Swiss medical weekly最新文献

Multiple myeloma is a malignant disease characterised by the clonal proliferation of plasma cells. Since the last update of the Swiss recommendations for the diagnosis and treatment of multiple myeloma in 2019, the therapeutic landscape has evolved significantly, with the development of new monoclonal antibodies, novel combination therapies, and the introduction of T-cell-redirecting treatments such as bispecific antibodies and CAR T-cell therapy. This article summarises the current diagnostic procedures and therapeutic recommendations in Switzerland.

Objective: To assess the association of patient and transport characteristics with mortality and morbidity of neonates who require interfacility transport in central Switzerland.

Methods: We conducted a retrospective single-centre cohort study including neonates transported by the neonatal transport service of the Bern University Children՚s Hospital between January 2019 and December 2022. We reviewed the transport protocols and electronic patient charts of the hospitalisation after transport, and investigated the association of patient characteristics, clinical management before transport and transport characteristics (transport mode, transport times, adverse events) with outcomes. The primary outcome was death or impairment; secondary outcomes were lengths of stay in the intensive care unit and hospital, inotrope-free days and respiratory support-free days following transport.

Results: Of 807 neonates who were included, 105 (13%) showed an unfavourable outcome (death: 25 patients, impairment at time of discharge: 80). We observed a significant association between patients' diagnosis and primary outcome (p <0.001). Patients with a primary neurological disorder (n = 120, 14.9%) had a significantly higher risk of an unfavourable outcome (odds ratio [OR]: 5, 95% confidence interval [CI]: 2.46-10.9) compared to patients with a cardiac diagnosis. Death or impairment (primary outcome) was more likely to be observed in ground-transported patients than in air-transported patients (crude OR: 2.12, 95% CI: 1.20-4.07, p = 0.009). This effect remained significant after adjustment for the potential confounding effect of a selection of patient and administrative characteristics (adjusted OR: 2.23, 95% CI: 1.14-4.68, p = 0.018). Emergency transports, extended medical support before transport, a five-minute APGAR score <6 and a Sarnat score ≥2 were associated with an unfavourable outcome in the crude analysis, but not in the adjusted analysis. There was no significant association between stabilisation time or total transport time and primary outcome.

Conclusions: Our study illustrates potential risk factors for morbidity and mortality in neonates requiring transport from the birth facility to a specialised neonatal care centre. The relevance of the primary diagnosis should influence logistical transport decision-making in the future. In particular, children with neurological diseases require special attention. As ground transport showed a worse outcome than air transport, the helicopter service might be considered more frequently. Transport times seem to be of less importance in regions with short transport distances, but optimising dispatch and call to arrival times would probably improve transport efficiency.

Study aims: The prevalence of Long COVID in children and adolescents is heterogeneous, ranging from 1% to 51%, depending on the population studied. The lack of a standardised approach for establishing a Long COVID diagnosis in children and adolescents complicates the accurate assessment of prevalence, risk factors and outcomes. The present study aimed to examine the value of standardised interviews and an adjudication process to better understand self- or proxy-reported symptoms lasting longer than 12 weeks compatible with Long COVID in children and adolescents during the COVID-19 pandemic.

Methods: We conducted a school-based, prospective cohort study (Ciao Corona) from March 2020 to July 2022 in the Canton of Zurich, Switzerland. Of 156 invited schools, 55 agreed to participate. Primary schools were randomly selected across all 12 districts of the Canton of Zurich, with nearby secondary schools subsequently invited. Within participating schools, classes were randomly selected, stratified by school level, and all students aged 6-17 years in selected classes were eligible. At three different time points (March/April 2021, November/December 2021 and June/July 2022), school-aged children and adolescents underwent serology testing and completed online questionnaires, including questions on symptoms lasting ≥12 weeks compatible with Long COVID. We invited those with persisting symptoms and who were seropositive for SARS-CoV-2 - whether "infected" i.e. infection and no vaccination or having "hybrid immunity" i.e. infection and vaccination - to participate in interviews to allow us to better understand the pattern, severity and timing of the reported symptoms. An adjudication process with experts then followed to assess the probability of Long COVID.

