Evangelia Liakoni, Samuel E Christen, Neal L Benowitz
Cigarette smoking remains an enormous public health problem causing millions of preventable deaths annually worldwide. Although safe and efficient smoking cessation pharmacotherapies such as nicotine replacement products and the medications varenicline and bupropion are available, long-term abstinence rates remain low and new approaches to help smokers successfully quit smoking are needed. In recent years, electronic nicotine delivery systems such as e-cigarettes and heated-tobacco products, and novel smokeless nicotine delivery products like nicotine pouches have gained widespread popularity. These products can deliver nicotine without combustion of tobacco and might thus present an alternative to the currently available smoking cessation methods if they prove able to help smokers quit smoking conventional cigarettes while decreasing their exposure to toxicants. In this narrative review, we provide a summary of the characteristics of these novel nicotine delivery products and the available data regarding their efficacy as smoking cessation tools and safety profile with a focus on the current situation in Switzerland.
{"title":"E-cigarettes, synthetic nicotine, heated-tobacco and smokeless nicotine delivery products: the nicotine landscape beyond combustible cigarettes.","authors":"Evangelia Liakoni, Samuel E Christen, Neal L Benowitz","doi":"10.57187/s.3583","DOIUrl":"https://doi.org/10.57187/s.3583","url":null,"abstract":"<p><p>Cigarette smoking remains an enormous public health problem causing millions of preventable deaths annually worldwide. Although safe and efficient smoking cessation pharmacotherapies such as nicotine replacement products and the medications varenicline and bupropion are available, long-term abstinence rates remain low and new approaches to help smokers successfully quit smoking are needed. In recent years, electronic nicotine delivery systems such as e-cigarettes and heated-tobacco products, and novel smokeless nicotine delivery products like nicotine pouches have gained widespread popularity. These products can deliver nicotine without combustion of tobacco and might thus present an alternative to the currently available smoking cessation methods if they prove able to help smokers quit smoking conventional cigarettes while decreasing their exposure to toxicants. In this narrative review, we provide a summary of the characteristics of these novel nicotine delivery products and the available data regarding their efficacy as smoking cessation tools and safety profile with a focus on the current situation in Switzerland.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3583"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011879","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}
Swiss Society For Anaesthesiology And Perioperative Medicine, Swiss Association For Anaesthesia Care
{"title":"Supplementum 282: Abstracts Swiss Anaesthesia 2024, joint annual congress of the Swiss Society for Anaesthesiology and Perioperative Medicine and the Swiss Association for Anaesthesia Care (Interlaken, Switzerland, November 7−9, 2024).","authors":"Swiss Society For Anaesthesiology And Perioperative Medicine, Swiss Association For Anaesthesia Care","doi":"10.57187/s.4283","DOIUrl":"10.57187/s.4283","url":null,"abstract":"","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"4283"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576030","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}
Chloé Alberto, Noémie Wagner, Yves Fougère, Patrick M Meyer Sauteur, Gioia Scherler, Karoline Aebbi-Popp, Marc Baumann, Nina Schöbi, Gaud Catho, Stéphane Emonet, Christian Polli, Lisa Kottanattu, Christian Kahlert, David Baud, Alix Coste, Begoña Martinez De Tejada, Klara M Posfay Barbe, Laurence Toutous Trellu
Background and aims of the study: Congenital syphilis is a rare complication of syphilis in pregnant women. Vertical transmission may occur at any time during pregnancy. The incidence of congenital syphilis has been increasing worldwide. Congenital syphilis has been a notifiable disease for many years in Switzerland but reporting does not include maternal features associated with syphilis in pregnancy or infant's subsequent development. We described syphilis cases among pregnant women screened over a 10-year period in Switzerland and subsequent cases of congenital syphilis, in order to identify maternal risk profiles and to optimise prevention. Second, we compared the characteristics of pregnant women screened early (1st trimester) vs late in pregnancy (2nd or 3rd trimester). Finally, we assessed the risk factors for premature birth among these women with syphilis.
