Swiss medical weekly最新文献

{"title":"Clinical outcomes and severe complications of hospitalised children and adolescents with varicella in central Switzerland: a retrospective observational study.","authors":"Jan Schwidetzky, Ulrich Heininger, Medea Salzmann, Thomas J Neuhaus, Michael Buettcher","doi":"10.57187/s.3962","DOIUrl":"https://doi.org/10.57187/s.3962","url":null,"abstract":"<p><strong>Aim: </strong>Recent data on clinical complications and mortality among hospitalised children and adolescents due to varicella are unavailable in Switzerland. The aim of the study was to explore data on severe varicella complications in hospitalised children before the introduction of a universal varicella vaccination recommendation, which the Swiss Federal Office of Public Health implemented in January 2023.</p><p><strong>Methods: </strong>This was a retrospective observational study of children hospitalised with varicella between 01.01.2010 and 31.03.2020 at a tertiary children's hospital in central Switzerland serving approximately 10% of the Swiss population. The inclusion criteria were acute varicella and/or related complications.</p><p><strong>Results: </strong>A total of 95 patients were identified. The median age at onset was 4 years (range: 2 months to 13 years) and the peak age of patients was between 1 and 4 years. 53 had mild and 42 patients had severe varicella-associated complications (8 had >1 severe complication). The most common severe complications were bacterial skin and soft tissue infections (n = 28), invasive secondary bacterial infections (n = 18), and central nervous system-related complications (n = 12). Admission to the paediatric intensive care unit and surgical intervention were required in 11 (12%) and 16 (17%) patients, respectively. Two previously healthy school-age children died because of secondary bacterial infections.</p><p><strong>Conclusion: </strong>Our results demonstrate that varicella can cause severe and even fatal complications in children living in a highly developed country. This study provides valuable clinical data on severe varicella complications in hospitalised children from a large catchment area of Switzerland, facilitating future data comparison of the disease burden before and after the introduction of universal varicella vaccination in Switzerland.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3962"},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410650","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":"When and what patients need to know about AI in clinical care.","authors":"David Shaw, Giorgia Lorenzini, Laura Arbelaez Ossa, Jens Eckstein, Luzius Steiner, Bernice S Elger","doi":"10.57187/s.4013","DOIUrl":"https://doi.org/10.57187/s.4013","url":null,"abstract":"<p><p>In this article, we describe and analyse when and what patients need to be told about the use of artificial intelligence in clinical care. In many circumstances, patients do not need to be told about the use of AI, but in cases in which AI is making decisions rather than supporting them or patient data are being transferred to a third party, specific consent must be sought from patients. Ultimately, AI will become a routine part of clinical care, but until then, clinicians must take great care to seek consent where necessary.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4013"},"PeriodicalIF":2.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415365","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":"Reimbursement policies of Swiss health insurances for the surgical treatment of symptomatic breast hypertrophy: a retrospective cohort study.","authors":"Astrid Navarra, Daniel Schmauss, Reto Wettstein, Yves Harder","doi":"10.57187/s.3923","DOIUrl":"https://doi.org/10.57187/s.3923","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients with symptomatic breast hypertrophy typically suffer from chronic back pain, recurrent skin irritation at the inframammary fold and/or low self-esteem resulting in impaired quality of life. Reduction mammaplasty has been shown to effectively treat symptomatic breast hypertrophy with high patient satisfaction. Despite the obvious benefits, reimbursement requests for reduction mammaplasty are initially often refused by the patient's health insurance company, thereby frequently resulting in additional examinations and eventually extra expenses. The study aim was to evaluate the reimbursement policy by health insurance companies for treatment costs of reduction mammaplasty in a patient cohort, to quantify the generation of additional costs due to initial refusal of reimbursement, as well as to assess back pain after surgical treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort study was conducted in two Swiss centres. Inclusion criteria were a diagnosis of symptomatic breast