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Volume 155, No. 5

Published May 1, 2025

Review article: Biomedical intelligence

  1. Damiano Bianda, Lars C. Huber, Johannes Trachsler, Mattia Arrigo (Author)

    Effects of chronic alcohol use disorder and alcohol withdrawal on phosphate, magnesium, and calcium

    In addition to frequent hyponatraemia, excessive and chronic alcohol consumption can lead to disturbances in phosphorus, magnesium and calcium balance.

    Due to the close physiological interactions between phosphorus, magnesium and calcium, changes in one or more of these substances can lead to a life-threatening vicious cycle.

    Electrolyte imbalances are common during alcohol withdrawal and require careful monitoring and treatment.

Systematic review

  1. Jasmin Huser, Tamara Dörr, Alisa Berger, Philipp Kohler, Stefan P. Kuster (Author)

    Economic evaluations of antibiotic stewardship programmes 2015–2024: a systematic review

    BACKGROUND: Numerous studies have demonstrated the effectiveness of Antibiotic Stewardship Programmes in reducing antibiotic resistance and healthcare costs. However, the use of different methods to assess these costs, along with the uncertainty regarding which interventions are cost-effective, hampers the comparison of results and the formulation of clear recommendations. The aim of this systematic review was to provide a comprehensive overview of the available evidence on economic evaluations of Antibiotic Stewardship Programmes and to assess their impact on healthcare costs.

    METHODS: The systematic review analysed articles indexed in Medline, Embase, Cochrane Reviews and Trials, Business Source Premier or EconLit that assessed the attributed economic impact of Antibiotic Stewardship Programme interventions in acute care settings and were published between 2015 and 2024. Studies identifying as economic analyses, cost-benefit analyses, cost-effectiveness analyses, cost-consequence analyses, cost analyses or cost-minimisation analyses and that fulfilled the essential parameters required for an economic analysis were included. A descriptive analysis was conducted to examine the impact of the interventions on overall costs, length of stay and antimicrobial costs. We also analysed the different kinds of interventions and the type of costs considered in the analyses. Study quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, version 2022.

    RESULTS: A total of 2965 publications were identified, of which 411 underwent full-text screening. The 27 studies ultimately included involved 20,232 patients in total and consistently demonstrated savings in antibiotic costs ranging from 2% to 95% relative cost savings, in length of stay costs (3% to 85%) and in overall hospital costs (3% to 86%). The intervention most frequently implemented was “therapy evaluation, review and/or feedback” (23/27, 85%), followed by “alteration of therapy guidelines” (8/27, 30%) and “education” (6/27, 22%). While operational costs were reported by all studies, implementation costs (8/27, 30%) and societal costs (3/27, 11%) were less frequently analysed. By CHEERS category, 9 (33%) of the included studies were rated as low-quality (<60%), 16 (59%) as medium-quality (60–80%) and 2 (7%) as high-quality (>80%).

    CONCLUSIONS: Our results emphasise that Antibiotic Stewardship Programmes may contribute to a substantial reduction in healthcare costs for a hospital. While the economic reporting in the field has recently improved, certain cost categories should be accounted for more consistently. There remains considerable potential for further improvement and standardisation to enhance the comparability of studies and facilitate the implementation of effective Antibiotic Stewardship Programmes.

Original article

  1. Joëlle Roos, Annina Bauer, Alexandra Griessbach, Regina Grossmann (Author)

    Socio-demographic and clinical factors affecting General Consent status and choice: insights from a cross-sectional study of University Hospital Zurich patients

    BACKGROUND: Hospitals in Switzerland accumulate substantial clinical data with enormous potential for medical research. The General Consent concept allows patients to contribute their health-related data and biological samples for future research projects. However, General Consent is a complex, multi-disciplinary concept influenced by ethical and legal considerations. At the University Hospital Zurich, Switzerland, General Consent status (known/unknown) and choice (yes/no) have been documented since 2015 and have demonstrated consistent increases in coverage rates. This study investigated socio-demographic factors influencing General Consent status and choice to enhance patient communication and refine the General Consent process at the University Hospital Zurich.

    METHODS: We assessed the effect of socio-demographic and clinical factors on General Consent status (known/unknown) and General Consent choice (yes/no) through logistic models and volcano plots. Patients who first visited University Hospital Zurich between January 1, 2018 and June 30, 2019 (pre COVID-19), or between July 1, 2020 and December 31, 2021 (during the COVID-19 pandemic) were included for analysis. Investigated factors included the type of visit, sex, age, nationality, religion, civil status, resuscitation preferences and living-will status, health insurance category and number of International Statistical Classification of Diseases and Related Health Problems, Version 10 (ICD-10) diagnoses. De-identified data from the University Hospital Zurichʼs clinical record system (KISIM) were used.

