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E-cigarettes, synthetic nicotine, heated-tobacco and smokeless nicotine delivery products: the nicotine landscape beyond combustible cigarettes. 电子烟、合成尼古丁、加热烟草和无烟尼古丁输送产品:可燃香烟之外的尼古丁景观。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-04 DOI: 10.57187/s.3583
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.

吸烟仍然是一个巨大的公共卫生问题,每年在全世界造成数百万可预防的死亡。虽然安全有效的戒烟药物疗法,如尼古丁替代产品和药物伐尼克兰和安非他酮是可用的,长期戒断率仍然很低,需要新的方法来帮助吸烟者成功戒烟。近年来,电子烟、加热烟草制品等电子尼古丁传递系统和尼古丁袋等新型无烟尼古丁传递产品得到了广泛的普及。这些产品可以在不燃烧烟草的情况下提供尼古丁,因此,如果证明它们能够帮助吸烟者戒烟,同时减少他们接触有毒物质,可能会成为目前可用的戒烟方法的替代方案。在这篇叙述性综述中,我们总结了这些新型尼古丁输送产品的特点,以及有关其作为戒烟工具的有效性和安全性的现有数据,并重点介绍了瑞士的现状。
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引用次数: 0
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). Supplementum 282:瑞士麻醉学和围术期医学会与瑞士麻醉护理协会联合年会 2024 年瑞士麻醉学摘要。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-04 DOI: 10.57187/s.4283
Swiss Society For Anaesthesiology And Perioperative Medicine, Swiss Association For Anaesthesia Care
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引用次数: 0
Syphilis in pregnant women and congenital syphilis from 2012 to 2021 in Switzerland: a multicentre, retrospective study. 2012年至2021年瑞士孕妇梅毒和先天性梅毒:一项多中心回顾性研究。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.57187/s.3678
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。
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引用次数: 0
Severity of native pulmonary annular hypoplasia and late outcomes of tetralogy of Fallot: retrospective cohort study. 原发性肺动脉环发育不全的严重程度与法洛氏四联症的晚期预后:回顾性队列研究。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.57187/s.3689
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":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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 &lt; -4; n = 20), group 2 (Z score -2 to -4; n = 56) and group 3 (Z score &gt; -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 &gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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}
引用次数: 0
Antipsychotic, benzodiazepine and Z-drug prescriptions in a Swiss hospital network in the Choosing Wisely and COVID-19 eras: a longitudinal study. 瑞士一家医院网络在 "明智选择 "和 "COVID-19 "时代的抗精神病药、苯二氮卓类药物和 Z 类药物处方:一项纵向研究。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-01 DOI: 10.57187/s.3409
