Romain Betend, Laurent Suppan, Michele Chan, Simon Regard, François Sarasin, Christophe A Fehlmann
Background: Clinical experience has been shown to affect many patient-related outcomes but its impact in the prehospital setting has been little studied.
Objectives: To determine whether rates of discharge at scene, handover to paramedics and supervision are associated with clinical experience.
Design, settings and participants: A retrospective study, performed on all prehospital interventions carried out by physicians working in a mobile medical unit ("service mobile d'urgence et de réanimationˮ [SMUR]) at Geneva University Hospitals between 1 January 2010 and 31 December 2019. The main exclusion criteria were phone consultations and major incidents with multiple casualties.
Exposure: The exposure was the clinical experience of the prehospital physician at the time of the intervention, in number of years since graduation.
Outcome measures and analysis: The main outcome was the rate of discharge at scene. Secondary outcomes were the rate of handover to paramedics and the need for senior supervision. Outcomes were tabulated and multilevel logistic regression was performed to take into account the cluster effect of physicians.
Results: In total, 48,368 adult patients were included in the analysis. The interventions were performed by 219 different physicians, most of whom were male (53.9%) and had graduated in Switzerland (82.7%). At the time of intervention, mean (standard deviation [SD]) level of experience was 5.2 (3.3) years and the median was 4.6 (interquartile range [IQR]: 3.4-6.0). The overall discharge at scene rate was 7.8% with no association between clinical experience and discharge at scene rate. Greater experience was associated with a higher rate of handover to paramedics (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13-1.21) and less supervision (aOR: 0.85, 95% CI: 0.82-0.88).
Conclusion: In this retrospective study, there was no association between level of experience and overall rate of discharge at scene. However, greater clinical experience was associated with higher rates of handover to paramedics and less supervision.
{"title":"Association between prehospital physician clinical experience and discharge at scene - retrospective cohort study.","authors":"Romain Betend, Laurent Suppan, Michele Chan, Simon Regard, François Sarasin, Christophe A Fehlmann","doi":"10.57187/s.3533","DOIUrl":"https://doi.org/10.57187/s.3533","url":null,"abstract":"<p><strong>Background: </strong>Clinical experience has been shown to affect many patient-related outcomes but its impact in the prehospital setting has been little studied.</p><p><strong>Objectives: </strong>To determine whether rates of discharge at scene, handover to paramedics and supervision are associated with clinical experience.</p><p><strong>Design, settings and participants: </strong>A retrospective study, performed on all prehospital interventions carried out by physicians working in a mobile medical unit (\"service mobile d'urgence et de réanimationˮ [SMUR]) at Geneva University Hospitals between 1 January 2010 and 31 December 2019. The main exclusion criteria were phone consultations and major incidents with multiple casualties.</p><p><strong>Exposure: </strong>The exposure was the clinical experience of the prehospital physician at the time of the intervention, in number of years since graduation.</p><p><strong>Outcome measures and analysis: </strong>The main outcome was the rate of discharge at scene. Secondary outcomes were the rate of handover to paramedics and the need for senior supervision. Outcomes were tabulated and multilevel logistic regression was performed to take into account the cluster effect of physicians.</p><p><strong>Results: </strong>In total, 48,368 adult patients were included in the analysis. The interventions were performed by 219 different physicians, most of whom were male (53.9%) and had graduated in Switzerland (82.7%). At the time of intervention, mean (standard deviation [SD]) level of experience was 5.2 (3.3) years and the median was 4.6 (interquartile range [IQR]: 3.4-6.0). The overall discharge at scene rate was 7.8% with no association between clinical experience and discharge at scene rate. Greater experience was associated with a higher rate of handover to paramedics (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13-1.21) and less supervision (aOR: 0.85, 95% CI: 0.82-0.88).</p><p><strong>Conclusion: </strong>In this retrospective study, there was no association between level of experience and overall rate of discharge at scene. However, greater clinical experience was associated with higher rates of handover to paramedics and less supervision.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"153 ","pages":"3533"},"PeriodicalIF":2.9,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871246","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}
Mayssan Nehme, O. Braillard, Pierre-Yves Rodondi, Idris Guessous
AIMS OF THE STUDY: Patients are increasingly using and requesting complementary medicine therapies, especially during the COVID-19 pandemic. However, it remains unclear whether they use them in conjunction with conventional medicine or to replace vaccination or other approaches and whether they discuss them with their physicians as part of shared decision-making. This study aimed to evaluate the use and initiation of complementary medicine during the COVID-19 pandemic, focusing on the association between complementary medicine use and COVID-19 vaccination status. METHODS: This study is a part of the longitudinal cohort of the CoviCare program, which follows all outpatients tested for COVID-19 at the Geneva University Hospitals. Outpatients tested for COVID-19 were contacted 12 months after their positive or negative test between April and December 2021. Participants were asked about their vaccination status and if they had used complementary medicine in the past 12 months. Complementary medicine use was defined based on a specific list of therapies from which participants could choose the options they had used. Logistic regression models adjusting for age, sex, education, profession, severe acute respiratory system coronavirus 2 (SARS-CoV-2) infection, and pre-existing conditions were used to evaluate the association between being unvaccinated and complementary medicine use. SARS-CoV-2 infection status was evaluated for effect modification in the association between being unvaccinated and complementary medicine use. RESULTS: This study enrolled 12,246 individuals (participation proportion = 17.7%). Their mean age was 42.8 years, 59.4% were women, and 63.7% used complementary medicine. Complementary medicine use was higher in women, the middle-aged, and those with a higher education level, a SARS-CoV-2 infection, or pre-existing comorbidities. A third of cases initiated complementary medicine therapies as prevention against COVID-19. Being unvaccinated was associated with complementary medicine use (adjusted odds ratio [aOR] 1.22 [1.09–1.37]), and more specifically when these therapies were used for COVID-19 prevention (aOR 1.61 [1.22–2.12]). Being unvaccinated was associated with the use of zinc (aOR 2.25 [1.98–2.55]), vitamin D (aOR 1.45 [1.30–1.62]), and vitamin C (aOR 1.59 [1.42–1.78]), and more specifically when these therapies were used for COVID-19 prevention. Only 4% of participants discussed using complementary medicine with their primary care physicians. CONCLUSION: While complementary medicine is increasingly used, it is rarely discussed with primary care physicians. Complementary medicine use, especially for COVID-19 prevention, is associated with COVID-19 vaccination status. Communication between physicians, patients, and complementary medicine therapists is encouraged to facilitate a truly holistic approach to making a shared decision based on the best available information.
