BACKGROUND AND AIM OF THE STUDY: Shortages of primary care paediatricians in Switzerland have been reported by the media, parents, and physicians. We sought to gain a comprehensive understanding of the paediatric primary care workforce by quantifying supply density and assessing paediatricians’ views on the shortage and its contributing factors. METHODS: We conducted an online survey from September 2024 to February 2025 among all board-certified members of the Swiss Society of Paediatrics, excluding retired members. The questionnaire included questions on perceived shortage, working conditions, and contributing factors. We estimated the paediatric primary care workforce in full-time equivalents (FTEs) and calculated the supply density across Swiss cantons by combining data from our survey with physician statistics from the Swiss Medical Association and population statistics from the Federal Statistical Office. RESULTS: We contacted 1940 paediatricians, 1155 (60%) of whom answered our survey. Among respondents, 61% were based in practices, 29% in hospitals, and 10% in both settings. We estimated that 1017 full-time equivalent (FTE) primary care paediatricians worked in Switzerland in 2024, resulting in 0.63 FTEs per 1000 children (<18 years). Among primary care paediatricians, two-thirds (70% [95% CI 68–73]) perceived a shortage. Most reported working part-time (87% [86–89]), and respondents saw a median of 22 [IQR 17, 26] patients per full day. Respondents agreed that there is an insufficient number of physicians in Switzerland (69% [66–71]) and a high prevalence of part-time work (65% [62–67]), resulting in insufficient FTEs in paediatric primary care (79% [77–81]). Marked regional differences in supply density emerged, and this variability could be partly attributed to associations with financial disincentives (R2: 0.39) and rural characteristics (R2: 0.33). CONCLUSION: The regional paediatric primary care shortages in Switzerland, which are linked to a limited workforce, prevalent part-time work, financial disincentives, and the rural nature of affected regions, highlight the need for regionally targeted policy solutions.
STUDY AIMS: The management of chronic non-cancer pain in nursing home residents represents a major challenge, given the complexity and fragility of this population. The aim of this study was to evaluate professional practice in this management in nursing homes of the French-speaking part of Switzerland. METHODS: Our observational study was based on a panel of 124 nursing homes in the Vaud canton. Two convergent parallel approaches were carried out to collect data: an online questionnaire for nurses and referring physicians about the chronic pain management practices of their nursing home, as well as a retrospective observational study analysing analgesic consumption in nursing homes of the Vaud canton between 2017 and 2021. RESULTS: Our study highlights that mixed pain evaluation (self- and hetero-assessment) and non-pharmacological measures (i.e. physiotherapy, psychological and adapted physical activities) are used in the management of chronic non-cancer pain within the studied nursing homes. Opioid analgesics are mainly considered when non-pharmacological measures and step 1 analgesics are insufficient to manage the pain. When an opioid analgesic is considered, tramadol and morphine are the most frequently prescribed drugs among step 2 and 3 analgesics. Collaboration between nurses and physicians in pain management is evaluated as good or excellent by most interviewees, with mutual recognition of each other’s professional role. The pharmacist’s role seems more limited, mainly to providing reminders of best prescribing practices for analgesics during quality circle sessions, and routinely verifying the adequacy of analgesic treatments prescribed. The lack of time at the resident’s bedside, the nurses’ specific skills in pain management, and the reluctance of patients to report their pain were the main obstacles mentioned by the interviewed professionals. A disparity between nursing homes was observed in terms of quantitative and qualitative consumption of analgesics. CONCLUSION: This study shows that healthcare professionals in nursing homes considered are aware and adhere to recommendations for chronic non-cancer pain management, whether in terms of pain assessment, or non-pharmacological and pharmacological measures. This management is supported by interprofessional practice within these nursing homes, in terms of defining the roles of each and sharing tasks between physicians and nurses. However, a strengthening of the interprofessional collaboration, a more extensive training of nurses as well as audit and feedback on analgesic use would be levers to foster better management of chronic non-cancer pain among nursing home residents.
