the treatment of people with spinal cord injury/disorder using the Basel Decubitus Approach.

Methods: We performed a retrospective cohort study based on routinely collected clinical data in a Swiss hospital. Risk predictors for major postoperative complications during hospitalisation in pressure injuries over the sacrum/coccyx, ischium or trochanter between 01/2016 and 12/2022 were identified using a mixed effects logistic Bayesian LASSO analysis.

Results: We included 252 treatment procedures in 167 individuals. Major complications occurred in 48 (19%) treatment procedures. Estimated glomerular filtration rate (eGFR) according to the cystatin formula (odds ratio [OR] 0.91, confidence interval [CI] 0.62-1.02), vitamin D (25-hydroxy vitamin D; OR 1.05, CI 0.98-1.23), vitamin B12 (OR 0.91, CI 0.74-1.05), sodium (OR 0.75, CI 0.16-1.05) and C-reactive protein (CRP; OR 0.98, CI 0.79-1.07) were found to be predictive of major complications at hospital admission.

Conclusion: For the Basel Decubitus Approach, high levels of eGFR, vitamin B12 and sodium negatively affected major postoperative complications and should, therefore, be assessed during hospital stay. Further investigation is needed to determine the positive effect of high vitamin D and low CRP levels on major postoperative complications.

Study aim: Renal biopsies provide important and decisive information for diagnosis and therapy. Although biopsies are considered safe, bleeding complications remain a concern. We analysed the complication rate after kidney biopsies in native and transplant kidneys and their association with platelet function analyser bleeding time (PFA BT) and estimated glomerular filtration rate (eGFR).

Methods: This single-centre observational study included all patients who underwent an ultrasound-guided kidney biopsy at the University Hospital Basel from 2015 to August 2019. The main objective was to investigate the association of PFA BT with significant bleeding complications in kidney biopsies. Significant bleeding was defined as a haemoglobin decrease of >10 g/l within 48 hours or the need for transfusion after bleeding, according to the discretion of the treating physician. The pre-biopsy assessment included bleeding time using PFA BT, INR, thrombocyte count, and eGFR.

Results: A total of 819 kidney biopsies-285 native and 534 transplant-were analysed. Complications occurred in 32 biopsies (3.9%): 18 (6.3%) in native and 14 (2.6%) in transplant kidneys. Bleeding was the most frequent complication in both groups. Overall, low eGFR (p = 0.01) and prolonged PFA BT (p = 0.02) were associated with bleeding complications. In native kidney biopsies, inpatient biopsy was associated with bleeding complications (p = 0.005), while in transplant kidney biopsies, bleeding complications were associated with time after transplantation (p <0.001), prolonged PFA BT (p <0.001), and diagnostic biopsies (p = 0.01). In the multivariable model, low eGFR was the only significant factor associated with bleeding complications (odds ratio 3.57, 95% confidence interval 1.76-7.23, p <0.001).

Conclusions: A low eGFR, especially below 30 ml/min, is associated with increased bleeding risk in native and transplant kidney biopsies.

Study aims: We created an instrument to assess the supervisors' perspective on their feedback behaviour to residents and investigated its validity. Our instrument is based on the SETQsmart, a Dutch instrument for assessing the quality of supervision in clinical training and the SwissSETQ, its German adaptation for residents. Our instrument is in English to ensure relevance across all Swiss language regions. The study specifically sought: to replicate the factor structure of the original trainee questionnaire for supervisors; to verify the alignment of SwissSETQ and SETQsmart domains with the factor structure; and to evaluate the psychometric properties of the English version.

Methods: The original SwissSETQ was translated into English, maintaining the Swiss context and local language usage. The questionnaire was adjusted to reflect the supervisor's perspective. The translated questionnaire was then distributed among supervisors in all Swiss cardiology training sites, and data were collected using the SoSci Survey platform between March and April 2024. The statistical analysis, including exploratory factor analysis (EFA) with promax rotation, Bartlett's test of sphericity, Kaiser-Meyer-Olkin (KMO) coefficient and psychometric evaluation, was conducted using R software.

Results: Of approximately 600 cardiology supervisors in Switzerland, 207 responded, with 135 valid cases remaining after data cleaning. The factor analysis identified three factors: Teaching structure, Attitude of the supervisor and Role modelling, resulting in a shortened 23-item questionnaire. The Kaiser-Meyer-Olkin coefficient was 0.83, and Bartlett's test was significant, confirming data suitability for factor analysis. The factors demonstrated high internal consistency, with Cronbach's α values of 0.89, 0.77 and 0.87, respectively. The partial credit model indicated the need for a revised 5-point Likert scale for better response distribution. No significant differences were found between factors and sociodemographic variables, suggesting the English version's applicability across all Swiss language regions.

Conclusions: The study investigated the English-translated and supervisor-adapted version of the SwissSETQ, demonstrating good psychometric properties and a clear factor structure. The instrument is suitable for use across different Swiss language regions, enhancing its utility in a multilingual context. The findings support the potential of the SwissSETQ to facilitate cross-cultural and cross-linguistic collaboration in medical training. Future research should explore additional factors influencing teaching quality, such as work environment and supervisor motivation.

Background and aim of the study: For many years, the standard treatment following liver transplantation for hepatitis B has been a combination of hepatitis B immunoglobulin and nucleos(t)ide analogues such as entecavir and tenofovir. However, because of the high costs and logistical challenges of long-term hepatitis B immunoglobulin use, alternative approaches such as vaccination and hepatitis B immunoglobulin-free regimens are being explored. This study gathered information on a potential response (or lack thereof) and addressed the adverse events associated with active immunisation in liver transplant recipients in a Swiss cohort with hepatitis B virus (HBV)-related diseases after discontinuing hepatitis B immunoglobulin.

