BackgroundPediatric emergency departments (PEDs) often face high volumes of low-acuity visits, reflecting gaps in primary care access and socio-economic disparities. We investigated how neighborhood socio-economic vulnerability, pediatrician availability, and proximity to the PED jointly influence PED utilization in Geneva, Switzerland.MethodsIn this retrospective ecological study (Jan 2023-Dec 2024), we aggregated all PED visits for children aged 0-16 years by neighborhood and Canadian Triage Acuity Scale (CTAS) level. Neighborhood visit incidence (unique patients per child population) was modeled using mixed-effects regression against a composite socio-economic vulnerability index (NSVI), pediatrician density within a 2 km radius, and distance to the PED, incorporating an exponential decay function for distance and postal code as a random intercept.ResultsThere were 68,482 PED visits by 35,994 children (35.1% of Geneva under-16 population). Low-acuity visits (CTAS 4-5) comprised ~50% of encounters. Both distance and socio-economic vulnerability showed clear dose-response relationships, with stronger effects observed for lower-acuity visits, and no interaction effect between them. Overall, proximity accounted for up to 20.8% of non-urgent PED use, while neighborhood socio-economic vulnerability explained up to 19.7% of low acuity visits across Geneva. Pediatrician density showed a modest inverse association for low-acuity visits only.ConclusionsBoth proximity and socio-economic vulnerability are independent determinants of non-urgent PED use. Policies focusing only on primary care access risk missing key drivers of PED use, highlighting the need for locally tailored strategies such as community outreach near hospitals or programs to strengthen health literacy among families.

BACKGROUND:Digital health history devices represent a promising wave of digital tools with the potential to enhance the quality and efficiency of medical consultations. They achieve this by providing physicians with standardized, high-quality patient history summaries and facilitating the development of differential diagnoses (DDs) before consultation, while also engaging patients in the diagnostic process. OBJECTIVE:This study evaluates the efficacy of one such digital health history device, diagnosis and anamnesis (DIANNA), in assisting with the formulation of appropriate DDs in an outpatient setting. METHODS:A pseudorandomized controlled trial was conducted with 101 patients seeking care at the University Hospital Geneva emergency outpatient department. Participants presented with various conditions affecting the limbs, back, and chest. The first 51 patients were assigned to the control group, while the subsequent 50 formed the intervention group. In the control group, physicians developed DD lists based on traditional history-taking and clinical examination. In the intervention group, physicians reviewed DIANNA-generated DD reports before interacting with the patient. In both groups, a senior physician independently formulated a DD list, serving as the gold standard for comparison. RESULTS:The study findings indicate that DIANNA use was associated with a notable improvement in DD accuracy (mean 79.3%, SD 24%) compared with the control group (mean 70.5%, SD 33%; P=.01). Subgroup analysis revealed variations in effectiveness based on case complexity: low-complexity cases (1-2 possible DDs) showed 8% improvement in the intervention group (P=.08), intermediate-complexity cases (3 possible DDs) showed 17% improvement (P=.03), and high-complexity cases (4-5 possible DDs) showed 15% improvement (P=.92). The intervention was not superior to the control in low-complexity cases (P=.08) or high-complexity cases (P=.92). Overall, DIANNA successfully determined appropriate DDs in 81.6% of cases, and physicians reported that it helped establish the correct DD in 26% of cases. CONCLUSIONS:The study suggests that DIANNA has the potential to support physicians in formulating more precise DDs, particularly in intermediate-complexity cases. However, its effectiveness varied by case complexity and further validation is needed to assess its full clinical impact. These findings highlight the potential role of digital health history devices such as DIANNA in improving clinical decision-making and diagnostic accuracy in medical practice. TRIAL REGISTRATION:ClinicalTrials.gov NCT03901495; https://clinicaltrials.gov/study/NCT03901495.

This short communication describes a crowdsourced, scenario-based evaluation of a system translating speech into pictograph sequences for doctor-patient communication in emergency settings. Results suggest that the proposed evaluation methodology allows efficient identification of problematic illustrations or sequences.

