INTRODUCTION:Optimising cardiopulmonary resuscitation (CPR) management is crucial for out-of-hospital cardiac arrest (OHCA) survival but requires a clear understanding of the entire chain of survival. However, detailed OHCA management data from Swiss emergency centres (EC) are limited. METHODS: A nationwide cross-sectional survey was conducted among Level 1 and 2 ECs affiliated with the Swiss Society of Emergency and Rescue Medicine (SGNOR). The questionnaire covered key aspects of CPR management, including EC characteristics, team composition, resuscitation protocols and challenges pertaining to the year 2022. Analyses were performed using descriptive methods. RESULTS: Response rates were 94% (15/16) from Level 1 and 28% (10/36) from Level 2 ECs. CPR training is widely implemented with 90% of centres conducting emergency bay simulations. ACLS certification is mandated in 73% of Level 1 but only 20% of Level 2 centres. Team composition and debriefing practices vary with a structured debriefing absent in 67%/60% of Level 1/2 ECs. Mechanical chest compression devices are used in 80%/30% of ECs, while extracorporeal membrane oxygenation is available in 73%/10% ECs. Standard operating procedures are widely implemented, but 40%/60% of ECs lack structured OHCA databases. Challenges differ by Level, with Level 1 centres reporting variability in expertise due to frequently rotating staff and Level 2 centres highlighting staff shortages especially during night shifts. Decision-making challenges include termination of resuscitation, interdisciplinary coordination and post-resuscitation care. Research engagement is limited to 20% of Level 1 centres, but 93% of Level 1 and 50% of Level 2 ECs report willingness to engage in research projects under specific conditions, such as minimal time commitment. CONCLUSION: Significant variability in CPR management, training and data collection exists across Swiss ECs. Standardised protocols, structured training and improved interdisciplinarity coordination are needed. Enhancing data registration and aligning practices with international guidelines could optimise patient outcomes, emphasising the need for further research and national standardisation efforts.
BACKGROUND: Initiatives like “Choosing Wisely” promote efficient and high-quality healthcare by reducing overuse. The interdisciplinary copAIN project aims to reduce resource utilisation in medical ward patients by providing specific guidelines to internal medicine residents. METHODS: This study was conducted in the Cantonal Hospital Aarau, a 500-bed tertiary care and academic facility.After implementing the copAIN project for medical inpatients on 1 June 2023, we conducted an interrupted time-series (ITS) cohort study and analysed it using a mixed-effects regression model for comparison. Neurological patients not involved in copAIN served as the control group. The primary outcome was resource utilisation defined by the measurement frequency of five vital signs and laboratory orders. The secondary, safety outcome was in-hospital mortality. RESULTS: Of 51,396 admissions between 1 September 2022 and 31 May 2024, 8344 cases were eligible for analysis. While there were no differences in measurement frequencies in the control group, we found a significant reduction in the intervention group for the frequency of measurements of blood pressure (0.28 measures per day per length of stay [dLOS]), heart rate (0.26 measures per dLOS), oxygen saturation (0.28 measures per dLOS) and temperature (0.27 measures per dLOS). However, this effect was temporary, and adjusted analyses showed no significant difference between pre- and post-intervention periods. There was no change in mortality between study periods in both groups. CONCLUSION: An intervention focusing on the reduction of routine parameters within the hospital settingresulted in a temporary decrease in resource use without increasing in-hospital mortality. This data supports recent initiatives aimed at improving resource efficiency in medicine without compromising quality. The absence of a sustained impact highlights the need for ongoing strategies to maintain and reinforce improvements.