    RESULTS: A total of 162,168 patients were included for analysis. The type of visit (in-patient or out-patient), number of diagnoses, existence of a living will and religious preference were associated with General Consent status (known/unknown). Religious preferences were also found to influence General Consent choice.

    CONCLUSION: This study identified significant differences in General Consent status between in-patients and out-patients at the University Hospital Zurich, with in-patients more likely to have an unknown General Consent status. To address this, we recommend reviewing the administrative process and documentation practices related to General Consent. Our results also indicated that patients actively involved in their medical decisions and those with multiple co-morbidities were more likely to have a known General Consent status. This is likely attributable to their increased health concerns and more frequent interactions with healthcare providers. Enhancing patient and physician understanding of General Consent can improve coverage rates and promote informed consent. However, further research is needed to explore cultural differences that may influence General Consent decisions. Ultimately, streamlining administrative procedures and implementing targeted educational initiatives will improve the understandability of the General Consent process and encourage greater participation in medical research.

  2. Daniela Neudecker, Ekkehardt Altpeter, Nicole Ritz, Nora Fritschi (Author)

    Sex distribution in tuberculosis disease in children, adolescents, and adults in a low-incidence country: a retrospective population-based cohort study

    AIM: Globally, tuberculosis incidence shows notable sex disparity, with higher rates observed in males. While this pattern is well documented in adults from high-incidence countries, the influence of sex on tuberculosis incidence in children and adolescents, particularly in low-incidence settings, remains unclear. This study investigated sex-specific tuberculosis incidence rates across all age groups, focusing on adolescents, in a low-incidence country.

    METHODS: In this retrospective cohort study, data from the Swiss Federal Office of Public Health (FOPH) tuberculosis database, which centrally consolidates mandatory notifications from physicians and laboratories across Switzerland, were analysed from 2000 to 2021. Tuberculosis incidence rates and male-to-female ratios were calculated and stratified by sex and age. Adolescence was divided into early (10–14 years) and late (15–19 years) stages for detailed analysis.

    RESULTS: Over 22 years, the average tuberculosis incidence in Switzerland was 6.78 per 100,000 population, with an overall male-to-female ratio of 1:0.75 (p <0.001). Among the 11,872 notified cases, 832 occurred in adolescents, yielding an incidence rate of 4.39 per 100,000. In late adolescence, males had a significantly higher tuberculosis incidence rate (5.73 per 100,000) than females (2.97 per 100,000, p <0.001), resulting in a male-to-female ratio of 1:0.5. Additionally, data on asylum seekers revealed nearly twice as many males as females arriving in Switzerland in late adolescence.

    CONCLUSIONS: This study reveals significant sex disparity in tuberculosis incidence in a country with low tuberculosis incidence, with males showing higher rates than females beginning in late adolescence. This discrepancy is likely influenced by the higher influx of male asylum seekers in adolescence.

  3. Eric Adler, Yasemin Krucker, Mirjam Kolev, Nasser Semmo (Author)

    Active hepatitis B virus vaccination in the prevention of viral reactivation in liver transplantation recipients with previous hepatitis B infection: a cohort study

    BACKGROUND AND AIM OF THE STUDY: For many years, the standard treatment following liver transplantation for hepatitis B has been a combination of hepatitis B immunoglobulin and nucleos(t)ide analogues such as entecavir and tenofovir. However, because of the high costs and logistical challenges of long-term hepatitis B immunoglobulin use, alternative approaches such as vaccination and hepatitis B immunoglobulin-free regimens are being explored. This study gathered information on a potential response (or lack thereof) and addressed the adverse events associated with active immunisation in liver transplant recipients in a Swiss cohort with hepatitis B virus (HBV)-related diseases after discontinuing hepatitis B immunoglobulin.

    METHODS: Participants were recruited at the University Hospital of Bern between January 2022 and December 2023. Eligibility was restricted to liver transplant recipients with HBV-related disease who were receiving hepatitis B immunoglobulin and nucleos(t)ide analogue therapy at the time of study entry. The primary outcome was HBV relapse following hepatitis B immunoglobulin discontinuation; secondary outcomes included the response rate to active immunisation and reported adverse events. After exclusion, 18 patients were analysed. These patients, under ongoing immunosuppression and antiviral nucleos(t)ide analogue therapy, received active immunisation a minimum of 4 weeks after stopping hepatitis B immunoglobulin. Blood samples were collected at baseline and 4 weeks after vaccination, with follow-up extending for at least 12 months. Responders were defined as those with anti-HB levels of >10 IU/l. All patients received at least three vaccinations.

