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Aim: This study aims to investigate the prevalence, intensity, and location of pain in children and adolescents with cerebral palsy (CP) and analyze pain-related symptoms and participation restrictions., Methods: Children and adolescents aged 2 to 16 years diagnosed with CP were invited to participate in a pain survey. The questionnaire was based on the German Pain Questionnaire for Children, Adolescents and Parents (DSF-KJ). It was administered to children (2-11 years) by their caregivers, while adolescents (12-16 years) were asked to complete the questionnaire themselves or with the help of their caregivers., Results: Fifty-seven of 133 children and adolescents with CP (43%) reported having pain in the past 12 months, of whom 17 (30%) reported chronic pain. Patients with Gross Motor Function Classification System (GMFCS) IV-V reported more frequent pain ( p  = 0.003) and higher pain intensity ( p  = 0.011). Lower extremity pain was the most common. Twenty-three percent of participants with pain did not receive any treatment. Pain often restricted participation, specifically by reducing sports activity in patients with GMFCS I-III, focusing attention on patients with GMFCS IV-V, and activities with the family in both GMFCS level categories., Interpretation: Pain is common in children and adolescents with CP and frequently restricts their participation. Therefore, it must be consistently recorded and addressed during the consultation. The goal of treatment should be not only to reduce pain but above all to increase participation., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose: To investigate the frequency, content, and clinical translation of advance directives in intensive care units (ICUs)., Material and Methods: Retrospective cohort study in a Swiss tertiary ICU, including patients with advance directives treated in ICUs ≥48 h. The primary endpoint was the violation of directives. Key secondary endpoints were the directives' prevalence and their translation into clinical practice., Results: Of 5'851 patients treated ≥48 h in ICUs, 2.7 % had documented directives. Despite 92 % using templates, subjective or contradictory wording was found in 19 % and 12 %. Nine percent of directives were violated. Patients with directive violations had worse in-hospital outcomes (p = 0.012). At admission, 64 % of patients experiencing violations could not communicate, and directives were missing/unrecognized in 30 %. Mostly, directives were not followed regarding life-prolonging measures (6 %), ICU admission (5 %), and mechanical ventilation (3 %). Kaplan Meier statistics revealed a lower survival rate with directives recognized at admission (p = 0.04) and when treatment was withheld (p < 0.001)., Conclusions: Advance directives are available in a minority of ICU patients and often contain subjective/contradictory wording. Physicians respected directives in 90 % of patients, with treatment adapted following their wishes. However, violation of directives may have serious consequences with unfavorable in-hospital outcomes and decreased long-term survival with treatment adaption following directives., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Workplace violence (WPV) presents challenges in intensive care units (ICUs) calling for reliable prediction of violence. This narrative review aimed to identify and evaluate risk assessment tools from acute care settings which are or might be used to predict violent behavior in adult ICU patients focusing on their performance and clinical utility., Methods: A screening of PubMed, Scopus and Google Scholar was conducted to identify risk scores used in the acute care setting such as emergency departments, hospitals and ICUs. Risk factors, predictive validity of scores and their relevance to the ICU setting were evaluated., Results: 24 studies were included. Two studies reported the use in general ICU populations, while eight studies were conducted in psychiatric ICUs and 14 studies implemented the use of risk tools in emergency departments or general wards. Ten risk scores were identified using 30 different variables. Those could be categorized into patient demographics, behavior, history of violence, mental status and other items such as sleep disturbances. The Broset Violence Checklist (BVC) was the most commonly used risk score. It showed moderate predictive accuracy in psychiatric settings including psychiatric ICUs, but limited validation for general ICUs. The overall evidence level was low with serious risk of bias. Other tools demonstrated varying sensitivity and specificity but lacked validation in ICUs., Implications for Clinical Practice: ICU nurses and physicians are often subjected to violence. There is little evidence on scores to predict patients' behavior. Most assessments come from outside the ICU, but may be promising in critical care., Conclusion: This review underscores the need for the development of violence risk assessment tools tailored to the ICU, as the challenges with violent ICU patients differ from other populations. New predictive models must be developed including factors associated with patients' violent behavior in ICUs as compiled in this review., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Conflicting data exist regarding sex-specific outcomes after cardiac arrest. This study investigates sex disparities in the provision of critical care and outcomes of in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) patients., Methods: Analysis of adult cardiac arrest patients admitted to certified Swiss intensive care units (ICUs) (01/2008-12/2022) using the nationwide prospective ICU registry. The primary outcome was ICU mortality, with secondary outcomes including ICU admission probability and advanced treatment provision., Results: Among 41,733 individuals (34.9% women), 21,692 patients (30.6% women) were admitted to ICUs (16,571 OHCA patients/5121 IHCA patients). Women were less likely to be admitted to the ICU than men (incidence rate ratio 0.82 [95% CI 0.80-0.85] and had a higher ICU mortality (41.8% vs 36.2%; p < 0.001). Mortality differences were more pronounced in OHCA patients (unadjusted HR: 1.35 [95% CI 1.28-1.43]; adjusted HR: 1.19 [95% CI 1.12-1.25]). In IHCA patients, mortality differences were