Swiss University Hospital Research Articles

Leadership in Zeiten von Corona: Die Perspektive von Pflegenden und Hebammen in einem Universitätsspital.

Leadership in the time of Corona: The perspective of nurses and midwives at a University Hospital - A quality assessment Abstract. Background: The high number of predicted patients arising from the COVID-19 pandemic presents several challenges to hospitals. Data is available on psychological stress in caregivers during pandemics. To date, there are no known studies regarding the impact of leadership on nursing and midwifery practice. Aim: Evaluation of leadership during the COVID-19 pandemic at a Swiss University Hospital. Methods: The approach to this study was based on action research. The authors defined quality indicators and "values of excellence" on the impact of leadership. In May 2020 140 nurses and midwives of different departments were interviewed using one-time questionnaires. The quantitative data was analyzed descriptively and the open questions evaluated by thematic analysis. Results: The results showed that through the combination of different interventions, a mostly positive working situation could be created for the interviewees. Uncertainty existed about the safety measures. The interviewees were highly stressed by their own private situations, the frequent changes in guidelines and the flood of information. However, the staff felt well supported by the leadership teams. Improvements were described in teamwork and decision-making. Conclusions: The results indicate an impact on leadership and demonstrate as well the need for adequate support. The framework of transformational leadership methods, practice development and Lean management empowers the organization to work in a focused manner, effectively and safely during challenging situations.

The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study

BackgroundWorldwide, hospitals face pressure to reduce costs. Some respond by working with a reduced number of nurses or less qualified nursing staff. ObjectiveThis study aims at examining the relationship between mortality and patient exposure to shifts with low or high nurse staffing. MethodsThis longitudinal study used routine shift-, unit-, and patient-level data for three years (2015–2017) from one Swiss university hospital. Data from 55 units, 79,893 adult inpatients and 3646 nurses (2670 registered nurses, 438 licensed practical nurses, and 538 unlicensed and administrative personnel) were analyzed. After developing a staffing model to identify high- and low-staffed shifts, we fitted logistic regression models to explore associations between nurse staffing and mortality. ResultsExposure to shifts with high levels of registered nurses had lower odds of mortality by 8.7% [odds ratio 0.91 95% CI 0.89–0.93]. Conversely, low staffing was associated with higher odds of mortality by 10% [odds ratio 1.10 95% CI 1.07–1.13]. The associations between mortality and staffing by other groups was less clear. For example, both high and low staffing of unlicensed and administrative personnel were associated with higher mortality, respectively 1.03 [95% CI 1.01–1.04] and 1.04 [95% CI 1.03–1.06]. Discussion and implicationsThis patient-level longitudinal study suggests a relationship between registered nurses staffing levels and mortality. Higher levels of registered nurses positively impact patient outcome (i.e. lower odds of mortality) and lower levels negatively (i.e. higher odds of mortality). Contributions of the three other groups to patient safety is unclear from these results. Therefore, substitution of either group for registered nurses is not recommended.

Mental health and its associations with weight in women with gestational diabetes mellitus. A prospective clinical cohort study

ObjectiveDespite the prevalence of depression in women with gestational diabetes mellitus (GDM) and the relationship between mental health (depression and well-being) and metabolic health, little is known about mental health or its metabolic impact in GDM pregnancy. This prospective clinical cohort study aimed to investigate associations between 1) well-being and depression, and 2) mental health and weight/weight gain in women with GDM. MethodsWe included 334 pregnant women with GDM treated at a Swiss University Hospital between January 2016 and December 2018. They completed two self-report questionnaires: The World Health Organization well-being index (WHO-5) at the first (29 weeks of gestation) and last (36 weeks of gestation) GDM visits during pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) at the first GDM visit. A cut-off of ≥11 was selected for this questionnaire to indicate the presence of elevated depression scores. ResultsThere was an inverse association between the well-being and depression total scores at the first GDM visit during pregnancy (r = −0.55; p < 0.0001). Elevated depression scores at the first GDM visit were associated with subsequent weight gain in GDM pregnancy (β = 1.249; p = 0.019). ConclusionIn women with GDM, elevated depression scores during pregnancy are prospectively associated with weight gain. Depression symptoms should therefore be screened for and treated in women with GDM to reduce the risks associated with excessive weight gain during pregnancy.

