Background: Digital health holds promise for enhancing care coordination and supporting patient self-management. However, various barriers, including at the healthcare professional level, hinder its adoption. This cross-sectional study explored the eHealth profile of primary care physicians and its relationship with care coordination.
Methods: As part of "The Commonwealth Fund's 2022 International Health Policy Survey of Primary Care Physicians in 10 Countries", 1114 physicians in Switzerland completed a questionnaire on their sociodemographic and workplace characteristics, digital health use and care coordination practices. Based on their responses concerning the modality, frequency and application of digital health tools, we created a digital health score. Based on responses describing the collaboration with specialists and paramedical health professionals, we created a care coordination score. The associations between both scores were assessed using stratified analyses and multiple linear regression.
Results: Among the 1114 participants (46% women, mean age 52 years), 83% used electronic patient records, 96% used teleconsultations for less than 5% of consultations, and 63% never used connected health tools to monitor patients with chronic diseases. Further, 16% allowed online appointments, 20% online medical prescriptions, 52% the possibility of electronically communicating lists of medications with other healthcare professionals, and 89% the possibility of email or web communications with the patient. The eHealth score was positively associated with the number of weekly working hours, being an internal medicine specialist or practising physician, the number of full-time equivalents in the practice and being in a group practice setting. The higher the eHealth profile score, the higher the care coordination score.
Conclusion: Digital health and care coordination were positively associated. This could underscore the potential benefits of digital health in enhancing collaborative and interprofessional care practices.
{"title":"Primary care physician eHealth profile and care coordination: a cross-sectional study.","authors":"Mathieu Jendly, Valérie Santschi, Stefano Tancredi, Arnaud Chiolero","doi":"10.57187/s.3851","DOIUrl":"https://doi.org/10.57187/s.3851","url":null,"abstract":"<p><strong>Background: </strong>Digital health holds promise for enhancing care coordination and supporting patient self-management. However, various barriers, including at the healthcare professional level, hinder its adoption. This cross-sectional study explored the eHealth profile of primary care physicians and its relationship with care coordination.</p><p><strong>Methods: </strong>As part of \"The Commonwealth Fund's 2022 International Health Policy Survey of Primary Care Physicians in 10 Countries\", 1114 physicians in Switzerland completed a questionnaire on their sociodemographic and workplace characteristics, digital health use and care coordination practices. Based on their responses concerning the modality, frequency and application of digital health tools, we created a digital health score. Based on responses describing the collaboration with specialists and paramedical health professionals, we created a care coordination score. The associations between both scores were assessed using stratified analyses and multiple linear regression.</p><p><strong>Results: </strong>Among the 1114 participants (46% women, mean age 52 years), 83% used electronic patient records, 96% used teleconsultations for less than 5% of consultations, and 63% never used connected health tools to monitor patients with chronic diseases. Further, 16% allowed online appointments, 20% online medical prescriptions, 52% the possibility of electronically communicating lists of medications with other healthcare professionals, and 89% the possibility of email or web communications with the patient. The eHealth score was positively associated with the number of weekly working hours, being an internal medicine specialist or practising physician, the number of full-time equivalents in the practice and being in a group practice setting. The higher the eHealth profile score, the higher the care coordination score.</p><p><strong>Conclusion: </strong>Digital health and care coordination were positively associated. This could underscore the potential benefits of digital health in enhancing collaborative and interprofessional care practices.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3851"},"PeriodicalIF":2.1,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chatbots are computer programs designed to engage in natural language conversations in an easy and understandable way. Their use has been accelerated recently with the advent of large language models. However, their application in medicine and healthcare has been limited due to concerns over data privacy, the risk of providing medical diagnoses, and ensuring regulatory and legal compliance. Medicine and healthcare could benefit from chatbots if their scope is carefully defined and if they are used appropriately and monitored long-term. The confIAnce chatbot, developed at the Geneva University Hospitals and the University of Geneva, is an informational tool aimed at providing simplified information to the general public about primary care and chronic diseases. In this paper, we describe the certification and regulatory aspects applicable to chatbots in healthcare, particularly in primary care medicine. We use the confIAnce chatbot as a case study to explore the definition and classification of a medical device and its application to chatbots, considering the applicable Swiss regulations and the European Union AI Act. Chatbots can be classified anywhere from non-medical devices (informational tools that do not handle patient data or provide recommendations for treatment or diagnosis) to Class III medical devices (high-risk tools capable of predicting potentially fatal events and enabling a pre-emptive medical intervention). Key considerations in the definition and certification process include defining the chatbot's scope, ensuring compliance with regulations, maintaining security and safety, and continuously evaluating performance, risks, and utility. A lexicon of relevant terms related to artificial intelligence in healthcare, medical devices, and regulatory frameworks is also presented in this paper. Chatbots hold potential for both patients and healthcare professionals, provided that their scope of practice is clearly defined, and that they comply with regulatory requirements. This review aims to provide transparency by outlining the steps required for certification and regulatory compliance, making it valuable for healthcare professionals, scientists, developers, and patients.
