Department of Clinical Research

Background

Due to well-known sociodemographic changes and the rising prevalence of multimorbidity, the demand for palliative and end-of-life care is expected to increase significantly in the coming years. This is particularly driven by the growing incidence of frailty, dementia, and chronic, progressive, and life-limiting conditions such as heart failure, lung diseases (e.g., chronic obstructive pulmonary disease [COPD]), and multimorbidity. Digital health technologies have the potential to facilitate automated detection of distress in palliative care, including symptoms like pain, breathlessness (dyspnea), panic, agitation, and delirium. Such advancements could alleviate the suffering of cognitively impaired patients who are unable to call for help, for instance, by pressing an alarm button, yet urgently require professional intervention (e.g., administration of medication for pain or breathlessness).

Aim

This observational feasibility study aims to assess if data output from a sensor system consisting of a 3-D-radar, photoplethysmographic sensors (wearables), and audio detection (microphones) is associated with patient’s distress events as identified by medical professionals during standard care.

Research Plan

We will utilize well-established sensor systems, including Qumea® and wearables, to monitor heart rate, respiratory rate, heart rate variability, body movements, postures, and audio signals, such as changes in sound intensity or voice frequency. These data will be compared against the current gold standard for detecting distress in cognitively impaired patients: assessments conducted by trained healthcare professionals, specifically specialist palliative care nurses and physicians. Identifying correlations between sensor data and professional distress assessments could facilitate future validation studies, potentially leading to the development of automated distress detection systems using sensor arrays. This advancement would significantly improve distress detection rates and reduce patient suffering.

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.

This randomized open-label study will evaluate the acceptance and patient preference of a new treatment involving protein supplementation of 80g per day over five days. This will be compared to the current first-line treatment, which is fluid restriction of <1000ml per day, in hospitalized patients with hyponatremia due to SIAD.

Whether pelvic lymph node dissection offers an oncological benefit remains unknown. This study will compare extended pelvic lymph node dissection versus no dissection in PSMA PET-negative, T3, or Grade Group > 2 prostate cancer patients. The study will be conducted across all major urological clinics in Switzerland (KFS-5775-02-2023).

Disruption of the hypothalamic-pituitary axis, whether due to inflammation, tumours, or head trauma, can lead to AVP deficiency (AVP-D) – formerly known as central diabetes insipidus (cDI) – characterized by polyuria and polydipsia. Desmopressin, an AVP receptor analogue, is the established treatment for AVP deficiency. 

Despite treatment, patients frequently report residual psychological symptoms, including reduced empathy, heightened anxiety, social interaction difficulties, and decreased sexual desire, substantially affecting their quality of life. Given the anatomical proximity, local disruptions of the AVP system could also disturb the oxytocin (OXT) system, resulting in an additional OXT deficiency. Our recent study utilized a novel stimulation test with MDMA, and revealed for the first time an additional OXT deficiency in patients with AVP-D. These findings may potentially explain the observed psychopathology in these patients. Although psychological changes in patients with anterior pituitary dysfunction are well-recognized and managed with respective hormonal replacement therapy, few efforts have been made to assess psychological comorbidities in patients with isolated AVP deficiency. Research on this condition is generally limited due to its rarity (currently affecting approximately 15,000 patients in Europe), especially on sexual desire and related outcomes.