Patients' and partners' experiences with prostate cancer and advanced practice nurse counselling

AbstractPatients with prostate cancer (PCa) often experience physical and psychological challenges after diagnosis and therapeutic side effects after radical prostatectomy. To meet the needs of these patients and their partners, an advanced practice nurse (APN) support programme was initiated at a Swiss university hospital. The APN served as a constant contact person and offered psycho‐oncological counselling from the first day after radical prostatectomy to follow‐up care in the outpatient clinic, every third month over the first year and twice in the second year. Counselling was provided in‐person and through the phone. It focused on coping skills regarding cancer‐related distress, hospital stay, treatment and therapeutic side effects, post‐discharge life, and physical activity. This study aimed to explore the experiences of patients and partners with the disease, including diagnosis, radical prostatectomy, and follow‐up care. Additionally, their experience with the APN support programme was evaluated. A qualitative content analysis, according to Mayring, was used. Interviews were conducted with 10 patients and 8 partners who participated in the APN counselling programme. Interviews were performed individually in‐person or by telephone. Patients reported a variety of experiences with respect to the diagnostic process and the final decision for radical prostatectomy. Patients and spouses also described some unmet information needs during the PCa care continuum. They wished they received more information about PSA testing, treatment options, and management of surgically induced side effects such as incontinence and erectile dysfunction. While most couples mastered the situation together, some patients did not involve their spouses. During the hospital stay, patients felt well cared for; the spouses agreed. Urinary incontinence was the primary challenge after discharge. Later, erectile dysfunction was a challenge for most participants. While counselling was experienced differently, patients and spouses valued the trustworthy APN as a constant contact person. In clinical practice, needs‐tailored information should be provided by all involved healthcare professionals. In addition, a support programme for patients and partners that includes an APN as a constant contact person over the PCa continuum is recommended.

Implementing SARS-CoV-2 Rapid Antigen Testing in the Emergency Ward of a Swiss University Hospital: The INCREASE Study.

Following the Swiss Federal Office of Public Health (FOPH) authorization of the rapid antigen test (RAT), we implemented the use of the RAT in the emergency ward of our university hospital for patients’ cohorting. RAT triaging in association with RT-PCR allowed us to promptly isolate positive patients and save resources. Among 532 patients, overall sensitivities were 48.3% for Exdia and 41.2% for Standard Q®, PanbioTM and BD Veritor™. All RATs exhibited specificity above 99%. Sensitivity increased to 74.6%, 66.2%, 66.2% and 64.8% for Exdia, Standard Q®, PanbioTM and BD Veritor™, respectively, for viral loads above 105 copies/mL, to 100%, 97.8%, 96.6% and 95.6% for viral loads above 106 copies/mL and 100% for viral loads above 107 copies/mL. Sensitivity was significantly higher for patients with symptoms onset within four days (74.3%, 69.2%, 69.2% and 64%, respectively) versus patients with the evolution of symptoms longer than four days (36.8%, 21.1%, 21.1% and 23.7%, respectively). Among COVID-19 asymptomatic patients, sensitivity was 33%. All Immunoglobulin-A-positive patients resulted negative for RAT. The RAT might represent a useful resource in selected clinical settings as a complementary tool in RT-PCR for rapid patient triaging, but the lower sensitivity, especially in late presenters and COVID-19 asymptomatic subjects, must be taken into account.

Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) seroconversion and occupational exposure of employees at a Swiss university hospital: A large longitudinal cohort study.