    RESULTS: Six patients responded to the active immunisation with anti-HBs development, showing a response rate of 33.3%. No side effects or HBV recurrence were reported during the study period.

    CONCLUSION: In this cohort, following liver transplantation for hepatitis B, patients who discontinued hepatitis B immunoglobulin while continuing nucleos(t)ide analogue therapy showed no relapse of hepatitis B, and a double-dose vaccination regimen yielded a modest response rate. These findings warrant further investigation into optimising vaccination strategies in this population.

  4. Fabienne Schwitz, Joy Backhaus, Monika Brodmann Maeder, Eva K. Hennel (Author)

    Supervisors’ self-assessment of feedback skills: a psychometric validation study of the English version of the SwissSETQ questionnaire for supervisors

    STUDY AIMS: We created an instrument to assess the supervisors’ perspective on their feedback behaviour to residents and investigated its validity. Our instrument is based on the SETQsmart, a Dutch instrument for assessing the quality of supervision in clinical training and the SwissSETQ, its German adaptation for residents. Our instrument is in English to ensure relevance across all Swiss language regions. The study specifically sought: to replicate the factor structure of the original trainee questionnaire for supervisors; to verify the alignment of SwissSETQ and SETQsmart domains with the factor structure; and to evaluate the psychometric properties of the English version.

    METHODS: The original SwissSETQ was translated into English, maintaining the Swiss context and local language usage. The questionnaire was adjusted to reflect the supervisor’s perspective. The translated questionnaire was then distributed among supervisors in all Swiss cardiology training sites, and data were collected using the SoSci Survey platform between March and April 2024. The statistical analysis, including exploratory factor analysis (EFA) with promax rotation, Bartlett’s test of sphericity, Kaiser-Meyer-Olkin (KMO) coefficient and psychometric evaluation, was conducted using R software.

    RESULTS: Of approximately 600 cardiology supervisors in Switzerland, 207 responded, with 135 valid cases remaining after data cleaning. The factor analysis identified three factors: Teaching structure, Attitude of the supervisor and Role modelling, resulting in a shortened 23-item questionnaire. The Kaiser-Meyer-Olkin coefficient was 0.83, and Bartlett’s test was significant, confirming data suitability for factor analysis. The factors demonstrated high internal consistency, with Cronbach’s α values of 0.89, 0.77 and 0.87, respectively. The partial credit model indicated the need for a revised 5-point Likert scale for better response distribution. No significant differences were found between factors and sociodemographic variables, suggesting the English version’s applicability across all Swiss language regions.

    CONCLUSIONS: The study investigated the English-translated and supervisor-adapted version of the SwissSETQ, demonstrating good psychometric properties and a clear factor structure. The instrument is suitable for use across different Swiss language regions, enhancing its utility in a multilingual context. The findings support the potential of the SwissSETQ to facilitate cross-cultural and cross-linguistic collaboration in medical training. Future research should explore additional factors influencing teaching quality, such as work environment and supervisor motivation.

  5. Monika Hagemann, Barbara Janina Kidszun, Matthias Schwenkglenks, Odile Stalder, Steffen Eychmüller, Maud Maessen (Author)

    Treatment goals indicate palliative care hospital costs: a longitudinal economic study

    STUDY AIMS: Although costs for inpatient palliative care have been widely studied, heterogeneity of patient needs in specialist palliative care challenges health scientists. A framework reflecting various treatment goals in daily clinical practice may help cluster patients with different care needs reasonably and account for such diversity of costs. The aim of this study was to show whether the care type framework reflects associated costs for different care needs in patients receiving specialist palliative care in a Swiss university hospital.

    METHODS: We performed a retrospective, observational analysis of hospital costs using administrative data from a Swiss university hospital of all specialist palliative care inpatients in the period 2016–2022. Patients were classified at admission into four different palliative care types reflecting treatment goals: care type 1: extensive palliative care needs (biopsychosocial-spiritual), goal = stabilisation and setting of realistic goals; care type 2: mobility evaluation and training, goal = return home; care type 3: focused symptom management, goal = symptom relief; care type 4: care for dying patients, goal = dying with dignity. We used a generalised linear model assuming gamma-distributed errors and with a logarithmic link function, adjusted by inverse probability weighting to adjust for differences in patient characteristics. We hypothesised that patients – classified into one of four care types based on treatment goals – differed substantially by cost, with care type 1 being most expensive.