Results: 39/1120 (3.5%) seropositive children and adolescents (i.e. infected or with hybrid immunity) reported persisting symptoms (≥12 weeks). The most frequently reported symptoms were headache, tiredness and stomach ache. In 20/39 (51%) with persisting symptoms who agreed to be interviewed, the adjudication committee concluded that Long COVID was unlikely in 13 (65%), possible in 7 (35%) and likely in 0 participants.

Conclusions: Relying exclusively on self- or proxy-reported questionnaire data, without more detailed information may overestimate Long COVID in children and adolescents. Implementing standardised interviews and an adjudication process helps to contextualise self- or proxy-reported symptoms compatible with Long COVID.

Trial registration:  https://clinicaltrials.gov NCT04448717.

Point-of-care ultrasound (POCUS) is a valuable addition to the diagnostic armamentarium of internal medicine specialists, improving patient assessment and treatment guidance. Early acquisition and continuous development of ultrasound skills during clinical training are key to maintaining the high quality of POCUS. In Switzerland, POCUS Component 1 (basics of emergency medicine ultrasound) of the Swiss Society of Ultrasound in Medicine (SGUM) postgraduate certification programme will be a mandatory component of board certification in General Internal Medicine (GIM) after 2026. Clinical institutions face the challenge of integrating POCUS teaching into daily practice. The following article addresses this challenge by describing the current regulatory conditions of POCUS training and presenting the POCUS training programme at Stadtspital Zürich Triemli as a blueprint for other postgraduate education sites in Switzerland.

Background: Switzerland's decentralised healthcare system delegates responsibility for paediatric hospital infrastructure to individual cantons. To date, official statistics on the number and types of paediatric hospital beds are lacking.

Objective: This study sought to fill this gap by collecting and analysing data from all paediatric hospitals in Switzerland.

Methods: A nationwide cross-sectional e-mail survey was conducted in January 2023. Data on both structurally available and operated beds were collected and descriptively analysed.

Results: The survey identified a total of 1751 beds in 29 paediatric hospitals or departments, of which 85% were operated. Of the total beds, 112 were paediatric intensive care unit beds (80% operated) and 339 were neonatology beds (86% operated). Significant regional disparities in bed availability were identified: the Lake Geneva region has the highest bed-to-child ratios, while Central Switzerland, Eastern Switzerland and Ticino show notably lower ratios.

Conclusion: These findings highlight the current distribution of paediatric beds, the considerable proportion of non-operated beds, and the importance of continued, comprehensive data collection to inform healthcare planning.

Switzerland invests substantially in research, yet many innovations fail to reach routine healthcare. This paper argues that embedding implementation science into national research infrastructures is key to closing this gap, reducing research waste and accelerating translation into practice. By strengthening initiatives such as IMPACT and national funding programmes, Switzerland can ensure its innovations deliver timely, sustainable benefits for patients and society.

Introduction: The COVID-19 pandemic has placed an enormous strain on the Swiss healthcare system. This study aims to assess the associations of the pandemic on Switzerland's hospital resource use and in-hospital mortality among both COVID-19 and non-COVID-19 patients.

Methods: In this national cohort study, we analysed administrative claims data for medical inpatients from 1 January 2018 to 31 December 2021, using mixed-effects segmented regression models. Hospitalisations were divided into a control and an exposure group before (January 2018 to December 2019) and during (January 2020 to December 2021) the pandemic. Before the pandemic, the division into the groups was performed by random split. We investigated trends in in-hospital mortality, hospital length of stay, 30-day hospital readmission and facility discharge rates before and during the COVID-19 pandemic, to assess the pandemic's association with both COVID-19 (exposure) and non-COVID-19 (control) patients.

