Imagerie par DXA: le couteau suisse multifonction [DXA imaging: the multifunction Swiss army knife?].

Les importants progrès dans la qualité et la résolution des images obtenues par «absorptiométrie biphotonique à rayons X» ou DXA ont amélioré certaines modalités existantes et favorisé le développement de nouvelles fonctions permettant d'affiner de manière significative la prise en charge de nos patients dans diverses pathologies. On peut par exemple améliorer la prédiction du risque fracturaire par l'analyse indirecte de la micro et de la macroarchitecture osseuse, rechercher les marqueurs de pathologies associées (recherche de fractures vertébrales ou de fractures fémorales atypiques), ou évaluer le statut métabolique par la mesure de la composition corporelle. Avec les appareils DXA les plus performants, on pourra bientôt déterminer l'âge osseux, estimer le risque cardiovasculaire (par la mesure de la calcification de l'aorte abdominale), ou prédire la progression de l'arthrose articulaire et son évolution après la prise en charge chirurgicale dans la routine clinique. The significant progress on the quality and resolution of the images obtained by "Dual X-ray Absorptiometry" or DXA has permitted on one hand to improve some existing features and on the other to develop new ones, significantly refining the care of our patients in various pathologies. For example, by improving the prediction of fracture risk by indirect analysis of micro- and macro-architecture of the bone, by looking for markers of associated bone diseases (research vertebral fractures or atypical femoral fractures), or by assessing the metabolic status by the measurement of body composition. With the best performing DXA devices we will soon be able, in clinical routine, to determine bone age, to estimate cardiovascular risk (by measuring the calcification of the abdominal aorta) or to predict the progression of joint osteoarthritis and its evolution after surgical management.

Sickness certification in primary care: a survey on views and practices among Swiss physicians.

QUESTIONS UNDER STUDY: Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients. METHODS: We conducted an online survey among GPs throughout Switzerland, exploring behaviour of physicians, patients and employers with regard to sickness certification; GPs' views about sickness certification; required competences for certifying sickness absence, and approaches to advance their competence. We piloted the questionnaire and disseminated it through the networks of the five Swiss academic institutes for primary care. RESULTS: We received 507 valid responses (response rate 50%). Only 43/507 GPs experienced sickness certification as problematic per se, yet 155/507 experienced problems in sickness certification at least once a week. The 507 GPs identified estimating a long-term prognosis about work capacity (64%), handling conflicts with patients (54%), and determining the reduction of work capacity (42%) as problematic. Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%). CONCLUSION: Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK. Swiss GPs did identify specific tasks of sickness certification as problematic. Training opportunities on sick-leave certification and insurance medicine in general were welcomed.

The SIB Swiss Institute of Bioinformatics' resources: focus on curated databases.

The SIB Swiss Institute of Bioinformatics (www.isb-sib.ch) provides world-class bioinformatics databases, software tools, services and training to the international life science community in academia and industry. These solutions allow life scientists to turn the exponentially growing amount of data into knowledge. Here, we provide an overview of SIB's resources and competence areas, with a strong focus on curated databases and SIB's most popular and widely used resources. In particular, SIB's Bioinformatics resource portal ExPASy features over 150 resources, including UniProtKB/Swiss-Prot, ENZYME, PROSITE, neXtProt, STRING, UniCarbKB, SugarBindDB, SwissRegulon, EPD, arrayMap, Bgee, SWISS-MODEL Repository, OMA, OrthoDB and other databases, which are briefly described in this article.

Patients' understanding of blood tests and attitudes to HIV screening in the emergency department of a Swiss teaching hospital: a cross-sectional observational study.

BACKGROUND: In Switzerland, patients may undergo "blood tests" without being informed what these are screening for. Inadequate doctor-patient communication may result in patient misunderstanding. We examined what patients in the emergency department (ED) believed they had been screened for and explored their attitudes to routine (non-targeted) human immunodeficiency virus (HIV) screening. METHODS: Between 1st October 2012 and 28th February 2013, a questionnaire-based survey was conducted among patients aged 16-70 years old presenting to the ED of Lausanne University Hospital. Patients were asked: (1) if they believed they had been screened for HIV; (2) if they agreed in principle to routine HIV screening and (3) if they agreed to be HIV tested during their current ED visit. RESULTS: Of 466 eligible patients, 411 (88%) agreed to participate. Mean age was 46 ± 16 years; 192 patients (47%) were women; 366 (89%) were Swiss or European; 113 (27%) believed they had been screened for HIV, the proportion increasing with age (p ≤0.01), 297 (72%) agreed in principle with routine HIV testing in the ED, and 138 patients (34%) agreed to be HIV tested during their current ED visit. CONCLUSION: In this ED population, 27% believed incorrectly they had been screened for HIV. Over 70% agreed in principle with routine HIV testing and 34% agreed to be tested during their current visit. These results demonstrate willingness among patients concerning routine HIV testing in the ED and highlight a need for improved doctor-patient communication about what a blood test specifically screens for.