STUDY AIMS:At the beginning of the 20th century, iodine deficiency was prevalent and goitre was a frequent indication for thyroid surgery. At that time, the hospital in Riehen (Switzerland) was an established centre for thyroid surgery. This study investigates the specific complications associated with thyroid surgery over time. METHODS:An analysis of thyroidectomy data from two retrospective cohorts of the Riehen hospital was performed for two decades: 1930-1939 (shortly after the start of salt iodination in Switzerland) and 1970-1979 (salt iodination well established). Demographics, clinical and surgical characteristics, and postoperative complications were compared. The primary endpoint included the rate of mortality, Chvostek tetany and recurrent laryngeal nerve injuries. We also compared last-century data with modern-era data consisting of Swiss diagnosis-related group (DRG) data on thyroidectomies for the years 2011-2015 and EUROCRINE registry data for the year 2024 (including data of endocrine surgical interventions from the five largest Swiss surgical centres). RESULTS:Among 3280 thyroidectomies analysed (1826 for 1930-1939 and 1454 for 1970-1979), the 1930s cohort was younger (mean age: 37.3 years, standard deviation (SD): 11.1 years vs 49.9 years, SD: 13.2 years; p <0.01) and more predominantly female (85.5% vs 83.1%; p <0.01). Compared to the 1930s, in the 1970s the weight of the resected thyroid gland had decreased (mean thyroid weight: 141.2 g, SD: 99.9 g vs 107 g, SD: 89.3 g; p <0.01) and there were lower rates of recurrent laryngeal nerve injuries (16% vs 4.2%; p <0.01) and Chvostek tetanies (6.1% vs 1%; p = 0.01). Modern-era data indicate a lower thyroidectomy mortality rate than in the 1970s. CONCLUSION:The reduction in complications following thyroidectomy over time seems to be multifactorial. While iodine supplementation and a decrease in goitre size played a role in the Riehen cohorts, advancements in surgical skills and perioperative management may also have contributed to the even more favourable outcomes in the modern era.
STUDY AIMS: To determine the incidence of mechanical restraint in the emergency department (ED) of the University Hospital of Bern, Switzerland; To assess differences in restraint frequency and practice across patient groups (sex, age, alcohol involvement); To characterise triggers of aggression or agitation and restraint-related interventions including medication use; To examine temporal patterns, particularly the impact of the COVID-19 lockdown and pandemic. METHODS: We included patients presenting at our institution between 1 January 2018 and 30 September 2022 who were subjected to mechanical restraint. Patients were identified through a keyword search followed by a comprehensive full-text review of the hospital database. Demographic and consultation characteristics, data about restraining circumstances and characteristics, as well as referral or discharge procedure were collected. Group comparisons were performed using the Wilcoxon rank-sum test or Kruskal–Wallis test, as appropriate. Categorical variables were compared using the chi-squared test. Incidence rate ratios across the three COVID-19 mitigation phases (pre, during, post) were estimated using Poisson regression. RESULTS: We identified 285 patients who were subjected to mechanical restraint, corresponding to an incidence of 1.22 (95% CI: 1.08–1.37) per 1000 ED consultations during the study period. Men were overrepresented with 67.4% and the median age was 30 years (IQR: 23–41). Alcohol intoxication was the primary trigger of aggression in 35.4% of cases, with mixed intoxication present in 24.2%. The largest subgroup consisted of young men (≤40 years) under the influence of alcohol (31.6%). Compared to men, women were generally younger (28 vs 32 years, p <0.001) and had a higher prevalence of psychiatric comorbidities (43.0% vs 20.3%, p <0.001). Older patients were more likely to be intoxicated with alcohol (52.8% vs 29.6%, p <0.001), whereas younger patients had a higher rate of mixed intoxication (28.2% vs 12.5%, p = 0.007) and psychiatric disorders (31.9% vs 15.3%, p = 0.006). Mechanical restraint involving alcohol was more common in men (74.7%, p = 0.001), associated with risk of harm to others (69.8%, p <0.001) and addiction problems (76.4%, p <0.001). Pharmacological coercive measures were primarily administered using benzodiazepines (78.2%, typically intravenous and/or nasal application) and haloperidol (47.4% intravenous and/or intramuscular). The median duration of mechanical restraint was 258 minutes (IQR: 160–400). Alcohol-involved presentations were significantly associated with young men, non-Swiss nationality, acute risk of harm to others, night shift, addiction and longer restraint times (all p ≤0.001). The number of mechanical restraints increased until mid-2020, stabilising during the COVID-19 mitigation period, with a higher incidence of mechanical restraints during the pandemic (1.43 vs 1.02 per 1000 consultations pre-pandemic, p = 0.008). CONCLUSION: The incidence of mechanical restraint was low (1.22 per 1000 visits). Predominantly, young, intoxicated men, presenting with risk of harm to others, were subject to mechanical restraint. Psychiatric comorbidities were more common in women, who were therefore more likely to pose a risk of self-harm. During the COVID-19 mitigation period, the incidence of mechanical restraint increased; however, the causal factors underlying this trend remain unclear.