The dynamics of coronavirus disease 2019 (COVID-19) seroconversion of hospital employees are understudied. We measured the proportion of seroconverted employees and evaluated risk factors for seroconversion during the first pandemic wave. In this prospective cohort study, we recruited Geneva University Hospitals employees and sampled them 3 times, every 3 weeks from March 30 to June 12, 2020. We measured the proportion of seroconverted employees and determined prevalence ratios of risk factors for seroconversion using multivariate mixed-effects Poisson regression models. Overall, 3,421 participants (29% of all employees) were included, with 92% follow-up. The proportion of seroconverted employees increased from 4.4% (95% confidence interval [CI], 3.7%-5.1%) at baseline to 8.5% [(95% CI, 7.6%-9.5%) at the last visit. The proportions of seroconverted employees working in COVID-19 geriatrics and rehabilitation (G&R) wards (32.3%) and non-COVID-19 G&R wards (12.3%) were higher compared to office workers (4.9%) at the last visit. Only nursing assistants had a significantly higher risk of seroconversion compared to office workers (11.7% vs 4.9%; P = .006). Significant risk factors for seroconversion included the use of public transportation (adjusted prevalence ratio, 1.59; 95% CI, 1.25-2.03), known community exposure to severe acute respiratory coronavirus virus 2 (2.80; 95% CI, 2.22-3.54), working in a ward with a nosocomial COVID outbreak (2.93; 95% CI, 2.27-3.79), and working in a COVID-19 G&R ward (3.47; 95% CI, 2.45-4.91) or a non-COVID-19 G&R ward (1.96; 95% CI, 1.46-2.63). We observed an association between reported use of respirators and lower risk of seroconversion (0.73; 95% CI, 0.55-0.96). Additional preventive measures should be implemented to protect employees in G&R wards. Randomized trials on the protective effect of respirators are urgently needed.

Unexpectedly High False-Positive Rates for Haemophilus influenzae Using a Meningoencephalitis Syndromic PCR Panel in Two Tertiary Centers.

False-positive results in the diagnostic of meningitis and encephalitis pose important challenges. This study aimed to determine false-positive rates for Haemophilus influenzae in cerebrospinal fluids evaluated by the BioFire FilmArray® Meningitis/Encephalitis Panel. We conducted a retrospective study of all H. influenzae-positive FilmArray®. Meningitis/Encephalitis Panel results from June 2016 to October 2019 in two Swiss university hospitals. Cases were classified as true positive, likely true-positive, and likely false-positive results according to cerebrospinal fluid culture, H. influenzae-specific quantitative real-time PCR (qPCR), and Gram staining, as well as culture of other materials. We performed 3,082 panels corresponding to 2,895 patients: 0.6% of the samples (18/3,082) were positive for H. influenzae. Culture and H. influenzae-specific qPCR were performed on 17/18 (94.4%) and 3/18 (16.7%) cerebrospinal fluid samples, respectively; qPCR was negative in all cases. Among 17 samples sent for culture, 10 concerned patients were not treated with antibiotics prior to lumbar puncture. Only 1/17 revealed growth of H. influenzae and was classified as a true positive. We further classified 3/18 (16.7%) cases with the identification of Gram-negative rods in the cerebrospinal fluid or positive blood cultures for H. influenzae as likely true-positive and 14/18 (77.8%) cases as likely false-positive. Diagnostic results should always be interpreted together with the clinical presentation, cerebrospinal fluid analysis, and other available microbiological results. All H. influenzae-positive results should be viewed with special caution and a H. influenzae-specific qPCR should be systematically considered.

Assessment of the introduction of DRG-based reimbursement in Switzerland: Evidence on the short-term effects on length of stay compliance in university hospitals

The implementation of a nationwide diagnosis-related groups (DRG) reimbursement system in 2012 marked an important step in increasing the transparency and efficiency of hospital services in Switzerland. However, no clear evidence exists to date on the response of hospitals to the introduction of SwissDRG. Using administrative data on inpatient stays in Swiss university hospitals and the length of stay compliance (LOSC) as a measure of hospital performance, we find a significant short-term reduction in LOSC for hospitals that experienced a change from retrospective per diem to prospective DRG reimbursement, compared to hospitals with a prospective payment system already before 2012. LOSC can be interpreted as a performance indicator because it compares the actual length of stay with a benchmark value, taken from the yearly DRG catalogue. The reduction in LOSC implies that hospitals in the treatment group on average had an increase in LOS relative to the benchmark compared to the control hospitals. This may be interpreted as a negative effect of SwissDRG on hospital performance, at least in the short-run, and we provide supporting evidence that hospitals that worked under DRG already before adapted more quickly and efficiently.