聊天机器人是一种计算机程序，旨在以简单易懂的方式进行自然语言对话。最近，随着大型语言模型的出现，聊天机器人的使用也在加速。然而，由于担心数据隐私、提供医疗诊断的风险以及确保监管和法律合规，聊天机器人在医疗和保健领域的应用一直很有限。如果能仔细界定聊天机器人的应用范围，并对其进行合理使用和长期监控，医疗和保健领域将受益匪浅。日内瓦大学医院和日内瓦大学开发的 confIAnce 聊天机器人是一款信息工具，旨在为公众提供有关初级保健和慢性疾病的简化信息。在本文中，我们将介绍适用于医疗保健聊天机器人的认证和监管问题，尤其是在初级医疗保健领域。我们以 confIAnce 聊天机器人为案例，探讨医疗设备的定义和分类及其在聊天机器人中的应用，同时考虑到适用的瑞士法规和欧盟人工智能法案。聊天机器人可分为非医疗设备（不处理患者数据或提供治疗或诊断建议的信息工具）和 III 类医疗设备（能够预测潜在致命事件并实现先发制人医疗干预的高风险工具）。定义和认证过程中的主要考虑因素包括：定义聊天机器人的范围、确保符合法规、维护安全性，以及持续评估性能、风险和效用。本文还介绍了与医疗保健、医疗设备和监管框架中的人工智能相关的术语词汇表。聊天机器人对患者和医疗保健专业人员来说都具有潜力，但前提是必须明确界定其业务范围并遵守监管要求。本综述旨在通过概述认证和监管合规所需的步骤来提供透明度，使其对医疗保健专业人员、科学家、开发人员和患者都有价值。
{"title":"Chatbots in medicine: certification process and applied use case.","authors":"Mayssam Nehme, Franck Schneider, Esther Amruthalingam, Elio Schnarrenberger, Raphaël Tremeaud, Idris Guessous","doi":"10.57187/s.3954","DOIUrl":"https://doi.org/10.57187/s.3954","url":null,"abstract":"<p><p>Chatbots are computer programs designed to engage in natural language conversations in an easy and understandable way. Their use has been accelerated recently with the advent of large language models. However, their application in medicine and healthcare has been limited due to concerns over data privacy, the risk of providing medical diagnoses, and ensuring regulatory and legal compliance. Medicine and healthcare could benefit from chatbots if their scope is carefully defined and if they are used appropriately and monitored long-term. The confIAnce chatbot, developed at the Geneva University Hospitals and the University of Geneva, is an informational tool aimed at providing simplified information to the general public about primary care and chronic diseases. In this paper, we describe the certification and regulatory aspects applicable to chatbots in healthcare, particularly in primary care medicine. We use the confIAnce chatbot as a case study to explore the definition and classification of a medical device and its application to chatbots, considering the applicable Swiss regulations and the European Union AI Act. Chatbots can be classified anywhere from non-medical devices (informational tools that do not handle patient data or provide recommendations for treatment or diagnosis) to Class III medical devices (high-risk tools capable of predicting potentially fatal events and enabling a pre-emptive medical intervention). Key considerations in the definition and certification process include defining the chatbot's scope, ensuring compliance with regulations, maintaining security and safety, and continuously evaluating performance, risks, and utility. A lexicon of relevant terms related to artificial intelligence in healthcare, medical devices, and regulatory frameworks is also presented in this paper. Chatbots hold potential for both patients and healthcare professionals, provided that their scope of practice is clearly defined, and that they comply with regulatory requirements. This review aims to provide transparency by outlining the steps required for certification and regulatory compliance, making it valuable for healthcare professionals, scientists, developers, and patients.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3954"},"PeriodicalIF":2.1,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christophe Alain Wyss, Roberto Corti, Thomas Nestelberger, Pascal Candolfi, Alexis Delbaere, Barbara Fischer, Matthias Schwenkglenks, Harry Telser
<p><strong>Aims of the study: </strong>The 2021 European Society of Cardiology Guidelines on valvular heart disease recommend transcatheter aortic valve implantation (TAVI) for patients with symptomatic severe aortic stenosis at low surgical risk and age ≥75 years who are suitable for a transfemoral approach (recommendation class IA) based on two large randomised controlled trials (PARTNER 3 and Evolut Low Risk) comparing transcatheter aortic valve implantation with surgical aortic valve replacement (SAVR). Whether such an approach is cost-effective in Switzerland remains unclear. The aim of this cost-utility analysis was to compare transcatheter aortic valve implantation with SAPIEN 3 versus surgical aortic valve replacement in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of Swiss compulsory health insurance using data from the PARTNER 3 trial (reflecting specifically the safety and efficacy of the SAPIEN 3 TAVI device).</p><p><strong>Methods: </strong>A previously published two-stage Markov-based model that captured clinical outcomes from the PARTNER 3 trial was adapted from the perspective of the Swiss compulsory health insurance system, using local or geographically close general population mortality and utility data, unit costs and medical resource use from publicly available sources and based on expert opinion. The model had a lifetime horizon with a 3% yearly discounting factor. The cost-utility analysis estimated changes in both direct healthcare costs and health-related quality-adjusted life years for transcatheter aortic valve implantation compared with surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low risk of surgical mortality.