BACKGROUND: Systolic blood pressure is a prognostic marker in acute heart failure, but the prognostic implications of in-hospital changes in systolic blood pressure are unclear. We assessed the association between in-hospital systolic blood pressure changes and outcomes in a real-world, multinational cohort of acute heart failure patients. METHODS: We analysed consecutive patients hospitalised for acute heart failure between 2005 and 2020 at two tertiary-care centres (CHUV, Switzerland; NCCIM, Kyrgyzstan) with available systolic blood pressure measurements at admission and discharge. Patients were classified into four systolic blood pressure trajectory categories: stable normal/low (systolic blood pressure consistently <140 mm Hg or minor increase, Δ<10), increasing (systolic blood pressure rose ≥10 mm Hg from <140 to ≥140 mm Hg), decreasing (systolic blood pressure dropped ≥10 mm Hg from ≥140 to <140 mm Hg), stable elevated (systolic blood pressure consistently ≥140 mm Hg or minor decrease, Δ<10). The primary outcome of the study was a composite of first heart failure hospitalisation or all-cause mortality, assessed over a 1-year follow-up period. The association between categories and the primary outcome was assessed with Cox models, adjusted for relevant covariates. RESULTS: Among 1490 patients (80% Swiss, 56% male, age 75 ± 13 years), 621 experienced the primary outcome at 1 year. Compared to those with stable normal/low systolic blood pressure, patients with decreasing systolic blood pressure had a significantly lower risk of the primary outcome (adjusted HR: 0.81; 95% CI: 0.66–0.99; p = 0.040), with no significant differences for the other systolic blood pressure trajectories. Results remained consistent regardless of sex, age and left ventricular ejection fraction (Pinteraction for all >0.05). CONCLUSION: In this real-world, multinational cohort of 1490 acute heart failure patients, in-hospital decline in systolic blood pressure was independently associated with improved outcomes in those with an elevated systolic blood pressure at admission.
The present recommendation document proposes a non-binding practical guide intended to support the standardised implementation of early mobilisation at Swiss Stroke Centres and Stroke Units, with application planned to begin in January 2026. It was developed by the “Early Mobilisation Working Group”, established in November 2023, to promote a consistent, evidence-based approach to mobilising stroke survivors in the (hyper)acute phase at Swiss Stroke Centres and Stroke Units. The group originated from the “Stroke Therapy Network” committee of the Swiss Stroke Society and developed into a collaboration with the “Stroke Nursing Network” committee of the Swiss Stroke Society. The current literature does not provide sufficient evidence to define all aspects of the dose and intensity of early mobilisation of stroke survivors. Therefore, this guide also draws upon clinical expertise and considers the structural and organisational conditions specific to Swiss Stroke Centres and Stroke Units. Some aspects of early mobilisation remain insufficiently defined and require ongoing discussion and research. The authors explicitly invite stakeholders and readers to provide feedback to support the continued development and improvement of this guide.
Population ageing is accelerating globally, creating complex clinical, ethical and organisational challenges for health systems. Older adults frequently experience multimorbidity, frailty and cognitive impairment, leading to unpredictable illness trajectories and high palliative care needs. Geriatric palliative care (GPC) has emerged as an integrative approach uniting geriatric, palliative and rehabilitative principles to address these multidimensional needs. Recent European recommendations emphasise needs‑based assessment, interdisciplinary collaboration, caregiver support, culturally sensitive communication and integration across care settings. In Switzerland, persistent barriers – including fragmented care pathways, limited workforce training, variable access in nursing homes, low uptake of advance care planning and inequities affecting socioeconomically and culturally diverse populations – underscore the urgency of implementing coordinated GPC models. Strengthening home‑ and nursing home‑based palliative care, embedding GPC competencies in undergraduate and postgraduate curricula, establishing shared‑care frameworks and aligning national strategies with international ageing agendas represent key priorities. Investment in GPC is essential to ensure equitable, person‑centred and sustainable care for a rapidly growing population of frail older adults.
