BACKGROUND: Opioid-containing antitussives are used to symptomatically treat dry coughs but are also consumed recreationally as euphoriant drugs, especially by teenagers and young adults. To curb misuse, in 2019 opioid-containing antitussives in Switzerland were relisted from over-the-counter to requiring a physician’s prescription or direct dispensing by a pharmacist. AIM: This study aimed to elucidate how this regulatory change impacted the dispensing behaviour of practicing community pharmacists in Switzerland in relation to opioid-containing antitussives. METHODS: We conducted a cross-sectional survey. The survey consisted of 24 questions and was distributed online via national and cantonal pharmacists’ associations’ mailing lists to community pharmacists in German, French and Italian. The survey was analysed descriptively. No outcomes for hypothesis testing were specified. RESULTS: Our survey was completed by 405 practicing community pharmacists. Most pharmacists reported that the upregulation of opioid-containing antitussives to prescription products led to less frequent (85.8%) and more cautious (74.3%) dispensing. The misuse potential was considered the most important deciding factor when dispensing opioid-containing antitussives. Despite being widely considered as effective (78.4%), opioid-containing antitussives were reported to be used mainly as second and third choice for dry cough, with the most popular first-line choice being butamirate-containing antitussives (43.0%). Notably, French-speaking participants showed the most restrictive attitude towards opioid-containing antitussives, with 49.6% reporting not dispensing them at all. CONCLUSIONS: Most pharmacists perceived a change in dispensing patterns after the upregulation, with the new dispensing competencies being rated as beneficial by some and as burdensome by others. There were regional differences in attitudes towards opioid-containing antitussives which seemed to be influenced by neighbouring countries.
BACKGROUND AND STUDY AIMS: Guidelines recommend early initiation of palliative care alongside anticancer therapy. However, ongoing treatment is often associated with delayed referral to palliative care. Factors that positively influence the initiation of palliative care have been studied in the past, but there is a gap in research regarding the individual degree of influence these factors have on the willingness to initiate palliative care. Therefore, we explored the degree of influence of 11 different factors on willingness to initiate palliative care, focusing on communicational and relational aspects. METHODS: We conducted a factorial survey among 1572 members of the Swiss public. Participants were presented with vignettes designed to explore willingness to start palliative care. A response format ranging from -5 to +5 was provided. Vignettes were analysed using mixed-effects regression models. RESULTS: The physician having enough time for the conversation, the provision of detailed and understandable information, and an expression about continuity of care led to the strongest increase in willingness. There was also an increase in willingness when treatment recommendations were based on experience and patient preferences, as well as with self-disclosure, the expression of sadness by the physician, work experience, a prior patient-physician relationship and older patient age. CONCLUSION: This study offers insight into the decision-making process regarding the initiation of palliative care at an advanced stage of disease progression. Supportive communication practices and expressions of understanding for the other led to a higher willingness to start palliative care. These aspects should be considered in discussions about advanced cancer in clinical practice, as well as emphasised in medical education.
INTRODUCTION: The HeartMate 3 left ventricular assist device (LVAD) is an established therapy for advanced heart failure, yet contemporary real-world data from low- or medium-volume centres remain limited. We aimed to describe the characteristics, management and clinical outcomes of patients undergoing HeartMate 3 LVAD implantation at a Swiss tertiary centre. METHODS: We conducted an observational study including consecutive adult patients who underwent HeartMate 3 implantation at Lausanne University Hospital between November 2015 and January 2026. Baseline characteristics, INTERMACS profiles, perioperative data, survival and LVAD-related complications were assessed. The primary outcome was survival on LVAD support. Comparisons by LVAD indication were pre-specified exploratory analyses (destination therapy vs bridge-to-transplant). Survival analyses on LVAD support, with heart transplantation or LVAD explantation treated as censoring events, were reported. RESULTS: A total of 100 patients (mean age 58 [standard deviation 12] years, 84% male, 29% destination therapy) underwent HeartMate 3 implantation. Ischaemic heart disease was the predominant aetiology (69%) and most patients (68%) were classified as INTERMACS profiles 3–4 at implantation. Over a median follow-up of 1.5 (IQR 0.5–3) years, 27 patients died on LVAD support, corresponding to a mortality incidence rate (IR) of 13.5 deaths per 100 patient-years, while 51 patients underwent heart transplantation, corresponding to an IR of transplantation of 25.4 per 100 patient-years. Five-year survival on LVAD support was 64%, with patients censored at LVAD explantation for recovery or transplantation. LVAD-related complications included bleeding (48%), infection (50%), ischaemic stroke (12%) and right ventricular failure (39%). Survival did not differ by LVAD indication (bridge-to-transplant as reference, adjusted HR 0.62, 95% CI 0.14–2.72). CONCLUSIONS: In this contemporary, real-world, medium-sized cohort, HeartMate 3 therapy provided durable long-term support across a broad spectrum of advanced heart failure patients, with outcomes consistent with those reported in large multicentre registries.