STUDY AIMS:Advance Directives (AD) are central to Advance Care Planning (ACP), allowing patients to document medical preferences in legally binding documents. Despite broad public awareness and support, only one-fifth of the Swiss population has completed an AD. Consequently, the roadmap for ACP implementation by the ACP National Task Force calls for the development of digital applications to promote ACP in Switzerland. This study details the development process for the mobile application "iDecide" for AD creation based on the Swiss Medical Association (FMH) AD template. The primary aim is to ensure optimal usability and user satisfaction with the app. METHODS:Using a Participatory Action Research (PAR) approach, four research cycles were conducted to create an evidence-based AD creation tool. The iDecide app, published in October 2024 (www.idecide.ch), was reviewed by users through an online survey. The survey evaluated the app's user-friendliness, educational information quality and concordance with ACP goals, measuring 14 items on a 5-point Likert scale. RESULTS:The PAR approach led to the successful development of the iDecide app for AD creation. The app guides users through the process of drafting their personalised AD. It provides multimedia patient information on the content and value of AD, encourages reflection on personal preferences and promotes communication with surrogate decision-makers and healthcare professionals. The drafted AD is available in both print and in a digital format via an offline QR code. This QR code allows AD information to be stored, shared and accessed when needed. Survey responses from 94 app users indicated high usability, information quality and user satisfaction. On a 5-star rating system, the mean overall rating was 4.69 (SD: 0.57, 95% CI: 4.56-4.81), consistent across age groups. Users rated the app as easy to use and making AD creation more attractive. DISCUSSION:While various online forms for AD creation exist in Switzerland, no mobile app has previously enabled the public to complete an AD. iDecide is a ready-to-use AD application, operating without the need for additional infrastructure and freely available to the general public. The tool aligns with the national roadmap for ACP implementation and adheres to key recommendations for digital ACP tool design. It effectively tackles barriers to widespread AD implementation in Switzerland, addressing engagement and accessibility issues. iDecide thus has the potential to empower people to actively engage in their ACP.
STUDY AIMS: Point-of-care ultrasound (POCUS) has become a key diagnostic modality in emergency departments, facilitating rapid clinical decision-making and improving patient care. Despite its benefits, POCUS adoption remains heterogeneous. Barriers reported in the literature include the absence of standardised certification pathways, limited access to training and insufficient equipment availability. This study aimed to explore barriers and enablers of successful implementation of POCUS in Swiss emergency departments. METHODS: We conducted a national, cross-sectional multicentre survey targeting medical residents from 15 category 1 emergency training centres in Switzerland. The survey included questions on POCUS usage, training, perceived barriers and facilitators. Data were analysed using descriptive statistical methods. The data collection period spanned from October 2023 to April 2024. RESULTS: A total of 165 residents participated in the survey (35.6% response rate). Of these, one-third (32%) had attended accredited POCUS training, while only 6% reported no prior ultrasound experience. Residents exhibited a positive attitude towards POCUS, with the majority recognising it as a valuable diagnostic tool and a core skill for trained emergency physicians. Key barriers to POCUS implementation in Swiss emergency departments included limited access to training, difficulties completing certification requirements and challenges in skill maintenance after initial training. Specific obstacles were unavailable courses, lack of supervision and time-consuming logbook completion. Unlike prior literature, this study did not identify doubtful attitudes towards POCUS utility, lack of a standardised national curriculum or resistance from other specialties as barriers. CONCLUSIONS: Swiss emergency medicine residents strongly support POCUS and are motivated to pursue certification. A nationally standardised training curriculum may help address some of the barriers commonly described in the literature by providing a structural advantage. However, inconsistent local implementation, limited mentorship and restricted training access hinder full integration into practice. Bridging this gap requires stronger institutional support, better awareness of certification pathways and more hands-on opportunities to ensure residents can achieve and maintain POCUS competency, ultimately advancing the quality and efficiency of emergency care in Switzerland.
STUDY AIMS: Switzerland will face a critical shortage of physicians in the coming years. In this study, we investigated the percentage of residents with an intention to leave the job and profession. Furthermore, we investigated the association between sociodemographic and profession-related factors and the intention to leave. METHODS: We conducted a cross-sectional study among residents in Switzerland in November 2024. We contacted all residents who use the Swiss Institute of Medical Education (SIWF) e-Logbook via an e-mail containing a link to an online survey about sociodemographic factors and their intention to leave the job and profession. The survey included questions related to professional factors such as workload, satisfaction with the job, decision on specialisation and the importance attached to teaching during working hours. Inferential statistics included odds ratio calculations. RESULTS: Of 14,616 residents contacted, 5080 (34.8%) participated. Of these 5080 respondents, 2358 (45.6%) reported considering leaving their job and 2800 (55.1%) leaving the profession. Participants could tick both options separately. One attrition factor identified for the job is longer time spent in residency. Attrition factors identified for both job and profession are: a high difference between contractual and effective weekly working hours, high weekly working hours, dissatisfaction with the job and the impression of not enough importance given to teaching during working hours. Attrition factors identified for the profession are: completion of medical studies in Switzerland, working in the German-language region, unemployment and being undecided on specialisation. A retention factor for the profession is having at least one parent who is a physician. CONCLUSIONS: The intention to leave the job and profession among residents working in Switzerland is alarmingly high. Retention requires strict adherence to contractual working hours – and, where possible, their reduction – as well as improvements in job satisfaction and the quality of teaching during working hours. Policymakers, institutions and teaching sites are called upon to enforce working hours regulations, protect structured teaching time and strengthen residency as postgraduate medical education aimed at building competence and specialisation. Without such measures, there is a risk that attrition among residents could increase, potentially contributing to the projected physician shortage in Switzerland.