This article presents a comprehensive overview of perioperative pain medicine based on recently published recommendations by the Swiss Society of Anaesthesiology and Perioperative Medicine (SSAPM). As it has long been known that improvements in postoperative pain management depend more on organisational structures than on new drugs or techniques, these recommendations focus on the structures and processes of perioperative pain management. The introduction of Acute Pain Services (APS) by anaesthesiology departments in the 1980s marked significant progress. However, APS coverage remains limited and inconsistent across institutions, often lacking sufficient resources. To address these gaps, the SSAPM convened a multiprofessional expert group to develop structural and procedural recommendations. Key structural recommendations emphasise the necessity of interdisciplinary and interprofessional collaboration, with jointly developed and signed protocols between surgical and pain services to clarify responsibilities and prevent care gaps. Hospitals are urged to maintain written, evidence-based standard procedures for multimodal pain management tailored to local conditions. The availability of qualified personnel for pain management is also a key recommendation. Process recommendations highlight the importance of multidisciplinary, multiprofessional approaches and seamless communication between personnel involved in perioperative care, patients, and external care providers. Preoperative patient education, the identification of individuals at risk for complex pain trajectories or chronic postsurgical pain (CPSP), and structured follow-up are essential components. The continuum of care from inpatient to outpatient settings is another key element. Overall, these recommendations aim to standardise and define perioperative pain management as a core element of modern perioperative medicine.
Armed conflicts such as those in Gaza and Ukraine highlight the urgent need for innovative solu- tions to deliver emergency medical and surgical support in inaccessible and high-risk environ- ments. Traditional supply chains often fail in war zones due to blockades, damaged infrastructure and safety concerns for healthcare personnel. Unmanned Aerial Vehicles (UAV), commonly refer- red to as drones, have emerged as a promising tool to bridge these critical gaps. This narrative re- view explores the role of drones in delivering medical supplies, supporting casualty triage and en- hancing emergency response in conflict settings. A structured literature search of MEDLINE and Embase (2000-2025) identified relevant studies assessing drone applications in healthcare, with particular focus on their deployment in war and disaster zones. Evidence demonstrates drones can significantly reduce delivery times for blood products, automated external defibrillators and essen- tial medicines, while providing reconnaissance to locate casualties and assess hazards. Advantag- es include improved timeliness, reduced risk to rescuers and enhanced situational awareness. However, challenges remain, including limited payload and range, vulnerability to adverse weather and electronic interference, regulatory and legal barriers, and civilian mistrust linked to military drone use. Future integration of artificial intelligence, secure communication systems and harmon- ised regulatory frameworks may expand drone utility, ultimately transforming emergency medical care in conflict zones.
STUDY AIMS: Timely defibrillation is a critical determinant of survival in out-of-hospital cardiac arrests, yet public access to automated external defibrillators (AEDs) remains spatially and temporally uneven, particularly in decentralised health systems. This study aimed to quantify AED accessibility and spatial overcoverage across the urban-rural gradient using high-resolution geospatial da- ta from Switzerland as a model system. METHODS: We conducted a national cross-sectional geospatial analysis using AED locations (n =14,446) from Defikarte.ch (December2024), hectare-level population grids from the Federal Statistical Office (2023) and the 9-category municipality typology. The primary outcome was AED accessibility, defined as the proportion of the population within a 300-metre retrieval buffer of a 24-hour-accessible AED. Secondary outcomes included population coverage gain, comparing current24-hour AED access with a hypothetical scenario in which all AEDs are accessible 24-hours, andspatial overcoverage, defined as overlapping AED buffers, indicating redundancy. Population expo-sure quantified the share of residents within these zones. Differences across municipality types were tested using the chi-squared test, paired t-test and Kruskal-Wallis test with Dunn's post-hoccomparison. RESULTS: Expanding all AEDs to 24-hour access significantly increased national coverage from 28.9% to 51.6% (t = 3.96, p <0.005) but failed to resolve persistent deficits in agricultural and tourist communes. Statistical tests confirmed significant variation in accessibility (chi-squared test, p <0.001) and overcoverage (Kruskal-Wallis test, p <0.001) across municipality types. Overcoverage was concentrated in urban cores, while rural areas exhibited predominantly single-device coverage. Population exposure analysis indicated that overlap zones accounted for 28.6% of the covered population and 8.3% of the total population. CONCLUSION: This national analysis identified major spatial and temporal inequities in AED accessibility across Switzerland. Expanding all AEDs to 24-hour availability improves coverage but does tial redistribution aligned with population needs.
