[Complementary and alternative medicine in primary care in Switzerland]

OBJECTIVE: This study investigated the current supply of complementary and alternative medicine (CAM) in Swiss primary care. Information was collected on physicians' qualifications in CAM, frequency of patients' demand for CAM, physicians' supply and temporal resources for CAM as well as physicians' referrals to CAM. MATERIAL AND METHODS: 750 (500 German-speaking and 250 French-speaking) randomly selected Swiss female and male primary care physicians were asked to complete a questionnaire (response rate 50.4%). Sociodemographic data on professional training, place of residence, and sex were used to calculate a weighting factor to correct the responders' data in the analysis accordingly. RESULTS: 14.2% of the physicians were qualified in at least one CAM discipline. Around 30% (95% confidence interval 25.4-34.6%) of the physicians were asked for CAM by their patients more than once a week. Homeopathy and phytotherapy were the most frequently offered therapies, followed by traditional Chinese medicine (TCM)/acupuncture. 62.5% (57.6-67.4%) of the physicians refer their patients to CAM. Most patients were referred to TCM/acupuncture. Of the 37.2% (32.6-42.4%) of the physicians who do not refer their patients to CAM, around 40% (35.1-44.9%) offer it themselves. CONCLUSION: About three quarters of the physicians offer CAM themselves or refer their patients to CAM treatments. CAM is very important in primary medical care in Switzerland. Clear regulations for CAM are required in order to ensure a high quality in care.

Empfehlungen zur Diagnostik und Therapie der behavioralen und psychologischen Symptome der Demenz (BPSD)

In patients with dementia, Behavioral and Psychological Symptoms of Dementia (BPSD) are frequent findings that accompany deficits caused by cognitive impairment and thus complicate diagnostics, therapy and care. BPSD are a burden both for affected individuals as well as care-givers, and represent a significant challenge for therapy of a patient population with high degree of multi-morbidity. The goal of this therapy-guideline issued by swiss professional associations is to present guidance regarding therapy of BPSD as attendant symptoms in dementia, based on evidence as well as clinical experience. Here it appears to be of particular importance to take into account professional experience, as at this point for most therapeutic options no sufficiently controlled clinical trials are available. A critical discussion of pharmaco-therapeutic intervention is necessary, as this patient-population is particularly vulnerable for medication side-effects. Finally, a particular emphasis is placed on incorporating and systematically reporting psycho-social and nursing options therapeutic intervention.

Challenges for medical educators: results of a survey among members of the German Association for Medical Education

BACKGROUND Despite the increasing interest in medical education in the German-speaking countries, there is currently no information available on the challenges which medical educators face. To address this problem, we carried out a web-based survey among the members of the Association for Medical Education (Gesellschaft für medizinische Ausbildung, GMA). METHODS A comprehensive survey was carried out on the need for further qualifications, expertise and the general conditions of medical educators in Germany. As part of this study, the educators were asked to list the three main challenges which they faced and which required urgent improvement. The results were analysed by means of qualitative content analysis. RESULTS The questionnaire was completed by 147 of the 373 members on the GMA mailing list (response rate: 39%). The educators named a total of 346 challenges and emphasised the following areas: limited academic recognition for engagement in teaching (53.5% of educators), insufficient institutional (31.5%) and financial support (28.4%), a curriculum in need of reform (22.8%), insufficient time for teaching assignments (18,9%), inadequate teacher competence in teaching methods (18.1%), restricted faculty development programmes (18.1%), limited networking within the institution (11.0%), lack of teaching staff (10.2%), varying preconditions of students (8.7%), insufficient recognition and promotion of medical educational research (5.5%), extensive assessment requirements (4.7%), and the lack of role models within medical education (3.2%). CONCLUSION The medical educators found the biggest challenges which they faced to be limited academic recognition and insufficient institutional and financial support. Consequently, improvements should be implemented to address these issues.

Wie fremdenfeindlich ist die Schweiz? Fünf Feldexperimente über prosoziales Verhalten und die Diskriminierung von Ausländern

Umfragen über Vorurteile führen oft zu verzerrten Ergebnissen, da die Befragten häufig „sozial erwünschte“ Antworten geben. In unserer Studie über Vorurteile und Diskriminierung haben wir dagegen vier Feldexperimente in der Stadt Zürich durchgeführt, in denen jeweils von Angehörigen verschiedener Nationalitäten oder religiöser Gruppen eine Hilfeleistung erbeten wurde. Beispielsweise wurden Passanten von einer Person mit Kopftuch um eine Hilfeleistung gebeten; in der Kontrollbedingung dagegen ohne Kopftuch. In einem anderen Experiment wurden Personen in Hochdeutsch angesprochen und in der Kontrollsituation im Schweizer Dialekt. Ein fünftes Experiment bezog sich auf die Reaktionen von Arbeitgebern auf Initiativbewerbungen. Es zeigte sich, dass im Alltagsverhalten keine signifikanten Unterschiede im Ausmaß der Hilfeleistung zwischen den Gruppen nachweisbar waren. Alle vier Experimente zu kleinen Hilfen im Alltag ergaben weder bezüglich Deutschen noch muslimischen Minderheiten Hinweise auf diskriminierendes Verhalten. Deutliche Hinweise gibt es dagegen für die Diskriminierung bestimmter ethnischer Gruppen auf dem Arbeitsmarkt, auch wenn Bewerber die gleiche Qualifikation wie Schweizer und die Schweizer Staatsbürgerschaft besitzen.

Conditions for the career entry of Swiss sports science graduates.

The differentiation and commercialisation of the sports domain means that graduates with sports science degrees have more and more occupational fields to choose from. On the other hand, formal admissions criteria are becoming less important in sports-related occupations. This means that graduates need to pursue specific strategies to successfully embark on a ca-reer. This article examines which factors determine the career entry of sports science graduates in Switzerland. Aside from the starting salary, non-monetary aspects such as appropriateness of the job for the level of education and job stability were also considered. The empirical study draws on data from a sample of n = 1,054 graduates from all Swiss universities, analys-ing the career entry of sports science graduates. The results show that education-related as-pects (e.g., university degree) lead to higher incomes and jobs that are appropriate to one’s academic education; however, differences exist between the diverse occupational domains of sport. Furthermore, additional qualifications obtained by sports science graduates and volun-tary activities in the field of sport are both associated with higher incomes, particularly in oc-cupations outside sport. However, other factors (e.g., social networks, internships) produce no relevant effects.

Simulation in vascular access surgery training.

Rapidly growing technical developments and working time constraints call for changes in trainee formation. In reality, trainees spend fewer hours in the hospital and face more difficulties in acquiring the required qualifications in order to work independently as a specialist. Simulation-based training is a potential solution. It offers the possibility to learn basic technical skills, repeatedly perform key steps in procedures and simulate challenging scenarios in team training. Patients are not at risk and learning curves can be shortened. Advanced learners are able to train rare complications. Senior faculty member's presence is key to assess and debrief effective simulation training. In the field of vascular access surgery, simulation models are available for open as well as endovascular procedures. In this narrative review, we describe the theory of simulation, present simulation models in vascular (access) surgery, discuss the possible benefits for patient safety and the difficulties of implementing simulation in training.