Swiss medical weekly最新文献

{"title":"Endocrine care of transgender and gender-diverse adults: Swiss recommendations.","authors":"Hüseyin Cihan, Barbara Bischofberger-Baumann, Julie Bucher, Verdiana Caironi, Fabien Claude, Federico Del Vento, Michelle Egloff, Niklaus Flütsch, David Garcia Nuñez, Ursula Gobrecht-Keller, Ulrike Iten, Martine Jacot-Guillarmod, Johannes Kliebhan, Maddalena Masciocchi, Maria Mavromati, Christian Meier, Georgios Papadakis, Carole Rieben, Lea Slahor, Lorenzo Soldati, Maria-Isabelle Streuli, Sébastien Thalmann, Vincent Vibert, Bettina Winzeler","doi":"10.57187/5059","DOIUrl":"10.57187/5059","url":null,"abstract":"<p><p>Transgender and gender-diverse individuals require standardised, evidence-based and culturally sensitive endocrine care. International guidelines such as those from the World Professional Association for Transgender Health (WPATH) and the Endocrine Society provide a strong foundation. These Swiss recommendations build on them and offer context-specific recommendations adapted to Switzerland's healthcare system, insurance policies and social considerations. These recommendations were developed by the \"Working Group Transgender\" of the Swiss Society of Endocrinology and Diabetology (SSED/SGED) in collaboration with multidisciplinary experts. They primarily focus on gender-affirming hormone therapy, including indications, monitoring and long-term management. They also address fertility preservation, bone and sexual health, and relevant psychological and legal aspects. Interdisciplinary collaboration among endocrinologists, primary care providers, mental health professionals, reproductive specialists and surgeons is recommended to ensure cohesive patient-centred care.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5059"},"PeriodicalIF":1.6,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654934","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":"Brain lesions and cognitive decline in patients with atrial fibrillation: a prospective multicentre cohort study.","authors":"Katalin Bhend, Rebecca Paladini, Stefanie Aeschbacher, Elisa Hennings, Michael Coslovsky, Philipp Krisai, Nicolas Rodondi, Jürg Beer, Angelo Auricchio, Giorgio Moschovitis, Nino Storrer, Patricia O Chocano-Bedoya, Elia Rigamonti, Tim Sinnecker, David Conen, Stefan Osswald, Leo Bonati, Michael Kühne","doi":"10.57187/s.4059","DOIUrl":"10.57187/s.4059","url":null,"abstract":"<p><strong>Study aim: </strong>Atrial fibrillation (AF) is associated with a high burden of vascular brain lesions, most of which are covert. We aimed to assess the association between vascular brain lesions (brain infarcts, microbleeds, white matter lesions) and cognitive decline over time in atrial fibrillation patients.</p><p><strong>Methods: </strong>We included 1536 atrial fibrillation patients with brain magnetic resonance imaging (MRI) from a prospective multicentre cohort study. Patients were enrolled between 2014 and 2017 across 14 centres in Switzerland. Their cognitive functioning was assessed at baseline and yearly intervals using Montreal Cognitive Assessment (MoCA) and Cognitive Construct (CoCo) scores. Cognitive decline was defined as a score decline of >1 standard deviation of the age- and education-standardised baseline population compared with individual baseline levels of the corresponding test.</p><p><strong>Results: </strong>Of 1536 patients, 1030 (mean age: 72 years; 73% male) had ≥1 vascular brain lesion on baseline MRI. During a median follow-up of 5.13 years, cognitive decline developed in 159 (10%) patients based on MoCA scores and in 144 (9%) based on CoCo scores. The incidence rate (per 100 person-years) for cognitive decline was 3.64 in patients with brain lesions vs 1.82 in patients without brain lesions on baseline MRI using MoCA scores, and 3.18 vs 2.0 using CoCo scores. In multivariable adjusted Cox proportional hazard models, the hazard ratio (HR) (95% confidence interval [CI]) of any brain lesion for cognitive decline was 1.29 (0.85-1.96) using the MoCA and 1.45 (0.95-2.20) using the CoCo score.</p><p><strong>Conclusions: </strong>In our atrial fibrillation cohort, the presence of brain lesions was not associated with a higher risk of cognitive decline using the MoCA or the CoCo score. However, there was an association with more-specific cognitive domains.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov NCT02105844.