{"title":"Use of complementary medicine and its association with SARS-CoV-2 vaccination during the COVID-19 pandemic: a longitudinal cohort study","authors":"Mayssan Nehme, O. Braillard, Pierre-Yves Rodondi, Idris Guessous","doi":"10.57187/s.3505","DOIUrl":"https://doi.org/10.57187/s.3505","url":null,"abstract":"AIMS OF THE STUDY: Patients are increasingly using and requesting complementary medicine therapies, especially during the COVID-19 pandemic. However, it remains unclear whether they use them in conjunction with conventional medicine or to replace vaccination or other approaches and whether they discuss them with their physicians as part of shared decision-making. This study aimed to evaluate the use and initiation of complementary medicine during the COVID-19 pandemic, focusing on the association between complementary medicine use and COVID-19 vaccination status. METHODS: This study is a part of the longitudinal cohort of the CoviCare program, which follows all outpatients tested for COVID-19 at the Geneva University Hospitals. Outpatients tested for COVID-19 were contacted 12 months after their positive or negative test between April and December 2021. Participants were asked about their vaccination status and if they had used complementary medicine in the past 12 months. Complementary medicine use was defined based on a specific list of therapies from which participants could choose the options they had used. Logistic regression models adjusting for age, sex, education, profession, severe acute respiratory system coronavirus 2 (SARS-CoV-2) infection, and pre-existing conditions were used to evaluate the association between being unvaccinated and complementary medicine use. SARS-CoV-2 infection status was evaluated for effect modification in the association between being unvaccinated and complementary medicine use. RESULTS: This study enrolled 12,246 individuals (participation proportion = 17.7%). Their mean age was 42.8 years, 59.4% were women, and 63.7% used complementary medicine. Complementary medicine use was higher in women, the middle-aged, and those with a higher education level, a SARS-CoV-2 infection, or pre-existing comorbidities. A third of cases initiated complementary medicine therapies as prevention against COVID-19. Being unvaccinated was associated with complementary medicine use (adjusted odds ratio [aOR] 1.22 [1.09–1.37]), and more specifically when these therapies were used for COVID-19 prevention (aOR 1.61 [1.22–2.12]). Being unvaccinated was associated with the use of zinc (aOR 2.25 [1.98–2.55]), vitamin D (aOR 1.45 [1.30–1.62]), and vitamin C (aOR 1.59 [1.42–1.78]), and more specifically when these therapies were used for COVID-19 prevention. Only 4% of participants discussed using complementary medicine with their primary care physicians. CONCLUSION: While complementary medicine is increasingly used, it is rarely discussed with primary care physicians. Complementary medicine use, especially for COVID-19 prevention, is associated with COVID-19 vaccination status. Communication between physicians, patients, and complementary medicine therapists is encouraged to facilitate a truly holistic approach to making a shared decision based on the best available information.","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"176 ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139175495","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}
C. Py, Claudio De Vito, P. Tsantoulis, Gürkan Kaya, S. Labidi-Galy, Pierre-Yves Dietrich
BACKGROUND: The development of immunotherapy and tyrosine kinase inhibitors dramatically improved the prognosis of metastatic melanoma. Consequently, chemotherapy is now rarely used. Here, we describe the characteristics of long-surviving patients with metastatic melanoma treated with immunochemotherapy. MATERIAL AND METHODS: We retrieved retrospective clinical and pathological data for patients diagnosed with metastatic melanoma between January 1993 and December 2015 who received the CVD-INF (cisplatin, vinblastine, dacarbazine, and interferon α-2b) regimen at the Hôpitaux Universitaires de Genève. We estimated their progression-free survival and overall survival. This ad hoc study’s primary aim was to describe the clinical and biological characteristics of long-term survivors, defined as patients surviving more than two years after immunochemotherapy initiation. The spatial distribution pattern of CD8+ T cells (inflamed, excluded, or desert) was immunohistochemically determined. RESULTS: Ninety patients received CVD-INF. Their median age at metastatic melanoma diagnosis was 55 years (20–75). Their median progression-free survival was 2.8 months, and median overall survival was 7.2 months. Eleven (12%) patients were long-term survivors. In multivariate analysis, central nervous system metastases (hazard ratio [HR]: 2.66; 95% confidence interval [CI]: 1.43–4.95; p = 0.001), multiple metastases (HR: 1.82; 95% CI: 1.01–3.29; p = 0.047), and elevated lactate dehydrogenase (LDH) (HR: 1.92; 95% CI: 1.12–3.30; p = 0.016) were independently associated with shorter survival. Most long-survivors (6/8; 75%) had a tumour-inflamed pattern compared to 25% of non-long survivors (5/20; Fisher’s test p = 0.030). CONCLUSIONS: A subset of patients with metastatic melanoma and a tumour-inflamed phenotype treated with CVD-INF survived over two years. Factors associated with prolonged survival are consistent with those previously reported in metastatic melanoma.