Methods: Participants were recruited at the University Hospital of Bern between January 2022 and December 2023. Eligibility was restricted to liver transplant recipients with HBV-related disease who were receiving hepatitis B immunoglobulin and nucleos(t)ide analogue therapy at the time of study entry. The primary outcome was HBV relapse following hepatitis B immunoglobulin discontinuation; secondary outcomes included the response rate to active immunisation and reported adverse events. After exclusion, 18 patients were analysed. These patients, under ongoing immunosuppression and antiviral nucleos(t)ide analogue therapy, received active immunisation a minimum of 4 weeks after stopping hepatitis B immunoglobulin. Blood samples were collected at baseline and 4 weeks after vaccination, with follow-up extending for at least 12 months. Responders were defined as those with anti-HB levels of >10 IU/l. All patients received at least three vaccinations.

Results: Six patients responded to the active immunisation with anti-HBs development, showing a response rate of 33.3%. No side effects or HBV recurrence were reported during the study period.

Conclusion: In this cohort, following liver transplantation for hepatitis B, patients who discontinued hepatitis B immunoglobulin while continuing nucleos(t)ide analogue therapy showed no relapse of hepatitis B, and a double-dose vaccination regimen yielded a modest response rate. These findings warrant further investigation into optimising vaccination strategies in this population.

Aim: Globally, tuberculosis incidence shows notable sex disparity, with higher rates observed in males. While this pattern is well documented in adults from high-incidence countries, the influence of sex on tuberculosis incidence in children and adolescents, particularly in low-incidence settings, remains unclear. This study investigated sex-specific tuberculosis incidence rates across all age groups, focusing on adolescents, in a low-incidence country.

Methods:  In this retrospective cohort study, data from the Swiss Federal Office of Public Health (FOPH) tuberculosis database, which centrally consolidates mandatory notifications from physicians and laboratories across Switzerland, were analysed from 2000 to 2021. Tuberculosis incidence rates and male-to-female ratios were calculated and stratified by sex and age. Adolescence was divided into early (10-14 years) and late (15-19 years) stages for detailed analysis.

Results: Over 22 years, the average tuberculosis incidence in Switzerland was 6.78 per 100,000 population, with an overall male-to-female ratio of 1:0.75 (p <0.001). Among the 11,872 notified cases, 832 occurred in adolescents, yielding an incidence rate of 4.39 per 100,000. In late adolescence, males had a significantly higher tuberculosis incidence rate (5.73 per 100,000) than females (2.97 per 100,000, p <0.001), resulting in a male-to-female ratio of 1:0.5. Additionally, data on asylum seekers revealed nearly twice as many males as females arriving in Switzerland in late adolescence.

Conclusions: This study reveals significant sex disparity in tuberculosis incidence in a country with low tuberculosis incidence, with males showing higher rates than females beginning in late adolescence. This discrepancy is likely influenced by the higher influx of male asylum seekers in adolescence.

Background: Numerous studies have demonstrated the effectiveness of Antibiotic Stewardship Programmes in reducing antibiotic resistance and healthcare costs. However, the use of different methods to assess these costs, along with the uncertainty regarding which interventions are cost-effective, hampers the comparison of results and the formulation of clear recommendations. The aim of this systematic review was to provide a comprehensive overview of the available evidence on economic evaluations of Antibiotic Stewardship Programmes and to assess their impact on healthcare costs.

Methods: The systematic review analysed articles indexed in Medline, Embase, Cochrane Reviews and Trials, Business Source Premier or EconLit that assessed the attributed economic impact of Antibiotic Stewardship Programme interventions in acute care settings and were published between 2015 and 2024. Studies identifying as economic analyses, cost-benefit analyses, cost-effectiveness analyses, cost-consequence analyses, cost analyses or cost-minimisation analyses and that fulfilled the essential parameters required for an economic analysis were included. A descriptive analysis was conducted to examine the impact of the interventions on overall costs, length of stay and antimicrobial costs. We also analysed the different kinds of interventions and the type of costs considered in the analyses. Study quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, version 2022.

Results: A total of 2965 publications were identified, of which 411 underwent full-text screening. The 27 studies ultimately included involved 20,232 patients in total and consistently demonstrated savings in antibiotic costs ranging from 2% to 95% relative cost savings, in length of stay costs (3% to 85%) and in overall hospital costs (3% to 86%). The intervention most frequently implemented was "therapy evaluation, review and/or feedback" (23/27, 85%), followed by "alteration of therapy guidelines" (8/27, 30%) and "education" (6/27, 22%). While operational costs were reported by all studies, implementation costs (8/27, 30%) and societal costs (3/27, 11%) were less frequently analysed. By CHEERS category, 9 (33%) of the included studies were rated as low-quality (<60%), 16 (59%) as medium-quality (60-80%) and 2 (7%) as high-quality (>80%).

Conclusions: Our results emphasise that Antibiotic Stewardship Programmes may contribute to a substantial reduction in healthcare costs for a hospital. While the economic reporting in the field has recently improved, certain cost categories should be accounted for more consistently. There remains considerable potential for further improvement and standardisation to enhance the comparability of studies and facilitate the implementation of effective Antibiotic Stewardship Programmes.