INTRODUCTION:Artificial intelligence (AI) has rapidly gained importance in medicine over recent years, particularly in medical imaging. AI is transforming cardiac imaging along the entire workflow - from image acquisition and reconstruction to interpretation and diagnosis. In echocardio-graphy, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine, AI systems have the potential to automatically capture and standardize measurements, reduce noise and artifacts, shorten acquisition and analysis times, and improve reproducibility. Applications range from real-time automated analysis of transthoracic echocardiograms and CT-based calcium scoring and plaque quantification to the detection of rare coronary anomalies, AI-assisted MRI planning and the identification of subtle pathological patterns of cardiac amyloidosis. In the future, multimodal AI models combining imaging, clinical, laboratory, and genetic data will enable highly precise risk stratification and individualized therapies. However, challenges remain in terms of generalizability, prospective validation, explainability, and integration into real-world workflows. Clinical validation, quality control, and physician oversight remain essential cornerstones for the responsible use of AI in cardiac imaging.
INTRODUCTION:Coronary artery disease (CAD) remains one of the leading causes of morbidity and mortality worldwide. Accurate, patient-centered, and efficient diagnostic strategies are therefore essential. Beyond clinical history, physical examination, and laboratory testing, cardiac imaging has become increasingly central to both diagnostic evaluation and risk stratification. In recent years, non-invasive imaging modalities for CAD have undergone remarkable technological and methodological advancements. They now play a pivotal role in confirming or excluding obstructive CAD, assessing the functional significance of coronary stenoses, and supporting individualized treatment decision-making. Selecting the most appropriate imaging modality is thus crucial for achieving diagnostic precision and optimal patient management. This article provides a comprehensive overview of the currently available non-invasive imaging techniques, highlights their respective strengths and limitations, and offers practical guidance on choosing the most suitable modality for different patient groups. Particular emphasis is placed on their application in routine clinical practice in Switzerland.
INTRODUCTION:Valvular heart disease is common in an aging population and is associated with substantial morbidity and mortality. Modern cardiovascular imaging is central to diagnosis, therapeutic decision-making, and longitudinal follow-up of aortic, mitral, and tricuspid valve disease throughout the entire care pathway - from initial evaluation to specialized intervention. Transthoracic echocardiography (TTE) remains the first-line modality for initial diagnosis and follow-up assessment. Transesophageal echocardiography (TEE) provides detailed morphological evaluation of the valves and is indispensable for surgical and interventional planning, particularly of the atrioventricular valves. Cardiac CT is the current standard for planning transcatheter aortic valve implantation (TAVI) and is gaining importance in percutaneous mitral and tricuspid valve replacement, including simulation-based planning and risk assessment. Cardiac MRI contributes primarily to precise volume quantification and the assessment of ventricular function and myocardial structure. Peri-interventional TEE has become an essential real-time guidance tool in the catheter laboratory, enabling precise device navigation and immediate evaluation of procedural success. The targeted use of complementary imaging modalities is crucial for accurate assessment of valvular pathology, optimal planning and guidance of interventions, and long-term patient follow-up. Imaging is therefore not merely a diagnostic aid but the foundation of modern, increasingly catheter-based valve therapy.
INTRODUCTION:Heart failure is clinical syndrome with many different underlying cardiac diseases. The definition of heart failure includes the presence of typical symptoms and the proof of a structural cardiac abnormality, which is responsible for a reduced cardiac output and/or elevated cardiac filling pressures at rest or on exertion. The identification and exact description of the main mechanism of heart failure is key for the introduction of an appropriate treatment, which when appropriately selected improves symptoms and prognosis. In patients with suspected heart failure, a basic assessment including history, physical examination, ECG, measurement of natriuretic peptides, and a comprehensive transthoracic echocardiogram should always be performed. Based on the finding of this initial assessment additional imaging modalities are selected on a case-to-case basis. In this review, we discuss the role of advanced echocardiography techniques, cardiac magnetic resonance imaging, computed tomography, cardiac catheterization and nuclear medicine examinations in this context.