{"title":"Characteristics of long-survivor metastatic melanoma after polychemotherapy and interferon: a retrospective study","authors":"C. Py, Claudio De Vito, P. Tsantoulis, Gürkan Kaya, S. Labidi-Galy, Pierre-Yves Dietrich","doi":"10.57187/s.3504","DOIUrl":"https://doi.org/10.57187/s.3504","url":null,"abstract":"BACKGROUND: The development of immunotherapy and tyrosine kinase inhibitors dramatically improved the prognosis of metastatic melanoma. Consequently, chemotherapy is now rarely used. Here, we describe the characteristics of long-surviving patients with metastatic melanoma treated with immunochemotherapy. MATERIAL AND METHODS: We retrieved retrospective clinical and pathological data for patients diagnosed with metastatic melanoma between January 1993 and December 2015 who received the CVD-INF (cisplatin, vinblastine, dacarbazine, and interferon α-2b) regimen at the Hôpitaux Universitaires de Genève. We estimated their progression-free survival and overall survival. This ad hoc study’s primary aim was to describe the clinical and biological characteristics of long-term survivors, defined as patients surviving more than two years after immunochemotherapy initiation. The spatial distribution pattern of CD8+ T cells (inflamed, excluded, or desert) was immunohistochemically determined. RESULTS: Ninety patients received CVD-INF. Their median age at metastatic melanoma diagnosis was 55 years (20–75). Their median progression-free survival was 2.8 months, and median overall survival was 7.2 months. Eleven (12%) patients were long-term survivors. In multivariate analysis, central nervous system metastases (hazard ratio [HR]: 2.66; 95% confidence interval [CI]: 1.43–4.95; p = 0.001), multiple metastases (HR: 1.82; 95% CI: 1.01–3.29; p = 0.047), and elevated lactate dehydrogenase (LDH) (HR: 1.92; 95% CI: 1.12–3.30; p = 0.016) were independently associated with shorter survival. Most long-survivors (6/8; 75%) had a tumour-inflamed pattern compared to 25% of non-long survivors (5/20; Fisher’s test p = 0.030). CONCLUSIONS: A subset of patients with metastatic melanoma and a tumour-inflamed phenotype treated with CVD-INF survived over two years. Factors associated with prolonged survival are consistent with those previously reported in metastatic melanoma.","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"428 ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139178880","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}
Christopher Schneeweis, Katharina Diebold, Thomas Schramm, Christine Syrek, Hans-Georg Predel, Robert Manka, Jonas Zacher
Introduction: The cardiac magnetic resonance (CMR) data on mid- to long-term myocardial damage due to COVID-19 infections in elite athletes are scarce. Therefore, this study investigated the mid -to long-term consequences of myocardial involvement after a COVID-19 infection in elite athletes.
Materials and methods: This study included 27 athletes at the German Olympic Centre North Rhine-Westphalia (NRW)/Rhineland with a confirmed previous COVID-19 infection between January 2020 and October 2021. The athletes were part of an ongoing observational COVID-19 study at the Institute of Cardiology and Sports Medicine Cologne at the German Sport University (DSHS).Nine healthy non-athletes with no prior COVID-19 illness served as controls. CMR was performed within a mean of 182 days (standard deviation [SD] 99) of the initial positive test result.
Results: CMR did not reveal any signs of acute myocarditis (according to the current Lake Louise criteria) or myocardial damage in any of the 26 elite athletes with previous COVID-19 infection. Of these athletes, 92% experienced a symptomatic course, and 54% reported symptoms lasting for more than 4 weeks. One male athlete was excluded from the analysis because CMR revealed an arrhythmogenic right ventricular cardiomyopathy (ARVC). Athletes had significantly enlarged left and right ventricle volumes and increased left ventricular myocardial mass in comparison to the healthy control group (LVEDVi 103.4 vs 91.1 ml/m2, p = 0.031; RVEDVi 104.1 vs 86.6 ml/m2, p = 0.007; LVMi 59.0 vs 46.2 g/m2, p = 0.002). Only two cases of elevated high-sensitivity-Troponin were documented; in one, the participant had previously engaged in high-intensity training, and in the other, CMR revealed a diagnosis of an arrhythmogenic cardiomyopathy.
Conclusion: Our findings suggest that the risk for mid- to long-term myocardial damage is very low to negligible in elite athletes. Our results do not allow conclusions to be drawn regarding myocardial injury in the acute phase of infection nor about possible long-term myocardial effects in the general population.
