Swiss medical weekly最新文献

Objective: This study explores how Swiss citizens prioritise healthcare resource allocation for rare diseases, considering variables such as disease rarity, treatment cost, patient age and treatment outcomes.

Methods: We conducted an exploratory survey using visual discrete-choice vignettes embedded in scenario cards. Each card depicted a fictional patient case based on real-world disease attributes. A total of 157 unique real-world scenarios were designed by combining variables such as rarity, age group, cost and impact on quality of life. Participants were asked whether they would recommend treatment funding for each scenario.

Results: A total of 375 participant responses were analysed. Our findings reveal that the probability of a positive decision to treat was influenced more by treatment effectiveness and quality-of-life outcomes than by disease rarity or cost.

Conclusion: The results suggest that while high treatment costs do pose challenges, they are often secondary to the perceived benefits of treatment; Swiss citizens prioritise treatment effectiveness and quality-of-life improvements over rarity or treatment cost when considering funding decisions.

Background: Medication-related readmissions are significant burdens on patients and healthcare systems and are particularly prevalent among older adults. We aimed to identify potentially preventable medication-related readmissions and to describe their causes.

Methods: We conducted a retrospective cohort study of 500 randomly selected patients, aged 65 or older, discharged from the general internal medicine department of a university hospital in Switzerland between January 2022 and October 2023 and readmitted within 30 days. Two pharmacists independently screened their electronic health records and analysed whether their readmission was medication-related using the AT-HARM10 tool. We assessed preventability using judgements similar to the Schumock statements. In cases of disagreement between the two pharmacists, readmissions were also screened by a senior physician. We analysed the causes of potentially preventable medication-related readmissions.

Results: We identified 116 (23.2%) potentially preventable medication-related readmissions among the 500 readmissions analysed. The most common diagnoses associated with readmission were heart failure (21.6%), worsening pain (12.1%) and infection (12.1%). The most common causes of readmission were underprescribing (29.3%), Other prescribing problems such as suboptimal medication selection or dosage issues (28.4%), and non-adherence (12.9%). Diuretics, analgesics and antibiotics were the most frequently involved medications.

Conclusions: Nearly one-quarter of 30-day readmissions involving older adults were medication-related and potentially preventable. The primary contributing factors were prescribing and non-adherence issues. The study highlighted common causes of such readmissions and underlines the need for further research to determine which interventions - such as medication reviews or improved care transitions - are most effective in addressing them. Identifying high-risk patients will also be essential to optimise the use of healthcare resources.

For more than 20 years, Switzerland has had a national binding set of learning objectives to guide medical education at universities. The learning expectations, compiled in the Principal Relevant Objectives and Framework for Integrative Learning and Education in Switzerland (PROFILES), were revised in 2023. The purpose of this article is to describe the revision process and highlight the changes and updates in PROFILES 2. The new document consists of three interrelated and interdependent chapters: the Competencies and Roles (CRs), the Entrustable Professional Activities (EPAs) and the Situations as Starting Points (SSPs). The CRs are based on the CanMEDS roles, which describe the personal attributes and competencies of the graduate. EPAs define what activities the graduate is expected to perform on the first day of residency. SSPs represent situations in which the professional activities are expected to be performed. In terms of content, three new areas of focus have been added: planetary health; diversity, equity and inclusion (DEI); and digitalisation. The revised PROFILES reflects current best practice in medical education and will help to ensure that the needs of future generations of doctors and society are met.

Study aim: Tuberculosis remains a public health issue in Switzerland. Adherence to treatment is a challenge. To promote adherence, Video-Observed Therapy (VOT) has been proposed as an alternative to Directly Observed Therapy (DOT) that is less stigmatising, respects patients' privacy and uses less resources. This study aimed to assess (1) the feasibility and (2) the acceptability of VOT for tuberculosis by patients and specialised nurses in our area.

Methods: All subjects aged above 16 years with a newly diagnosed active tuberculosis, irrespective of site of infection, and followed by our centre could be included. Patients were provided with a pictogram-based smartphone app and trained by specialised nurses to send daily videos of their treatment to a secure platform. Acceptability by patients and by specialised nurses, ratio of number of videos sent to those expected and technical issues were prospectively recorded.

