Swiss University Hospital Research Articles

Diagnostic accuracy of SARS-CoV-2 saliva antigen testing in a real-life clinical setting

BackgroundSARS-CoV-2 antigen tests with saliva facilitate examination in settings that lack trained personnel. However, little is known about the diagnostic accuracy in real-life clinical settings. Therefore, we studied the diagnostic accuracy of a saliva antigen test in diagnosing SARS-CoV-2 infection in a primary/secondary care testing facility. MethodsIndividuals who presented at a COVID-19 testing facility affiliated with a Swiss university hospital were prospectively recruited (n=377). Saliva specimen was obtained, and the PCL Inc. COVID19 Gold antigen test was conducted in parallel with 2 real-time polymerase chain reaction (RT-PCR) assays from a nasopharyngeal swab. ResultsRT-PCR results were positive in 53 individuals, corresponding to a prevalence of 14.1% (missing material in 1 individual). The PCL saliva antigen test was positive in 22 individuals (5.8%) and negative in 354 (93.9%). The sensitivity of the saliva antigen test was 30.2% (95% confidence interval 18.3, 44.3), both overall and in symptomatic individuals. The specificity was 98.1% (96.0, 99.3). ConclusionsThe diagnostic accuracy of a SARS-CoV-2 saliva antigen test in a primary/secondary care testing facility was remarkably lower than that reported in the manufacturer's specifications.

Retrospective Analysis of Autologous Chondrocyte-Based Cytotherapy Production for Clinical Use: GMP Process-Based Manufacturing Optimization in a Swiss University Hospital.

Cultured autologous human articular chondrocyte (HAC) implantation has been extensively investigated for safe and effective promotion of structural and functional restoration of knee cartilage lesions. HAC-based cytotherapeutic products for clinical use must be manufactured under an appropriate quality assurance system and follow good manufacturing practices (GMP). A prospective clinical trial is ongoing in the Lausanne University Hospital, where the HAC manufacturing processes have been implemented internally. Following laboratory development and in-house GMP transposition of HAC cell therapy manufacturing, a total of 47 patients have been treated to date. The main aim of the present study was to retrospectively analyze the available manufacturing records of the produced HAC-based cytotherapeutic products, outlining the inter-individual variability existing among the 47 patients regarding standardized transplant product preparation. These data were used to ameliorate and to ensure the continued high quality of cytotherapeutic care in view of further clinical investigations, based on the synthetic analyses of existing GMP records. Therefore, a renewed risk analysis-based process definition was performed, with specific focus set on process parameters, controls, targets, and acceptance criteria. Overall, high importance of the interdisciplinary collaboration and of the manufacturing process robustness was underlined, considering the high variability (i.e., quantitative, functional) existing between the treated patients and between the derived primary HAC cell types.

Musculoskeletal healthcare at a Swiss university hospital chiropractic medicine outpatient clinic in 2019: a health services research study

BackgroundThe Balgrist University Hospital in Zurich, Switzerland, is an academic hospital focused on musculoskeletal disorders. An integrated chiropractic medicine clinic provides chiropractic care to a broad patient population. This health services research study aims to advance understanding of chiropractic healthcare service for quality assurance and healthcare quality improvement.MethodsWe performed an observational clinical cohort study at the Balgrist chiropractic medicine outpatient clinic in 2019. The records of all patients with initial visits or returning initial visits (> 3 months since last visit) and their subsequent visits from January 1, 2019, to December 31, 2019, were used to create the study dataset. Data collected included demographic characteristics, diagnoses, imaging data, conservative treatments, surgeries, and other clinical care data. Descriptive statistics were used to summarize data.Results1844 distinct patients (52% female, mean age 48 ± 17 years) were eligible and included in the study. 1742 patients had a single initial visit, 101 had 2 initial visits, and 1 patient had 3 initial visits during the study period (total of 1947 initial visit records). The most common main diagnoses were low back pain (42%; 95% CI 40–46%), neck pain (22%; 20–24%), and thoracic pain (8%; 7–9%). 32% of patients presented with acute (< 4 weeks) symptoms, 11% subacute (4–12 weeks), and 57% chronic (> 12 weeks). Patients had a median of 5 chiropractic visits during their episode of care within a median of 28 days duration. Only 49% (95% CI 47–52%) of patient records had a clinical outcome that was extractable from routine clinical documentation in the hospital information system.ConclusionThis health services study provides an initial understanding of patient characteristics and healthcare delivered in a Swiss academic hospital chiropractic outpatient setting and areas for improved clinical data quality assurance. A more concerted effort to systematically collect patient reported outcome measures would be a worthwhile healthcare quality improvement initiative.