Several studies have been published in 2023, in the field of general internal medicine, addressing various aspects of health and covering topics ranging from hormonal treatment of menopause to the management of chronic and acute diseases. A selection of articles was chosen for this update in outpatient general internal medicine, showing recent studies on outpatient care of patients (treatment, follow-up). The summary of articles is supplemented this year by a table of medical recommendations published in 2023, modestly proposed, and covering various areas. These guidelines, most of them from North America, show advances in the care and monitoring of outpatients, and should be interpreted in light of the various recommendations in Switzerland.

Introduction SARS-CoV-2 mainly infects respiratory endothelial cells, which is facilitated through its spike protein binding to heparan sulphate. Calcium dobesilate (CaD) is a well-established, widely available vasoactive and angioprotective drug interacting with heparan sulphate, with the potential to interfere with the uptake of SARS-CoV-2 by epithelial cells. The CADOVID trial aims to evaluate the efficacy and safety of CaD in reducing the SARS-CoV-2 viral load in non-hospitalised adult patients diagnosed with COVID-19, confirmed by a positive SARS-CoV-2 PCR, including its efficacy to reduce the impact of persistent COVID-19 symptoms.Methods and analysis This is a randomised, placebo-controlled, double-blind, monocentric phase II trial. Enrolment began in July 2022. A total of 74 adult patients will be randomly allocated to the CaD arm or the placebo group with a 1:1 ratio, respectively. Participants in the intervention arm will receive two capsules of CaD 500 mg two times per day and the placebo arm will receive two matching capsules of mannitol 312.5 mg two times per day, with a treatment period of 7 days for both arms, followed by a 77-day observational period without treatment administration. Participants will be asked to complete secured online questionnaires using their personal smartphone or other electronic device. These include a COVID-19 questionnaire (assessing symptoms, temperature measurement, reporting of concomitant medication and adverse events), a COVID-19 persistent symptoms’ questionnaire and the Short Form 12-Item (SF-12) survey. SARS-CoV-2 PCR testing will be performed on nasopharyngeal swabs collected on days 1, 4, 8 and 21. The primary endpoint is the reduction from baseline of SARS-CoV-2 viral load determined by RT-PCR at day 4.Ethics and dissemination This trial has received approval by the Geneva Regional Research Ethics Committee (2022-00613) and Swissmedic (701339). Dissemination of results will be through presentations at scientific conferences and publication in scientific journals.Trial registration number NCT05305508; Clinicaltrials.gov; Swiss National Clinical Portal Registry (SNCTP 000004938).

Several studies have been published in 2023, in the field of general internal medicine, addressing various aspects of health and covering topics ranging from hormonal treatment of menopause to the management of chronic and acute diseases. A selection of articles was chosen for this update in outpatient general internal medicine, showing recent studies on outpatient care of patients (treatment, follow-up). The summary of articles is supplemented this year by a table of medical recommendations published in 2023, modestly proposed, and covering various areas. These guidelines, most of them from North America, show advances in the care and monitoring of outpatients, and should be interpreted in light of the various recommendations in Switzerland.

Access to healthcare profoundly impacts the health and quality of life of Deaf people. Automatic translation tools are crucial in improving communication between Deaf patients and their healthcare providers. The aim of this chapter is to present the pipeline used to create the Swiss-French Sign Language (LSF-CH) version of BabelDr, a speech-enabled fixed phrase translator that was initially conceived to improve communication in emergency settings between doctors and allophone patients (Bouillon et al., 2021). In order to do so, we start off by explaining how we ported BabelDr in LSF-CH using both human and avatar videos. We first describe the creation of a reference corpus consisting of video translations done by human translators, then we present a second corpus of videos generated with a virtual human. Finally, we relate the findings of a questionnaire on Deaf users' perspective on the use of signing avatars in the medical context. We showed that, although respondents prefer human videos, the use of automatic technologies associated with virtual characters is not without interest to the target audience and can be useful to them in the medical context.

