Prof. Dr. med. Anne Leuppi-Taegtmeyer

Unspezifische untere Rückenschmerzen stellen ein komplexes Krankheitsbild dar, von welchen Patienten jeglicher Populationen weltweit betroffen sind. Etwa 5% aller Notfallkonsultationen sind mit Rückenschmerzen assoziiert.

Die Ätiologie sowie die optimale Behandlung dieser Erkrankung ist weiterhin unklar.

Die frühzeitige bildgebende Diagnostik wird aufgrund der hohen finanziellen Kosten und der Strahlenbelastung der Patienten in den ersten 6 Wochen nicht empfohlen, sofern keine Red Flags vorliegen. Ebenso sollte auf eine analgetische Therapie mit Opioiden bei akuter Symptomatik verzichtet werden. Hierbei sind insbesondere die unerwünschten Nebenwirkungen sowie gefährliche Überdosierungen von Bedeutung. Zusätzliche Konsequenzen können längere Arbeitsplatzabsenzen sowie Mehrfachkonsultationen sein. Im Spitalalltag bleibt es jedoch eine Herausforderung, die Diskrepanz zwischen Patientenanforderungen und den Empfehlungen der Guidelines zu meistern.

Wir planen eine retrospektive Single-Center-Beobachtungsstudie. Ziel der Studie ist die Analyse des Rückenschmerzenmanagements anhand von Fallserie-Analysen von Patientinnen und Patienten, welche in den Jahren zwischen 2018 und 2023 auf die Notfallstation mit Rückenschmerzen eingetreten sind. Aus den Erkenntnissen der Studie sollen weitere Massnahmen wie Patientenedukation und Mitarbeiterschulungen entstehen, um so die Versorgung und Sicherheit der Patienten zu verbessern. 

Background: Dyslipidemia is common after hematopoietic stem cell transplantation (HSCT). Few data regarding the time course of lipid profiles after HSCT, the effect of multiple transplantations, and efficacy and safety of lipid-lowering treatments are available.

Objective: The objective of the study was to determine the prevalence and treatment of dyslipidemia over a 25-year period in a large, single-center cohort.

Methods: One thousand one hundred ninety-six adult patients (≥16 years) who underwent HSCT during 1973 to 2013 and who survived ≥100 days were studied retrospectively.

Results: The prevalence of dyslipidemia before transplantation was 36% and 28% in the autologous and allogeneic groups, respectively (P < .001). Three months after HSCT, the prevalence rose to 62% and 74% (P < .001), and at 25 years, it was 67% and 89%. Lipid profiles were similar after first and subsequent transplants. Baseline dyslipidemia (odds ratio [OR] = 2.72), allogeneic transplant (OR = 2.44), and age ≥ 35 years (OR = 2.33) were independent risk factors for dyslipidemia at 1 year. Lipid-lowering treatment was given to 223 (19%) patients, primarily in the form of statins (86%) and was associated with a decrease in total cholesterol from 246 to 192 mg/dL (P < .01) and from 244 to 195 mg/dL (P < .001) in the autologous and allogeneic groups, respectively. There were 10 cases (4%) of muscle symptoms prompting cessation of lipid-lowering therapy, including 1 case of rhabdomyolysis. The OR for dyslipidemia among patients who suffered a cardiovascular event (conditional logistic regression) was 3.5 (95% confidence interval = 1.6-7.7, P = .002).

Conclusion: This study confirms that dyslipidemia is a common and long-lasting phenomenon among both allogeneic and autologous HSCT patients. Statins are effective, generally well-tolerated and should be highly recommended for the management of post-HSCT dyslipidemia.

Hyponatremia is the most common electrolyte disorder. A proper diagnosis is important for its successful management, especially in profound hyponatremia. The European hyponatremia guidelines point at sodium and osmolality measurement in plasma and urine, and the clinical evaluation of volume status as the minimum diagnostic workup for the diagnosis of hyponatremia. We aimed to determine compliance with guidelines and to investigate possible associations with patient outcomes. In this retrospective study, we analysed the management of 263 patients hospitalised with profound hyponatremia at a Swiss teaching hospital between October 2019 and March 2021. We compared patients with a complete minimum diagnostic workup (D-Group) to patients without (N-Group). A minimum diagnostic workup was performed in 65.5% of patients and 13.7% did not receive any treatment for hyponatremia or an underlying cause. The twelve-month survival did not show statistically significant differences between the groups (HR 1.1, 95%-CI: 0.58-2.12, p-value 0.680). The chance of receiving treatment for hyponatremia was higher in the D-group vs. N-Group (91.9% vs. 75.8%, p-value < 0.001). A multivariate analysis showed significantly better survival for treated patients compared to not treated (HR 0.37, 95%-CI: 0.17-0.78, p-value 0.009). More efforts should be made to ensure treatment of profound hyponatremia in hospitalised patients.

The aim of this study is to characterise the patient cases where the opioid antagonist naloxone was administered for the management of a life-threatening opioid intoxication. We determined the incidence per 10'000 opioid-treated hospital inpatients before and after the implementation of an as-needed opioid prescribing tool for morphine and hydromorphone.

In this collaboration we are investigating the incidences of naloxone-use for hospital inpatients with opioid intoxication in a further Swiss university hospital and in a German university hospital in order to compare these with our data from the University Hospital Basel. Furthermore, we are developing a compulsory online modular training course about opioid safety in hospitals for doctors, nurses and pharmacists.

This study seeks to investigate if the introduction of guidelines introduced in 2015 supporting a shortened OCS course during acute exacerbation of COPD (AECOPD) altered the treatment efficacy and safety. The study population of interest will consist of patients with AECOPD treated with OCS in general practices in the United Kingdom that form part of the CPRD (Clinical Practice Research Datalink). The primary exposure is treatment with OCS before and after the introduction of the guidelines recommending only five days of treatment. The primary outcome is the time to next exacerbation during the 12 months after the index exacerbation. Secondary outcomes will be the number of exacerbations during the 12 months after the index exacerbation; duration of OCS therapy (if available), treatment safety, notably, the number of patients with new onset diabetes during twelve months after AECOPD.