{"title":"Mid- to long-term cardiac magnetic resonance findings in elite athletes recovered from COVID-19: results from an ongoing observational COVID-19 study at a German Olympic medical centre.","authors":"Christopher Schneeweis, Katharina Diebold, Thomas Schramm, Christine Syrek, Hans-Georg Predel, Robert Manka, Jonas Zacher","doi":"10.57187/s.3534","DOIUrl":"https://doi.org/10.57187/s.3534","url":null,"abstract":"<p><strong>Introduction: </strong>The cardiac magnetic resonance (CMR) data on mid- to long-term myocardial damage due to COVID-19 infections in elite athletes are scarce. Therefore, this study investigated the mid -to long-term consequences of myocardial involvement after a COVID-19 infection in elite athletes.</p><p><strong>Materials and methods: </strong>This study included 27 athletes at the German Olympic Centre North Rhine-Westphalia (NRW)/Rhineland with a confirmed previous COVID-19 infection between January 2020 and October 2021. The athletes were part of an ongoing observational COVID-19 study at the Institute of Cardiology and Sports Medicine Cologne at the German Sport University (DSHS).Nine healthy non-athletes with no prior COVID-19 illness served as controls. CMR was performed within a mean of 182 days (standard deviation [SD] 99) of the initial positive test result.</p><p><strong>Results: </strong>CMR did not reveal any signs of acute myocarditis (according to the current Lake Louise criteria) or myocardial damage in any of the 26 elite athletes with previous COVID-19 infection. Of these athletes, 92% experienced a symptomatic course, and 54% reported symptoms lasting for more than 4 weeks. One male athlete was excluded from the analysis because CMR revealed an arrhythmogenic right ventricular cardiomyopathy (ARVC). Athletes had significantly enlarged left and right ventricle volumes and increased left ventricular myocardial mass in comparison to the healthy control group (LVEDVi 103.4 vs 91.1 ml/m2, p = 0.031; RVEDVi 104.1 vs 86.6 ml/m2, p = 0.007; LVMi 59.0 vs 46.2 g/m2, p = 0.002). Only two cases of elevated high-sensitivity-Troponin were documented; in one, the participant had previously engaged in high-intensity training, and in the other, CMR revealed a diagnosis of an arrhythmogenic cardiomyopathy.</p><p><strong>Conclusion: </strong>Our findings suggest that the risk for mid- to long-term myocardial damage is very low to negligible in elite athletes. Our results do not allow conclusions to be drawn regarding myocardial injury in the acute phase of infection nor about possible long-term myocardial effects in the general population.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"153 ","pages":"3534"},"PeriodicalIF":2.9,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861824","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}
Vera Lehmann, Franco Noti, Markus Laimer, Christoph Stettler, Thomas Züger
AIMS OF THE STUDY: To assess glucose levels in adults with diabetes at a Swiss tertiary hospital when transitioning from insulin delivery with a sensor-augmented pump with (predictive) low-glucose suspend ([P]LGS) to a hybrid-closed loop (HCL) and from a HCL to an advanced hybrid-closed loop (AHCL). METHODS: Continuous glucose monitoring data for 44 adults with type 1 diabetes transitioning from (P)LGS to hybrid-closed loop and from hybrid-closed loop to advanced hybrid-closed loop were analysed, including the percentage of time spent within, below, and above glucose ranges. In addition, a subgroup analysis (n = 14) of individuals undergoing both transitions was performed. RESULTS: The transition from a (P)LGS to a hybrid-closed loop was associated with increased time in range (6.6% [2.6%–12.7%], p <0.001) and decreased time above range (5.6% [2.3%–12.7%], p <0.001). The transition from a hybrid-closed loop to an advanced hybrid-closed loop was associated with increased time in range (1.6% [−0.5%–4.5%], p = 0.046) and decreased time above range (1.5% [–1.8%–5.6%], p = 0.050). Both transitions did not change the time below range. In the subgroup analysis ([P]LGS → HCL → AHCL), the time in range increased from 69.4% (50.3%–79.2%) to 76.5% (65.3%–81.3%) and 78.7% (69.7%–85.8%), respectively (p <0.001). CONCLUSIONS: Glucose levels significantly improved when transitioning from a (P)LGS to a hybrid-closed loop. Glucose levels improved further when switching from a hybrid-closed loop to an advanced hybrid-closed loop. However, the added benefit of an advanced hybrid-closed loop was comparably smaller. This pattern was also reflected in the subgroup analysis.