Trends and characteristics of attendance at the emergency department of a Swiss university hospital: 2002-2012.

BACKGROUND: The numbers of people attending emergency departments (EDs) at hospitals are increasing. We aimed to analyse trends in ED attendance at a Swiss university hospital between 2002 and 2012, focussing on age-related differences and hospital admission criteria. METHODS: We used hospital administrative data for all patients aged ≥16 years who attended the ED (n = 298,306) at this university hospital between 1 January 2002, and 31 December 2012. We descriptively analysed the numbers of ED visits according to the admission year and stratified by age (≥65 vs <65 years). RESULTS: People attending the ED were on average 46.6 years old (standard deviation 20 years, maximum range 16‒99 years). The annual number of ED attendances grew by n = 6,639 (27.6%) from 24,080 in 2002 to 30,719 in 2012. In the subgroup of patients aged ≥65 the relative increase was 42.3%, which is significantly higher (Pearson's χ2 = 350.046, df = 10; p = 0.000) than the relative increase of 23.4% among patients <65 years. The subgroup of patients ≥65 years attended the ED more often because of diseases (n = 56,307; 85%) than accidents (n = 9,844; 14.9%). This subgroup (patients ≥65 years) was also more often admitted to hospital (Pearson's χ2 = 23,377.190; df = 1; p = 0.000) than patients <65 years. CONCLUSIONS: ED attendance of patients ≥65 years increased in absolute and relative terms. The study findings suggest that staff of this ED may want to assess the needs of patients ≥65 years and, if necessary, adjust the services (e.g., adapted triage scales, adapted geriatric screenings, and adapted hospital admission criteria).

Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS: We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. RESULTS: A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21-12.20). CONCLUSIONS: There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.

Sociodemographic, behavioral and genetic determinants of allostatic load in a Swiss population-based study.

Allostatic load (AL) is a marker of physiological dysregulation which reflects exposure to chronic stress. High AL has been related to poorer health outcomes including mortality. We examine here the association of socioeconomic and lifestyle factors with AL. Additionally, we investigate the extent to which AL is genetically determined. We included 803 participants (52% women, mean age 48±16years) from a population and family-based Swiss study. We computed an AL index aggregating 14 markers from cardiovascular, metabolic, lipidic, oxidative, hypothalamus-pituitary-adrenal and inflammatory homeostatic axes. Education and occupational position were used as indicators of socioeconomic status. Marital status, stress, alcohol intake, smoking, dietary patterns and physical activity were considered as lifestyle factors. Heritability of AL was estimated by maximum likelihood. Women with a low occupational position had higher AL (low vs. high OR=3.99, 95%CI [1.22;13.05]), while the opposite was observed for men (middle vs. high OR=0.48, 95%CI [0.23;0.99]). Education tended to be inversely associated with AL in both sexes(low vs. high OR=3.54, 95%CI [1.69;7.4]/OR=1.59, 95%CI [0.88;2.90] in women/men). Heavy drinking men as well as women abstaining from alcohol had higher AL than moderate drinkers. Physical activity was protective against AL while high salt intake was related to increased AL risk. The heritability of AL was estimated to be 29.5% ±7.9%. Our results suggest that generalized physiological dysregulation, as measured by AL, is determined by both environmental and genetic factors. The genetic contribution to AL remains modest when compared to the environmental component, which explains approximately 70% of the phenotypic variance.

The updated Swiss guidelines 2016 for the treatment and follow-up of cutaneous melanoma.

Cutaneous melanoma is the most deadly cutaneous neoplasm. In order to guide treatment decisions and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland were inaugurated in 2001 and revised in 2006 and 2016. Recent data on surgical and medical treatments from randomised trials necessitated modification of the treatment and follow-up recommendations.

Wenceslai Clementis à Lybeo Monte Lechiados, sive Regum rerumque Polonicarum libri IV. versibus heroïcis.

Colbertinus

Jacobus de Voragine. Ogerius Locediensis. Guillelmus de Malliaco.