</p><p><strong>Results: </strong>Overall, transcatheter aortic valve implantation with SAPIEN 3 resulted in lifetime costs per patient of CHF 79,534 and quality-adjusted life years per patient of 9.64, compared with surgical aortic valve replacement lifetime costs and quality-adjusted life years per patient of CHF 76,891 and 8.96, respectively. Compared with surgical aortic valve replacement, transcatheter aortic valve implantation was estimated to offer an incremental improvement of +0.68 quality-adjusted life years per patient at an increased cost of +CHF 2643 per patient over a lifetime horizon. The incremental cost-effectiveness ratio was CHF 3866 per quality-adjusted life year gained and remained below CHF 50,000 per quality-adjusted life year gained across several sensitivity analyses.</p><p><strong>Conclusions: </strong>This analysis suggests that transcatheter aortic valve implantation using the SAPIEN 3 device is likely to be a highly cost-effective alternative for symptomatic severe aortic stenosis patients at a low risk of surgical mortality, treated in the contemporary Swiss setting. These findings may help to inform a holistic approach when making policy decisions for the management of this patient group
{"title":"Transcatheter aortic valve implantation with SAPIEN 3 versus surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low risk of surgical mortality: a cost-utility analysis for Switzerland.","authors":"Christophe Alain Wyss, Roberto Corti, Thomas Nestelberger, Pascal Candolfi, Alexis Delbaere, Barbara Fischer, Matthias Schwenkglenks, Harry Telser","doi":"10.57187/s.3558","DOIUrl":"https://doi.org/10.57187/s.3558","url":null,"abstract":"<p><strong>Aims of the study: </strong>The 2021 European Society of Cardiology Guidelines on valvular heart disease recommend transcatheter aortic valve implantation (TAVI) for patients with symptomatic severe aortic stenosis at low surgical risk and age ≥75 years who are suitable for a transfemoral approach (recommendation class IA) based on two large randomised controlled trials (PARTNER 3 and Evolut Low Risk) comparing transcatheter aortic valve implantation with surgical aortic valve replacement (SAVR). Whether such an approach is cost-effective in Switzerland remains unclear. The aim of this cost-utility analysis was to compare transcatheter aortic valve implantation with SAPIEN 3 versus surgical aortic valve replacement in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of Swiss compulsory health insurance using data from the PARTNER 3 trial (reflecting specifically the safety and efficacy of the SAPIEN 3 TAVI device).</p><p><strong>Methods: </strong>A previously published two-stage Markov-based model that captured clinical outcomes from the PARTNER 3 trial was adapted from the perspective of the Swiss compulsory health insurance system, using local or geographically close general population mortality and utility data, unit costs and medical resource use from publicly available sources and based on expert opinion. The model had a lifetime horizon with a 3% yearly discounting factor. The cost-utility analysis estimated changes in both direct healthcare costs and health-related quality-adjusted life years for transcatheter aortic valve implantation compared with surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low risk of surgical mortality.</p><p><strong>Results: </strong>Overall, transcatheter aortic valve implantation with SAPIEN 3 resulted in lifetime costs per patient of CHF 79,534 and quality-adjusted life years per patient of 9.64, compared with surgical aortic valve replacement lifetime costs and quality-adjusted life years per patient of CHF 76,891 and 8.96, respectively. Compared with surgical aortic valve replacement, transcatheter aortic valve implantation was estimated to offer an incremental improvement of +0.68 quality-adjusted life years per patient at an increased cost of +CHF 2643 per patient over a lifetime horizon. The incremental cost-effectiveness ratio was CHF 3866 per quality-adjusted life year gained and remained below CHF 50,000 per quality-adjusted life year gained across several sensitivity analyses.</p><p><strong>Conclusions: </strong>This analysis suggests that transcatheter aortic valve implantation using the SAPIEN 3 device is likely to be a highly cost-effective alternative for symptomatic severe aortic stenosis patients at a low risk of surgical mortality, treated in the contemporary Swiss setting. These findings may help to inform a holistic approach when making policy decisions for the management of this patient group","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3558"},"PeriodicalIF":2.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giuliano Pigazzini, Maud Wieczorek, Clément Meier, Jürgen Maurer
