Evidence for age-based rationing in a Swiss university hospital.

Abstract:

AIM:To test the hypothesis that rationing of medical management mainly based on age exists in our health care system today. METHODS:We studied 303 consecutive patients hospitalised for acute coronary syndrome (ACS) and 163 consecutive patients hospitalised with congestive heart failure (CHF). They were divided into two age groups; patients aged less than 75 years and those equal to or older than 75 years. RESULTS:Our main findings were a significant underuse of stress tests (p < 0.001) and coronary angiography (p < 0.0001) in elderly patients with ACS and a significant underuse of echocardiography (p < 0.0001) in patients with CHF of the same age group. In patients with ACS, there was also a trend towards underuse of statins in elderly patients with hypercholesterolaemia. In addition, we noted that the use of beta-blockers in ACS and of ACE inhibitors in CHF was better than in previous published studies but that many patients were still not treated according to evidence based medicine. CONCLUSION:The lower rates of diagnostic tests performed and the lower statin use observed in elderly patients suggest "hidden" rationing of health care in elderly patients.

journal_name

Swiss Med Wkly

journal_title

Swiss medical weekly

authors

Jenni D,Osterwalder R,Osswald S,Buser P,Pfisterer M

doi

2001/43/smw-09823

keywords:

subject

Has Abstract

pub_date

2001-11-10 00:00:00

pages

630-4

issue

43-44

eissn

1424-7860

issn

1424-3997

pii

smw-09823

journal_volume

131

pub_type

杂志文章
  • Cystatin C and neutrophil gelatinase-associated lipocalin: biomarkers for acute kidney injury after congenital heart surgery.

    abstract:QUESTIONS UNDER STUDY:To evaluate the diagnostic value of serum Cystatin C and urine neutrophil gelatinase-associated lipocalin (NGAL) for the detection of acute kidney injury in patients undergoing congenital heart surgery. METHODS:Serial samples of serum Cystatin C and urine NGAL were collected from 139 consecutive ...

    journal_title:Swiss medical weekly

    pub_type: 临床试验,杂志文章

    doi:10.4414/smw.2013.13744

    authors: Seitz S,Rauh M,Gloeckler M,Cesnjevar R,Dittrich S,Koch AM

    更新日期:2013-01-17 00:00:00

  • Diagnosis and workup of 522 consecutive patients with neuroendocrine neoplasms in Switzerland.

    abstract:BACKGROUND:Neuroendocrine neoplasms (NENs) are difficult to diagnose. We used SwissNET data to characterise NEN patients followed in the two academic centres of western Switzerland (WS), and to compare them with patients followed in eastern Switzerland (ES) as well as with international guidelines. METHOD:SwissNET is ...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2014.13924

    authors: Gouffon M,Iff S,Ziegler K,Larche M,Schwarzenbach C,Prior JO,Matter M,Stettler C,Pralong FP

    更新日期:2014-02-19 00:00:00

  • Renal denervation: time to open Pandora's box.

    abstract::Depending on the populations studied and the definitions applied, the prevalence of treatment-resistant hypertension varies from 10% to 15%, but is higher in conditions associated with increased sympathetic drive, such as obesity, obstructive sleep apnoea, diabetes or renal dysfunction. The Symplicity studies recently...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章,评审

    doi:10.4414/smw.2012.13638

    authors: Gu YM,Asayama K,Liu YP,Staessen JA

    更新日期:2012-07-17 00:00:00

  • TNF-alpha blockers in inflammatory bowel diseases: practical consensus recommendations and a user's guide.

    abstract::More than seventy years after their initial characterisation, the aetiology of inflammatory bowel diseases remains elusive. A recent review evaluating the incidence trends of the last 25 years concluded that an increasing incidence has been observed almost worldwide. A north-south gradient is still found in Europe. Ge...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章,评审

    doi:smw-12549

    authors: Pache I,Rogler G,Felley C

    更新日期:2009-05-16 00:00:00

  • Distribution of the functional MDR1 C3435T polymorphism in the Han population of China.

    abstract:PRINCIPLES:3435C>T, a single nucleotide polymorphism (SNP) in exon 26 of the MDR1 gene, is linked to the variability of P-gp expression and function among different individuals. It was found that ethnic differences exist in the polymorphism of the MDR1(C3435T) gene. However, the distribution of 3435C>T genotypes in the...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:2006/23/smw-11113

    authors: Li Y,Wang Y,Sun J,Li Y,Yang L

    更新日期:2006-06-10 00:00:00

  • Time trends in avoidable cancer mortality in Switzerland and neighbouring European countries 1996-2010.

