[A map for the improvement of healthcare: Swiss Health Care Atlas]. / Cartographie pour l'amélioration des soins : Atlas suisse des services de santé.

The Swiss Health Care Atlas (ASSS) is a free platform accessible to healthcare professionals and the general public. It provides a detailed overview of healthcare practices and the use of pharmaceutical and technological resources in both acute and outpatient care settings throughout Switzerland. It serves as an interactive tool for visualizing medical services and practices in Switzerland, along with regional variations. The ASSS allows the identification of potential under and overutilization of healthcare services, making it a valuable planning and management tool for healthcare and political authorities. This article reviews healthcare practices related to general internal medicine and guides the reader in interpreting a selection of ASSS indicators.

L'Atlas suisse des services de santé (ASSS) est une plateforme gratuite accessible aux professionnels de santé, mais aussi au grand public. Il permet un aperçu détaillé des pratiques de soins et de l'utilisation des ressources pharmacologiques et technologiques, en milieux hospitalier et/ou ambulatoire, sur le territoire helvétique. Il s'agit d'un moyen interactif permettant de visualiser certaines prestations médicales, ainsi que leur variation régionale. L'ASSS permet d'identifier une potentielle sous/surutilisation des services de soins et constitue ainsi un outil de planification et de pilotage pour les autorités sanitaires et politiques. Cet article passe en revue les pratiques de soins liées à la médecine interne générale et guide le lecteur dans l'interprétation d'une sélection d'indicateurs de l'ASSS.

[Value-Based Healthcare, PROMs and Shared Decision-Making - How Are They Connected?] / Value-based Healthcare, PROMs und Shared Decision-Making.

Value-Based Healthcare, PROMs and Shared Decision-Making - How Are They Connected? Abstract. The best possible healthcare delivery measured by the individually perceived value of a treatment at reasonable costs is the short formula of value-based healthcare (VBHC). Developed in 2006 by Harvard economists Michael Porter and Elizabeth Teisberg in their landmark book 'Redefining Healtcare' [1], this formula and its principles are currently under considerations as a comprehensive concept for transforming the healthcare system in many countries, including Switzerland. The aim is to focus on the value of a treatment from the patient's perspective as a measure for treatment quality. Standardized Patient-Reported Outcome Measurement (PROM) as a core element of the VBHC concept is the prime metric, which can only be optimized, when Shared Decision-Making (SDM) is an embedded part, thereby integrating the individually best choices regarding the 'value' (and harm!) of specific diagnostic and therapeutic medical procedures.

[Patient Decision Aids for Values Clarification and Preference Elicitation - Challenges and Developments]. / Patienten-Entscheidungshilfen zur Werteklärung und Präferenzerhebung.

Patient Decision Aids for Values Clarification and Preference Elicitation - Challenges and Developments Abstract. Shared decision-making is especially appropriate when the available evidence does not indicate which medical intervention is the better option, so that the final decision depends on the patient's personal values and preferences. The process of value clarification and preference elicitation can be time-consuming and cognitively and emotionally demanding for patients. Increasingly, decision aids provide tasks (e.g., on benefit-harm trade-offs) to help patients work through this process, better prepare for medical consultations, and make values-congruent medical decisions with their physicians. Most clinically validated decision aids are paper-based flyers and educational brochures. There are also computer-, audio-, video-, or web-based decision aids. The web-based aids make little use of the potential of interactive technologies, despite the known benefits of these technologies. The aims of this paper are to provide an overview of decision aids for and challenges of values clarification and preference elicitation and to highlight some developments in interactive web-based technologies that might facilitate values clarification and preference elicitation.

Validation of the German version of two scales (RIS, RCS-HCP) for measuring regret associated with providing healthcare.

BACKGROUND: The regret intensity scale (RIS) and the regret coping scale for healthcare professionals (RCS-HCP) working in hospitals assess the experience of care-related regrets and how healthcare professional deal with these negative events. The aim of this study was to validate a German version of the RIS and the RCS-HCP. METHODS: The RIS and RCS-HCP in German were first translated into German (forward- and backward translations) and then pretested with 16 German-speaking healthcare professionals. Finally, two surveys (test and 1-month retest) administered the scales to a large sample of healthcare professionals from two different hospitals. RESULTS: Of the 2142 eligible healthcare professionals, 494 (23.1%) individuals (108 physicians) completed the cross-sectional web based survey and 244 completed the retest questionnaire. Participants (n = 165, 33.4% of the total sample) who reported not having experienced a regret in the last 5 years, had significantly more days of sick leave during the last 6 months. These participants were excluded from the subsequent analyses. The structure of the scales was similar to the French version with a single dimension for the regret intensity scale (Cronbach's alpha: 0.88) and three types of coping strategies for the regret coping scale (alphas: 0.69 for problem-focused strategies, 0.67 for adaptive strategies and 0.86 for the maladaptive strategies). Construct validity was good and reproduced the findings of the French study, namely that higher regret intensity was associated with situations that entailed more consequences for the patients. Furthermore, higher regret intensity and more frequent use of maladaptive strategies were associated with more sleep difficulties and less work satisfaction. CONCLUSIONS: The German RIS and RCS-HCP scales were found valid for measuring regret intensity and regret coping in a population of healthcare professionals working in a hospital. Reporting no regret, which corresponds to the coping strategy of suppression, seems to be a maladaptive strategy because it was associated with more frequent sick day leaves.