<p><strong>Background and aim: </strong>Population ageing in Switzerland poses significant challenges, including for the healthcare system. Inadequate health literacy can hinder individuals' ability to seek appropriate treatments and navigate the healthcare system efficiently. This study explores the associations between health literacy and the number of consultations with general practitioners and healthcare specialists in a population-based sample of adults aged 58+ in Switzerland.</p><p><strong>Methods: </strong>We used data from 1424 older adults who participated in Wave 8 (2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis focuses on two outcomes: the reported number of consultations with (1) general practitioners or (2) healthcare specialists in the year prior to the interview. Health literacy, i.e. the ability to find, understand, assess and apply health information, is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The final health literacy score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0-8), problematic (9-12) and sufficient (13-16). Bivariate analyses were conducted using Kruskal-Wallis tests. Partial associations were examined using multivariate generalised Poisson regression models controlling for key sociodemographic, regional and health-related variables.</p><p><strong>Results: </strong>Overall, 68.5% of the respondents were classified as having sufficient health literacy, while the health literacy level of 23.5% and 7.9% of respondents was classified as problematic or inadequate, respectively. The median number of general practitioner consultations and specialist visits was 2 and 1, respectively, both with an interquartile range of 1. Lower levels of health literacy were statistically significantly associated (p = 0.0011) with a higher number of general practitioner consultations in the year prior to the interview. By contrast, we did not find any significant association between health literacy and the number of specialist consultations.</p><p><strong>Conclusion: </strong>This study finds that lower health literacy is associated with higher healthcare utilisation for older adults in Switzerland. The findings may suggest that general practitioners could have a significant role as advisors for individuals with low levels of health literacy, while a similar pattern is not observed for specialists. This discrepancy might be attributed, at least in part, to the role of general practitioners as intermediaries between patients and specialised care providers. Ensuring accessibility to general practitioners, particularly for individuals with low health literacy, could prove to be a beneficial strategy in addressing the healthcare requirements of this particularly vulnerable patient group. Additionally, improving health literacy in the population may provide further health benefits and lead to resource savings
{"title":"Inadequate health literacy and higher healthcare utilisation among older adults in Switzerland: cross-sectional evidence from a population-based study.","authors":"Giuliano Pigazzini, Maud Wieczorek, Clément Meier, Jürgen Maurer","doi":"10.57187/s.3515","DOIUrl":"https://doi.org/10.57187/s.3515","url":null,"abstract":"<p><strong>Background and aim: </strong>Population ageing in Switzerland poses significant challenges, including for the healthcare system. Inadequate health literacy can hinder individuals' ability to seek appropriate treatments and navigate the healthcare system efficiently. This study explores the associations between health literacy and the number of consultations with general practitioners and healthcare specialists in a population-based sample of adults aged 58+ in Switzerland.</p><p><strong>Methods: </strong>We used data from 1424 older adults who participated in Wave 8 (2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis focuses on two outcomes: the reported number of consultations with (1) general practitioners or (2) healthcare specialists in the year prior to the interview. Health literacy, i.e. the ability to find, understand, assess and apply health information, is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The final health literacy score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0-8), problematic (9-12) and sufficient (13-16). Bivariate analyses were conducted using Kruskal-Wallis tests. Partial associations were examined using multivariate generalised Poisson regression models controlling for key sociodemographic, regional and health-related variables.</p><p><strong>Results: </strong>Overall, 68.5% of the respondents were classified as having sufficient health literacy, while the health literacy level of 23.5% and 7.9% of respondents was classified as problematic or inadequate, respectively. The median number of general practitioner consultations and specialist visits was 2 and 1, respectively, both with an interquartile range of 1. Lower levels of health literacy were statistically significantly associated (p = 0.0011) with a higher number of general practitioner consultations in the year prior to the interview. By contrast, we did not find any significant association between health literacy and the number of specialist consultations.