How do Swiss general practitioners agree with and report adhering to a top-five list of unnecessary tests and treatments? Results of a cross-sectional survey.

In 2014, the 'Smarter Medicine' campaign released a top five list of unnecessary tests and treatments in Swiss primary care, such as imaging for acute low-back pain and long-term prescribing of proton pump inhibitors. Measure general practitioners' (GPs) agreement with the recommendations and self-reported adherence. Cross-sectional, online survey of GPs in the 'Swiss primary care active monitoring' (SPAM) network, which assessed awareness of 'Smarter Medicine' and views on each recommendation. Questions included whether the clinical situation is common, whether the recommendation is followed, whether GPs agree with the recommendation and reasons why the recommendation would not be followed. One-hundred-and-sixty-seven of 277 GPs from the SPAM network participated (60%), of which 104 (62%) knew of 'Smarter Medicine', including 79% in German areas, 49% in French areas and 38% in Italian areas (P < 0.001). Agreement with the five recommendations was high, with scores around nine out of 10. The proportion saying they typically follow each recommendation was 68 to 74%, except not continuing long-term PPI prescriptions without attempting dose reduction, with only 34%. Common reasons for not following the recommendations were patient or other provider requests and situations that might suggest the need for more aggressive care. Two years after the launch of the campaign, awareness and acceptance of 'Smarter Medicine' appear to be high among Swiss GPs. By self-report, the recommendations are adhered to by most of the respondents but there may be room for improvement, especially for long-term PPI prescriptions

Next generation software environments : principles, problems, and research directions

The past decade has seen a burgeoning of research and development in software environments. Conferences have been devoted to the topic of practical environments, journal papers produced, and commercial systems sold. Given all the activity, one might expect a great deal of consensus on issues, approaches, and techniques. This is not the case, however. Indeed, the term "environment" is still used in a variety of conflicting ways. Nevertheless substantial progress has been made and we are at least nearing consensus on many critical issues.The purpose of this paper is to characterize environments, describe several important principles that have emerged in the last decade or so, note current open problems, and describe some approaches to these problems, with particular emphasis on the activities of one large-scale research program, the Arcadia project. Consideration is also given to two related topics: empirical evaluation and technology transition. That is, how can environments and their constituents be evaluated, and how can new developments be moved effectively into the production sector

«Smarter Medicine»: 5 Interventionen, die in der ambulanten allgemeinen inneren Medizin vermieden werden sollten

Seit 2012 befasst sich die Schweizerische Gesellschaft für Allgemeine Innere Medizin mit der Problematik der Überdiagnostik und Überversorgung in der Medizin. Nun hat sie beschlossen, eine Liste mit fünf Untersuchungen auf dem Gebiet der ambulanten allgemeinen inneren Medizin zusammenzustellen, die ohne oder mit nur geringem Nutzen bei zahlreichen Patienten durchgeführt werden, gleichzeitig jedoch unerwünschte Nebenwirkungen haben können und zum Anstieg der Gesundheitskosten beitragen

Urban Space, Politics, and Socio-ethnic Relations in Roma

Roma, written and directed by Alfonso Cuaron, has been one of the most successful Latin American films of recent decades, while also widely recognised as an important piece of social commentary, and a window on Mexico City in the early 1970s. The cinematography and storyline of the film offer insights into social change in the city, as well as the use of private and public space, and what this says about social and ethnic relations, as well as how business is carried out within the city. This developmental paper sets out a project to explore these themes

Proteomic profiling of urinary proteins in renal cancer by surface enhanced laser desorption ionisation (SELDI) and neural-network analysis: Identification of key issues affecting potential clinical utility.