less pronounced (unadjusted HR: 1.14 [95% CI 1.04-1.25]) and vanished after adjustment for confounders: adjusted HR: 1.03 [95% CI 0.94-1.13]). Women after cardiac arrest were older, more severely ill, and received fewer interventions before (44.7% vs 54.0%; p < 0.001) and during ICU stay. A subgroup analysis of 11,202 patients revealed that treatment limitations were more frequent in women (46.7% vs 38.7%; p < 0.001). However, these limitations were associated with an increased risk of death in both sexes., Conclusions: This study highlights sex disparities in short-term mortality and ICU resource allocation among cardiac arrest patients, with women potentially facing disadvantages, in particular after OHCA. The limitations of ICU registry data, particularly the lack of detailed cardiac arrest-specific and comorbidity information, restrict definitive conclusions. Future research should prioritize prospective studies with more granular data to better understand and address these disparities., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of Northwestern and Central Switzerland (EKNZ UBE-15/47) and the scientific committee of the SSICM. It was carried out according to the principles of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The ARCR&#95;Pred study was initiated to document and predict the safety and effectiveness of arthroscopic rotator cuff repair (ARCR) in a representative Swiss patient cohort. In the present manuscript, we aimed to describe the overall and baseline characteristics of the study, report on functional outcome data and explore case-mix adjustment and differences between public and private hospitals. Between June 2020 and November 2021, primary ARCR patients were prospectively enrolled in a multicenter cohort across 18 Swiss and one German orthopedic center. Baseline characteristics, including sociodemographic and diagnostic variables, were reported. Clinical scores and patient-reported outcome measures were assessed up to 24-month follow-up. After screening 2350 individuals, 973 patients with ARCR were included. Follow-up rates reached 99%, 95%, 89% and 88% at 6 weeks, 6, 12, and 24 months, respectively. While the proportion of massive tears was higher in the study population (44% vs. 20%, Std. Diff. = 0.56), there were no other major differences in key characteristics between enrolled and non-enrolled patients or in patients lost to follow-up. Functional scores improved over time, with positive changes rates ranging from 83% to 92% at 6-month, reaching 91% to 97% at 12- and 24-month follow-up. In linear mixed models, used to estimate the associations between baseline factors, hospital type and standardized 0-100 scores, marginal effects for time ranged from 20 to 30, 28 to 39 and 34 to 41 points at the 6-, 12- and 24-month follow-up, respectively. Except at the 12-month follow-up, where marginal effects for the interaction terms ranged from -5 to -4 points in the standardized scores, there were no consistent outcome differences between public and private hospitals. Increasing number of years of education was consistently associated with better scores, greater feelings of depression and anxiety, smoking and ASA group III-IV were consistently associated with worse scores. Tear severity showed a consistent negative association solely for the Constant-Score. The ARCR&#95;Pred study shows high potential for generalizability to the population of patients undergoing an ARCR in Switzerland. Further analyses are needed to establish relevant clinimetrics for the Swiss population and to compare outcomes for surgical techniques, surgeon experiences profiles and post-operative management., Competing Interests: All authors declare that they have no competing interests., (Copyright: © 2025 Stojanov et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aims of the Study: Interprofessional ward rounds are a cornerstone of patient-centred care for medical inpatients and offer opportunities to discuss and coordinate patient treatment and further management. We aimed to identify factors associated with lower satisfaction and efficiency of interprofessional ward rounds, as reported by physicians and nurses., Methods: An anonymous Swiss nationwide online survey of physicians and nurses was conducted in 28 Swiss internal medicine inpatient departments between 9 August and 19 October 2023. Analyses were conducted from November to December 2023. The primary outcome was physicians' and nurses' perceived lower satisfaction with ward rounds, which was assessed using visual analogue scales ranging from 0 to 10, with lower satisfaction defined as scores below the median. The main secondary outcome was perceived lower efficiency using a similar definition. Qualitative analysis was performed through inductive thematic analysis., Results: The survey had a response rate of 21.6% (547/2530). Of the 547 physicians and nurses included in the final analysis, the median satisfaction was 7 points (interquartile range [IQR] 6-8). A total of 61% of physicians (156/254) and 76% of nurses (224/293) reported lower satisfaction. Lower satisfaction was reported significantly more frequently by nurses (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.58-3.43; p ≤0.001) and female team members (adjusted OR 1.95, 95% CI 1.32-2.9; p <0.01). The median perceived efficiency of ward rounds was 7 points (IQR 5-8), and the nursing profession was associated with lower perceived efficiency (adjusted OR 1.95, 95% CI 1.3-2.93; p <0.01). Adherence to in-house guidelines for ward rounds was associated with satisfaction (adjusted OR for lower satisfaction 0.25, 95% CI 0.16-0.39; p <0.001) and perceived efficiency (adjusted OR for lower efficiency 0.27, 95% CI 0.17-0.43; p <0.001). Both physicians and nurses preferred to perform ward rounds as part of an interprofessional team. The qualitative analysis of the data revealed a preference for structured interprofessional ward rounds and the active involvement of nurses., Conclusions: This survey revealed an overall high preference for interprofessional ward rounds. In addition, we identified several factors that were associated with lower satisfaction and efficiency. Structured in-house protocols for ward rounds may increase the satisfaction and efficiency of interprofessional collaboration during ward rounds.