{"title":"Glycaemic outcomes in adults with type 1 diabetes transitioning towards advanced automated insulin delivery systems – a real-world analysis at a Swiss tertiary centre","authors":"Vera Lehmann, Franco Noti, Markus Laimer, Christoph Stettler, Thomas Züger","doi":"10.57187/s.3501","DOIUrl":"https://doi.org/10.57187/s.3501","url":null,"abstract":"AIMS OF THE STUDY: To assess glucose levels in adults with diabetes at a Swiss tertiary hospital when transitioning from insulin delivery with a sensor-augmented pump with (predictive) low-glucose suspend ([P]LGS) to a hybrid-closed loop (HCL) and from a HCL to an advanced hybrid-closed loop (AHCL).\u0000METHODS: Continuous glucose monitoring data for 44 adults with type 1 diabetes transitioning from (P)LGS to hybrid-closed loop and from hybrid-closed loop to advanced hybrid-closed loop were analysed, including the percentage of time spent within, below, and above glucose ranges. In addition, a subgroup analysis (n = 14) of individuals undergoing both transitions was performed.\u0000RESULTS: The transition from a (P)LGS to a hybrid-closed loop was associated with increased time in range (6.6% [2.6%–12.7%], p <0.001) and decreased time above range (5.6% [2.3%–12.7%], p <0.001). The transition from a hybrid-closed loop to an advanced hybrid-closed loop was associated with increased time in range (1.6% [−0.5%–4.5%], p = 0.046) and decreased time above range (1.5% [–1.8%–5.6%], p = 0.050). Both transitions did not change the time below range. In the subgroup analysis ([P]LGS → HCL → AHCL), the time in range increased from 69.4% (50.3%–79.2%) to 76.5% (65.3%–81.3%) and 78.7% (69.7%–85.8%), respectively (p <0.001).\u0000CONCLUSIONS: Glucose levels significantly improved when transitioning from a (P)LGS to a hybrid-closed loop. Glucose levels improved further when switching from a hybrid-closed loop to an advanced hybrid-closed loop. However, the added benefit of an advanced hybrid-closed loop was comparably smaller. This pattern was also reflected in the subgroup analysis.","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"104 S1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138998582","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}
S. Mitterer, Karin Zimmermann, Günther Fink, Michael Simon, A. Gerber, Eva Bergsträsser
BACKGROUND: Effective funding models are key for implementing and sustaining critical care delivery programmes such as specialised paediatric palliative care (SPPC). In Switzerland, funding concerns have frequently been raised as primary barriers to providing SPPC in dedicated settings. However, systematic evidence on existing models of funding as well as primary challenges faced by stakeholders remains scarce. AIMS: The present study’s first aim was to investigate and conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. Its second aim was to identify obstacles to and priorities for funding these programmes sustainably. METHODS: A 4-step process, including a document analysis, was used to conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. In consultation with a purposefully selected panel of experts in the subject, a 3-round modified Delphi study was conducted to identify funding-relevant obstacles and priorities regarding SPPC. RESULTS: Current funding of hospital-based consultative specialised paediatric palliative care programmes is complex and fragmented, combining funding from public, private and charitable sources. Overall, 21 experts participated in the first round of the modified Delphi study, 19 in round two and 15 in round three. They identified 23 obstacles and 29 priorities. Consensus (>70%) was obtained for 12 obstacles and 22 priorities. The highest level of consensus (>90%) was achieved for three priorities: the development of financing solutions to ensure long-term funding of SPPC programmes; the provision of funding and support for integrated palliative care; and sufficient reimbursement of inpatient service costs in the context of high-deficit palliative care patients. CONCLUSION: Decision- and policy-makers hoping to further develop and expand SPPC in Switzerland should be aware that current funding models are highly complex and that SPPC funding is impeded by many obstacles. Considering the steadily rising prevalence of children with life-limiting conditions and the proven benefits of SPPC, improvements in funding models are urgently needed to ensure that the needs of this highly vulnerable population are adequately met.
{"title":"The funding of specialised paediatric palliative care in Switzerland: a conceptualisation and modified Delphi study on obstacles and priorities","authors":"S. Mitterer, Karin Zimmermann, Günther Fink, Michael Simon, A. Gerber, Eva Bergsträsser","doi":"10.57187/s.3498","DOIUrl":"https://doi.org/10.57187/s.3498","url":null,"abstract":"BACKGROUND: Effective funding models are key for implementing and sustaining critical care delivery programmes such as specialised paediatric palliative care (SPPC). In Switzerland, funding concerns have frequently been raised as primary barriers to providing SPPC in dedicated settings. However, systematic evidence on existing models of funding as well as primary challenges faced by stakeholders remains scarce.\u0000AIMS: The present study’s first aim was to investigate and conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. Its second aim was to identify obstacles to and priorities for funding these programmes sustainably.\u0000METHODS: A 4-step process, including a document analysis, was used to conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. In consultation with a purposefully selected panel of experts in the subject, a 3-round modified Delphi study was conducted to identify funding-relevant obstacles and priorities regarding SPPC.\u0000RESULTS: Current funding of hospital-based consultative specialised paediatric palliative care programmes is complex and fragmented, combining funding from public, private and charitable sources. Overall, 21 experts participated in the first round of the modified Delphi study, 19 in round two and 15 in round three. They identified 23 obstacles and 29 priorities. Consensus (>70%) was obtained for 12 obstacles and 22 priorities. The highest level of consensus (>90%) was achieved for three priorities: the development of financing solutions to ensure long-term funding of SPPC programmes; the provision of funding and support for integrated palliative care; and sufficient reimbursement of inpatient service costs in the context of high-deficit palliative care patients.\u0000CONCLUSION: Decision- and policy-makers hoping to further develop and expand SPPC in Switzerland should be aware that current funding models are highly complex and that SPPC funding is impeded by many obstacles. Considering the steadily rising prevalence of children with life-limiting conditions and the proven benefits of SPPC, improvements in funding models are urgently needed to ensure that the needs of this highly vulnerable population are adequately met.","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"21 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138589855","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}
L. Meuli, B. Reutersberg, P. Risteski, Omer Dzemali, A. Zimmermann
AIMS OF THE STUDY: The incidence of type A aortic dissection (TAAD) has increased in several countries in recent decades, but epidemiological data for Switzerland are lacking. Furthermore, there are conflicting data regarding a gender-disparity with higher type A aortic dissection mortality in women. This study analysed sex-specific hospital incidence and in-hospital mortality rates of TAAD in Switzerland. METHODS: This study is a secondary data analysis of case-related hospital discharge data from the Swiss Federal Statistical Office for 2009–2018. Cases that were hospitalised and surgically treated for type A aortic dissection were included in this analysis. Standardised incidence rates were calculated using the European standard population in 2013. All-cause in-hospital mortality rates were calculated as raw values and standardised for age, sex, and the van Walraven comorbidity score. RESULTS: A total of 2117 participants were included in this study, of whom 67.1% were male. The age-standardised cumulative hospital incidence for type A aortic dissection treatment was 3.5 per 100,000 (95% CI: 3.3–3.7) for men and 1.7 (1.6–1.8) per 100,000 for women (p <0.001). The incidence rates increased in both sexes during the observed decade. The adjusted mortality rates for treatment of TAAD decreased from 27.6% (26.7–28.5%) in 2009 to 18.5% (17.9–19.1%) in 2018 in women, and they decreased from 19.0% (18.4–19.6%) to 12.3% (11.9–12.7%) in the same period in men. Multivariable logistic regression analysis revealed that female sex was significantly associated with higher mortality, with an odds ratio of 1.39 (1.07–1.79) (p = 0.012). CONCLUSIONS: Hospital incidence rates for the treatment of type A aortic dissection increased in both sexes over the observed decade. The mortality rate was significantly higher in women than it was in men, but it decreased in both sexes. TAAD remains a cardiovascular emergency with a high mortality rate even after emergency surgery.
