BACKGROUND AND OBJECTIVE: Clinical decision support (CDS) might improve management of potassium-increasing drug-drug interactions (DDI). We studied CDS with five features intended to increase effectiveness: (i) focus on serious DDIs, (ii) fewer notifications, (iii) presentation of current laboratory results, (iv) timing (when adverse event becomes likelier), (v) removal of notification when appropriate.

METHODS: We conducted a 1-year, hospital-wide, cluster-randomised controlled trial in the inpatient setting at a large tertiary-care academic medical centre. Three CDS types were implemented: monitoring reminders (unknown potassium, no monitoring ordered), elevated potassium warnings (≥4.9 mEq/l), and hyperkalaemia alerts (≥5.5 mEq/l). The primary endpoint was the frequency of potassium-monitoring intervals >72 h.

RESULTS: We analysed 15,272 and 18,981 stays with 2804 and 2057 potassium-increasing DDIs in the intervention and control groups, respectively. Patient-specific notifications: displayed were 869 reminders (1 per 3.2 potassium-increasing DDIs), 356 warnings (1:7.9), and 62 alerts (1:45.2). Nevertheless, insufficiently monitored DDIs were not reduced (intervention 451 of 9686 intervals >72 h [4.66%]; control 249 of 6140 [4.06%]). The only secondary outcome improved was the length of potassium monitoring intervals (intervention group mean 22.9 h, control 23.7 h; p <0.001). However, in the intervention group, during 50 of 2804 observed potassium-increasing DDI periods (1.78%) one or more serum potassium values ≥ 5.5mEq/l were measured, in the control group, during 27 of 2057 (1.31%; p = 0.20).

CONCLUSIONS: A highly patient-specific CDS feature combination had a negligible impact on the management of potentially serious potassium-increasing DDIs and was unable to improve safety among hospitalised patients.

BACKGROUND: Nutrition in the first 1000 days between pregnancy and 24 months of life is critical for child health, and exclusive breastfeeding is promoted as the infant’s best source of nutrition in the first 6 months. Caffeine is a central nervous system stimulant occurring naturally in some foods and used to treat primary apnoea in premature babies. However high caffeine intake can be harmful, and caffeine is transmitted into breastmilk.

AIM: To systematically review the evidence on the effects of maternal caffeine consumption during breastfeeding on the breastfed child.

METHOD: A systematic search was conducted to October 2017 in MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library. The British Library catalogue, which covers doctoral theses, was searched and PRISMA guidelines followed. Two reviewers screened for experimental, cohort, or case-control studies and performed independent quality assessment using the Newcastle-Ottawa scale. The main reviewer performed data extraction, checked by the second reviewer.

RESULTS: Two cohort, two crossover studies, and one N-of-1 trial were included for narrative synthesis. One crossover and two cohort studies of small sample sizes directly investigated maternal caffeine consumption. No significant effects on 24-hour heart rate, 24-hour sleep time, or frequent night waking of the breastfed child were found. One study found a decreased rate of full breastfeeding at 6 months postpartum. Two studies indirectly investigated caffeine exposure. Maternal chocolate and coffee consumption was associated with increased infant colic, and severe to moderate exacerbation of infant atopic dermatitis. However, whether caffeine was the causal ingredient is questionable. The insufficient and inconsistent evidence available had quality issues impeding conclusions on the effects of maternal caffeine consumption on the breastfed child.

CONCLUSION: Evidence for recommendations on caffeine intake for breastfeeding women is scant, of limited quality and inconclusive. Birth cohort studies investigating the potential positive and negative effects of various levels of maternal caffeine consumption on the breastfed child and breastfeeding mother could improve the knowledge base and allow evidence-based advice for breastfeeding mothers.

Systematic review registration number: CRD42017078790

BACKGROUND: Advance directives enable people to describe their preferences for medical treatment (living will) and/or to appoint a healthcare proxy who may decide on their behalf should they lose decision-making capacity. Advance directives are potentially important in determining the course of end-of-life care, as deaths are frequently preceded by end-of-life treatment decisions, which often require someone to make decisions on the patient’s behalf. Switzerland introduced legally binding advance directives through its new child and adult protection law of 2013. But there is still no comprehensive evidence on older persons’ awareness, attitudes and behaviours with regard to advance directives in Switzerland.

AIM AND METHOD: Our study aimed to assess levels of awareness, approval and completion of advance directives, as well as their respective associations with sociodemographic characteristics in the Swiss population aged 55 and older. Our study was cross-sectional and used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), which included a special module on end-of-life issues in wave 6 (2015) in Switzerland (n = 2085).

RESULTS: Two years after the introduction of advance directives in Switzerland, 78.7% of adults aged 55 years and older had heard of them prior to the survey and 24% reported that they had completed one. Awareness of advance directives was higher in the German-speaking part of Switzerland (91%) than in the Italian- (57.1%) and French-speaking (43.3%) regions (p

OBJECTIVE: The aim of this work was to gain knowledge on the health status of pregnant women in Switzerland, especially their attitude to and decisions about diet, use of medication and consumption of drugs, including alcohol and tobacco.

METHODS: Data collected by the consecutive Swiss Health Surveys of 2007 and 2012 on sociodemographic and lifestyle characteristics (including nutrition), type and intake of medication, use of alcohol, tobacco and illicit drugs of the female population were analysed. To compare pregnant with non-pregnant women, a group of 10 times as many non-pregnant women (reference group, n = 3090) was matched with all the participating women who said they were pregnant at the time of the survey (pregnant group, n = 309). The two groups were then compared.

RESULTS: The pregnant and non-pregnant participant groups were comparable with respect to most sociodemographic characteristics and both showed a high awareness of health-related issues. Significantly more pregnant than non-pregnant women revealed a high nutritional awareness, claiming to pay attention to what they ate (78.3 vs 73.0%). Frequent consumption of milk products and fish, and moderate consumption of meat were found more often in the pregnant group. Use of medication was comparable between the two groups, except that pregnant women took pain killers less frequently than did non-pregnant women (30.0 vs 61.5%) and relied more often on prescribed medication. Pregnant women were more restrictive in their alcohol consumption than non-pregnant women. Nevertheless, 10.0 and 1.9% of the pregnant women declared consumption of wine and beer, respectively, in the previous 7 days. Regular smoking was less frequent in the pregnant group than in the reference group (11.7 vs 30.3%) and less intensive (pregnant smokers smoked 3.6 cigarettes fewer per day). A few pregnant women (1.9%) said they consumed marijuana; no other illicit drugs were mentioned.

CONCLUSIONS: In Switzerland, women of child-bearing age revealed high general health-awareness. During pregnancy, a considerable proportion of the women adapted their diet and seemed to refrain from using pain killers and from consuming alcohol, tobacco and illicit drugs. However, since a fairly large minority of the pregnant women mentioned drinking alcohol and/or smoking tobacco, further preventive work is needed.

QUESTIONS UNDER STUDY: This pilot study aimed to assess the feasibility, acceptance and costs of an ultrasound scan screening programme for abdominal aortic aneurysms (AAA) in the elderly male population resident in Canton Ticino, Switzerland.

METHODS: The target population were male patients aged 65–80 years who attended the outpatient clinics of the Lugano Regional Hospital in 2013. The patients showing interest were contacted by phone to verify their eligibility and fix the appointment for the ultrasound scan of the abdominal aorta. Patients with recent examinations suitable for AAA detection were excluded. Aneurysm was defined as an abdominal aorta with sagittal and/or axial diameter  30 mm. Patients’ characteristics and study results were presented as descriptive statistics. The chi-squared test was used to compare categorical variables with p