Abstract Introduction Treatment initiation or intensification to prevent exacerbation of chronic obstructive pulmonary disease (COPD) is based on the identification of patients with high exacerbation risk. The commonly used high-risk category of at least 2 moderate or 1 severe exacerbation within the prior 12 months has limited supporting evidence. We aimed to test the discriminative accuracy and assess the clinical utility of various COPD exacerbation categories for predicting future exacerbations. Methods In the COPDGene and NOVELTY cohorts, for each 1-year and 2-year recall periods, we estimated 6 distinct categories of exacerbation frequencies: ≥1 moderate (M1), ≥2 moderate (M2), ≥1 severe (S1), ≥1 moderate and ≥1 severe (M1andS1), ≥1 moderate or ≥ 1 severe (M1orS1), and ≥2 moderate or ≥ 1 severe (M2orS1), each ascertained in 3 ways: within 1 year, in each of 2 consecutive years (suffix E), and over a rolling combined 2-year period (suffix R). We used the area under the receiver operating characteristic curve (AUC) and decision curve analysis to evaluate the discriminative accuracy and clinical utility of these 18 categories for predicting the occurrence of M2orS1 (current standard) in the subsequent year. Results In COPDGene (n = 3,035), for the prediction of future M2orS1, baseline M1orS1R had the highest AUC (0.69, 95%CI 0.67-0.71) vs. baseline M2orS1 (0.66, 95%CI 0.64-0.67; Δ = 0.03;p<0.001). In NOVELTY (n = 3,080), M1orS1R category had the highest AUC (0.87, 95%CI 0.85-0.88) vs. M2orS1 (0.75, 95%CI 0.72-0.77, Δ = 0.12;p<0.001). Decision curve analysis demonstrated that the two-year rolling patterns provided the highest clinical utility across a clinically relevant treatment threshold range of 5% to 30% (Figure). M1orS1R also had the highest AUC for predicting any exacerbation (M1orS1) in both COPDGene (AUC = 0.68, 95%CI 0.66-0.70) and in NOVELTY (AUC = 0.86, 95%CI 0.85-0.88). Conclusions At least 1 moderate or 1 severe exacerbation over the previous 2 years has the highest discrimination and confers the highest clinical utility for predicting high COPD exacerbation risk. Overall, the combination of higher performance of various exacerbation history patterns in terms of their statistical (AUC) and clinical utility (net benefit) indicates that using a two-year recall and a lower threshold for high-risk classification (any moderate/severe events) is superior to the current standard of care. This abstract is funded by: This work was supported by NHLBI R01 HL151421 (SPB and AN), U01 HL089897 and U01 HL089856, by NIH contract 75N92023D00011, and by a Team Grant from the Canadian Institutes of Health Research (PHT 178432). COPDGene is also supported by the COPD Foundation through contributions made to an Industry Advisory Board that has included AstraZeneca, Bayer Pharmaceuticals, Boehringer Ingelheim, Genentech, GlaxoSmithKline, Novartis, Pfizer, and Sunovion. The NOVELTY study was funded by AstraZeneca.
Diamond Open Access is the fairest and most sustainable model for scientific communication. The Diamond model promotes editorial independence, supports researchers by waiving article processing charges, and serves as an indispensable public research infrastructure. “Read & Publish” agreements increase dependence on large commercial publishers, and some of the funds currently spent on such agreements could instead be used to provide long-term support for Diamond journals. Promising models for sustainable funding and collaboration are emerging through national and international initiatives. However, Switzerland is already providing concrete evidence that institutions do not have to wait until national mechanisms are fully developed. In 2025, the University of Lausanne launched the “Diamond Open Access Fund”, a pioneering initiative of its kind in Switzerland. The future development of Diamond Open Access should focus not only on sustainable funding but also on enhancing the quality, transparency, and culture of scholarly publishing. As Switzerland’s only fully peer-reviewed English-language Diamond medical journal, the Swiss Medical Weekly (SMW) provides an essential platform for clinically relevant Swiss research, offering international visibility and immediate open access without author fees or embargoes. SMW will continue to work towards modernising its quality assurance processes and contributing to international developments in the field of Open Science, with a view to strengthening transparency, reproducibility, and relevance in medical research.