Recent advances in proteomic profiling technologies, such as surface enhanced laser desorption ionization mass spectrometry, have allowed preliminary profiling and identification of tumor markers in biological fluids in several cancer types and establishment of clinically useful diagnostic computational models. There are currently no routinely used circulating tumor markers for renal cancer, which is often detected incidentally and is frequently advanced at the time of presentation with over half of patients having local or distant tumor spread. We have investigated the clinical utility of surface enhanced laser desorption ionization profiling of urine samples in conjunction with neural-network analysis to either detect renal cancer or to identify proteins of potential use as markers, using samples from a total of 218 individuals, and examined critical technical factors affecting the potential utility of this approach. Samples from patients before undergoing nephrectomy for clear cell renal cell carcinoma (RCC; n 48), normal volunteers (n 38), and outpatients attending with benign diseases of the urogenital tract (n 20) were used to successfully train neural-network models based on either presence/absence of peaks or peak intensity values, resulting in sensitivity and specificity values of 98.3–100%. Using an initial “blind” group of samples from 12 patients with RCC, 11 healthy controls, and 9 patients with benign diseases to test the models, sensitivities and specificities of 81.8–83.3% were achieved. The robustness of the approach was subsequently evaluated with a group of 80 samples analyzed “blind” 10 months later, (36 patients with RCC, 31 healthy volunteers, and 13 patients with benign urological conditions). However, sensitivities and specificities declined markedly, ranging from 41.0% to 76.6%. Possible contributing factors including sample stability, changing laser performance, and chip variability were examined, which may be important for the long-term robustness of such approaches, and this study highlights the need for rigorous evaluation of such factors in future studies

“I didn’t have any option”: Experiences of people receiving in-centre haemodialysis during the COVID-19 pandemic

People receiving in-centre haemodialysis (ICHD) during the COVID-19 pandemic had to adjust to more challenging treatment conditions. To explore people’s experiences of adjustment to ICHD during the pandemic. Thematic analysis of in-depth, semi-structured interviews with 14 adult UK ICHD patients. Findings: Four themes were identified: ‘perceptions of the threat’, ‘impacts on treatment’, ‘impaired communication’ and ‘coping and positive adjustment’. These described participants’ experiences of vulnerability to COVID-19; the ways the pandemic affected dialysis and clinical care; the impact that measures to reduce viral transmission had on communication and interaction within dialysis units; and ways that participants coped and made positive adjustments to the adversities imposed by the pandemic. The findings give insights into adjustment during extreme adversity. They also help to identify ways that support for ICHD patients could be improved as pandemic conditions recede, and ways that dialysis units could prepare for future outbreaks of infectious illness

Associations between primary care practice type and patient-reported access.

We recently defined a global typology of primary care (PC) in Switzerland using a mixed inductive/deductive approach to construct latent, composite variables that summarize variance between practices. Now we explore associations between the primary variable that describes the comprehensiveness of services and patient-perceived access to PC in Switzerland. Cross-sectional surveys were administered to physicians from the Swiss PC Active Monitoring (SPAM) network and their patients. The primary outcomes were patient responses to: "Was it easy to get the appointment?", "The opening hours are too restricted" and "In the past 12 months, did you postpone or abstain from a visit to this doctor or another GP when you needed one?" Multivariate, multilevel analyses with stepwise regression were used to assess associations between practice type (practices with a broader range of services have higher scores) and perceived access, controlling for patient characteristics. One hundred and ninety nine of 200 PC physicians in the network completed the questionnaire. Of 2628 patients approached after a physician visit, 1791 accepted (participation = 76%), with 9 patients at each practice. No association was observed between comprehensiveness of services and difficulty getting an appointment. When controlling for patient factors, there was a weak association between higher scores for comprehensiveness of services and patients reporting that the opening hours are too restricted (p = 0.05), though this was no longer significant after controlling for language area. Greater comprehensiveness of services was associated with fewer patients needing to postpone visits (OR 0.93, 95%CI 0.88-0.99, p = 0.03). Though fewer patients report needing to postpone visits at practices with more comprehensive offering of services, there is limited evidence of associations between patient-reported access and a global typology of Swiss primary care