Effect of the COPE Program on Self-Efficacy in Mothers of Preterm Infants: A Pretest-Posttest Quasi-Experimental Study.

The birth of a premature infant and its subsequent hospitalization in the neonatal intensive care unit are stressful experiences for mothers. Because of uncertainty concerning interactions with a premature baby, mothers often feel helpless and only hesitantly assume their maternal role. This may have a negative impact on the mother-child interaction and prevents mothers from taking an active part in E46www.jpnnjournal.com the care for their child. "Creating Opportunities for Parent Empowerment" (COPE) is a 4-phase educational intervention program aiming to systematically involve parents into caring for their premature infant. In this pretest-posttest quasi-experimental study in 2 Swiss university hospitals, we focused on maternal self-efficacy. We compared self-efficacy in mothers receiving the COPE program or standard care alone at baseline and 3 months after estimated delivery date. To measure maternal self-efficacy, we used the "Tool to measure Parenting Self-Efficacy" (TOPSE). While scores for "Emotion and Affection," "Empathy and Understanding," as well as "Learning and Knowledge" increased in both groups, only "Learning and Knowledge" scores were significantly higher in the intervention group. Given the intention of improving learning and knowledge, the COPE program might be a promising intervention contributing to enhanced maternal self-efficacy.

Serological testing for SARS-CoV-2 antibodies in clinical practice: A comparative diagnostic accuracy study.

BackgroundSerological tests are a powerful tool in the monitoring of infectious diseases and the detection of host immunity. However, manufacturers often provide diagnostic accuracy data generated through biased studies, and the performance in clinical practice is essentially unclear.ObjectivesWe aimed to determine the diagnostic accuracy of various serological testing strategies for (a) identification of patients with previous coronavirus disease‐2019 (COVID‐19) and (b) prediction of neutralizing antibodies against SARS‐CoV‐2 in real‐life clinical settings.MethodsWe prospectively included 2573 consecutive health‐care workers and 1085 inpatients with suspected or possible previous COVID‐19 at a Swiss University Hospital. Various serological immunoassays based on different analytical techniques (enzyme‐linked immunosorbent assays, ELISA; chemiluminescence immunoassay, CLIA; electrochemiluminescence immunoassay, ECLIA; and lateral flow immunoassay, LFI), epitopes of SARS‐CoV‐2 (nucleocapsid, N; receptor‐binding domain, RBD; extended RBD, RBD+; S1 or S2 domain of the spike [S] protein, S1/S2), and antibody subtypes (IgG, pan‐Ig) were conducted. A positive real‐time PCR test from a nasopharyngeal swab was defined as previous COVID‐19. Neutralization assays with live SARS‐CoV‐2 were performed in a subgroup of patients to assess neutralization activity (n = 201).ResultsThe sensitivity to detect patients with previous COVID‐19 was ≥85% in anti‐N ECLIA (86.8%) and anti‐S1 ELISA (86.2%). Sensitivity was 84.7% in anti‐S1/S2 CLIA, 84.0% in anti‐RBD+LFI, 81.0% in anti‐N CLIA, 79.2% in anti‐RBD ELISA, and 65.6% in anti‐N ELISA. The specificity was 98.4% in anti‐N ECLIA, 98.3% in anti‐N CLIA, 98.2% in anti‐S1 ELISA, 97.7% in anti‐N ELISA, 97.6% in anti‐S1/S2 CLIA, 97.2% in anti‐RBD ELISA, and 96.1% in anti‐RBD+LFI.The sensitivity to detect neutralizing antibodies was ≥85% in anti‐S1 ELISA (92.7%), anti‐N ECLIA (91.7%), anti‐S1/S2 CLIA (90.3%), anti‐RBD+LFI (87.9%), and anti‐RBD ELISA (85.8%). Sensitivity was 84.1% in anti‐N CLIA and 66.2% in anti‐N ELISA. The specificity was ≥97% in anti‐N CLIA (100%), anti‐S1/S2 CLIA (97.7%), and anti‐RBD+LFI (97.9%). Specificity was 95.9% in anti‐RBD ELISA, 93.0% in anti‐N ECLIA, 92% in anti‐S1 ELISA, and 65.3% in anti‐N ELISA. Diagnostic accuracy measures were consistent among subgroups.ConclusionsThe diagnostic accuracy of serological tests for SARS‐CoV‐2 antibodies varied remarkably in clinical practice, and the sensitivity to identify patients with previous COVID‐19 deviated substantially from the manufacturer's specifications. The data presented here should be considered when using such tests to estimate the infection burden within a specific population and determine the likelihood of protection against re‐infection.

