Hospital Neuchâtel

Emergency medical services (EMS) providers face elevated burnout risk due to job-related stressors, organizational challenges, and physical and emotional demands. Stigma and limited support further endanger EMS providers’ wellbeing. Burnout not only affects providers but can also compromise care recipients, and system sustainability. Research on EMS providers’ wellbeing remains limited and subject to moderate generalisability. This study examines the prevalence of burnout, depression, suicidal thoughts, and turnover intention among Swiss EMS providers, offering a national multicentre perspective across all 26 cantons plus Liechtenstein. A web-based survey was distributed to all active EMS providers in Switzerland and Liechtenstein between May and June 2024. The questionnaire included validated patient-reported outcome measures of burnout (Maslach Burnout Inventory (MBI) and Copenhagen Burnout Inventory (CBI)), and depression (Patient Health Questionnaire-9). The primary outcome was the prevalence of burnout, and secondary outcomes were prevalences of depression, suicidal thoughts (measured using two dedicated additional questions) and turnover intention (evaluated with a specific frequency-based question). Multivariable logistic regressions were run separately for MBI and CBI outcomes to identify burnout determinants. Of 3669 eligible providers, 1485 completed the questionnaire (40.5%). Burnout prevalence was 43.4% (MBI) and 36.5% (CBI), with regional variations. Night shift frequency was consistently associated with increased burnout risk across both MBI and CBI in a dose-dependent manner. Age, gender, professional title categorized as “Other”, canton of work and childlessness, were associated with burnout in a scale-specific manner. Turnover intention was high, with 67.7% of respondents reporting having considered leaving their job at least once. A total of 13.4% of participants reported moderate to severe depression, and 10.2% indicated they had contemplated suicide, of which 46.7% within the past year. Burnout is a significant concern among Swiss EMS providers. Night shift frequency emerged as the only predictor consistently associated with burnout, showing a dose-dependent effect, and highlighting it as a priority target for intervention. Scale-specific associations reflect the multidimensional nature of burnout. These findings underscore the urgent need for targeted, evidence-based interventions to protect EMS providers’ wellbeing and mitigate cascading effects on prehospital care quality, safety, and the sustainability of the healthcare system.

Emergency physicians (EPs) are particularly susceptible to burnout because of the high-stress environment in which they operate, characterized by rapid decision-making, long shifts, and limited resources. This review aims to explore the prevalence and contributing factors to burnout among EPs and to describe different interventions to mitigate this issue. The most used tool to measure burnout is the Maslach Burnout Inventory (MBI), which evaluates emotional exhaustion, depersonalization, and personal accomplishment. Various studies identified both organizational and individual risk factors contributing to high burnout rates, exceeding 70% in some regions. Key organizational factors include increased workload, poor collegial relationships, and work-life conflict, while individual factors involve maladaptive coping strategies. This paper emphasizes the importance of personal and system resilience, defined as the ability to manage stress and thrive under hardship, in combating burnout. It highlights the Stanford Model of Professional Fulfillment, which focuses on cultivating a culture of wellness, enhancing practice efficiency, and fostering personal resilience through self-care and peer support. According to our literature review, proposed interventions include improving shift length and scheduling, managing workload, and reducing bureaucratic tasks. These measures aim to create a supportive environment that prioritizes clinician well-being and enhances job satisfaction. Recognizing the need for a multifaceted approach, this paper suggests combining organizational changes with individual support strategies to effectively reduce burnout rates. This paper underscores the necessity for systemic changes in EM settings to ensure sustainable healthcare delivery and improved outcomes for both patients and healthcare professionals. Implementing these strategies can lead to a more resilient workforce, capable of providing high-quality care while maintaining personal well-being.

A patient initially presents with an abnormal sensation on the tip of her nose, followed by the appearance of a localized redness and oedematous macule progressively evolving into a necrotic lesion at follow-up. This dermatological finding is known as the Hutchinson's Sign, a reactivation of the varicella-zoster virus along the nasociliary branch of the fifth cranial nerve. Hutchinson's sign can be associated with a risk of ocular involvement, and requires immediate systemic treatment. Ophthalmologic referral is recommended in cases of clinical suspicion of ocular globe involvement.

