Swiss medical weekly最新文献

{"title":"Barriers and enablers to point-of-care ultrasound use in emergency departments: a multicentre survey of practicing residents in Switzerland.","authors":"Emilie Ulrich, Youcef Guechi, Ludovic Galofaro, Raphaël Bonvin, Flora Gobet, Vincent Ribordy","doi":"10.57187/4848","DOIUrl":"10.57187/4848","url":null,"abstract":"<p><strong>Study aims: </strong>Point-of-care ultrasound (POCUS) has become a key diagnostic modality in emergency departments, facilitating rapid clinical decision-making and improving patient care. Despite its benefits, POCUS adoption remains heterogeneous. Barriers reported in the literature include the absence of standardised certification pathways, limited access to training and insufficient equipment availability. This study aimed to explore barriers and enablers of successful implementation of POCUS in Swiss emergency departments.</p><p><strong>Methods: </strong>We conducted a national, cross-sectional multicentre survey targeting medical residents from 15 category 1 emergency training centres in Switzerland. The survey included questions on POCUS usage, training, perceived barriers and facilitators. Data were analysed using descriptive statistical methods. The data collection period spanned from October 2023 to April 2024.</p><p><strong>Results: </strong>A total of 165 residents participated in the survey (35.6% response rate). Of these, one-third (32%) had attended accredited POCUS training, while only 6% reported no prior ultrasound experience. Residents exhibited a positive attitude towards POCUS, with the majority recognising it as a valuable diagnostic tool and a core skill for trained emergency physicians. Key barriers to POCUS implementation in Swiss emergency departments included limited access to training, difficulties completing certification requirements and challenges in skill maintenance after initial training. Specific obstacles were unavailable courses, lack of supervision and time-consuming logbook completion. Unlike prior literature, this study did not identify doubtful attitudes towards POCUS utility, lack of a standardised national curriculum or resistance from other specialties as barriers.</p><p><strong>Conclusions: </strong>Swiss emergency medicine residents strongly support POCUS and are motivated to pursue certification. A nationally standardised training curriculum may help address some of the barriers commonly described in the literature by providing a structural advantage. However, inconsistent local implementation, limited mentorship and restricted training access hinder full integration into practice. Bridging this gap requires stronger institutional support, better awareness of certification pathways and more hands-on opportunities to ensure residents can achieve and maintain POCUS competency, ultimately advancing the quality and efficiency of emergency care in Switzerland.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4848"},"PeriodicalIF":1.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040555","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":"Sociodemographic and profession-related attrition factors that lead residents to consider leaving medicine: a cross-sectional study.","authors":"Valeria Scheiwiller, Joy Backhaus, Monika Maria Brodmann Maeder, Eva K Hennel","doi":"10.57187/4549","DOIUrl":"https://doi.org/10.57187/4549","url":null,"abstract":"<p><strong>Study aims: </strong>Switzerland will face a critical shortage of physicians in the coming years. In this study, we investigated the percentage of residents with an intention to leave the job and profession. Furthermore, we investigated the association between sociodemographic and profession-related factors and the intention to leave.</p><p><strong>Methods: </strong>We conducted a cross-sectional study among residents in Switzerland in November 2024. We contacted all residents who use the Swiss Institute of Medical Education (SIWF) e-Logbook via an e-mail containing a link to an online survey about sociodemographic factors and their intention to leave the job and profession. The survey included questions related to professional factors such as workload, satisfaction with the job, decision on specialisation and the importance attached to teaching during working hours. Inferential statistics included odds ratio calculations.</p><p><strong>Results: </strong>Of 14,616 residents contacted, 5080 (34.8%) participated. Of these 5080 respondents, 2358 (45.6%) reported considering leaving their job and 2800 (55.1%) leaving the profession. Participants could tick both options separately. One attrition factor identified for the job is longer time spent in residency. Attrition factors identified for both job and profession are: a high difference between contractual and effective weekly working hours, high weekly working hours, dissatisfaction with the job and the impression of not enough importance given to teaching during working hours. Attrition factors identified for the profession are: completion of medical studies in Switzerland, working in the German-language region, unemployment and being undecided on specialisation. A retention factor for the profession is having at least one parent who is a physician.