    RESULTS: Of 1099 included patients, overall unadjusted median costs per patient during specialist palliative care treatment were CHF 20,253 (interquartile range [IQR] 12,327–30,104). Median costs (% of total patients; median length of stay) by care type were: CHF 23,999 for care type 1 (44%; 13 days); CHF 21,598 for care type 2 (9%; 14 days); CHF 17,946 for care type 3 (24%; 12 days); and CHF 14,997 for care type 4 (23%; 8 days). Patients showed clearly different adjusted overall costs and adjusted daily costs by care type. Overall potential mean costs were the lowest for care type 4 (CHF 21,908) and clearly different (-15%) from the most expensive care type 1 (CHF 25,827). In contrast, potential mean daily adjusted costs were the most expensive for care type 4 (CHF 2361). Most daily costs for care type 4 (88%) belonged to the cost category “staff costs” (CHF 2070) of which 59% (CHF 1229) were nursing costs.

    CONCLUSION: Based on distinct treatment goals, care types provide an important yet – until now – missing explanatory framework for clustering hospital costs of specialist palliative care. Patients hospitalised in specialist palliative care units clearly differ regarding costs and cost categories, depending on care type.

  6. Annika Bonin, Robert Escher, Neal Breakey (Author)

    Evolution of adult respiratory syncytial virus detection: impact of testing strategy changes and pandemic-related measures at a Swiss regional hospital, 2016–2023

    BACKGROUND AND AIMS: Respiratory syncytial virus (RSV) is increasingly recognised as an important cause of respiratory illness in adults. We aimed to analyse clinical and epidemiological characteristics of patients with a positive reverse transcription–polymerase chain reaction (RT-PCR) test in a Swiss regional hospital between 2016 and 2023, including predisposing factors, patient demographics, treatment approaches and clinical outcomes. We also examined temporal patterns of RSV detection during periods of changes in testing strategies and public health measures.

    METHODS: In this retrospective cohort study at Spital Emmental, we analysed all consecutive in- and outpatients with respiratory symptoms who underwent nasopharyngeal RT-PCR testing following local syndrome-based testing protocols between December 2016 and February 2023. The testing methodology changed from trivalent (influenza A/B, RSV) to quadrivalent (SARS-CoV-2, influenza A/B, RSV) RT-PCR in March 2022, with simultaneous expansion of the testing criteria. Temporal patterns and incidence of positive RSV tests relating to periods of national COVID-19-related public health measures (13 March 2020 and 17 February 2022) were assessed.

    RESULTS: Of 8135 RT-PCR tests performed, 231 (2.8%) were positive for RSV. The mean age was 69 years, with complete clinical data available for 194 patients. Of these, 157 (81%) required hospitalisation, of whom 19 (12%) were classified as nosocomial infections. Of the hospitalised patients, 14 (9%) required intensive care, with an in-hospital mortality rate of 6%. Major comorbidities in inpatients included cardiac disease (54%), pulmonary disease (49%) and anaemia (43%). Testing patterns showed marked temporal variation: 1766 tests (22%) were performed pre-pandemic, 125 (1%) during pandemic measures and 6244 (77%) after pandemic restrictions were lifted. The introduction of quadrivalent testing in March 2022 led to an increase in testing volume, but lower positivity rates (6% pre- vs 2% post-implementation).

    CONCLUSIONS: Our results demonstrate RSV-associated resource use and mortality in adults. The temporal evolution of RSV detection in our cohort paralleled changes in testing practices, highlighting the complex interplay between diagnostic strategies and observed disease patterns in a regional hospital setting. Recently introduced preventive vaccination strategies may help to address the impact on patients and healthcare resource utilisation.

  7. Serena Petrocchi, Qianfeng Lu, Luca Gabutti, Sandro Bonetti, Mjriam Rodella Sapia, Franco Denti, Mario Bianchetti, Peter Schulz (Author)

    Mediation effects of attitudes on the generational and gender influence on Swiss General Practitioners’ home visits: a cross-sectional study

    BACKGROUND: In family medicine, home visits are a tangible manifestation of patient-centred care, allowing physicians to comprehensively understand patients’ circumstances and cater to their medical and psychosocial needs. However, a recent decline in general practitioner home visits has raised significant concerns about the potential impact on care quality, particularly for older patients. General practitioners’ age, gender and attitudes may play a role. Attitudes refer to positive or negative thinking or feelings about something typically reflected in a person’s behaviour.

    AIMS: To study the effects of age and gender (i.e. predictors) on the number of home visits conducted during a typical week of work (i.e. outcome) by general practitioners in Canton Ticino, Switzerland. To investigate whether attitudes (i.e. mediators) mediate the relationship between age and home visits, controlling for gender.

