Kantonsspital Baden

Quantitative single-photon emission computed tomography (SPECT) with 99m Tc-3,3-diphosphono-1,2 propanodicarboxylicacid ([ 99m Tc]Tc-DPD) is a cornerstone in the noninvasive diagnostic workup of amyloid transthyretin-related cardiomyopathy (ATTR-CM). As diagnosis is often suspected after transthoracic echocardiography (TTE), this study aims to explore the correlations between global and regional quantitative [ 99m Tc]Tc-DPD SPECT results and TTE findings in patients with suspected ATTR-CM. Patients with suspected ATTR-CM from a single-center registry (B-CARE) were retrospectively included. All underwent quantitative [ 99m Tc]Tc-DPD SPECT/CT at the baseline examination with calculation of standardized values [maximum standardized uptake value (SUV max ) and peak SUV (SUV peak )], also normalized to bone activity (nSUV max and nSUV peak ). Data on TTE, performed within 2 weeks from the DPD scintigraphy, were also collected. One hundred forty four patients were included. Of these, 99 patients were eventually diagnosed with ATTR-CM. There was a significant correlation between septal ( P ≤ 0.001) and lateral wall thickness ( P = 0.004) and their respective, regional SUVs ( P < 0.001 and P = 0.004, respectively), as well as global SUVs and maximum wall thickness ( P = 0.024). Also, the presence of severe diastolic dysfunction correlated with nSUVs ( P = 0.011). The robust correlation found between TTE-derived parameters and the corresponding [ 99m Tc]Tc-DPD SPECT SUVs supports the link between morphologic alterations and [ 99m Tc]Tc-DPD activity within the myocardium, also potentially highlighting a pathophysiological mechanism involved in the progression of ATTR-CM.

Acute vertigo and dizziness are among the most frequent complaints presenting to the emergency department (ED). If acute-onset and persistent vertigo/dizziness (lasting > 24h) are accompanied by motion intolerance, gait imbalance, nausea/vomitus, and (usually also) nystagmus, this refers to the acute vestibular syndrome (AVS). We aimed at collecting epidemiologic data about the frequency of AVS etiologies for improving the diagnostic workup. We conducted a Prospero-registered systematic literature search (MEDLINE, Embase - in June 2024) retrieving information on AVS's clinical presentation, differential diagnosis, and stroke frequency. Two independent reviewers screened abstracts and full texts. Studies were rated with QUADAS-2 for risk of bias. Due to heterogeneity, we refrained from meta-analysis. We identified 6731 unique articles and 45 manuscripts (reporting on > 5 Mio. dizzy patients) that were included. 3.45% of all ED visits were related to dizziness/vertigo. One tenth (i.e., 0.3%) met the diagnostic criteria for an AVS. Only about 74% of AVS patients received peripheral or central vestibular diagnoses, while 26% were non-specific. Stroke was the second most common cause (21% in our dedicated review) after acute unilateral vestibulopathy (38%). Selected studies assessing infarction location showed posterior-inferior cerebellar artery (36%) involvement most commonly. Stroke cases were seen at similar rates in patients with or without nystagmus (22 vs. 25%). Representing 10% of all dizzy patients, AVS in the ED is frequent. With a stroke fraction among all AVS cases of approximately 21%, profound clinical training to differentiate peripheral from central causes reliably should be prioritized.

Observation remains the recommended management approach for low-risk prostate cancer (PCa), aiming to balance oncological control and avoidance of overtreatment. This study investigated the use of observation and its association with patients' socioeconomic position (SEP), age, and prostate-specific antigen (PSA) level on treatment choice in Switzerland. This cohort study analyzed Gleason score 6 PCa diagnoses in 2020 and 2021 from the Swiss National Agency for Cancer Registration dataset. Variables included age, PSA value, residence, and treatment codes. Municipality-based SEP deciles were linked to patients. Multivariable regression assessed the associations between SEP and observational management. Of 4296 men, 2876 (65.4%) received observational management, 792 (18.0%) underwent active treatment, and management was unknown in 728 (16.6%). Compared with men from low SEP areas, those from middle (odds ratio [OR] 1.11, 95% confidence interval [CI]: 0.92-1.35) and high SEP (OR 1.29, 95% CI: 1.06-1.58) areas had higher odds of observation. Men aged 60-70yr (OR 1.53, 95% CI: 1.24-1.89) and >70yr (OR 2.10, 95% CI: 1.68-2.62) were more likely to undergo observation than those aged <60yr. PSA 5-10ng/ml (OR 0.67, 95% CI: 0.55-0.82) and >10ng/ml (OR 0.60, 95% CI: 0.46-0.78) were associated with lower odds of observation compared with PSA <5ng/ml. Most men diagnosed with localized low-risk PCa in Switzerland underwent observational management as the primary strategy in 2020 and 2021. However, at least 18% of men still received active treatment. Lower SEP, younger age, and higher PSA values were risk factors for active treatment within low-risk PCa patients. We looked at how men in Switzerland with low-risk prostate cancer were treated in 2020 and 2021. We found that most men chose observation instead of immediate treatment, but men with lower socioeconomic position, younger age, or higher prostate-specific antigen levels were more likely to have active treatment. This suggests that there are opportunities to reduce unnecessary treatment for certain patient groups.