</p><p><strong>Conclusions: </strong>The intention to leave the job and profession among residents working in Switzerland is alarmingly high. Retention requires strict adherence to contractual working hours - and, where possible, their reduction - as well as improvements in job satisfaction and the quality of teaching during working hours. Policymakers, institutions and teaching sites are called upon to enforce working hours regulations, protect structured teaching time and strengthen residency as postgraduate medical education aimed at building competence and specialisation. Without such measures, there is a risk that attrition among residents could increase, potentially contributing to the projected physician shortage in Switzerland.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4549"},"PeriodicalIF":1.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866786","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":"The Diamond road to Open Science.","authors":"Patrick Furrer, Carlos Quinto","doi":"10.57187/5646","DOIUrl":"https://doi.org/10.57187/5646","url":null,"abstract":"<p><p>Diamond Open Access is the fairest and most sustainable model for scientific communication. The Diamond model promotes editorial independence, supports researchers by waiving article processing charges, and serves as an indispensable public research infrastructure. \"Read & Publish\" agreements increase dependence on large commercial publishers, and some of the funds currently spent on such agreements could instead be used to provide long-term support for Diamond journals. Promising models for sustainable funding and collaboration are emerging through national and international initiatives. However, Switzerland is already providing concrete evidence that institutions do not have to wait until national mechanisms are fully developed. In 2025, the University of Lausanne launched the \"Diamond Open Access Fund\", a pioneering initiative of its kind in Switzerland. The future development of Diamond Open Access should focus not only on sustainable funding but also on enhancing the quality, transparency, and culture of scholarly publishing. As Switzerland's only fully peer-reviewed English-language Diamond medical journal, the Swiss Medical Weekly (SMW) provides an essential platform for clinically relevant Swiss research, offering international visibility and immediate open access without author fees or embargoes. SMW will continue to work towards modernising its quality assurance processes and contributing to international developments in the field of Open Science, with a view to strengthening transparency, reproducibility, and relevance in medical research.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5646"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649181","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":"Nocardia farcinica septic bursitis - a case report and scoping literature review.","authors":"Nader Maai, Justus Baarts, Peter M Keller, Claudia Lang, Daniel Baumhoer, Florian A Frank, Mario Morgenstern, Martin Clauss, Richard Kuehl","doi":"10.57187/5110","DOIUrl":"10.57187/5110","url":null,"abstract":"<p><strong>Background: </strong>Septic bursitis is mainly caused by Staphylococcus aureus and Streptococcus spp. However, patients with immunosuppression may develop infections caused by rare pathogens. Here, we describe a case of septic olecranon bursitis caused by Nocardia farcinica and provide a literature review of musculoskeletal infections caused by this pathogen.</p><p><strong>Case presentation: </strong> A male patient in his mid-70s with seronegative rheumatoid arthritis who was receiving methotrexate, low-dose prednisone, and golimumab experienced trauma to the elbow, followed by progressive painful swelling, slight erythema, and the formation of a fistula draining cloudy fluid over the subsequent two weeks. Culture of the aspirated bursal fluid yielded slow-growing yellow-pigmented colonies identified as Nocardia farcinica. Whole-genome sequencing confirmed the species without detecting any known virulence genes or resistance mutations. Clinical and radiological evaluation showed no signs of systemic dissemination. The patient underwent surgical bursectomy and received targeted antimicrobial therapy with oral trimethoprim/sulfamethoxazole. After 3 weeks, the patient developed a systemic allergic reaction, necessitating a switch to susceptibility-guided amoxicillin/clavulanate. Treatment was continued for 3 months, ultimately resulting in the complete and successful resolution of the bursitis.