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Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cardiovascular diseases (CVD) represent a significant health problem worldwide and in Switzerland. Despite preventive measures and advances in treatment, cardiovascular diseases still lead to a significant number of hospitalizations in Switzerland (133 000 in 2021) and are for responsible for almost 1/3 of all deaths (19 600 in 2021). Emergency care for acute cardiovascular events now has a very high standard in Switzerland compared to other countries. However, there is a large discrepancy between evidence and daily practice (evidence-performance gap) in cardiovascular risk factor control, because a large percentage of patients do not achieve the goals of the guideline recommendations: 55% of hypertensives, 81% of patients with elevated LDL cholesterol and 44% of diabetics. In addition, 21% of people in Switzerland currently smoke, 42% are considered obese and 24% of people are sedentary. Therefore, primary and secondary prevention offers great potential for reducing the morbidity and mortality of cardiovascular diseases. Sub-optimal control of cardiovascular risk factors leads to preventable cardiovascular events and associated economic costs. Thus, cardiovascular diseases not only affect life expectancy, but also influence the years with reduced quality of life (disability-adjusted life years, DALY). In Switzerland, the main risk factors of cardiovascular diseases lead to a loss of 311 332 DALYs in total, 45 454 DALYs lost by hypertension, 64 445 DALYs lost due to hyperlipidema, 24 283 DALYs due to diabetes mellitus, 47 639 DALYs due to smoking, 21 170 DALYs lost by obesity)and 4 669 DALYs lost due to a lack of exercise. Assuming that one DALY is associated with a socioeconomic burden of CHF 99 417, the total socioeconomic cost of all cardiovascular diseases is 4% of gross domestic product (GDP). Furthermore, cardiovascular diseases caused a cost burden of CHF 27,8 billion in direct and indirect healthcare costs in 2021. [ABSTRACT FROM AUTHOR]

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study "Beta-blockers after a heart attack?" examines the benefits of beta-blockers in patients after a heart attack with preserved left ventricular function. Previous studies showed a reduction in mortality of around 20%, but these were from the 1980s and mainly included patients with large infarctions and impaired function. Therefore, the REDUCE-AMI study investigated the benefits and safety of beta-blockers in post-heart attack patients without heart failure. The study found that long-term beta-blocker therapy does not offer a significant survival advantage or fewer reinfarctions in these patients. The results should lead to a paradigm shift in current guidelines. [Extracted from the article]

Older Americans still take aspirin too frequently for cardiovascular primary prevention. According to a study, in 2021, 18.5% of individuals over the age of 40 took aspirin for primary prevention, with 29.7% of those over 60 taking it. A decrease in aspirin intake was observed in all age groups from 2012 to 2021, but this decrease was smaller among older participants. In the group of individuals over 70 years old, 38.3% still took aspirin. The European Society of Cardiology (ESC) advises against the primary preventive use of aspirin due to the unfavorable benefit-risk ratio, except for those with high cardiovascular risk and low bleeding risk. [Extracted from the article]

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article "Medical Guidelines: Knowledge is not everything" by Prof. Thomas Rosemann emphasizes the importance of medical guidelines or guidelines. These not only summarize medical knowledge, but also evaluate the methodological quality of individual studies and their relevance for medical practice. It is emphasized that medical evidence must always be considered in the context of the respective healthcare system. Guidelines serve as a corridor for orientation, but should be created independently of industry influences. It is also pointed out that in addition to external evidence, the individual clinical experience of doctors and the needs of patients are important elements that can justify adaptation or deviation from the guidelines. [Extracted from the article]

Multimorbid and chronically ill patients require models of care for which the collaboration of all involved professionals must be redefined. Inter-professional teams are successful in certain countries. However, little is known about the views of Swiss Primary Care Physicians (PCPs) on models of care involving advanced practice nurses (APNs). Therefore, we explored PCPs' views on potential models of collaboration. Focus groups were conducted with PCPs. In advance, topics of inter-professional collaboration were explored by a group of experts. The interviews were analysed by qualitative content analysis. The results show that maintaining the quality of care is important to PCPs. They are willing to collaborate, but PCPs know little about an APN's expertise. Furthermore, the situation is made difficult by the fact the financing of non-medical services is not yet regulated. [ABSTRACT FROM AUTHOR]

