Kantonsspital Winterthur

Aviation emissions have been the focus of research and regulation since the 1970s. Switzerland's Federal Office of Civil Aviation (FOCA) and research groups in Switzerland have contributed significantly to an improved understanding of these emissions and their impact on the environment and health. This paper presents a brief history of aviation emissions research in Switzerland. We also present the direction of future research on aviation emissions using the Swiss mobile aircraft emissions measurement system (SMARTEMIS).

To assess patterns and institutional variability of anti-angiogenic treatment discontinuation in neovascular age-related macular degeneration (nAMD) within Switzerland, and to examine the association of digital home monitoring with treatment persistence. Retrospective observational analysis combined nationwide health insurance claims data (Helsana, n = 4840) and clinical data from a major tertiary centre (LUKS, n = 1932; nAMD subset n = 1387). Discontinuation was defined as no further injections for 31-365 days after the last intravitreal injection (IVI) and classified as supervised ( ≥ 1 follow-up visit in this period) or unsupervised (no follow-up visits in this period). Variability was evaluated among the 20 largest providers and across seven regions. Digital home monitoring's impact on non-persistence was assessed in the clinical cohort. Substantial heterogeneity was observed. Supervised discontinuation ranged from 20.7 to 45.7% (pooled proportion 32.0%, 95% confidence interval [CI] 30.2-33.9%) and unsupervised from 10.9 to 25.7% (pooled proportion 18.2%, 95%CI 16.8-19.8%) across centres. In the LUKS cohort, 1-year persistence was 93.7%, dropping to 72.7% by year 4, with unsupervised discontinuation rising from 3.0 to 12.5%. In 100 patients using voluntary digital home monitoring non-persistence was less likely (adjusted OR 0.59, 95%CI 0.35-0.98); among those who discontinued, home-monitoring users were more likely to remain under supervision (74% vs 54%). Treatment discontinuation in nAMD is frequent and demonstrates striking institutional and regional variability. The heterogeneity in discontinuation patterns suggests that treatment persistence may be modifiable through targeted, systematic, and patient-centred interventions. Digital home monitoring may be a promising strategy to support engagement and reduce non-persistence.

Comprehensive geriatric assessment (CGA) and targeted functional assessments have become indispensable tools for safe and effective pharmacotherapy in older adults. Chronological age alone is apoor predictor of drug response and adverse outcomes; in contrast, CGA reliably detects frailty, cognitive impairment, and motor dysfunction-key determinants of pharmacokinetic and pharmacodynamic changes, as well as vulnerability to delirium, falls, and functional decline. By integrating validated instruments (e.g., frailty indexes, neuropsychological tests, the Timed-Up-and-Go test, gait speed, and handgrip strength), CGA unmasks subclinical deficits and quantifies individual risk profiles that directly influence clinical decisions: initiation, dosing, choice of agent, and, in particular, deprescribing of high-risk medications (anticholinergics, benzodiazepines, and fall-risk increasing drugs [FRID]). There is alarge body of evidence demonstrating that CGA-guided prescribing reduces serious adverse drug reactions, falls, hospitalisations, and mortality while improving quality of life. In an era of increasingly complex regimens, systematic functional assessment in older people is no longer optional-it is the cornerstone of personalised, evidence-based pharmacotherapy in geriatric medicine.

Rare cancers combine low incidence with high biological heterogeneity and multi-institutional care trajectories. These features make single-center learning structurally incomplete and render pathway fragmentation a dominant driver of preventable harm, variability, and waste. In this context, care quality is best understood as a property of pathway integrity across routing, diagnostics (imaging/biopsy planning), multidisciplinary intent-setting, definitive treatment, and surveillance-rather than as a department-level attribute. To define a pragmatic, transferable operating blueprint for a rare-cancer Learning Health System (LHS) that turns routine care into continuous, auditable learning under explicit governance, while maintaining claims discipline and protecting measurement validity. We synthesize an implementation-oriented operating model using the Swiss Sarcoma Network (SSN) as an exemplar. The blueprint couples clinical governance (Integrated Practice Unit logic, hub-and-spoke routing, auditable multidisciplinary team decision systems) with an interoperable real-world-time data backbone designed for benchmarking, pathway mapping, and feedback. The operating logic is expressed as a closed-loop control cycle: capture → harmonize → benchmark → learn → implement → re-measure, with explicit owners, minimum requirements, and failure modes. Results/Blueprint: (i) The model specifies a minimal set of data primitives-time-stamped and traceable decision points covering baseline and tumor characteristics, pathway timing, treatment exposure, outcomes and complications, and feasible longitudinal PROMs and PREMs; (ii) a VBHC-ready, multi-domain measurement backbone spanning outcomes, harms, timeliness, function, process fidelity, and resource stewardship; and (iii) two non-negotiable validity guardrails: explicit applicability ("N/A") rules and mandatory case-mix/complexity stratification. Implementation is treated as a governed step with defined workflow levers, fidelity criteria, balancing measures, and escalation thresholds to prevent "dashboard medicine" and surrogate-driven optimization. This perspective contributes an operating model-not a platform or single intervention-that enables credible improvement science and establishes prerequisites for downstream causal learning and minimum viable digital twins. By distinguishing enabling infrastructure from the governed clinical system as the primary intervention, the blueprint supports scalable, learnable excellence in rare-cancer care while protecting against gaming, inequity, and inference drift. Distinct from generic LHS or VBHC frameworks, this blueprint specifies validity gates required for rare-cancer benchmarking-explicit applicability ("N/A") rules, denominator integrity/capture completeness disclosure, anti-gaming safeguards, and escalation governance. These elements are critical in rare cancers because small denominators, high heterogeneity, and multi-institutional pathways otherwise make benchmarking prone to artifacts and unsafe inferences.