BACKGROUND: Reliable and accurate measurement of creatinine is essential for the estimation of kidney function (eGFR) and for survival prediction with the model of the end-stage liver disease (MELD) score. Bilirubin interference is considered an important interference of Jaffe creatinine as- says; the enzymatic assay is also affected but less so. This study aimed to evaluate the compara- bility of the Jaffe and enzymatic creatinine methods and the impact of their discrepancy on clinical decision-making, particularly in the context of bilirubin interference. METHODS: We compared creatinine measurements from the Roche Jaffe Gen.2 (CREJ2) and Ro- che Creatinine Plus ver.2 (CREP2) assays using routine heparin plasma samples (n = 15,618). To estimate the clinical impact of bilirubin interference on these two assays, we evaluated our results in the context of eGFR-based staging of severity of kidney disease and the MELD score. RESULTS: The Roche Jaffe and enzymatic methods agree well for non-icteric samples with a mean relative bias of 3.97% but not in icteric samples. In samples with 5-20 mg/dl and 20-53 mg/dl bilir- ubin, the biases amounted to 10.9% and 43.4%, respectively. CONCLUSIONS: The Jaffe method's susceptibility to bilirubin interference, in comparison to the enzymatic assay, can result in higher MELD scores and can lead to an underestimation of kidney function.
BACKGROUND AND AIMS: Bulevirtide 2 mg/day was approved in Switzerland in February 2025 for the treatment of chronic hepatitis D virus (HDV) infection. We present real-world data on efficacy and safety in patients treated under an early access programme. METHODS:This retrospective, multicentre Swiss cohort study included patients with compensated HDV-associated cirrhosis in whom bulevirtide therapy (2 mg/day) was initiated between January 2020 and August 2024 under a compassionate use programme. Virological response was defined as a HDV RNA level that was undetectable or declined ≥2 log10 IU/ml from baseline. Biochemical response was defined as normalisation of ALT. Combined response was defined as achieving both virological and biochemical response. Liver-related events and adverse events were assessed. RESULTS:Fourteen patients with compensated HDV-related cirrhosis received bulevirtide for a median duration of 1.85 years (1.1-2.1). Median age was 51.3 years (43.9-58.5), and 71.4% were men. Baseline ALT was 81 U/l (55.8-88.8), platelet count 102.5 × 109/l (67.3-141.3) and liver stiffness 15.3 kPa (11.8-22.1). Baseline HDV RNA was 4.82 log10 IU/ml (4.52-6.23). Biochemical, virological and combined responses were observed in 50%, 64.3% and 35.7% at 6 months; 66.7%, 75% and 58.3% at 12 months; and 62.5% for all three response types at 24 months. Two patients (14.3%) developed de novo hepatocellular carcinoma, and one (7.14%) patient underwent liver transplantation. No serious adverse events were reported. Mild transient pruritus occurred in two (14.3%) patients. CONCLUSIONS:In this real-world cohort of patients with compensated HDV cirrhosis, bulevirtide demonstrated favourable efficacy and safety. These findings support the integration of bulevirtide into routine care for patients with HDV and compensated cirrhosis in Switzerland following its reimbursement status as of 2025. Longer-term follow-up is warranted to assess the impact on liver-related outcomes.
BACKGROUND: Urban swimming, especially in the Aare River, is popular in Switzerland but carries risks, particularly for those unfamiliar with its currents and hazards. This study describes the epidemiology of river-related emergency department (ED) visits, focusing on injury patterns, patient demographics and presentation characteristics. METHODS:A retrospective cross-sectional study at the University Hospital of Bern was conducted, analysing river-related ED visits from 2012 to 2024. Data on demographics, injury types, triage levels and outcomes were extracted from electronic medical records. RESULTS:A total of 263 river-related ED visits were identified among a total of 541,561 ED visits over the study period (proportional incidence: 0.49 per 1000 ED consultations, 95% CI: 0.43-0.55). Most patients were male (62.7%), aged ≤35 years (65.4%) and Swiss nationals (65.4%). The most frequent injuries were trauma (63.1%), mainly affecting the lower extremities (30.8%) and head/face (16.3%), often due to collisions with submerged objects or bridge jumping. Drowning cases (12.2%) were less common, with seven fatalities (2.7%). Most incidents occurred in the summer between June and August (78.7%), with 37.3% on weekends. Suicide attempts (20.4% vs 3%) and boating-related incidents (11.2% vs 6.7%) were more common in females and jumping-related incidents more frequent in males (22.4% vs 11.2%), p <0.001. Hypothermia was significantly more often found in non-Swiss nationality ED visits (p = 0.002) and those of people aged >35 years (p <0.001). Compared to younger patients, those aged >35 years were significantly more likely to be triaged as life-threatening (22% vs 7.6%; p <0.001), report intentions other than swimming (notably more suicide attempts and accidents; p <0.001), and had higher rates of admission to an ICU or of transfer to a psychiatric clinic (p <0.001). CONCLUSION:River-related ED visits are a recurring seasonal concern, primarily affecting young males. People with non-Swiss nationality and those engaging in high-risk activities are at higher risk. Adopting a multilingual approach could be a key objective of safety campaigns to more effectively reduce risks for non-Swiss swimmers and promote safer swimming practices in urban waters. Prevention efforts should continue to focus on public education, enhanced safety signage and improved emergency preparedness.