    abstract:QUESTION UNDER STUDY:What are the trends in avoidable cancer mortality in Switzerland and neighbouring countries? METHODS:Mortality data and population estimates 1996-2010 were obtained from the Swiss Federal Statistical Office for Switzerland and the World Health Organization Mortality Database (http://www.who.int/he...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2015.14184

    authors: Feller A,Mark MT,Steiner A,Clough-Gorr KM

    更新日期:2015-10-02 00:00:00

  • Communication challenges in end-of-life decisions.

    abstract::This article discusses communication challenges in end-of-life decision making and outlines strategies from an area of growing interest and research. ...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2020.20351

    authors: Becker C,Beck K,Vincent A,Hunziker S

    更新日期:2020-09-18 00:00:00

  • Anticoagulant treatment: the end of the old agents?

    abstract::New oral anticoagulants used as single target inhibitors of coagulation enzymes have been developed and tested in extensive trial programmes. Results of most of these trials showed non-inferior and/or superior efficacy and safety compared to standard treatment with LMWH or VKA. These results led to registration of the...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章,评审

    doi:10.4414/smw.2012.13684

    authors: Graf L,Tsakiris DA

    更新日期:2012-10-01 00:00:00

  • Physical activity behaviour in patients with metabolic syndrome.

    abstract:STUDY/PRINCIPLES:Physical activity improves the clinical course of the metabolic syndrome and its risk factors. The aim of this study was to investigate the physical activity behaviour in patients with metabolic syndrome in regard to the recommendation of the Federal Offices of Public Health (BAG) and Sports (BASPO): "...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2012.13691

    authors: Murer M,Schmied C,Battegay E,Keller DI

    更新日期:2012-10-25 00:00:00

  • Social contexts of sports-practicing youths' hazardous drinking.

    abstract::Sports-practicing youths are at an elevated risk for alcohol use and misuse. Although much attention has recently been given to depicting subgroups facing the greatest threats, little evidence exists on the contexts in which their drinking takes place. Using data from a cross-sectional study on youth sports participat...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2012.13526

    authors: Bélanger RE,Ohl F,Berchtold A,Akre C,Suris JC

    更新日期:2012-02-17 00:00:00

  • Nurse-reported patient safety climate in Swiss hospitals: a descriptive-explorative substudy of the Swiss RN4CAST study.

    abstract:QUESTIONS UNDER STUDY:Measuring the patient safety climate in the organisation of healthcare can help to identify problematic issues with a view to improving patient safety. We aimed (1) to describe the nurse-reported engagement in safety behaviours, (2) to describe the prevailing nurse-reported patient safety climate ...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章,多中心研究

    doi:10.4414/smw.2012.13501

    authors: Ausserhofer D,Schubert M,Engberg S,Blegen M,De G,Schwendimann R

    更新日期:2012-01-20 00:00:00

  • Minimally invasive extracorporeal circulation: excellent outcome and life expectancy after coronary artery bypass grafting surgery.

    abstract:OBJECTIVE:Coronary artery bypass grafting (CABG) remains the gold standard for complex revascularisation in multivessel disease. The concept of the minimally invasive extracorporeal circulation circuit (MiECC) was introduced to minimise pathophysiological side effects of conventional extracorporeal circulation. This st...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2017.14474

    authors: Winkler B,Heinisch PP,Zuk G,Zuk K,Gahl B,Jenni HJ,Kadner A,Huber C,Carrel T

    更新日期:2017-07-10 00:00:00

  • Tobacco and alcohol during pregnancy: prevalence and determinants in Geneva in 2008.

    abstract:OBJECTIVES:To describe alcohol and tobacco consumption during pregnancy in women giving birth in a public hospital in Geneva, to evaluate risk factors related to these consumptions and to explore the influence of close relatives on the consumption habits of pregnant women. METHODS:A cross-sectional questionnaire surve...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2013.13795

    authors: Dupraz J,Graff V,Barasche J,Etter JF,Boulvain M

    更新日期:2013-05-25 00:00:00

  • Renal safety of combined cyclooxygenase 2 (COX-2) inhibitor and angiotensin II receptor blocker administration in mild volume depletion.