BACKGROUND:Septic bursitis is mainly caused by Staphylococcus aureus and Streptococcus spp. However, patients with immunosuppression may develop infections caused by rare pathogens. Here, we describe a case of septic olecranon bursitis caused by Nocardia farcinica and provide a literature review of musculoskeletal infections caused by this pathogen. CASE PRESENTATION:A male patient in his mid-70s with seronegative rheumatoid arthritis who was receiving methotrexate, low-dose prednisone, and golimumab experienced trauma to the elbow, followed by progressive painful swelling, slight erythema, and the formation of a fistula draining cloudy fluid over the subsequent two weeks. Culture of the aspirated bursal fluid yielded slow-growing yellow-pigmented colonies identified as Nocardia farcinica. Whole-genome sequencing confirmed the species without detecting any known virulence genes or resistance mutations. Clinical and radiological evaluation showed no signs of systemic dissemination. The patient underwent surgical bursectomy and received targeted antimicrobial therapy with oral trimethoprim/sulfamethoxazole. After 3 weeks, the patient developed a systemic allergic reaction, necessitating a switch to susceptibility-guided amoxicillin/clavulanate. Treatment was continued for 3 months, ultimately resulting in the complete and successful resolution of the bursitis. CONCLUSION:This report highlights that it is important for clinicians to consider rare pathogens in immunosuppressed patients with bursitis, especially in those presenting with atypical courses. Localised musculoskeletal infections caused by Nocardia are mostly treated with a combined surgical and antibiotic approach. Antibiotics are typically administered for one to six months. In cases of surgical removal, a shorter antibiotic treatment duration seems sufficient. A multidisciplinary approach involving infectious diseases specialists, microbiologists, and surgeons is critical for achieving favourable outcomes.
In this case report, we describe a child with a near-fatal foreign body aspiration rescued by a unique lifesaving endoscopic manoeuvre and transfer for foreign body retrieval to an extracorporeal membrane oxygenation (ECMO) centre. A 2-year-5-month-old girl suffered a near-fatal foreign body aspiration at home and was successfully resuscitated by the paramedics. On arrival, she was severely dyspnoeic, hypercapnic and cyanotic, showed marked paradoxical breathing movements with hardly any breath sounds consistent with near-complete central airway obstruction. After induction of anaesthesia for emergency bronchoscopy, bag mask ventilation was nearly impossible resulting in a “cannot ventilate, cannot oxygenate” scenario and bradycardia. Only after successfully pushing down the foreign body into the right main bronchus (push-down manoeuvre) was mask ventilation successful. Any further manipulation led to severe desaturations and attempts to retrieve the foreign body were impossible. Therefore, transfer to the nearest centre with paediatric ECMO facilities via air ambulance was carried out. Foreign body retrieval was successful under veno-venous ECMO and the girl showed a complete recovery without any neurological sequelae. In this case of total airway obstruction, the bronchoscopic push-down manoeuvre was lifesaving and allowed temporary stabilisation to enable transport to a centre where secondary difficult foreign body retrieval was performed under ECMO.
BACKGROUND: Conducting ward rounds is a complex task requiring physicians and nurses to make use of a large set of competencies. The inability to conduct effective rounds can lead to errors of omission. Based on evidence gathered primarily in intensive care settings, checklists may improve the structure of ward rounds, interprofessional communication, and clinical outcomes. OBJECTIVE: To test the hypothesis that the implementation of a checklist to structure internal medicine ward rounds reduces the omission of key clinical items. DESIGN: This quality improvement study was designed as a prospective, monocentric, pre-post intervention study. PARTICIPANTS: Physicians and nurses conducting ward rounds in an internal medicine division of a 1500-bed university hospital. INTERVENTION: The implementation of a checklist with 19 key clinical items, defined as such because they are critical for patient care and must be discussed in every round for acute patients admitted to general internal medicine wards. An omission was defined as occurring when an item was not discussed. The 19 items included the patient’s main diagnostics, new diagnostics or problems, orientation, sleep, pain, nutrition, bowel habits, mobility, thrombo-embolic prophylaxis, skin and risk of bedsores, the presence and local status of IV catheters, the presence of a urinary catheter, medication review, targeted patient history and clinical examination, daily and hospital goals, discharge plan, and patient understanding. MAIN MEASURES: The primary outcome was the number of key clinical items discussed during ward rounds before and after the checklist implementation. Secondary outcomes included (a) the proportion of patients with venous or urinary catheters, (b) catheter use in accordance with guideline-based indications, (c) the proportion of patients mobilised at two predefined times, (d) ward round duration, (e) ward round location (bedside vs hallway), and (f) patients’ and nurses’ understanding of care goals, rated on a 0–100 visual scale. RESULTS: The study period lasted six days before implementation, from 27 January to 3 February 2023, and six days after, from 18 to 25 April 2023. Rounds conducted by a resident and a nurse were assessed using an observation plan, which ensured an equal distribution of observations across all units in the division. In total, 56 residents and 83 nurses participated in 368 patient encounters (172 pre-intervention and 196 post-intervention).The median number of key clinical items discussed per round increased from 11 [IQR 8.5–13] to 16 [IQR 14–18] (p <0.01) after the intervention. The proportion of patients with urinary catheters decreased (9% vs 4%; p = 0.04), as did the proportion with venous catheters in place without adequate indication (16% vs 2%; p <0.01). Patient mobilisation did not improve: before the intervention, 48% of patients were found in bed, 36% were sitting in their chairs, and 12% were walking, compared with 50%, 35%, and 11% after the intervention, respectively. The understanding of care goals increased for patients (score of 85/100 [IQR 50–100] pre-intervention vs 90/100 [IQR 70–100] post-intervention; p = 0.04) and, to a lesser extent, for nurses (90.5/100 [IQR 80–100] pre-intervention vs 100/100 [IQR 85–100] post-intervention (p = 0.08). LIMITATIONS: This was a monocentric study involving one specific type of ward round. CONCLUSIONS: The implementation of a checklist to structure internal medicine ward rounds reduced the omission of key clinical items and improved adherence to standard-of-care protocols, both of which are considered important mediators of clinical outcomes.