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and objectives: Both France and Switzerland face a general practitioner (GP) shortage. What differences or parallels exist between the two countries with regard to the causes for this shortage? What conclusions might be drawn from a systematic comparison? Methods: Literature review with qualitative and semi-quantitative content analysis. Results: Parallels exist in the comparing categories work contents, working structure, income and social status, medical school formation, private life, psychological motives. Differences are found in the categories biography and social selection, medical socialisation, residency. In Switzerland, residency is not uniformly structured, rarely institutionally organised and contains only few elements specific to general medicine. In France, medical socialisation not only exalts the specialists, but also strongly devaluates the GPs. Conclusions: By systematic analysis and comparison of both countries' pertinent literature, France and Switzerland can deepen their understanding of GP shortage.This paper identifies possible fields of action from medical school through residency up to workplace conditions that are pivotal in addressing the shortage of GPs. [ABSTRACT FROM AUTHOR]

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We present the case of a 48-year-old man complaining of pain in his hands. In a first step, a two-sided carpal tunnel syndrome was found, and in the further course of the disease an acromegaly. The combinations of carpal tunnel syndrome, impaired glucose tolerance and radiological findings in the area of the sella turcica were the clues for the diagnosis of acromegaly. [ABSTRACT FROM AUTHOR]

We present the case of a 26 year old man reporting to the family doctor due to swelling and redness of the foot. After thrombosis and a tumorous mass could be excluded, the suspicion fell on an acrodermatitis chronica atrophican which could be confirmed by laboratory tests. During therapy there was a significant regression of the cutaneous lesion. The treatment of the Lyme disease was taken over by the casualty insurer. [ABSTRACT FROM AUTHOR]

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The subject of this guideline from the Institute of Family Medicine at the University of Zurich (IHAMZ) is the management of venous thrombosis. The review summarizes the current evidence and recommendations from international guidelines (1-6). The IHAMZ-guidelines focus on primary care, they also provide guidance on the coordination of general and specialist medical care as well as on the transition between outpatient and hospital care taking into account the special features of the Swiss healthcare system. The guideline is devided in two parts. Part 1 discusses the diagnosis and treatment of deep vein thrombosis (DVT). A validated algorithm is recommended for the diagnostic process, which begins with the assessment of the clinical probability. With the inclusion of the D-dimer test, the need for subsequent imaging diagnostics can be reduced. The differences between the evaluation of an initial and recurrent DVT are shown and the indications and scope of evidence-based environmental diagnostics (thrombophilia and tumor search) are presented. All patients with DVT should receive anticoagulation (AC) for 3-6 months, as there is a high risk of recurrence with AC  3 months. The duration of the subsequent secondary prophylaxis depends on the presumed risk of recurrence on the one hand and the risk of bleeding on the other. Part 2 is dedicated to special thrombosis situations such as shoulder-arm vein thrombosis (SAVT), cancer-associated thrombosis (CAT) and superficial vein thrombosis (SVT). The article on hormone- and pregnancy-associated DVT, developed together with the Department of Gynecology at the University Hospital of Zurich, discusses the importance of hormonal contraception and menopausal hormone replacement therapy (HRT) as a thrombogenic risk factor as well as special features in the diagnosis and treatment of thrombosis in pregnancy., Competing Interests: Die Autorinnen und Autoren haben keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Introduction: There is potential for improvement in the care of cardiovascular diseases in Switzerland, particularly when it comes to achieving target values defined in guidelines. Adherence scores such as the SGED score for diabetic care established in Switzerland can help to reduce the evidence-performance gap. The CARE score presented here is an adherence score that validly reflects the quality of care for patients with a cardiovascular risk using process and outcome indicators., Competing Interests: Die Autoren haben keine Interessenkonflikte in Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Introduction: Cardiovascular diseases (CVD) represent a significant health problem worldwide and in Switzerland. Despite preventive measures and advances in treatment, cardiovascular diseases still lead to a significant number of hospitalizations in Switzerland (133 000 in 2021) and are for responsible for almost 1/3 of all deaths (19 600 in 2021). Emergency care for acute cardiovascular events now has a very high standard in Switzerland compared to other countries. However, there is a large discrepancy between evidence and daily practice (evidence-performance gap) in cardiovascular risk factor control, because a large percentage of patients do not achieve the goals of the guideline recommendations: 55% of hypertensives, 81% of patients with elevated LDL cholesterol and 44% of diabetics. In addition, 21% of people in Switzerland currently smoke, 42% are considered obese and 24% of people are sedentary. Therefore, primary and secondary prevention offers great potential for reducing the morbidity and mortality of cardiovascular diseases. Sub-optimal control of cardiovascular risk factors leads to preventable cardiovascular events and associated economic costs. Thus, cardiovascular diseases not only affect life expectancy, but also influence the years with reduced quality of life (disability-adjusted life years, DALY). In Switzerland, the main risk factors of cardiovascular diseases lead to a loss of 311 332 DALYs in total, 45 454 DALYs lost by hypertension, 64 445 DALYs lost due to hyperlipidema, 24 283 DALYs due to diabetes mellitus, 47 639 DALYs due to smoking, 21 170 DALYs lost by obesity)and 4 669 DALYs lost due to a lack of exercise. Assuming that one DALY is associated with a socioeconomic burden of CHF 99 417, the total socioeconomic cost of all cardiovascular diseases is 4% of gross domestic product (GDP). Furthermore, cardiovascular diseases caused a cost burden of CHF 27,8 billion in direct and indirect healthcare costs in 2021. Keywords: Cardiovascular diseases, hypertension, risk factors, prevention, healthcare costs, DALY, mortality., Competing Interests: Das vorliegende Paper ist im Rahmen des von Novartis unterstützten Projektes «Take action» entstanden, das darauf abzielt, die Versorgung von kardiovaskulären Risikopatient/-innen zu verbessern, und von Frau Dr. Agnès Bachofner geleitet wird. Novartis hat auf den Inhalt keinen Einfluss genommen., (© 2024 Aerzteverlag medinfo AG.)