[Repetition of blood testing : which risks for the patient?] / Prises de sang répétées :quels risques pour le patient?

Numerous tests are performed in the hospital, often on a daily basis. These tests should answer a specific scientific question and be performed only if their results can have an impact on patient care. In addition to causing anemia, overutilization of tests, such as useless blood testing, can have a deleterious impact on the patients because they carry the risk of false positive results, which can trigger downstream unnecessary investigations and costs.

De nombreuses investigations diagnostiques sont pratiquées à intervalles réguliers en milieu hospitalier. Ces examens devraient répondre à une question clinique spécifique et ne devraient être réalisés que si leur résultat peut influencer la prise en charge du patient. Outre le risque de générer une anémie, la surutilisation de ces tests, comme des prises de sang inutiles, peut avoir un impact délétère sur la prise en charge du patient. En effet, cette surutilisation comporte également le risque de générer des résultats « faux positifs ¼ et ainsi de devoir suivre et potentiellement traiter des patients qui n'en ont pas besoin. Finalement, cette pratique augmente de façon conséquente les coûts de la santé.

The Swiss Atlas of Health Care: monitoring variations in care to improve health care delivery in Switzerland.

No abstract available.

Comparison of analog and digital patient decision aids for the treatment of depression: a scoping review.

Introduction: Patient decision aids (PDAs) are important tools to empower patients and integrate their preferences and values in the decision-making process. Even though patients with mental health problems have a strong interest in being more involved in decision making about their treatment, research has mainly focused on PDAs for somatic conditions. In this scoping review, we focus on patients suffering from depression and the role of PDAs for this patient group. The review offers an overview of digital and analog PDAs, their advantages and disadvantages as well as recommendations for further research and development. Methods: A systematic search of the existing literature guided by the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for scoping reviews (PRISMA-ScR) was conducted. Three electronic literature databases with the appropriate thematic focus were searched (PubMed, PsycInfo, and Web of Science). The search strategy used controlled and natural language to search for the key concepts decision aids and depression. The articles were selected in a two-step process guided by predefined inclusion and exclusion criteria. We narratively synthetized information extracted from 40 research articles. Results: We included 40 articles in our review. Our review revealed that there is more focus on digital PDAs in research than in clinical practice. Digitalization can enhance the benefits of PDAs by developing tools that are more efficient, interactive, and personalized. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. There is more research needed to study which forms of PDAs are most appropriate for various patient groups (e.g., older adults, or patients with comorbidities), and to identify the most effective ways of PDAs' integration in the clinical workflow. The findings from our review could be well aligned with the International Patient Decision Aids Standards. Discussion: More research is needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups.

[Differentiated thyroid carcinoma--essential for the practitioner]. / Das differenzierte Schilddrüsenkarzinom--das Wichtigste für die Praxis.

Differentiated thyroid carcinoma (DCT) is a rare carcinoma (incidence 8-12/100,000) with an excellent prognosis (five year survival of papillary thyroid carcinoma 95%). The presenting symptom of DCT is most frequently an indolent thyroid nodule, often discovered by chance at the occasion of a routine clinical examination. Rarely, DCT presents with a fixed ipsilateral cervical lymph node enlargement or a newly developed hoarseness of the voice. Patients at risk are those who have had irradiation of the head or neck, those with rapid enlargement of a thyroid nodule or patients with rare familiar tumour syndromes. Treatment is most frequently accomplished with total thyroidectomy followed by radioiodine ablation with or without suppressive levothyroxine therapy. In special situations, several radioiodine therapies are needed. All patients need regular long term follow up by neck sonography, measurements of thyroglobuline levels and control of thyroid hormone replacement therapy. DCT may relapse many years (>10) after initial therapy. Patients should ideally be followed by specialized interdisclipinary centres.

Handrub dispensers per acute care hospital bed: a study to develop a new minimum standard.