INTRODUCTION:The effect of a (neuro-)psychopharmacological drug is determined by its interaction with its target structure in the brain (pharmacodynamics). A number of pharmacokinetic factors determine whether a drug is capable of reaching its site of action in a sufficient concentration. The concentration of the active compound can be significantly affected by its metabolism, which is genetically determined in each individual (known as the pharmacokinetic genotype), and by potential interactions with other prescribed drugs (known as the pharmacokinetic phenotype). For example, changes in drug metabolism inevitably lead to changes in the concentration of active compounds and thus to changes in the exposure of the drug. Therapeutic drug monitoring (TDM) is a tool for individualized pharmacotherapy that helps to optimize pharmacological treatment. On the one hand, TDM helps to detect deviations from expected drug concentrations and individualize treatment by adjusting doses. On the other hand, looking at the ratio of the parent compound and its metabolite (known as the metabolic ratio) helps to identify any abnormalities or peculiarities in drug metabolism supporting dose adjustments. This article provides a clinically oriented overview of how changes in drug metabolism can lead to treatment failure and which tools can be used to optimize treatment.
INTRODUCTION:Depressive syndromes are among the most common mental conditions in primary care. They are associated with high morbidity and relevantly reduced quality of life. General practitioners (GPs) play a central role in early detecting and diagnosing depression as well as in initial treatment. This paper summarises the new Swiss treatment recommendations and gives an overview of evidence-based treatment algorithms with a focus on applicability in primary care. Diagnosis is based on core symptoms of depression. In addition to a structured anamnesis, validated instruments for screening and development of symptoms should be used. Further, somatic causes should be excluded using basic laboratory tests and, if indicated, neuroimaging. Treatment depends on the severity of depression: In mild depression, active monitoring, low-intensity interventions (e. g. self-help strategies, activation, sleep and circadian strategies, physical activity, etc.) and psychotherapy are indicated. In moderate episodes, psychotherapy or antidepressants are indicated; severe episodes require a combination of psychotherapy and antidepressants. First-line antidepressants are SSRIs and SNRIs and other modern antidepressants. In case of non-response, a combination of antidepressants or augmentation with atypical antipsychotics or Lithium is recommended. Psychotherapy has proven efficacy across all severity levels, and it should be combined with antidepressants in severe episodes. In severe, psychotic and difficult to treat depressive episodes, strategies from the field of interventional psychiatry (ECT, rTMS, Esketamine) are effective. Complementary approaches such as physical activity/exercise, light therapy, or social therapy further enhance treatment outcomes. In conclusion, guideline-based multimodal care for patients starting in primary care improves outcome and prognosis for patients with depression and can reduce the risk of chronification and relapses. Key elements are structured diagnostics, early initiation of evidence-based therapy with regular valid monitoring within a strong doctor-patient-relationship.
INTRODUCTION:Sleep disorders occur in almost one out of three people and are therefore among the most common disorders that physicians encounter in their practice. They often also present in the context of mental disorders. While it was previously assumed that they were merely a symptom of mental illness, current literature emphasizes the bidirectional connection between sleep and mental disorders. Even in the most common sleep disorders, namely sleep-related breathing disorders, insomnia, and restless legs syndrome / periodic limb movement disorder, reciprocal and sometimes complex interactions between sleep and the mental health are found. A diagnostic classification is often successful based on a targeted and sleep-specific medical history and can then be efficiently narrowed down using a step-by-step diagnostic approach. Due to the bidirectional connection between sleep and mental disorders, it is crucial to also inquire about mental symptoms in sleep disorders and to consider sleep in mental disorders. If a sleep disorder occurs together with a mental disorder, it is essential to treat both disorders specifically. While nocturnal continuous positive airway pressure therapy is the primary treatment for sleep-related breathing disorders, insomnia is ideally treated with cognitive behavioural therapy. Interestingly, this treatment also shows effects on the associated mental disorder. Restless legs syndrome and periodic limb movement disorder, on the other hand, are usually treated pharmacologically, with particular attention to the association with psychotropic medications.