</p><p><strong>Conclusion: </strong>This study finds that lower health literacy is associated with higher healthcare utilisation for older adults in Switzerland. The findings may suggest that general practitioners could have a significant role as advisors for individuals with low levels of health literacy, while a similar pattern is not observed for specialists. This discrepancy might be attributed, at least in part, to the role of general practitioners as intermediaries between patients and specialised care providers. Ensuring accessibility to general practitioners, particularly for individuals with low health literacy, could prove to be a beneficial strategy in addressing the healthcare requirements of this particularly vulnerable patient group. Additionally, improving health literacy in the population may provide further health benefits and lead to resource savings","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3515"},"PeriodicalIF":2.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tiffany Prétat, Thomas Hügle, Johanna Mettler, Marc Suter, Sandy Jean Scherb, Reine-Laure Taily, Charlotte Hans, Marielle Hoarau, Laurent Monod, Pierre Frossard, Sonia Turchi, Guillaume Marillier, Nastasya Delavignette, Marc Blanchard, Antonio Le Thanh, Pedro Ming Azevedo
<p><strong>Background: </strong>Chronic musculoskeletal pain syndromes, including fibromyalgia, are heterogeneous entities with a major socioeconomic burden. Multimodal treatment programmes have shown greater efficacy than conventional approaches for these patients, at least in the short term. A profound understanding of chronic musculoskeletal pain syndrome patients treated in multimodal treatment programmes is important for their development and to provide insight into these conditions.</p><p><strong>Aim: </strong>To provide a comprehensive and objective description of medical, psychosocial and sleep characteristics of the treatment-refractory chronic musculoskeletal pain syndrome patients treated at the multimodal treatment programmes provided by our tertiary service in Switzerland.</p><p><strong>Methods: </strong>This was a cross-sectional analysis of 202 refractory chronic musculoskeletal pain syndrome patients with or without a concomitant autoimmune disorder hospitalised between 2018 and 2022 in a 12-day Swiss multimodal treatment programme. They underwent a comprehensive self-assessment with eight different questionnaires and assessments by a psychiatrist, rheumatologist, pain specialist, occupational therapist and physiotherapist. Sleep assessment was performed via actigraphy. Clinical and demographic variables were selected by consensus of three experienced rheumatologists and chronic pain specialists. The Fibromyalgia Rapid Screening Test (FiRST), American College of Rheumatology (ACR)-2010 criteria (ACR2010) and Toronto Alexithymia Scale-20 (TAS-20) were also applied.</p><p><strong>Results: </strong>The mean age of the patients was 47 years (SD = 10), 73% were female, and 30% were obese. Half (50%) were not from Switzerland, and 12% came from conflict zones. Almost half (40%) lived alone. Back pain was the principal site (90%). Of the patients, 78% fulfilled the ACR2010 criteria for fibromyalgia, and 17% were diagnosed with an underlying immune-mediated disorder, mostly spondylarthritis. Pain since childhood occurred in 45% of the patients, and 68% had pain since adolescence. Disability financial aid had been pursued by 69%, and 46% were still awaiting a response. Psychiatric comorbidities were highly prevalent (73%), of which 56% consisted of depression. Of all patients, 15% were diagnosed with enduring personality changes after a catastrophic experience (EPCACE), and 10% had post-traumatic stress disorder. Alexithymia affected 34% of patients. Objective sleep disorder was observed in 78% of patients, and 41% were under opioid therapy.</p><p><strong>Conclusion: </strong>This analysis reveals the complex psychosomatic and socioeconomic patterns of the patients treated in Switzerland with refractory chronic musculoskeletal pain syndromes, often originating in childhood and adolescence. Obesity, immigration, social isolation, psychiatric comorbidities, sleep deprivation and opiate use, among others, stood out as target characteristics f