This paper describes a first attempt to map UMLS concepts to pictographs as a resource for translation systems for the medical domain. An evaluation of pictographs from two freely available sets shows that for many concepts no pictograph could be found and that word-based lookup is inadequate for this task.

In this paper, we present a study comparing two mediums that can be used to communicate with allophone patients: a speech-enabled phraselator (BabelDr) and telephone interpreting. To identify the satisfaction provided by these mediums and their pros and cons, we conducted a crossover experiment where doctors and standardized patients completed anamneses and filled in surveys. Our findings suggest that telephone interpreting offers better overall satisfaction, but both mediums presented advantages. Consequently, we argue BabelDr and telephone interpreting can be complementary.

In emergency care settings, there is a crucial need for automated translation tools. We focus here on the BabelDr system, a speech-enabled fixed-phrase translator used to improve communication in emergency settings between doctors and allophone patients. The aim of the chapter is two-fold. First, we will assess if a bidirectional version of the phraselator allowing patients to answer doctors' questions by selecting pictures from open-source databases will improve user satisfaction. Second, we wish to evaluate pictograph usability in this context. Our hypotheses are that images will in fact help to improve patient satisfaction and that multiple factors influence pictograph usability. Factors of interest include not only the comprehensibility of the pictographs per se, but also how the images are presented to the user with respect to their number and ordering. We showed that most respondents prefer to use the interface with pictographs and that multiple factors influence participants' ability to find a pictograph based on a written form, but that the comprehensibility of the individual pictographs is probably the most important.

BACKGROUND:COVID-19 is a viral prothrombotic respiratory infection. Heparins exert antithrombotic and anti-inflammatory effects, and might have antiviral properties. We aimed to investigate whether thromboprophylaxis with enoxaparin would prevent untoward hospitalisation and death in symptomatic, but clinically stable outpatients with COVID-19. METHODS:OVID was a randomised, open-label, parallel-group, investigator-initiated, phase 3 trial and was done at eight centres in Switzerland and Germany. Outpatients aged 50 years or older with acute COVID-19 were eligible if they presented with respiratory symptoms or body temperature higher than 37·5°C. Eligible participants underwent block-stratified randomisation (by age group 50-70 vs >70 years and by study centre) in a 1:1 ratio to receive either subcutaneous enoxaparin 40 mg once daily for 14 days versus standard of care (no thromboprophylaxis). The primary outcome was a composite of any untoward hospitalisation and all-cause death within 30 days of randomisation. Analysis of the efficacy outcomes was done in the intention-to-treat population. The primary safety outcome was major bleeding. The study was registered in ClinicalTrials.gov (NCT04400799) and has been completed. FINDINGS:At the predefined formal interim analysis for efficacy (50% of total study population), the independent Data Safety Monitoring Board recommended early termination of the trial on the basis of predefined statistical criteria having considered the very low probability of showing superiority of thromboprophylaxis with enoxaparin for the primary outcome under the initial study design assumptions. Between Aug 15, 2020, and Jan 14, 2022, from 3319 participants prescreened, 472 were included in the intention-to-treat population and randomly assigned to receive enoxaparin (n=234) or standard of care (n=238). The median age was 57 years (IQR 53-62) and 217 (46%) were women. The 30-day risk of the primary outcome was similar in participants allocated to receive enoxaparin and in controls (8 [3%] of 234 vs 8 [3%] of 238; adjusted relative risk 0·98; 95% CI 0·37-2·56; p=0·96). All hospitalisations were related to COVID-19. No deaths were reported during the study. No major bleeding events were recorded. Eight serious adverse events were recorded in the enoxaparin group versus nine in the control group. INTERPRETATION:These findings suggest thromboprophylaxis with enoxaparin does not reduce early hospitalisations and deaths among outpatients with symptomatic COVID-19. Futility of the treatment under the initial study design assumptions could not be conclusively assessed owing to under-representation of older patients and consequent low event rates. FUNDING:SNSF (National Research Programme COVID-19 NRP78: 198352), University Hospital Zurich, University of Zurich, Dr-Ing Georg Pollert (Berlin), Johanna Dürmüller-Bol Foundation.