INTRODUCTION:Alcohol use disorders are common and contribute significantly to the global burden of disease. The treatment of alcohol dependence includes the acute withdrawal phase and the post-acute rehabilitation phase. The primary goal of post-acute treatment is long-term abstinence, although reduction of alcohol consumption is also recognized as an intermediate goal. In addition to psychosocial and psychotherapeutic interventions, the use of medications is recommended. In Switzerland, four medications (acamprosate, naltrexone, nalmefene, and disulfiram) are approved for post-acute treatment. Their efficacy in reducing relapse risk, drinking days, and overall alcohol consumption is well established. Baclofen, topiramate, and gabapentin are used "off-label", but sufficient evidence of their effectiveness is still lacking. Innovative approaches such as cannabidiol, psilocybin, and glucagon-like peptide-1 receptor agonists show promising therapeutic potential, which needs to be confirmed in further clinical studies. The use of pharmacological interventions can help improve patient outcomes, reduce the need for inpatient treatment, and lower healthcare costs.
INTRODUCTION:The prevention of dementia syndromes is becoming increasingly important. Previous studies have shown that around 40 % of dementia risk factors are modifiable. A total of 61 factors have been described, with the highest level of evidence for 12 factors, such as cardiovascular risk factors, hearing loss and depression. Particular focus is being placed on previously underestimated risk factors such as early menopause, other mental illnesses - especially bipolar disorder - as well as herpes zoster and physical inactivity. Consistent and early treatment of these risk factors - including new antidiabetic drugs, hearing aids, treatment of mental illness, vaccinations against herpes zoster, increased social interaction and regular high-intensity physical activity - can have a positive impact on the risk of dementia. In the future, more attention and screening will be needed, particularly with regard to factors specific to women, such as early menopause. Multimodal early dementia prevention through lifestyle changes and a socially and physically active lifestyle not only reduces risk but also delays the onset of the disease.
INTRODUCTION:Mental disorders are common in primary care and impose substantial societal costs. Current psychiatric care still relies largely on trial-and-error prescribing, often delaying response and increasing adverse effects. Precision psychiatry aims to shift practice toward data-driven, individualized decisions by integrating biological markers, clinical phenotypes and contextual factors. This article introduces practical tools with an emphasis on real-world use in general practice: RNA-editing blood biomarkers (the EDIT-B test) to support the differentiation of bipolar disorder from unipolar major depression; genomic approaches targeting the AVP/V1B pathway as a proxy for HPA-axis hyperactivity and as a potential companion diagnostic for V1B-receptor antagonists; and pharmacogenomics (CYP2D6/CYP2C19) to guide antidepressant selection and dosing. Additional emerging components include inflammatory markers such as hsCRP, digital phenotyping with wearables for longitudinal monitoring, and metabolomic/lipidomic signatures for stratification. Finally, key implementation issues in primary care are discussed, including training needs, workflow and EHR integration, reimbursement, and data protection/informed consent.
INTRODUCTION:Obsessive-compulsive disorders (OCD) are common and often chronic mental illnesses, characterized by recurring, intrusive thoughts, ideas and impulses (obsessions) and repetitive, stereotypical behaviors (compulsions). Etiopathogenetically, OCD is explained by a complex interplay of genetics and epigenetics, neurotransmission, imbalances in cortico-striato-thalamo-cortical circuits, as well as learning mechanism and environmental factors. In ICD-11, OCD is now classified in the chapter "Obsessive-compulsive and related disorders", which share compulsive and impulsive behavioral patterns. This article provides diagnostic recommendations, common psychiatric comorbidities, and key differential diagnoses. In terms of psychotherapy, disorder-specific cognitive behavioral therapy (CBT) with exposure and response prevention is highly effective and recommended as first-line treatment. New approaches describe intensified and internet-based formats as well as modern developments in CBT. Pharmacologically, serotonin inhibitors (SSRIs and Clomipramin) are recommended at high dosages. Atypical antipsychotics may be used in low dosages for augmentation. For treatment-resistant cases, brain stimulation techniques such as repetitive transcranial magnetic stimulation and bilateral deep brain stimulation may be considered following a careful risk-benefit analysis.