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4059"},"PeriodicalIF":1.6,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654982","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":"Diagnostic assessment of first-episode psychosis patients and adherence to German S3 guidelines: a retrospective cross-sectional study.","authors":"Karen J Schulz, Marie C Khorsandian, Claudio Corda, Franziska C Grätz, Andreas B Hofmann, Anne Henriette Hövel, Mario Müller, Philipp Homan, Erich Seifritz, Tobias R Spiller, Achim Burrer","doi":"10.57187/s.4490","DOIUrl":"10.57187/s.4490","url":null,"abstract":"<p><p>BACKGROUND: Guidelines for diagnostic work-up in first-episode psychosis (FEP) vary worldwide. The German DGPPN S3 guidelines recommend a comprehensive work-up, including neuroimaging. However, real-world adherence to these recommendations remains unclear. This study examined guideline adherence in a Swiss tertiary psychiatric hospital.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study analysing electronic healthcare records of first-episode psychosis patients hospitalised with an ICD-10 chapter F2 diagnosis for the first time between October 2022 and September 2023. We assessed adherence to recommended mandatory DGPPN S3 assessments - neurological examinations, blood analyses, drug screening, MRI - and evaluated completion of optional assessments such as EEG and lumbar puncture.</p><p><strong>Results: </strong>A total of 68 first-episode psychosis patients were included from 364 patients screened: 44 (64.7%) were men; their median age was 29 (IQR: 23-33) years; 35 (51.5%) were involuntary admissions. Nearly all patients (n = 66 or 97.1%) received thorough neurological examinations and blood analyses, while 56 (82.4%) underwent drug screening (with 35 [44.6%] testing positive for cannabis). MRI was conducted in 38 (55.9%) cases. Non-completion of MRI was mainly due to patient refusal (n = 10 or 14.7%) or early discharge (n = 16 or 23.5%). Optional EEG and lumbar puncture were less frequently performed: in 26 (38.2%) and 4 (5.9%) patients, respectively.</p><p><strong>Conclusions: </strong>Overall, guideline adherence was high, particularly for essential diagnostic procedures. However, only around half of the sample underwent MRI imaging, largely because of patient refusal or patient-requested discharge prior to completion of the suggested assessment. These findings highlight the need for optimised diagnostic workflows and enhanced patient education strategies to improve guideline adherence in FEP assessment.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4490"},"PeriodicalIF":1.6,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654941","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":"Effectiveness of community mental health nursing on psychiatric hospitalisations in Switzerland: a mirror-image analysis.","authors":"Anna Hegedüs, Dirk Richter","doi":"10.57187/s.4692","DOIUrl":"10.57187/s.4692","url":null,"abstract":"<p><p>BACKGROUND: Community mental health nursing has gained importance in Switzerland as part of a broader shift towards community-based psychiatric care. While community mental health nursing services are increasingly implemented, empirical evidence on their effectiveness in reducing psychiatric hospitalisations remains limited. This study aims to evaluate the effect of community mental health nursing on psychiatric hospitalisations and to identify risk factors for hospitalisation during community mental health nursing care.</p><p><strong>Methods: </strong>We conducted a naturalistic observational study using data from two linked national databases: the HomeCareData register and the Medical Statistics of Hospitals. The study included adults who were admitted to community mental health nursing services between January 2020 and December 2022 and whose data was documented in HomeCareData. With mirror-image methods, we compared psychiatric hospitalisation rates in equally long pre-index and post-index periods, defined by each individual's duration of community mental health nursing care, with each participant serving as their own control. The start of community mental health nursing care was defined as the index date. For a sensitivity analysis, individuals hospitalised within 60 days before the start of community mental health nursing were excluded to address potential regression to the mean effects. Uni- and multivariable logistic regression were used to identify risk factors of hospitalisation during community mental health nursing care.</p><p><strong>Results: </strong>The study sample comprised 5252 individuals with a mean age of 52 years; 66% were female. The primary mirror-image analysis revealed a significant reduction in psychiatric hospitalisations following the start of community mental health nursing (unadjusted Incidence Rate Ratio: 0.60; 95% confidence interval: 0.55-0.65). No significant effect was observed in the sensitivity analysis (unadjusted Incidence Rate Ratio: 0.97; 95% confidence interval: 0.87-1.09). Multivariable logistic regression identified previous psychiatric hospitalisations and compulsory admissions as significant risk factors of hospitalisation during community mental health nursing care. Sociodemographic and diagnostic variables showed no significant associations.