hypertrophy, cost approval for reduction mammaplasty by the health insurance between October 2014 and March 2021 and informed consent for the study. The exclusion criteria were private payers for reduction mammaplasty and patients aged below 18. Primary outcome measures included median duration between the first request for reimbursement sent to the health insurance and the receipt of its approval, the number of requests needed per patient, as well as the number and type of additional outpatient visits conducted by specialists other than plastic surgeons, including the need for further diagnostic investigations and therapeutic measures. Secondary outcome measures included the additional costs generated in patients with more than one request. Finally, back pain after surgical treatment was assessed using a visual analogue scale (VAS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt; A total of 46 patients with symptomatic breast hypertrophy and approval for reimbursement were included in the study. The median duration to obtain cost approval for reduction mammaplasty was 9.4 weeks (ranging from 1 to 154 weeks). Reimbursement was approved after 1, 2, 3 or 4 requests in 26, 6, 11 and 3 patients, respectively. If the first request was refused, further clinical evaluation by specialists, additional imaging of the cervical spine and physiotherapy was necessary in 70%, 35% and 80% of the patients, respectively. A patient requiring more than one request to obtain cost approval for reduction mammaplasty generated additional mean costs of approximately 2400 CHF, i.e. 2181 CHF, 164 CHF and 46 CHF for ongoing physiotherapy, additional outpatient visit by a specialist doctor and complementary imaging compared to patients needing only one request for cost approval. The level of back pain could be reduced from 7.0 before surgery to 1.6 after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt; Patients with symptomatic breast hypertrophy who needed more than one re","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3923"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060240","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":"Blastic plasmacytoid dendritic cell neoplasm: a Swiss case series of a very rare disease and a structured review of the literature.","authors":"Ramona Meier-Lienhard, Cosima Suter, Thomas Pabst, Felicitas Hitz, Jakob R Passweg, Olivier Spertini, Nathan Cantoni, Daniel Betticher, Lucas Simeon, Michael Medinger, Stefanie Hayoz, Adrian Schmidt","doi":"10.57187/s.3885","DOIUrl":"https://doi.org/10.57187/s.3885","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a very rare disease, with unique diagnostic challenges and often dismal outcome. There are no widely accepted treatment guidelines available. Lymphoma-like regimens with or without autologous or allogenic transplantation were the cornerstone of most therapeutic concepts. A few years ago, the CD123-directed immunoconjugate tagraxofusp emerged as a new valuable treatment option. The goal of our research was to collect available data on BPDCN-patients treated at large centres in Switzerland and worldwide and to draw conclusions regarding the incidence, clinical presentation, prognostic factors and therapeutic strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We collected data from BPDCN patients from leading Swiss haemato-oncology centres from 2005 to 2022. Furthermore, we reviewed and analysed the published literature (cohorts and case reports in peer-reviewed journals) from 1997 to 2020 (structured review of the literature).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 115 international publications including 600 patients from all over the world. Most of them had very small sample sizes (only ten papers with more than ten patients) and all but one were retrospective or observational respectively. Most included patients were Europeans (n = 385, 64%) and Asians (n = 120, 20%), followed by Americans (n = 90, 15%) and patients from Australia/New Zealand (n = 3) and Africa (n = 2). BPDCN was more common in men with a predominance of 3:1. The median age (n = 414) at diagnosis was 66.5 years ranging from one month to 103 years. Newly diagnosed women were significantly younger than men (median: 62 vs 67 years, mean: 53.4 vs 59.3 years, p = 0.027) and less often had bone marrow infiltration and affected lymph nodes. Upfront allogenic transplantation as well as ALL regimens performed best, with response to first-line therapy clearly associated with better overall survival. The Swiss cohort contained 26 patients (23 males and 3 females) over 18 years (2005-2022). The median age at diagnosis was 68.5 years (range: 20-83). Ten patients underwent upfront stem cell transplantation (seven allogenic and three autologous), at least trending towards a better overall survival than other