BACKGROUND: Granulomatous tubulointerstitial nephritis is an uncommon cause of acute kidney injury with a broad differential diagnosis that includes drug exposure, infections, autoimmune conditions, and sarcoidosis. Although renal infiltration by small lymphocytic lymphoma/chronic lymphocytic leukaemia (SLL/CLL) is frequently observed in autopsy series, it rarely results in clinically significant renal dysfunction. Granulomatous interstitial nephritis directly related to lymphomatous infiltration is particularly rare, with only a few cases described in the literature. CASE PRESENTATION: A man in his seventh decade with indolent SLL developed rapidly progressive acute kidney injury. Extensive evaluation excluded obstructive, infectious (including tuberculosis), autoimmune, and drug-related causes, and sarcoidosis was considered unlikely in the absence of supportive clinical and laboratory findings. Immunohistochemistry and molecular techniques demonstrated a clonal B-cell population consistent with SLL, establishing the diagnosis of lymphoma-related granulomatous tubulointerstitial nephritis. Treatment with high-dose corticosteroids and acalabrutinib improved renal function, though targeted therapy was discontinued due to severe infectious complications. CONCLUSION: Granulomatous tubulointerstitial nephritis secondary to lymphomatous infiltration should be considered in the differential diagnosis of unexplained acute kidney injury in patients with indolent CLL/SLL. Immunohistochemistry is crucial for confirming B-cell infiltration. Corticosteroids and targeted therapies may lead to renal improvement but require careful monitoring given the risk of infectious complications. This case adds a rare and well-documented presentation of SLL-associated granulomatous tubulointerstitial nephritis to the current medical literature.
OBJECTIVES: Analysis of acid-base status is crucial for diagnosing and treating underlying disorders. There is a scarcity of data on causes of severe acidosis in emergency patients. The current analysis aimed to evaluate the cause of severe acidaemia on admission to an emergency department by using the physical-chemical approach as simplified by Story. Moreover, we evaluated the outcome of patients with severe acidaemia on admission to the emergency department in terms of hospitalisation, length of hospital stay, ICU admission and in-hospital mortality. METHODS: The retrospective analysis included all adult patients presenting to the Emergency Department of Kepler University Hospital Linz, Austria, with a pH <7.15 in venous blood gas between 1 July 2022 and 30 June 2024. Respiratory acidosis was defined as pCO2 >45 mm Hg, while respiratory alkalosis was defined as pCO2 <35 mm Hg. Analysis of metabolic components was performed using Story’s simplified approach. RESULTS: The study included 79 patients with severe acidaemia (pH <7.15). Median pH was 7.08 (interquartile range [IQR]: 7.04–7.11) with a minimum of 6.78. The pCO2 was 41 mm Hg / 5.47 kPa (IQR: 33–78 mm Hg / 4.4–10.4 kPa) with a minimum of 13/1.73 and a maximum of 164/21.86. Median standard bicarbonate was 11 mmol/l (IQR: 8–17) with a minimum of 3.9. Median base excess was –16.3 mmol/l (IQR: –21.85 – –5.75) with a minimum of –29.7. Median lactate was 3.6 mmol/l (IQR: 1.8–8.8). Primary respiratory acidosis was present in 49% of patients, while 51% had primary metabolic acidosis. 58% of patients with primary metabolic acidosis had a combination of strong ion difference-associated and unmeasured-anion (UMA) acidosis. The main causes of UMA acidosis were lactic acidosis, diabetic ketoacidosis and uraemia. CONCLUSION: Severe acidaemia is caused equally by primary respiratory and metabolic acidoses. Combinations of different mechanisms leading to severe acidaemia are common and can potentially mask therapeutically relevant acid-base disorders such as diabetic ketoacidosis.