Methods: A multicentre retrospective study conducted in Swiss hospitals from 2012 to 2021, including pregnant women who screened positive for syphilis (Treponema pallidum haemagglutination assay [TPHA] / T. pallidum particle agglutination assay [TPPA ] ≥1:80) and newborns exposed to T. pallidum in utero and/or congenitally infected and with a positive syphilis serology at birth. Data were collected from medical records.
Results: A total of 147 syphilis-positive pregnant women and 102 infants were included. A history of treated syphilis was known for 44% (65/147) of the mothers corresponding to a serological scar and the remaining 56% (82/147) were newly identified syphilis cases. Syphilis screening was done during the first trimester in 54%, second trimester in 29% and third trimester in 13% of cases. Two babies were diagnosed with congenital syphilis (1.96%). Several potential factors that could contribute to women's risk of syphilis during pregnancy were identified such as a foreign origin (93% of mothers), lack of healthcare insurance (25%), no employment status (37%), drug use (5%), co-infection with other sexually transmitted infections (24%) and a late first antenatal consultation (42%). The number of pregnant women without insurance was higher in women diagnosed in the second or third trimester than in those diagnosed in the first trimester (odds ratio 0.41; 95% CI 0.19-0.89; p = 0.024). Syphilis diagnosed in the second or third trimester was associated with a late first antenatal consultation (odds ratio 77.82; 95% CI 9.81-617.21; p <0.001). A high rate of intrauterine growth retardation and of preterm birth was observed in newborns (18% versus 6% in Switzerland in 2022).
Conclusion: Congenital syphilis remains rare in Switzerland. However, we found potential maternal factors associated with a positive syphilis serology during pregnancy, which can help to improve future prevention measures. The study protocol was registered on ClinicalTrials.gov (ID NCT05975502).
研究的背景和目的:先天性梅毒是孕妇梅毒的一种罕见并发症。垂直传播可能发生在怀孕期间的任何时候。先天性梅毒的发病率在全球范围内呈上升趋势。在瑞士,先天性梅毒多年来一直是一种应报告的疾病,但报告并不包括与妊娠期梅毒或婴儿后续发育相关的母体特征。我们描述了瑞士10年间接受筛查的孕妇中的梅毒病例以及随后出现的先天性梅毒病例,以确定孕产妇的风险特征,优化预防措施。其次,我们比较了孕早期(怀孕前三个月)和孕晚期(怀孕后三个月或三个月)接受筛查的孕妇的特征。最后,我们评估了这些梅毒孕妇早产的风险因素:方法:2012年至2021年在瑞士医院开展的一项多中心回顾性研究,包括梅毒筛查阳性(苍白螺旋体血凝试验[TPHA] /苍白螺旋体颗粒凝集试验[TPPA] ≥1:80)的孕妇和在子宫内暴露于苍白螺旋体和/或先天感染梅毒且出生时梅毒血清学检测呈阳性的新生儿。数据来自医疗记录:结果:共纳入147名梅毒阳性孕妇和102名婴儿。44%(65/147)的母亲有梅毒治疗史,血清学疤痕阳性,其余56%(82/147)为新发现的梅毒病例。54%的梅毒筛查是在妊娠头三个月进行的,29%是在妊娠后三个月进行的,13%是在妊娠后三个月进行的。两名婴儿被诊断患有先天性梅毒(1.96%)。研究发现了几种可能导致妇女在怀孕期间感染梅毒的潜在因素,如来自国外(93%的母亲)、没有医疗保险(25%)、没有工作(37%)、吸毒(5%)、合并感染其他性传播疾病(24%)和首次产前咨询过晚(42%)。与妊娠头三个月的孕妇相比,妊娠后三个月或第三个月确诊的孕妇中没有保险的人数更高(几率比 0.41;95% CI 0.19-0.89;P = 0.024)。第二或第三孕期确诊的梅毒与首次产前咨询时间较晚有关(几率比77.82;95% CI 9.81-617.21;P 结论:先天性梅毒仍然很少见:先天性梅毒在瑞士仍然很少见。不过,我们发现了与孕期梅毒血清学阳性相关的潜在母体因素,这有助于改进未来的预防措施。研究方案已在ClinicalTrials.gov(ID NCT05975502)上注册。
{"title":"Syphilis in pregnant women and congenital syphilis from 2012 to 2021 in Switzerland: a multicentre, retrospective study.","authors":"Chloé Alberto, Noémie Wagner, Yves Fougère, Patrick M Meyer Sauteur, Gioia Scherler, Karoline Aebbi-Popp, Marc Baumann, Nina Schöbi, Gaud Catho, Stéphane Emonet, Christian Polli, Lisa Kottanattu, Christian Kahlert, David Baud, Alix Coste, Begoña Martinez De Tejada, Klara M Posfay Barbe, Laurence Toutous Trellu","doi":"10.57187/s.3678","DOIUrl":"10.57187/s.3678","url":null,"abstract":"<p><strong>Background and aims of the study: </strong>Congenital syphilis is a rare complication