Swiss medical weekly最新文献

Background: Information on severely injured patients transported by helicopter emergency medical services (HEMS) in Switzerland is scarce. This study, with a special focus on sex differences, aimed to gain insights into the demographics, injury characteristics and outcomes of these patients and to provide data that could help improve prehospital trauma care.

Methods: This is a retrospective multicentre cohort study analysing data collected by the Swiss Trauma Registry. Patients aged 16 or older, who were admitted by helicopter emergency medical services to a level 1 trauma centre in Switzerland between 2018 and 2022, with an Injury Severity Score (ISS) of ≥16, were included.

Results: Overall, 2714 trauma patients were analysed in the present study. The majority of these patients were male (73.7%). Blunt trauma was the main cause of injury (93.6%), with traffic accidents (43.5%) and falls (43.3%) being the most common accident mechanisms. A greater percentage of male patients than female patients were involved in motorcycle crashes (16.5% vs 6.9%, p <0.001). Female patients were more frequently involved in accidents as pedestrians (6% vs 2.7%, p <0.001) and experienced more falls below 3 metres of height (22.9% vs 14.7%, p <0.001). The median ISS of our cohort was 24 (interquartile range [IQR]: 19-30). The most common injuries were thoracic trauma (67%), head trauma (66.7%) and spine trauma (50.3%). Men suffered more thoracic injuries (68.9% vs 61.9%, p = 0.001) and their median Abbreviated Injury Score (AIS) Thorax was significantly higher (3.0 [IQR: 0-3] vs 2.0 [IQR: 0-3], p <0.001). Women had a higher prevalence of pelvic fractures (29.3% vs 21.5%, p <0.001) and suffered more fractures of long bones in their upper extremities (22.2% vs 15.7%, p <0.001). There was no significant difference in in-hospital mortality between women and men (15.7% vs 14.6%, p = 0.493), nor in other outcome parameters.

Conclusion: To our knowledge, this is the first analysis of data on severely injured trauma patients transported by helicopter emergency medical services in Switzerland. While there were notable differences between women and men in terms of accident mechanisms and injury characteristics, no significant differences in outcome parameters were observed.

Background: Due to persistent organ shortage, the selection criteria for living kidney donors have broadened to include elderly donors and those with co-morbidities. As little is known about metabolic health after living kidney donation, this prospective, multicentre cohort study explored metabolic changes among living kidney donors, with a particular focus on weight trajectories.

Methods: We analysed metabolic and cardiovascular parameters before and after living kidney donation in 466 consecutive living kidney donors recorded in the Swiss Organ Living-Donor Health Registry between January 2018 and August 2022. Outcomes included weight, blood pressure, haemoglobin A1c (HbA1c) levels, and the occurrence of new-onset type 2 diabetes mellitus, arterial hypertension and cardiovascular diseases. Donors were stratified by predonation body mass index (BMI) and by postdonation weight change.

Results: Obese donors (BMI ≥30 kg/m²) more frequently had pre-existing hypertension at baseline than non-obese donors (31.6% vs 18.3%, p = 0.03). During follow-up (median 2.9 years), 6% of living kidney donors developed arterial hypertension, 2.6% developed cardiovascular diseases and 1.1% developed type 2 diabetes mellitus. Obese donors had a higher incidence of postdonation type 2 diabetes mellitus than non-obese donors (p = 0.01). Changes in BMI postdonation were not correlated with age or predonation BMI. Donors with postdonation weight gain had slightly higher follow-up blood pressure, but no clear differences in rates of new-onset hypertension or type 2 diabetes mellitus were observed between weight-change groups.

Conclusions: This exploratory analysis suggests that living kidney donation is generally metabolically safe. While metabolic changes were modest overall, obesity at the time of donation was associated with a slightly higher frequency of postdonation type 2 diabetes mellitus, underscoring the importance of counselling on lifestyle modification before donation.

The ultrasound examination in the first trimester is a crucial tool in prenatal diagnostics. Its primary aim is the early detection of fetal structural anomalies with the option to assess the risk for the common fetal trisomies (in Switzerland: "Ersttrimestertest"). The latter is achieved by combining ultrasound data with biochemical blood tests. In addition to chromosomal diagnostics, the first-trimester ultrasound plays an essential role in evaluating pregnancy risks as well as the overall health of the fetus. This method is non-invasive, safe and effective, offering invaluable information to both healthcare professionals and expectant parents that is critical for further pregnancy care. The introduction and wide-spread use of another, molecular test, NIPT ("non-invasive prenatal testing") should be seen as a useful additional option to, not a substitute for first trimester ultrasound. NIPT has high detection rates for "the common trisomies", but, in isolation, is insufficient for comprehensive early fetal assessment.