INTRODUCTION:More and more people are spending time at high altitudes, either recreationally or permanently. As altitude increases, the partial pressure of inspired oxygen decreases, leading to hypobaric hypoxia and triggering a wide range of physiological adaptations. This article discusses the most relevant (patho)physiological acclimatization effects at high altitudes in healthy subjects. Hypobaric hypoxia primarily affects respiration, circulation, blood, as well as sleep and brain function. Respiration responds immediately with increased ventilation (hypoxic ventilatory response), reducing CO₂ levels and causing respiratory alkalosis, which is later compensated renally. Above approximately 2500 m, periodic breathing often occurs, disrupting sleep. Cardiac output initially rises due to an increased heart rate but decreases later as stroke volume declines. Plasma volume contracts rapidly, raising hematocrit and increasing blood viscosity. In the long term, erythropoietin stimulates red blood cell production, enhancing oxygen transport capacity. Physical performance begins to decline linearly from around 1500 m, and maximum oxygen uptake remains limited despite acclimatization.
INTRODUCTION:Hypoxia represents a major physiological challenge in aviation, often underestimated due to its subtle onset and individually variable symptoms. This article summarizes the physical basis of decreasing oxygen partial pressure with altitude and its impact on human performance. Even at moderate altitudes (2500-4000 m), cognitive functions, reaction times, and visual performance decline significantly-often without the affected person noticing. At higher altitudes, time of useful consciousness rapidly decreases, especially in cases of sudden decompression. Although the body initiates compensatory mechanisms, such as hyperventilation and increased heart rate, these are limited and can lead to secondary complications. The key threat lies in the mismatch between actual impairment and perceived capability. Understanding hypoxia's mechanisms, recognizing early signs, and using oxygen systems correctly are critical to maintaining flight safety across all aviation sectors.
INTRODUCTION:The physical and biological effects of hyperbaric oxygen therapy (HBOT) are used to treat various medical conditions, such as decompression sickness after diving accidents or in cases of gas embolism or CO-poisoning. Another, generally less well-known indication for HBOT is the use of HBOT in supporting the healing of chronic wounds. HBOT corrects tissue hypoxia, stimulates angiogenesis and collagen synthesis, reduces environmental oedema and has anti-inflammatory and anti-microbial effects. Various clinical studies have shown a positive effect of HBOT on wound healing, particularly in diabetic foot syndrome. Nevertheless, the indication for HBOT in wound healing disorders is not conclusively clarified for all forms of chronic wounds, which is partly due to the heterogeneity of the existing data. Barriers in application include potentially long treatment protocols and the distance to the nearest pressure chamber.
INTRODUCTION:Acute altitude illnesses are significant can occur in unacclimatized individuals at altitudes above 2,500 meters. They essentially comprise three clinical pictures: Acute Mountain Sickness (AMS), High Altitude Cerebral Edema (HACE), and High Altitude Pulmonary Edema (HAPE), which can manifest alone or in combination. All are triggered by hypobaric hypoxia, with individual predisposition, pre-existing medical comorbidities and in particular ascent rate and destination altitude influencing risk. AMS is the most common, presenting with headache, nausea, dizziness, and fatigue. Prevention includes slow ascent, pre-acclimatization, and eventually acetazolamide or dexamethasone. In severe cases, descent, oxygen therapy, and dexamethasone are key. HACE is considered a life-threatening complication of AMS with ataxia, altered consciousness, and neurological deficits. Pathophysiologically, vasogenic edema, hypoxic cell injury, and disturbed cerebrospinal fluid dynamics play a role. Treatment also includes descent, oxygen therapy, and dexamethasone. HAPE is a non-cardiogenic pulmonary edema due to an excessive hypoxic pulmonary vasoconstriction with consecutive elevation of pulmonary artery pressure and increased capillary pressure. Symptoms include dyspnea and cough; clinically, cyanosis and crackles are evident. Treatment requires descent, oxygen therapy, and possibly nifedipine or PDE-5-inhibitors. If untreated, HACE and HAPE progress rapidly and can be fatal. Prevention, early recognition and immediate treatment are crucial.
