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Background: The implementation of electronic health information technologies is a key target for healthcare quality improvement. Among Swiss chiropractors, reliable data on the use of electronic heath information technologies and distribution of the health workforce was lacking. Objectives: To estimate the prevalence of electronic patient record (EPR) and encrypted email communication use among Swiss chiropractors and describe the geographic distribution of chiropractors in Switzerland. Methods: Population-based cross-sectional study of all active practising members of the Swiss Chiropractic Association (ChiroSuisse) between 3 December 2019 and 31 January 2020. We asked about clinician and practice characteristics, EPR use for clinical record keeping, use of encrypted email for patient communication, and information on EPR and encrypted email communication products used. Multivariable logistic regression analyses assessed the association between clinician and practice characteristics and (1) EPR use and (2) encrypted email use. Results: Among 286 eligible Swiss chiropractors (193 [68%] men; mean age, 51.4 [SD, 11.2] years), 217 (76%) completed the survey (140 [65%] men; mean age 50.7 [11.2] years). The density of chiropractors in Switzerland was 3.3 per 100,000 inhabitants. 47% of respondents (95% confidence interval [CI], 40% to 54%) reported using an EPR in their practice, while 60% (95% CI, 54% to 67%) endorsed using encrypted email technology. Chiropractors aged ≥60 (versus those ≤39) years were 74% less likely to use an EPR system (OR 0.26, 95% CI 0.08 to 0.77), while clinicians from practices with 4 or more chiropractors (versus those from solo practices) were over 5 times more likely to report EPR use (OR 5.6, 2.1 to 16.5). Findings for factors associated with encrypted email use were similar. Conclusions: As of January 2020, 286 duly licensed chiropractors were available to provide musculoskeletal healthcare in Switzerland — just under 50% of Swiss chiropractors used an EPR system in clinical practice, while 60% used encrypted email technology. Better implementation of EPR and electronic health information technologies in Swiss chiropractic practice is possible and desirable for the purpose of musculoskeletal healthcare quality improvement.

The Swiss chiropractic practice-based research network (PBRN) is a nationwide project developed in collaboration with patients, clinicians, and academic stakeholders to advance epidemiological research relating to chiropractic care and musculoskeletal pain. The aim of this study was to describe the clinician population recruited and representativeness of this PBRN to inform future collaboration. A population-based cross-sectional study of clinician members of the Swiss Chiropractic Association who consented and completed a PBRN entry questionnaire was performed. Clinician characteristics were described and factors related to motivation to participate in a subsequent patient cohort pilot study (operationalised as VAS score ≥ 70) were assessed using multivariable logistic regression analysis. Among 326 eligible chiropractors, 152 enrolled in the PBRN (47% participation; mean age 47 years; 53% men). The PBRN was representative of the larger Swiss chiropractic clinician population with regards to age, language, and geographic distribution of chiropractors and clinics. Of those enrolled, 39% endorsed being motivated to participate in a nested patient cohort pilot study. Motivation was associated with age 40 years or older versus 39 years or younger (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.0 to 5.5), and with a moderate clinic size of 2 or 3 chiropractors (OR 2.5, 95%CI 1.1 to 5.9) or large clinic size of 4 or more chiropractors (OR 2.8, 95%CI 1.0 to 7.0) versus solo practice. The Swiss chiropractic PBRN has enrolled almost half of all Swiss chiropractors in over 100 clinical practices and has potential to facilitate collaborative practice-based research to improve chiropractic health care quality. Trial registration Swiss chiropractic PBRN (ClinicalTrials.gov identifier: NCT05046249); Swiss chiropractic cohort (Swiss ChiCo) pilot study (ClinicalTrials.gov identifier: NCT05116020).

BACKGROUND The implementation of electronic health information technologies is a key target for health care quality improvement. Among Swiss chiropractors, reliable data on the use of electronic heath information technologies and distribution of the health workforce was lacking. OBJECTIVE To estimate the prevalence of electronic patient record (EPR) and encrypted email communication use among Swiss chiropractors and describe the geographic distribution of chiropractors in Switzerland. METHODS Population-based cross-sectional study of all active practising members of the Swiss Chiropractic Association (ChiroSuisse) between 3 December 2019 and 31 January 2020. We asked about clinician and practice characteristics, EPR use for clinical record keeping, use of encrypted email for patient communication, and information on EPR and encrypted email communication products used. Multivariable logistic regression analyses assessed the association between clinician and practice characteristics and (1) EPR use and (2) encrypted email communication use. RESULTS Among 286 eligible Swiss chiropractors (193 [68%] men; mean age, 51.4 [SD, 11.2] years), 217 (76%) completed the survey (140 [65%] men; mean age 50.7 [11.2] years). The density of chiropractors in Switzerland was 3.3 per 100,000 inhabitants. 47% (95% confidence interval [CI], 40% to 54%) of respondents reported using an EPR in their practice, while 60% (95% CI, 54% to 67%) endorsed using encrypted email technology. Chiropractors aged ≥60 (versus those ≤39) years were 74% less likely to use an EPR system (OR 0.26, 95% CI 0.08 to 0.77), while clinicians from practices with 4 or more chiropractors (versus those from solo practices) were over 5 times more likely to report EPR use (OR 5.6, 2.1 to 16.5). Findings for factors associated with encrypted email use were similar. CONCLUSIONS As of January 2020, 286 duly licensed chiropractors were available to provide musculoskeletal healthcare in Switzerland and just under 50% of Swiss chiropractors used an EPR system in clinical practice. Better implementation of EPR and electronic health information technologies in Swiss chiropractic practice is possible and desirable for the purpose of musculoskeletal healthcare quality improvement. CLINICALTRIAL Not applicable.

