Swiss medical weekly最新文献

{"title":"Epidural dexamethasone-21-palmitate for spinal stenosis-related pain: a retrospective cohort study using patient-reported outcome data.","authors":"Anja Lehmann, Matthijs De Leeuw, Wilhelm Ruppen, Tobias Schneider","doi":"10.57187/s.4100","DOIUrl":"10.57187/s.4100","url":null,"abstract":"<p><strong>Objective: </strong>Epidural steroid infiltration has been used for decades as symptomatic pain therapy. To record and evaluate treatment response to epidural steroid infiltration, patient-reported outcome data were collected from patients receiving interlaminar or transforaminal epidural steroid infiltration with dexamethasone-21-palmitate (Lipotalon®).</p><p><strong>Methods: </strong>This retrospective study included patient-reported outcome data from 212 patients who received treatment with translaminar or transforaminal epidural steroid infiltration at University Hospital Basel between July 2019 and April 2022. To evaluate pain and quality of life after treatment, the Numeric Rating Scale (NRS), Pain and Enjoyment of Life and General Activity (PEG) scale, European Quality of Life 5 Dimensions Questionnaire (EQ-5D-5L) and Oswestry Disability Index (ODI) were assessed prior to and at 7 days, one month and three months after treatment.</p><p><strong>Results: </strong>There was a significant decrease in back pain on the NRS at 7 days and 3 months post-intervention compared to admission: 6.07 (SD 2.27) at admission, 4.52 (SD 2.26) at 7 days and 4.21 (SD 2.69) at 3 months (all p-values <0.001). Similarly, a significant decrease could be reported for leg pain: 5.59 (SD 2.72) at admission, 3.89 (SD 2.64) at 7 days and 3.58 (SD 2.84) at 3 months (all p-values <0.001). The mean PEG scale was 6.34 (SD 1.84) at admission, 4.52 (SD 2.15) at 7 days and 3.93 (SD 2.6) at 3 months (all p-values <0.001). The mean ODI score also improved significantly: 35.67 (SD 15.75) at admission, 28.24 (SD 16.11) at 7 days and 25.17 (SD 16.22) at 3 months (all p-values <0.002). The mean EQ-5D-5L score did not differ significantly during the observation period.</p><p><strong>Conclusions: </strong>Dexamethasone-21-palmitate may be a potential treatment alternative to traditional water-soluble steroids. However, further controlled trials are necessary to confirm the efficacy and safety of this treatment.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4100"},"PeriodicalIF":2.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200045","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":"Analysis of the need for a mobile application to support family caregivers of patients with incurable cancer - The development of the \"Angehörigen-App\": a qualitative study in Switzerland.","authors":"Beat Huber, Natalie Röderer, Monica Fliedner, Alexander Wünsch","doi":"10.57187/s.4089","DOIUrl":"10.57187/s.4089","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of cancer is rising continuously worldwide. Relatives play an important role in caring for cancer patients and are at the same time affected by the illness and treatment of their loved ones. They have often been referred to as a forgotten group. Advances in digital technology offer various opportunities to enhance the well-being of and care for relatives.</p><p><strong>Objectives: </strong>The aim of the study was to investigate the utility of a mobile application to support the relatives of palliative cancer patients in Switzerland, the potential content elements of such an app, and its optimal functional and structural design.</p><p><strong>Method: </strong>Using a purposive sampling strategy, three focus group discussions were conducted at the University Hospital of Bern. The 15 participants included both relatives and experts. Data was analysed using content structuring qualitative content analysis according to Kuckartz and Rädiker.</p><p><strong>Results: </strong>Statements from the focus groups were summarised in four main categories. These included statements from participants about the need for and potential benefits of an app, such as resource gains or easier access to care. Statements regarding possible content components of the app, such as tools for professional support and coordination or the provision of information, were also summarised. Statements were also included on the necessary functional features and the structural embedding of the app.</p><p><strong>Conclusions: </strong>The results indicate a need for a caregivers app in Switzerland. The app should reduce gaps in care, focus on family members, and strengthen their empowerment and access to resources. In terms of content, bundled information, low-threshold support offers, coordination tools, and self-care options should be guaranteed. The modular and simply structured app should be designed in a needs-oriented manner to be used safely throughout Switzerland.