The so-called 4P medicine, preventive, predictive, participatory, and personalized, which places the patient at the center has influenced the latest recommendations for the management of common low back pain. The management of low back pain in the acute, subacute, and chronic phase is currently based on the profile of each patient with their risk factors, their prognosis, and the respect of their preferences, promoting an integrative approach. During the first consultation, it is important to identify factors of moderate to poor prognosis, including kinesiophobia and to search for false beliefs, through a detailed medical history. The non-pharmacological approaches are more effective and have less side effects than the medications. Reassurance and therapeutic education are the first steps in good management of common low back pain.

Background: Many factors influence patient satisfaction during an emergency department (ED) visit, but the perception of wait time plays a central role. A long wait time in the waiting room increases the risk of hospital-acquired infection, as well as the risk of a patient leaving before being seen by a physician, particularly those with a lower level of urgency who may have to wait for a longer time. Objective: We aimed to improve the perception of wait time through the implementation of a semiautomatic SMS text message system that allows patients to wait outside the hospital and facilitates the recall of patients closer to the scheduled time of meeting with the physician. Methods: We performed a cross-sectional survey to evaluate the system using a tailored questionnaire to assess the patient perspective and the Unified Theory of Acceptance and Use of Technology questionnaire for the caregiver perspective. We also monitored the frequency of system use with logs. Results: A total of 110 usable responses were collected (100 patients and 10 caregivers). Findings revealed that 97 of 100 (97%) patients were satisfied, with most patients waiting outside the ED but inside the hospital. The caregiver evaluation showed that it was very easy to use, but the adoption of the system was more problematic because of the perceived additional workload associated with its use. Conclusions: Although not suitable for all patients, our system allows those who have a low-severity condition to wait outside the waiting room and to be recalled according to the dedicated time defined in the Swiss Emergency Triage Scale. It not only has the potential to reduce the risk of hospital-acquired infection but also can enhance the patient experience; additionally, it was perceived as a real improvement. Further automation of the system needs to be explored to reduce caregiver workload and increase its use.

Background Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors. Objective The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative. Methods From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date. Results At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history. Conclusion SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

Healthcare workers have potentially been among the most exposed to SARS-CoV-2 infection as well as the deleterious toll of the pandemic. This study has the objective to differentiate the pandemic toll from post-acute sequelae of SARS-CoV-2 infection in healthcare workers compared to the general population. The study was conducted between April and July 2021 at the Geneva University Hospitals, Switzerland. Eligible participants were all tested staff, and outpatient individuals tested for SARS-CoV-2 at the same hospital. The primary outcome was the prevalence of symptoms in healthcare workers compared to the general population, with measures of COVID-related symptoms and functional impairment, using prevalence estimates and multivariable logistic regression models. Healthcare workers (n = 3083) suffered mostly from fatigue (25.5 %), headache (10.0 %), difficulty concentrating (7.9 %), exhaustion/burnout (7.1 %), insomnia (6.2 %), myalgia (6.7 %) and arthralgia (6.3 %). Regardless of SARS-CoV-2 infection, all symptoms were significantly higher in healthcare workers than the general population (n = 3556). SARS-CoV-2 infection in healthcare workers was associated with loss or change in smell, loss or change in taste, palpitations, dyspnea, difficulty concentrating, fatigue, and headache. Functional impairment was more significant in healthcare workers compared to the general population (aOR 2.28; 1.76-2.96), with a positive association with SARS-CoV-2 infection (aOR 3.81; 2.59-5.60). Symptoms and functional impairment in healthcare workers were increased compared to the general population, and potentially related to the pandemic toll as well as post-acute sequelae of SARS-CoV-2 infection. These findings are of concern, considering the essential role of healthcare workers in caring for all patients including and beyond COVID-19.