of syphilis in pregnant women. Vertical transmission may occur at any time during pregnancy. The incidence of congenital syphilis has been increasing worldwide. Congenital syphilis has been a notifiable disease for many years in Switzerland but reporting does not include maternal features associated with syphilis in pregnancy or infant's subsequent development. We described syphilis cases among pregnant women screened over a 10-year period in Switzerland and subsequent cases of congenital syphilis, in order to identify maternal risk profiles and to optimise prevention. Second, we compared the characteristics of pregnant women screened early (1st trimester) vs late in pregnancy (2nd or 3rd trimester). Finally, we assessed the risk factors for premature birth among these women with syphilis.</p><p><strong>Methods: </strong>A multicentre retrospective study conducted in Swiss hospitals from 2012 to 2021, including pregnant women who screened positive for syphilis (Treponema pallidum haemagglutination assay [TPHA] / T. pallidum particle agglutination assay [TPPA ] ≥1:80) and newborns exposed to T. pallidum in utero and/or congenitally infected and with a positive syphilis serology at birth. Data were collected from medical records.</p><p><strong>Results: </strong>A total of 147 syphilis-positive pregnant women and 102 infants were included. A history of treated syphilis was known for 44% (65/147) of the mothers corresponding to a serological scar and the remaining 56% (82/147) were newly identified syphilis cases. Syphilis screening was done during the first trimester in 54%, second trimester in 29% and third trimester in 13% of cases. Two babies were diagnosed with congenital syphilis (1.96%). Several potential factors that could contribute to women's risk of syphilis during pregnancy were identified such as a foreign origin (93% of mothers), lack of healthcare insurance (25%), no employment status (37%), drug use (5%), co-infection with other sexually transmitted infections (24%) and a late first antenatal consultation (42%). The number of pregnant women without insurance was higher in women diagnosed in the second or third trimester than in those diagnosed in the first trimester (odds ratio 0.41; 95% CI 0.19-0.89; p = 0.024). Syphilis diagnosed in the second or third trimester was associated with a late first antenatal consultation (odds ratio 77.82; 95% CI 9.81-617.21; p <0.001). A high rate of intrauterine growth retardation and of preterm birth was observed in newborns (18% versus 6% in Switzerland in 2022).</p><p><strong>Conclusion: </strong>Congenital syphilis remains rare in Switzerland. However, we found potential maternal factors associated with a positive syphilis serology during pregnancy, which can help to improve future prevention measures. The study protocol was registered on ClinicalTrials.gov (ID NCT05975502).</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3678"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606516","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}
Tugba Erdil, Klaus Steigmiller, John Ethan Rampa, Martin Christmann, Ulrike Held, Hitendu Dave