{"title":"Patients with refractory musculoskeletal pain syndromes undergoing a multimodal assessment and therapy programme: a cross-sectional study.","authors":"Tiffany Prétat, Thomas Hügle, Johanna Mettler, Marc Suter, Sandy Jean Scherb, Reine-Laure Taily, Charlotte Hans, Marielle Hoarau, Laurent Monod, Pierre Frossard, Sonia Turchi, Guillaume Marillier, Nastasya Delavignette, Marc Blanchard, Antonio Le Thanh, Pedro Ming Azevedo","doi":"10.57187/s.3466","DOIUrl":"https://doi.org/10.57187/s.3466","url":null,"abstract":"<p><strong>Background: </strong>Chronic musculoskeletal pain syndromes, including fibromyalgia, are heterogeneous entities with a major socioeconomic burden. Multimodal treatment programmes have shown greater efficacy than conventional approaches for these patients, at least in the short term. A profound understanding of chronic musculoskeletal pain syndrome patients treated in multimodal treatment programmes is important for their development and to provide insight into these conditions.</p><p><strong>Aim: </strong>To provide a comprehensive and objective description of medical, psychosocial and sleep characteristics of the treatment-refractory chronic musculoskeletal pain syndrome patients treated at the multimodal treatment programmes provided by our tertiary service in Switzerland.</p><p><strong>Methods: </strong>This was a cross-sectional analysis of 202 refractory chronic musculoskeletal pain syndrome patients with or without a concomitant autoimmune disorder hospitalised between 2018 and 2022 in a 12-day Swiss multimodal treatment programme. They underwent a comprehensive self-assessment with eight different questionnaires and assessments by a psychiatrist, rheumatologist, pain specialist, occupational therapist and physiotherapist. Sleep assessment was performed via actigraphy. Clinical and demographic variables were selected by consensus of three experienced rheumatologists and chronic pain specialists. The Fibromyalgia Rapid Screening Test (FiRST), American College of Rheumatology (ACR)-2010 criteria (ACR2010) and Toronto Alexithymia Scale-20 (TAS-20) were also applied.</p><p><strong>Results: </strong>The mean age of the patients was 47 years (SD = 10), 73% were female, and 30% were obese. Half (50%) were not from Switzerland, and 12% came from conflict zones. Almost half (40%) lived alone. Back pain was the principal site (90%). Of the patients, 78% fulfilled the ACR2010 criteria for fibromyalgia, and 17% were diagnosed with an underlying immune-mediated disorder, mostly spondylarthritis. Pain since childhood occurred in 45% of the patients, and 68% had pain since adolescence. Disability financial aid had been pursued by 69%, and 46% were still awaiting a response. Psychiatric comorbidities were highly prevalent (73%), of which 56% consisted of depression. Of all patients, 15% were diagnosed with enduring personality changes after a catastrophic experience (EPCACE), and 10% had post-traumatic stress disorder. Alexithymia affected 34% of patients. Objective sleep disorder was observed in 78% of patients, and 41% were under opioid therapy.</p><p><strong>Conclusion: </strong>This analysis reveals the complex psychosomatic and socioeconomic patterns of the patients treated in Switzerland with refractory chronic musculoskeletal pain syndromes, often originating in childhood and adolescence. Obesity, immigration, social isolation, psychiatric comorbidities, sleep deprivation and opiate use, among others, stood out as target characteristics f","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3466"},"PeriodicalIF":2.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thomas Menter, Elisabeth Bruder, Irene Hösli, Olav Lapaire, Luigi Raio, Henning Schneider, Sylvia Höller, Roland Hentschel, Simone Brandt, Peter Bode, Sven Schultzke, Gero Drack
The placenta is a unique and complex organ that combines the circulatory systems of two or more individuals within a single dynamic organ with a set, short lifespan. A diverse spectrum of disorders, including infections as well as metabolic, genetic, circulatory, and maturation defects, may affect its function. Pathology investigation of the placenta is key for identifying several pathogenic processes in both the mother and the foetus. Aberrant placentation, maternal and foetal vascular compromise, infection, inflammatory immunologic conditions, and disorders of maturation are elements of newly proposed classification schemes. The clinical impact of placental examination consists of diagnosing maternal and foetal disease, identifying the potential for recurrence, correlating clinical pathological findings with distinct morphologic features, and identifying the aetiology responsible for growth restriction or foetal death. Gestational trophoblastic disease occurs more frequently in the first trimester; however, in very rare cases, it can affect the term or third-trimester placenta. The application of reproducible nomenclature is expected to facilitate progress in the diagnosis and treatment of obstetric and foetal disorders with placental manifestation. Therefore, this review aims to facilitate communication between obstetricians, neonatologists, and pathologists involved in this diagnostic process.