</p><p><strong>Conclusions: </strong>This is the first study to show a reduction in psychiatric hospitalisations after participation in community mental health nursing services in Switzerland. However, this effect was not confirmed in the sensitivity analysis which may suggest a regression to the mean effect. The study demonstrates the feasibility of using linked routine data to evaluate real-world mental health interventions and underscores the need for broader data coverage and improved documentation to strengthen future research.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4692"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865580","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":"Molecular epidemiology of respiratory syncytial virus in Switzerland 2019-2024 from nucleic acid testing and whole-genome sequencing.","authors":"Alexander Kuznetsov, Rainer Gosert, Ulrich Heininger, Nina Khanna, Sarah Tschudin-Sutter, Richard A Neher, Karoline Leuzinger","doi":"10.57187/s.4600","DOIUrl":"10.57187/s.4600","url":null,"abstract":"<p><strong>Background and aims: </strong>Respiratory syncytial virus (RSV) infection is one of the leading causes of hospitalisation in infants, the elderly and immunocompromised patients, with significant morbidity and mortality rates. Despite its global impact, epidemiological surveillance of RSV in Switzerland has historically been limited compared to the USA and European countries. A significant surge in RSV activity and hospitalisations after the COVID-19 pandemic, along with the introduction of new monoclonal antibodies and RSV vaccines, has led to an increased interest in the molecular epidemiology of RSV. To ensure continued efficacy of the new preventive options, monitoring of the genetic diversity of circulating RSV strains, their evolutionary dynamics and the potential emergence of resistance mutations is of central importance. The present study aimed to characterise the genetic diversity and seasonal trends of RSV dynamics in Switzerland from 2019 to 2024, mainly over the last two post-pandemic winter seasons (2022/23 and 2023/24).</p><p><strong>Methods: </strong>A total of 48,897 respiratory clinical specimens from 30,782 patients with respiratory tract infections were tested for RSV at a tertiary care centre in Northwestern Switzerland between July 2019 and June 2024. RSV activity over these seasons was investigated. Amplicon-based whole-genome sequencing was performed on 182 selected samples, with 125 high-quality consensus genomes and phylogenies reconstructed. Lineage distribution and seasonal subtype prevalence were compared to European data.</p><p><strong>Results: </strong>RSV activity was absent during the 2020/21 pandemic season, but surged with an off-season peak in summer 2021. RSV B predominated during the 2022/23 season, while a shift to RSV A occurred in the 2023/24 winter season, which is in line with neighbouring European countries. Lineage subtype distribution showed high concordance with circulating European strains. RSV A exhibited greater diversity (mean pairwise Hamming distance 0.015, SD 0.006) than RSV B (mean 0.006, 0.003), with all current strains falling within G protein duplication clades A.D.1, 2, 3 and 5 for RSV A, and B.D.E.1 and B.D.4.1.1 for RSV B.</p><p><strong>Conclusion: </strong>By contributing 125 newly assembled RSV genome sequences, we have significantly increased the number of publicly available whole-genome sequences from Switzerland. Our study provides a genomic surveillance of RSV in Switzerland, analysing seasonal patterns, alternating subtype dominance, and consistency with broader European trends. A comprehensive understanding of the molecular epidemiology of RSV enables healthcare providers and public health authorities to monitor the effectiveness of current vaccines and monoclonal antibodies, associate lineages and serotypes with disease severity, implement timely interventions and detect emerging variants, ultimately reducing the burden of RSV-related illnesses.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4600"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865660","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":"Survival and quality of life after liver transplantation in patients with or without pre-transplant alcohol abstinence: a retrospective cohort study.","authors":"Felix A Fries, Sena Blümel, Beat Müllhaupt, Andre Richter, On Behalf Of The Swiss Transplant Cohort Study","doi":"10.57187/s.4381","DOIUrl":"10.57187/s.4381","url":null,"abstract":"<p><p>INTRODUCTION: Most European transplant centres require patients to abstain from alcohol consumption for at least 6 months to be listed for liver transplantation, even though delayed transplantation is associated with increased mortality. This study examined the effects of a shorter duration of alcohol abstinence before placement on the waiting list for liver transplantation on post-transplant survival and quality of life. This article contributes to the ongoing debate on whether patients with less than 6 months of alcohol abstinence should be categorically excluded from transplantation.