This study aims to assess the impact of the Volunteer Community Responders (VCR) Network on the outcomes of Out-of-hospital Cardiac Arrest (OHCA) patients in the Swiss Canton Fribourg from 2018 to 2022. We collected data from the SWISSRECA registry of all OHCA occurring in the Swiss Canton of Fribourg between January 1, 2018 and December 31, 2022. The patients were divided in two groups according to whether a VCR intervened and were compared using descriptive statistics. We constructed exact multivariable logistic regression models to analyse the association of a VCR intervention with Return of Spontaneous Circulation (ROSC) rate, survival to hospital admission and survival to hospital discharge, adjusting for age, sex, emergency services arrival time, witness status, initial rhythm and location of the OHCA. We included 559 patients, 319 in the VCR intervention group and 240 in the other group. The key differences were more home located OHCA (80% vs 63%; p-value = < 0.001), longer EMS arrival times (13 [11, 17] vs 11 [8, 14] minutes; p-value = < 0.001) and more pre-EMS CPR performed (95% vs 63%; p < 0.001) and pre-EMS AED usage (48% vs 13%; p < 0.001) in the VCR intervention group. In the adjusted model, the odds ratios with VCR Cardiopulmonary Resuscitation (CPR) were 0.82 (95% CI: 0.39–1.74; p = 0.61) for ROSC, 0.65 (95% CI: 0.27–1.53; p = 0.32) for survival to hospital admission and 1.22 (95% CI: 0.26–5.74; p = 0.80) for survival to hospital discharge. In the sub-cohort of home-located OHCA, consisting of 192 patients the VCR intervention group and 202 in the other group, the adjusted odds ratios of VCR CPR were 0.78 (95% CI: 0.34–1.81; p = 0.57) for ROSC, 0.75 (95% CI: 0.27–2.08; p = 0.58) for survival to hospital admission and 1.34 (95% CI: 0.23–7.79; p = 0.75) for survival to hospital discharge. The rates of CPR performed and AED usage before EMS arrival were higher in the VCR intervention group. However, the VCR intervention was not independently associated with ROSC rate, survival to hospital admission and survival to hospital discharge. Potential key explanations are the sequential manual activation of the VCR network, leading firstly to potential delays in VCR deployment and secondly to potentially more VCR deployment on home-located OHCAs or on OHCA with longer expected EMS travel time. Updating the deployment system of the emergency medical communication centre could be a key improvement measure to address this. Further studies are needed to explore these issues and to improve the chain of survival including the VCR Network.

For centuries, turmeric has been utilized for its therapeutic properties; however, it is now being more frequently associated with the development of drug‐induced liver injury (DILI). The popularity of dietary supplements (DS) is rising, yet patients frequently omit disclosing their use to healthcare providers, as they do not perceive them as drugs. This dynamic will expose doctors to more patients suffering from the adverse effects of DS consumption. We present the case of a 61‐year‐old white European male, presenting with right upper quadrant abdominal pain, initially managed with antibiotic therapy based on radiological evidence of acute cholecystitis. The clinical course was complicated by progressive jaundice and severe hepatitis, necessitating hospital admission for comprehensive diagnostic evaluation. Despite an exhaustive assessment, a definitive etiology was elusive until the patient revealed self‐administration of a DS comprising turmeric and black pepper over the preceding year as adjunctive treatment for depressive symptoms. This disclosure led to the diagnosis of DILI, and complete normalization of hepatic function was observed within 2 months following discontinuation of the DS. This case underscores the potential for turmeric‐containing DS, particularly those combined with bioavailability enhancers such as black pepper, to trigger DILI in patients at risk. Healthcare professionals should proactively inquire about their patients' DS consumption and remain vigilant for their potential adverse effects.

Background/Objective: Tibial eminence avulsion fracture (TEAF) is a traumatic injury of the anterior cruciate ligament that occurs in children with an immature skeletal system. It has an incidence of 3 per 100,000 children, with an increasing prevalence over time. The objective of this study was to evaluate the long-term clinical and subjective outcomes of displaced TEAF requiring surgical intervention and to assess the return to sport. Methods: A retrospective cohort study was conducted, identifying all patients who underwent arthroscopic-assisted TEAF refixation at HFR-Fribourg between 2012 and 2020, performed by a single surgeon. A total of fifteen patients were included for descriptive analysis, while twelve patients underwent clinical assessment of knee joint stability and functional outcomes using patient-reported outcome measures (PROMs): Pedi-IKDC, Lysholm, Tegner, and Marx. Results: Of the fifteen patients, fourteen had type III and one had type II TEAF according to the McKeever classification. The mean age at the time of injury was 11.5 years, and the average time between surgery and long-term follow-up was 5.1 years (range: 0.9–8.9 years). For the primary outcomes of the operated knee, no significant differences were observed in muscle mass or range of motion between the operated and non-operated limbs (p > 0.05). Anterior knee stability, as assessed by the Lachman test and Rolimeter, showed no significant difference between the operated and non-operated knee (p > 0.05). Regarding secondary outcomes, the Pedi-IKDC and Lysholm scores were 98 out of 100, the Tegner score was 5.5 out of 10, and the Marx score was 14.5 out of 20 at the final follow-up. There were no significant differences in the number of hours per week or frequency of sport activity (mean three times per week) before and after surgery. Conclusions: The surgical treatment for displaced TEAF, specifically the pull-out suture technique with arthroscopic assistance, demonstrates excellent clinical and functional outcomes, with high recovery rates and restored knee stability. This technique allows patients to return to sports without significant impairment. Although no comparative analysis was performed, these findings provide a foundation for future studies to further validate and compare the effectiveness of this surgical approach.