Background This study aimed to assess the effectiveness of sodium‐glucose cotransporter 2 inhibitors in reducing the incidence of mortality and cardiovascular outcomes in adults with type 2 diabetes. Methods and Results We conducted a Bayesian meta‐analysis of randomized controlled trials comparing sodium‐glucose cotransporter 2 inhibitors with placebo. We used meta‐regression to examine the association between treatment effects and control group event rates as measures of cardiovascular baseline risk. Fifty‐three randomized controlled trials were included in our synthesis. Empagliflozin, canagliflozin, and dapagliflozin reduced the incidence of all‐cause mortality (empagliflozin: rate ratio [RR], 0.79; 95% credibility interval [CrI], 0.63–0.97; canagliflozin: RR, 0.86; 95% CrI, 0.69–1.05; dapagliflozin: RR, 0.86; 95% CrI, 0.72–1.01) and cardiovascular mortality (empagliflozin: RR, 0.78; 95% CrI, 0.61–1.00; canagliflozin: RR, 0.83; 95% CrI, 0.63–1.05; dapagliflozin: RR, 0.88; 95% CrI, 0.71–1.08), with a 90.1% to 98.7% probability for the true RR to be Conclusions Empagliflozin, canagliflozin, and dapagliflozin reduced the incidence of all‐cause and cardiovascular mortality versus placebo. Treatment effects of sodium‐glucose cotransporter 2 inhibitors versus placebo do not vary by baseline risk.

IntroductionMusculoskeletal (MSK) pain conditions, a leading cause of global disability, are usually first managed in primary care settings such as medical, physiotherapy, and chiropractic community-based practices. While chiropractors often treat MSK conditions, there is limited real-world evidence on the topic of health service outcomes among patients receiving this type of care. A nationwide Swiss chiropractic practice-based research network (PBRN) and MSK pain patient cohort study will have potential to monitor the epidemiological trends of MSK pain conditions and contribute to healthcare quality improvement. The primary aims of this protocol are to (1) describe the development of an MSK-focused PBRN within the Swiss chiropractic setting, and (2) describe the methodology of the first nested study to be conducted within the PBRN—an observational prospective patient cohort pilot study.Methods and analysisThis initiative is conceptualised with two distinct phases. Phase I focuses on the development of the Swiss chiropractic PBRN, and will use a cross-sectional design to collect information from chiropractic clinicians nationwide. Phase II will recruit consecutive patients aged 18 years or older with MSK pain from community-based chiropractic practices participating in the PBRN into a prospective chiropractic cohort pilot study. All data collection will occur through electronic surveys offered in the three Swiss official languages (German, French, Italian) and English. Surveys will be provided to patients prior to their initial consultation in clinics, 1 hour after initial consultation, and at 2, 6 and 12 weeks after initial consultation.Ethics and disseminationEthics approval has been obtained from the independent research ethics committee of Canton Zurich (BASEC-Nr: 2021-01479). Informed consent will be obtained electronically from all participants. Findings will be reported to stakeholders after each study phase, presented at local and international conferences, and disseminated through peer-reviewed publications.Study pre-registrationPhase I—Swiss chiropractic PBRN (ClinicalTrials.gov identifier: NCT05046249); Phase 2—Swiss chiropractic cohort (Swiss ChiCo) pilot study (ClinicalTrials.gov identifier: NCT05116020).

In 2015, the U.S. Soccer Federation banned heading for players aged 10-13.To assess the change in proportion of children aged 10-13 playing soccer in the US presenting to an Emergency Department (ED) with a concussion in relation to any other injury before and after the ban.Analysis was restricted to soccer athletes between 10-13 years that reported to a National Electronic Injury Surveillance System (NEISS) participating hospital ED following injury in 2013-2014 and 2016-2017. Multivariable logistic regression was performed to assess the association between year of injury and concussion diagnosis in relation to other injury diagnosis after adjusting for age, sex, and ethnicity.Concussion in relation to other injuries showed a significant increase in 2016-2017 when compared to 2013-2014 after adjustment (OR= 1.286, 95%CI = 1.090-1.517).These results suggest that banning heading may not reduce concussion within this population. However, significant confounders, including increased reporting, were not controlled for.En 2015, la U.S. Soccer Federation a interdit le coup de tête au ballon aux joueurs de 10 à 13 ans.Déterminer le changement de proportion de jeunes joueurs de soccer américains de 10 à 13 ans arrivant en salle des urgences avec une commotion cérébrale liée à d’autres types de blessures subies avant et après l’interdiction.L’analyse s’est limitée aux jeunes joueurs de soccer âgés de 10Le rapport entre commotion cérébrale et autres blessures a considérablement augmenté en 2016–2017par rapport à ce qu’il était en 2013–2014 après correction (RR = 1,286, IC à 95 % = 1,090–1,517).Ces résultats laissent supposer que l’interdiction de coups de tête au ballon peut ne pas réduire le nombre de commotions cérébrales dans cette population. Cependant, il y a eu d’importantes variables confondantes, comme l’augmentation du nombre de cas signalés, pour lesquelles aucun contrôle n’a été inclus.