    abstract:PRINCIPLES:Drugs that either inhibit prostaglandin synthesis or antagonise angiotensin II effects are likely to impair renal function, especially in patients with an activated renin-angiotensin-aldosterone system. Of the former, nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, and newer agents with cycloo...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:2001/13/smw-09680

    authors: Kistler T,Ambühl PM

    更新日期:2001-04-07 00:00:00

  • Risk behaviours among native and immigrant youths in Switzerland: a cross-sectional study.

    abstract:QUESTION UNDER STUDY:Switzerland has been receiving migrants of various origins for more than 50 years. The adoption of risk-taking behaviours among migrant youths is unclear. Moreover, when studied, migrant youths are rarely analysed according to whether they are first or second generation, or just young people with m...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2017.14531

    authors: Campisi L,Berchtold A,Barrense-Dias Y,Akre C,Gehri M,Suris JC

    更新日期:2017-11-08 00:00:00

  • Delay of diagnosis and treatment in psychiatric patients applying for a disability pension - a challenge for all of us.

    abstract:UNLABELLED:In an earlier study in 2002 we showed that of 101 persons applying for a disability pension for psychiatric reasons, a psychiatric diagnosis that affected their ability to work, could only be confirmed in 83%. Furthermore, and even more importantly, only 64% of these cases were receiving any psychiatric trea...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:2008/23/smw-12102

    authors: Apfel T,Richer-Rössler A

    更新日期:2008-06-14 00:00:00

  • How patients with insulin-treated type 1 and type 2 diabetes view their own and their physician's treatment goals.

    abstract:OBJECTIVES:To investigate the subjective treatment goals of insulin-treated diabetic patients. METHODS:297 type 1 and 205 type 2 diabetic patients, representative of the North-western Swiss population, filled out a self report questionnaire focusing on their own treatment goals using standardized measures wherever ava...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:2006/35/smw-11502

    authors: Puder JJ,Endrass J,Moriconi N,Keller U

    更新日期:2006-09-02 00:00:00

  • Idiopathic pulmonary fibrosis--a disorder of alveolar wound repair?

    abstract::Idiopathic pulmonary fibrosis (IPF) is a chronic and usually progressive lung disorder of unknown aetiology. Conventional management of patients with IPF has been primarily based on the concept that suppressing inflammation would prevent progression to fibrosis. Although the pathogenesis is incompletely understood, it...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章,评审

    doi:2003/29/smw-09986

    authors: Geiser T

    更新日期:2003-07-26 00:00:00

  • Population based age stratified morbidities of premature infants in Switzerland.

    abstract:OBJECTIVE:To provide population-based, gestational age (GA) stratified incidence of mortality and morbidities. METHODS:Population-based prospective observational study of infants born between 23 0/7 and 31 6/7 weeks GA in the years 2000-2004 in all Swiss neonatal intensive care units. Outcomes measured were: mortality...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2011.13212

    authors: Bajwa NM,Berner M,Worley S,Pfister RE,Swiss Neonatal Network.

    更新日期:2011-06-24 00:00:00

  • Use of brain natriuretic peptide to detect previously unknown left ventricular dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease.

    abstract:BACKGROUND:Up to 30% of patients with chronic obstructive pulmonary disease (COPD) simultaneously suffer from often-unrecognised chronic heart failure (HF). Their timely identification is challenging as both conditions share similar clinical presentations. OBJECTIVE:To assess the performance of BNP in detecting left v...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2011.13298

    authors: Gariani K,Delabays A,Perneger TV,Agoritsas T

    更新日期:2011-11-09 00:00:00

  • Mechanical circulatory support for destination therapy.

    abstract::Patients with chronic heart failure who are not eligible for heart transplant and whose life expectancy depends mainly on the heart disease may benefit from mechanical circulatory support. Mechanical circulatory support restores adequate cardiac output and organ perfusion and eventually improves patients' clinical con...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章,评审

    doi:10.4414/smw.2016.14267

    authors: Tozzi P,Hullin R

    更新日期:2016-03-05 00:00:00

  • Medical care of type 2 diabetes mellitus in light of international and national recommendations: a retrospective analysis.

    abstract:QUESTION UNDER STUDY:Type 2 diabetes mellitus (T2Dm) is a chronic disease with great economic impact. In 2009, the Swiss Society for Endocrinology and Diabetes (SSED) published recommendations for treatment of T2Dm. In Switzerland, few data are currently available on metabolic control and physician compliance with trea...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2013.13871

    authors: Burgmann K,Fatio S,Jordi B,Rutishauser J

    更新日期:2013-10-25 00:00:00

  • Antifungal chemotherapy: advances and perspectives.

