[Planning hospital-focused training in internal medicine at the CHUV].

Switzerland already suffers from the long-predicted shortage of physicians. Moreover, the latter often face long and meandering postgraduate training. At the beginning of their career, most doctors work on internal medicine hospital wards, even though their future may just as well lie in an outpatient or inpatient setting, in general internal medicine or in other disciplines.

Dabigatran accumulation in acute kidney injury: is more better than less to prevent bleeding? A case report.

Dabigatran is an oral anticoagulant that is mainly renally excreted. Despite its efficacy in preventing thromboembolic events, concerns arise regarding bleeding complications in patients with acute kidney injury. Idarucizumab is its specific antidote and reverses quickly and effectively dabigatran anticoagulation effects in situations of severe bleeding or pending surgical procedures, but its benefit beyond these two indications remains uncertain.

[Towards eco-responsible medical devices : life cycle analysis of medicine cups].

Human Health relies on Environmental Health, we thus must assess the environmental impact of healthcare systems. Life cycle analysis (LCA) quantifies the impacts on : human health, climate change, ecosystems and resources. This technique allows for evaluation of the environmental impacts of objects or processes.

[Do we all suffer from imposter syndrome?].

Imposture syndrome is widespread among physicians and medical students. It is defined as a psychological experience in which people doubt their own skills and achievements despite proven successes and thus have an unfounded fear of being found out. This can have serious consequences, such as anxiety and/or depressive disorders, and can lead to burn-out.

[Cockpit: a tool to support interprofessional communication and collaboration].

In hospitals, many different professions work together with the same goal: optimal patient care. This challenge requires effective coordination and communication as well as good knowledge of each other's work. Due to an ever-increasing administrative workload and a large patient flow, time dedicated to this interprofessional collaboration is dwindling.

Running against the clock: a qualitative study of internal medicine residents' work experience.

Aim Of The Study: While hospitals are adopting strategies designed to increase the overall efficiency of the healthcare system, physicians are facing expanding requirements. Such changes in work environment add new psychosocial and physical stressors. Building on a previous quantitative time-motion study, we conducted a qualitative study to better understand the work experience of internal medicine residents.

Polypill eligibility and equivalent intake in a Swiss population-based study.

The polypill has been advocated for cardiovascular disease (CVD) management. The fraction of the population who could benefit from the polypill in Switzerland is unknown. Assess (1) the prevalence of subjects (a) eligible for the polypill and (b) already taking a polypill equivalent; and (2) the determinants of polypill intake in the first (2009-2012) and second follow-ups (2014-2017) of a population-based prospective study conducted in Lausanne, Switzerland.

[Medical students at the bedside of COVID-19 patients : motivations and challenges].

The SARS-CoV-2 pandemic is putting our healthcare system under exceptional pressure, given the number of affected patients. In a context of limited human healthcare resources, senior medical students represent a valuable workforce that can quickly be mobilized for patient care. This is the approach followed in Switzerland and other countries, in several outpatient structures or inpatient services, including the Department of Internal Medicine, of the Lausanne University Hospital (CHUV).

[Organizational Impacts and Clinical Challenges of the COVID-19 Pandemic on a Swiss Tertiary Internal Medicine Department].

The rapid progression of COVID-19 is an organizational challenge for all hospitals. To secure the patient overflow, the Department internal medicine of the University Hospital of Lausanne increased nurse and medical workforces as well as bed capacity by 65 %, with extraordinary help from other departments. The implemented crisis management stood upon three pillars : a crisis management team, steering documents and internal communication.

Inter-hospital comparison of working time allocation among internal medicine residents using time-motion observations: an innovative benchmarking tool.

Objectives: The vast majority of residents' working time is spent away from patients. In hospital practice, many factors may influence the resident's working day structure.Using an innovative method, we aimed to compare working time allocation among internal medicine residents using time-motion observations.

[Analysis of chest x-rays, a systematic to remember].

The interpretation of chest x-rays, which is part of a comprehensive medical management, requires a specific mastery, this despite the promising performance of artificial intelligence software. Alternatives to this imaging modality exist, particularly ultra-low dose CT (CT-ULD) and thoracic ultrasound (US) in some indications, but they are not a substitute for chest x-rays in clinical routine. Among the rules to be followed, a systematic reading technique is required, in order to reduce the risk of error.