Randomized clinical trial to evaluate a cancer pain self-management intervention for outpatients

ObjectiveUnrelieved pain is common in patients with advanced cancer. Although psychoeducational interventions were found to decrease pain, effects were moderate. The purpose of this study was to evaluate the efficacy of a pain self-management intervention compared with usual care and to explore participants’ experiences with pain management and study participation. MethodsA multicenter randomized controlled trial design with post-trial interviews was used. Outpatients with cancer pain and their family caregivers were recruited from three Swiss university hospitals. The intervention group (IG) received the six-week intervention consisting of education, skills building, and nurse coaching. The control group (CG) received usual care. Outcome variables were analyzed using multilevel models. Interpretive description guided the qualitative study part. ResultsTwenty-one patients with advanced cancer and seven family caregivers completed the study. The group x time effect showed a statistically significant decrease in average pain (P ​= ​0.04), but no significant group x time effect for worst pain (P ​= ​0.06). Pain scores, pain-related knowledge, Pain Management Index, self-efficacy, and performance status improved in the IG (P ​< ​0.05). Almost all of the interviewed participants perceived the pain management diary, tailored intervention sessions, and weekly support as useful. None experienced study participation as burdensome. ConclusionsThis study was the first to test the efficacy of a psychoeducational cancer pain self-management intervention in a German-speaking context, with most patients receiving palliative care. Clinicians can recommend the use of pain management diaries. Tailoring interventions to an individual's situation and dynamic pain trajectory may improve patients' pain self-management. Registration numberThis study has been registered via ClinicalTrials.gov: NCT02713919.https://clinicaltrials.gov/ct2/show/NCT02713919?term=NCT02713919&draw=2&rank=1.

Adverse Drug Reactions Due to Opioid Use in Oldest-Old Patients Visiting the Emergency Unit of the Geneva Geriatric Hospital.

Opioid use has much increased in several countries during the last two decades, accompanied by a rise in associated morbidity and mortality, especially in the United States. Data on a possible opioid crisis are scarcer in Europe. We performed a study aiming to assess the frequency of adverse drug reactions (ADR) related to opioids in patients presenting to the emergency unit (EU) of a geriatric tertiary Swiss University Hospital. This particular setting is intended for patients aged 75 and older. Our retrospective, monocentric survey of opioid use and related ADR was conducted over two months in 2018. The main and secondary outcomes were the frequency of EU visits considered due to an opioid ADR and insufficient pain relief, respectively. Current opioid use was identified in 20.3% (n=99) of the 487 included EU visits (mean age 86). An ADR was the suspected cause of the EU visit in 22 opioid users, mainly fall-related injury and gastrointestinal disorders. All these patients had at least one comorbid condition. In 19/22 cases (86%) of ADR, a drug-drug interaction might have been involved. In 12 opioid users (12%), insufficient pain relief was suspected as the cause of the EU visit. In conclusion, one-third of opioid users visiting a geriatric EU consulted for a problem related to its use mainly adverse drug-related reaction (22%) followed by insufficient pain relief (12%).

Evaluation of an APN service in acute inpatient care of patients with a malignant brain tumor: a qualitative study in a Swiss university hospital / Evaluation eines APN-Angebots in der akut-stationären Versorgung von Patienten und Patientinnen mit malignem Hirntumor: eine qualitative Studie in einem Schweizer Universitätsspital

