Swiss medical weekly最新文献

Aim: Recent data on clinical complications and mortality among hospitalised children and adolescents due to varicella are unavailable in Switzerland. The aim of the study was to explore data on severe varicella complications in hospitalised children before the introduction of a universal varicella vaccination recommendation, which the Swiss Federal Office of Public Health implemented in January 2023.

Methods: This was a retrospective observational study of children hospitalised with varicella between 01.01.2010 and 31.03.2020 at a tertiary children's hospital in central Switzerland serving approximately 10% of the Swiss population. The inclusion criteria were acute varicella and/or related complications.

Results: A total of 95 patients were identified. The median age at onset was 4 years (range: 2 months to 13 years) and the peak age of patients was between 1 and 4 years. 53 had mild and 42 patients had severe varicella-associated complications (8 had >1 severe complication). The most common severe complications were bacterial skin and soft tissue infections (n = 28), invasive secondary bacterial infections (n = 18), and central nervous system-related complications (n = 12). Admission to the paediatric intensive care unit and surgical intervention were required in 11 (12%) and 16 (17%) patients, respectively. Two previously healthy school-age children died because of secondary bacterial infections.

Conclusion: Our results demonstrate that varicella can cause severe and even fatal complications in children living in a highly developed country. This study provides valuable clinical data on severe varicella complications in hospitalised children from a large catchment area of Switzerland, facilitating future data comparison of the disease burden before and after the introduction of universal varicella vaccination in Switzerland.

In this article, we describe and analyse when and what patients need to be told about the use of artificial intelligence in clinical care. In many circumstances, patients do not need to be told about the use of AI, but in cases in which AI is making decisions rather than supporting them or patient data are being transferred to a third party, specific consent must be sought from patients. Ultimately, AI will become a routine part of clinical care, but until then, clinicians must take great care to seek consent where necessary.

Background: Clinical guidelines for acute non-specific low back pain recommend avoiding imaging studies, refraining from strong opioids and invasive treatments, and providing information to patients to stay active. Despite these recommendations, many patients undergo diagnostic and therapeutic assessments that are not in line with the current evidence.

Aim: To assess the management of acute non-specific low back pain by Swiss general practitioners (GPs) and their adherence to guideline recommendations.

Methods: We performed a survey using two clinical case vignettes of patients with acute non-specific low back pain without red flags or neurological deficits. The main differences between the vignettes were sex, age, profession, pain duration and medical history. GPs were asked about their management of those patients.

Results: Of 1253 GPs, 61% reported knowing current clinical guidelines and 76% being aware of "Choosing Wisely" recommendations. Diagnostic evaluations included X-ray (18% for vignette 1, 32% for vignette 2) and magnetic resonance imaging (MRI) (31% and 62%). For pain management, GPs recommended mostly non-steroidal anti-inflammatory drugs, paracetamol and metamizole. Treatments with potential harm included muscle relaxants (78% and 77%), oral steroids (26% and 33%), long-acting opioids (8% and 11%) and spinal injections (28% and 42%). A very high proportion recommended activity restrictions (82% and 71%) and some recommended bed rest (3% and 2%).

Conclusion: Although GPs reported being aware of current guideline recommendations, management of acute non-specific low back pain was not in line with these recommendations. A substantial proportion of GPs considered imaging, treatments (e.g. muscle relaxants, long-acting strong opioids), and activity and work restrictions with potentially harmful consequences.

Study aims: Sarcopenia is a progressive, age-related loss of muscle mass, strength and function. Given the ageing population and the adverse outcomes associated with sarcopenia, monitoring its epidemiology is particularly important. This study aimed to describe sarcopenia prevalence, 5-year incidence and agreement between definitions using the latest operational criteria in Swiss postmenopausal women.

Methods: Postmenopausal women from the last 5 years of the CoLaus/OsteoLaus prospective population-based cohort were included based on complete case analysis (April 2015 to October 2022; Lausanne, Switzerland). We assessed appendicular lean mass via Dual X-ray Absorptiometry (GE Lunar iDXA), handgrip strength using a Jamar Dynamometer and 6-metre gait speed at multiple visits. Sarcopenia was defined based on handgrip strength and/or appendicular lean mass and/or gait speed using 11 definitions, including that from the European Working Group on Sarcopenia in Older People (EWGSOPII, 2019). Prevalence was measured as the number and rate of sarcopenic cases at the last visit, while incidence was measured as the number and rate of new sarcopenic cases over 2.5 or 5 years.