therapies. With a follow-up of 8 years, the median overall survival was 1.2 years. Eight patients in this cohort were treated with tagraxofusp, which became available in 2020 and was approved by Swissmedic in 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our study confirms that BPDCN is a very rare and difficult-to-treat disease. Underdiagnosis and underreporting in the literature pose further challenges. Symptoms at presentation seem to differ slightly between sexes and reaching a complete remission after first-line treatment remains crucial for a prolonged overall survival. Effective treatment protocols in first line include transplantation regimens (mainly allogenic, potentially also autologous) as wel","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3885"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059684","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":"Diagnostics and treatment of acute non-specific low back pain: do physicians follow the guidelines?","authors":"Maria Trachsel, Maurizio A Trippolini, Ilaria Jermini-Gianinazzi, Nicole Tochtermann, Caroline Rimensberger, Valentin N Hubacher, Manuel R Blum, Maria M Wertli","doi":"10.57187/s.3697","DOIUrl":"https://doi.org/10.57187/s.3697","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines for acute non-specific low back pain recommend avoiding imaging studies, refraining from strong opioids and invasive treatments, and providing information to patients to stay active. Despite these recommendations, many patients undergo diagnostic and therapeutic assessments that are not in line with the current evidence.</p><p><strong>Aim: </strong>To assess the management of acute non-specific low back pain by Swiss general practitioners (GPs) and their adherence to guideline recommendations.</p><p><strong>Methods: </strong>We performed a survey using two clinical case vignettes of patients with acute non-specific low back pain without red flags or neurological deficits. The main differences between the vignettes were sex, age, profession, pain duration and medical history. GPs were asked about their management of those patients.</p><p><strong>Results: </strong>Of 1253 GPs, 61% reported knowing current clinical guidelines and 76% being aware of \"Choosing Wisely\" recommendations. Diagnostic evaluations included X-ray (18% for vignette 1, 32% for vignette 2) and magnetic resonance imaging (MRI) (31% and 62%). For pain management, GPs recommended mostly non-steroidal anti-inflammatory drugs, paracetamol and metamizole. Treatments with potential harm included muscle relaxants (78% and 77%), oral steroids (26% and 33%), long-acting opioids (8% and 11%) and spinal injections (28% and 42%). A very high proportion recommended activity restrictions (82% and 71%) and some recommended bed rest (3% and 2%).</p><p><strong>Conclusion: </strong>Although GPs reported being aware of current guideline recommendations, management of acute non-specific low back pain was not in line with these recommendations. A substantial proportion of GPs considered imaging, treatments (e.g. muscle relaxants, long-acting strong opioids), and activity and work restrictions with potentially harmful consequences.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3697"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417153","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":"Prevalence and incidence of sarcopenia in Swiss postmenopausal women: findings from the OsteoLaus Cohort.","authors":"Colin Vendrami, Elena Gonzalez Rodriguez, Guillaume Gatineau, Peter Vollenweider, Pedro Marques-Vidal, Olivier Lamy, Didier Hans, Enisa Shevroja","doi":"10.57187/s.4034","DOIUrl":"https://doi.org/10.57187/s.4034","url":null,"abstract":"<p><strong>Study aims: </strong>Sarcopenia is a progressive, age-related loss of muscle mass, strength and function. Given the ageing population and the adverse outcomes associated with sarcopenia, monitoring its epidemiology is particularly important. This study aimed to describe sarcopenia prevalence, 5-year incidence and agreement between definitions using the latest operational criteria in Swiss postmenopausal women.</p><p><strong>Methods: </strong>Postmenopausal women from the last 5 years of the CoLaus/OsteoLaus prospective population-based cohort were included based on complete case analysis (April 2015 to October 2022; Lausanne, Switzerland). We assessed appendicular lean mass via Dual X-ray Absorptiometry (GE Lunar iDXA), handgrip strength using a Jamar Dynamometer and 6-metre gait speed at multiple visits. Sarcopenia was defined based on handgrip strength and/or appendicular lean mass and/or gait speed using 11 definitions, including that from the European Working Group on Sarcopenia in Older People (EWGSOPII, 2019). Prevalence was measured as the number and rate of sarcopenic cases at the last visit, while incidence was measured as the number and rate of new sarcopenic cases over 2.5 or 5 years.