ABSTRACTBackgroundSubglottic stenosis (SGS) is a narrowing of the airway below the glottis and may be congenital or acquired. While prolonged intubation is the most common cause of acquired SGS, other etiologies remain incompletely understood.MethodsA 37‐year‐old woman presented with a four‐year history of mild progressive stridor, dysphonia, and chronic cough. Her medical history was notable for Graves' disease, treated initially with long‐term carbimazole followed by radioactive iodine (RAI). She had never been intubated and had no autoimmune or rheumatologic disease. Awake fiberoptic endoscopy raised suspicion of SGS, which was confirmed by preoperative magnetic resonance imaging.ResultsSuspension microlaryngoscopy with biopsy and dilation revealed a Myer‐Cotton grade II SGS with an irregular aspect and exposed cartilage. Histopathology demonstrated chronic inflammation, fibrosis, and reactive epithelial changes consistent with radiation‐induced injury. After a second endoscopic dilation, only a minor anterior synechia remained, without evidence of recurrent stenosis.ConclusionsThis case report highlights a temporal association between RAI therapy and the subsequent development of SGS, supported by histopathological findings suggestive of radiation‐induced tissue injury. In the absence of other established risk factors, RAI treatment may represent a rare but clinically relevant cause of acquired SGS, a complication not previously reported in the literature.

Chronic Kidney Disease Associated-Pruritus (CKD-aP) is frequent among hemodialysis patients. Its associations with hemodiafiltration or conventional hemodialysis and clinical characteristics are inconsistent in observational studies. This study aimed to assess the prevalence, severity and factors associated with CKD-aP among patients on hemodialysis in the French-speaking part of Switzerland, where hemodiafiltration is widely used. A cross-sectional design was used. Adults on hemodialysis for ≥ 6 months and free of cognitive impairment were recruited from 15 dialysis centers. A research nurse collected sociodemographic, clinical, laboratory data and assessed CKD-aP using the Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). A multilevel mixed-effects model with maximum likelihood estimation was performed to investigate associations. A total of 413 participants, mean age was 69.68 years (SD 13.52), were included; 66% were men, 73% on hemodiafiltration. CKD-aP prevalence was 25%. VAS average itch score of participants with CKD-aP was 4.74 ± 1.99, versus 6.62 ± 2.18 for the worst intensity itch. According to VRS, most participants with CKD-aP suffered moderate (61.4%) to severe (22%) itch within the past 24 h. Higher phosphorus levels were significantly associated with increased CKD-aP severity, but not prevalence. Depression, smoking, and polypharmacy were associated with increased CKD-aP severity, whereas hemodialysis modality, volume substitution, filter or access type were not. Despite high dialysis standards, CKD-aP remains a frequent symptom in Switzerland. Depression is associated with CKD-aP and its severity while hemodialysis modality is not. These results suggest that effective management of CKD-aP requires not only optimal dialysis prescription but also a holistic approach. Registered at ClinicalTrials.gov (NCT05524467) on 10.06.2022.

Substance use disorder (SUD) is common in first-episode psychosis (FEP) and linked to poorer clinical and functional outcomes. Previous studies were mostly cross-sectional or short-term, leaving the longitudinal impact of SUD course unclear. This study aimed to (A) group patients based on different trajectories of cannabis use disorder (CUD) and alcohol use disorder (AUD) over 3-year follow-up and to (B) examine associations with baseline characteristics and clinical outcomes. We included 467 FEP patients enrolled in a 3-year early intervention program. Latent class analysis found subgroups based on cannabis and alcohol use trajectories. Groups were then compared using logistic regressions and mixed-model repeated measures (MMRM), adjusting for relevant confounders. We found different evolution of AUD and CUD: alcohol users tended to maintain consumption over time, while a subset of cannabis users reduced their consumption. Persistent alcohol users showed worst baseline characteristics and outcomes if compared to abstinent or light consumers. Concerning cannabis, MMRM analyses showed that abstinent or light users consistently had better symptom evolution compared to persistent or decreased users. However, the decreased group showed higher hospitalization rates than the other groups. They also showed gradual improvement in negative symptoms, reaching similar levels to abstinent users by the end of the program. This study outlines the distinct evolution of alcohol and cannabis consumption in FEP patients, suggesting the importance of tailored therapeutic approaches. Consistently with existing literature, abstinence or light use seems to be beneficial, while reducing cannabis use appears to offer a limited clinical improvement.