This case discusses a 76-year-old female patient with a large mass at the major papilla of Vater, initially suspected to be an ampullary adenoma. The lesion, identified during an upper endoscopy for anemia and fatigue, showed chronic inflammation but no malignancy. The patient's medical history included breast cancer and a partial distal pancreatectomy for an intraductal papillary mucinous neoplasm. Further imaging and biopsies did not confirm malignancy or adenoma but suggested actinomycosis. Actinomycosis, caused by Actinomyces species, presents challenges due to its rarity, slow progression, and difficulty in diagnosis. It can mimic malignancies, especially occurs following surgery, and requires long-term antibiotic therapy. We present the first documented case of actinomycosis involving the ampulla of Vater and emphasize the importance of considering actinomycosis in the differential diagnosis of ampullary masses, particularly in postsurgical patients with granulomatous tissue.
Introduction:Inflammatory bowel diseases (IBD), in particular Crohn's disease (CD) and ulcerative colitis (UC), are chronic conditions that have a considerable impact on patients' quality of life and healthcare resources, as they require frequent visits and hospitalisations. Telemedicine offers a potential advantage by enabling remote healthcare. Studies have shown that telemedicine can improve quality of life and reduce healthcare use, although results vary depending on study design and location. Our study investigates the views of French-speaking Belgian IBD patients on telemedicine. It aims to assess acceptability and preferences to guide future implementation. Methods:We designed a questionnaire available online (between October 2023 and June 2024) for which any patient with IBD followed up in an adult gastroenterology consultation was eligible. The 69-item questionnaire was validated by test patients and distributed via Epic®, social media and printed forms. Data were collected using REDCap® and analyzed using SPSS®, applying univariate and multivariate analyses to identify factors influencing acceptance of telemedicine. Results:257 respondents validated their questionnaire. The majority were women (54%) with an average age of 45 years [17-85]. Most patients had Crohn's disease (63%) and were using immunosuppressive therapy (44%) and/or biologics (30%), with a high compliance rate (98%). Although 68% had discovered telemedicine because of our survey, 82% were interested in remote consultations, citing time savings and reduced absence from work as advantages, while expressing concerns about reduced personal contact and technical problems. Acceptance was significantly associated with time saved and frequency of visits (p<0.05). Conclusion:Our study reveals strong acceptance of telemedicine, regardless of previous experience, with a preference for video over telephone consultations. It also demonstrates openness to follow-up without direct human contact (e.g., application-based tools), although concerns remain about the potential loss of personal interaction. The results underline the importance of addressing patient concerns and ensuring a solid human and technical infrastructure for the expansion of telemedicine.
Acute ischemic colitis associated with the use of neuroleptic agents is a rare but potentially life-threatening condition, and its true incidence is likely underestimated. The exact pathophysiological mechanisms underlying this complication remain poorly understood. Sigmoidoscopy or colonoscopy is considered the gold standard for diagnosis, although various imaging modalities can also aid in the diagnostic process. Preventive measures primarily involve the management of constipation and the reduction of risk factors. In cases of suspected neuroleptic-induced ischemic colitis, prompt adjustments in medication-either through dose reduction or substitution with alternative antipsychotics-should be considered. This article presents two cases of ischemic colitis caused by neuroleptic treatment, emphasizing the critical importance of early diagnosis and timely intervention.
Irritable bowel syndrome with constipation (IBS-C) is a common subtype of functional bowel disorder associated with substantial symptom burden and reduced quality of life. Management typically begins with dietary and lifestyle modification, laxatives, and antispasmodics; however, many patients experience inadequate relief, underscoring the need for more effective therapies. Linaclotide, a synthetic guanylin analog, is an established treatment for IBS-C. By activating guanylate cyclase-C (GCC) receptors on intestinal epithelial cells, it promotes intestinal fluid secretion, accelerates transit, and alleviates visceral hypersensitivity. Randomized controlled trials have demonstrated its efficacy and favorable safety profile, with mild-to-moderate diarrhea and abdominal pain being the most common adverse events. Because clinical trial populations may not fully reflect real-world patient diversity, real-world evidence (RWE) provides valuable complementary data. This review summarizes current RWE on linaclotide in IBS-C, integrating findings from multiple studies to present a comprehensive view of its effectiveness and safety in routine clinical practice.