</p><p><strong>Conclusion: </strong>This report highlights that it is important for clinicians to consider rare pathogens in immunosuppressed patients with bursitis, especially in those presenting with atypical courses. Localised musculoskeletal infections caused by Nocardia are mostly treated with a combined surgical and antibiotic approach. Antibiotics are typically administered for one to six months. In cases of surgical removal, a shorter antibiotic treatment duration seems sufficient. A multidisciplinary approach involving infectious diseases specialists, microbiologists, and surgeons is critical for achieving favourable outcomes.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5110"},"PeriodicalIF":1.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649144","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":"Incidence of long COVID-related consultations in family medicine in Switzerland: a cross-sectional study within the Sentinella network.","authors":"Pawan Prasad, Mohamed Amir Moussa, Yolanda Mueller, Laure Ziegler, Andreas Zeller, Dagmar M Haller","doi":"10.57187/4300","DOIUrl":"https://doi.org/10.57187/4300","url":null,"abstract":"<p><strong>Study aims: </strong>The initial prevalence estimates of long COVID exhibited significant heterogeneity. In Switzerland, early findings estimated a 39-53% prevalence of long COVID symptoms among adult patients who tested positive for SARS-CoV-2. However, studies conducted in a primary care setting suggested a significantly lower burden of care, with long COVID accounting for less than 1% of family medicine consultations. The objective of this study was to estimate the incidence of long COVID-related consultations in Swiss family medicine practices, in order to guide health services planning.</p><p><strong>Methods: </strong>This repeat cross-sectional study was conducted using the data collected by family physicians (general internists and paediatricians) within the Swiss Sentinella network, part of the epidemiological surveillance system managed by the Federal Office of Public Health. Data was collected between August 2021 and April 2023 via monthly reports of doctors' activity over the past four weeks. Long COVID-related consultations were defined as visits where physicians recorded symptoms or conditions linked to post-acute SARS-CoV-2 effects, based on clinical definitions at the time. Doctor characteristics were measured and analysed for associations with monthly median incidence rates of long COVID-related consultations.</p><p><strong>Results: </strong>181 family practices provided data for at least one month during the study (154 general internists and 27 paediatricians): 85% of doctors were general internists, 32% were women and 74% worked in an urban area. The median incidence of monthly long COVID-related consultations was 3/1000 consultations for general internists and 0/1000 consultations for paediatricians. Multivariable ordinal logistic regression showed that internists were significantly more likely to report long COVID-related consultations compared to paediatricians. Also, physicians in central Switzerland were more likely to have a higher median incidence of long COVID-related consultations in comparison to those in other regions.</p><p><strong>Conclusions: </strong>Our study shows that the incidence of long COVID-related consultations in Swiss family medicine is markedly lower than expected, considering the estimated prevalence of long COVID post-SARS-CoV-2 infection. This discrepancy may result from potential biases in earlier studies, epidemiological variations and diagnostic challenges. These findings underscore the need for improved diagnostic criteria and enhanced support for primary care providers in recognising long COVID and facilitating referrals for more severely affected patients.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4300"},"PeriodicalIF":1.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649146","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":"Cost-effectiveness of home treatment compared to inpatient care in child and adolescent psychiatry: evidence from a pilot trial.","authors":"Daniel Graf, Silvano Sele, Corinna Reichl, Sarah Oberli, Katharina Blankart, Daniel Ammann, Michael Kaess","doi":"10.57187/4899","DOIUrl":"10.57187/4899","url":null,"abstract":"<p><strong>Study aims: </strong>Mental disorders in children and adolescents have increased substantially, placing growing pressure on healthcare systems. Home treatment has emerged as an alternative to conventional inpatient treatment as usual (I-TAU), potentially offering clinical and cost benefits. This study aimed to evaluate the cost-effectiveness of an intensive home treatment programme (AT_HOME) compared to I-TAU in Switzerland.