The Swiss expert group published revised guidelines on the prevention and antibiotic prophylaxis against infective endocarditis in 2021. In this viewpoint article, the group reports on their experiences two years after implementing the new prevention concept, which included information flyers and antimicrobial prophylaxis cards. Challenges included communicating the concept and indications for antimicrobial prophylaxis to both high-risk patients and providers.

Background: Opioid-containing antitussives are used to symptomatically treat a dry, irritative cough but bring a risk of misuse as recreational drugs. Since the update of the Swiss Therapeutic Products Act in 2019, opioid-containing antitussives are regulated more strictly, being available only on prescription and no longer over the counter.

Aim: This study aimed to describe the sales trends of opioid-containing antitussives in Switzerland between 2011 and 2022 to assess the impact of the regulation change.

Methods: We descriptively analysed cross-sectional data of opioid sales from wholesalers to pharmacies and self-dispensing physicians as an indicator of community use.

Main findings: An estimated 369 million standard units of opioid-containing antitussives were sold over the whole observation period, of which 59% contained dextromethorphan as the active ingredient. Sales decreased slowly between 2011 and 2019, then dropped substantially in 2020 (-30.4% compared to previous year) and 2021 (-15.2%), then partially recovered in 2022. The sales of codeine-containing antitussives did not recover until the end of the study period (quarter 3 of 2022) and remained 37.3% lower than before the rescheduling (quarter 4 of 2018).

Discussion: It is likely that repeated media attention on cases of misuse of opioid-containing antitussives led to more cautious dispensing in Switzerland leading up to the revision of the Therapeutic Products Act in 2019. The substantial decrease in sales in 2020 and 2021 was likely related to the COVID-19 pandemic rather than the rescheduling of opioid-containing antitussives. Longer data collection will be needed to assess the impact of the regulation change post-pandemic.

As patient and public involvement (PPI) in academic clinical research, especially clinical trials, is gaining recognition, including acceptance and implementation, questions arise about how to establish an effective "basic framework for PPI in academic clinical research" for all stakeholders in Switzerland. In this Viewpoint, the authors focus on one aspect of the survey and interview results reported by Eberle and colleagues from PPI contributors, researchers, academic research infrastructure staff, and representatives of regulatory and funding bodies to identify a possible direction for a basic PPI framework in Switzerland. Specifically, they describe how they prepare two groups of stakeholders - clinical researchers and PPI contributors - for collaboration. They present clear definitional distinctions to help clinical researchers prepare for the 2025 call for proposals from the Swiss National Science Foundation (SNSF) for Investigator-Initiated Clinical Trials (IICT) and provide important background information that is essential for understanding the fundamentals of PPI.

Study aims: This study aimed to deepen the understanding of endometriosis symptoms, types, and therapy recommendations for Swiss endometriosis patients in Swiss-certified endometriosis centres in 2022.

Methods: In this exploratory retrospective multicentre cohort study, data from 3538 women who had their first consultation at a certified endometriosis centre in Switzerland in 2022 were analysed retrospectively. Data were collected by using questionnaires that were filled out by the patient and the physician at the first consultation, to evaluate parameters that included the main reason for consultation, visual analogue scale (VAS) scores for pain, clinical findings and therapy recommendations.

Results: This study analysed all patients who had provided consent and were diagnosed with endometriosis (n = 3403, 96.2%) during their first consultation at a Swiss-certified endometriosis centre in 2022. The median age was 33.0 years (11-66 years). Of 812 documented VAS scores, 71.6% of the patients felt general pain, resulting in a median VAS score for dysmenorrhoea of 8 (0-10). After the first examination, peritoneal endometriosis (n = 1453, 54.8%) was diagnosed most often, followed by adenomyosis (n = 1366, 51.5%), deep infiltrating endometriosis (n = 857, 32.3%) and cystic/ovarian endometriosis (n = 643, 24.2%). In 46.2% of the patients, more than one working hypothesis, with regard to their condition, was identified - in most cases, a combination of peritoneal endometriosis and adenomyosis (15.6%). Endocrine therapy was the most frequent treatment recommended (60.6%), followed by recommendations for medical pain therapy (57%), surgery (34.4%), complementary procedures (23.5%), reproductive therapy (5.7%) and multimodal pain therapy (5.6%). Analysis of correlations between symptoms, diagnosis and treatment recommendations showed only a few notable findings such as correlations between peritoneal endometriosis and hormonal-/medical treatment as well as correlations between deep infiltrating endometriosis and treatment recommendation for surgery.