    METHODS: A cross-sectional study was conducted from June to October 2023 on 142 family doctors (28% women) with an average age of 56.42 years (standard deviation [SD] = 11.51, range 36–83). Correlations between variables and a t-test with gender were conducted. A mediation analysis was performed to examine the potential association in which the attitudes may mediate the relationship between age and home visits, controlling for gender.

    RESULTS: Older physicians conducted more home visits in a typical week (r = 0.32, p <0.001) than younger physicians, while female doctors conducted fewer visits (M = 2.39±1.8) than males (M = 4.09±2.9), t(100.8) = 3.77, p <0.001. The mediation analysis suggested that younger general practitioners tend to have more negative attitudes towards home visits, which in turn leads to a decrease in the number of home visits they make in a typical week (indirect effect B = 0.02).

    CONCLUSION: There is a generational and gender effect on home visit practice in family medicine. Moreover, younger doctors hold more negative attitudes towards home visits.

  8. Noelle Stalder, Ulrich Heininger, Michael Buettcher (Author)

    Surveillance of varicella-associated paediatric hospitalisations and complications in Switzerland from 2021 to 2023

    AIM: To prospectively assess varicella zoster virus-associated disease burden in hospitalised children 0–16 years of age prior to the introduction of universal varicella vaccination in Switzerland.

    METHODS: We performed an observational, prospective surveillance study. Anonymised data (clinical characteristics, diagnostics, treatment and outcome) of hospitalised children were available from monthly active case reporting by 29 paediatric clinics and hospitals to the Swiss Paediatric Surveillance Unit from July 2021 to June 2023.

    RESULTS: During the 2-year study period, 239 children were hospitalised with varicella (n = 224; 94%) or herpes zoster (n = 15; 6%). Mean age was 5 years, median 4.7 years (range 0–16 years). In 13 patients, varicella was concomitant and not the primary reason for hospitalisation. 199 patients (83%) were primary healthy, 138 were male (58%). Mean duration of hospitalisation for varicella patients was 5.7 days. Of the 224 children with varicella, 211 (94%) were primary hospitalised due to varicella, 120 (54%) had acute skin complications (including 52 Streptococcus pyogenes infections), 29 (13%) musculoskeletal and 27 (12%) neurological complications. Two patients (1%) had ischaemic strokes. 33 (14%) patients (32 with varicella and 1 with herpes zoster) required intensive care treatment (mean duration 3.5 days). 40 patients with varicella (18%) required surgical interventions. Two (1%) patients died. The calculated hospitalisation incidence rate was 7.2 per 100,000 for children and the calculated hospitalisation rate was 12.6 per 10,000 cases.

    CONCLUSIONS: Varicella is associated with considerable morbidity, particularly in primary healthy children. Complications affecting the skin (mainly secondary bacterial infections), musculoskeletal and neurological systems are the main reasons for hospitalisation and may cause death even in previously healthy, immunocompetent children. The baseline burden of disease presented herein will permit evaluation of the impact of universal varicella vaccination, introduced in Switzerland in January 2023.

  9. Silvia Valisena, Giacomo De Marco, Oscar Vazquez, Anne Tabard-Fougère, Nastassia Guanziroli-Pralong, Christina Steiger-Tuc, Romain Olivier Dayer, Dimitri Ceroni (Author)

    Demographic distribution and injury patterns of ankle physeal fractures in children: a retrospective cohort study

    INTRODUCTION: Ankle physeal fractures are a significant concern in paediatric populations due to their potential to cause growth disturbances, including premature physeal closure. The present study aimed to describe the epidemiology and injury patterns of ankle physeal fractures in children treated at a single university hospital centre in Switzerland over a 19-year period.

    MATERIALS AND METHODS: This retrospective cohort study included children aged 0 to 16 years who were admitted to our institution for an ankle physeal fracture between January 2004 and April 2023. Demographic and radiological data were collected, and fractures were classified according to the Salter-Harris and Dias-Tachdjian classifications. Statistical analyses, including Fisher’s exact test, were performed for dichotomous outcomes, with significance set at p<0.05.

    RESULTS: We included 259 patients with a mean age of 12.3 years old, mostly males (58.7%), with most fractures occurring among boys aged 14 and girls aged 12. Sports-related activities accounted for 51% of fractures, with the highest incidence in autumn. Isolated fractures of the distal tibia were most common (47.1%), and Salter-Harris type II fractures represented 51% of cases (p <0.05). The predominant mechanism of injury was supination–plantar flexion (33.6%).