Vanessa Gagliano, Gloria Salemme, Alessandro Ceschi, Angela Greco, Nicola Grignoli, Luca Clivio, Alessandro Merler, Vanessa Feyling Benitez, Jvan Gianini, Martina Zandonà, Luca Gabutti
<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
研究目的医生经常在标签外开具抗精神病药物处方,用于治疗失眠和焦虑等症状。瑞士的 "明智用药-明智选择 "运动试图提高人们对其风险的认识,并限制苯二氮卓类药物和 Z 类药物的处方。在瑞士的意大利语地区,我们的公立医院网络也加入了这一运动,目的是通过处方监测、基准设定和教育贡献,避免不必要的苯二氮卓和 Z 类药物治疗。考虑到抗精神病药物处方可能发生转变的风险,并意识到 COVID-19 大流行的潜在作用,我们决定分析干预前、干预期间(2016-2017 年)和干预后抗精神病药物和苯二氮卓/Z 类药物的处方趋势:在这项纵向研究中,我们重新启动了对住院患者苯二氮卓/Z-类药物和抗精神病药物处方/处方的持续监测,在内部 "明智选择 "运动结束后的2018年暂停了这项工作,并以常规收集的观察性健康数据为基础。我们筛选了属于 EOC(Ente Ospedaliero Cantonale)网络的四家教学医院(H1-H4)内科住院患者的所有人口统计学、行政管理和处方数据,时间从 2014 年第四季度到 2023 年第二季度:我们分析了 74,659 次住院(H1/H2/H3/H4 医院分别为 14,645 次/16,083 次/24,285 次/19,646 次)。平均(± SD)病例组合(反映治疗患者的多样性、复杂性和严重性的指标)和患者年龄分别为 1.08 ± 0.14 岁和 73 ± 2 岁。10.6%和12.1%的患者在入院前和出院时分别服用了抗精神病药物(新处方3.3±0.7%;停药13.3±5.2%)。新处方呈上升趋势,每年增加 0.20%(p 结论:新处方的增加与抗精神病药物的增加有关:抗精神病药物处方量的增加与苯二氮卓/Z 类药物处方量的减少相吻合,这表明镇静剂疗法正在从一种向另一种转变。入院时的持续处方也呈现出同样的趋势,显示出类似的院外治疗方法。这表明镇静剂处方策略发生了变化,而不是选择了其他非药物疗法。此外,不同医院同类服务之间的差异也说明了当地处方文化的影响,以及持续监控和设定用药处方基准的重要性。
{"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":"&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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 &lt;0.001). Patients admitted with ongoing antipsychotics therapy increased 0.36% per year (p &lt;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 &lt;0.001). New antipsychotics prescriptions showed differences between hospitals, with H3 above and H2 below the average.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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}
引用次数: 0
Primary care physician eHealth profile and care coordination: a cross-sectional study. 初级保健医生电子健康档案与护理协调:一项横断面研究。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-27 DOI: 10.57187/s.3851
Mathieu Jendly, Valérie Santschi, Stefano Tancredi, Arnaud Chiolero

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.