Introduction: Due to their advantageous benefit-risk-profile, direct oral anticoagulants (DOACs) are preferred over vitamin-K-antagonists for stroke prevention in atrial fibrillation as well as therapy and secondary prevention of venous thromboembolism. This guideline provides information on the practical use of DOACs, their advantages and disadvantages and limitations. It is based on recommendations from international guidelines (ESC, EHRA, DGA) and adapts them for the general practitioner setting in Switzerland., Competing Interests: Es bestehen keine Interessenskonflikte., (© 2023 Aerzteverlag medinfo AG.)

Introduction: Medical guidelines summarize evidence based knowledge and give helpful recommendations for diagnostics and therapy in daily practice. Most Swiss medical societies therefore adapt international guidelines for the Swiss setting. In primary care this adaption must not only take into account the specific Swiss healthcare system, but also the specific setting of primary care, which is characterized by a low prevalence of most diseases as well as by chronic conditions and multimorbidity. Exactly these multimorbid patients are underrepresented in the studies, which underline the current guidelines of medical societies. The institute of primary care at the university of Zurich, IHAMZ, therefore creates evidence based guidelines according to international established quality criteria for the Swiss primary care setting., (© 2023 Aerzteverlag medinfo AG.)

Gout and Its Management in Clinical Practice Abstract. Resolution of an acute attack is usually the prime objective in routine clinical management of gout. Crystal identification in synovial fluid by polarised light microscopy is considered the diagnostic gold standard. Imaging procedures such as high-resolution ultrasonography are also useful. Non-steroidal anti-inflammatory drugs, steroids and colchicine (not approved in Switzerland, available from pharmacies) are used to treat an acute gout attack. Just as important as the diagnosis and treatment of an acute attack is the long-term management of hyperuricaemia in order to prevent further gout attacks as well as possible renal, cardiac or metabolic complications. Therefore, patients with a confirmed diagnosis of gout should, apart from non-pharmacologic interventions, receive hypouricaemic therapy with a target uric acid level of <360 µmol/l (<6 mg/dl). Drugs of first choice are xanthine oxidase inhibitors. Achievement of the therapeutic objective should be periodically reviewed, adjusting therapy as necessary.