Hirslanden Salem-Spital

BACKGROUNDValue-based healthcare emphasises patient-centred outcomes. However, Patient-Reported Outcomes Measures (PROMs) and Patient-Reported Experience Measures (PREMs) remain underused in peri-operative care. Postoperative delirium (POD) is a common and serious complication associated with increased morbidity and healthcare costs. Understanding the prognostic value of PROMs and PREMs may support identification and prevention of POD in the postoperative anaesthesia care unit (PACU).OBJECTIVE(S)We assessed the association between peri-operative patient-reported symptoms and PACU POD using systematically collected PROMs and PREMs (including pain, anxiety, thirst, stress, and satisfaction), following the implementation of a brain protection care bundle.DESIGNProspective cohort study.SETTINGA single-centre study in a secondary-care private hospital in Switzerland from January 2023 to January 2024.PATIENTS1419 adults undergoing elective or urgent surgery. Exclusion criteria included age <18 years, inability to provide consent, language barriers, need for postoperative mechanical ventilation, or pre-operative Nursing Delirium Screening Scale (Nu-DESC > or equal to 2).INTERVENTION(S)Implementation of the Safe Brain Initiative (SBI) care bundle, incorporating 18 multidisciplinary, nonpharmacologic strategies to optimise peri-operative brain health.MAIN OUTCOME MEASURESThe primary outcome was PACU POD incidence, assessed using the Nu-DESC at emergence and PACU discharge. Secondary outcomes included associations between PACU POD and pre-operative PROMs (pain, anxiety, stress, nausea) and PREMs (satisfaction, well being).RESULTSPACU POD occurred in 19.6% of patients. Pre-operative anxiety (NRS > 7) was an independent predictor of POD (P = 0.012). Pre-operative PROMs showed increasing trends, while postoperative symptoms (pain, anxiety, nausea) significantly decreased. Patients with POD reported lower well being scores despite high satisfaction in other PREM domains.CONCLUSIONSPre-operative anxiety and stress strongly predict PACU POD, supporting early risk stratification and targeted interventions. Integrating PROMs and PREMs into peri-operative workflows enhances patient-centred care.

Postgraduate education programs for healthcare professionals have seen rising demand due to socio-demographic shifts, digitalisation, and evolving healthcare models. This trend underscores the need for providers to offer high-quality, innovative teaching and learning opportunities that align with participants' needs and interests. Understanding the motivations behind enrolment is essential for tailoring curricula and didactical methods effectively. This study explores key motivational factors influencing healthcare professionals' decisions to join postgraduate education programs. The findings aim to inform curriculum planning to ensure that programs better meet the specific needs and interests of their learners. We conducted a qualitative study with N=23 semi-structured interviews with 13 students from the Master's program in Medical Education (MAS) and 10 with students from the Certificate of Advanced Studies in Palliative Care (CAS). The interviews were thematically analysed to identify common and differentiating motivational factors, with coding conducted independently by two researchers to enhance reliability. This study identified both general and program-specific motivational factors among MAS and CAS participants. MAS participants frequently mentioned career development, professional advancement, and empowerment as key motivations. CAS participants, on the other hand, placed greater emphasis on content-specific motivations. For both groups, local proximity and the education format played a crucial role in their decision to enrol in these programs. In addition, seven implications for program planning were identified to enhance the alignment of postgraduate education with participants' needs. With the method of qualitative analysis and the focus on post-graduate program-participants' needs and interests, new insights on motivation to attend postgraduate education were gained. The significance of these findings is supported by existing literature. Consequently, these results offer valuable implications for the planning and development of postgraduate education programs.