Abstract Background Caring for patients with a malignant brain tumor is complex and requires a high degree of coordination. The disease reduces life expectancy and affects quality of life. Therefore, patients often depend on the support of their relatives. To achieve better care for such patients and their relatives, a Department of Neurosurgery at a Swiss university hospital introduced a Nurse Practitioner (NP) and their service in 2017. 18 months after implementation, an evaluation of this NP role was conducted. It was aimed for to explore the experience of the interprofessional health care team. Method A qualitative research design was used. Eight individual interviews and one focus group interview were conducted with representatives of the interprofessional health care team. Using a literature-based structured interview guide, the experience of participants was explored. Interviews were analyzed thematically. Results The NP and their service was appreciated. Collaboration with the medical profession and the coordination of profession-specific demands also improved. The NP as a constant person of contact had a positive effect on the continuity of care e.g., with regard to discharge management. Medical doctors and registered nurses experienced an improved patient satisfaction. Further need for improvement was identified regarding the clarification of the NP role and the interprofessional collaboration. Conclusion The study reports on the successful introduction of an NP and their service in oncological care; it demonstrates that the implementation of this role can also be beneficial in acute inpatient care.

Development and Implementation of an e-Trigger Tool for Adverse Drug Events in a Swiss University Hospital.

PurposeThe purpose of the study was to develop and implement an institution-specific trigger tool based on the Institute for Healthcare Improvement medication module trigger tool (IHI MMTT) in order to detect and monitor ADEs.MethodsWe performed an investigator-driven, single-center study using retrospective and prospective patient data to develop (“development phase”) and implement (“implementation phase”) an efficient, institution-specific trigger tool based on the IHI MMTT. Complete medical data from 1008 patients hospitalized in 2018 were used in the development phase. ADEs were identified by chart review. The performance of two versions of the tool was assessed by comparing their sensitivities and specificities. Tool A employed only digitally extracted triggers (“e-trigger-tool”) while Tool B employed an additional manually extracted trigger. The superior tool – taking efficiency into account – was applied prospectively to 19–22 randomly chosen charts per month for 26 months during the implementation phase.ResultsIn the development phase, 189 (19%) patients had ≥1 ADE (total 277 ADEs). The time needed to identify these ADEs was 15 minutes/chart. A total of 203 patients had ≥1 trigger (total 273 triggers – Tool B). The sensitivities and specificities of Tools A and B were 0.41 and 0.86, and 0.43 and 0.86, respectively. Tool A was more time-efficient than Tool B (4 vs 9 minutes/chart) and was therefore used in the implementation phase. During the 26-month implementation phase, 22 patients experienced trigger-identified ADEs and 529 did not. The median number of ADEs per 1000 patient days was 6 (range 0–13). Patients with at least one ADE had a mean hospital stay of 22.3 ± 19.7 days, compared to 8.0 ± 7.6 days for those without an ADE (p = 2.7×10−14).ConclusionWe developed and implemented an e-trigger tool that was specific and moderately sensitive, gave consistent results and required minimal resources.

Musculoskeletal Physiotherapy in the Emergency Department – Evaluation of a New Physiotherapy Service in a Swiss University Hospital

Abstract Background Many countries report a significant increase in emergency department (ED) visits. Patients with musculoskeletal disorders account for a large proportion of non-urgent cases. Objective Characterization and evaluation of a new service that provides immediate access to physiotherapy for patients in the ED. Method To characterize a new service at the Department of Emergency Medicine, Bern University Hospital, and to evaluate first experiences with it, a mixed methods approach was chosen. Data was collected from the electronic patient file and from a logbook kept by the physiotherapists. In addition, guideline-based interviews with involved health care staff were conducted. Results During the 63 days of the pilot study 79 patients were treated by physiotherapists. The most frequently reported patient complaint was back pain (47 %). Interventions included taking the medical history, performing manual tests and multimodal treatment and developing recommendations for further treatment. In 59 % of patients no medical imaging and in 58 % no additional physiotherapy was prescribed. Patients rated the physiotherapeutic service as very good or excellent (88 %). Physiotherapy was experienced as positive and appreciated by the other professions, and all interviewees emphasized the added value for patients. Conclusion The pilot study indicates that the physiotherapeutic consultation service has the potential to improve quality of care. The findings of this study are therefore valuable when considering the introduction of such a service in an ED.

Increasing morbidity and mortality of candidemia over one decade in a Swiss university hospital.