背景:数字医疗在加强护理协调和支持患者自我管理方面大有可为。然而,包括医疗保健专业人员在内的各种障碍阻碍了其应用。这项横断面研究探讨了初级保健医生的电子健康状况及其与护理协调的关系:作为 "联邦基金 2022 年对 10 个国家的初级保健医生进行的国际卫生政策调查 "的一部分,瑞士的 1114 名医生填写了一份调查问卷,内容涉及他们的社会人口和工作场所特征、数字医疗使用情况以及护理协调实践。根据他们对数字医疗工具的使用方式、频率和应用情况的回答,我们得出了数字医疗得分。根据他们对与专家和医务辅助人员合作情况的回答,我们得出了护理协调得分。我们使用分层分析和多元线性回归评估了这两项得分之间的关联:在 1114 名参与者(46% 为女性,平均年龄 52 岁)中,83% 的人使用电子病历,96% 的人在不到 5% 的咨询中使用远程会诊,63% 的人从未使用联网健康工具来监控慢性病患者。此外,16% 的人允许在线预约,20% 的人允许在线开处方,52% 的人允许与其他医疗专业人员以电子方式交流药物清单,89% 的人允许与患者通过电子邮件或网络交流。电子健康状况得分与每周工作时数、内科专科医生或执业医生、诊所中的全职等同人数以及团体诊所设置呈正相关。电子健康档案得分越高,护理协调得分也越高:结论:数字健康与护理协调呈正相关。结论:数字医疗与护理协调呈正相关,这表明数字医疗在加强协作和跨专业护理实践方面具有潜在优势。
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引用次数: 0
Chatbots in medicine: certification process and applied use case. 医疗聊天机器人:认证程序和应用案例。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-25 DOI: 10.57187/s.3954
Mayssam Nehme, Franck Schneider, Esther Amruthalingam, Elio Schnarrenberger, Raphaël Tremeaud, Idris Guessous

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}
引用次数: 0
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. 在手术死亡率风险较低的症状性重度主动脉瓣狭窄患者中使用 SAPIEN 3 经导管主动脉瓣植入术与手术主动脉瓣置换术:瑞士的成本效用分析。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-24 DOI: 10.57187/s.3558
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
研究目的根据两项大型随机对照试验(PARTNER 3 和 Evolut 低风险试验)对经导管主动脉瓣植入术和外科主动脉瓣置换术(SAVR)的比较,2021 年欧洲心脏病学会瓣膜性心脏病指南建议对手术风险低、年龄≥75 岁且适合经股动脉入路(推荐等级 IA)的无症状重度主动脉瓣狭窄患者进行经导管主动脉瓣植入术(TAVI)。在瑞士,这种方法是否具有成本效益仍不清楚。本成本效用分析的目的是从瑞士强制医疗保险的角度,利用PARTNER 3试验的数据(特别反映了SAPIEN 3 TAVI设备的安全性和有效性),对低手术死亡率风险的无症状重度主动脉瓣狭窄患者进行SAPIEN 3经导管主动脉瓣植入术与手术主动脉瓣置换术的比较:方法:从瑞士强制医疗保险系统的角度,利用当地或地理位置相近的普通人群死亡率和效用数据、单位成本和医疗资源使用情况,并根据专家意见,对之前发表的基于马尔可夫的两阶段模型进行了调整,该模型捕捉了 PARTNER 3 试验的临床结果。该模型的期限为一生,每年的贴现率为 3%。成本效用分析估算了经导管主动脉瓣植入术与手术主动脉瓣置换术相比,在低手术死亡率风险的无症状重度主动脉瓣狭窄患者中,直接医疗成本和健康相关质量调整生命年的变化:总体而言,使用 SAPIEN 3 进行经导管主动脉瓣植入术每位患者的终生费用为 79,534 瑞士法郎,每位患者的质量调整生命年为 9.64 年,而手术主动脉瓣置换术每位患者的终生费用为 76,891 瑞士法郎,质量调整生命年为 8.96 年。与外科主动脉瓣置换术相比,经导管主动脉瓣植入术估计可为每位患者带来+0.68质量调整生命年的增量改善,而每位患者的终生成本增加+2643瑞士法郎。每个质量调整生命年的增量成本效益比为3866瑞士法郎,在多项敏感性分析中,每个质量调整生命年的增量成本效益比仍低于5万瑞士法郎:这项分析表明,使用 SAPIEN 3 设备进行经导管主动脉瓣植入术可能是一种极具成本效益的替代方案,适用于在当代瑞士环境下接受治疗的手术死亡率较低的无症状重度主动脉瓣狭窄患者。这些研究结果可能有助于在对这一患者群体的管理做出决策时采用综合方法。
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引用次数: 0
Inadequate health literacy and higher healthcare utilisation among older adults in Switzerland: cross-sectional evidence from a population-based study. 瑞士老年人健康知识不足与较高的医疗保健使用率:一项基于人口的研究的横断面证据。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-24 DOI: 10.57187/s.3515