    CONCLUSION: This study provided a comprehensive overview of the distribution and patterns of paediatric ankle physeal fractures. It underscored the need for future prospective multicentre studies to explore causative factors and outcomes related to growth disturbances. Targeted prevention and management strategies may help mitigate the incidence and consequences of these injuries.

  10. Loric Stuby, Laurent Bourgeois, Jean-Marie Tinembart, Elisa Mühlemann, David Thurre, Johan N. Siebert, Laurent Suppan (Author)

    Effect of intermediate airway management on ventilation parameters in simulated paediatric out-of-hospital cardiac arrest: a multicentre randomised crossover trial

    INTRODUCTION: Paediatric out-of-hospital cardiac arrest survival rates remain low despite advancements in resuscitation science. Prompt restoration of oxygenation is crucial for achieving return of spontaneous circulation. Delays in airway management are associated with decreased survival rates. The primary objective of this study was to determine whether early i-gel® insertion, without prior bag-valve-mask, could enhance ventilation parameters in comparison with a bag-valve-mask-only approach.

    METHODS: This multicentre, randomised crossover study used a simulated paediatric out-of-hospital cardiac arrest model to compare standard American Heart Association guidelines with an intermediate airway management approach using an i-gel® device. Paramedics and emergency medical technicians from eight participating emergency medical service centres were randomised into teams and performed two 10-minute simulations. Each team employed one of the airway management strategies. Data was automatically collected by a high-fidelity manikin. The primary outcome was alveolar ventilation per minute. Secondary outcomes included metrics for ventilation quality and timing, chest compression performance and timing of adrenaline administration. Statistical analysis involved paired tests suitable for the crossover design.

    RESULTS: From 30 January 2023 to 13 June 2023, 68 participants formed 34 resuscitation teams. Minute alveolar ventilation was similar between intermediate airway management and bag-valve-mask strategies (difference: 36 ml [95% CI −28 to 99]). A sensitivity analysis showed comparable results. Intermediate airway management delivered more ventilations, but bag-valve-mask enabled quicker ventilation initiation and more ventilations within the target volume. Chest compression fraction was higher with intermediate airway management, although chest recoil was better with bag-valve-mask. Adrenaline administration rates and times were similar in both strategies. Minor protocol deviations were observed but did not introduce significant bias. The study was underpowered due to an error in the sample size calculation, limiting the robustness and generalisability of the findings.

    CONCLUSION: In a simulated paediatric out-of-hospital cardiac arrest model, immediate use of intermediate airway management did not show relevant differences compared to bag-valve-mask. Intermediate airway management devices cannot be recommended as first-line choice but may be considered when bag-valve-mask is challenging. Whichever device is used, the focus should remain on providing high-quality ventilations.

    ClinicalTrials.gov ID: NCT05498402

  11. Taru Singhal, Kaja Widmer, Anton Beloconi, Suzanne Dhaini, Matthias Schwenkglenks, Cordula Blohm, Rolf Weitkunat, Sabina De Geest, Penelope Vounatsou (Author)

    Mortality atlas of the main causes of death for the elderly population (≥75 years) in Switzerland during 2010–2020

    BACKGROUND: Mortality atlases provide insight into the health burdens a society is facing and help visualise them spatially. Here we estimate the geographical distribution of different mortality causes in the elderly population (≥75 years) in Switzerland. Knowledge of the spatial patterns enables better identification of high-risk areas for specific causes of death and potential risk factors, and can help guide policy, allocate resources and raise awareness in a more targeted manner.

    METHODS: We analysed Swiss mortality data, provided by the Swiss Federal Statistical Office, for the elderly population (≥75 years) for the period 2010–2020. We employed Bayesian spatial models for areal data to produce smoothed maps presenting the age- and sex-adjusted standardised mortality rates for the 25 main causes of death at the municipality level. Additionally, we evaluated the effects of language, urbanisation and income levels on cause-specific mortality.

    RESULTS: Language regions are associated with mortality rates for many causes of death. In particular, the French-and Italian-speaking regions are associated with a lower burden of mortality due to cardiovascular diseases and diabetes compared to German-speaking Switzerland, but this is offset by increased rates of certain cancers. In 2020, most COVID-19 deaths were concentrated in the French- and Italian-speaking regions. Higher income levels tend to be a protective factor for most causes of death.

    CONCLUSIONS: We have provided the first model-based mortality maps focusing on the elderly population (≥75 years) in Switzerland. Our estimates identify areas with the highest cause-specific mortality rates and indicate potential health services that are needed in specific areas. The maps can also raise awareness of the most prominent health problems of the ageing population in different parts of the country and guide targeted health interventions.