Pancytopenia in an adult patient with thiamine-responsive megaloblastic anaemia.

Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 25-year-old woman known for TRMA, who presented with pancytopenia (haemoglobin 7.

Trends and Determinants of Polypharmacy and Potential Drug-Drug Interactions at Discharge From Hospital Between 2009-2015.

Background: Polypharmacy (PP) and excessive polypharmacy (EPP) are increasingly common and associated with risk of drug-drug interactions (DDIs). We aimed to measure the trends and determinants of PP and DDIs among patients discharged from the Department of Internal Medicine of the Lausanne University Hospital.

Methods: The retrospective study included 17,742 adult patients discharged between 2009 and 2015.

[When the ward overflows : the impact of outlying beds on patient care].

Due to the chronic lack of beds in hospitals, patients are often hospitalized in other departments (outlier patients), with a responsible physician working in another department. This causes increased thromboembolics risks, nosocomial infections, falls and delirium in the elderly, morbidity and mortality. Outlier patients, compared to standard patients, stay longer in the emergency department and their discharge documents are available later.

Prevalence and determinants of polypharmacy in Switzerland: data from the CoLaus study.

Background: Polypharmacy is a frequent condition, but its prevalence and determinants in the Swiss mid-aged population are unknown. We aimed to evaluate the prevalence and determinants of polypharmacy in a large Swiss mid-aged population-based sample.

Methods: Data from 4938 participants of the CoLaus study (53% women, age range 40-81 years) were collected between 2009 and 2012.

[Delegation of medico-administrative tasks : what do medical interns and secretaries think?].

The hospital activity of physicians in training mainly consists in direct contacts with patients, tasks indirectly linked to patients such as administration, as well as clinical and theoretical training. In our era of digitalization, an important administrative work load without any added medical value fills their daily chores. In parallel activities of medical secretaries are getting more partitioned, with their desks situated far from physicians' and tasks often limited to finalizing discharge letters.

[From incident-reporting to morbidity and mortality rounds].

In 2015 a computer-based system of incident reporting was implemented in our hospital. Since then our department has successfully managed this reporting process with a constant interest shown by our staff (1 report / 100 days of hospitalization which equals nearly 2 reports a day). All incidents are analyzed.

Determinants of change in polypharmacy status in Switzerland: the population-based CoLaus study.

Objectives: This study aimed to assess the prevalence, the change, and the determinants of change in polypharmacy in a population-based sample.

Methods: Baseline (2003-2006) and follow-up (2009-2012) data are from 4679 participants aged between 35 and 75 years (53.5% women, mean age 52.

Computer usage and task-switching during resident's working day: Disruptive or not?

Background: Recent implementation of electronic health records (EHR) has dramatically changed medical ward organization. While residents in general internal medicine use EHR systems half of their working time, whether computer usage impacts residents' workflow remains uncertain. We aimed to observe the frequency of task-switches occurring during resident's work and to assess whether computer usage was associated with task-switching.

Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts.

Background: Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers.

Objective: To describe how residents allocate their time during day and evening hospital shifts.

Design: Time and motion study.

[General internal medicine in hospital practice: the year 2013 put into perspective by residents].

2013 was full of significant advances in all areas of medicine, which may have an impact on daily practice in general internal medicine. From salt and water restriction in heart failure to transfusion threshold in upper gastrointestinal bleeding and fecal infusion in Clostridium difficile colitis; from new data in resuscitation and persistent questions in palliative care and intensive care medicine, through pneumology, nephrology and endocrinology, the literature has been rich in new considerations. Each year, the residents of the Department of internal medicine of the University hospital of Vaud (CHUV) meet to share their most interesting readings.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and oligoarthritis.

A 24-year-old woman who had sinus histiocytosis with massive lymphadenopathy (SHML, Rosai-Dorfman disease) also had oligoarthritis. We found only four previously reported cases of SHML with clinical joint disease. The clinical picture may suggest rheumatoid arthritis or a spondylarthropathy with peripheral joint involvement.