Switzerland's decentralised healthcare system delegates responsibility for paediatric hospital infrastructure to individual cantons. To date, official statistics on the number and types of paediatric hospital beds are lacking. This study sought to fill this gap by collecting and analysing data from all paediatric hospitals in Switzerland. A nationwide cross-sectional e-mail survey was conducted in January 2023. Data on both structurally available and operated beds were collected and descriptively analysed. The survey identified a total of 1751 beds in 29 paediatric hospitals or departments, of which 85% were operated. Of the total beds, 112 were paediatric intensive care unit beds (80% operated) and 339 were neonatology beds (86% operated). Significant regional disparities in bed availability were identified: the Lake Geneva region has the highest bed-to-child ratios, while Central Switzerland, Eastern Switzerland and Ticino show notably lower ratios. These findings highlight the current distribution of paediatric beds, the considerable proportion of non-operated beds, and the importance of continued, comprehensive data collection to inform healthcare planning.

In children under 4, septic arthritis of the hip (SAH) caused by Kingella kingae (SAH-KK) can be misdiagnosed, as it does not meet classic septic joint criteria (fever > 38.5°, pain, limited range of motion, and inability to bear weight). The objective of this study was to report clinical and paraclinical characteristics in a large cohort of children with confirmed SAH-KK and to evaluate the reliability of the Kocher (KC) and Caird criteria (CC) in predicting SAH-KK. Medical records of 140 children with confirmed SAH-KK were collected. Data on sex, age, temperature on admission, weight-bearing status, white blood cell (WBC) count, platelet count, C-reactive protein (CRP) value, and erythrocyte sedimentation rate (ESR) were extracted. The study focused on the sensitivity of KC (body temperature, refusal to bear weight, leukocytosis, and ESR) and CC (KC criteria plus CRP level). All patients had bacteriologically confirmed SAH-KK; most had mild symptoms and near-normal inflammatory markers. CRP (76.2%) had the highest sensitivity, followed by weight-bearing status (73.8%) and WBC count (69.6%). Body temperature and ESR exceeded cutoff values in less than 50% of cases. Among 77 patients fulfilling all KC, 49 (63.5%) had less than a 40% probability of SAH. Of 50 children with complete CC, 20 (40%) had a 62.4% or lower probability of SAH. KC and CC are not sufficiently accurate to confidently exclude SAH-KK in preschool-aged children due to heterogeneous clinical presentations. Further studies are needed to redefine diagnostic criteria based on patient age and causative pathogens.

<bold>Background:</bold> Pulmonary embolism (PE) is a major health burden. Its acute management has been extensively studied permitting in the past decades progress on mortality. Recent studies showed that number of patients complains of long-term symptoms after a PE. Up to half of patients report dyspnea months after acute PE. The term post-PE syndrome was proposed as definition for all the manifestations after PE that cannot be associated to other causes. These symptomatic patients seem to have a higher morbidity and therefore to consume more healthcare resources. <bold>Objectives:</bold> The aim of this study is to analyses which are the preexisting conditions associated with a dyspnea after PE. <bold>Methods:</bold> This study is a post-hoc analysis on a large cohort of PE patients (n=508) followed with a dyspnea-based algorithm (INPUT study). We analyzed which baseline characteristics of these patients were significantly associated with a NYHA functional class ≥ II after an acute PE. <bold>Results:</bold> 19% of the patients in the cohort presented new dyspnea during the two years following an acute PE. Multivariate and univariate analysis showed that higher BMI (OR 1.08), female sex (OR 2.48) and CETPH were significantly associated with dyspnea. Age, smoking status, anticoagulation type, active cancer, cause of PE were not significantly associated with dyspnea. <bold>Conclusions:</bold> Dyspnea is a frequent complain after a PE. Pre-existing characteristics such BMI and female sex may play a role in its development. The comorbidities probably also play a relevant role in the development of a dyspnea after a PE. Further studies are needed to assess and help patient with persisting respiratory symptoms after PE.

Emergency physicians are experts in managing critical conditions in a fast-paced everchanging environment. They deliver continuous 24/7 care and are the entry point to the healthcare system for many patients. It is essential to have healthy, alert and skilled emergency physicians at all times of the day and yet they face the physical and mental challenges of shift work. This article aims to explore the current literature on emergency department (ED) shiftwork, the mental well-being and physical implications of shift work and offer strategies to mitigate its detrimental effects on emergency physicians.