The Lausanne University Hospital (French: Centre hospitalier universitaire vaudois, CHUV), in Lausanne, is one of the five university hospitals in Switzerland.The Lausanne University Hospital is linked to the Faculty of Biology and Medicine of the University of Lausanne (UNIL).The CHUV's medical services benefit over 45,000 patients a year. Almost 3000 babies are born every year in the obstetrics department. Approximately 9000 employees work at the CHUV.The university hospital acts as a general university hospital for people living in the Lausanne area, covering all areas of medical treatment. It also serves as a hospital offering acute and specialist care for the whole Canton of Vaud and parts of French-speaking Switzerland.In 2019, the university hospital was rated as the leading hospital in Switzerland and 9th best hospital in the world by Newsweek Magazine.
Following the new ESPEN Standard Operating Procedures, the previous 2019 guideline to provide best medical nutritional therapy to critically ill patients has been shortened and partially revised. Following this update, we propose this publication as a practical guideline based on the published scientific guideline, but shortened and illustrated by flow charts. The main goal of this practical guideline is to increase understanding and allow the practitioner to implement the Nutrition in the ICU guidelines. All the items discussed in the previous guidelines are included as well as special conditions.
Osteoporosis is a major and growing health concern in the Asia-Pacific region, y et it remains widely underdiagnosed and undertreated due to limited access to dual-energy X-ray absorptiometry (DXA) in many areas. Artificial intelligence (AI) offers new opportunities to improve osteoporosis screening and management, but unvalidated tools pose risks of inconsistent care. This consensus was developed to provide regionally harmonized guidance on the safe, effective, and equitable use of AI in osteoporosis care. Purpose The aim of this work was to establish expert consensus recommendations on the role of AI in osteoporosis screening and management in the Asia-Pacific region. Key objectives were to define appropriate applications of AI (e.g., imaging-based bone assessment and fracture risk prediction) and specify minimum standards for validation and reporting, addressing region-specific implementation challenges and ensuring that AI use aligns with clinical guidelines and ethical principles. Methods This consensus was developed through multidisciplinary collaboration among experts across the Asia-Pacific region. Each participant reviewed draft statements, contributed feedback during virtual meetings, and provided insights based on clinical experience and current evidence. Consensus was reached iteratively until full agreement was achieved for all statements. The process integrated global best practices and regional adaptations, drawing from peer-reviewed studies, international AI guidelines, and local fracture registry data. The final recommendations emphasize the validation, transparency, and ethical implementation of AI within regional healthcare systems, ensuring compatibility with local regulations. Ultimately, twelve consensus statements were established to guide the responsible use of AI for osteoporosis screening and management in the Asia-Pacific region. Results The panel produced 12 consensus statements covering the role of AI as an adjunct for opportunistic osteoporosis screening rather than a diagnostic tool, requirements for imaging quality and AI model transparency, standards for validation and performance reporting, integration of AI with clinical risk stratification, demonstration of clinical utility in real-world settings, adherence to data protection laws and ethical AI principles, training of clinicians in AI use, strategies for implementation and monitoring (including post-market surveillance and feedback loops), and recognition of technical, clinical, and equity limitations of AI. All 12 statements give extensive recommendations for using AI to improve osteoporosis management while ensuring patient safety, accuracy, and equity. Conclusion This first Asia-Pacific consensus on AI in osteoporosis concludes that AI, when appropriately validated and implemented, can help bridge the osteoporosis care gap by identifying high-risk patients who would otherwise remain undiagnosed, thus facilitating earlier intervention. It emphasizes that AI should complement-not replace-standard diagnostic methods and clinical judgment. The guidance emphasizes validation, transparency, and ethical oversight to facilitate early intervention while minimizing risks associated with unvalidated or premature AI adoption.