</p><p><strong>Methods: </strong>This retrospective cohort study analysed patients at the University Hospital Zurich who underwent liver transplantation for any indication between 2011 and 2019. Patients younger than 18 years and those with acute liver failure were excluded. The follow-up period was 3 years. The outcomes were post-transplant survival and quality of life in patients with less than (group 1) or more than (group 2) 6 months of abstinence before being listed for liver transplantation. Survival was compared using log-rank tests, and quality of life (scored from 0 to 100) was compared using multivariate ANOVA with repeated measures.</p><p><strong>Results: </strong>Of the 206 included patients, 50 (24%) had abstained from alcohol for less than 6 months before being listed for liver transplantation (group 1). The cohort had a median (IQR) age at transplantation of 59 (53-64) years, and 155 (75%) were men. Three-year survival was similar in patients with less than or more than 6 months of alcohol abstinence before listing (76% [95% CI, 62%; 86%] vs 78% [95% CI, 70%; 83%]). No significant differences in quality-of-life scores were observed between groups (F(2,244) = 0.814, p = 0.435), and no significant changes in quality of life over time were found within each group (F(1,133) = 0.346, p = 0.557). The median (IQR) quality of life score at 36 months after transplantation was 80 (56-92) in patients with less than 6 months of abstinence before listing versus 78 (63-90) in those with more than 6 months of abstinence.</p><p><strong>Conclusion: </strong>Post-transplant survival and quality of life did not differ between patients with less than 6 months and those with more than 6 months of alcohol abstinence before being listed for liver transplantation. These findings suggest that the strict 6-month abstinence requirement for inclusion on the waiting list should be reconsidered to prevent patients from being denied access to life-saving transplantation solely because of a shorter abstinence duration.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4381"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865654","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":"Passive RSV immunisation using nirsevimab in neonatal care: a structured multidisciplinary approach and immunisation data from a Swiss tertiary centre.","authors":"Katalin Kalya, Jehudith Fontijn, Flurina Famos, Dirk Bassler, Nicole Ochsenbein-Kölble, Ladina Vonzun","doi":"10.57187/s.4689","DOIUrl":"10.57187/s.4689","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) infection is a major cause of severe lower respiratory tract infections in newborns and young infants, especially during the winter season from October to March. In Switzerland, RSV infection represents a leading cause of hospital admissions among newborns. Since October 2024, a long-acting monoclonal antibody, nirsevimab (Beyfortus®), has been available in Switzerland for standard care in newborns.</p><p><strong>Objectives: </strong>This paper presents a multidisciplinary, standardised protocol for the administration of nirsevimab, as well as immunisation data from the first season of application in 2024/25 at a tertiary centre in Switzerland.</p><p><strong>Methods: </strong>A protocol for implementing the RSV immunisation strategy was developed at University Hospital Zurich by a multidisciplinary team of obstetricians, neonatologists, nurses, from in- and outpatient services. The focus was on prenatal counselling during outpatient consultations as well as inpatient procedures on maternity and neonatology wards. The goal was to provide expectant parents with consistent information by different healthcare professionals. Neonatal immunisation data from the first season in 2024/25 (25 October to 31 March ) were retrieved from patient charts (Yes/No) in a retrospective, quality control, observational cohort study. All newborns discharged from the maternity ward or the neonatology unit of our centre were included in the analysis.</p><p><strong>Results: </strong>The protocol included early and multidisciplinary parental education, offering consistent oral and written information, as well as opportunities to discuss their questions regarding the new immunisation, ensured informed consent and enabled timely administration of nirsevimab by healthcare professionals in the obstetrics and neonatology units. Over the 2024/25 season, 78% of the newborns were immunised before leaving hospital care: 78% (588/758) of newborns discharged home from the maternity ward were immunised and 82% (125/153) of those discharged home from the neonatology unit were immunised.   