  12. Sylvie Anne Genier, Gessica Trivelli, Vera Ruth Mitter (Author)

    Intrapartum antibiotic prophylaxis for Streptococcal B colonisation: a cross-sectional study of hospital internal protocols in Switzerland

    STUDY AIMS: Streptococcus agalacticae is a pathogen associated with maternal and neonatal morbidity and mortality. The current gold standard for preventing neonatal sepsis is the intrapartum antibiotic prophylaxis (IAP) of Streptococcus agalacticae-positive mothers. Antimicrobial resistance is on the rise and increasingly threatens public health. Therefore, the responsible use of antibiotics is critical. Switzerland lacks unified IAP guidelines. IAP management varies by obstetric ward and is based on various national and international guidelines. This study aimed to gain an overview of the variability of existing internal protocols for IAP for Streptococcus agalacticae in Swiss obstetrics wards.

    METHOD: In March and April 2024, all identified obstetric wards in Switzerland were contacted and invited to submit their internal protocols so that they could be analysed for the choice of antibiotics for IAP, the referenced literature supporting their protocols and the professions involved in their development.

    RESULTS: Of 87 departments contacted, 43 (49%) shared their protocols. Three β-lactam antibiotics were identified as the first choice: penicillin G (56%, n = 24), amoxicillin (28%, n = 12) and co-amoxicillin (9%, n = 4). In 19% of the protocols (n = 8), there was no distinction between mild or severe allergy to penicillin derivatives. In this group (n = 8), 75% (n = 6) administered clindamycin as the second choice, with 50% (n = 3 of 6) offering vancomycin as an alternative in cases of known clindamycin resistance or allergy. In the group with allergy severity classification (n = 35), first- and second-generation cephalosporins were preferred for mild penicillin allergy: 71% (n = 25) used cefazolin, 26% (n = 9) used cefuroxime and erythromycin was mentioned by n = 1. In 21 of the 33 received protocols with references, Expert Letter No. 19 from the Swiss Society of Gynaecology and Obstetrics (SGGG) was referenced, making up 64 % of the used literature. This was followed by other literature (58 %, n = 19) and the revised guidelines of the Swiss Society of Neonatology in collaboration with the Paediatric Infectious Disease Group Switzerland (PIGS) (30 %, n = 10). Mostly gynaecologists (90%; n = 28 of 31) were involved as authors of internal protocols. Neonatologists were not mentioned by any.

    CONCLUSION: Our study highlights that the management of intrapartum antibiotic prophylaxis is heterogeneous, and antimicrobial stewardship is lacking in most Swiss obstetric wards. In terms of literature, German-speaking wards in Switzerland are more orientated towards German-speaking neighbouring countries than French- and Italian-speaking wards. There is a need to enhance interdisciplinarity in the development of internal protocols and to create a joint national guideline among professional societies.

  13. Flavia Breitenmoser, Aaron Rixecker, Rahel Naef, Pascal Probst, Nils Horn, Markus K. Müller, Alexander Dullenkopf, JoEllen Welter (Author)

    Persistent opioid use among patients who underwent intermediate-to-major elective surgery at a Swiss cantonal hospital: a prospective cohort study

    STUDY AIM: To investigate the extent of persistent opioid use among patients undergoing intermediate-to-major elective surgery at a Swiss cantonal hospital and as a secondary aim to identify factors potentially predictive of persistent opioid use (6 to 12 weeks after surgery).

    METHODS: For this single-centre prospective cohort study, all consecutive patients undergoing elective primary hip arthroplasty, partial or complete prostatectomy, caesarean delivery, spinal surgery, intermediate-to-major visceral surgery or major hand surgery were screened for enrolment from June 2022 to May 2023. We collected basic demographic and medical data, perioperative opioid use (converted to morphine milligram equivalents), postoperative complications, and opioid prescriptions issued by the hospital or other healthcare providers. Telephone interviews about opioid use were conducted with patients 6 weeks after surgery. Only those patients who were still taking opioids at the 6-week interview were contacted 12 weeks after surgery. The primary endpoint was the rate of persistent opioid use 6 or 12 weeks after surgery, and the secondary endpoints were (a) the percentage of patients who received and reported filling prescriptions, and (b) the type and amount of opioids dispensed. With persistent opioid use as the dependent variable, bivariate (predictors: pain or preoperative morphine milligram equivalent) and multivariate logistic regression models were used to assess associations (predictors: age, sex, ASA [American Society of Anesthesiologists] score, preoperative pain).