BackgroundThe epidemiology of candidemia is evolving with raising concern about the emergence of intrinsically resistant non‐albicans Candida species and acquisition of antifungal resistance. In addition to microbiological surveys, epidemiological studies including clinical data are needed to assess the impact of candidemia on morbidity and mortality.ObjectivesTo assess the clinical and microbiological trends of candidemia in a Swiss university hospital.Patients/Methods.This single‐centre retrospective study compared the incidence of candidemia, Candida species distribution, antifungal resistance profiles, clinical characteristics and outcomes between two periods separated by one decade.ResultsA total of 170 candidemic episodes were included (68 from period 1, 2004‐2006, and 102 from period 2, 2014‐2017). Incidence of candidemia (0.85 to 0.97 episode/10,000 patient‐days), species distribution (55%–57% C albicans) and antifungal susceptibilities remained unchanged. During period 2, candidemia was more frequently observed in intensive care units (ICU, 38% vs 19% in period 1, P = .01) and amongst older patients (median age 68 vs 59 years old, P < .01) with more immunosuppressive conditions (24% vs 9%, P = .01). Candidemia in period 2 was more frequently followed by septic shock (23% vs 7% in period 1, P = .01) and ICU admission (42% vs 12%, P < .01) and was associated with higher mortality (34% vs 18%, P = .03). Overall, factors associated with mortality in multivariate analyses included cirrhosis, solid malignancies and ICU stay at the time of candidemia.ConclusionsDespite stable incidence, species distribution and antifungal resistance of candidemia, an epidemiological shift of the disease towards older and more critically ill patients was observed, with higher mortality rates.

Systemic immune-inflammation index predicts major adverse cardiovascular events in patients with ST-elevation myocardial infarction

Abstract Background ST-elevation myocardial infarction (STEMI) represents the life-threatening manifestation of atherosclerosis, a chronic inflammatory disease of arterial wall, and is associated with high rate of morbidity and mortality. Thus, inflammatory biomarkers may be useful in identifying high inflammatory burden patients who may benefit from tailored high-intensity secondary prevention therapy. Purpose We therefore assessed the relationship between the systemic immune-inflammation index (SII) and CV outcomesamong 1144 all-comers patients admitted to four Swiss University Hospital for STEMI and enrolled in the prospective multicenter SPUM registry cohort I (NCT 01000701). Methods SII was calculated as platelet counts x neutrophil counts / lymphocyte counts. Patients were subdivided into three groups according to SII tertiles. The composite primary endpoint was major adverse cardiac and cerebrovascular events (MACCE: stroke, myocardial infarction, CV death). Adjusted Cox proportional hazards regression models were implemented to determine the risk associated with SII and outcomes. Results Out of 1144 STEMI patients, 912 patients (79,7%) had available for SII. Patients within the highest tertile were slightly more frequently male (23.0 vs 22.0%, p=0.05), with higher plasma values of neutrophils (11.4±2.4 vs 6.5±3.7 G/l, p&amp;lt;0.001), platelets (275.3±97.5 vs 202.5±51.6 G/l, p&amp;lt;0.001) and lower levels of lymphocytes (1.0±0.6 vs 2.1±1.1 G/l, p&amp;lt;0.001) and LVEF (46.4±11.5% vs 50.4±10.3%, p&amp;lt;0.001) (Fig. 1A). At 1 year, these patients presented the highest rate of all-cause mortality (7.2% vs 2.6%, p=0.02) and MACCE (8.2% vs 3.3, p=0.03). This enhanced risk persisted for all-cause mortality and MACCE, after adjustment for age, sex, ace-inhibitors and statin therapy (Adj. HR 2.85, 95% CI 1.30–6.70, p=0.03 and Adj. HR 2.63, 95% CI 1.25–5.55, p=0.03, respectively, Fig. 1B). Conclusions Among a real-world cohort of STEMI-patients, SII highlights the highest inflammatory risk phenotype, being associated with significant increased rates of MACCE and all-cause of death. These observations might help clinicians to furtherly identify patients who may derive the greatest benefit from tailored more intense secondary prevention therapies including inflammatory modulation. Funding Acknowledgement Type of funding sources: None. Figure 1

Survival and long-term outcomes following in-hospital cardiac arrest in a Swiss university hospital: a prospective observational study