{"title":"Pathologic findings of the placenta and clinical implications - recommendations for placental examination.","authors":"Thomas Menter, Elisabeth Bruder, Irene Hösli, Olav Lapaire, Luigi Raio, Henning Schneider, Sylvia Höller, Roland Hentschel, Simone Brandt, Peter Bode, Sven Schultzke, Gero Drack","doi":"10.57187/s.3929","DOIUrl":"https://doi.org/10.57187/s.3929","url":null,"abstract":"<p><p>The placenta is a unique and complex organ that combines the circulatory systems of two or more individuals within a single dynamic organ with a set, short lifespan. A diverse spectrum of disorders, including infections as well as metabolic, genetic, circulatory, and maturation defects, may affect its function. Pathology investigation of the placenta is key for identifying several pathogenic processes in both the mother and the foetus. Aberrant placentation, maternal and foetal vascular compromise, infection, inflammatory immunologic conditions, and disorders of maturation are elements of newly proposed classification schemes. The clinical impact of placental examination consists of diagnosing maternal and foetal disease, identifying the potential for recurrence, correlating clinical pathological findings with distinct morphologic features, and identifying the aetiology responsible for growth restriction or foetal death. Gestational trophoblastic disease occurs more frequently in the first trimester; however, in very rare cases, it can affect the term or third-trimester placenta. The application of reproducible nomenclature is expected to facilitate progress in the diagnosis and treatment of obstetric and foetal disorders with placental manifestation. Therefore, this review aims to facilitate communication between obstetricians, neonatologists, and pathologists involved in this diagnostic process.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3929"},"PeriodicalIF":2.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isabelle Vock, Lisandra Aguilar-Bultet, Nina Khanna, Adrian Egli, Elisabeth Wehrle-Wieland, Pranita D Tamma, Sarah Tschudin Sutter
Aims: Aminoglycoside resistance is frequently detected in extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-PE), questioning the appropriateness of aminoglycosides as empiric therapy in patients with suspected ESBL-PE infections. Therefore, we aimed to evaluate the frequency of aminoglycoside resistance in patients harbouring ESBL-PE and identify patient-related risk factors associated with aminoglycoside resistance to facilitate early detection of at-risk patients.
Methods: This retrospective single-centre cohort study included hospitalised patients aged ≥18 years with an ESBL-PE-positive sample between January 2016 and December 2018. Aminoglycoside resistance was defined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints for Enterobacterales for the current year of testing.
Results: Five hundred forty-four patients met the eligibility criteria, of which 240 (44.1%) harboured aminoglycoside-resistant ESBL strains. Identification of ESBL-Klebsiella pneumoniae was significantly associated with aminoglycoside resistance (odds ratio [OR] = 2.64, 95% confidence interval [CI] = 1.65-4.21, p <0.001) and an international travel history within the past 12 months was marginally associated with aminoglycoside resistance (OR = 1.51, 95% CI = 0.95-2.42, p = 0.084).
Conclusions: In a low ESBL endemicity setting, aminoglycoside resistance in patients harbouring ESBL-PE is common, especially ESBL-K. pneumoniae, and needs to be considered in clinicians' decision-making regarding empiric therapy regimens.
{"title":"Quantifying aminoglycoside resistance in extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales clinical isolates: a retrospective cohort study.","authors":"Isabelle Vock, Lisandra Aguilar-Bultet, Nina Khanna, Adrian Egli, Elisabeth Wehrle-Wieland, Pranita D Tamma, Sarah Tschudin Sutter","doi":"10.57187/s.3904","DOIUrl":"https://doi.org/10.57187/s.3904","url":null,"abstract":"<p><strong>Aims: </strong>Aminoglycoside resistance is frequently detected in extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-PE), questioning the appropriateness of aminoglycosides as empiric therapy in patients with suspected ESBL-PE infections. Therefore, we aimed to evaluate the frequency of aminoglycoside resistance in patients harbouring ESBL-PE and identify patient-related risk factors associated with aminoglycoside resistance to facilitate early detection of at-risk patients.</p><p><strong>Methods: </strong>This retrospective single-centre cohort study included hospitalised patients aged ≥18 years with an ESBL-PE-positive sample between January 2016 and December 2018. Aminoglycoside resistance was defined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints for Enterobacterales for the current year of testing.</p><p><strong>Results: </strong>Five hundred forty-four patients met the eligibility criteria, of which 240 (44.1%) harboured aminoglycoside-resistant ESBL strains. Identification of ESBL-Klebsiella pneumoniae was significantly associated with aminoglycoside resistance (odds ratio [OR] = 2.64, 95% confidence interval [CI] = 1.65-4.21, p <0.001) and an international travel history within the past 12 months was marginally associated with aminoglycoside resistance (OR = 1.51, 95% CI = 0.95-2.42, p = 0.084).</p><p><strong>Conclusions: </strong>In a low ESBL endemicity setting, aminoglycoside resistance in patients harbouring ESBL-PE is common, especially ESBL-K. pneumoniae, and needs to be considered in clinicians' decision-making regarding empiric therapy regimens.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3904"},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthias Paul, Arnold Eggerschwiler, Gesine Meyer, Christian Studer, Urs Hürlimann, Michael Brändle, Peter Wiesli, Giacomo Gastaldi, Mattia Arrigo, Philippe Meyer, Christian Mueller, Kathrin Zimmermann, Roger Lehmann
Diabetes is a well-recognised risk factor for the development of heart failure, with a prevalence higher than 30% in patients with diabetes aged over 60 years. Heart failure often emerges as the primary cardiovascular manifestation in patients with type 2 diabetes and appears to be even more prevalent in type 1 diabetes. In Switzerland, there are approximately 500,000 individuals with diabetes, and the number of affected people has been steadily rising in recent years. Therefore, the consequences of heart failure will affect an increasing number of patients, further straining the Swiss healthcare system. Early lifestyle modification and initiation of appropriate treatment can prevent or at least significantly delay the onset of symptomatic heart failure by several years. These facts underscore the urgent need for early detection of individuals with subclinical heart failure, which often remains undiagnosed until the first episode of acute heart failure requiring hospital admission occurs. To address this issue, the European Society of Cardiology, the American Diabetes Association (ADA) and other international professional societies have published recommendations on heart failure screening, diagnosis and management. To address this issue in Switzerland, experts from the Swiss Society of Endocrinology and Diabetology, the Swiss Society of Cardiology and the General Internal Medicine specialty met and prepared a consensus report including a simple diagnostic algorithm for use in everyday practice.