With the aim to optimize delirium management, an algorithm was introduced in general internal medicine wards of a Swiss University Hospital in 2018. We evaluated its impact on prevalence, therapeutic measures, and outcomes of delirium in a real-world setting. Retrospective before/after study of patients aged ≥ 65years hospitalized in general internal medicine. During 2018, an interprofessional delirium algorithm was introduced. We compared the delirium prevalence and secondary outcomes including mortality, length of stay (LoS), discharge home, delirium duration, and use of pharmacological and non-pharmacological interventions between the pre-intervention (2017) and the post-intervention (2019) periods in unadjusted and adjusted analyses. Of 4855 cases (pre 2253/post 2602), the overall delirium prevalence was 10.3% (n = 499); the prevalence in 2017 was 9.5% (n = 213) and 2019 11.0% (n = 286) (p = 0.08, adjusted OR 1.04, 95% CI 0.93 to 1.15). The delirium duration was similar in the pre- and post-intervention periods (adjusted mean difference -0.61days, 95% CI -2.35 to 0.12). The use of antipsychotic medications decreased (adjusted OR 0.45, 95% CI 0.23 to 0.88) and non-pharmacological interventions were increasingly used (involvement of relatives adjusted OR 16.59, 95% CI 4.74 to 58.07; delirium screening instruments adjusted OR 25.22, 95% CI 7.24 to 87.93). The introduction of an interdisciplinary delirium algorithm did not change delirium prevalence, but was associated with a decreased use of antipsychotic medications and an increased use of non-pharmacological interventions. However, there is further need for quality improvement to unlock the full potential to prevent and treat delirium in the acute hospital wards.

IntroductionThe analgesic and antipyretic paracetamol (acetaminophen) is generally considered safe in therapeutic doses. The most important toxic effect is hepatotoxicity after supratherapeutic doses or in the presence of risk factors (eg, malnutrition, alcoholism). According to the WHO analgesic ladder, a combination of a non-opioid analgesic such as paracetamol with a strong opioid is recommended as step III treatment of patients with chronic pain, despite limited evidence for this approach. The main aim of this study is to test the hypothesis that paracetamol does not provide clinically relevant benefits when added to strong opioids in patients with chronic pain.Methods and analysisInvestigator-initiated, randomised, double-blind, placebo-controlled, non-inferiority trial at two Swiss hospitals. A total of 140 patients with chronic pain requiring strong opioids and paracetamol ≥1.5 g/day for at least 7 days will be enrolled and randomised to either continued combination treatment or strong opioid plus placebo. In the first study phase (days 1–7), patients receive identically looking capsules containing either paracetamol at the exact dose previously used or a placebo. During a second study phase (days 7–14), all patients stop the blinded study medication (paracetamol and placebo) with follow-up to day 14. Adherence will be assessed by pill count and measurement of paracetamol and opioid serum concentrations. Patients are instructed to use a pain diary daily during the whole study. The primary outcome is the average pain score on day 7 using a 10 cm visual analogue scale (VAS). A difference between groups of ≤8 mm will be considered clinically irrelevant. Secondary outcomes will include VAS pain score on day 14, number of opioid rescue doses used, subjective ratings of overall feeling of well-being, quality of life, nausea/vomiting, drowsiness and constipation, and other adverse events, and potential effects of study drug concentrations and opioid receptor and cytochrome P450 (CYP) genotypes on the observed differences.Ethics and disseminationThe study was approved by the Ethics Committee (Ethikkommission Bern, reference number 2021-01518) and the Swiss Agency for Therapeutic Products (Swissmedic, reference number 701286). Results will be published in open-access policy peer-reviewed journals. The study is funded by the Swiss National Science Foundation (grant number 32 003B_201072).Trial registration numberNCT05088876.