INTRODUCTION:Staying at moderate to high altitudes leads to hypobaric hypoxia due to the reduced atmospheric oxygen partial pressure, which can have clinically relevant effects in individuals with chronic respiratory diseases. This article summarizes current findings on altitude exposure in patients with asthma, chronic obstructive pulmonary disease (COPD), pulmonary vascular diseases (PVD), obstructive sleep apnea (OSA), interstitial lung diseases (ILD), and after lung transplantation. Pre-travel counseling should include functional testing, risk assessment, and preventive strategies. With appropriate preparation, altitude stays can be safe for many affected individuals.
INTRODUCTION:People dive out of fascination or for economic reasons. Today, technical devices allow us land-dwelling organisms to breathe underwater. The effect of water pressure has a significant impact on physiological processes in the organism and leads to specific pathophysiologies. A sound knowledge of this is the basis of good medical care for people who dive to depths below the surface. Based on a number of exemplary accident scenarios, the article will examine the important pathophysiologies in diving medicine. Various accident mechanisms produce gas bubbles in the body, which can lead to symptoms in the central and peripheral nervous system. Barotrauma of the lungs can have fatal consequences. The importance of maximum oxygen supply as the most important therapeutic agent in any diving incident is discussed in detail. The medical assessment of diving fitness and competent advice are of great importance for safe diving. A well-founded examination reveals individual health risks and achieves the goal of prevention.
INTRODUCTION:Integrative oncology is gaining increasing importance in cancer care. Patients seek additional support that addresses not only physical, but also emotional and spiritual needs. At the same time, studies show positive effects of complementary therapy intervention on quality of life and symptom control. Nevertheless, healthcare professionals often remain uncertain in clinical practice regarding the safety, effectiveness, and communication of such therapies. This article provides an overview of continuing education and training opportunities in the field of integrative oncology in Switzerland, highlights existing gaps, and defines key competencies required for safe and evidence-informed application. Based on international recommendations, practice-relevant learning content, educational formats, and interprofessional teaching strategies are presented. A particular focus is placed on the development of multiprofessional, evidence-based, and practice-oriented educational programs that address various professional groups - from physicians and nurses to complementary therapists. The aim is to promote interprofessional collaboration through structured training and to ensure the safe and effective use of complementary therapies in the oncological setting.
INTRODUCTION:Palliative care focuses on the quality of life of people with life-limiting illnesses through bio-psycho-social-spiritual support and multiprofessional collaboration, as early as possible in the disease course and continuing until the end of life. In this context, many patients also seek integrative medical approaches which, with their salutogenetic and multidimensional orientation, align well with the core principles of palliative care. Using anthroposophic medicine and phytotherapy as examples, a spectrum of remedies, external applications, and artistic therapies is presented that can relieve symptoms and strengthen inner resources. A competent indication with careful consideration of benefits and burdens is essential. When applied appropriately, integrative interventions can contribute to providing individualized and comprehensive support for people at the end of life and effectively reinforce the principles of palliative care.
INTRODUCTION:Integrative oncology (IO) combines conventional cancer medicine with evidence-based complementary procedures, thereby placing special demands on the concept of evidence, research methodology, and the evaluation of care quality. This article highlights key theoretical, methodological, and practical principles. The classic concept of evidence is examined in detail through the three pillars of evidence-based medicine. Complementary research designs such as mixed methods, pragmatic studies, whole-systems approaches, and preference-based designs, are discussed as they offer new perspectives for generating valid and patient-centered evidence. In addition, regulation and practice-oriented quality criteria are presented as well as the current consensus process within the newly founded "Swiss Network for Integrative Oncology" (SNIO), which defines common standards, training structures, and research strategies. These efforts lay the foundation for the ongoing development of the field - toward an IO that is safe, effective, and truly patient-centered.