Impact of a nurse-led family support intervention on family members' satisfaction with intensive care and psychological wellbeing: A mixed-methods evaluation

BackgroundFamilies of critically ill persons face uncertainty and experience distress during and after their close other's stay in an intensive care unit (ICU). Proactive nurse engagement and support is recommended to meet families' needs in the ICU, but little is known about its impact on quality of family care. We introduced a family support intervention that consisted of an interprofessional family support pathway and a new role of an advanced practice family nurse. ObjectivesThe aim of the study was to examine the effect of an advanced practice nurse–led family support intervention on family members' satisfaction, wellbeing, and psychological distress. MethodsWe conducted a quasi-experimental before-and-after study with embedded qualitative interviews in a Swiss University Hospital from March 2018 to July 2019 using a questionnaire (Family Satisfaction in the ICU-24 Survey, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised-6) and qualitative interviews (n = 19) after patient discharge. ResultsFamilies in the intervention group (n = 75) showed a trend for increased overall satisfaction (difference of 5.544, 95% confidence interval [CI]: −0.11 to 11.20), a statistically significant increase in satisfaction with decision-making (7.258, 95% CI: 0.89 to 13.63), and a nonsignificant increase in satisfaction with care (4.178, 95% CI: −1.53 to 9.89). Psychological distress was higher in the intervention group, with depression reaching statistical significance (difference of 1.706, 95% CI: 0.16 to 3.25), which may be explained by longer ICU stays and higher proportion of deaths in the intervention group. Families receiving the intervention reported to be feeling cared for, well informed, and better able to cope. Data integration suggests that early onset, fit to need, and quality of intervention were the most important intervention characteristics impacting family wellbeing. ConclusionsOur study found that family members experience a nurse-led support intervention as beneficial for their wellbeing. It increased their satisfaction, but was unable to demonstrate a favourable impact on psychological distress.

The development and validation of a resource consumption score of an emergency department consultation

BackgroundEmergency Department (ED) visits and health care costs are increasing globally, but little is known about contributing factors of ED resource consumption. This study aims to analyse and to predict the total ED resource consumption out of the patient and consultation characteristics in order to execute performance analysis and evaluate quality improvements.MethodsCharacteristics of ED visits of a large Swiss university hospital were summarized according to acute patient condition factors (e.g. chief complaint, resuscitation bay use, vital parameter deviations), chronic patient conditions (e.g. age, comorbidities, drug intake), and contextual factors (e.g. night-time admission). Univariable and multivariable linear regression analyses were conducted with the total ED resource consumption as the dependent variable.ResultsIn total, 164,729 visits were included in the analysis. Physician resources accounted for the largest proportion (54.8%), followed by radiology (19.2%), and laboratory work-up (16.2%). In the multivariable final model, chief complaint had the highest impact on the total ED resource consumption, followed by resuscitation bay use and admission by ambulance. The impact of age group was small. The multivariable final model was validated (R2 of 0.54) and a scoring system was derived out of the predictors.ConclusionsMore than half of the variation in total ED resource consumption can be predicted by our suggested model in the internal validation, but further studies are needed for external validation. The score developed can be used to calculate benchmarks of an ED and provides leaders in emergency care with a tool that allows them to evaluate resource decisions and to estimate effects of organizational changes.

\u201cGuboow\u201d\u2014child abuse or traditional medical treatment? a case report

The examination of children suspected of being abused poses a great challenge for forensic pathologists. The risk of misjudgment is high and can have serious consequences for the child and the family. In unclear cases, an assessment should always be carried out on an interdisciplinary basis with the involvement of the relevant disciplines such as pediatrics, dermatology, or radiology. We present the case of a 2.5-year-old boy who was presented by his parents at the Pediatric Emergency Department of a Swiss University Hospital due to fever and weight loss. During the physical examination, conspicuous findings on the abdomen were present, and the responsible emergency physicians informed the child protective services. A clinical forensic examination occurred on behalf of the child protection services. The abdomen of the child showed several symmetrical scars. The initial questioning of the parents did not provide clear information about the origin of the injuries. Further professional questioning of the family by the child protective services concluded that the injuries were the result of a traditional medical treatment in Somalia, which occurred several weeks before.

Retrospective analysis of adverse drug reactions leading to short-term emergency hospital readmission.