</p><p><strong>Results: </strong>A total of 930 women were included, with a mean (standard deviation) age of 72.9 (6.9) years, BMI of 25.7 (4.8) kg/m2, appendicular lean mass 16.8 (2.5) kg, handgrip strength 21.2 (5.5) kg, gait speed 1.1 (0.2) m/s. Sarcopenia prevalence based on EWGSOPII definitions ranged from 2.2% to 5.7%, while other definitions varied from 0.5% to 13.4%. The 5-year incidence rates based on EWGSOPII were 1.9% to 4.7%. Prevalence and incidence increased significantly between the lowest and highest age tertiles (Fisher's exact test, p <0.05) for most definitions. Agreement between definitions was predominantly \"none\" or \"minimal\" according to the Cohen Kappa score.</p><p><strong>Conclusion: </strong>This population-based cohort of postmenopausal women highlights an increase in sarcopenia prevalence and incidence beginning in the seventh decade of life, underscoring the accelerated decline in muscle health with age. The minimal agreement between the definitions highlights the need for a consensus, which would improve future research and clinical implementations.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4034"},"PeriodicalIF":2.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469135","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":"Evaluation and testing of the proportional hazards assumption in analysis of time-to-event data in subgroup analysis of randomised controlled trials: a meta-epidemiological study.","authors":"Dominique Lisa Birrer, Lukas Werner Widmer, Lulu Tanno, Romano Schneider, Amanda Dirnberger, Alexander Wilhelm, Urs Zingg, Beat Müller, Lorenz Meuli, Christoph Kuemmerli","doi":"10.57187/s.4022","DOIUrl":"https://doi.org/10.57187/s.4022","url":null,"abstract":"<p><strong>Background: </strong>When Cox regression models are used to analyse time-to-event data, the proportional hazard assumption (PHA) must be reassured to obtain valid results. Transparent reporting of the statistics used is therefore essential to interpret research. This study aimed to assess the quality of statistical reporting and testing of the PHA in subgroup analysis of surgical randomised controlled trials (RCTs).</p><p><strong>Methods: </strong>All published articles (see appendix 1) in the top quartile (25%) of surgical journals from 2019 to 2021 were screened in a literature review according to the ClarivateTM journal citation report impact factor. Subgroup analyses of surgical RCT data that used Cox models were identified. Statistical reporting was rated using a previously established 12-item PHA Reporting Score as our primary endpoint. For original surgical publications, the PHA was formally tested on reconstructed time-to-event data from Kaplan-Meier estimators. Methodological reporting quality was rated according to the CONSORT statement. Digitalisation was only possible in studies where a Kaplan-Meier estimator including numbers at risk per time interval was published. All results from the subgroup analyses were compared to primary surgical RCT reports and benchmark RCTs using Cox models published in the New England Journal of Medicine and The Lancet.</p><p><strong>Results: </strong>Thirty-two studies reporting secondary subgroup analyses on surgical RCT data using Cox models were identified. Statistical reporting of surgical subgroup publications was significantly inferior compared to original benchmark publications: median PHA Reporting Score 50% (interquartile range [IQR]: 39 to 58) vs 58% (IQR: 42 to 67), p <0.001. The subgroups did not differ in comparison to primary surgical RCTs: median PHA Reporting Score 50% (IQR: 39 to 58) vs 42% (IQR: 33 to 58), p = 0.286. Adherence to the CONSORT reporting standards did significantly differ between subgroup studies and benchmark publications (p <0.001) as well as between subgroup studies and primary surgical RCT reports: 13 (12.5 to 14) vs 13 (IQR: 11 to 13), p = 0.042.</p><p><strong>Conclusion: </strong>Statistical methodological reporting of secondary subgroup analyses from surgical RCTs was inferior to benchmark publications but not worse than primary surgical RCT reports. A comprehensive statistical review process and statistical reporting guidelines might help improve the reporting quality.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4022"},"PeriodicalIF":2.