AIMS: To examine all-cause and cause-specific mortality by age group in Switzerland during and after the COVID-19 pandemic, in order to determine whether pre-pandemic trends recovered in 2023–24. METHODS: Standardised mortality rates since COVID-19 were compared with those expected by continuing trends estimated over the pre-pandemic years 2000–19 by log-linear Poisson models, resulting in estimates of all-age and age-specific excess death and mortality for 2020–24. Mortality trends for the leading causes of death were analysed by age group using Joinpoint regression models. RESULTS: In 2024, all-cause mortality in Switzerland showed a complete return to pre-pandemic trends. However, marked differences between age groups were observed. While mortality among people aged 85 and over was significantly lower than trend in 2024 (–5.4% for men and –3.5% for women), people aged 65 to 84 were still struggling to recover the pre-pandemic trend this year (+4.2% for men and +3.5% for women). Mortality in the 15–44 age group began to stagnate a few years before the pandemic and remained significantly above trend in recent years, with excess mortality being systematically outside the 95% prediction intervals, reaching +33.6% for men and +20.4% for women in 2024. At the same time, accidents and suicides, among the leading causes of death in this age group, appear to have stopped declining, with a stabilisation in the suicide trend since 2014 among men (p = 0.005) and 2013 among women (p = 0.001), and in the accident trend since 2019 among men (p = 0.031). A slowdown in the decline of cardiovascular and respiratory mortality has been observed in the 65–84 age group. CONCLUSIONS: The long-standing decline in mortality has stalled in recent years in Switzerland among young adults and, to a lesser extent, among young retirees, due to stagnation or slowdown of several major causes of death in these age groups. These phenomena, in addition to their importance for considering appropriate preventive interventions, also raise questions about the future of mortality and longevity in Switzerland and, more generally, in Western societies, and must be taken into account when developing realistic life expectancy and demographic scenarios. These are essential for decision-making in the areas of insurance, retirement planning and healthcare cost management.
STUDY AIMS: Clostridioides difficile infection (CDI) is associated with high recurrence and mortality. Faecal microbiota transplantation (FMT) is recognised as the most effective treatment for recurrent CDI. However, implementation varies internationally, and real-world data from Switzerland – where FMT is now regulated as a medicinal product – are scarce. Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, established a standardised FMT programme in 2019, yet its outcomes have not previously been reported. PATIENTS AND METHODS: This retrospective cohort study evaluated all adult patients treated with FMT for recurrent Clostridioides difficile (CDI) infection at CHUV between January 2021 and February 2025. Standardised procedures included strict donor screening, frozen preparation of stool suspensions or capsules, and administration by colonoscopy, jejunostomy, enema or oral capsules. The primary efficacy endpoint was clinical cure, defined as no CDI recurrence at 8 weeks. Adverse events and serious adverse events were recorded prospectively, with causality assessed according to international criteria. RESULTS: Among the 88 patients who received 100 FMTs, a clinical cure was achieved in 93% of cases after a single treatment, 98% after two and 100% after three. Only three new episodes were reported beyond the 8-week time point. Efficacy was consistent across subgroups, including immunosuppressed individuals. Early gastrointestinal adverse events were mild and transient. Of 24 serious adverse events recorded during follow-up, most were infections or complications related to underlying conditions. Eight deaths occurred during follow-up. Importantly, no serious adverse events or deaths were attributed to FMT. CONCLUSION: FMT demonstrated a high efficacy and a favourable safety profile for recurrent Clostridioides difficile infection in a real-world Swiss cohort, consistent with international evidence. Standardised donor selection, treatment production and pharmacovigilance were key to maintaining safety. These findings support FMT as a reliable therapeutic option for recurrent Clostridioides difficile infection, including high-risk populations. Further trials are warranted to evaluate earlier use of FMT in the CDI disease course.
Shiitake-induced flagellate dermatitis is a rare cutaneous reaction characterised by linear, erythematous, itchy lesions that appear after the consumption of raw or undercooked shiitake mushrooms. Shiitake mushrooms are traditionally consumed in Asian countries such as Japan, where the first case of flagellate dermatitis was documented. As shiitake mushrooms have become increasingly popular in Western countries, the incidence of this reaction has increased. We present the case of a 54-year-old man who presented to the emergency room with widespread linear erythematous skin lesions and was diagnosed with shiitake-induced flagellate dermatitis, a condition that is rarely reported in Western emergency settings. The case was triggered by undercooked rather than raw shiitake mushrooms. The dermatologist’s pattern recognition skills and detailed enquiry into the patient's dietary history enabled the diagnosis. His symptoms resolved completely within one week following treatment with oral antihistamines and topical corticosteroids. When considering the differential diagnosis of flagellate dermatitis, clinicians should include adverse drug reactions, particularly those related to chemotherapeutic agents, as well as systemic diseases such as dermatomyositis, adult-onset Still’s disease, systemic-onset juvenile idiopathic arthritis, and, less commonly, phytophotodermatitis or infectious exanthems. In cases presenting with atypical linear skin eruptions, clinicians should also inquire about the patient’s dietary history.