研究目的：近几十年来，A 型主动脉夹层（TAAD）的发病率在一些国家有所上升，但瑞士却缺乏流行病学数据。此外，关于女性主动脉夹层死亡率较高的性别差异数据也相互矛盾。本研究分析了瑞士TAAD的性别特异性住院发病率和院内死亡率。方法：本研究对瑞士联邦统计局2009-2018年与病例相关的出院数据进行了二次数据分析。因 A 型主动脉夹层而住院并接受手术治疗的病例被纳入本次分析。标准化发病率采用 2013 年欧洲标准人口计算。全因住院死亡率以原始值计算，并根据年龄、性别和 van Walraven 合并症评分进行标准化。治疗 A 型主动脉夹层的年龄标准化累积住院发病率为男性每 10 万人 3.5 例（95% CI：3.3-3.7），女性每 10 万人 1.7 例（1.6-1.8）（P <0.001）。在观察的十年中，男女发病率均有所上升。治疗 TAAD 调整后的死亡率，女性从 2009 年的 27.6% （26.7-28.5%）下降到 2018 年的 18.5%（17.9-19.1%），同期男性从 19.0% （18.4-19.6%）下降到 12.3%（11.9-12.7%）。多变量逻辑回归分析显示，女性性别与较高的死亡率显著相关，几率比为 1.39（1.07-1.79）（P = 0.012）.结论：在观察的十年间，治疗 A 型主动脉夹层的医院发病率在男女两性中均有所增加。女性的死亡率明显高于男性，但男性和女性的死亡率都有所下降。A型主动脉夹层仍然是一种心血管急症，即使在急诊手术后死亡率仍然很高。
{"title":"Hospital incidence, mortality, and gender disparities in patients treated for type A aortic dissections in Switzerland – a secondary data analysis of Swiss DRG statistics","authors":"L. Meuli, B. Reutersberg, P. Risteski, Omer Dzemali, A. Zimmermann","doi":"10.57187/s.3499","DOIUrl":"https://doi.org/10.57187/s.3499","url":null,"abstract":"AIMS OF THE STUDY: The incidence of type A aortic dissection (TAAD) has increased in several countries in recent decades, but epidemiological data for Switzerland are lacking. Furthermore, there are conflicting data regarding a gender-disparity with higher type A aortic dissection mortality in women. This study analysed sex-specific hospital incidence and in-hospital mortality rates of TAAD in Switzerland.\u0000METHODS: This study is a secondary data analysis of case-related hospital discharge data from the Swiss Federal Statistical Office for 2009–2018. Cases that were hospitalised and surgically treated for type A aortic dissection were included in this analysis. Standardised incidence rates were calculated using the European standard population in 2013. All-cause in-hospital mortality rates were calculated as raw values and standardised for age, sex, and the van Walraven comorbidity score.\u0000RESULTS: A total of 2117 participants were included in this study, of whom 67.1% were male. The age-standardised cumulative hospital incidence for type A aortic dissection treatment was 3.5 per 100,000 (95% CI: 3.3–3.7) for men and 1.7 (1.6–1.8) per 100,000 for women (p <0.001). The incidence rates increased in both sexes during the observed decade. The adjusted mortality rates for treatment of TAAD decreased from 27.6% (26.7–28.5%) in 2009 to 18.5% (17.9–19.1%) in 2018 in women, and they decreased from 19.0% (18.4–19.6%) to 12.3% (11.9–12.7%) in the same period in men. Multivariable logistic regression analysis revealed that female sex was significantly associated with higher mortality, with an odds ratio of 1.39 (1.07–1.79) (p = 0.012).\u0000CONCLUSIONS: Hospital incidence rates for the treatment of type A aortic dissection increased in both sexes over the observed decade. The mortality rate was significantly higher in women than it was in men, but it decreased in both sexes. TAAD remains a cardiovascular emergency with a high mortality rate even after emergency surgery.","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"59 ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139012309","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}
R. Hullin, T. Abdurashidova, Barbara Pitta-Gros, Sara Schukraft, V. Rancati, Henri Lu, Anouck Zurbuchen, Carlo Marcucci, Zaid Ltaief, Karl Lefol, Christoph Huber, Manuel Pascual, Piergiorgio Tozzi, Philippe Meyer, Matthias Kirsch
BACKGROUND: Worldwide, almost half of all heart transplantation candidates arrive today at their transplant operation with durable continuous-flow mechanical circulatory support (CF-MCS). This evolution is due to a progressive increase of waiting list time and hence an increased risk of haemodynamic worsening. Longer duration of CF-MCS is associated with a higher risk of device-related complications with potential adverse impact on post-transplant outcome as suggested by recent results from the United Network of Organ Sharing of the United States. METHODS: A 2-centre Swiss heart transplantation programme conducted a retrospective observational study of consecutive patients of theirs who underwent a transplant in the period 2008–2020. The primary aim was to determine whether post-transplant all-cause mortality is different between heart transplant recipients without or with pre-transplant CF-MCS. The secondary outcome was the acute cellular rejection score within the first year post-transplant. RESULTS: The study participants had a median age of 54 years; 38/158 (24%) were females. 