</p><p><strong>Methods: </strong>Data were collected within a monocentric pilot trial involving 75 children and adolescents (aged 6-17 years) admitted for acute psychiatric care between May 2019 and July 2020. Participants were allocated to AT_HOME if they met geographical and safety criteria and consented to receive home treatment (n = 27); all remaining patients received I-TAU (n = 48). Clinical effectiveness was assessed as between-group differences in change in psychosocial functioning from admission to follow-up at 18-24 months, assessed with the Global Assessment of Functioning (GAF) scale. The primary outcome of this secondary analysis was the cost-effectiveness of home treatment compared with I-TAU. Cost estimates included direct medical costs for the initial treatment period and follow-up healthcare utilisation from a comprehensive multi-payer healthcare system perspective. Cost-effectiveness was analysed using incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves (CEAC). Secondary outcomes included the costs of the index treatment, costs of follow-up mental healthcare utilisation and total costs.</p><p><strong>Results: </strong>The point estimate of the incremental cost of home treatment compared to I-TAU was CHF -48,591 (95% CI: -108,493 to 11,312; SE: 30,563) and the incremental effect was 9.41 (95% CI: 0.52 to 18.31; SE: 4.54) on the GAF scale. The resulting ICER was -5161 per 1-point improvement in the GAF score (95% CI: - 49,482 to 39,161; SE: 22,613) and the CEAC suggested a high probability (94.6%) that home treatment was cost-effective compared with I-TAU across willingness-to-pay thresholds.</p><p><strong>Conclusions: </strong>In this pilot trial, home treatment for children and adolescents with severe psychiatric disorders was associated with favourable cost-effectiveness estimates compared with I-TAU. These findings suggest that intensive home-based treatment models may have the potential to contribute to more efficient use of mental health resources.</p><p><strong>Clinical trial registration number: </strong>DRKS00025424 (German Clinical Trials Register, registered on 27 May 2021).</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4899"},"PeriodicalIF":1.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649118","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":"Metamizole-induced agranulocytosis: utilisation trends, pharmacovigilance signals and regulatory risk-minimisation in Switzerland.","authors":"Oliver Wildner, Isabelle Wenker, Stephanie Storre, Thomas Stammschulte","doi":"10.57187/5062","DOIUrl":"https://doi.org/10.57187/5062","url":null,"abstract":"<p><p> INTRODUCTION: The therapeutic role of metamizole (dipyrone) remains controversial because of the risk of metamizole-induced agranulocytosis, a very rare, idiosyncratic, life-threatening adverse reaction. We described utilisation, spontaneous reporting and recent regulatory actions in Switzerland.</p><p><strong>Methods: </strong> We estimated national metamizole utilisation as defined daily doses (DDD; WHO DDD 3 g/day) for 2014-2023, derived from aggregated national sales data; individual case safety reports (ICSR) of metamizole-induced agranulocytosis were retrieved from VigiBase (the WHO global safety database) for 2014-2024. Outputs included annual counts, fatal proportion and utilisation-normalised reporting (metamizole-induced agranulocytosis per million DDD); analyses were primarily descriptive.</p><p><strong>Results: </strong>Utilisation increased by ~79% during the analysed period with a formulation mix of 95.7% oral, 4.2% ampoules, 0.1% suppositories. Metamizole-induced agranulocytosis reports rose from 13 (2014) to 57 (2024), with year-to-year variability; the fatal proportion declined from 13.5% (2014-2018; 17/126) to 5.8% (2019-2023; 13/224) and 1.8% in 2024 (1/57). Utilisation-normalised reporting increased from 1.42 to 3.29 per million DDD (total), while fatal reports remained low and trended downward (mean 0.249 per million DDD, 2014-2023). Among Swiss fatal cases, methotrexate was co-reported as a concomitant drug in 39.5% (15/38) (extended fatal set 2011-2025; fatal ICSRs irrespective of onset year). Switzerland contributes a disproportionately high absolute number of cumulative metamizole-induced agranulocytosis reports.</p><p><strong>Regulatory actions: </strong> EMA and Swissmedic implemented strengthened warnings; Swissmedic additionally required a red-framed outer carton statement, clarified indications (second-line severe pain; refractory high fever) and advised avoiding concomitant methotrexate; a Direct Healthcare Professional Communication was issued.