STUDY AIMS:The initial prevalence estimates of long COVID exhibited significant heterogeneity. In Switzerland, early findings estimated a 39-53% prevalence of long COVID symptoms among adult patients who tested positive for SARS-CoV-2. However, studies conducted in a primary care setting suggested a significantly lower burden of care, with long COVID accounting for less than 1% of family medicine consultations. The objective of this study was to estimate the incidence of long COVID-related consultations in Swiss family medicine practices, in order to guide health services planning. METHODS:This repeat cross-sectional study was conducted using the data collected by family physicians (general internists and paediatricians) within the Swiss Sentinella network, part of the epidemiological surveillance system managed by the Federal Office of Public Health. Data was collected between August 2021 and April 2023 via monthly reports of doctors' activity over the past four weeks. Long COVID-related consultations were defined as visits where physicians recorded symptoms or conditions linked to post-acute SARS-CoV-2 effects, based on clinical definitions at the time. Doctor characteristics were measured and analysed for associations with monthly median incidence rates of long COVID-related consultations. RESULTS:181 family practices provided data for at least one month during the study (154 general internists and 27 paediatricians): 85% of doctors were general internists, 32% were women and 74% worked in an urban area. The median incidence of monthly long COVID-related consultations was 3/1000 consultations for general internists and 0/1000 consultations for paediatricians. Multivariable ordinal logistic regression showed that internists were significantly more likely to report long COVID-related consultations compared to paediatricians. Also, physicians in central Switzerland were more likely to have a higher median incidence of long COVID-related consultations in comparison to those in other regions. CONCLUSIONS:Our study shows that the incidence of long COVID-related consultations in Swiss family medicine is markedly lower than expected, considering the estimated prevalence of long COVID post-SARS-CoV-2 infection. This discrepancy may result from potential biases in earlier studies, epidemiological variations and diagnostic challenges. These findings underscore the need for improved diagnostic criteria and enhanced support for primary care providers in recognising long COVID and facilitating referrals for more severely affected patients.
STUDY AIMS:Mental disorders in children and adolescents have increased substantially, placing growing pressure on healthcare systems. Home treatment has emerged as an alternative to conventional inpatient treatment as usual (I-TAU), potentially offering clinical and cost benefits. This study aimed to evaluate the cost-effectiveness of an intensive home treatment programme (AT_HOME) compared to I-TAU in Switzerland. METHODS:Data were collected within a monocentric pilot trial involving 75 children and adolescents (aged 6-17 years) admitted for acute psychiatric care between May 2019 and July 2020. Participants were allocated to AT_HOME if they met geographical and safety criteria and consented to receive home treatment (n = 27); all remaining patients received I-TAU (n = 48). Clinical effectiveness was assessed as between-group differences in change in psychosocial functioning from admission to follow-up at 18-24 months, assessed with the Global Assessment of Functioning (GAF) scale. The primary outcome of this secondary analysis was the cost-effectiveness of home treatment compared with I-TAU. Cost estimates included direct medical costs for the initial treatment period and follow-up healthcare utilisation from a comprehensive multi-payer healthcare system perspective. Cost-effectiveness was analysed using incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves (CEAC). Secondary outcomes included the costs of the index treatment, costs of follow-up mental healthcare utilisation and total costs. RESULTS:The point estimate of the incremental cost of home treatment compared to I-TAU was CHF -48,591 (95% CI: -108,493 to 11,312; SE: 30,563) and the incremental effect was 9.41 (95% CI: 0.52 to 18.31; SE: 4.54) on the GAF scale. The resulting ICER was -5161 per 1-point improvement in the GAF score (95% CI: - 49,482 to 39,161; SE: 22,613) and the CEAC suggested a high probability (94.6%) that home treatment was cost-effective compared with I-TAU across willingness-to-pay thresholds. CONCLUSIONS:In this pilot trial, home treatment for children and adolescents with severe psychiatric disorders was associated with favourable cost-effectiveness estimates compared with I-TAU. These findings suggest that intensive home-based treatment models may have the potential to contribute to more efficient use of mental health resources. CLINICAL TRIAL REGISTRATION NUMBER:DRKS00025424 (German Clinical Trials Register, registered on 27 May 2021).
BACKGROUND:Frailty, a state of increased vulnerability, is a well-established risk factor of adverse outcomes following surgery. While its prognostic value has been demonstrated in various contexts, data are lacking on its impact in emergency general surgery within the Swiss healthcare system. This study aimed to evaluate the association between frailty and outcomes among older patients undergoing emergency general surgery in a Swiss tertiary hospital. METHODS:We conducted a retrospective cohort study including patients aged 65 years or over who underwent emergency general surgery between January 2016 and December 2019. Eligible procedures included laparotomy, bowel resection, peptic ulcer repair, appendectomy and cholecystectomy performed within 72 hours of admission. Frailty was assessed retrospectively using the Clinical Frailty Scale (CFS), based on clinical documentation. The primary outcome was 1-year mortality. Secondary outcomes included complications, hospital length of stay and discharge destination. Multivariable regression models were used to analyse associations. RESULTS:Of 683 patients (median age 76 years; 52.7% female), 38.2% were classified as living with frailty (CFS ≥5). One-year mortality was significantly higher among patients with frailty (25.6%) than those without (6.6%), with an adjusted odds ratio (aOR) of 3.0 (95% CI: 1.7-5.1). Frailty was associated with an increased risk of complications (aOR: 2.3; 95% CI: 1.5-3.6), prolonged hospital stay (+46.4%; 95% CI: 26.8-69.0%) and discharge to a location other than home (aOR: 2.1; 95% CI: 1.4-3.2). CONCLUSION:Frailty is associated with worse outcomes after emergency general surgery in older adults. Routine frailty screening could improve risk stratification and guide patient-centred surgical decision-making.