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4089"},"PeriodicalIF":2.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200016","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":"Well-being of the Swiss General Internal Medicine workforce: a nationwide survey.","authors":"Rahel Villiger, Carlota Beneyto Afonso, Damiana Pulver, Odile Stalder, Andreas Limacher, Drahomir Aujesky","doi":"10.57187/s.4073","DOIUrl":"10.57187/s.4073","url":null,"abstract":"<p><strong>Study aims: </strong>Physician well-being is related to productivity and quality of care. The well-being of general internists (physicians who provide most primary care services) has never been comprehensively examined in Switzerland. In this survey, we assessed the well-being of Swiss general internists and its relationship to personal and work-related factors.</p><p><strong>Methods: </strong>In November 2022, we conducted a national survey among members of the Swiss Society of General Internal Medicine. We evaluated the association between personal and work-related factors and reduced well-being (Physician Well-Being Index ≥4 points) using multivariable logistic regression.</p><p><strong>Results: </strong>The response rate was 21% (1672/8111 members). Among the respondents whose data was analysed, 44% (710/1624) were women and 76% (1234/1613) primarily worked in an out-patient setting. Overall, 33% (543/1621) reported reduced well-being and 54% (876/1623) felt burnt out. Older age was associated with a lower likelihood of reduced well-being (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.96-0.98, per year) while being female was associated with a higher likelihood of reduced well-being (aOR 1.33, 95% CI 1.03-1.72). Factors associated with reduced well-being included working in an outpatient setting (aOR 1.76, 95% CI 1.24-2.51), having ≤2.5 personally rewarding working hours/day (aOR 2.18, 95% CI 1.63-2.90), long weekly working hours (aOR 1.02, 95% CI 1.01-1.03, per hour) and dissatisfaction with income (aOR 2.42, 95% CI 1.78-3.30).</p><p><strong>Conclusions: </strong>A third of Swiss general internists reported having a reduced well-being and approximately half felt burnt out. Female sex and several work-related factors such as working in an out-patient setting, long working hours, few personally rewarding work hours, and income dissatisfaction were related to having a reduced well-being.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4073"},"PeriodicalIF":2.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200037","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":"Cohort profile: pulmonary early assessment of the lung in paediatric cancer patients (SWISS-PEARL Study).","authors":"Christine Schneider, Gabriele Raffler, Maša Žarković, Christina Schindera, Jochen Rössler, Claudia E Kuehni, Philipp Latzin, Alexander Moeller, Rahel Heule, Jakob Usemann","doi":"10.57187/s.4203","DOIUrl":"10.57187/s.4203","url":null,"abstract":"<p><strong>Background: </strong>Due to the limited sensitivity of conventional lung function tests in detecting small airway abnormalities, cancer treatment-related pulmonary toxicity may be underdiagnosed. It has been suggested that the nitrogen multiple-breath washout test (N2MBW) might be more sensitive in detecting small airway abnormalities in childhood cancer survivors.</p><p><strong>Objective: </strong>The Pulmonary Early Assessment of the Lung in Paediatric Cancer Patients (SWISS-PEARL) study aims to assess the prevalence and development of early pulmonary toxicity at baseline and longitudinally in paediatric cancer patients using spirometry, body plethysmography, diffusing capacity for carbon monoxide (DLCO), N2MBW and magnetic resonance imaging (MRI) and to identify treatment-related pulmotoxic risk factors.</p><p><strong>Methods: </strong>This prospective, multicentre, cohort study at the University Children's Hospitals of Basel, Bern, Lausanne and Zurich, is enrolling patients aged ≥4 and <22 years at study entry exposed to at least one of the following cancer treatments: chest radiation, chemotherapy or targeted agents, haematopoietic stem cell transplantation and/or thoracic surgery. Participants perform comprehensive lung function testing at baseline (i.e. within 28 days of the start of systemic cancer treatment) and during four follow-up visits until two years after the end of intensive treatment. Respiratory symptoms are also assessed at each time point, and MRI is planned at one and two years post-treatment.