BackgroundIncidence of in-hospital cardiac arrest is reported to be 0.8 to 4.6 per 1,000 patient admissions. Patient survival to hospital discharge with favourable functional and neurological status is around 21–30%. The Bern University Hospital is a tertiary medical centre in Switzerland with a cardiac arrest team that is available 24 h per day, 7 days per week. Due to lack of central documentation of cardiac arrest team interventions, the incidence, outcomes and survival rates of cardiac arrests in the hospital are unknown. Our aim was to record all cardiac arrest team interventions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests.MethodsWe conducted a prospective single-centre observational study that recorded all adult in-hospital cardiac arrest team interventions over 1 year, using an Utstein-style case report form. The primary outcome was 30-day survival after in-hospital cardiac arrest. Secondary outcomes were return of spontaneous circulation, neurological status (after return of spontaneous circulation, after 24 h, after 30 days, after 1 and 5 years), according to the Glasgow Outcomes Scale, and functional status at 30 days and 1 year, according to the Short-form-12 Health Survey.ResultsThe cardiac arrest team had 146 interventions over the study year, which included 60 non-life-threatening alarms (41.1%). The remaining 86 (58.9%) acute life-threatening situations included 68 (79.1%) as patients with cardiac arrest. The mean age of these cardiac arrest patients was 68 ± 13 years, with a male predominance (51/68; 75.0%). Return of spontaneous circulation was recorded in 49 patients (72.1%). Over one-third of the cardiac arrest patients (27/68) were alive after 30 days with favourable neurological outcome. The patients who survived the first year lived also to 5 years after the event with favourable neurological and functional status.ConclusionsThe in-hospital cardiac arrest incidence on a large tertiary Swiss university hospital was 1.56 per 1000 patient admissions. After a cardiac arrest, about a third of the patients survived to 5 years with favourable neurological and functional status. Alarms unrelated to life-threatening situations are common and need to be taken into count within a low-threshold alarming system.Trial Registration: The trial was registered in clinicaltrials.gov (NCT02746640).

Exploring learning processes associated with a cancer pain self-management intervention in patients and family caregivers: A mixed methods study

AimExplore learning processes associated with a psychoeducational pain selfmanagement intervention. BackgroundSelf-management of cancer pain is challenging for patients and their family caregivers (FCs). While psychoeducational interventions can support them to handle these tasks, it remains unclear how learning processes are hampered or facilitated. MethodsA convergent parallel mixed methods design with qualitative data collection embedded in a randomized controlled trial (RCT) was used. Outpatients with cancer and FCs were recruited from three Swiss university hospitals. The six-week intervention consisted of education, skills building, and nurse coaching. Quantitative data on pain management knowledge and self-efficacy were analyzed using multilevel models. Patients and FCs were interviewed post-RCT regarding their learning experiences. Qualitative data analysis was guided by interpretive description. Finally, quantitative and qualitative data were integrated using case level comparisons and a meta-matrix. ResultsTwenty-one patients and seven FCs completed this study. The group-by-time effect showed increases in knowledge (p = 0.035) and self-efficacy (p = 0.007). Patients' and FCs' learning through experience was supported by an intervention nurse, who was perceived as competent and trustworthy. After the study, most intervention group participants felt more confident to implement pain self-management. Finally, data integration showed that declining health hampered some patients' pain self-management. ConclusionsCompetent and trustworthy nurses can support patients' and FCs' pain self-management by providing individualized interventions. Using a diary, jointly reflecting on the documented experiences, and addressing knowledge deficits and misconceptions through the use of academic detailing can facilitate patients' and FCs' learning of critical skills.

Diagnostic accuracy of a SARS-CoV-2 rapid antigen test in real-life clinical settings

BackgroundLaboratory tests are a mainstay in managing the COVID-19 pandemic, and high hopes are placed on rapid antigen tests. However, the accuracy of rapid antigen tests in real-life clinical settings is unclear because adequately designed diagnostic accuracy studies are essentially lacking. ObjectivesThe aim of this study was to assess the accuracy of a rapid antigen test in diagnosing SARS-CoV-2 infection in a primary/secondary care testing facility. MethodsConsecutive individuals presenting at a COVID-19 testing facility affiliated to a Swiss University Hospital were recruited (n = 1465%). Nasopharyngeal swabs were obtained, and the Roche/SD Biosensor rapid antigen test was conducted in parallel with two real-time PCR tests (reference standard). ResultsAmong the 1465 patients recruited, RT-PCR was positive in 141 individuals, corresponding to a prevalence of 9.6%. The Roche/SD Biosensor rapid antigen test was positive in 94 patients (6.4%), and negative in 1368 individuals (93.4%; insufficient sample material in 3 patients). The overall sensitivity of the rapid antigen test was 65.3% (95% confidence interval [CI] 56.8–73.1), the specificity was 99.9% (95% CI 99.5–100.0). In asymptomatic individuals, the sensitivity was 44.0% (95% CI 24.4–65.1). ConclusionsThe accuracy of the SARS-CoV-2 Roche/SD Biosensor rapid antigen test in diagnosing SARS-CoV-2 infections in a primary/secondary care testing facility was considerably lower compared with the manufacturer's data. Widespread application in such a setting might lead to a considerable number of individuals falsely classified as SARS-CoV-2 negative.