Results: A total of 930 women were included, with a mean (standard deviation) age of 72.9 (6.9) years, BMI of 25.7 (4.8) kg/m2, appendicular lean mass 16.8 (2.5) kg, handgrip strength 21.2 (5.5) kg, gait speed 1.1 (0.2) m/s. Sarcopenia prevalence based on EWGSOPII definitions ranged from 2.2% to 5.7%, while other definitions varied from 0.5% to 13.4%. The 5-year incidence rates based on EWGSOPII were 1.9% to 4.7%. Prevalence and incidence increased significantly between the lowest and highest age tertiles (Fisher's exact test, p <0.05) for most definitions. Agreement between definitions was predominantly "none" or "minimal" according to the Cohen Kappa score.

Conclusion: This population-based cohort of postmenopausal women highlights an increase in sarcopenia prevalence and incidence beginning in the seventh decade of life, underscoring the accelerated decline in muscle health with age. The minimal agreement between the definitions highlights the need for a consensus, which would improve future research and clinical implementations.

Background: When Cox regression models are used to analyse time-to-event data, the proportional hazard assumption (PHA) must be reassured to obtain valid results. Transparent reporting of the statistics used is therefore essential to interpret research. This study aimed to assess the quality of statistical reporting and testing of the PHA in subgroup analysis of surgical randomised controlled trials (RCTs).

Methods: All published articles (see appendix 1) in the top quartile (25%) of surgical journals from 2019 to 2021 were screened in a literature review according to the ClarivateTM journal citation report impact factor. Subgroup analyses of surgical RCT data that used Cox models were identified. Statistical reporting was rated using a previously established 12-item PHA Reporting Score as our primary endpoint. For original surgical publications, the PHA was formally tested on reconstructed time-to-event data from Kaplan-Meier estimators. Methodological reporting quality was rated according to the CONSORT statement. Digitalisation was only possible in studies where a Kaplan-Meier estimator including numbers at risk per time interval was published. All results from the subgroup analyses were compared to primary surgical RCT reports and benchmark RCTs using Cox models published in the New England Journal of Medicine and The Lancet.

Results: Thirty-two studies reporting secondary subgroup analyses on surgical RCT data using Cox models were identified. Statistical reporting of surgical subgroup publications was significantly inferior compared to original benchmark publications: median PHA Reporting Score 50% (interquartile range [IQR]: 39 to 58) vs 58% (IQR: 42 to 67), p <0.001. The subgroups did not differ in comparison to primary surgical RCTs: median PHA Reporting Score 50% (IQR: 39 to 58) vs 42% (IQR: 33 to 58), p = 0.286. Adherence to the CONSORT reporting standards did significantly differ between subgroup studies and benchmark publications (p <0.001) as well as between subgroup studies and primary surgical RCT reports: 13 (12.5 to 14) vs 13 (IQR: 11 to 13), p = 0.042.

Conclusion: Statistical methodological reporting of secondary subgroup analyses from surgical RCTs was inferior to benchmark publications but not worse than primary surgical RCT reports. A comprehensive statistical review process and statistical reporting guidelines might help improve the reporting quality.

Aims of the study: Interprofessional ward rounds are a cornerstone of patient-centred care for medical inpatients and offer opportunities to discuss and coordinate patient treatment and further management. We aimed to identify factors associated with lower satisfaction and efficiency of interprofessional ward rounds, as reported by physicians and nurses.

Methods: An anonymous Swiss nationwide online survey of physicians and nurses was conducted in 28 Swiss internal medicine inpatient departments between 9 August and 19 October 2023. Analyses were conducted from November to December 2023. The primary outcome was physicians' and nurses' perceived lower satisfaction with ward rounds, which was assessed using visual analogue scales ranging from 0 to 10, with lower satisfaction defined as scores below the median. The main secondary outcome was perceived lower efficiency using a similar definition. Qualitative analysis was performed through inductive thematic analysis.

Results: The survey had a response rate of 21.6% (547/2530). Of the 547 physicians and nurses included in the final analysis, the median satisfaction was 7 points (interquartile range [IQR] 6-8). A total of 61% of physicians (156/254) and 76% of nurses (224/293) reported lower satisfaction. Lower satisfaction was reported significantly more frequently by nurses (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.58-3.43; p ≤0.001) and female team members (adjusted OR 1.95, 95% CI 1.32-2.9; p <0.01). The median perceived efficiency of ward rounds was 7 points (IQR 5-8), and the nursing profession was associated with lower perceived efficiency (adjusted OR 1.95, 95% CI 1.3-2.93; p <0.01). Adherence to in-house guidelines for ward rounds was associated with satisfaction (adjusted OR for lower satisfaction 0.25, 95% CI 0.16-0.39; p <0.001) and perceived efficiency (adjusted OR for lower efficiency 0.27, 95% CI 0.17-0.43; p <0.001). Both physicians and nurses preferred to perform ward rounds as part of an interprofessional team. The qualitative analysis of the data revealed a preference for structured interprofessional ward rounds and the active involvement of nurses.