</p><p><strong>Results: </strong>Since May 2022, we have recruited 44 patients and performed 134 lung function tests at baseline. Mean age at diagnosis was 12 years (range 4-18). The most common cancer diagnoses were leukaemia (41%) and lymphoma (23%). Pulmonary assessment was feasible and of good quality in 43/44 (98%) patients for at least one test at baseline; only 4 patients dropped out after baseline measurements.</p><p><strong>Conclusion: </strong>This study will assess the potential development of early pulmonary dysfunction during and post-treatment. Findings from the SWISS-Pearl study may help inform future guidelines for pulmonary surveillance in paediatric cancer patients.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4203"},"PeriodicalIF":2.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200041","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":"Human flourishing in the context of farm characteristics and occupational hazards - Baseline findings from the FarmCoSwiss cohort.","authors":"Priska Ammann, Ayoung Jeong, Gianfranco Lovison, Julia Doetzer, Samuel Fuhrimann, Medea Imboden, Karin Ingold, Mirko S Winkler, Nicole Probst-Hensch","doi":"10.57187/s.4135","DOIUrl":"10.57187/s.4135","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction and objectives: &lt;/strong&gt;In Switzerland, little is known about farmers' wellbeing. Based on cross-sectional baseline data from the Swiss agricultural health cohort FarmCoSwiss, we carried out a study to investigate farmers' flourishing i.e. complete wellbeing and ability to thrive - to our knowledge, the first study worldwide to do so -, to descriptively compare it to the general population and to explore its association with farm characteristics and occupational hazards.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Of 1480 self-registered adult farmers recruited as a Swiss-wide convenience sample, 947 individuals (63.9%) signed the informed consent form, and 872 answered the online questionnaire in German, French or Italian at baseline between November 2022 and August 2023. The questionnaire obtained information on, among others, the primary outcome flourishing as assessed by the Secure Flourish Index (SFI) with its six subdomains Happiness and life satisfaction, Mental and physical health, Meaning and purpose, Character and virtue, Close social relationships, and Financial and material stability, each assessed on a scale from 0 to 10. Participants additionally answered questions on the primary predictors farm characteristics and 20 pre-selected occupational hazards classified into five domains (physical, chemical, biological, psychosocial and environmental). Participants assessed the hazards in terms of exposure frequency (Likert scale from 1 to 5) and perceived health harmfulness (Likert scale from 1 to 4). First, farmer's mean SFI was descriptively compared to mean SFI in the general adult population using the data of 7220 participants from the 2023 follow-up of the population-based COVCO-Basel cohort established in Basel-Stadt and Basel-Landschaft cantons. Second, zero-one inflated beta regression models were constructed to investigate the age- and sex-adjusted association of mean SFI values (overall; domain-specific) with the farming system (non-organic or organic), the production system (animal husbandry or crop cultivation), farm size (five categories) as well as the exposure to, and perception of, occupational hazards (sum of respective Likert scales).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean SFI values were between 7 and 8, in both FarmCoSwiss and COVCO-Basel. Descriptively comparing these two samples, farmers showed lower flourishing overall (7.44, SD = 1.41; COVCO: 7.70, SD = 1.30) and in the four domains Happiness and life satisfaction (7.39, SD = 1.87; COVCO: 7.91, SD = 1.55), Mental and physical health (7.03, SD = 1.73; COVCO: 7.68, SD = 1.53), Close social relationships (7.66, SD = 2.08; COVCO: 7.94, SD = 1.73) and Financial and material stability (7.06, SD = 2.45; COVCO: 7.33, SD = 2.69). Farmers reported being most frequently exposed to biological hazards (66.2% often/always exposed), but psychosocial hazards were perceived as the most harmful to health (51.9% judging them as rather/very harmful). Exposure to psychosocial","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4135"},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200049","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":"Urinary tract infections are common and have an impact on