Importance of critical care staffing and standard intensive care therapy in the COVID-19 era: a descriptive study of the first epidemic wave at a Swiss tertiary intensive care unit.

Mortality rates of COVID-19 patients hospitalised in intensive care units (ICUs) are generally high. Availability of ICU resources might influence clinical outcomes. The aim of this study was to examine the clinical course of the 42 patients treated during the first epidemic wave between 2 March and 20 May 2020 at the tertiary ICU of the Bern University Hospital, where staffing, equipment and drugs were not limited. For this descriptive study, retrospective data of the first COVID-19 wave in an interdisciplinary adult ICU of a Swiss University hospital was used. The study included data regarding healthcare staffing and COVID-19 patients. The primary outcome was the ICU mortality in COVID-19 patients. Patients&rsquo; median age was 61 years (range 32&ndash;86), simplified acute physiology score (SAPS-II) was 46 (13&ndash;90), 81% of the patients were males, 79% were mechanically ventilated (3 of them on extracorporeal membrane oxygenation), 31% were under renal replacement therapy and 21% received steroids. All patients were fully anticoagulated from the time of admission. No off-label experimental antiviral or anti-inflammatory drugs were used with the exception of one patient, and antibiotic prescription was restrictive. Nurse-to-patient ratio was 1:1 during all shifts, and the physician-to-patient ratio was 1:4 (day shift) and 1:10 (night shift). Infectious disease specialists and physiotherapists were present every day. The median ICU length of stay was 10 days (1&ndash;38) days, and ICU and hospital mortality rates were 7% and 12%, respectively. Careful intensive care treatment, without off-label drug use but including steroids in selected cases, combined with an interdisciplinary approach and provision of sufficient human resources, were associated with low ICU and hospital mortality rates despite high disease severity. Availability of qualified human resources may have an important impact on the outcome of COVID-19.

Female genital mutilation/cutting (FGM/C) coding capacities in Swiss university hospitals using the International Classification of Diseases (ICD)

BackgroundThe real prevalence and incidence of women living with or at risk of female genital mutilation/cutting (FGM/C) is unknown in Switzerland and many parts of Europe, as there are no representative surveys similar to DHS or MICS for European countries. Indirect estimates are commonly used to estimate the number of women with FGM/C in high-income countries, but may not reflect the actual FGM/C prevalence among migrants. Direct measures may provide more accurate estimates that could guide policy- and clinical decision-making. Swiss hospital data may provide a sample of patients that can be used to describe the prevalence of FGM/C in Swiss hospitals. Our study assesses the number of inpatient women and girls in Swiss university hospitals from countries with high FGM/C prevalence, and of inpatients with a coded diagnosis of FGM/C.MethodsWe conducted an exploratory descriptive study in Switzerland to assess the number of women and girls admitted to Swiss university hospitals between 2016 and 2018 from 30 FGM/C practicing countries, as well as inpatients with a coded diagnosis of FGM/C using anonymized data. We calculated indirect estimates for inpatient women and girls living with or at risk of FGM/C and compared them with the number of inpatients with a coded diagnosis of FGM/C.Results8720 women and girls from FGM/C practicing countries were admitted. 207 patients had a coded diagnosis of FGM/C, including 7 with a nationality outside the 30 targeted countries, corresponding to an overall prevalence of 2.3% (95%CI, 2.0–2.6). The number of FGM/C cases by hospital was significantly different across years (P < 0.001), with a higher proportion of cases collected in Geneva, Switzerland.ConclusionsThe comparison between indirect estimates of inpatients with or at risk of FGM/C and the low number of FGM/C cases coded, suggests low recording and coding capacities of FGM/C.Tweetable abstractThe capacity of coding primary and secondary diagnosis of FGM/C in Swiss university hospitals seems low.Protocol number: 2018–01851: SwissEthics Committee, Canton of Geneva, Switzerland.

