Swiss medical weekly最新文献

Aims: We aimed to explore atrial fibrillation (AF)-induced productivity losses in working-age atrial fibrillation patients and to estimate atrial fibrillation-related indirect costs.

Methods: Between 2014 and 2017, the Swiss Atrial Fibrillation prospective cohort study (Swiss-AF) enrolled 217 working-age patients with documented atrial fibrillation. Self-reported changes in professional activity and the reasons thereof were descriptively analysed over 8 years of follow-up or until patients reached the retirement age. Results were put into perspective, and indirect costs were planned to be estimated, through comparison with a general population-based, age-, sex- and year-matched comparison sample from the Swiss labour force survey (SLFS).

Results: Of 217 analysed Swiss-AF patients, 14.7% reported a professional activity change (9.2% stop, 5.5% reduction) due to atrial fibrillation before the end of observation. Of those working at enrolment (n = 157), 3.8% had a subsequent professional activity change due to atrial fibrillation, 11.6% due to other reasons. Patients were more likely to report an impact of atrial fibrillation on professional activity if they had had atrial fibrillation longer and were closer to the retirement age. Slightly fewer Swiss-AF patients were employed (75%) than in the comparison sample (77%). For those working however, the degree of employment was higher (88% vs 83%). Lack of differences between the Swiss-AF patients and the comparison sample indicated no relevant indirect costs of atrial fibrillation due to lost productivity.

Conclusion: Only a minority of atrial fibrillation patients reported a negative impact of atrial fibrillation on their professional activity. Professional activity changes due to other reasons were reported more frequently. Compared with the general population, atrial fibrillation did not cause distinct differences.

Aims of the study: As emergency department consultations rise across Europe, patients must be guided to obtain appropriate care at the right time and place.In Switzerland, the absence of a unique health number that would enable the avoidance of emergency services through telephone medical advice, and the shortage of general practitioners, redirecting low-severity patients from the emergency department before medical consultation to other healthcare facilities could help reduce emergency department overload. This study assessed the safety of a newly implemented redirection process by examining the rate of unexpected returns to any healthcare facility.

Methods: This monocentric cohort study included patients aged 18 or older who presented to the emergency department of a regional hospital in Switzerland between 1 January and 31 May 2023 and who accepted redirection before medical consultation. Patients were identified from our electronic medical registry and retrospectively enrolled after telephone interviews. The primary outcome was the rate of unexpected returns to any healthcare facility within 2 days of redirection. The secondary outcomes were the rate of returns within 7 days, hospital admissions, and patient satisfaction.

Results: Among 16,362 patients who came to the emergency department during the study period, 688 (4%) were redirected. A total of 321 patients were included in the final analysis after telephone interviews. The rate of unexpected returns to any healthcare facility after redirection was 4% within 2 days and 16% within 7 days. The rate of returns to any hospital was 1.2% within 2 days and 4.7% within 7 days after redirection. Six patients (2%) required hospitalisation, and no fatalities were reported. The mean satisfaction score was 3.9/5 (standard deviation [SD] = 1.1) for triage experience, 4.4/5 (SD = 1) for care received in partner clinics, and 3.7/5 (SD = 1) for the redirection process.

Conclusion: The rate of unexpected returns to any healthcare facility after redirection was 4% within 2 days and 16% within 7 days. The implementation of this protocol appeared to provide safe redirection to nearby clinics for redirected low-acuity patients. Satisfaction with care received in partner clinics was high, although it was lower for the redirection process and triage experience.

The choice of modality of treatment for unruptured intracranial aneurysms is based on various clinical aspects and the patient's preference. Financial considerations should not be among these. To evaluate any financial variations between endovascular and microsurgical treatment of unruptured intracranial aneurysms in the Swiss healthcare system, we retrospectively reviewed 100 consecutive aneurysm cases treated as inpatients in our institution. Case-based financial data were collected (revenues, costs, net earnings) and compared between the treatments. Among 100 consecutive aneurysm cases treated at our institution (2021-2023), 58 were unruptured intracranial aneurysm. Treatment was endovascular in 33, microsurgery in 23 and conservative/antibiotic in 2 cases. Length of stay (but not duration in the intensive care unit) was longer after microsurgical treatment. Total median revenues (public insurance, private insurance, material reimbursement) were Swiss Francs (CHF) 30,012.25 with a maximum of CHF 125,337.20 and a minimum of CHF 9543.25. No marked difference was found between the treatment groups (endovascular and microsurgery). Despite the fact that median net earnings per patient were positive (CHF 3655.03), more than one third of all cases led to a net loss for the hospital with a tendency for more stable net earnings in microsurgery cases. The only factor associated with a higher risk of net loss per case was higher implant costs in endovascular cases. Reimbursement within the Swiss healthcare system does not promote financial bias for decision-making in treatment modality for unruptured intracranial aneurysm. The fact that one third of all cases does not result in positive net earnings (even in the highly paid unruptured intracranial aneurysm sector), although overall net earnings were positive, should be monitored - especially in times of rising costs.

No abstract available.

Background: While patient and public involvement (PPI) in clinical research contributes substantially to research ethics, feasibility and quality, the uptake and implementation of PPI-based approaches in Switzerland remain unknown. This study aimed to evaluate the current state and acceptance of PPI in academic clinical research in Switzerland, with the goal of developing recommendations for its future implementation and development.