performance in elite wheelchair athletes: a cross-sectional study of self-reported data.","authors":"Anneke Hertig-Godeschalk, Claudio Perret, Jörg Krebs, Fabian Ammann","doi":"10.57187/s.4113","DOIUrl":"10.57187/s.4113","url":null,"abstract":"<p><strong>Study aims: </strong>Wheelchair athletes may be at risk of urinary tract infections, especially those with spinal cord injury. A urinary tract infection can lead to a loss of training hours and reduced performance in athletes. We assessed the self-reported occurrence of urinary tract infections and the impact of urinary tract infections on training and performance in elite wheelchair athletes. We also evaluated the prophylactic measures used, as reported by the athletes.</p><p><strong>Methods: </strong>Data were collected from September 2022 to August 2023 at an institute specialised in examining wheelchair athletes. All wheelchair athletes active in international and/or national competitions who attended one of the routine checkups at the institute during the study period were included. The number of self-reported urinary tract infections during the previous 12 months was collected, including symptoms associated with urinary tract infections, prophylaxis, and impact on training and performance. The method of bladder voiding was assessed by catheter use, either \"Yes\" (intermittent and indwelling) or \"No\" (no catheter use at all).</p><p><strong>Results: </strong>Eighty-one athletes were included (mean ± standard deviation age 35±11 years; 24 females; 67 with spinal cord injury; 56 using a catheter). Prophylaxis was used by 38 (47%) athletes; the most common was natural supplements, including cranberry juice and D-mannose. Thirty-six (44%) athletes had had at least one urinary tract infection during the previous 12 months. Athletes were more likely to have had at least one urinary tract infection if they had spinal cord injury (34 [94%] vs 2 [6%] athletes, p = 0.013) or were using a catheter (32 [89%] vs 4 [11%] athletes, p = 0.001). A urinary tract infection resulted in 4±6 lost training days and impaired performance.</p><p><strong>Conclusion: </strong>Urinary tract infections are common in elite wheelchair athletes and have a negative impact on training volume and performance. About half of the athletes use prophylaxis. Athletes with spinal cord injury or who use a catheter are especially at risk of urinary tract infections.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4113"},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200036","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":"Hereditary alpha-tryptasemia - a potential cause of severe anaphylactic reactions and a modifier of mast cell diseases.","authors":"Axel Rüfer, Gerhard Müllner, Oliver Fuchs, Wolfgang R Sperr, Gregor Hoermann","doi":"10.57187/s.3679","DOIUrl":"10.57187/s.3679","url":null,"abstract":"<p><p>Hereditary alpha-tryptasemia (HAT) is an autosomal dominant genetic trait affecting 4% to 6% of the general population. Hereditary alpha-tryptasemia is caused by an excess of alpha tryptase encoding TPSAB1 copy numbers on one parenteral allele, most often duplications or triplications, leading to elevated levels of basal serum tryptase. There might be a gene dosage effect between the number of additional TPSAB1 copies, the level of basal serum tryptase and the severity of clinical symptoms, including atopic, cutaneous, gastrointestinal, musculoskeletal, autonomic and neuropsychiatric manifestations. Hereditary alpha-tryptasemia is a potential risk factor for severe anaphylactic reactions. The prevalence of hereditary alpha-tryptasemia is higher in patients with systemic mastocytosis. In the diagnostic workup of patients with anaphylactic reactions and symptoms of mast cell mediator release after measurement of basal serum tryptase, it is therefore essential to screen for both the KIT D816V activating point mutation and hereditary alpha-tryptasemia by droplet digital polymerase chain reaction. Such a diagnostic approach can identify patients with hereditary alpha-tryptasemia, which may allow the avoidance of further diagnostic workup with bone marrow examination. Moreover, it can identify patients at high risk of anaphylactic reactions. So far, no targeted therapy for hereditary alpha-tryptasemia is available. Treatment for symptom control consists of H1- and H2-blockers, leukotriene antagonists and cromoglicic acid. Urticaria and anaphylaxis are especially successfully treated with the monoclonal anti-IgE-antibody omalizumab in patients with hereditary alpha-tryptasemia. H1-blockers and steroids are sufficient in emergencies. As hereditary alpha-tryptasemia is a hereditary condition, first-degree relatives with anaphylactic reactions or symptoms of mast cell mediator release should be tested for hereditary alpha-tryptasemia after measurement of basal serum tryptase.