CONCLUSION: The implementation of passive RSV immunisation was overall successful with an immunisation rate of around 80% for the first season in 2024/25.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4689"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865584","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":"Limitation of therapeutic efforts in internal medicine: a retrospective analysis of evolution and determinants (2013-2023) in a Swiss university hospital.","authors":"Malik Benmachiche, Claudio Sartori, Peter Vollenweider, Pedro Marques-Vidal","doi":"10.57187/s.4477","DOIUrl":"10.57187/s.4477","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background/aims: &lt;/strong&gt;In-hospital goals of care documentation is crucial for determining the adequate level of care in case of life-threatening emergencies. They might include limitation of therapeutic efforts, such as Do Not Resuscitate, Do Not Admit to intensive care unit (ICU) and Do Not Admit to intermediate care unit (IMCU) orders, or a \"comfort care only\" instruction. An ethical recommendation has recently been published to guide Do Not Resuscitate decisions, and several studies have shown a poor prognosis of frail multimorbid patients in case of critical illness. However, little is known on the use of limitation of therapeutic efforts other than Do Not Resuscitate in a hospital internal medicine population. We evaluated the evolution and determinants of the limitations of therapeutic efforts Do Not Resuscitate, Do Not Admit to ICU and Do Not Admit to IMCU between January 2013 and July 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We conducted a retrospective observational study in a Swiss university hospital internal medicine service. Overall, 51,569 hospital stays (28,273 patients) were included. We assessed the yearly prevalence of the different limitations of therapeutic efforts and searched for the determinants of each limitation of therapeutic effort through multivariable analysis with adjustments for year of hospitalisation, age, sex, religion, co-diagnoses, hospital length of stay, ICU or IMCU admission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The prevalence of Do Not Resuscitate, Do Not Admit to ICU and Do Not Admit to IMCU increased between 2013 and 2023 from 47.5%, 4.5% and 0.8%, respectively, to 58%, 31.4% and 14.6%. In multivariable analysis, the main factor associated with limitation of therapeutic efforts overall was older age, with odds ratios and 95% confidence intervals of 406 (329-501) (Do Not Resuscitate), 8.98 (7.93-10.2) (Do Not Admit to ICU) and 7.52 (6.25-9.05) (Do Not Admit to IMCU) for the &gt;85 relative to the 56-65 year subgroup. The comorbidities most associated with limitation of therapeutic efforts were metastatic cancer and dementia: 7.59 (6.54-8.82) and 5.49 (4.74-6.37), respectively, for Do Not Resuscitate; 2.19 (1.96-2.45) and 1.72 (1.59-1.87) for Do Not Admit to ICU; and 2.13 (1.81-2.50) and 2.10 (1.89-2.34) for Do Not Admit to IMCU. Male sex was associated with lower limitation of therapeutic efforts: 0.66 (0.61-0.72) for Do Not Resuscitate, 0.83 (0.79-0.88) for Do Not Admit to ICU and 0.84 (0.77-0.92) for Do Not Admit to IMCU.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The prevalence of limitation of therapeutic efforts in hospitalised medicine patients of our hospital increased during the past decade, with a remarkably large increase in limitation of admission to ICU (7-fold increase) and IMCU (18-fold increase). The main determinants of limitation of therapeutic efforts are older age, metastatic cancer and dementia. Reasons for the lower prevalence of limitation of therapeutic efforts in males shou","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4477"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865609","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":"Monitoring of antimicrobial stewardship implementation in Swiss hospitals: results from a national survey.","authors":"Marcus Eder, Vinciane Vouets, Alexandra U Scherrer, Simon Gottwalt, Philipp Jent, Laurence Senn, On Behalf Of The StAR-Consortium","doi":"10.57187/s.4860","DOIUrl":"10.57187/s.4860","url":null,"abstract":"<p><p>AIM: Antimicrobial stewardship (AMS) is essential to containing antimicrobial resistance. Under the Swiss Strategy on Antibiotic Resistance (StAR), a nationwide survey was conducted to assess antimicrobial stewardship implementation in acute care hospitals and inform future national stewardship strategies.