Methods: A sequential explanatory mixed-methods study was conducted to assess the current landscape and acceptance of PPI in academic clinical research across different stakeholder groups in Switzerland. The groups were "Patients and Public", "Researchers", "Staff Members of Academic Research Infrastructure (ARI)" and representatives from "Regulatory and Funding Bodies". Data was collected through a combination of surveys and semi-structured interviews. The survey results were analysed descriptively, while interview data was analysed qualitatively. The results were further synthesised into a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis.

Results:  A total of 123 survey responses were collected.Surveys revealed great support and acceptance for PPI in academic clinical research in Switzerland across all stakeholder groups. Despite this support, several challenges were identified, including gaps in training, limited funding opportunities and insufficient infrastructure to facilitate PPI.

Conclusion: The current framework for PPI in Switzerland is in an early stage of development. A joint effort by all stakeholders is needed to catch up with international progress to reach high-level ethical and quality standards. A basic framework for PPI in academic clinical research in Switzerland should be implemented, including guidelines for qualification and collaboration, best practices as well as widespread information for patients, the public and researchers. Further needed are training opportunities in "PPI in clinical research" for all stakeholders as well as sustainable sources of funding.

Aim: To assess the perceptions of adults with diabetes regarding their care and health during the COVID-19 pandemic in the canton of Vaud, Switzerland.

Methods: Cross-sectional data was analysed from the 2021 follow-up questionnaire of the CoDiab-VD survey, a cohort of adults living with diabetes in the canton of Vaud. Various aspects of diabetes care and issues relating to the COVID-19 pandemic were assessed. Descriptive analyses were conducted to detail access to care, self-management, and psychosocial burden during the pandemic. Regression analyses were then performed to explore the relationship between these domains and factors associated with COVID-19 outcomes.

Results: Respondents (n = 566; 79%) had a mean age of 70 years (range: 22-94), and most had type 2 diabetes (73%). The COVID-19 pandemic did not appear to have strongly affected their care. Indeed, access to diabetes care remained similar to before the pandemic: only 10% of respondents reported having diabetes-related care postponed or cancelled. While 16% experienced increased difficulty in managing physical activity, the majority were able to continue diabetes self-management, with minimal changes in glucose control. In terms of psychosocial burden, only 33% expressed high levels of worry about the pandemic.

Conclusion: Diabetes self-management, glucose control, and access to diabetes care were not severely affected for the CoDiab-VD cohort during the COVID-19 pandemic. Despite some reported postponements in care and increased difficulty in physical activity management, the majority maintained their diabetes management practices with minimal impact on glucose control. Overall, psychosocial worry about the pandemic was relatively low, highlighting the resilience of individuals in managing their diabetes despite challenging circumstances.

Clinicaltrials: gov number: NCT01902043.

Aims: A wide range of reproductive health issues, including fertility, pregnancy outcomes and contraceptive practices can be affected by morbid obesity and weight loss subsequent to bariatric surgery. This study aimed to explore the attitudes and practices of bariatric healthcare professionals in Switzerland regarding reproductive health counselling in the context of bariatric surgery.

Methods: We conducted a national, cross-sectional, 36-question online survey among bariatric professionals in Switzerland. Survey topics included demographic factors, baseline characteristics of bariatric patients, perioperative reproductive health practices, attitudes and knowledge about contraception and recommendations regarding pregnancy. The survey was open from 1 October 2022 to 30 April 2023.

Results: A total of 75 healthcare professionals participated in the survey. The majority of participants responded that female patients of reproductive age constitute more than half of the referred bariatric patients. Forty participants (57%) recommended contraception for a duration of 18-24 months following a bariatric operation. Only twenty-three respondents (31%) stated that they always refer their female bariatric patients of reproductive age to a gynaecologist prior to bariatric surgery. Fifty-six participants (75%) replied that they always discuss family planning prior to surgery. There was high variation regarding the recommended methods of contraception after surgery.Only thirty-nine participants (52%) reported that they always inform their patients about the occurrence of possible surgery-related complications during future pregnancies. More than half of the participants reported inadequate knowledge regarding absorption and safety of contraceptive pills after bariatric surgery. Although most professionals routinely follow up and provide counselling on maternal and foetal risks in pregnant women with previous bariatric surgery, forty-nine participants (65%) have no standardised protocol for such patients who present with acute abdominal pain in their practice.

Conclusion: Despite acknowledging the importance of reproductive health counselling, bariatric professionals address perioperative and contraception issues inconsistently and mostly reported a lack of adequate knowledge in the latter. Therefore, a stronger collaboration between bariatric professionals and women's healthcare providers is needed to improve care of female bariatric patients of reproductive age.

In 2015, around 4400 individuals received a diagnosis of lung cancer, and Switzerland recorded approximately 3200 deaths related to lung cancer. Advances in detection, such as lung cancer screening and improved treatments, have led to increased identification of early-stage lung cancer and higher chances of long-term survival. This progress has introduced new considerations in imaging, emphasising non-invasive diagnosis and characterisation techniques like radiomics. Treatment aspects, such as preoperative assessment and the implementation of immune response evaluation criteria in solid tumours (iRECIST), have also seen advancements. For those undergoing curative treatment for lung cancer, guidelines propose follow-up with computed tomography (CT) scans within a specific timeframe. However, discrepancies exist in published guidelines, and there is a lack of universally accepted recommendations for follow-up procedures. This white paper aims to provide a certain standard regarding the use of imaging on the diagnosis, staging, treatment and follow-up of patients with lung cancer.