Results: Over 18 months, 55 patients were invited to participate. Four (7.2%) declined (92.7% acceptance rate). Of the remaining 51, 5 (9.8%) failed to start VOT, thus leaving 46 patients followed by VOT (their median age was 40.3 years with interquartile range [IQR] 33-45; 27 [53%] were female). Three cases (6.5%) dropped out. No cases of multidrug-resistant tuberculosis were documented. The ratio of total number of videos received/ expected (5744/6392) was 89.9%; the median individual ratio of videos sent/received was 96% (IQR: 73-100); the number of videos sent remained stable over 6 months. Of the 5744 videos sent, 312 (5.4%) showed minor technical problems. Results of an 18-item questionnaire showed that VOT was well accepted by our specialised nurses.

Conclusions: VOT showed a high rate of acceptance by patients and specialised nurses in our area and appears to be a feasible alternative to DOT.

Study aims: Patients with type 2 diabetes mellitus are typically managed in primary care settings, but management has become more complex in recent years due to modern therapeutic options. There is a paucity of data on the role of a one-off referral to an outpatient diabetes centre (a "pitstop" approach) in improving the quality of diabetes care.

Methods: This was a retrospective study of patients with type 2 diabetes mellitus who were referred to an outpatient diabetes centre at a regional hospital in Switzerland between 1 January 2019 and 31 December 2020. The primary outcome was the change in glycated haemoglobin (HbA1c) between the first and last consultation. Secondary endpoints included changes in body weight, blood pressure, low-density lipoprotein cholesterol and use of antidiabetic medications.

Results: At a median follow-up of 5.1 months (interquartile range [IQR] 3.0-9.1) after referral to an outpatient diabetes centre, haemoglobin A1c improved from 8.6% / 70.5 mmol/mol to 7.3% / 56.3 mmol/l (difference -1.28% / -14.2 mmol/l; 95% confidence interval [CI] -1.50 to -1.05), body weight decreased from 91.0 kg to 88.0 kg (difference -3.93; 95% CI -4.9 to -3.0) and systolic blood pressure values decreased by 1.6 mm Hg (95% CI -2.7 to -0.5), while low-density lipoprotein cholesterol levels remained unchanged. Compared to baseline, the pitstop approach resulted in decreased prescriptions for sulfonylureas (11.0% vs 2.8%) and dipeptidyl peptidase-4 inhibitors (31.4% vs 20.0%), but increased prescriptions for sodium-glucose cotransporter 2 (SGLT2) inhibitors (15.3% vs 27.5%) and glucagon-like peptide-1 (GLP1) receptor agonists (13.7% vs 46.3%).

Conclusion: A short-term intervention by an outpatient diabetes clinic was associated with significant improvements in glycaemic control and body weight in patient with type 2 diabetes. It promoted a shift towards modern antidiabetic medications with proven cardiorenal protective effects.

Adoptive cell therapy (ACT) with tumour-infiltrating lymphocytes (TIL) is an effective personalised immunotherapy for patients with advanced pretreated melanoma. For TIL-ACT, tumour-specific T cells are expanded from excised tumour samples and stimulated in cell culture with interleukin-2 (IL-2). The resulting autologous tumour-infiltrating lymphocytes are reinfused to the patient after a non-myeloablative lymphodepleting chemotherapy with cyclophosphamide and fludarabine. Thereafter, activation of tumour-infiltrating lymphocytes in the patient is supported by the administration of high-dose IL-2. Although effective, there is a need for enhancement of TIL-ACT in terms of effectiveness and toxicity. Most of the toxicity in this multistep, complex treatment regimen is due to the preparative chemotherapy and high-dose IL-2 treatment. At University Hospital Basel, we are currently evaluating an experimental approach of TIL-ACT in which we replace high-dose IL-2 by in vivo tumour-infiltrating lymphocyte activation with ANV419, a novel antibody-cytokine fusion protein consisting of IL-2 fused to an anti-IL-2 monoclonal antibody, in an ongoing phase I trial (BaseTIL-03M). The primary endpoint of the study is safety. We herein describe the case of a patient included in the BaseTIL-03M trial with chronic inflammatory demyelinating polyneuropathy who received TIL-ACT with ANV419 and developed an acute polyneuropathy of Guillain-Barré syndrome.