BackgroundRandomized controlled trials (RCTs) are the gold standard for evaluating interventions in oncology, but reporting can be subject to “spin”—presenting results in ways that mislead readers about true efficacy.ObjectiveThis study aimed to investigate whether large language models (LLMs) could provide a standardized approach to detect spin, particularly in the conclusions, where it most commonly occurs.MethodsWe randomly sampled 250 two-arm, single–primary end point oncology RCTs from 7 major medical journals published between 2005 and 2023. Two authors independently annotated trials as positive or negative based on whether they met their primary end point. Three commercial LLMs (GPT-3.5 Turbo, GPT-4o, and GPT-o1) were tasked with classifying trials as positive or negative when provided with (1) conclusions only; (2) methods and conclusions; (3) methods, results, and conclusions; or (4) title and full abstract. LLM performance was evaluated against human annotations. Afterward, trials incorrectly classified as positive when the model was provided only with the conclusions but correctly classified as negative when provided with the whole abstract were analyzed for patterns that may indicate the presence of spin. Model performance was assessed using accuracy, precision, recall, and F1-score calculated from confusion matrices.ResultsOf the 250 trials, 146 (58.4%) were positive, and 104 (41.6%) were negative. The GPT-o1 model demonstrated the highest performance across all conditions, with F1-scores of 0.932 (conclusions only; 95% CI 0.90-0.96), 0.96 (methods and conclusions; 95% CI 0.93-0.98), 0.98 (methods, results, and conclusions; 95% CI 0.96-0.99), and 0.97 (title and abstract; 95% CI 0.95-0.99). Analysis of trials incorrectly classified as positive when the model was provided only with the conclusions revealed shared patterns, including absence of primary end point results, emphasis on subgroup improvements, or unclear distinction between primary and secondary end points. These patterns were almost never found in trials correctly classified as negative.ConclusionsLLMs can effectively detect potential spin in oncology RCT reporting by identifying discrepancies between how trials are presented in the conclusions vs the full abstracts. This approach could serve as a supplementary tool for improving transparency in scientific reporting, although further development is needed to address more complex trial designs beyond those examined in this feasibility study.

Despite advancements in minimally invasive surgery, access to robotic-assisted cholecystectomy remains limited, largely due to robot availability and high costs for this procedure. The DEXTER® Robotic Surgery System offers a small, mobile, and cost-effective alternative designed for ease of use and seamless integration into routine surgical workflows. The present study aimed to confirm the safety and performance of robotic-assisted cholecystectomy using DEXTER®. A prospective study of robotic-assisted cholecystectomy was conducted by six surgeons across four centers in three countries. The primary objectives were to document the successful completion of the surgeries without conversion to laparoscopic or open surgery and the occurrence of serious adverse events (Clavien-Dindo grade ≥ III) up to 30days post-surgery. Secondary endpoints included surgical performance metrics such as operative time. A total of 51 patients underwent surgical intervention for the management of symptomatic Cholecystolithiasis, Cholecystitis, choledocholithiasis, and biliary pancreatitis. The median patient age was 59years (IQR 42-65), and BMI was 28.0kg/m2 (IQR 24.9-29.6). All procedures were completed successfully without device deficiencies or conversions to open surgery. The median operative time was 58min (IQR 49-78), including a median docking time of 3min (IQR 2-5) and a median console time of 25min (IQR 21-36). The median estimated blood loss was 5mL (IQR 0-10) and no blood transfusions were required. One Clavien-Dindo grade IIIa event occurred in one patient requiring an ERCP for postoperative Choledocholithiasis, which was resolved without the need for reoperation. 26 patients (51%) were discharged within 24h of the surgery. This study confirmed that DEXTER® enables safe and effective cholecystectomy in a non-emergent setting, including in outpatient sites of care.

ObjectivesInflammatory bowel disease (IBD) constitutes a challenging and long‐lasting burden for pediatric patients. The management of IBD is multifaceted involving conventional medication but also dietary measures. An increasing number of patients are turning to complementary and alternative medicine (CAM) in their quest to alleviate IBD‐related symptoms and improve their overall well‐being. We therefore investigated the patterns of CAM use and associated patients' and disease characteristics to identify indicators of CAM use in pediatric IBD patients in Switzerland.MethodsPediatric and adolescent patients enrolled in the Swiss IBD Cohort Study, a nationwide prospective cohort study, completed a questionnaire about CAM and supplementation use as well as dietary restrictions. Associations of CAM use with disease characteristics including conventional medication and patient‐recorded outcomes were analyzed.ResultsA total of 111 pediatric IBD patients (59 Crohn′s disease, 41 ulcerative colitis, 11 IBD unclassified) answered the questionnaire. Sixty‐five percent (72/111) of patients used at least one CAM since diagnosis, 73% (81/110) took vitamins and micronutrient supplements and 53% (59/111) followed dietary restrictions. The latter was in 68% self‐imposed and significantly associated with CAM use in multivariable models (odds ratio [OR]: 4.48; 95% confidence interval [CI]: 1.84–10.92). CAM use was not associated with IBD subtype, need for biologicals or extraintestinal manifestations. Health‐related quality of life (HRQOL) and disease activity did not differ between CAM and no‐CAM users.ConclusionCAM use as well as self‐imposed dietary restrictions are frequent in IBD patients, whereby both are closely interrelated. While CAM users do not have higher HRQOL compared to no‐CAM users, they subjectively report an improvement in health associated with CAM use.