Adverse drug reactions (ADRs) are an important cause of hospital admissions. Insufficient data are available about the frequency and characteristics of ADR-related emergency readmissions in Switzerland. The aim of this retrospective study was to characterise ADRs related to short-term emergency readmissions in a large Swiss University Hospital and to assess their reporting frequency. Electronic records of all patients discharged from the University Hospital Bern within a 12-month period (1 January to 31 December 2012) and emergency readmission within 30 calendar days were reviewed. Case inclusion required a known ADR. Cases with intentional overdosing, lack of compliance or insufficient documentation were excluded. Identified ADR-related readmission cases were searched in the Swiss ADR reporting system to assess reporting rate. There were 1294 emergency readmissions among the 4792 readmissions (14% of all admissions) within 30 days after discharge. We identified 270 cases of ADR-related readmissions, corresponding to 21% of emergency readmissions and 6% of all readmissions within 30 days. The most frequent ADRs were gastrointestinal disorders (26%), infections and infestations (19%), and nervous system disorders (10%). The most frequent drug classes leading to ADRs were antineoplastic/immunomodulating (35%) and antithrombotic agents (25%). Only 8 (3%) of the 270 cases were reported to the Swiss ADR reporting system. ADR-related readmissions constituted a considerable part of short-term emergency readmissions. Despite being a relevant cause for rehospitalisation, only a minority of the ADRs were reported to the regulatory authorities. Strategies to prevent ADR-related readmissions and to improve reporting rates are needed.

Trends in prevalence and outcomes of frailty in a Swiss university hospital: a retrospective observational study.

Frailty complicates management and worsens outcomes. We assessed the prevalence, determinants and consequences of frailty among elderly patients in a hospital setting. Retrospective observational study in a Swiss university hospital. 22,323 patients aged ≥65 years hospitalized between January 2009 and December 2017 at the internal medicine ward were included. Frailty was defined by the Hospital Frailty Risk Score (HFRS) and patients were categorized as low (HFRS<5), intermediate (HFRS 5-15) and high (HFRS>15) risk. Overall prevalence of intermediate and high risk of frailty was 43% and 20%, respectively; prevalence was higher in women and increased with age. Prevalence of high risk of frailty increased from 11.4% in 2009 to 31% in 2012, and decreased to 19.2% in 2017. After multivariable adjustment, frailty was associated with increased length of stay: average and (95% confidence interval) 11.9 (11.7-12.1), 15.6 (15.4-15.8) and 19.7 (19.3-20.1) days for low, intermediate and high risk, respectively, and increased likelihood of ICU stay: odds ratio (OR) and (95% CI) 1.57 (1.41-1.75) and 2.10 (1.82-2.42) for intermediate and high risk, respectively, p for trend <0.001. Frailty was associated with increased likelihood of hospital costs >70,000 CHF: OR and (95% CI) 3.46 (2.79-4.29) and 10.7 (8.47-13.6) for intermediate and high risk, respectively, p for trend <0.001, and with a lower likelihood of complete cost coverage: OR and (95% CI) 0.70 (0.65-0.76) and 0.52 (0.47-0.58) for intermediate and high risk, respectively, p for trend<0.001. Frailty is a frequent condition among hospitalized patients and is associated with higher costs.

Acute and Post-traumatic Stress Disorder Symptoms in Mothers and Fathers Following Childbirth: A Prospective Cohort Study.

IntroductionUp to 30% of women view their childbirth as traumatic. This experience can lead to acute stress disorder or post-traumatic stress disorder. The negative impact of maternal post-traumatic stress disorder following childbirth reaches beyond the mother, potentially affecting her child's development and the couple's relationship. Research on paternal post-traumatic stress disorder following childbirth is scarce. Acute stress disorder is suggested to be an important predictor of post-traumatic stress disorder in mothers, but little is known about paternal acute stress disorder following childbirth. Furthermore, there is limited information about the comparison or relation of acute stress disorder and post-traumatic stress disorder following childbirth between parents.Aim[1] To compare the prevalence rates and severity of acute stress disorder and post-traumatic stress disorder symptoms between parents following childbirth by taking anxiety and depression symptoms, as well as obstetric variables and previous traumatic events into account and [2] To determine if acute stress disorder is a predictor of post-traumatic stress disorder.MethodA prospective population-based design was used. N = 647 participants were recruited from future parents who attended appointments at the Obstetrics and Gynecology unit at a Swiss university hospital. Self-report questionnaires were used: Post-traumatic Diagnostic Scale in the third trimester of pregnancy (T1) and 1 month post-partum (T3), Acute Stress Disorder Scale at 1 week post-partum (T2), and Hospital Anxiety and Depression Scale at all time points. Obstetric and neonatal variables were retrieved from hospital records.ResultsAt T2, 8.9% of mothers and 4.4% of fathers presented symptoms of acute stress disorder. At T3, 20.7% of mothers and 7.2% of fathers had symptoms of post-traumatic stress disorder. Acute stress disorder was a predictor of post-partum post-traumatic stress disorder (Odds ratio: 8.6, IC 95% [1.85; 40.42]). Depression symptoms was a significant confounder in the prediction of post-traumatic stress disorder following childbirth, but not anxiety or previous perinatal loss.ConclusionLittle is known about parental differences in acute stress disorder and post-traumatic stress disorder symptoms following childbirth. Results indicate that both parents may suffer from acute stress disorder and post-traumatic stress disorder symptoms after childbirth and that acute stress disorder is a predictor of post-traumatic stress disorder after childbirth for both parents. Sensitization of maternity staff to these results may assist in earlier identification of and appropriate treatment for at-risk parents.

