Department of Public Health

Imported from Grants Tool 4707568

RemEDy (Reducing Mistriage in Emergency Departments)

The demand for emergency care varies and can change rapidly. Emergency Department (ED) performance depends on the number of patients who present, and their flow through the ED to their safest and most appropriate disposition (admission to tertiary care, referral to one of the partnering hospitals, or discharge). Effective triage is critical for the safe management of patients presenting to the ED, ensuring the right patient receives the right care at the right time in the right place with the right resources. Despite the recognized importance of accurate triage of emergency department patients, approximately 20% to 30% experience incorrect triage level assignment, known as mistriage. Mistriage might be associated with adverse health outcomes. To enhance triage accuracy, it is crucial to understand the causes of mistriage and how they are associated with the characteristics of patients, triage clinicians, and ED metrics. A comprehensive understanding of mistriage will allow for the identification of potential areas for improvement, leading to the development of measures to avoid it. RemEDy (Reducing Mistriage in Emergency Departments) will identify and analyze mistriage in a real-time triage setting in 7 ED’s in German-speaking Switzerland, comparing routine triage procedures with expert triage simultaneously, and develop and evaluate an AI model that can potentially assist with triage decisions, aiming to detect patients who should not wait early. Based on the results, we will develop a learning module for triage clinicians and assess its effectiveness in reducing mistriage. This could result in enhanced accuracy in triage code assignment, thereby reducing mistriage and its associated consequences.

New plant breeding technologies (NBTs) such as genome editing enable more efficient and flexible innovations in agriculture and food production than conventional breeding methods. Therefore, they can potentially contribute to global food security and improve public health and environmental sustainability. However, NBTs are currently covered by the Swiss moratorium on genetically modified organisms (GMOs). The regulation of NBTs is difficult due to the low societal and political acceptance of GMOs and their ethical and social impacts. These issues need to be addressed to overcome polarization and enable a conscious public and political debate.

This project aims to provide an ethical assessment of the social and societal impacts of NBTs. We will combine ethical analysis with empirical analysis of public debates and stakeholder perceptions, with a focus on the social acceptance of NBTs in Switzerland. The results of the research project will help to analyze the nature and possible reasons for the low societal acceptance of GMOs in Switzerland and its implications for the regulation of NBTs in Switzerland and the European Union.

Background and rationale:

Despite their potential for more sustainable global food production and growing evidence on their security, New Plant Breeding Technologies (NBTs) are currently strictly regulated in Switzerland and the European Union. They fall under the regulations for Genetically Modified Organisms (GMOs), whose use is currently forbidden in Switzerland and burdened by complicated administrative processes in the EU. Scientists have been voicing their dissatisfaction with these legislations.

Objectives and aims:

Few studies have assessed regulations of GMOs from a perspective that combines international law with an empirical bioethics approach. This project addresses this gap by combining a legal part on the international law dimension of GMO regulations with an empirical part that explores attitudes of two major stakeholder groups: lawyers and plant scientists from Switzerland and from countries with more permissive regulations. We will compare attitudes of both stakeholder groups and of Swiss and international interviewees to understand how they balance involved interests. A normative legal and ethics analysis will be carried out by the project team to integrate and balance health, environmental and sustainability concerns and to propose a new framework for evaluating GMO regulations in Swiss law that integrates under-researched aspects of international law.

Methods:

Traditional legal and ethical desk top research methods will be used to conduct a legal and ethical assessment of the regulations of NBTs, integrating Swiss law and international law and its relevance for Switzerland, as well as internationally. We will combine a legal analysis of international laws and standards relevant to the plant breeding and food industry with a qualitative stakeholder interview study.

We will carry out 60-80 individual interviews combining four cohorts of 15-20 interviewees: Swiss law scholars, international law scholars, Swiss plant scientists, and international scientists (international means here: from countries that have more permissive regulations). In addition, 4 Focus Groups (FG), each bringing together 6-10 participants, will be carried out. All FG will be composed of participants from all four cohorts.

In a final part, we will triangulate the results from all previous parts: we will compare the balancing of interests carried out by the interviewed persons with a legal and ethical balancing of interests. These findings will serve as a "de lege feranda" approach, in order to make policy recommendations. The latter will be discussed with a larger group of Swiss and international stakeholders to broaden the debate by raising awareness of relevant international law applicable in Switzerland, as well as of approaches from the international countries included in the empirical interview part.