F. 13-142v [Jacobus de Voragine, Sermones excerpti e collectione sermonum festivalium per anni circulum]; cf. Schneyer, Repert. lat. Serm., III, 246-268. [In Nativitate]; cf. ibid., n° 319, incomplet du début, et n° 324 (13-18v); — « In circumcissione [sic] Domini »; cf. ibid., n° 346 et 347 (18v-24); — « In Epiphania Domini »; cf. ibid., n° 351 et 354 (24-28v); — « In Purificatione sancte Marie »; cf. ibid., n° 374 et 376 (28v-34); — « In Adnunciatione beate Marie.; cf. ibid., n° 396 (34-36v) et n° 397, incomplet du début par lacune matérielle (38-39); — « De s. Johanne Baptista »; cf. ibid., n° 465 et 467 (39-44); — « De apostolis Petro et Paulo »; cf. ibid., n° 471 et 473 (44-49v); — « De b. Paulo apostolo »; cf. ibid., n° 474 (49v-53); — « De s. Maria Magdalena »; cf. ibid., n° 479 et 480 (53-59v); — « De b. Laurentio martyre »; cf. ibid., n° 497 et 499 (59v-65); — « In Assumpcione b. Marie »; cf. ibid., n° 504 et 509 (65-72v); — « De s. Augustino »; cf. ibid., n° 521 et 523 (72v-79v); — « In Nativitate b. Marie »; cf. ibid., n° 528 et 530, incomplet de la fin, en réclame « virginis » (79v-84v); — [De s. Michaele]; cf. ibid., n° 544, incomplet du début par lacune matérielle, et n° 550 (86-90v); — « In festo omnium sanctorum »; cf. ibid., n° 568 et 570 (90v-96v); — « De mortuis »; cf. ibid., n° 574-577 (96v-107v); — « De s. Martino »; cf. ibid., n° 582, incomplet de la fin (107v-109v) et n° 583 incomplet du début par lacune matérielle (111-113v); — « De b. Katerina »; cf. ibid., n° 591 et 592 (113v-119v); — « De dedicacione ecclesie »; cf. ibid., n° 594 et 595 (119v-127); — « De consecracione altaris »; cf. ibid., n° 597 (127-130); — « De vestibus sacris sacerdotis quid significant »; cf. ibid., n° 598 (130-134); — « De exposicione misse »; cf. ibid., n° 599 et 600 (134-142v). F. 142v-146 « Sermo ad religiosos. Quia existis indesertum... (Mt. XI, 7). Istam questionem quam fecit Dominus... ». F. 146-150v [Guillelmus de Malliaco, Sermo excerptus e collectione sermonum de Tempore dicta « Abjiciamus »]; cf. Schneyer, op. cit., II, 483-489. « De visitacione et officio visitacionis »; cf. ibid., n° 72. F. 150v-158 Sermones. « In concilio magnatum. Quoniam ecce reges terre... (Ps. XLVII, 5). Hic duo tanguntur scilicet magnorum conveniencia temporalis... » (150v-151v); — « In synodo clericorum. Pro patribus tui nati sunt tibi filii... (Ps. XLIV, 17). Adtendant ecclesiarum prelati tria... » (151v-155); — « Sermo ad religiosos. Deus qui habit are facit unanimes in domo secundum hebraicam veritatem et secundum Johannem. Deus qui habitare racit monachos... » (155-158). F. 158-160v [Jacobus de Voragine, Sermo de s. Mathia] « Sermo in electione », incomplet par lacune matérielle, en réclame « vir perfectus »; cr. Schneyer, loc. cit., n° 382, moins développé. F. 161-169v [Ogerius Locediensis] « Planctus b. Bernardi de dolore Marie virginis propter filium » (en titre-courant). « Quis dabit capiti meo aquam et oculis meis imbrem sicut presens dies demostrat [sic] cunctis aperte. Inclita regina celica rosa flos sine spina// ...memento mei »; extrait du De Laudibus b. Virginis, rédaction B; cf. H. Barré, dans Revue d'ascétique et de mystique, XXVIII (1952), 243-266, mss. et éditions. Le texte est incomplet par lacune matérielle, un f. ayant été coupé entre les fr. 163 et 164. F. 169v-184 Sermones. « Sermo in Assumptione b. Marie. Surrexit rex in occursum... (III Reg. II, 19). Quam multiplici figura Salomon ille... », incomplet de la fin (169v-171v); — sermon incomplet du début par lacune matérielle (174); — « Sermo in capite jejunii. Convertimini ad Dominum Deum vestrum... (Joel II, 13). Agreditur hodie Spiritus sanctus multitudinem peccatorum... » (174-175v); — « Sermo in Paraceve. Cum egressus fuero de urbe... (Ex. lX, 29). Verba ista sunt Moysi qui gerit typum Salvatoris... » (175v-180v); — « Alius sermo in Paraceve. O vos omnes qui transitis per viam... (Thren. I, 12). Consideranti michi piam et superpiam