Abstract Objective The anatomy of carotid arteries is evaluated with magnetic resonance angiography (MRA), while its stiffness-related parameters are evaluated using ultrasound. An isotropic three-dimensional (3D) MRA technique enabling the measurement of diameter changes could provide a dynamic assessment of the entire carotid tree, extending the existing clinical carotid MR toolset. The goal of this feasibility study was to comprehensively characterize stiffness-related parameters with dynamic 3D MRA and evaluate its repeatability compared to ultrasound. Materials and methods A non-contrast-enhanced free-running 3D radial MRA sequence was used in 18 healthy volunteers (9 males, 9 females, aged 49 ± 20 years, mean ± standard deviation), scanned twice with both MRA and ultrasound. Diameter changes throughout the cardiac cycle were measured in MRA and ultrasound images to compute stiffness-related parameters: systolic-diastolic relative diameter change (RDC), stiffness index, arterial compliance (AC), local pulse wave velocity and pressure–strain Young’s elastic modulus (E), computed for the left (LC) and right (RC) common carotid arteries. Repeatability was evaluated for systolic and diastolic diameter measurements using the intraclass correlation coefficient (ICC). Sub-analyses were performed on a junior and senior subgroup of the volunteers. Results When evaluating MRA versus ultrasound differences, a relative MRA overestimation of the RDC in the senior cohort (p < 0.001) led to higher AC (p = 0.010) and E (p = 0.042). All stiffness-related parameters were significantly different between the age cohorts. MRA showed high repeatability for the LC (ICC = 0.95) and RC (ICC = 0.93) compared to ultrasound (ICC = 0.78, ICC = 0.51, respectively). Conclusion Carotid stiffness can be repeatably quantified with non-contrast-enhanced 4D MRA, providing information traditionally obtained with ultrasound. Relevance statement Dynamic free-running non-contrast-enhanced MRA allows the noninvasive quantification of carotid dynamic properties and anatomy, demonstrating its potential for the assessment of 3D vascular age, showing superior repeatability compared to the clinical standard ultrasound. Key Points Carotid stiffness is assessed with ultrasound and anatomy with MR imaging; combining both assessments in an examination would be valuable. Carotid stiffness can be repeatably quantified with free-running non-contrast-enhanced MRA and yields metrics comparable to ultrasound in healthy volunteers. Dynamic 3D MRA may enable the measurement of stiffness parameters throughout the carotid tree. Graphical Abstract
Cardiovascular drug therapy in adults is steadily progressing. However, the extent to which children with heart disease in Switzerland benefit from this progress remains unknown. This survey aimed to investigate the current outpatient prescribing practices among paediatric cardiologists in Switzerland. We conducted a cross-sectional survey among Swiss paediatric cardiologists. The physicians were asked to state how often they administer drugs on a pre-defined list for the following indications: heart failure, arrhythmia and thromboembolism. Forty-three (56
Abstract Background Orphan drugs (ODs) are increasingly used to treat rare diseases, including inherited metabolic diseases (IMDs), but real-world access remains insufficiently characterized. This study aimed to evaluate access to ODs in adults with IMDs treated at a Swiss reference center and to analyze the associated regulatory and reimbursement frameworks. Methods In this retrospective, single-center study conducted between 2017 and 2022, we included all adult patients with a confirmed biochemical and/or genetic diagnosis of an IMD who received an OD. The primary outcome was the proportion of patients receiving OD therapy. Secondary outcomes included the types of ODs used, reimbursement procedures, time from treatment indication to treatment initiation, timelines in Swiss marketing authorization (MA) and reimbursement compared with international benchmarks. Results Of 190 patients followed, 41 (21.6%) had an indication for OD therapy and 39 (20.5%) received treatment (median age 30.3 years, range 19–65). Seventeen different ODs were prescribed. The median time from treatment indication to treatment initiation was 1.0 month [IQR 0.6–2.6] but was longer for drugs without Swiss MA (Art. 71c OAMal: 6.5 months [IQR 2.5–11.9]). Swissmedic MA occurred a median of 1.9 years [IQR 1.5–2.7] after approval by other international regulators. Three patients were the first adults in Switzerland to access novel substances (olipudase alfa, pegvaliase, metreleptin), and one received the newly approved formulation of nitisinone. Conclusion In this cohort from a specialized adult metabolic clinic, most patients with an indication for OD therapy accessed treatment. However, administrative burden, fragmented reimbursement procedures, and regulatory delays may still affect timely treatment initiation in certain situations. These findings highlight the need for continued efforts to streamline regulatory and reimbursement pathways and to ensure equitable access to innovative therapies for rare diseases. Trial registration ClinicalTrials.gov, NCT05818566, registered 18 April 2023.