INTRODUCTION: Schnitzler syndrome is a rare acquired autoinflammatory disease characterised by a chronic urticarial rash, recurrent fever, arthralgia or arthritis, bone pain, elevated inflammatory markers, and monoclonal gammopathy. The disease is driven by dysregulated inflammasome activation and excessive interleukin-1 (IL-1) production. Because of its rarity, data on the management of Schnitzler syndrome during pregnancy remain extremely limited. We report the case of a pregnant woman presenting with a SARS-CoV-2-induced inflammatory flare that was successfully treated with anakinra, highlighting both the diagnostic and therapeutic challenges of this uncommon condition in pregnancy. CASE PRESENTATION: A pregnant woman in her early 40s with previously diagnosed Schnitzler syndrome presented with an acute inflammatory flare triggered by SARS-CoV-2 infection. Clinical manifestations included urticaria and musculoskeletal symptoms consistent with disease reactivation, along with elevated inflammatory markers. The diagnosis of Schnitzler syndrome had previously been established based on clinical criteria, supported by the presence of a chronic urticarial rash and monoclonal gammopathy in accordance with the Strasbourg and Lipsker diagnostic criteria. Due to the severity of the symptoms and the central role of IL-1 in disease pathophysiology, treatment with anakinra, an IL-1 receptor antagonist, was initiated. The patient experienced rapid clinical improvement, with resolution of systemic symptoms and normalisation of inflammatory parameters. Treatment was well tolerated, with favourable maternal and foetal outcomes throughout the pregnancy. CONCLUSION: This case highlights the importance of recognising Schnitzler syndrome as a rare but potentially severe autoinflammatory condition requiring prompt multidisciplinary management. It also suggests that anakinra may be a potential therapeutic option for inflammatory flares during pregnancy. Early recognition and targeted pharmacological treatment are essential to improving patient outcomes and preventing long-term complications.
AIMS: Using more than five decades of national data, we examine how age, period and cohort factors influence lung cancer mortality in Switzerland, and forecast future death counts to the early 2040s. METHODS: Lung cancer deaths were extracted from Swiss vital statistics. We applied age-period-cohort (APC) modelling to lung cancer mortality rates using substantiated assumptions about the age-mortality relationship as model constraints. To account for the uncertainty in the age-mortality relationship, boundary constraints were applied to the line of APC solutions, yielding a range of plausible results. In an alternative model, we replaced the cohort terms with smoking prevalence estimates from Swiss health surveys, enabling unconstrained modelling of age and period effects. Predictions are based on modelled age trends, and linearly extrapolated period and cohort trends. RESULTS: Plausible age, period and cohort effects indicated that age-specific mortality risks decline at the oldest ages, that period effects were minimal, while cohort effects showed distinct peak risks for men born around 1909 and women born around 1954. Among women, birth cohorts with the highest mortality closely aligned with those exhibiting the highest smoking prevalence. The models predicted a decline in the number of lung cancer deaths among men beginning in the mid-2020s, and among women from the mid-2030s onwards. CONCLUSIONS: This population-based analysis of lung cancer mortality not only highlights declining mortality rates in men of all ages, but reveals an emerging downward trend among younger women. We predict that the total number of lung cancer deaths in women will begin to decrease by the mid-2030s.
