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Background: Supporting individuals in managing their suicidality can prevent suicidal behavior. This study evaluated the suicide prevention project SERO, which was launched in Central Switzerland in 2021. SERO comprises four components: the suicide risk assessment technique PRISM-S, a personal safety plan, mental health first aid courses for relatives, and a self-management app. We assessed the mental health of individuals at increased suicide risk after hospital discharge and evaluated the usage and usefulness of SERO components., Methods: A cross-sectional study targeted former patients of Lucerne Psychiatry with an increased suicide risk. Between March 2023 and March 2024, we collected data from 24 individuals through a questionnaire administered six months post-discharge. Descriptive statistics characterized sociodemographics, assessed self-efficacy, self-management, and health literacy, and analyzed the usage and usefulness of SERO components. Associations between the usage of SERO components and mental health outcomes were investigated using Wilcoxon rank sum tests., Results: Mental health assessments indicated, on average, low to moderate levels of self-efficacy, self-management, and health literacy, with substantial variations across individuals. Participants' exposure to SERO components varied: 83% used PRISM-S for suicide risk assessment, 67% developed a personal safety plan, 38% used the SERO app, and 8% reported that their relatives participated in a mental health first aid course. 50% of safety plan users and 44% of SERO app users found the tools helpful before or during a suicidal crisis. 78% of SERO app users would recommend the app to others., Conclusion: Low to moderate levels of self-efficacy, self-management, and health literacy underscore the need for targeted interventions to support individuals at suicide risk. Positive feedback on the personal safety plan and the SERO app suggests their potential effectiveness in helping individuals manage their suicidality. Therefore, integrating structured measures for promoting self-management into standard care protocols in psychiatric hospitals and into patients' lives may contribute to preventing suicides. The main limitation of our study is its small sample size. Future larger-scale studies should investigate user experiences in detail, assess the causal effects of SERO components on specific mental health and suicide outcomes, and evaluate the cost-effectiveness of each component separately and in combination., Competing Interests: The co-authors MD, CG, GH, IW, and the SERO Study Group are members of the SERO project team and/or employees at Lucerne Psychiatry, contributing to the design and implementation of the SERO components examined in this study. Thus, they hold a financial and employment relationship with the SERO project. However, these authors did not participate in the data analysis and interpretation of the results. No direct funding or other financial support from the SERO project was received for conducting this research. The specific roles of all authors are detailed in the author contributions statement to provide transparency regarding their contributions and potential influences on the research. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor CH declared a shared parent affiliation with authors GF, SR, KW at the time of review., (Copyright © 2024 Werdin, Fink, Rajkumar, Durrer, Gurtner, Harbauer, Warnke and Wyss.)

Autoinjectable devices continue to provide real-life benefits for patients with chronic conditions since their widespread adoption 30 years ago with the rise of macromolecules. Nonetheless, issues surrounding adherence, patient administration techniques, disease self-management, and data outcomes at scale persist despite product design innovation. The interface of drug device combination products and digital health technologies formulates a value proposition for next-generation autoinjectable devices to power the delivery of precision care at home and achieve the full potential of biologics. Success will largely be dependent on biopharma's digital health maturity to implement this framework. This viewpoint measures the digital health maturity of the top 15 biopharmaceutical companies in the US biologics autoinjector market and establishes the framework for next-generation autoinjectable devices powering home-based precision care and the need for formal digital health training., (©Ramin Rafiei, Chelsea Williams, Jeannette Jiang, Timothy Dy Aungst, Matthias Durrer, Dao Tran, Ralph Howald. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 18.03.2021.)

Background: Deep sternal wound infection is a serious and expensive complication after cardiac surgical procedures. We tried to identify risk factors for failure of vacuum-assisted sternal closure and compare the outcome and long-term quality of life (QoL) with the results obtained after sternal resection and muscle flap., Methods: Between January 1998 and December 2003, 5,690 patients underwent cardiac surgical procedures at our institution. Fifty-five patients who had deep sternal wound infection were identified between January 1998 and December 2003. In-hospital data were assessed and the outcome was analyzed. QoL, using the Short Form 36 Health Survey Questionnaire (SF-36), was assessed and an additional questionnaire focused on specific problems., Results: Overall mortality was 5.4%. Patients with successful vacuum-assisted sternal closure were younger and had fewer cumulative risk factors (chronic obstructive pulmonary disease, bilateral internal mammary artery, obesity, diabetes), than patients in whom secondary closure failed. Quality of life was better among patients with secondary vacuum-assisted closure than among patients with musculocutaneous flap. Independently of the modality of treatment, pain was not a serious problem reported by the patients during the follow-up., Conclusions: We conclude that preservation of the sternum should be the principal aim of surgical treatment in patients with deep sternal wound infection. Early diagnosis, aggressive surgical treatment by débridement, and the use of vacuum-assisted systems allows us to achieve a good long-term result with nearly normal QoL. Resection and musculocutaneous flap is a therapeutic option for high-risk patients, providing a safe, effective control of the infection, and it leads to acceptable results in terms of pain control and QoL.