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3679"},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200048","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":"Reporting of paediatric exercise-induced respiratory symptoms by physicians and parents: an observational prospective study.","authors":"Eva S L Pedersen, Sarah Glick, Carmen C M De Jong, Cristina Ardura-Garcia, Anja Jochmann, Carmen Casaulta, Katharina Hartog, Diana Marangu-Boore, Dominik Mueller-Suter, Nicolas Regamey, Florian Singer, Alexander Moeller, Claudia E Kuehni","doi":"10.57187/s.3939","DOIUrl":"10.57187/s.3939","url":null,"abstract":"<p><strong>Study aims: </strong>Routinely collected health data are increasingly used for research; however important anamnestic details may be missing from medical records. We compared physician documentation of paediatric exercise-induced respiratory symptoms in clinical notes with parental questionnaire responses for the same children.</p><p><strong>Methods: </strong>We analysed data from the Swiss Paediatric Airway Cohort (SPAC), a multicentre observational study of children treated in Swiss outpatient pulmonology clinics. We included children aged 6 to 17 years who were referred to a paediatric pulmonologist for evaluation of exercise-induced respiratory symptoms. Features of exercise-induced respiratory symptoms recorded by physicians were extracted from outpatient clinic letters transmitted to the referring physician, while parent-reported exercise-induced respiratory symptom data was collected from a standardised questionnaire completed at Swiss Paediatric Airway Cohort enrolment. We calculated agreement between physician-documented and parent-reported exercise-induced respiratory symptom characteristics using Cohen's and Fleiss's kappa.</p><p><strong>Results: </strong>Of 1669 children participating in the Swiss Paediatric Airway Cohort (2017-2019), 193 (12%) met the inclusion criteria, of whom 48% were girls. Physicians provided detailed information on exercise-induced respiratory symptoms in 186 (96%) outpatient clinic letters. Documented characteristics included: type of physical activity triggering exercise-induced respiratory symptoms (69%), location of exercise-induced respiratory symptoms in chest or throat (48%), respiratory phase of exercise-induced respiratory symptoms (45%) and timing of exercise-induced respiratory symptoms during or after exercise (37%). Previous bronchodilator use (94%) and its effect on exercise-induced respiratory symptoms (88%) were consistently documented by physicians. The clinic letters for children diagnosed with dysfunctional breathing more often contained detailed exercise-induced respiratory symptom characteristics than those diagnosed with asthma. The level of agreement between physician-documented and parent-reported exercise-induced respiratory symptoms was moderate for use of bronchodilators (κ = 0.53) and poor-to-fair for all other features (κ = 0.01-0.36).</p><p><strong>Conclusion: </strong>This study highlights that outpatient clinic letters may lack some details on exercise-induced respiratory symptom characteristics - information that parents could provide. A standardised and detailed method for documenting paediatric respiratory symptoms in the coordinated data infrastructure may enhance future analyses of routinely collected health data.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3939"},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200030","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":"Conference report: Trends, new technologies and implications for dementia diagnostics, treatment and care in Switzerland.","authors":"Julius Popp, Reto W Kressig, Mélanie Bieler-Aeschlimann, Miriam Rabl, Marcello Ienca, Andreas U Monsch, Hans Pihan, Stefan Klöppel, Tatjana Meyer-Heim, Stefanie Becker","doi":"10.57187/s.4017","DOIUrl":"10.57187/s.4017","url":null,"abstract":"<p><p>Dementia diseases represent a major burden for the directly affected people, their relatives and modern society. Despite considerable efforts in recent years, early and accurate disease diagnosis and monitoring is still a challenge while no cure is available in most cases. New drugs, in particular disease-modifying therapies, and recent technological advancements offer promising perspectives. The integration of novel biomarkers, artificial intelligence and digital health tools