INTRODUCTION: The therapeutic role of metamizole (dipyrone) remains controversial because of the risk of metamizole-induced agranulocytosis, a very rare, idiosyncratic, life-threatening adverse reaction. We described utilisation, spontaneous reporting and recent regulatory actions in Switzerland. METHODS: We estimated national metamizole utilisation as defined daily doses (DDD; WHO DDD 3 g/day) for 2014–2023, derived from aggregated national sales data; individual case safety reports (ICSR) of metamizole-induced agranulocytosis were retrieved from VigiBase (the WHO global safety database) for 2014–2024. Outputs included annual counts, fatal proportion and utilisation-normalised reporting (metamizole-induced agranulocytosis per million DDD); analyses were primarily descriptive. RESULTS: Utilisation increased by ~79% during the analysed period with a formulation mix of 95.7% oral, 4.2% ampoules, 0.1% suppositories. Metamizole-induced agranulocytosis reports rose from 13 (2014) to 57 (2024), with year-to-year variability; the fatal proportion declined from 13.5% (2014–2018; 17/126) to 5.8% (2019–2023; 13/224) and 1.8% in 2024 (1/57). Utilisation-normalised reporting increased from 1.42 to 3.29 per million DDD (total), while fatal reports remained low and trended downward (mean 0.249 per million DDD, 2014–2023). Among Swiss fatal cases, methotrexate was co-reported as a concomitant drug in 39.5% (15/38) (extended fatal set 2011–2025; fatal ICSRs irrespective of onset year). Switzerland contributes a disproportionately high absolute number of cumulative metamizole-induced agranulocytosis reports. REGULATORY ACTIONS: EMA and Swissmedic implemented strengthened warnings; Swissmedic additionally required a red-framed outer carton statement, clarified indications (second-line severe pain; refractory high fever) and advised avoiding concomitant methotrexate; a Direct Healthcare Professional Communication was issued. CONCLUSION: Regulatory assessments by EMA and Swissmedic concluded that the benefits of metamizole continue to outweigh the risks, provided the drug is used appropriately, action is taken promptly at first symptoms and concomitant methotrexate is avoided. However, the number of reported cases of agranulocytosis underscores the known risk in the context of widespread use. Spontaneous reports reflect reporting intensity, not incidence; ongoing monitoring of risk-minimisation effectiveness is warranted.
Abstract Rationale Prolonged mechanical ventilation (MV) occurs in approximately 14% of post lung transplant patients and is associated with increased mortality. The AeroPace temporary transvenous diaphragmatic neurostimulation (TTDN), a novel FDA-approved device, has been shown to shorten MV duration by an average of 2.8 days (Lungpacer Medical, PA). In the RESCUE3 study, the AeroPace patient were weaned 34% faster by day 30 or 43% faster per protocol. We describe our single-center experience using TTDN in lung transplant recipients requiring prolonged MV and extracorporeal membrane oxygenation (ECMO). Methods Between June and August 2021, patients with difficulty weaning from MV following lung transplantation at the University of Florida were identified under the Emergency Use Authorization (EUA) program during the COVID-19 pandemic. The AeroPace TTDN subclavian catheter was placed at bedside. Each TTDN session delivered 60 electrical stimulations, administered once or twice daily during volume-controlled or pressure-support ventilation. Therapy was continued until successful liberation from MV or for a maximum of 30 days. Results Three patients underwent TTDN therapy. Case 1: A 55-year-old man underwent bilateral orthotopic lung transplantation (BOLT) for drug-induced fibrotic lung disease, complicated by primary graft dysfunction requiring veno-venous (VV) ECMO and six months of MV. After 30 days of TTDN and subsequent automatic tube compensation (ATC) trials, he was successfully liberated from MV. Case 2: A 48-year-old woman received BOLT for COVID-19-related respiratory failure complicated by multiple episodes of hospital-acquired pneumonia. TTDN was initiated one month post-transplant, leading to successful liberation after six sessions. Case 3: A 55-year-old man underwent lung-kidney transplantation for COVID-19-associated respiratory failure requiring VV ECMO. TTDN was started two weeks post-transplant, while still on ECMO. Patient was weaned from MV after nine days of therapy. All patients tolerated TTDN without complications related to catheter placement or stimulation. Conclusion This case series is the first to report the use of TTDN in post-lung transplant patients with prolonged MV. TTDN was well tolerated and may facilitate earlier ventilator liberation by mitigating diaphragmatic atrophy associated with prolonged MV. Further prospective studies are warranted to evaluate its efficacy in improving post-transplant outcomes. This abstract is funded by: None