Out-of-hospital cardiac arrest (OHCA) has a high mortality rate worldwide. A first responder (FR) and automated external defibrillator (AED) network was implemented to complement emergency medical services (EMS) in the Swiss canton of Fribourg. This study aims to assess geospatial disparities in FR deployment, AED usage and prehospital response efficiency relative to OHCA clusters. This retrospective observational study analysed all OHCA cases recorded in the Swiss Registry of Cardiac Arrest between 2018 and 2022, which occurred in the canton of Fribourg. We used visual spatial mapping to illustrate clusters of OHCA survival and explore their relationship with FR presence and AED use, including outcome proportions in five predefined geographical zones. Multivariate exact logistic regression models were constructed to assess the impact of the five geographical zones in which OHCA occurred on survival to hospital discharge. Of 1127 OHCA included, 34 % had a FR on-site and an AED was used in 19 % of cases. All OHCA clusters corresponded to the most densely inhabited areas. Survival rates were highest in urban areas (8.5 %) but decreased to 3.6 % in sparsely populated zones. Cardiopulmonary resuscitation (CPR) performance and AED use by first responders or bystanders showed no statistically significant impact across geographic areas. Heatmaps of FR deployment showed a lower intensity in urban areas and a more even distribution across the territory. Despite a higher AED density in urban areas, usage remained low (12 %). By the end of 2022, 2050 FRs and 549 AEDs were registered in the canton, which remains below international recommendations. Geospatial disparities highlighted the need for optimized FR recruitment, improved AED distribution and refined EMS activation strategies to enhance OHCA survival rates. These findings provide actionable insights for targeted resource allocation of the existing system at the cantonal level.

A 31‐year‐old Cameroonian man presented to the emergency department (ED) with a productive cough, exertional dyspnoea, and asthenia for a few days. The initial evaluation was limited due to cultural barriers, lack of known medical history, and the patient's migration journey through Libya, Tunisia, and Germany over the past 5 years before recently arriving in Switzerland. Clinical examination revealed no red flags. Blood counts were normal, C‐reactive protein (CRP) was elevated at 91 mg/L, and a chest X‐ray was unremarkable. A diagnosis of influenza‐like syndrome was made. The patient returned the following day with increased fatigue and fever. A rapid malaria test was negative, a blood smear was ordered, and CRP levels rose to 148 mg/L. During an influenza epidemic, PCR confirmed Influenza A. The patient was reassured and prescribed ibuprofen and paracetamol. Subsequently, the laboratory detected not malaria but filariae, and a diagnosis of Loiasis ( Loa loa ) was established. The patient was referred for specialist consultation. Treatment with albendazole was initiated, leading to gradual improvement.

BACKGROUND Emergency department (ED) overcrowding threatens healthcare systems internationally. This poses risks to patient safety, lowers quality of care as well as patient satisfaction. Patient input, defined as the caseload of patients presenting to the ED, is one of the factors contributing to overcrowding. Redirecting patients presenting with non-urgent complaints to external healthcare services could help alleviate ED workload. OBJECTIVE In this study, we will investigate the safety and efficiency of redirection of low-acuity patients using an electronic clinical decision support system. We aim to assess the impact of this intervention on subsequent health care use, patient satisfaction and health literacy over a 6-month follow-up period. METHODS A single center, observational study with 2 consecutive cohorts of low acuity patients presenting to the ED will be conducted. The first cohort will be triaged and offered redirection according to current practice. In the second cohort, after triage, low-acuity patients will be evaluated by an electronic clinical support system to determine eligibility to redirection. If eligible for redirection, an appointment at a nearby clinic will be arranged through the system. The primary endpoint are any unexpected returns to health care services within 48 hours of triage. Secondary endpoints are patient satisfaction as well as the number of unexpected consultation and evolution of health literacy during a 6-month follow-up period. RESULTS We aim to include 300-420 patients from June to October 2025 CONCLUSIONS We expect the redirection process of low-acuity patients to other healthcare facilities using an electronic clinical support system to be safe and efficient. If results are positive, application of this reproductible strategy could reduce the number of patients treated in emergency departments and provide alternative healthcare pathways to low-acuity patients. CLINICALTRIAL ClinicalTrials.gov NCT06971419