has the potential to transform dementia care, making it more personalised, efficient and adapted to the living conditions and needs of older people. In November 2023, the 7th Dementia Summit convened a panel of experts from geriatrics, neurology, neuropsychology, psychiatry, ethics as well as general medicine to discuss interdisciplinary challenges, advancements and their implications for the future of dementia care in Switzerland. The conference underscored the importance of a multidisciplinary approach to successfully integrate new technologies in both clinical-translational research and dementia prevention, diagnosis and care. While recent innovations represent major steps forward, their implementation also comes with important challenges including questions on healthcare system preparedness and adaptation, ethical aspects, technology literacy, acceptance and appropriate use.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4017"},"PeriodicalIF":2.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711076","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 relationship between surgeon case load and revision rates in total hip arthroplasty: Evidence from the Swiss National Joint Registry.","authors":"Andreas Ladurner, Karlmeinrad Giesinger, Bernhard Jost, Vilijam Zdravkovic","doi":"10.57187/s.3850","DOIUrl":"10.57187/s.3850","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study aims: &lt;/strong&gt;Higher surgeon volume has been correlated with improved therapy outcomes following total hip arthroplasty, and many countries have implemented minimum volume standards as a precondition for claiming reimbursement. However, there are large differences between healthcare systems worldwide and the applicability of international studies to a particular local healthcare environment may be limited. The aim of this study was to assess the relationship between surgeon case load (= number of procedures per year) and short-term revision rates (within two years of the index procedure) in patients undergoing primary total hip arthroplasty for hip osteoarthritis in a nationwide, registry-based study. In addition, the effects of increasing minimum volume standard thresholds on the potential reduction of the revision burden was simulated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All patients registered in the Swiss National Joint Registry (SIRIS) for undergoing primary total hip arthroplasty for hip osteoarthritis between 2015 and 2021 were considered. Patients were aggregated according to the lead surgeon's individual code. Surgeons lacking five years of uninterrupted practice were excluded. Multiple logistic and bivariate multinomial regressions were employed to model the odds of revision surgery (overall and for specific diagnoses) as a function of surgeon case load. Two-year revision rates, the proportional reduction of the revision burden and the number of patients hypothetically needing treatment reassignment to higher-volume surgeons were simulated for increasing minimum volume standard thresholds.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 74,565 total hip arthroplasty procedures performed by 384 surgeons were assessed. The mean surgeon case load was 28.7 total hip arthroplasties / year (min/max: 1.8/269.1; median: 18.1). The average overall 2-year revision rate in the observation period was 2.25%. A higher surgeon case load was associated with lower cumulative revision rates (revision for any reason, and revision due to infection, dislocation and femoral periprosthetic fracture). Overall revision rates of surgeons with a minimal case load of up to 10 / 20 / 50 total hip arthroplasties / year were 2.18% / 2.01 % / 1.70%, respectively. Implementation of a minimum volume standard of 10 / 20 / 50 total hip arthroplasties / year would reduce the overall 2-year revision rates by 3.2%, 10.5% and 23.8%, respectively, but also require that 5.1%, 18.1% and 53.8% of patients be reassigned to higher-volume surgeons instead of initially intended lower volume surgeons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A higher surgeon case load independently predicts a lower overall 2-year revision rate in patients undergoing primary total hip arthroplasty for hip osteoarthritis in Switzerland. Implementation of a minimal case load has the potential to significantly reduce 2-year revision rates, at the cost of more patients needing to have their treatment rea","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3850"},"PeriodicalIF":2.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711349","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}