Partial knee replacement has proven to be an effective therapy for advanced unicompartmental arthrosis of the knee. Despite continuous advancements in implants and surgical techniques over the past decades, the global preference for total knee arthroplasty still persists for historical reasons. This report aims to illuminate advantages and disadvantages of partial knee replacement considering long-term results, the evolution of indication criteria over recent decades and new aspects in patient selection with potential improvements through emerging technologies. The analysis involves the examination of long-term results from clinical studies and registry data, highlighting the risk factors for potential failures and their influence on the development of indication criteria. Present-day long-term results demonstrate excellent prosthetic survival, aligning with outcomes from total knee arthroplasty. New perspectives for expanding indication criteria are discussed, including the possible application of partial knee replacement in cases of severe varus deformity > 15°, anterior cruciate ligament insufficiency, young active patients, anterior knee pain, and/or patellofemoral arthritis, as well as mild radiographic arthritis with degenerative medial meniscus root tear and meniscal extrusion. Indication criteria have consistently expanded in recent years, taking into account modern insights, and the application of advanced technologies can enhance precision and minimize surgical errors. Furthermore, this report emphasizes that revision rates are not the sole criterion for success and underscores the necessity for acomprehensive examination of clinical results.

This review navigates the landscape of precision anaesthesia, emphasising tailored and individualized approaches to anaesthetic administration. The aim is to elucidate precision medicine principles, applications, and potential advancements in anaesthesia. The review focuses on the current state, challenges, and transformative opportunities in precision anaesthesia. The review explores evidence supporting precision anaesthesia, drawing insights from neuroscientific fields. It probes the correlation between high-dose intraoperative opioids and increased postoperative consumption, highlighting how precision anaesthesia, especially through initiatives like Safe Brain Initiative (SBI), could address these issues. The SBI represents multidisciplinary collaboration in perioperative care. SBI fosters effective communication among surgical teams, anaesthesiologists, and other medical professionals. Precision anaesthesia tailors care to individual patients, incorporating genomic insights, personalised drug regimens, and advanced monitoring techniques. From EEG to cerebral/somatic oximetry, these methods enhance precision. Standardised reporting, patient-reported outcomes, and continuous quality improvement, alongside initiatives like SBI, contribute to improved patient outcomes. Precision anaesthesia, underpinned by collaborative programs, emerges as a promising avenue for enhancing perioperative care.

Malignant focal liver lesions (FLLs) are commonly reported in adults but rarely seen in the pediatric population. Due to the rarity, the understanding of these diseases is still very limited. In children, most malignant FLLs are congenital. It is very important to choose appropriate imaging examination concerning various factors. This paper will outline common pediatric malignant FLLs, including hepatoblastoma, hepatocellular carcinoma, and cholangiocarcinoma and discuss them against the background of the latest knowledge on comparable/similar tumors in adults. Medical imaging features are of vital importance for the non-invasive diagnosis and follow-up of treatment of FLLs in pediatric patients. The use of CEUS in pediatric patients for characterizing those FLLs that remain indeterminate on conventional B mode ultrasounds may be an effective option in the future and has great potential to be integrated into imaging algorithms without the risk of exposure to ionizing radiation.

The aim of this study was to evaluate ultrasound as aroutinely used procedure and extended physical examination in geriatric patients in acute care. Prospective study of 86patients using ultrasound as ascreening examination (abdomen, basal sections of the thorax, thyroid glands) under comparative use of a hand-held ultrasound device (HHUSD) and ahigh-end ultrasound (HEUS = gold standard). In 20/86 (23.2%) clinically relevant findings with therapeutic consequences were found (pleural effusion, urinary retention, choledocholithiasis metatases, colon tumor). In 22/86 (25.6%) patients, additional questions existed besides the screening indication: tumor search (9.3%), anemia (5.8%), liver value elevation (5.8%), dyspnea (5.8%), splenic pathologies (2.3%), weight loss (1.2%), infectious focus (1.2%), diarrhea (1.2%), intra-abdominal hematoma (1.1%), abdominal aortic aneurysm (1.2%). The most common sonographic findings included: cholecystolithiasis (32.6%); right pleural effusion (31.4%), thyroid nodules (30.2%), renal cysts (27.9%), and fatty liver (26.7%). There were significant differences in sizing between HHUSD and HEUS (kidneys, pancreatic corpus and pancreatic caudal diameters, portal vein, left hepatic vein) without diagnostic relevance. The extended screening by ultrasound provided important answers to classical questions in geriatrics (e.g. urinary retention, volume deficiency/pleural effusion) in many cases. The new findings had therapeutic consequences in one fifth of the patients. The HHUSD can be used in screening.