    abstract::Invasive fungal infections have emerged as important causes of morbidity and mortality in immunocompromised patients. In response to this challenge, the field of antifungal chemotherapy has considerably expanded. Fluconazole and itraconazole, introduced in the late 1980s, were the first durably useful alternatives to ...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章,评审

    doi:2002/23/smw-09729

    authors: Groll AH,Walsh TJ

    更新日期:2002-06-15 00:00:00

  • Cost of disorders of the brain in Switzerland with a focus on mental disorders.

    abstract:QUESTIONS UNDER STUDY:This study aims at estimating the costs of disorders of the brain in Switzerland based on the published epidemiological and economic evidence. METHODS:the data presented for Switzerland are derived from the "cost of disorders of the brain in Europe" study of the European Brain Counsil (EBC). Avai...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:2008/01/smw-11910

    authors: Jäger M,Sobocki P,Rössler W

    更新日期:2008-01-12 00:00:00

  • Work-life conflicts and health among Swiss physicians--in comparison with other university graduates and with the general Swiss working population.

    abstract:QUESTION UNDER STUDY:The present study aimed to compare the prevalence of work-life conflicts and the health status of physicians, with a representative sample of university graduates as well as with a representative sample of the general Swiss working population. Furthermore, it aimed to analyse whether work-life conf...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2010.13063

    authors: Knecht M,Bauer GF,Klaghofer R,Buddeberg-Fischer B,Stamm M,Hämmig O

    更新日期:2010-07-11 00:00:00

  • The HMG-CoA reductase inhibitor simvastatin inhibits IFN-gamma induced MHC class II expression in human vascular endothelial cells.

    abstract::HMG-CoA reductase inhibitors, or statins, are lipid-lowering agents that have been shown to effectively decrease severe rejection periods and development of transplant coronary artery disease after heart transplantation. Precise regulation of major histocompatibility complex class II (MHC class II) gene expression pla...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:2001/03/smw-06144

    authors: Kwak B,Mulhaupt F,Veillard N,Pelli G,Mach F

    更新日期:2001-01-27 00:00:00

  • Survey of management of first-ever seizures in a hospital based community.

    abstract:BACKGROUND:Epidemiological studies focusing on first-ever seizures have been carried out mainly on community based populations. However, since hospital populations may display varying clinical features, we prospectively analysed patients with first-ever seizure in a hospital based community to evaluate prognosis and th...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:2004/39/smw-10738

    authors: Kawkabani A,Rossetti AO,Despland PA

    更新日期:2004-10-02 00:00:00

  • Accuracy of doctors' anthropometric measurements in general practice.

    abstract:PURPOSE:There is increasing pressure on general practitioners (GPs) to identify patients with abdominal obesity in order to reduce the life-threatening consequences of this condition in the population. We aimed to confirm previous findings on the inaccuracy of anthropometric measurements performed by GPs in an academic...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章

    doi:10.4414/smw.2015.14115

    authors: Sebo P,Haller D,Pechère-Bertschi A,Bovier P,Herrmann F

    更新日期:2015-02-21 00:00:00

  • Proteostasis: bad news and good news from the endoplasmic reticulum.

    abstract::The endoplasmic reticulum (ER) is an intracellular compartment dedicated to the synthesis and maturation of secretory and membrane proteins, totalling about 30% of the total eukaryotic cells proteome. The capacity to produce correctly folded polypeptides and to transport them to their correct intra- or extracellular d...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章,评审

    doi:10.4414/smw.2014.14001

    authors: Noack J,Brambilla Pisoni G,Molinari M

    更新日期:2014-08-21 00:00:00

  • Osteoarticular infections in young children: what has changed over the last years?

    abstract::Osteoarticular infections remain a significant cause of morbidity worldwide in young children. They can have a devastating impact with a high rate of serious and long-lasting sequelae, especially on remaining growth. Depending on the localisation of infection, they manifest as osteomyelitis, septic arthritis, a combin...

    journal_title:Swiss medical weekly

    pub_type: 杂志文章,评审

    doi:10.4414/smw.2014.13971

    authors: Ceroni D,Kampouroglou G,Valaikaite R,Anderson della Llana R,Salvo D

    更新日期:2014-06-12 00:00:00