BACKGROUND: Accessibility to alcohol-based handrub (ABHR) dispenser is crucial to improve compliance to hand hygiene (HH), being offered as wall-mounted dispensers (ABHR-Ds), and/or pocket bottles. Nevertheless, information on the distribution and density of ABHR-Ds and their impact on HH have hardly been studied. Institutions such as the World Health Organisation or the Centers for Disease Control and Prevention do not provide guidance. The Robert-Koch-Institute (RKI) from Germany recommends an overall density of > 0.5 dispensers per patient bed. We aimed to investigate current conditions in hospitals to develop a standard on the minimal number of ABHR-D. METHODS: Between 07 and 09/2019, we applied a questionnaire to 178 hospitals participating in the Swissnoso National Surveillance Network to evaluate number and location of ABHR-Ds per bed in acute care hospitals, and compared the data with consumption and compliance with HH. RESULTS: 110 of the 178 (62%) hospitals provided data representing approximately 20,000 hospital beds. 83% hospitals provided information on both the total number of ABHR-Ds and patient beds, with a mean of 2.4 ABHR-Ds per bed (range, 0.4-22.1). While most hospitals (84%) had dispensers located at the room entrance, 47% reported also locations near or at the bed. Additionally, pocket-sized dispensers (100 mL) are available in 97% of hospitals. CONCLUSIONS: Swiss hospitals provide 2.4 dispensers per bed, much more than governmental recommendation. The first study on the number of ABHR-Ds in hospitals may help to define a minimal standard for national and international recommendations.

Reproductive number of the COVID-19 epidemic in Switzerland with a focus on the Cantons of Basel-Stadt and Basel-Landschaft.

The reproductive number in Switzerland was between 1.5 and 2 during the first third of March, and has consistently decreased to around 1. After the announcement of the latest strict measure on 20 March 2020, namely that gatherings of more than five people in public spaces are prohibited, the reproductive number dropped significantly below 1; the authors of this study estimate the reproductive number to be between 0.6 and 0.8 in the first third of April.

Monocyte chemoattractant protein-1 secreted by adipose tissue induces direct lipid accumulation in hepatocytes.

UNLABELLED: For many years, adipose tissue has been mainly considered as an inert reservoir for storing triglycerides. Since the discovery that adipocytes may secrete a variety of bioactive molecules (hormones, chemokines, and cytokines), an endocrine and paracrine role for white adipose tissue (WAT) in the regulation of energy balance and other physiological processes has been established, particularly with regard to brain and muscle. In contrast, little is known about the interactions of WAT with liver. Hence, we examined the effect of the secretory products of WAT on hepatocytes. Conditioned medium of human WAT explants induced significant steatosis in hepatocyte cell lines. Factor(s) responsible for the conditioned medium-induced steatosis were screened by a battery of blocking antibodies against different cytokines/chemokines shown to be secreted by WAT. In contrast to interleukin-8 and interleukin-6, the monocyte chemoattractant protein-1 was capable of inducing steatosis in hepatocytes in a time-dependent manner at concentrations similar to those found in conditioned medium. Incubation of conditioned medium with antimonocyte chemoattractant protein-1 antibodies prevented triglyceride accumulation. Investigation of the mechanism leading to the triglyceride accumulation showed that both a diminution of apolipoprotein B secretion and an increase in phosphoenolpyruvate carboxykinase messenger RNA may be involved. CONCLUSION: The monocyte chemoattractant protein-1 secreted by adipose tissue may induce steatosis not only recruiting macrophages but also acting directly on hepatocytes.

Shared Decision-Making Training in Internal Medicine: A Multisite Intervention Study.

BACKGROUND: Research shows that when patients and health care providers share responsibility for clinical decisions, both patient satisfaction and quality of care increase, and resource use decreases. Yet few studies have assessed how to train residents to use shared decision-making (SDM) in their practice. OBJECTIVE: We developed and evaluated a SDM training program in internal medicine. METHODS: Senior internal medicine residents from 3 hospitals in Switzerland were assessed shortly before and 2 months after completing a program that included a 2-hour workshop and pocket card use in clinical practice. Encounters with standardized patients (SPs) were recorded and SDM performance was assessed using a SDM completeness rating scale (scores ranging from 0 to 100), a self-reported questionnaire, and SPs rating the residents. RESULTS: Of 39 eligible residents, 27 (69%) participated. The mean (SD) score improved from 65 (SD 13) to 71 (SD 12; effect size [ES] 0.53; P = .011). After training, participants were more comfortable with their SDM-related knowledge (ES 1.42, P < .001) and skills (ES 0.91, P < .001), and with practicing SDM (ES 0.96, P < .001). Physicians applied SDM concepts more often in practice (ES 0.71, P = .001), and SPs felt more comfortable with how participants discussed their care (ES 0.44, P = .031). CONCLUSIONS: The SDM training program improved the competencies of internal medicine residents and promoted the use of SDM in clinical practice. The approach may be of interest for teaching SDM to residents in other disciplines and to medical students.

Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate Orders: A Systematic Review and Meta-analysis.

Importance: Whether specific communication interventions to discuss code status alter patient decisions regarding do-not-resuscitate code status and knowledge about cardiopulmonary resuscitation (CPR) remains unclear. Objective: To conduct a systematic review and meta-analysis regarding the association of communication interventions with patient decisions and knowledge about CPR. Data Sources: PubMed, Embase, PsycINFO, and CINAHL were systematically searched from the inception of each database to November 19, 2018. Study Selection: Randomized clinical trials focusing on interventions to facilitate code status discussions. Two independent reviewers performed the data extraction and assessed risk of bias using the Cochrane Risk of Bias Tool. Data were pooled using a fixed-effects model, and risk ratios (RRs) with corresponding 95% CIs are reported. Data Extraction and Synthesis: The study was performed according to the PRISMA guidelines. Main Outcomes and Measures: The primary outcome was patient preference for CPR, and the key secondary outcome was patient knowledge regarding life-sustaining treatment. Results: Fifteen randomized clinical trials (2405 patients) were included in the qualitative synthesis, 11 trials (1463 patients) were included for the quantitative synthesis of the primary end point, and 5 trials (652 patients) were included for the secondary end point. Communication interventions were significantly associated with a lower preference for CPR (390 of 727 [53.6%] vs 284 of 736 [38.6%]; RR, 0.70; 95% CI, 0.63-0.78). In a preplanned subgroup analysis, studies using resuscitation videos as decision aids compared with other interventions showed a stronger decrease in preference for life-sustaining treatment (RR, 0.56; 95% CI, 0.48-0.64 vs 1.03; 95% CI, 0.87-1.22; between-group heterogeneity P < .001). Also, a significant association was found between communication interventions and better patient knowledge (standardized mean difference, 0.55; 95% CI, 0.39-0.71). Conclusions and Relevance: Communication interventions are associated with patient decisions regarding do-not-resuscitate code status and better patient knowledge and may thus improve code status discussions.

Reduced expression of the NADPH oxidase NOX4 is a hallmark of adipocyte differentiation.

Adipocyte differentiation is a complex process regulated among other factors by insulin and the production of reactive oxygen species (ROS). NOX4 is a ROS generating NADPH oxidase enzyme mediating insulin's action in 3T3L1 adipocytes. In the present paper we show that NOX4 is expressed at high levels both in white and brown preadipocytes and that differentiation into adipocytes results in a decrease in their NOX4 mRNA content. These in vitro results were confirmed in vivo by demonstrating that in intact adipose tissue the majority of NOX4 expressing cells are localized within the preadipocyte containing stromal/vascular fraction, rather than in the portion consisting of mature adipocytes. In line with these observations, quantification of NOX4 mRNA in fat derived from different rodent models of insulin resistance indicated that alteration in NOX4 expression reflects changes in the ratio of adipocyte/interstitial fractions. In conclusion, we reveal that decreased NOX4 mRNA content is a hallmark of adipocyte differentiation and that NOX4 expression measured in whole adipose tissue is not an unequivocal indicator of intact or impaired insulin action.

Explant cultures of white adipose tissue.

Obesity is characterized by increased adiposity of visceral and subcutaneous depots as well as other organs, including the vasculature. These fat depots secrete various hormone-like proteins implicated in metabolic homeostasis (e.g., adiponectin, resistin), the central control of appetite (e.g., leptin) and the increased production of cytokines. These molecules act either in a paracrine or endocrine manner, contributing to the metabolic and cardiovascular complications of obesity. Explant cultures of white adipose tissue are an important step in analyzing the secretory mechanisms of adipose tissue by preserving the physiological in vivo cross-talk between the various types of cells.

Local adipose tissue depots as cardiovascular risk factors.

Obesity is associated with increased cardiovascular morbidity and mortality. Although obesity-associated hypertension, dyslipidemia and insulin resistance account in part for this association, it becomes increasingly apparent that a systemic and local pro-inflammatory response of adipose tissue might also be a contributing factor. White adipose tissue (WAT) is a highly active organ secreting various peptides such as cytokines, chemokines and hormone-like proteins. Besides the visceral and subcutaneous depots, WAT is also found in the close vicinity of blood vessels (perivascular adipose tissue), where it secretes cytokines such as interleukin-1, tumor necrosis factor alpha, pro-atherogenic chemokines, and pro-angiogenic peptides. These factors appear to contribute directly to alterations of the function and structure of the vascular wall, including chronic inflammation, alterations of vascular tone, proliferation of smooth muscle cells, neo-angiogenesis and hence to the development of atherosclerosis and cardiovascular complications.