</p><p><strong>Conclusion: </strong>Regulatory assessments by EMA and Swissmedic concluded that the benefits of metamizole continue to outweigh the risks, provided the drug is used appropriately, action is taken promptly at first symptoms and concomitant methotrexate is avoided. However, the number of reported cases of agranulocytosis underscores the known risk in the context of widespread use. Spontaneous reports reflect reporting intensity, not incidence; ongoing monitoring of risk-minimisation effectiveness is warranted.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5062"},"PeriodicalIF":1.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353575","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":"Association between frailty and outcomes in emergency department patients requiring emergency general surgery: a retrospective cohort study.","authors":"Christophe A Fehlmann, Clément Stierlin, Kristina Van Dooren, Romeo Restellini, Daniel McIsaac, Frederic Rouyer, Debra Eagles, Monica Taljaard, Jeffrey Perry","doi":"10.57187/5114","DOIUrl":"https://doi.org/10.57187/5114","url":null,"abstract":"<p><strong>Background: </strong>Frailty, a state of increased vulnerability, is a well-established risk factor of adverse outcomes following surgery. While its prognostic value has been demonstrated in various contexts, data are lacking on its impact in emergency general surgery within the Swiss healthcare system. This study aimed to evaluate the association between frailty and outcomes among older patients undergoing emergency general surgery in a Swiss tertiary hospital.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study including patients aged 65 years or over who underwent emergency general surgery between January 2016 and December 2019. Eligible procedures included laparotomy, bowel resection, peptic ulcer repair, appendectomy and cholecystectomy performed within 72 hours of admission. Frailty was assessed retrospectively using the Clinical Frailty Scale (CFS), based on clinical documentation. The primary outcome was 1-year mortality. Secondary outcomes included complications, hospital length of stay and discharge destination. Multivariable regression models were used to analyse associations.</p><p><strong>Results: </strong>Of 683 patients (median age 76 years; 52.7% female), 38.2% were classified as living with frailty (CFS ≥5). One-year mortality was significantly higher among patients with frailty (25.6%) than those without (6.6%), with an adjusted odds ratio (aOR) of 3.0 (95% CI: 1.7-5.1). Frailty was associated with an increased risk of complications (aOR: 2.3; 95% CI: 1.5-3.6), prolonged hospital stay (+46.4%; 95% CI: 26.8-69.0%) and discharge to a location other than home (aOR: 2.1; 95% CI: 1.4-3.2).</p><p><strong>Conclusion: </strong>Frailty is associated with worse outcomes after emergency general surgery in older adults. Routine frailty screening could improve risk stratification and guide patient-centred surgical decision-making.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5114"},"PeriodicalIF":1.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649023","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":"New evidence of stagnation in mortality among young adults in Switzerland: a population-based study.","authors":"Isabella Locatelli, Djuly Asumpta Pierre-Paul, Valentin Rousson","doi":"10.57187/5052","DOIUrl":"https://doi.org/10.57187/5052","url":null,"abstract":"<p><strong>Aims: </strong>To examine all-cause and cause-specific mortality by age group in Switzerland during and after the COVID-19 pandemic, in order to determine whether pre-pandemic trends recovered in 2023-24.</p><p><strong>Methods: </strong>Standardised mortality rates since COVID-19 were compared with those expected by continuing trends estimated over the pre-pandemic years 2000-19 by log-linear Poisson models, resulting in estimates of all-age and age-specific excess death and mortality for 2020-24. Mortality trends for the leading causes of death were analysed by age group using Joinpoint regression models.</p><p><strong>Results: </strong> In 2024, all-cause mortality in Switzerland showed a complete return to pre-pandemic trends. However, marked differences between age groups were observed. While mortality among people aged 85 and over was significantly lower than trend in 2024 (-5.4% for men and -3.5% for women), people aged 65 to 84 were still struggling to recover the pre-pandemic trend this year (+4.2% for men and +3.5% for women). Mortality in the 15-44 age group began to stagnate a few years before the pandemic and remained significantly above trend in recent years, with excess mortality being systematically outside the 95% prediction intervals, reaching +33.6% for men and +20.4% for women in 2024. At the same time, accidents and suicides, among the leading causes of death in this age group, appear to have stopped declining, with a stabilisation in the suicide trend since 2014 among men (p = 0.005) and 2013 among women (p = 0.001), and in the accident trend since 2019 among men (p = 0.031). A slowdown in the decline of cardiovascular and respiratory mortality has been observed in the 65-84 age group.