Results: Among 1,510,836 included cases, 763,533 were hospitalised before and 747,303 during the COVID-19 pandemic including 61,151 with a diagnosis of COVID-19. Before the pandemic, there were no relevant changes in population-averaged in-hospital mortality in the control group and the randomly defined exposure group (-0.0263% and 0.0201% per month, respectively). During the pandemic, however, mortality showed an increase among COVID-19 patients by 0.3553% per month (95% confidence interval [CI]: 0.3546-0.3560; change in slope p <0.001; difference in slopes p <0.001), while there was no relevant change in the pandemic control group (slope: -0.0277% per month). Similarly, COVID-19 patients showed an increase in hospital length of stay and discharge to a post-acute care facility, while the trend for 30-day hospital readmission was decreased.

Conclusion: In this study, we observed an association between the COVID-19 pandemic and hospital resource use in COVID-19 patients only, resulting in higher in-hospital mortality, longer lengths of hospital stay and more frequent facility discharges. No relevant differences were seen in the control group during both time periods.

Study aims: Left atrial appendage occlusion (LAAO) is an accepted alternative stroke prevention strategy for patients with atrial fibrillation (AF) and contraindications to oral anticoagulation despite the lack of randomised data in this population. This study aims to compare the outcomes of LAAO and direct oral anticoagulation (DOAC) therapy in patients with high bleeding risk.

Methods: This cardinality-matched analysis comprised data from the Beat-AF and Swiss-AF cohorts (n = 3960; enrolment from 2010 to 2014 and from 2014 to 2017, respectively), along with the Zurich LAAO Registry (n = 535; patients included between 2010 and 2023). The primary endpoint was a composite of stroke, cardiovascular death or major bleeding. The individual components constituted the secondary endpoints. Time-dependent cumulative incidence curves were constructed and a competing risk analysis was included.

Results: After matching, 478 patients with a DOAC score ≥8 and 159 patients with previous major bleeding were compared in a 1:1 and 1:2 ratio, respectively, regarding their stroke prevention strategy (DOAC versus LAAO). After a median follow-up time of 4.9 years (interquartile range [IQR]: 2.2-6.1) in all patients with a DOAC score ≥8 and 4.4 years (IQR: 2.0-6.0) in all patients with previous major bleeding, there were no significant differences in the primary endpoint (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.67-1.14, p = 0.33 and HR: 0.79, 95% CI: 0.50-1.27, p = 0.33) and in the rates of stroke (HR: 0.74, 95% CI: 0.39-1.42, p = 0.36 and HR: 1.09, 95% CI: 0.33-3.62, p = 0.89) and cardiovascular death (HR: 0.97, 95% CI: 0.68-1.38, p = 0.85 and HR: 0.91, 95% CI: 0.50-1.64, p = 0.74). The rate of major bleedings was significantly lower in the LAAO group of both cohorts (HR: 0.55, 95% CI: 0.32-0.94, p = 0.029 and HR: 0.32, 95% CI: 0.13-0.79, p = 0.013).

Conclusion: In this high bleeding risk population, LAAO was associated with similar effectiveness in preventing atrial fibrillation-related stroke and cardiovascular death and significantly lower rates of major bleeding compared to DOAC therapy. This strengthens the value of LAAO as an alternative stroke prevention strategy for patients at high risk of bleeding.

Glucagon-like peptide-1 receptor agonists are increasingly used in the management of obesity and diabetes. Their potential risks, however, particularly regarding pancreatitis and pancreatic cancer, remain contentious. Despite numerous studies and meta-analyses indicating no significant correlation between GLP-1 RA therapy and the incidence of acute pancreatitis or pancreatic cancer, gaps in the literature persist regarding their effects in patients with frequent pancreatic conditions, such as intraductal papillary mucinous neoplasms, a disease with potential for malignant transformation. Further rigorous clinical studies addressing the safety of GLP-1 receptor agonists in patients with intraductal papillary mucinous neoplasms should be conducted to understand the potential risks and benefits, establish clear guidelines for clinical practice and ultimately ensure the safety of these medications in this potentially vulnerable patient population.