Triemli Hospital

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.

Objective The approval of budesonide orodispersible tablets and dupilumab has introduced new therapeutic options for the treatment of eosinophilic oesophagitis (EoE). However, there is a shortage of data on perspectives of the affected patients regarding therapeutic interventions. We aimed to assess the beliefs, restrictions and preferences of patients with EoE with respect to medical and dietary treatment options. Design/method We conducted a web-based survey consisting of 34 questions addressing treatment preferences, including currently available and potentially emerging options, using SurveyMonkey among patients with confirmed diagnosis of EoE in Switzerland, Austria and Germany. Results 150 patients (64% male; 70.7% with concomitant atopic diseases; 44% previously dilated; 22% with ≥3 sessions) responded. With regard to the routes of administration, one to two times daily swallowed topical corticosteroid (STC) was ranked the highest (89.3% generally preferred STC, and 52.7% preferred STC as single most preferred route within the scenario, including every potentially imaginable route of administration and assuming all options would be equally effective), followed by subcutaneous administration every 4 weeks (62.7%, 22%), peroral systemic steroids (46.7%, 18.7%) and weekly subcutaneous administration (38.7%, 0%). Although one-third did not have reservations against long-term medical therapy, 42% were sceptical about long-term treatment and 65% were afraid of adverse events. Patients with fear of drug-related side events were significantly younger (p=0.001), less often dilated (ever) (p=0.03) and had more often experienced adverse events of any prior therapy (p=0.03). Conclusion Patients with EoE prefer topical agents over other available routes of administration. Patient education is crucial to address concerns regarding long-term treatment.

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.

Integrative oncology (IO) combines conventional cancer medicine with evidence-based complementary procedures, thereby placing special demands on the concept of evidence, research methodology, and the evaluation of care quality. This article highlights key theoretical, methodological, and practical principles. The classic concept of evidence is examined in detail through the three pillars of evidence-based medicine. Complementary research designs such as mixed methods, pragmatic studies, whole-systems approaches, and preference-based designs, are discussed as they offer new perspectives for generating valid and patient-centered evidence. In addition, regulation and practice-oriented quality criteria are presented as well as the current consensus process within the newly founded "Swiss Network for Integrative Oncology" (SNIO), which defines common standards, training structures, and research strategies. These efforts lay the foundation for the ongoing development of the field - toward an IO that is safe, effective, and truly patient-centered.

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.

Point-of-care ultrasound (POCUS) is a valuable addition to the diagnostic armamentarium of internal medicine specialists, improving patient assessment and treatment guidance. Early acquisition and continuous development of ultrasound skills during clinical training are key to maintaining the high quality of POCUS. In Switzerland, POCUS Component 1 (basics of emergency medicine ultrasound) of the Swiss Society of Ultrasound in Medicine (SGUM) postgraduate certification programme will be a mandatory component of board certification in General Internal Medicine (GIM) after 2026. Clinical institutions face the challenge of integrating POCUS teaching into daily practice. The following article addresses this challenge by describing the current regulatory conditions of POCUS training and presenting the POCUS training programme at Stadtspital Zürich Triemli as a blueprint for other postgraduate education sites in Switzerland.