Conclusions: This survey revealed an overall high preference for interprofessional ward rounds. In addition, we identified several factors that were associated with lower satisfaction and efficiency. Structured in-house protocols for ward rounds may increase the satisfaction and efficiency of interprofessional collaboration during ward rounds.

Background and objective: Because of the lack of effective targeted treatment options, docetaxel has long been the standard second-line therapy for patients with advanced non-small cell lung cancer, including the Kirsten rat sarcoma virus (KRAS) G12C mutation. The CodeBreak 200 trial demonstrated that sotorasib, a new drug targeting the G12C-mutated KRAS protein, modestly improved progression-free survival compared with docetaxel in patients whose cancer had progressed after receiving platinum chemotherapy and programmed cell death protein 1 (PD-1) / programmed death ligand 1 (PD-L1) inhibitors as first-line treatment. Consequently, sotorasib received temporary approval in Switzerland. Our analysis assessed the cost-effectiveness of sotorasib as a second-line treatment in Swiss patients with non-small cell lung cancer from the perspective of the Swiss statutory health insurance system.

Methods: A partitioned survival model based on the CodeBreak 200 trial was constructed with a time horizon of 10 years and a discount rate of 3% for costs and quality-adjusted life years (QALYs). Parametric survival curves were fitted to the published Kaplan-Meier data, and survival was extrapolated. QALYs were obtained from the CodeBreak 100 trial and the literature. The costs of drugs, drug administration, diagnostics, disease management, and adverse events were considered. Because the price of sotorasib has not been established in Switzerland, two scenarios were analysed: the first used the published expected monthly United Kingdom (UK) price in Swiss francs (CHF 7870); the second used one-quarter of that price (CHF 1968), according to the lower dose used in the most recent trial, under the condition that one-quarter of the original sotorasib dose is equally effective. Treatment costs of adverse events were included.

Results: Log-normal functions best fitted the survival curves from CodeBreak 200. For sotorasib versus docetaxel, our estimation showed no difference in QALYs (1.28 QALYs for both treatments), as the reduced adverse events reported in CodeBreak 200 for sotorasib had a minimal impact on the QALYs in our calculation. This made an incremental cost-effectiveness ratio (ICER) calculation irrelevant. Total per-patient costs were CHF 138,894 for the full sotorasib dose, CHF 82,741 for the one-quarter dose, and CHF 80,383 for docetaxel. These results were robust in 99% of probabilistic simulations.

Conclusion: Sotorasib did not demonstrate cost-effectiveness at the full dosage nor when reduced to a quarter of the dose. The primary factors motivating clinicians to prescribe sotorasib are its superior overall response rate compared with docetaxel and the reported improvement in patients' quality of life. These factors suggest that it would be reasonable to price it at approximately one-quarter of the assumed cost in the UK.

Background: Coronary artery ectasias and aneurysms (CAE/CAAs) are among the less common forms of coronary artery disease, with undefined long-term outcomes and treatment strategies.

Aims: To assess the clinical characteristics, angiographic patterns, and long-term outcomes in patients with CAE, CAA, or both.

Methods: This 15-year (2006-2021) retrospective single-centre registry included 281 patients diagnosed with CAE/CAA via invasive coronary angiography. Major adverse cardiovascular events included all-cause death, non-fatal myocardial infarction, unplanned ischaemia-driven revascularisation, hospitalisation for heart failure, cerebrovascular events, and clinically overt bleeding. Time-dependent event risks for the CAE and CAA groups were assessed using Cox regression models and Kaplan-Meier curves.

Results: CAEs (n = 161, 57.3%) often had a multi-district distribution (45.8%), while CAAs (78, 27.8%) exhibited a single-vessel pattern (80%). The co-existence of CAAs and CAE was observed in 42 cases (14.9%), and multi-vessel obstructive coronary artery disease was prevalent (55.9% overall). Rates of major adverse cardiovascular events were 14.3% in-hospital and 38.1% at a median follow-up of 18.9 (interquartile range [IQR] 6.0-39.9) months. The presence of CAAs was associated with increased major adverse cardiovascular events risk in comparison to CAE (hazard ratio [HR] = 2.26, 95% confidence interval [CI] 1.38-3.69, p = 0.001), driven by a higher hazard ratio of non-fatal myocardial infarctions (HR = 5.00, 95% CI 1.66-15.0, p = 0.004) and unplanned ischaemia-driven revascularisation in both dilated (HR = 3.23, 95% CI 1.40-7.45, p = 0.006) and non-dilated coronary artery segments (HR 3.83, 95% CI 2.08-7.07, p = 0.001).

Conclusions: Overlap between obstructive and dilated coronary artery disease is frequent. Among the spectrum of dilated coronary artery disease, the presence of a CAA was associated with worse long-term outcomes.