Flow is the optimal mental state for peak focus and performance, positively correlating with well-being. This study investigated electroencephalographical (EEG) and circulatory heart rate (HR) markers of flow during virtual reality (VR) surgical training on the da Vinci Skills Simulator. Twenty urologic surgeons participated, categorised as High or Low Performers based on VR task scores. Generalised estimating equations and Spearman’s rank correlation were used to analyse differences in EEG, HR, Flow Short Scale scores, and professional experience. High performers exhibited significantly higher Theta activity Wald(1) = 5.96, p = .015; Wald(1) = 5.11, p < .001) and a positive correlation between VR scores and flow r(10) = 0.63, p = .048). No significant HR differences were observed. The study highlights the importance of Theta activity in achieving flow, suggesting that neurofeedback and biofeedback could provide a point of departure to enhance surgical performance and well-being of surgeons and patient health.

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.

Hospital-initiated opioid analgesics that extend beyond discharge can lead to long-term use and adverse outcomes. Despite a growing understanding of opioid-related harms, there is a lack of published protocols for structured deprescribing of hospital-initiated opioids in Europe. Opioid stewardship initiatives, which encompass coordinated approaches to optimize prescribing practices and reduce long-term use, require deprescribing frameworks that extend beyond medication discontinuation to include patient communication and systematic care coordination. We aimed to develop an actionable opioid deprescribing framework that builds on trialed reduction protocols with patient-centered determinants for systematic implementation in tertiary care. We conducted a multi-level consensus study to bridge evidence, clinician expertise, and patient perspectives. Initial framework development included focus group discussions with multidisciplinary clinicians (n = 5). The framework was validated for our institution via a two-round Delphi survey across six medical specialties (n = 11). An opioid reduction calculator was developed in Python, incorporating clinical parameters to determine reduction trajectories for prespecified starting and end doses. Final refinement included interviews with patients receiving opioid therapy (n = 11) to optimize understandability of the reduction plan as a patient handout and for developing a patient pamphlet on opioids with patients (n = 13). The framework identified four critical domains for successful deprescribing of hospital-initiated opioids: interventional reduction strategies, patient-specific physiological variables, environmental enablers, and procedural elements. Reduction strategies categorized patients into chronic and new users, incorporating grace periods for dose stabilization, with particular attention given to patients exhibiting pain catastrophizing behavior and frailty. Environmental and procedural factors included shared responsibility and interdisciplinarity, ensuring that follow-up is facilitated by a coordinated care team. These findings were operationalized into the reduction calculator, proposing initial individualized reduction plans (10–25%) based on key patient-specific variables with built-in stabilization periods. Delphi validation achieved full consensus (87.8% first-round agreement; 100% final consensus) on all framework components. Patient involvement refined the handout to improve understandability and actionability, and yielded comprehensive information on opioids. We developed an actionable opioid deprescribing framework that bridges published evidence with patient-centered care for our institution, providing other healthcare institutions with a practical blueprint for their own implementation. Our multi-level consensus identified critical patient-specific and environmental determinants, and established individualized reduction protocols, addressing a critical gap in transitional care while facilitating safe opioid deprescribing practices.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-19823-9.

Aging is associated with enhanced platelet activation and inflammatory responses, contributing to an increased risk of thrombotic and cardiovascular events. However, how megakaryocytes (Mk) change with age or between sexes is still unclear.We performed single-cell RNA sequencing to profile bone marrow from young (3-month-old) and old (> 24-month-old) C57BL/6 mice, as well as from young and middle-aged human donors. In parallel, platelet activation was assessed by CD62P expression using flow cytometry in isolated and washed mouse platelets from young and old donors. Single-cell clustering in mouse bone marrow revealed five distinct Mk subpopulations. The age-dependent shift was more pronounced for subpopulations associated with platelet activation (mMk3) and immune/inflammatory responses (mMk4). mMk3 cells were more abundant in females, whereas mMk4 predominated in males. An increased platelet activation phenotype in old mice was confirmed in both sexes by CD62P expression analyses. Differential gene expression analyses showed that aging alters gene expression patterns related to platelet activation and aggregation via receptor signaling, granule formation, and inflammation. Aged males exhibited enrichment in genes linked to mitochondrial function, oxidative stress, lipid metabolism and membrane dynamics, whereas aged females showed upregulation of serotonin receptor genes. Human transcriptomic data support our murine findings, exhibiting increased expression of genes involved in mitochondrial electron transport and immune signaling in middle-aged individuals. Our study reveals a complex, sex-specific remodeling of Mk subpopulations in the aging organisms, characterized by distinct pro-thrombotic and pro-inflammatory transcriptional profiles. These observations suggest potential targets for developing age- and sex-tailored antithrombotic therapies.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40364-025-00830-x.