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416736","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":"Enhancing interprofessional ward rounds by identifying factors associated with low satisfaction and efficiency: a quantitative and qualitative national survey of Swiss healthcare professionals.","authors":"Armon Arpagaus, Aron Strub, Rahel Kuster, Christoph Becker, Sebastian Gross, Flavio Gössi, Eliska Potlukova, Stefano Bassetti, Drahomir Aujesky, Philipp Schuetz, Sabina Hunziker","doi":"10.57187/s.4006","DOIUrl":"https://doi.org/10.57187/s.4006","url":null,"abstract":"<p><strong>Aims of the study: </strong>Interprofessional ward rounds are a cornerstone of patient-centred care for medical inpatients and offer opportunities to discuss and coordinate patient treatment and further management. We aimed to identify factors associated with lower satisfaction and efficiency of interprofessional ward rounds, as reported by physicians and nurses.</p><p><strong>Methods: </strong>An anonymous Swiss nationwide online survey of physicians and nurses was conducted in 28 Swiss internal medicine inpatient departments between 9 August and 19 October 2023. Analyses were conducted from November to December 2023. The primary outcome was physicians' and nurses' perceived lower satisfaction with ward rounds, which was assessed using visual analogue scales ranging from 0 to 10, with lower satisfaction defined as scores below the median. The main secondary outcome was perceived lower efficiency using a similar definition. Qualitative analysis was performed through inductive thematic analysis.</p><p><strong>Results: </strong>The survey had a response rate of 21.6% (547/2530). Of the 547 physicians and nurses included in the final analysis, the median satisfaction was 7 points (interquartile range [IQR] 6-8). A total of 61% of physicians (156/254) and 76% of nurses (224/293) reported lower satisfaction. Lower satisfaction was reported significantly more frequently by nurses (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.58-3.43; p ≤0.001) and female team members (adjusted OR 1.95, 95% CI 1.32-2.9; p <0.01). The median perceived efficiency of ward rounds was 7 points (IQR 5-8), and the nursing profession was associated with lower perceived efficiency (adjusted OR 1.95, 95% CI 1.3-2.93; p <0.01). Adherence to in-house guidelines for ward rounds was associated with satisfaction (adjusted OR for lower satisfaction 0.25, 95% CI 0.16-0.39; p <0.001) and perceived efficiency (adjusted OR for lower efficiency 0.27, 95% CI 0.17-0.43; p <0.001). Both physicians and nurses preferred to perform ward rounds as part of an interprofessional team. The qualitative analysis of the data revealed a preference for structured interprofessional ward rounds and the active involvement of nurses.</p><p><strong>Conclusions: </strong>This survey revealed an overall high preference for interprofessional ward rounds. In addition, we identified several factors that were associated with lower satisfaction and efficiency. Structured in-house protocols for ward rounds may increase the satisfaction and efficiency of interprofessional collaboration during ward rounds.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4006"},"PeriodicalIF":2.1,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011862","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":"Implementation of evidence-based clinical nutrition: Usability of the new digital platform clinicalnutrition.science.","authors":"Valentina Viola Huwiler, Pascal Tribolet, Caroline Rimensberger, Christine Roten, Katja A Schönenberger, Stefan Mühlebach, Philipp Schuetz, Zeno Stanga","doi":"10.57187/s.3764","DOIUrl":"https://doi.org/10.57187/s.3764","url":null,"abstract":"<p><strong>Aim of the study: </strong>Malnutrition is a common and complex challenge in inpatient and outpatient settings, associated with increased risk of morbidity and mortality. Its management is often neglected, despite strong evidence of the benefits of adequate nutritional therapy. We introduced clinicalnutrition.science (https://clinicalnutrition.science/en/), a digital platform that provides healthcare professionals with easy online access to evidence and streamlines the nutritional care process. The aim of this study was to assess the usability and to validate improvements in nutritional management when the digital platform is used by healthcare professionals.</p><p><strong>Methods: </strong>The usability study, conducted from 28 September to 16 November 2023, involved 56 healthcare professionals from the University Hospital of Bern and the Cantonal Hospital of Aarau. In an adapted cross-over study design, participants completed key steps of nutritional management for a simulated hepatology and oncology case both with and without the clinicalnutrition.science platform. Usability was assessed using the validated Healthcare Systems Usability Scale questionnaire, supplemented by collection of demographic data. Subgroup analysis was performed for recommended protein and energy intakes by different professional representatives.