Mental health and its associations with glucose-lowering medication in women with gestational diabetes mellitus. A prospective clinical cohort study

AimsMental health symptoms are frequent in women with gestational diabetes mellitus (GDM) and may influence glycemic control. We therefore investigated if mental health symptoms (high depression and low well-being scores) predicted a need for glucose-lowering medication and if this use of medication influenced the trajectory of mental health during pregnancy and in the postpartum period. MethodsWe included 341 pregnant women from a cohort of GDM women in a Swiss University Hospital. The World Health Organization Well-being Index-Five was collected at the first and last GDM and at the postpartum clinical visits and the Edinburgh Postnatal Depression Scale at the first GDM and the postpartum clinical visits. Medication intake was extracted from participants’ medical records. We conducted linear and logistic regressions with depression as an interaction factor. ResultsMental health symptoms did not predict a need for medication (all p ≥ 0.29). Mental health improved over time (both p ≤ 0.001) and use of medication did not predict this change (all p ≥ 0.40). In women with symptoms of depression, medication was associated with less improvement in well-being at the postpartum clinical visit (p for interaction=0.013). ConclusionsMental health and glucose-lowering medication did not influence each other in an unfavourable way in this cohort of women with GDM.

Epidemiology, risk factors and clinical course of SARS-CoV-2 infected patients in a Swiss university hospital: An observational retrospective study.

BackgroundThis study aims to describe the epidemiology of COVID-19 patients in a Swiss university hospital.MethodsThis retrospective observational study included all adult patients hospitalized with a laboratory confirmed SARS-CoV-2 infection from March 1 to March 25, 2020. We extracted data from electronic health records. The primary outcome was the need to mechanical ventilation at day 14. We used multivariate logistic regression to identify risk factors for mechanical ventilation. Follow-up was of at least 14 days.Results145 patients were included in the multivariate model, of whom 36 (24.8%) needed mechanical ventilation at 14 days. The median time from symptoms onset to mechanical ventilation was 9·5 days (IQR 7.00, 12.75). Multivariable regression showed increased odds of mechanical ventilation with age (OR 1.09 per year, 95% CI 1.03–1.16, p = 0.002), in males (OR 6.99, 95% CI 1.68–29.03, p = 0.007), in patients who presented with a qSOFA score ≥2 (OR 7.24, 95% CI 1.64–32.03, p = 0.009), with bilateral infiltrate (OR 18.92, 3.94–98.23, p<0.001) or with a CRP of 40 mg/l or greater (OR 5.44, 1.18–25.25; p = 0.030) on admission. Patients with more than seven days of symptoms on admission had decreased odds of mechanical ventilation (0.087, 95% CI 0.02–0.38, p = 0.001).ConclusionsThis study gives some insight in the epidemiology and clinical course of patients admitted in a European tertiary hospital with SARS-CoV-2 infection. Age, male sex, high qSOFA score, CRP of 40 mg/l or greater and a bilateral radiological infiltrate could help clinicians identify patients at high risk for mechanical ventilation.

Scientific publications in internal medicine and family medicine: a comparative cross-sectional study in Swiss university hospitals.