{"title":"Recommendations for early identification of heart failure in patients with diabetes: Consensus statement of the Swiss Society of Endocrinology and Diabetology and the Heart Failure Working Group of the Swiss Society of Cardiology.","authors":"Matthias Paul, Arnold Eggerschwiler, Gesine Meyer, Christian Studer, Urs Hürlimann, Michael Brändle, Peter Wiesli, Giacomo Gastaldi, Mattia Arrigo, Philippe Meyer, Christian Mueller, Kathrin Zimmermann, Roger Lehmann","doi":"10.57187/s.4000","DOIUrl":"https://doi.org/10.57187/s.4000","url":null,"abstract":"<p><p>Diabetes is a well-recognised risk factor for the development of heart failure, with a prevalence higher than 30% in patients with diabetes aged over 60 years. Heart failure often emerges as the primary cardiovascular manifestation in patients with type 2 diabetes and appears to be even more prevalent in type 1 diabetes. In Switzerland, there are approximately 500,000 individuals with diabetes, and the number of affected people has been steadily rising in recent years. Therefore, the consequences of heart failure will affect an increasing number of patients, further straining the Swiss healthcare system. Early lifestyle modification and initiation of appropriate treatment can prevent or at least significantly delay the onset of symptomatic heart failure by several years. These facts underscore the urgent need for early detection of individuals with subclinical heart failure, which often remains undiagnosed until the first episode of acute heart failure requiring hospital admission occurs. To address this issue, the European Society of Cardiology, the American Diabetes Association (ADA) and other international professional societies have published recommendations on heart failure screening, diagnosis and management. To address this issue in Switzerland, experts from the Swiss Society of Endocrinology and Diabetology, the Swiss Society of Cardiology and the General Internal Medicine specialty met and prepared a consensus report including a simple diagnostic algorithm for use in everyday practice.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"4000"},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline Arber, Gabriela Baerlocher, Yves Chalandon, Michael Daskalakis, Michel Duchosal, Martin Fehr, Sabine Gerull, Tayfun Güngör, Gayathri Nair, Thomas Pabst, Jakob R Passweg, Barbara Piccolruaz, Christoph Renner, Axel Ruefer, Dominik Schneidawind, Georg Stüssi, Sacha Zeerleder, Jörg P Halter
{"title":"Technical comment on: Trottmann M, et al. Real-world expenditures and survival time after CAR-T treatment for large B-cell lymphoma in Switzerland: a retrospective study using insurance claims data.","authors":"Caroline Arber, Gabriela Baerlocher, Yves Chalandon, Michael Daskalakis, Michel Duchosal, Martin Fehr, Sabine Gerull, Tayfun Güngör, Gayathri Nair, Thomas Pabst, Jakob R Passweg, Barbara Piccolruaz, Christoph Renner, Axel Ruefer, Dominik Schneidawind, Georg Stüssi, Sacha Zeerleder, Jörg P Halter","doi":"10.57187/s.3704","DOIUrl":"https://doi.org/10.57187/s.3704","url":null,"abstract":"","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3704"},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Trottmann, Eva Blozik, Marcel Hilbig, Mark Pletscher, Niklaus Meier
No abstract available.
无摘要。
{"title":"Reply to comment by Arber C, et al. on: Real-world expenditures and survival time after CAR-T treatment for large B-cell lymphoma in Switzerland.","authors":"Maria Trottmann, Eva Blozik, Marcel Hilbig, Mark Pletscher, Niklaus Meier","doi":"10.57187/s.3958","DOIUrl":"https://doi.org/10.57187/s.3958","url":null,"abstract":"<p><p>No abstract available.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3958"},"PeriodicalIF":2.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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