Expected results and impact in the field:

The international focus of this study will fill a gap concerning legal research, as the implications of different parts of international law (WTO, UN etc.) for the discussion in Switzerland are not fully clear at present. The empirical part will be a way to explore differences in the knowledge and use of available facts and evidence, as well in the balancing of interests of two stakeholder groups that play a major role for the development of new legal regulations. Project results will make larger Swiss stakeholder groups aware of the role of international law and of attitudes in non-European countries and inform recommendations on how to regulate NBTs in Switzerland in line with existing international (trade and environment) law ratified by Switzerland.

EQUIMED investigates sex and gender inequalities in implantable medical devices. Through interviews and multidisciplinary research, it aims to improve equity in medical technology.

Despite technological advancements, medical devices do not function the same way for men and women, with women experiencing more adverse effects. Implantable devices are particularly affected by sex and gender biases. EQUIMED studies this issue in Switzerland, the UK, and Germany by analyzing data, interviewing experts and patients, and evaluating ethical policies. Its goal is to make these devices safer and more effective for everyone.

EQUIMED seeks to understand and reduce these inequalities by exploring why women and gender minorities face higher risks and what factors contribute to these disparities. Its research will support the development of fairer solutions for implantable medical devices, such as pacemakers and neural implants, while also setting new ethical standards in medical technology.

By addressing biases in research, design, and regulation, EQUIMED aims to improve the safety of medical devices for all. The project will provide evidence-based recommendations to help policymakers, manufacturers, and healthcare professionals create more inclusive technologies. Collaboration between regulators, industry, and healthcare providers is essential to ensuring safer and fairer medical devices for everyone.

Background and rationale for project

Frailty is a major public health challenge. Frailty is a multidimensional syndrome in which a person accumulates impairments in multiple life domains due to ageing. Examples include physical impairments (e.g. reduced mobility), social status (e.g. social isolation) and cognition impairment. Frailty predisposes a person to negative health outcomes and is associated with long-term disability, a lower quality of life, and high costs. As impairments accumulate, persons are less able to participate in society, interact with their direct environment, and become socially isolated. Social isolation contributes to social frailty and physical frailty. Both frailty and social isolation can therefore be considered key outcomes for novel public health solutions.

Overall objective and specific aims

The overall objective is to develop a program theory for engaging older persons in a program that combines physical and social activities to prevent frailty and reduces social isolation, operationalize this program for adoption and implementation in the community setting, and evaluate the effectiveness and implementation in two Swiss Cantons. The ENGAGE project will achieve this through the following aims:

1. To investigate current practice regarding screening and management of older persons’ frailty risk and social isolation in primary and community care, and identify determinants for improving these outcomes in this setting.
2. To investigate experiences and perceptions of older persons concerning their participation in a community program that focusses on physical activity and social engagement, and identify determinants for their participation.
3. To develop a program theory for frailty prevention and reduction of social isolation and to operationalise this in a program that combines physical and social activities that is adopted and implemented in the community setting.
4. To implement the program in two Swiss cantons and test the acceptability and feasibility, and to evaluate its impact on reducing frailty and social isolation in older persons living in the community, and to identify determinants for and costs of implementation.

Methods

A multi-phased mixed methods project methodology will be used, in collaboration with a Patient and Public Involvement (PPI) group. First, a mixed methods study will be performed using QUAN – QUAL explanatory sequential design, including a survey and interviews with healthcare professionals and community stakeholders (Objective 1). Second, a qualitative study using semi-structured interviews with older persons will be conducted, followed by group discussions using a World Café methodology (objective 2). Third, Intervention Mapping will be used to develop a program theory for preventing frailty and reducing social isolation, and will be operationalized in a program in the community that combines physical and social activities (objective 4). Fourth, a pragmatic effectiveness–implementation hybrid type-1 trial will be conducted to evaluate the impact of the program, including its effects on frailty and social isolation. A pilot study will be embedded to evaluate study burden, acceptability and feasibility. A process -and economic evaluation are included to investigate the implementation and inform scale-up strategies and costs.

Expected results

The first program theory for frailty prevention in the community will be developed. This will be the first experimental study combining physical and social activities for frailty prevention and reduction of social isolation. This will be the first project studying implementation of frailty prevention in the community, informing scale-up.