53/158 study participants (34%) had pre-transplant CF-MCS with a median treatment duration of 280 days. In heart transplant recipients with pre-transplant CF-MCS, the prevalence of ischaemic cardiomyopathy was higher (51 vs 32%; p = 0.013), the left ventricular ejection fraction was lower (20 vs 25; p = 0.047) and pulmonary vascular resistance was higher (2.3 vs 2.1 Wood Units; p = 0.047). Over the study period, the proportion of heart transplant recipients with pre-transplant CF-MCS and the duration of pre-transplant CF-MCS treatment increased (2008–2014 vs 2015–2020: 22% vs 45%, p = 0.009; increase of treatment days per year: 34.4 ± 11.2 days, p = 0.003; respectively). The primary and secondary outcomes were not different between heart transplant recipients with pre-transplant CF-MCS or direct heart transplantation (log-rank p = 0.515; 0.16 vs 0.14, respectively; p = 0.81). CONCLUSION: This data indicates that the strategy of pre-transplant CF-MCS with subsequent orthotopic heart transplantation provides post-transplant outcomes not different to direct heart transplantation despite the fact that the duration of pre-transplant assist device treatment has progressively increased.
背景：如今，全球几乎有一半的心脏移植手术候选者在接受移植手术时需要接受持久的持续血流机械循环支持（CF-MCS）。这种演变是由于等待时间逐渐延长，从而增加了血液动力学恶化的风险。美国器官共享联合网络（United Network of Organ Sharing）最近的研究结果表明，CF-MCS持续时间越长，发生与设备相关并发症的风险越高，可能会对移植后的预后产生不利影响。方法：瑞士的一个两中心心脏移植项目对 2008-2020 年间接受移植手术的连续患者进行了一项回顾性观察研究。研究的主要目的是确定移植后全因死亡率在无 CF-MCS 或移植前有 CF-MCS 的心脏移植受者之间是否存在差异。次要结果是移植后第一年内的急性细胞排斥评分。结果：研究参与者的中位年龄为54岁；38/158（24%）人为女性。53/158名研究参与者（34%）在移植前患有CF-MCS，中位治疗时间为280天。在移植前患有CF-MCS的心脏移植受者中，缺血性心肌病的发病率较高（51% vs 32%；p = 0.013），左心室射血分数较低（20 vs 25；p = 0.047），肺血管阻力较高（2.3 vs 2.1 Wood Units；p = 0.047）。在研究期间，移植前患有CF-MCS的心脏移植受者比例和移植前CF-MCS治疗持续时间均有所增加（2008-2014年 vs 2015-2020年：22% vs 45%，p = 0.009；每年治疗天数增加：分别为 34.4 ± 11.2 天，p = 0.003）。移植前接受 CF-MCS 或直接接受心脏移植的心脏移植受者之间的主要和次要结果没有差异（对数秩 p = 0.515；分别为 0.16 vs 0.14；p = 0.81）。结论：该数据表明，尽管移植前辅助装置治疗的持续时间逐渐延长，但移植前CF-MCS和随后的正位心脏移植策略提供的移植后预后与直接心脏移植并无不同。
{"title":"Post-transplant survival with pre-transplant durable continuous-flow mechanical circulatory support in a Swiss cohort of heart transplant recipients","authors":"R. Hullin, T. Abdurashidova, Barbara Pitta-Gros, Sara Schukraft, V. Rancati, Henri Lu, Anouck Zurbuchen, Carlo Marcucci, Zaid Ltaief, Karl Lefol, Christoph Huber, Manuel Pascual, Piergiorgio Tozzi, Philippe Meyer, Matthias Kirsch","doi":"10.57187/s.3500","DOIUrl":"https://doi.org/10.57187/s.3500","url":null,"abstract":"BACKGROUND: Worldwide, almost half of all heart transplantation candidates arrive today at their transplant operation with durable continuous-flow mechanical circulatory support (CF-MCS). This evolution is due to a progressive increase of waiting list time and hence an increased risk of haemodynamic worsening. Longer duration of CF-MCS is associated with a higher risk of device-related complications with potential adverse impact on post-transplant outcome as suggested by recent results from the United Network of Organ Sharing of the United States. METHODS: A 2-centre Swiss heart transplantation programme conducted a retrospective observational study of consecutive patients of theirs who underwent a transplant in the period 2008–2020. The primary aim was to determine whether post-transplant all-cause mortality is different between heart transplant recipients without or with pre-transplant CF-MCS. The secondary outcome was the acute cellular rejection score within the first year post-transplant. RESULTS: The study participants had a median age of 54 years; 38/158 (24%) were females. 53/158 study participants (34%) had pre-transplant CF-MCS with a median treatment duration of 280 days. In heart transplant recipients with pre-transplant CF-MCS, the prevalence of ischaemic cardiomyopathy was higher (51 vs 32%; p = 0.013), the left ventricular ejection fraction was lower (20 vs 25; p = 0.047) and pulmonary vascular resistance was higher (2.3 vs 2.1 Wood Units; p = 0.047). Over the study period, the proportion of heart transplant recipients with pre-transplant CF-MCS and the duration of pre-transplant CF-MCS treatment increased (2008–2014 vs 2015–2020: 22% vs 45%, p = 0.009; increase of treatment days per year: 34.4 ± 11.2 days, p = 0.003; respectively). The primary and secondary outcomes were not different between heart transplant recipients with pre-transplant CF-MCS or direct heart transplantation (log-rank p = 0.515; 0.16 vs 0.14, respectively; p = 0.81). CONCLUSION: This data indicates that the strategy of pre-transplant CF-MCS with subsequent orthotopic heart transplantation provides post-transplant outcomes not different to direct heart transplantation despite the fact that the duration of pre-transplant assist device treatment has progressively increased.","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"106 4","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186848","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}
