Rainer Tan

• Policlinique Médicale Universitaire Lausanne

The number of asylum seekers and refugees in Switzerland has increased over the past 20 years, many of whom come from countries where the epidemiology of infectious diseases is different from that of Switzerland. In this review, we discuss the considerations taken into account when deciding which diseases to screen for in asylum seekers and refugee...

Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-ca...

Racism remains a major obstacle in access to quality healthcare. Understanding the concept and definition of racism in healthcare remains unclear for many. This first article in a series on racism in health care, aims to clarify the different forms of racism in health care, their influence on access to health care, and propose measures to limit the...

Background Hypoxemia predicts mortality at all levels of care, and appropriate management can reduce preventable deaths. However, pulse oximetry and oxygen therapy remain inaccessible in many primary care health facilities. We aimed to develop and validate a simple risk score comprising commonly evaluated clinical features to predict hypoxemia in 2...

Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-ca...

Early recognition of children at risk of serious illness is essential in preventing morbidity and mortality, particularly in low- and middle-income countries (LMICs). This study aimed to validate the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in acute care settings in LMICs. This observational study is based on previously...

Large language and multimodal models (LLMs and LMMs) will transform access to medical knowledge and clinical decision support. However, the current leading systems fall short of this promise, as they are either limited in scale, which restricts their capabilities, closed-source, which limits the extensions and scrutiny that can be applied to them,...

The timing of taking antihypertensive medication does not have an impact on the cardiovascular plan. Geniculate block is an alternative to oral analgesic treatment for knee osteoarthritis. Feedback and audits are ineffective in reducing the inappropriate prescription of antibiotics in Switzerland. The intervention of community health professionals...

Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital clinical decision support algorithm in combination with C-reactive protein test, hemoglobin test, pulse oximeter and mentorship, to guide health-care providers in managing acutely sick children under 15 years old. To evaluate...

Clinical decision support systems (CDSSs) can strengthen the quality of integrated management of childhood illness (IMCI) in resource-constrained settings. Several IMCI-related CDSSs have been developed and implemented in recent years. Yet, despite having a shared starting point, the IMCI-related CDSSs are markedly varied due to the need for interp...

Effective, scalable and sustainable strategies to improve quality of care are needed to address the substantial burden of preventable deaths of children under-five in resource-constrained settings. Clinical decision support systems (CDSS), digital tools which generate recommendations for healthcare providers based on patient-specific information, s...

Clinical Decision Support Systems (CDSS) have the potential to improve and standardise care with probabilistic guidance. However, many CDSS deploy static, generic rule-based logic, resulting in inequitably distributed accuracy and inconsistent performance in evolving clinical environments. Data-driven models could resolve this issue by updating pre...

Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital Clinical Decision Support Algorithm in combination with C-reactive protein test, haemoglobin test, pulse oximeter and mentorship, to guide healthcare providers in managing acutely sick children under 15 years old. To evaluate...

Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include their limited scope, usability, and outdated clinical content. To address these challenges we develope...

Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include its limited scope, usability, and outdated clinical algorithms. To address these challenges we develop...

Background Clinical Decision Support Systems (CDSS) have the potential to improve and standardise care with probabilistic guidance. However, many CDSS deploy static, generic rule-based logic, resulting in inequitably distributed accuracy and inconsistent performance in evolving clinical environments. Data-driven models could resolve this issue by u...

Which recommendations family doctors and travel health practitioners can provide to their patients, to reduce their environmental footprint when travelling? Avoiding flying is the biggest action a traveler can take to reduce their greenhouse gas emissions. Staying at eco-lodges, or carbon offsetting, may help, but one must be aware of false or exag...

Aim: To provide insight in the primary health care (PHC) case management of febrile children under-five in Dar es Salaam, and to identify areas for improving quality of care. Methods: We used data from the routine care arm of the ePOCT trial, including children aged 2–59 months who presented with an acute febrile illness to two health centers in Da...

Introduction Early identification of children at risk of severe febrile illness can optimise referral, admission and treatment decisions, particularly in resource-limited settings. We aimed to identify prognostic clinical and laboratory factors that predict progression to severe disease in febrile children presenting from the community. Methods We...

Background Safety of live vaccines in patients treated with immunosuppressive therapies is not well known, resulting in contradictory vaccination recommendations. We describe here the first case of vaccine-associated measles in a patient on natalizumab treatment. Case presentation A young female patient with relapsing-remitting multiple sclerosis...

Children with malnutrition compared with those without are at higher risk of infection, with more severe outcomes. How clinicians assess nutritional risk factors in febrile children in primary care varies. We conducted a post hoc subgroup analysis of febrile children with severe malnutrition enrolled in a randomized, controlled trial in primary car...

Background: Malaria prevention methods for travellers to low or moderate malaria risk areas vary and remain controversial. Standby emergency treatment (SBET) for malaria is one possible strategy increasingly recommended since 1988 with little evidence on its effectiveness or how it is truly being used. Methods: A systematic review and meta-analy...

Introduction: The emergency department (ED) has an important role in facilitating the early diagnosis of HIV infection through testing, and in reducing consequent morbidity, mortality, health care costs and onward HIV transmission. How HIV testing programs in the ED are implemented has been the subject of much debate, in part due to the low testing...

Sexual Reproductive Health is recognized as a lifesaving intervention and therefore a priority action in humanitarian response. Despite increased efforts over the last decade to build technical expertise, collaborate and institutionalize reproductive health, there is little information on how that has translated to programming at the field level. F...