Family medicine is a relatively new academic medical discipline. We aimed to compare the main bibliometric indices of hospital-based senior physicians practicing internal medicine versus family medicine in Switzerland. We conducted this cross-sectional study in March 2020. We selected all hospital-based senior physicians practicing internal medicine or family medicine in the six Swiss university hospitals. Using Web of Science, after removing from both groups of physicians the 5% with the highest number of publications, we extracted the number of publications, the number of publications per year, the number of citations, the number of citations per year, the number of citations per publication and the h-index. We compared the data between the two groups using negative binomial regressions and the proportion of physicians having at least one publication using chi-square tests. We included 349 physicians in the study (internal medicine: 51%, men: 51%). The median number of publications was three [interquartile range (IQR) = 18], the median number of citations was nine (IQR = 158) and the median h-index was one (IQR = 5). All bibliometric indices were similar in both groups, as was the proportion of physicians having at least one publication (family medicine: 87% versus 82%, P = 0.15). We found no association between the bibliometric indices and the medical specialty. Further studies are needed to explore other important indicators of academic output, such as those more specifically assessing its quality and scientific importance.

Predicting Venous Thromboembolic Events in Patients with Coronavirus Disease 2019 Requiring Hospitalization: an Observational Retrospective Study by the COVIDIC Initiative in a Swiss University Hospital.

Background Coronavirus disease 2019 (COVID-19) can result in profound changes in blood coagulation. The aim of the study was to determine the incidence and predictors of venous thromboembolic events (VTE) among patients with COVID-19 requiring hospital admission. Subjects and Methods. We performed a retrospective study at the Lausanne University Hospital with patients admitted because of COVID-19 from February 28 to April 30, 2020. Results Among 443 patients with COVID-19, VTE was diagnosed in 41 patients (9.3%; 27 pulmonary embolisms, 12 deep vein thrombosis, one pulmonary embolism and deep vein thrombosis, one portal vein thrombosis). VTE was diagnosed already upon admission in 14 (34.1%) patients and 27 (65.9%) during hospital stay (18 in ICU and nine in wards outside the ICU). Multivariate analysis revealed D-dimer value > 3,120 ng/ml (P < 0.001; OR 15.8, 95% CI 4.7-52.9) and duration of 8 days or more from COVID-19 symptoms onset to presentation (P 0.020; OR 4.8, 95% CI 1.3-18.3) to be independently associated with VTE upon admission. D-dimer value ≥ 3,000 ng/l combined with a Wells score for PE ≥ 2 was highly specific (sensitivity 57.1%, specificity 91.6%) in detecting VTE upon admission. Development of VTE during hospitalization was independently associated with D-dimer value > 5,611 ng/ml (P < 0.001; OR 6.3, 95% CI 2.4-16.2) and mechanical ventilation (P < 0.001; OR 5.9, 95% CI 2.3-15.1). Conclusions VTE seems to be a common COVID-19 complication upon admission and during hospitalization, especially in ICU. The combination of Wells ≥ 2 score and D − dimer ≥ 3,000 ng/l is a good predictor of VTE at admission.

Uncontrolled hypertension and elevated NT-proBNP predict acute kidney injury and cardiac death in all-comer patients 1 year after acute coronary syndromes