</p><p><strong>Results: </strong>Clinicalnutrition.science achieved a good overall usability score of 71.8%. Use of the platform significantly improved the protein intake recommendation (p = 0.03; median 96.5 and 80.0 g/d) and the basal metabolic rate estimate (p <0.01; median 1420.8 and 1755.5 kcal/d) of the simulated oncology case. The variance in protein and energy intake recommendations, basal metabolic rate estimation and energy deficit estimation was reduced by using the digital platform. These improvements were achieved without increasing the time required to complete key steps in nutritional management for the two patient cases (median between 10.5 and 15.0 minutes; p = 0.09 and p = 0.67) and without prior training on the platform. There was no effect on the malnutrition detection rate, the selection of an appropriate nutritional product or the identification of the most appropriate guideline.</p><p><strong>Conclusions: </strong>The use of clinicalnutrition.science improved evidence-based clinical practice in prescribing personalised nutritional therapy and increased the accuracy of both protein and energy intake recommendations, without increasing the time taken to complete key steps in the nutritional management process.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3764"},"PeriodicalIF":2.1,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804037","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":"A cost-effectiveness analysis of sotorasib as second-line treatment for patients with KRAS-G12C-mutated metastatic non-small cell lung cancer (mNSCLC) in Switzerland.","authors":"Tämer El Saadany, Judith Lupatsch, Michael Mark, Michaela Barbier, Tarun Mehra, Matthias Schwenkglenks, Roger Von Moos","doi":"10.57187/s.3777","DOIUrl":"https://doi.org/10.57187/s.3777","url":null,"abstract":"<p><strong>Background and objective: </strong>Because of the lack of effective targeted treatment options, docetaxel has long been the standard second-line therapy for patients with advanced non-small cell lung cancer, including the Kirsten rat sarcoma virus (KRAS) G12C mutation. The CodeBreak 200 trial demonstrated that sotorasib, a new drug targeting the G12C-mutated KRAS protein, modestly improved progression-free survival compared with docetaxel in patients whose cancer had progressed after receiving platinum chemotherapy and programmed cell death protein 1 (PD-1) / programmed death ligand 1 (PD-L1) inhibitors as first-line treatment. Consequently, sotorasib received temporary approval in Switzerland. Our analysis assessed the cost-effectiveness of sotorasib as a second-line treatment in Swiss patients with non-small cell lung cancer from the perspective of the Swiss statutory health insurance system.</p><p><strong>Methods: </strong>A partitioned survival model based on the CodeBreak 200 trial was constructed with a time horizon of 10 years and a discount rate of 3% for costs and quality-adjusted life years (QALYs). Parametric survival curves were fitted to the published Kaplan-Meier data, and survival was extrapolated. QALYs were obtained from the CodeBreak 100 trial and the literature. The costs of drugs, drug administration, diagnostics, disease management, and adverse events were considered. Because the price of sotorasib has not been established in Switzerland, two scenarios were analysed: the first used the published expected monthly United Kingdom (UK) price in Swiss francs (CHF 7870); the second used one-quarter of that price (CHF 1968), according to the lower dose used in the most recent trial, under the condition that one-quarter of the original sotorasib dose is equally effective. Treatment costs of adverse events were included.</p><p><strong>Results: </strong>Log-normal functions best fitted the survival curves from CodeBreak 200. For sotorasib versus docetaxel, our estimation showed no difference in QALYs (1.28 QALYs for both treatments), as the reduced adverse events reported in CodeBreak 200 for sotorasib had a minimal impact on the QALYs in our calculation. This made an incremental cost-effectiveness ratio (ICER) calculation irrelevant. Total per-patient costs were CHF 138,894 for the full sotorasib dose, CHF 82,741 for the one-quarter dose, and CHF 80,383 for docetaxel. These results were robust in 99% of probabilistic simulations.</p><p><strong>Conclusion: </strong>Sotorasib did not demonstrate cost-effectiveness at the full dosage nor when reduced to a quarter of the dose. The primary factors motivating clinicians to prescribe sotorasib are its superior overall response rate compared with docetaxel and the reported improvement in patients' quality of life. These factors suggest that it would be reasonable to price it at approximately one-quarter of the assumed cost in the UK.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3777"},"PeriodicalIF":2.1,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059683","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}