<p><strong>Objective: </strong>Pulmonary annular hypoplasia and valvar dysplasia are key morphological features affecting long-term outcomes of tetralogy of Fallot. This retrospective study aimed to analyse factors affecting contemporary long-term outcomes with a focus on pulmonary annular growth and function over time.</p><p><strong>Methods: </strong>131 consecutive isolated tetralogy of Fallot repairs performed between 2004 and 2014 at University Children's Hospital Zurich were included. Median age and weight at the time of repair were 4.8 (interquartile range [IQR] 3.2-6.3) months and 6.1 (IQR 5.1-7) kg, respectively. Based on the severity of native pulmonary annular hypoplasia, the cohort was divided into group 1 (preoperative pulmonary annular Z score < -4; n = 20), group 2 (Z score -2 to -4; n = 56) and group 3 (Z score > -2; n = 54). A transannular patch was used in 88/131 (67.2%) patients: 80%, 67.9% and 61.1% in groups 1, 2 and 3, respectively. The primary outcome was defined as right ventricular outflow tract (RVOT) reoperation or pulmonary valve replacement. Secondary outcome was composite pulmonary valve dysfunction defined as peak gradient >40 mm Hg or severe pulmonary regurgitation at follow-up. A multiple Cox regression model was used to quantify the association of age at tetralogy of Fallot repair, preoperative pulmonary annular Z score and RVOT approach with primary and secondary outcome. Follow-up was 98.5% complete, with a median follow-up duration of 9.6 (95% confidence interval [CI] 9-10.4) years.</p><p><strong>Results: </strong>All patients were alive at last follow-up resulting in 100% survival. 20/131 patients underwent pulmonary valve replacement (14 surgical and 6 catheter interventional) while 5/131 underwent RVOT reoperations other than valve replacement. The Kaplan-Meier 10-year freedom from primary outcome was 85% (95% CI 78-92%); 69% (46-100%), 91% (82-100%) and 84% (74-95%) for groups 1, 2 and 3, respectively (log rank p = 0.16). Composite dysfunction at follow-up was observed in 29.8% (overall): 45%, 28.6% and 25.9% for groups 1, 2 and 3, respectively (p = 0.12). The multiple Cox regression analysis for primary outcome indicated that the use of a transannular patch results in a Hazard Ratio (HR) of 3.3 (95% CI 0.7-14.7, p = 0.13). Additionally, the presence of composite dysfunction at discharge results in a HR of 2.1 (95% CI 0.8-5.4, p = 0.1). Age (in months) with a HR of 0.8 (95% CI 0.6-1, p = 0.06) and group 2 with a HR of 0.4 (95% CI 0.14-1.2, p = 0.11) showed a trend to being protective for the primary outcome. However, the 95% CI of all estimates included the HR of 1.</p><p><strong>Conclusions: </strong>Transannular patch use and composite dysfunction at discharge, although not statistically significant at 5% level, may be associated with pulmonary valve replacement and RVOT reoperation. Avoiding the use of a transannular patch or using reconstructive techniques to achieve a better composite dysfunction at di
目的:肺动脉环发育不良和瓣膜发育不良是影响法洛氏四联症长期预后的主要形态特征。这项回顾性研究旨在分析影响当代长期预后的因素,重点关注肺动脉环随着时间推移的生长和功能。方法:研究纳入了 2004 年至 2014 年期间在苏黎世大学儿童医院进行的 131 例连续孤立法洛四联症修复手术。修复手术时的中位年龄和体重分别为4.8个月(四分位距[IQR] 3.2-6.3)和6.1(IQR 5.1-7)公斤。根据原发性肺动脉瓣环发育不全的严重程度,队列被分为第1组(术前肺动脉瓣环Z评分<-4;n=20)、第2组(Z评分-2至-4;n=56)和第3组(Z评分>-2;n=54)。88/131(67.2%)例患者使用了经腔补片:第 1、2 和 3 组的使用率分别为 80%、67.9% 和 61.1%。主要结果定义为右室流出道(RVOT)再手术或肺动脉瓣置换术。次要结果是复合肺动脉瓣功能障碍,即随访时峰值梯度>40毫米汞柱或严重肺动脉瓣反流。采用多元 Cox 回归模型来量化法洛四联症修复时的年龄、术前肺动脉瓣环 Z 评分和 RVOT 方法与主要和次要结果的关系。随访完成率为 98.5%,中位随访时间为 9.6 年(95% 置信区间 [CI] 9-10.4 年):结果:所有患者在最后一次随访时均存活,存活率为 100%。20/131例患者接受了肺动脉瓣置换术(14例手术,6例导管介入),5/131例患者接受了除瓣膜置换术以外的RVOT再手术。第 1、2 和 3 组的主要结局 10 年 Kaplan-Meier 自由度分别为 85% (95% CI 78-92%)、69% (46-100%)、91% (82-100%) 和 84% (74-95%)(对数秩 p = 0.16)。29.8% 的患者(总体)在随访时出现综合功能障碍:1、2、3 组分别为 45%、28.6% 和 25.9%(P = 0.12)。针对主要结果的多重考克斯回归分析表明,使用经环形补片的危险比(HR)为 3.3(95% CI 0.7-14.7,P = 0.13)。此外,出院时出现复合功能障碍的危险比为 2.1 (95% CI 0.8-5.4, p = 0.1)。年龄(以月为单位)的 HR 为 0.8(95% CI 0.6-1,p = 0.06),第 2 组的 HR 为 0.4(95% CI 0.14-1.2,p = 0.11),显示出对主要结果有保护作用的趋势。然而,所有估计值的 95% CI 均包括 HR 1.结论:结论:经瓣膜贴片的使用和出院时的综合功能障碍虽然在 5%水平上无统计学意义,但可能与肺动脉瓣置换术和 RVOT 再次手术有关。避免使用跨瓣补片或使用重建技术来改善出院时的综合功能障碍,可降低主要结局。需要进行大型多中心研究,以更准确地证明肺动脉瓣环 Z 评分对预后的影响。