Conclusion: The high VAS scores in dysmenorrhoea underline the degree of suffering of patients with endometriosis seeking consultation at a certified endometriosis centre. Most patients presented multiple phenotypes with uncorrelated symptoms and diverse as well as multimodal treatment options were indicated, underlining the complexity and individuality of the disease.

Purpose: To compare the costs of 25-fraction vs 5-fraction postoperative radiotherapy regimens in breast cancer patients. Several clinical trials have confirmed at least comparable safety and efficacy of short hypofractionated partial and whole breast radiation regimens. This study was focused on providing detailed cost data and analysing the advantages or disadvantages of either treatment strategy for patients.

Materials and methods: Calculations were performed based on patient and infra-structure data collected from the department of radiation oncology at Lucerne Cantonal Hospital (LUKS) in Switzerland from 1 July to 31 December 2020. The process maps were created to identify resources used for each radiation therapy option, from initial consultation to treatment completion. Cost comparisons represent the viewpoints of the hospital, insurance coverages and societal costs. To estimate hospital costs, time-driven activity-based costing was used, including equipment purchase and personnel costs. For insurers, estimates were based on the TARMED tariff system in Switzerland, which is used for billing ambulatory services and reflecting insurance coverage. The social cost was defined as productivity loss (e.g. absence from work) due to treatment appointments.

Results: The 5-fraction regimens resulted in a total of 53% (972 CHF) lower hospital costs, including personnel and equipment resources, a 42% (3153 CHF) reduction of charges to insurers and a 62% (372 CHF) lower social burden in terms of productivity losses due to the patient's absence from work. The major findings from studies using 5-fraction regimens have shown a comparable result in terms of local control and treatment tolerance.

Conclusion: A5-fraction radiotherapy regimen in breast cancer patients results in a lower cost than a conventional 25-fraction regimen.

Background and study aims: Is there a post-acute infection syndrome for Legionnaires' disease? Legionnaires' disease is a form of primarily community-acquired pneumonia caused by Legionella spp. bacteria. Legionnaires' disease and other forms of bacterial community-acquired pneumonia may lead to persistent health and wellbeing impairments. It remains unclear whether these are caused by the community-acquired pneumonia-causing pathogen or the pneumonia itself. We present the rationale and design of a matched cohort study to investigate the persistent health impacts of Legionnaires' disease and compare them with persistent manifestations of other bacterial (Legionella test-negative) community-acquired pneumonia. We also present baseline characteristics of the study cohorts.

Methods: Legionnaires' disease patients and Legionella test-negative community-acquired pneumonia patients with confirmed or clinically suspected bacterial aetiology were recruited from university and cantonal/regional hospitals and matched for sex, age, hospital type and date of diagnosis. Questionnaire-based interviews are conducted at baseline and 2, 6 and 12 months after the start of appropriate antibiotics. The questionnaires focus on patient-reported outcome measures and cover long-term symptoms, use of health services and health-related quality of life.

Results: Between June 2023 and June 2024, 59 patients with Legionnaires' disease (59.3% male, median age 69 years [interquartile range [IQR]: 57-80]) and 60 patients with other bacterial (Legionella test-negative) community-acquired pneumonia (63.3% male, median age 69 years [IQR: 60-79]) were enrolled. Admission to the intensive care unit was required for 13.6 % of Legionnaires' disease patients and 8.3 % of other bacterial community-acquired pneumonia patients. Chronic kidney failure was more prevalent among Legionnaires' disease patients (15.3% vs 10.0%), while chronic obstructive pulmonary disease (20.0% vs 11.9%), malignancies (33.3% vs 13.6%) and an immunocompromised status (25.0% vs 13.6%) were more common in Legionella test-negative community-acquired pneumonia patients. Furthermore, Legionella test-negative community-acquired pneumonia patients reported lower baseline quality of life scores than Legionnaires' disease patients. Differences in pneumonia severity, comorbidities and self-reported quality of life scores will be accounted for in future analyses.

Conclusions: The LongLEGIO study will contribute to research on post-acute infection syndromes and provide the data for a more holistic assessment of the disease burden of Legionnaires' disease.