materiam... » (180v-183v); — « Domine, bonum est nos hic esse... (Lc. lX, 33). Ubi? Petro. Isti enim tria tanguntur in mentis sublimitate... » (183v-184). F. 184v Table des ff. 1 à 193. — Addition fin XIVe s. F. 185-193 Sermones. « Sermo in Nativitate. Sicut lux aurore oriente sole... (II Reg. XXIII, 4, 2). Verba sunt David cui Dominus... » (185-186); — « Sermo in Paraceve. Deducant oculi nostri lacrimas... (Jer. lX, 18). ...ut gloriosa Virgo septies flevisse.. » (186-191); — « Quod Corpus Christi vere sit in altari. Cenantibus autem eis, accepit Jesus panem... Item Joh. (VI, 51): Ego sum panis vivus... Credebant enim quod manducaretur sicut alie carnes. ..) (191-193). F. 193v Table des ff. 194 à 285. — Addition fin XIVe s. La suite de la table a été coupée. F. 194-335v Sermones de Tempore, excerpti praesertim e collectione « Abjiciamus » Guillelmi de Malliaco et e collectionibus De Tempore et De Sanctis et festis Jacobi de Voragine; cf. Schneyer, op. cit., II, 483-489 et III, 221-233 et 246-268. F. 194-208. [Guillelmus de Malliaco] « Dom. 1a in Adventu Domini »; cf. Schneyer, II, loc. cit., n° 1 et 2 (194-203); Dom. 2a »; cf. ibid., n° 3 (203-208). F. 208-213 [Jacobus de Voragine] « Dom. 2a in Adventu Domini »; cf. Schneyer, III, loc. cit., n° 5. F. 213-218 [Guillelmus de Malliaco] « Dom. 3a »; cf. Schneyer, II, n° 6. F. 218-222 [Jacobus de Voragine] « Dom. 3a »; cf. Schneyer, III, n° 8. F. 222v-228 [Guillelmus de Malliaco] « Dom. 4a »; cf. Schneyer, II, n° 7. F. 228-232 [Jacobus de Voragine] « Dom. eadem »; cf. Schneyer, III, n° 11. F. 232-236. « Feria 4a in capite jejunii. Cum jejunatis nolite fieri... (Mt. VI, 16). Hodie incipit tempus penitentie... ». F. 236-240 « De eadem feria. Convertimini ad me in toto corde... (Joel II, 12). Homo per peccatum tria mala incurrit... ». F. 240-246 [Guillelmus de Malliaco] « Dom. 1a in quadragesima »; cf. Schneyer, II, n° 25. F. 246-319 [Jacobus de Voragine] « Dom. eadem »; cf. Schneyer, 111, n° 41 (246-251v); — « Dom. 2a in quadragesima »; cf. ibid. n° 44 et 45 (251v-259v); — « Dom. 3a in quadragesima »; cf. ibid., n° 47 et 48 (259v-270); — « Dom. 4a in quadragesima »; cf. ibid., n° 50 et 51 (270-279v); — « Dom. de passione »; cf. ibid., n° 53 et 54 (279v-290); — « Dom. de Ramis »; cf. ibid., n° 56 et 57 (290-302); — « In Cena Domini »; cf. ibid., n° 401 et 402 (302-307v); — « In Parasceve »; cf. ibid., n° 405 et 411 (307v-312); — « In die Pasce »; cf. ibid., n° 414 et 415 (312-316v); — « Feria 2a post Pasca »; cf. ibid., n° 419 (316v-319). F. 319-325v « De eadem feria. Duo ex discipulis Jhesu ibant... (Lc. XXIV, 13). Introduxit nos Dominus in terram fluentem lac... » F. 326-334 [Jacobus de Voragine] « In adscensione Domini »; cf. ibid., n° 446 et 445 (326-329v); — [In Pentecoste]; cf. ibid., n° 452 et 457 (329v-334). F. 334-335v « De eodem. Ad Deum [sic pro: eum] veniemus et mansionem... (Job. XIV, 23). Super illo verbo dicit b. Eusebius... ». F. 335v-337v Extraits patristiques. « Incipiunt quedam problemata. Lingua mea calamus ego sum. » Sont cités s. Grégoire, s. Paul, s. Augustin, s. Isidore, Boèce, Bède, Josèphe, s. Hilaire, etc.

1.° Joannis Andreae apparatus super Clementinis. — 2.° Clementinarum textus. — 3.° Guillelmi de Monte-lauduno apparatus super Clementinis : ad calcem subjiciuntur Joannis XXII. tres constitutiones

Colbertinus

1.° Guillelmi de Monte-lauduno apparatus super Clementinis et super prima, secunda et tertia Extravagantibus Joannis XXII. — 2.° Ejusdem sacramentale ad amicum suum Pontium de Villamuro. — 3.° Berengarii, Biterrensis Episcopi, libellus de sententia Excommunicationis et Interdicti ; sive casus totius juris in quibus excommunicatio incurritur ipso facto : item casus in quibus universitas vel civitas subjiciuntur, ipso jure, interdicto ecclesiastico

Colbertinus

Memoria informativa per i marchesi di Colle, Petriolo e Petrella, relativamente alla immunità ed esenzione dei medesimi contro i rappresentanti Cortonesi...

[Factum. Petrella. 1772]