</p><p><strong>Conclusions: </strong>The long-standing decline in mortality has stalled in recent years in Switzerland among young adults and, to a lesser extent, among young retirees, due to stagnation or slowdown of several major causes of death in these age groups. These phenomena, in addition to their importance for considering appropriate preventive interventions, also raise questions about the future of mortality and longevity in Switzerland and, more generally, in Western societies, and must be taken into account when developing realistic life expectancy and demographic scenarios. These are essential for decision-making in the areas of insurance, retirement planning and healthcare cost management.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5052"},"PeriodicalIF":1.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649065","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":"Drug prescription before and after implementation of a CPOE system on the Paediatric Intensive Care Unit: a quality improvement study.","authors":"Rebecca Angresius, Katharina Wyss, Diana Reppucci, Florian Rebling, Ulrike Subotic, Verena Gotta","doi":"10.57187/%x","DOIUrl":"https://doi.org/10.57187/%x","url":null,"abstract":"<p><strong>Study aims: </strong>Paediatric drug prescription is complex, especially in the paediatric intensive care unit (PICU), where errors may be particularly harmful due to frequent use of high-risk medications. The widespread use of electronic prescriptions is a national goal in Switzerland to improve the quality of prescriptions and reduce medication errors.With this background, this study assessed the quality of drug prescriptions before and after implementation of electronic prescriptions on the PICU of a tertiary Paediatric University Hospital.</p><p><strong>Methods: </strong>This quality improvement study was conducted during implementation of a Computerised Physician Order Entry (CPOE) on the PICU of a Swiss paediatric university hospital. A paediatric dosing standard with an integrated dose calculator was incorporated as a default clinical decision support tool. Manual prescriptions before (April-September 2022) and electronic prescriptions after (September-December 2022) CPOE implementation were assessed for (1) dose calculation errors (primary outcome), (2) eight quality criteria defining a formally complete prescription according to the internal medication standard and (3) dose compatibility with the paediatric dosing standard (secondary outcomes).</p><p><strong>Results: </strong>A total of 767 (348 manual, 419 electronic) prescriptions from 107 patients (53 before and 54 after CPOE implementation) were collected. No dose calculation errors were detected in electronic prescriptions versus three in manual prescriptions (0.8%, p = 0.09) from three patients (5.6%). A total of 16 (5%) manual prescriptions were formally complete versus 197 (47%) of electronic prescriptions following CPOE implementation (p <0.001) according to the internal medication standard. The most frequently missing elements in manual prescriptions were total daily dose (64%), pharmaceutical form (58%) or brand name (32%), versus total daily dose (38%), pharmaceutical form (25%) or strength (2%) in electronic prescriptions. Dosing was consistent with the paediatric dosing standard in 235 (68%) of manual prescriptions and 313 (75%) of electronic prescriptions (p = 0.035).</p><p><strong>Conclusion: </strong>The findings of this quality study provide arguments for the potential of CPOE with integrated paediatric dose selection and calculation to improve paediatric medication safety on PICU, in particular by increasing completeness and standardisation of drug prescriptions. Nevertheless, only 47% of electronic prescriptions were formally complete, and new potential sources of prescribing errors linked to increased complexity of drug prescriptions were seen. This underlines the need for close interdisciplinary monitoring of electronic prescription systems, additional training time for users, and flexibility for adjustments based on user experience with corresponding dedicated resources.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4978"},"PeriodicalIF":1.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353592","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}