{"title":"Severity of native pulmonary annular hypoplasia and late outcomes of tetralogy of Fallot: retrospective cohort study.","authors":"Tugba Erdil, Klaus Steigmiller, John Ethan Rampa, Martin Christmann, Ulrike Held, Hitendu Dave","doi":"10.57187/s.3689","DOIUrl":"https://doi.org/10.57187/s.3689","url":null,"abstract":"<p><strong>Objective: </strong>Pulmonary annular hypoplasia and valvar dysplasia are key morphological features affecting long-term outcomes of tetralogy of Fallot. This retrospective study aimed to analyse factors affecting contemporary long-term outcomes with a focus on pulmonary annular growth and function over time.</p><p><strong>Methods: </strong>131 consecutive isolated tetralogy of Fallot repairs performed between 2004 and 2014 at University Children's Hospital Zurich were included. Median age and weight at the time of repair were 4.8 (interquartile range [IQR] 3.2-6.3) months and 6.1 (IQR 5.1-7) kg, respectively. Based on the severity of native pulmonary annular hypoplasia, the cohort was divided into group 1 (preoperative pulmonary annular Z score < -4; n = 20), group 2 (Z score -2 to -4; n = 56) and group 3 (Z score > -2; n = 54). A transannular patch was used in 88/131 (67.2%) patients: 80%, 67.9% and 61.1% in groups 1, 2 and 3, respectively. The primary outcome was defined as right ventricular outflow tract (RVOT) reoperation or pulmonary valve replacement. Secondary outcome was composite pulmonary valve dysfunction defined as peak gradient >40 mm Hg or severe pulmonary regurgitation at follow-up. A multiple Cox regression model was used to quantify the association of age at tetralogy of Fallot repair, preoperative pulmonary annular Z score and RVOT approach with primary and secondary outcome. Follow-up was 98.5% complete, with a median follow-up duration of 9.6 (95% confidence interval [CI] 9-10.4) years.</p><p><strong>Results: </strong>All patients were alive at last follow-up resulting in 100% survival. 20/131 patients underwent pulmonary valve replacement (14 surgical and 6 catheter interventional) while 5/131 underwent RVOT reoperations other than valve replacement. The Kaplan-Meier 10-year freedom from primary outcome was 85% (95% CI 78-92%); 69% (46-100%), 91% (82-100%) and 84% (74-95%) for groups 1, 2 and 3, respectively (log rank p = 0.16). Composite dysfunction at follow-up was observed in 29.8% (overall): 45%, 28.6% and 25.9% for groups 1, 2 and 3, respectively (p = 0.12). The multiple Cox regression analysis for primary outcome indicated that the use of a transannular patch results in a Hazard Ratio (HR) of 3.3 (95% CI 0.7-14.7, p = 0.13). Additionally, the presence of composite dysfunction at discharge results in a HR of 2.1 (95% CI 0.8-5.4, p = 0.1). Age (in months) with a HR of 0.8 (95% CI 0.6-1, p = 0.06) and group 2 with a HR of 0.4 (95% CI 0.14-1.2, p = 0.11) showed a trend to being protective for the primary outcome. However, the 95% CI of all estimates included the HR of 1.</p><p><strong>Conclusions: </strong>Transannular patch use and composite dysfunction at discharge, although not statistically significant at 5% level, may be associated with pulmonary valve replacement and RVOT reoperation. Avoiding the use of a transannular patch or using reconstructive techniques to achieve a better composite dysfunction at di","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3689"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606508","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}