</p><p><strong>Methods: </strong>A total of 136 acute care hospitals in Switzerland were invited to complete a questionnaire adapted from a validated Dutch tool and modified for the Swiss context. The questionnaire gathered information on whether a formal antimicrobial stewardship programme was present (primary outcome), institutional characteristics, as well as key antimicrobial stewardship activities (secondary outcomes) such as guideline implementation, education, raising awareness, prescription restrictions, and audits. Descriptive statistics and analyses compared the implementation of antimicrobial stewardship activities by the presence of a formal antimicrobial stewardship programme.</p><p><strong>Results: </strong>Sixty-nine hospitals completed the survey (response rate: 51%); these hospitals represent 67% of all patient discharges in Switzerland in 2023. Although 86% reported engaging in at least one antimicrobial stewardship activity, only 47% had a formal antimicrobial stewardship programme (primary outcome). Most institutions reported providing infectious diseases specialist consult services (93%), clinical pharmacy support (84%), and microbiology advice (78%). Treatment guidelines (90%) and monitoring antimicrobial use (85%) were widely implemented. However, critical stewardship measures such as prescription audits with feedback were underutilised (20%), and few hospitals (18%) had allocated dedicated staff resources for antimicrobial stewardship. Hospitals with formal antimicrobial stewardship programmes reported key activities such as guideline use, prescriber education, antimicrobial restrictions, and audits more frequently.</p><p><strong>Conclusion: </strong>This nationwide survey demonstrates encouraging progress in antimicrobial stewardship implementation since 2017, with most hospitals reporting stewardship activities and half having established a formal antimicrobial stewardship programme. However, critical gaps remain, highlighting the need for strengthened coordination and national support for hospitals to establish formal antimicrobial stewardship programmes to ensure the implementation and a sustainable impact of key antimicrobial stewardship activities.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"4860"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865631","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 digital stethoscope: Why Switzerland's Electronic Health Record requires citizen testing.","authors":"Barbara C Biedermann, Peter Grolimund, Bruno Wildhaber, Ernst Hafen","doi":"10.57187/s.5160","DOIUrl":"10.57187/s.5160","url":null,"abstract":"<p><p>Switzerland's Electronic Patient Record (EPR) system faces a critical adoption crisis: less than 2% of the population has opened an account despite years of investment. To understand this failure from the citizen's perspective, we launched the first \"expedition\" in which 120 volunteers (\"salutonauts\") systematically tested Switzerland's current digital health infrastructure by opening EPRs, requesting their health data and documenting their experiences. This represents the first real-world, citizen-led assessment of Switzerland's health data infrastructure. Our findings reveal three fundamental insights. First, citizens appreciate the concept of personally controlled health records governed by a trustworthy national framework. Second, the current EPR implementation is both impractical and economically untenable under existing conditions: opening an EPR nationwide would cost CHF 400 million (calculated from required man-hours alone), while uploading historic documents would cost CHF 1 billion, and obtaining insurance claims data would cost over CHF 5 billion in lost productivity. Third, the recently announced draft of the new Electronic Health Dossier Law (E-GD) comes at a critical moment, since evidence-based redesign of the EPR system is essential. 95% of participants valued comprehensive medical checkups producing structured data, demonstrating citizens' appetite for high-quality digital health records when they provide tangible benefits. Our expedition methodology, which is agile, citizen-centred and involves real-world testing, offers a replicable model for evaluating digital health initiatives before massive implementation costs are incurred. With the E-GD revision underway, Switzerland has a unique opportunity to develop an EPR system that serves patients and physicians above all. Successful implementation requires EPR opening at birth by default (with the ability to opt-out), the AI-powered automation of data collection and uploading, seamless healthcare professional interfaces, and using the EPR as the billing data gateway. The alternative - i.e. continuing the current approach - virtually guarantees failure based on economic factors alone.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"5160"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865591","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}