Background and study aims:Since 2019, pancreatic surgery in Belgium has been centralised to high-volume centres to improve care quality and reduce postoperative morbidity and mortality. All patients who are potential surgical candidates are discussed preoperatively at a centralised multidisciplinary board (MCCC = Multidisciplinair Consult Complexe Chirurgie). Typically, patients with a (possible) malignancy have already been evaluated by a multidisciplinary tumour board (MDT) in the referring hospital. This study aimed to assess the impact of the MCCC on the diagnosis of solid and cystic pancreatic lesions and to analyse referral patterns. Patients and methods:This single-centre, non-interventional retrospective study included 217 patients with a newly diagnosed pancreatic lesion, discussed at the MCCC of Ghent University Hospital between July 1, 2019, and December 31, 2021. The influence of the MCCC on the diagnosis of pancreatic lesions was analysed. Results:Among 217 patients (median age 65 years; 50% male), the most frequent diagnoses were pancreatic adenocarcinoma (n=99; 45,6%), IPMN (12%) and pancreatitis (7%). The MCCC altered the initial diagnostic assessment in 18,4% of cases. Among benign referrals, 20% (5/25) were ultimately found malignant, likely altering treatment. None of the 166 patients referred with a malignant diagnosis were reclassified as benign. During the first three years after centralisation, referral quality remained unchanged, with 12% unspecified lesions annually. Summary:Centralisation may over time affect referral quality as expertise concentrates. Initial diagnosis and staging still occur in referring hospitals and are first discussed locally. This early analysis shows stable referral appropriateness after centralisation. Ongoing monitoring is needed to evaluate longterm effects of centralisation on diagnostic quality and early detection.
We report a case of a patient who received three cycles of Peptide Receptor Radionuclide Therapy (PRRT) with [177Lu] Lu-DOTATATE for a small intestine neuroendocrine tumor (siNET) and developed recurrent GI (gastrointestinal) bleeding. These complications required four admissions on intensive care unit (ICU), transfusion of fourteen units of packed cells and finally surgery. Radiation safety precautions were respected at all hospital wards. Histopathology of the culprit lesion did not reveal tumor, but showed a large-caliber angiodysplastic lesion. The somatostatin receptor (SSTR) positive tumor consisted of a confluent mass of adenopathies invading the mesenteric vein. We hypothesize the amino-acid infusion, which is supportive therapy given prior to PRRT, caused vasodilatation in the pre-existing angiodysplastic lesion. The vasodilatation together with the high venous pressure due to tumoral invasion of the mesenteric vein may have aggravated bleeding symptoms.
Background and aim of the study:Cardiopulmonary complications, malnutrition, frailty and minimal hepatic encephalopathy are underrecognized complications of cirrhosis with a major impact on mortality and morbidity. The aim of this study is to investigate a new locally introduced care pathway with standardized screening for these complications and its impact on patients care and hospital financing. Patients and methods:We performed a single center retrospective study of 40 patients hospitalized with cirrhosis who participated in the care pathway between April 2023 and June 2024. Electronic medical records were evaluated for screened complications and financial outcomes were calculated within our population, consecutively with and without this care pathway. Long term data regarding survival and referral were collected in June 2025. Results:Hepatopulmonary syndrome was diagnosed in 14.7% of the patients. Frailty was present in 57.7% of the patients and malnutrition in 45%. Minimal hepatic encephalopathy was established in 17.5% of the patients. The median justified hospital days were significantly higher with the care pathway compared to without [8.4 (6.0-10.8) vs 6.2( 4.9-8.6) p<0.01 ( Z=-3.43)]. In 15 (37.5%) patients, the care pathway added a higher financial reimbursement for the hospital compared to when the care pathway would not have been performed. Conclusions:This study emphasizes the importance of systematic screening and education of these complications. Due to systematical screening these underrecognized complications get identified earlier. Performing this care pathway did significantly and positively impact the number of justified hospital days and financial reimbursement for the hospital.