How do nurses spend their time? A time and motion analysis of nursing activities in an internal medicine unit.

AimTo describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward.DesignA single‐centre observational descriptive study.MethodUsing a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre‐registered list of 42 activities classified into 13 dimensions.ResultsA total of 507.5 work hours were observed. Less than one third of registered nurses’ work time was spent with patients. They allocated the most time to the dimensions of ‘communication and care coordination’ and ‘care planning’, whereas ‘optimizing the quality and safety of care’, ‘integrating and supervising staff’ and ‘client education’ were allocated the least time.ConclusionThis study provided a reliable description of nurses’ time use at work. It highlighted suboptimal use of the full scope of nursing practice.ImpactBoth work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses’ skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses’ knowledge.

Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS.

Background:Lung-protective ventilation is key in bridging patients suffering from COVID-19 acute respiratory distress syndrome (ARDS) to recovery. However, resource and personnel limitations during pandemics complicate the implementation of lung-protective protocols. Automated ventilation modes may prove decisive in these settings enabling higher degrees of lung-protective ventilation than conventional modes.Method:Prospective study at a Swiss university hospital. Critically ill, mechanically ventilated COVID-19 ARDS patients were allocated, by study-blinded coordinating staff, to either closed-loop or conventional mechanical ventilation, based on mechanical ventilator availability. Primary outcome was the overall achieved percentage of lung-protective ventilation in closed-loop versus conventional mechanical ventilation, assessed minute-by-minute, during the initial 7 days and overall mechanical ventilation time. Lung-protective ventilation was defined as the combined target of tidal volume <8 ml per kg of ideal body weight, dynamic driving pressure <15 cmH2O, peak pressure <30 cmH2O, peripheral oxygen saturation ≥88% and dynamic mechanical power <17 J/min.Results:Forty COVID-19 ARDS patients, accounting for 1,048,630 minutes (728 days) of cumulative mechanical ventilation, allocated to either closed-loop (n = 23) or conventional ventilation (n = 17), presenting with a median paO2/ FiO2 ratio of 92 [72-147] mmHg and a static compliance of 18 [11-25] ml/cmH2O, were mechanically ventilated for 11 [4-25] days and had a 28-day mortality rate of 20%. During the initial 7 days of mechanical ventilation, patients in the closed-loop group were ventilated lung-protectively for 65% of the time versus 38% in the conventional group (Odds Ratio, 1.79; 95% CI, 1.76-1.82; P < 0.001) and for 45% versus 33% of overall mechanical ventilation time (Odds Ratio, 1.22; 95% CI, 1.21-1.23; P < 0.001).Conclusion:Among critically ill, mechanically ventilated COVID-19 ARDS patients during an early highpoint of the pandemic, mechanical ventilation using a closed-loop mode was associated with a higher degree of lung-protective ventilation than was conventional mechanical ventilation.

Are we fit to teach? A survey in physicians of the in- and outpatient departments of internal medicine at a Swiss university hospital.

Teaching is one of the three pillars of medical-academic activity, alongside patient care and research. The aim of our study was to assess current teaching practice in the medical departments of the University Hospital Basel, Switzerland, in order to organise a faculty development programme tailored to local needs. We performed a cross-sectional online survey among the teaching faculty and the residents. For both groups, we assessed their estimation of the general importance and perceived frequency of various teaching formats in everyday practice. Additionally, we asked the senior physicians to evaluate their teaching competencies and the residents to state their opinion on factors promoting a positive learning experience. Twenty-eight of 34 senior physicians (82%) and 48 of 90 residents (53%) participated in the study. Both groups broadly agreed on the importance of various teaching formats for the professional development of physicians, placing particular importance on bedside teaching, providing feedback, teaching during case discussions, and observation and modeling. However, the residents perceived that they obtained less teaching, feedback and support than the senior physicians perceived they were giving. Overall, teaching during case discussions represented the format most often applied, and it was also the one in which the senior physicians felt most competent. Residents claimed &ldquo;time&rdquo; to be the most important factor promoting a positive learning experience, followed by a positive attitude und the personal characteristics of the supervisor. Our study shows that, despite being an integral part of everyday work at a university clinic, many aspects of current teaching practice allow discussion on possibilities of adaptations and improvement. Evaluation of current teaching practice provides the basis for designing a faculty development programme tailored to specific needs.