Abstract Background Hypertension is a recognized cardiovascular (CV) risk factor and, although many highly effective antihypertensive drugs have been developed, most patients fail to achieve recommended blood pressure target levels. This may increase major adverse CV events after acute coronary syndromes (ACS) such as acute kidney injury (AKI) and cardiac death (CD). Purpose We assessed the prognostic value of uncontrolled hypertension (UH) and elevated NT-proBNP among 2,168 all-comer patients admitted to 4 Swiss University Hospitals for acute coronary syndromes (ACS) enrolled in the prospective multicenter SPUM registry. Methods Patients with UH defined as a systolic blood pressure≥140 mmHg, and a NT-proBNP&amp;gt;900 ng/l were considered for the analysis. The composite primary endpoint was AKI and CD. Adjusted Cox proportional hazards regression models were implemented to determine risk prediction for UH and elevated NT-proBNP levels. Results Out of 2,168 ACS patients, 235 patients (10.8%) showed UH and NT-proBNP&amp;gt;900 ng/l (Fig. 1A). Compared to the general ACS population, those with UH and elevated NT-proBNP were more likely to be older (41.7% vs 20.0%, p&amp;lt;0.001), of female sex (36.2% vs 19.7%, p&amp;lt;0.001) and with a more complex history of CV disease, such as hypertension (77.0% vs 56.2%, p&amp;lt;0.001), diabetes (24.7% vs 17.5%, p=0.006), peripheral artery disease (9.4% vs 5.2%, p=0.011), cerebrovascular disease (6.8% vs 3.4%, p=0.013), chronic heart failure (3.4% vs 1.3%, p=0.025), dialysis (2.1% vs 0.3%, p=0.004) as well as prior CABG (9.4% vs 5.2%, p=0.010) and more often admitted as NSTEMIs (59.6% vs 40.9%, p&amp;lt;0.001). Although these patients were on a more aggressive antihypertensive therapy at admission (all p&amp;lt;0.05 for ACEi, ARB, Beta-blockers, calcium antagonists, nitrates and diuretics), there was a higher rate of death (OR 1.83, 95% CI 1.07–3.14, p=0.027), CD (OR 2.13, 95% CI 1.19–3.81, p=0.009), AKI (OR 2.83, 95% CI 1.41–5.67, p=0.002) and composite endpoint AKI+CD (OR 2.46, 95% CI 1.56–3.90, p&amp;lt;0.001) at one year. This combined risk persisted after adjustment for baseline differences, with a 71% (Adj. HR 1.71, 95% CI 1.44–1.84, p=0.003) increase for the composite endpoint (Fig. 1B). Conclusions Among a real-world cohort of ACS patients, coexistence of UH with elevated levels of NT-proBNP confers increased risk for AKI and CD up to one year after ACS. These observations might help clinicians to identify ACS patients at risk using simple clinical parameters and biomarkers and to target them for more intense preventive therapies. Figure 1. A: GRADE1 = 140–159 mmHg and/or 90–99 mmHg; GRADE2 = 160–179 mmHg and/or 100–109 mmHg; GRADE3 = ≥180 mmHg and/or ≥110 mmHg; ISH (isolate systolic hypertension) = ≥140 mmHg and &amp;lt;90 mmHg; NT-proBNP = N-terminal-pro B-type natriuretic peptide. B: UH = uncontrolled hypertension; AKI = acute kidney injury; CD = cardiac death. Funding Acknowledgement Type of funding source: None

Applicability of ISCHEMIA to the daily practice of a Swiss University Hospital

Abstract Introduction The ISCHEMIA trial found that an invasive strategy was not associated with a reduction in major adverse cardiovascular events when compared with optimal medical treatment (OMT) alone among patients with moderate/severe ischemia. However, given the extensive exclusion criteria of the study, we sought to investigate if these results would actually change our daily practice. Methods We performed a retrospective analysis of the last 1,000 consecutive PCIs undertaken in our university hospital in Switzerland. We applied the ISCHEMIA exclusion criteria to this population in order to estimate the proportion of patients that would have been excluded from the trial. Results Between October 2018 and November 2019, 1,000 PCIs were performed in a population with a mean age of 65.5 (IQR 51.0–76.0) years, of which 76.8% were men. Among these procedures, 603 (60.3%) were performed for an acute coronary syndrome (ACS) and 197 (19.7%) in the context of either an ACS within 2 months (n=131), or a PCI/CABG within 12 months (n=66) (Figure 1). A further 84 (8.4%) procedures were performed in patients with other high-risk features (ventricular arrhythmias, cardiac arrest, NYHA III-IV, eGFR &amp;lt;30 ml/min or LVEF &amp;lt;35%). Finally, 25 (2.5%) were performed in patients with unacceptable angina whilst on OMT, a cardiac transplant, a recent stroke, or another exclusion criterion. This left only 91 patients (9.1%) without any ISCHEMIA exclusion criteria. When considering only patients with SCAD (n=320), 229 (71.6%) would have been excluded due to the presence of at least one exclusion criterion. Conclusion In this retrospective analysis of 1,000 consecutive PCIs, the vast majority were performed in patients with at least one ISCHEMIA exclusion criterion. These results suggest that the impact of ISCHEMIA on the real-world practice of a medium-sized PCI center like ours is likely to be limited. Figure 1 Funding Acknowledgement Type of funding source: None