    RESULTS: A total of 855 patients were included in the main analysis. Median age was 62 years (interquartile range [IQR] 45–73), 52% were male and postsurgical complications occurred in 51 patients (6%). Fifty-six patients (7%) were preoperative opioid users. At discharge, 40 patients (5%) received an opioid prescription. Of the 724 patients who completed the 6-week follow-up interview, 30 (4%) had filled an opioid prescription (17 hospital-issued, 9 from an external source and 4 from both). Of the 30 patients (4%) who took opioids, the median length of consumption was 7 days (IQR 3–18). Seventeen patients (2%, 9 preoperative users) were taking opioids after 6 weeks. Seven of these 724 patients (1%, 5 preoperative users) continued use at 12 weeks postoperatively. Bivariate logistic regression analyses showed preoperative pain levels (at rest and during movement) were associated with persistent opioid use (odds ratio [OR] 1.27, 95% confidence interval [CI]: 1.11–1.46, p = 0.001; OR 1.3, 95% CI: 1.12–1.5, p = 0.001, respectively), as were 6-week postoperative pain levels (OR 1.96, 95% CI: 1.61–2.39, p <0.0001; OR 1.82, 95% CI: 1.52–2.18, p <0.0001, respectively). The median preoperative morphine milligram equivalent of persistent opioid users was 60 (IQR 30–180) versus 22.5 (IQR 15–30) in non-persistent users (p = 0.0155). There was a slight positive association between higher preoperative morphine milligram equivalent dosage and persistent postoperative opioid use (OR 1.024, 95% CI: 1.003–1.0456, p = 0.023), with a 2.4% increase in the likelihood of prolonged use per morphine milligram equivalent unit. After controlling for potential confounding factors, multivariate logistic regression analyses indicated associations with higher ASA score (OR 11.8, 95% CI: 2.48–56.51, p = 0.002) and preoperative pain levels (OR 1.23, 95% CI: 1.05–1.43, p = 0.008).

    CONCLUSIONS: Only a small proportion (1%) of surgical patients continued opioid use 12 weeks after intermediate-to-major elective surgery, with an even much lower proportion (0.3%) having been opioid-naive before surgery. This low rate of prolonged opioid use may be due to the restrictive prescription policy of the centre and local healthcare providers.

  14. Michelle Dey, Thomas Volken, Szilvia Altwicker-Hámori, Michael von Rhein, Michelle Seiler, Ursula Laasner, Frank Wieber, Julia Dratva (Author)

    Did the COVID-19 pandemic impact paediatric health service utilisation in Switzerland? Interrupted time-series models of health insurance data

    BACKGROUND: There is a scarcity of studies that examined the impact of the COVID-19 pandemic on different primary paediatric health services beyond the first pandemic year and with longitudinal analytical approaches. Concerning Switzerland, studies are also lacking that assessed the impact of the pandemic on primary paediatric health services with objective and representative data. The current study addresses these research gaps.

    METHODS: Representative Swiss health insurance data (covering 96% of the population) of 0–18-year-olds, aggregated by month and by age groups 0–5, 6–10, 11–15 and 16–18 years were used for the analyses. The study period was from January 2018 to March 2022. Interrupted time-series models were applied to compare pandemic and pre-pandemic health care utilisation. The first lockdown served as the point of differentiation between these two periods. Regular visits, urgent visits, well-child visits and telephone consultations as well as routine vaccinations in the primary care setting were used as outcomes.

    RESULTS: Among 0–5-year-olds, the average utilisation rates of regular, urgent and well-child visits were statistically significantly lower during the pandemic compared to the pre-pandemic period. This decrease in utilisation was primarily due to an initial marked drop after the lockdown, followed by a partial recovery during the pandemic phase. Additionally, the average vaccination rates for measles/mumps/rubella were statistically significantly lower during the pandemic for this age group, without indication of a catch-up over the pandemic phase. For 6–10-year-olds, a decreased average utilisation of regular and urgent visits was found without a statistically significant recovery over the pandemic period. No statistically significant changes were shown for older age groups regarding regular or urgent visits. However, telephone consultations showed statistically significantly higher average utilisation rates during the pandemic compared to the pre-pandemic phase across all age groups.

    CONCLUSIONS: Delayed or missed well-child visits, which might persist even after a certain recovery, pose the risk of delayed detection of clinical/developmental abnormalities. Furthermore, missed vaccinations for measles/mumps/rubella increase the likelihood of infections and outbreaks, which can be particularly dangerous for the youngest children. Therefore, promoting catch-up well-child visits and vaccinations is essential. Higher utilisation of telephone consultations during the pandemic may have partially compensated the underutilisation of face-to-face consultations/visits in young children. In adolescents, in whom no changes in the utilisation of face-to-face consultations were observed, the increased use of telephone consultations may indicate an increase in health concerns within this age group.

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