{"title":"Healthcare access and health equity: intricate challenges for rare diseases.","authors":"Susanne Wehrli, Sebastian Wäscher","doi":"10.57187/s.3644","DOIUrl":"10.57187/s.3644","url":null,"abstract":"<p><p>No abstract available.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"153 ","pages":"3644"},"PeriodicalIF":2.9,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499408","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}
Michael Sommer, Bronwyn Glaser, Emiliano Soldini, Peter Weber, Gian Paolo Ramelli
Aims: Early diagnosis of autism spectrum disorders (ASD) offers the possibility of early intervention and, in turn, gains in adaptive behaviour, language and cognition. The aim of the present study was to analyse whether age at diagnosis of autism spectrum disorders decreased in two regions of Switzerland from 2006 to 2016 following the implementation of different screening and referral techniques. In southern Switzerland, systematic paediatric screening using the Modified Checklist for Autism (M-CHAT) in toddlers was implemented in 2013, whereas in northwestern Switzerland, periodic trainings were used to increase paediatrician awareness of ASD. We investigated which method was associated with a younger average age at diagnosis.
Methods: We conducted a retrospective, two-centre study searching clinical records of children and adolescents (aged 0-16 years) diagnosed with ASD in two neuropaediatric departments at Swiss hospitals between January 2006 and December 2016. All patients were diagnosed via a standardised evaluation based on two approved diagnostic tests: the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R).
Results: In southern Switzerland, training and subsequent widespread use of the M-CHAT among paediatricians appeared to contribute to a significantly younger age at diagnosis. Age at diagnosis did not significantly decrease during the same period in northwestern Switzerland.
Conclusion: Our results point to the possibility of successfully reducing age at diagnosis in specific geographic areas through the implementation of screening questionnaires, such as the M-CHAT, at year 2 well-baby visits.
{"title":"Age at initial diagnosis of autism spectrum disorders: a retrospective comparison of screening techniques between the southern and northwestern regions of Switzerland.","authors":"Michael Sommer, Bronwyn Glaser, Emiliano Soldini, Peter Weber, Gian Paolo Ramelli","doi":"10.57187/smw.2023.40131","DOIUrl":"10.57187/smw.2023.40131","url":null,"abstract":"<p><strong>Aims: </strong>Early diagnosis of autism spectrum disorders (ASD) offers the possibility of early intervention and, in turn, gains in adaptive behaviour, language and cognition. The aim of the present study was to analyse whether age at diagnosis of autism spectrum disorders decreased in two regions of Switzerland from 2006 to 2016 following the implementation of different screening and referral techniques. In southern Switzerland, systematic paediatric screening using the Modified Checklist for Autism (M-CHAT) in toddlers was implemented in 2013, whereas in northwestern Switzerland, periodic trainings were used to increase paediatrician awareness of ASD. We investigated which method was associated with a younger average age at diagnosis.</p><p><strong>Methods: </strong>We conducted a retrospective, two-centre study searching clinical records of children and adolescents (aged 0-16 years) diagnosed with ASD in two neuropaediatric departments at Swiss hospitals between January 2006 and December 2016. All patients were diagnosed via a standardised evaluation based on two approved diagnostic tests: the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R).</p><p><strong>Results: </strong>In southern Switzerland, training and subsequent widespread use of the M-CHAT among paediatricians appeared to contribute to a significantly younger age at diagnosis. Age at diagnosis did not significantly decrease during the same period in northwestern Switzerland.</p><p><strong>Conclusion: </strong>Our results point to the possibility of successfully reducing age at diagnosis in specific geographic areas through the implementation of screening questionnaires, such as the M-CHAT, at year 2 well-baby visits.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"153 ","pages":"40131"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462763","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号