<p><strong>Aims of the study: </strong>Physicians frequently prescribe antipsychotics off-label to treat, among others, insomnia and anxiety. The Swiss "smarter medicine - Choosing Wisely" campaign has tried to raise awareness about the risks and to limit benzodiazepine and Z-drug prescriptions. In the Italian-speaking part of Switzerland, our network of public hospitals joined the campaign with the aim of avoiding unnecessary benzodiazepine and Z-drug treatments, with prescription monitoring, benchmarking and educational contributions. Considering the risks of a possible shift towards the prescription of antipsychotics, and aware of the potential role of the COVID-19 pandemic, we decided to analyse the prescription trends of antipsychotics and benzodiazepines/Z-drugs before, during (2016-2017) and after the intervention.</p><p><strong>Methods: </strong>For this longitudinal study, we reactivated a continuous monitoring of inpatient benzodiazepine/Z-drug and antipsychotics prescriptions/deprescriptions, paused in 2018 after the end of the internal Choosing Wisely campaign, based on routinely collected observational health data. We screened all demographic, administrative and prescription data of patients admitted to the internal medicine department of the four teaching hospitals (H1-H4) belonging to the EOC (Ente Ospedaliero Cantonale) network, from the fourth quarter of 2014 to the second quarter of 2023.</p><p><strong>Results: </strong>We analysed 74,659 hospital stays (14,645 / 16,083 / 24,285 / 19,646 at hospitals H1 / H2 / H3 / H4 respectively). The mean (± SD) case mix (a metric that reflects the diversity, complexity and severity of the treated patients) and patient age were 1.08 ± 0.14 and 73 ± 2 years. 10.6% and 12.1% of patients received antipsychotics prior to admission and at discharge respectively (new prescriptions 3.3 ± 0.7%; deprescriptions 13.3 ± 5.2%). New prescriptions showed an upward trend, with +0.20% per year (p <0.001). Patients admitted with ongoing antipsychotics therapy increased 0.36% per year (p <0.001). New benzodiazepine/Z-drug prescriptions showed a 0.20% per year decrease (p = 0.01). Patients admitted with ongoing benzodiazepine/Z-drug therapy decreased 0.32% per year (p <0.001). New antipsychotics prescriptions showed differences between hospitals, with H3 above and H2 below the average.</p><p><strong>Conclusions: </strong>The increase in antipsychotics quantitatively matched the decrease in benzodiazepine/Z-drug prescribing, suggesting a shift from one to the other sedative therapy. The same trend was visible in the ongoing prescriptions at admission revealing a similar out-of-hospital approach. This suggests a change in sedative prescribing strategy rather than the choice of alternative, non-pharmacological approaches. Furthermore, the variation between similar services of different hospitals points out the consequences of local prescribing cultures and the importance of continuously monitoring and benchmarking