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
背景和目的:瑞士的人口老龄化带来了巨大的挑战,包括对医疗保健系统的挑战。健康素养不足会妨碍个人寻求适当治疗和有效利用医疗系统的能力。本研究以瑞士 58 岁以上的成年人为样本,探讨了健康素养与向全科医生和医疗专家咨询次数之间的关系:我们使用了 1424 名老年人的数据,他们参加了第八波(2020 年)欧洲健康、老龄和退休调查(SHARE)。分析的重点是两个结果:访谈前一年中报告的(1)全科医生或(2)医疗保健专家的咨询次数。健康素养,即查找、理解、评估和应用健康信息的能力,采用简版欧洲健康素养调查问卷(HLS-EU-Q16)进行测量。最终的健康素养得分从 0 到 16 分不等,分为三个健康素养等级:不足(0-8 分)、有问题(9-12 分)和足够(13-16 分)。采用 Kruskal-Wallis 检验法进行双变量分析。使用多变量广义泊松回归模型对部分相关性进行了检验,并对主要的社会人口、地区和健康相关变量进行了控制:总体而言,68.5%的受访者被归类为具有足够的健康素养,而23.5%和7.9%的受访者的健康素养水平分别被归类为有问题或不足。受访者健康素养水平较低与受访前一年内全科医生问诊次数较多有显著统计学关联(p = 0.0011)。相比之下,我们没有发现健康素养与专科医生问诊次数之间有任何明显关联:本研究发现,在瑞士,较低的健康素养与老年人较高的医疗保健利用率有关。研究结果可能表明,对于健康素养水平较低的人来说,全科医生可以发挥重要的顾问作用,而对于专科医生来说,却没有发现类似的情况。这种差异至少可以部分归因于全科医生在患者和专科医疗服务提供者之间所扮演的中介角色。确保全科医生的可及性,尤其是对健康素养较低的个人而言,可能会被证明是解决这一特别弱势患者群体医疗保健需求的有益策略。此外,提高民众的健康素养还能带来更多的健康益处,并节省资源。
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引用次数: 0
Patients with refractory musculoskeletal pain syndromes undergoing a multimodal assessment and therapy programme: a cross-sectional study. 接受多模式评估和治疗方案的难治性肌肉骨骼疼痛综合征患者:一项横断面研究。
IF 2.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-21 DOI: 10.57187/s.3466
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
背景:包括纤维肌痛在内的慢性肌肉骨骼疼痛综合征是一种异质性实体,对社会经济造成沉重负担。对这些患者而言,多模式治疗方案已显示出比传统方法更高的疗效,至少在短期内是如此。深入了解接受多模式治疗方案治疗的慢性肌肉骨骼疼痛综合征患者,对于这些方案的发展和深入了解这些疾病非常重要。目的:全面客观地描述瑞士三级医疗机构提供的多模式治疗方案中接受治疗的难治性慢性肌肉骨骼疼痛综合征患者的医疗、社会心理和睡眠特征:这是一项横断面分析,研究对象是2018年至2022年期间在瑞士为期12天的多模式治疗项目中住院治疗的202名难治性慢性肌肉骨骼疼痛综合征患者,无论是否伴有自身免疫性疾病。他们通过八种不同的问卷进行了全面的自我评估,并接受了精神病学家、风湿病学家、疼痛专家、职业治疗师和物理治疗师的评估。睡眠评估是通过动态心电图进行的。临床和人口统计学变量由三位经验丰富的风湿病专家和慢性疼痛专家共同选定。此外,还采用了纤维肌痛快速筛查测试(FiRST)、美国风湿病学会(ACR)-2010 标准(ACR2010)和多伦多 Alexithymia 量表-20(TAS-20):患者的平均年龄为 47 岁(SD = 10),73% 为女性,30% 为肥胖。半数(50%)患者并非来自瑞士,12%来自冲突地区。近一半(40%)的患者独居。背痛是主要病因(90%)。78%的患者符合 ACR2010 纤维肌痛的标准,17%的患者被诊断患有潜在的免疫介导疾病,主要是脊柱关节炎。45%的患者自童年起就有疼痛感,68%的患者自青春期起就有疼痛感。69%的患者申请过残疾经济援助,46%的患者仍在等待答复。精神并发症的发病率很高(73%),其中 56% 为抑郁症。在所有患者中,15%被诊断出患有灾难性经历后持久人格改变(EPCACE),10%患有创伤后应激障碍。34%的患者患有亚历山大症。78%的患者出现客观睡眠障碍,41%的患者接受阿片类药物治疗:这项分析揭示了在瑞士接受治疗的难治性慢性肌肉骨骼疼痛综合征患者复杂的心身疾病和社会经济模式,这些疾病通常起源于儿童和青少年时期。肥胖、移民、社会隔离、精神病合并症、睡眠不足和使用鸦片制剂等等,都是需要进一步研究的目标特征。
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Swiss medical weekly
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