{"title":"Antipsychotic, benzodiazepine and Z-drug prescriptions in a Swiss hospital network in the Choosing Wisely and COVID-19 eras: a longitudinal study.","authors":"Vanessa Gagliano, Gloria Salemme, Alessandro Ceschi, Angela Greco, Nicola Grignoli, Luca Clivio, Alessandro Merler, Vanessa Feyling Benitez, Jvan Gianini, Martina Zandonà, Luca Gabutti","doi":"10.57187/s.3409","DOIUrl":"https://doi.org/10.57187/s.3409","url":null,"abstract":"<p><strong>Aims of the study: </strong>Physicians frequently prescribe antipsychotics off-label to treat, among others, insomnia and anxiety. The Swiss \"smarter medicine - Choosing Wisely\" campaign has tried to raise awareness about the risks and to limit benzodiazepine and Z-drug prescriptions. In the Italian-speaking part of Switzerland, our network of public hospitals joined the campaign with the aim of avoiding unnecessary benzodiazepine and Z-drug treatments, with prescription monitoring, benchmarking and educational contributions. Considering the risks of a possible shift towards the prescription of antipsychotics, and aware of the potential role of the COVID-19 pandemic, we decided to analyse the prescription trends of antipsychotics and benzodiazepines/Z-drugs before, during (2016-2017) and after the intervention.</p><p><strong>Methods: </strong>For this longitudinal study, we reactivated a continuous monitoring of inpatient benzodiazepine/Z-drug and antipsychotics prescriptions/deprescriptions, paused in 2018 after the end of the internal Choosing Wisely campaign, based on routinely collected observational health data. We screened all demographic, administrative and prescription data of patients admitted to the internal medicine department of the four teaching hospitals (H1-H4) belonging to the EOC (Ente Ospedaliero Cantonale) network, from the fourth quarter of 2014 to the second quarter of 2023.</p><p><strong>Results: </strong>We analysed 74,659 hospital stays (14,645 / 16,083 / 24,285 / 19,646 at hospitals H1 / H2 / H3 / H4 respectively). The mean (± SD) case mix (a metric that reflects the diversity, complexity and severity of the treated patients) and patient age were 1.08 ± 0.14 and 73 ± 2 years. 10.6% and 12.1% of patients received antipsychotics prior to admission and at discharge respectively (new prescriptions 3.3 ± 0.7%; deprescriptions 13.3 ± 5.2%). New prescriptions showed an upward trend, with +0.20% per year (p <0.001). Patients admitted with ongoing antipsychotics therapy increased 0.36% per year (p <0.001). New benzodiazepine/Z-drug prescriptions showed a 0.20% per year decrease (p = 0.01). Patients admitted with ongoing benzodiazepine/Z-drug therapy decreased 0.32% per year (p <0.001). New antipsychotics prescriptions showed differences between hospitals, with H3 above and H2 below the average.</p><p><strong>Conclusions: </strong>The increase in antipsychotics quantitatively matched the decrease in benzodiazepine/Z-drug prescribing, suggesting a shift from one to the other sedative therapy. The same trend was visible in the ongoing prescriptions at admission revealing a similar out-of-hospital approach. This suggests a change in sedative prescribing strategy rather than the choice of alternative, non-pharmacological approaches. Furthermore, the variation between similar services of different hospitals points out the consequences of local prescribing cultures and the importance of continuously monitoring and benchmarking","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"154 ","pages":"3409"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606470","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}
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}