[Issues and challenges of primary care medicine: The Northern Vaud Project].

On the face of challenges, particularly related to population aging, increasing complexity of medicine, demographic changes, and uneven geographical distribution of general practitioners (GPs), the healthcare system needs to be reimagined to ensure and maintain efficient care and address the chronic burden on emergency services. A concept of integrated community-based continuity of care, aimed at training future GPs, is one of the solutions proposed by the Northern Vaud Hospital Institutions. This project contributes to strengthening the interface and transition between the hospital and community medicine.

Causal modelling of heavy-tailed variables and confounders with application to river flow.

Unlabelled: Confounding variables are a recurrent challenge for causal discovery and inference. In many situations, complex causal mechanisms only manifest themselves in extreme events, or take simpler forms in the extremes. Stimulated by data on extreme river flows and precipitation, we introduce a new causal discovery methodology for heavy-tailed variables that allows the effect of a known potential confounder to be almost entirely removed when the variables have comparable tails, and also decreases it sufficiently to enable correct causal inference when the confounder has a heavier tail.

[Environmental impact of prescribing in family medicine - Example of simple urinary tract infection].

As the pharmaceutical industry keeps growing, the presence and impact of drug residues in water is becoming increasingly well documented. These end up in wastewater after human consumption, and then in surface water if they are not sufficiently removed in wastewater treatment plants, harming aquatic organisms even in minute quantities. Antibiotics and NSAIDs are the most worrying for the environment.

[Accounting basics for the self-employed physician].

The work of a self-employed physician being a liberal activity, his practice does not only require the mastery of the medical art but also of the financial management of his practice. This article aims at reminding some basic accounting notions necessary for the adequate financial management of a medical practice.

[Case discussion groups : « training or treatment » ?].

Since the creation of Balint groups in the 1950s, the concept of meeting among doctors to discuss difficult clinical situations has spread widely, whether or not in line with Michael Balint's initial model. While the latter had thought of these groups as training, their therapeutic role was quickly questioned in the medical literature. At a time when we are seeing and concerned about the poor mental health of primary care doctors, we wanted to show that the added value provided by participation in a practice exchange group is both formative and therapeutic.

[2019 scientific breakthroughs in ambulatory general internal medicine].

In healthy adults, vitamin D does not prevent falls or hip fractures. The diabetogenic effect of topical steroids is significant and dose dependent. Pulmonary embolism can be surely ruled out by the YEARS algorithm adapted to pregnancy.

Deciding whether to consult the GP or an emergency department: A qualitative study of patient reasoning in Switzerland.

Non-urgent care is an important factor responsible for rising healthcare costs and general practitioners (GPs) are known to be more cost-effective than emergency departments (EDs). To understand the reasons why patients confronted with a medical problem perceived as urgent choose to consult either a GP or an ED. We conducted a qualitative study in Switzerland, using data collected between 2014 and 2015 through semi-structured interviews of adults with non-vital medical problems.

[2018 scientific breakthroughs in ambulatory general internal medicine].

Mindfulness meditation and cognitive-behavioral therapy are more cost-effective than conventional management of chronic low back pain. Women with iron deficiency can be treated with oral iron substitution every other day to improve tolerance. Smokers who smoke four or less cigarettes per day have a disproportionately high risk of cardiovascular and cerebrovascular events.

[Standard radiological examinations in general practice. A few basic principles].

Standard radiography remains an important diagnostic tool in the practice of primary care medicine. As a result of the development of radiological facilities, ionising radiation doses have become less and less important and image quality has improved considerably. Nevertheless, each radiological examination must be justified with a proper indication.

[General internal medicine : 2017 scientific breakthroughs in ambulatory care].

Bariatric surgery improves glycemic control in obese patients with diabetes type 2. Dual antiplatelet therapy can be maintained beyond 12 months after a myocardial infarction. Levothyroxine is not beneficial among patients ≥ 65 years that have subclinical hypothyroidism.

[Opioid dependence treatment in general practice].

Opioid dependence causes numerous comorbidities primary care physicians have often to deal with. We currently have alternative substitution treatments available in Switzerland for opioid dependent patients, all of whom are known to be effective in treating and preventing the consequences of this addiction. Some of the known medications have a narrow therapeutic range that may hinder the prescription.

[Doctor, I'm afraid of suffocating! COPD and psychiatric manifestations].

The chronic obstructive pulmonary disease is a frequent and increasing disease in Western countries. Psychiatric comorbidities, such as depression or anxiety, are often observed and have a major impact on the quality of life and on the prognosis of the patients. Several models based on physiopathological and behavioral psychotherapy researches help us to understand this association between somatic and psychiatric disease.

[2016 literature findings in internal general medicine].

Treatment with diclofenac appears to be more effective compared to other NSAIDs in the treatment of osteoarthritis of the large joints. Opioids do not diminish significantly the pain in chronic lower back pain. Degenerative tears of the meniscus, without signs of osteoarthritis, should be treated conservatively.

[Examination of the abdomen, let's train again ?].

This article describes the main clinical gestures to perform when a patient complains of acute abdominal pain. It summarizes the knowledge in general medicine by integrating whenever possible clinical reasoning with likelihood ratios. This chapter does not address complex situations.

[It all started with a simple symptom and then… Basic palliative medical tools for primary care physicians].

The treatment of symptoms in palliative care is of primary importance, though this in itself is not sufficient for the relief of all aspects of a patient's suffering. Pain, dyspnea, or anxiety cannot be reduced to a single somatic characteristic, the psychological implications and the consequences on the patient's daily life being of paramount importance. A respect with regard to certain basic principles, and a full knowledge of the main therapeutic approaches available, allow for a better initial management of the symptoms.

[The hand : review of the main pathologies for the primary care physician].

The general practitioner is often the first person to have to assess and treat a patient complaining about his hand, especially in areas far away from an emergency health center. The hand is the largest sensitive area of our cortex. It is the most used part of our body and is therefore prone to traumas, cuts, infections, tendinous inflammation and compressive nerve disorders.

[The informatics: a remarkable tool for teaching general internal medicine].

INTERMED training implies a three week course, integrated in the "primary care module" for medical students in the first master year at the school of medicine in Lausanne. INTERMED uses an innovative teaching method based on repetitive sequences of e-learning-based individual learning followed by collaborative learning activities in teams, named Team-based learning (TBL). The e-learning takes place in a web-based virtual learning environment using a series of interactive multimedia virtual patients.

[Knee pain in ambulatory practice].

Knee pain is a frequent complaint in ambulatory practice. Because of its complexity, the knee is prone to trauma, arthritis and the impact of aging. Septic arthritis is an emergency and has to be suspected when important knee pain is associated with fever, an alteration of the general condition, or in a particular social context.

[2013 literature findings in internal general medicine].

The prescribing of antibiotics for uncomplicated skin abscesses and diverticulitis has no benefit. Some antibiotics are more at risk of causing a Clostridium difficile infection. The tests used to exclude a history of a penicillin allergy are safe.

[Shoulder pain in ambulatory practice].

Scapulalgias or omalgias are a frequent complaint, with more than half of them being linked to an injury of the rotators cuff. As they often become chronic, omalgias result in higher rates of absenteeism and significant health care costs. Scapulalgias have three main causes: posttraumatic, intrinsic of the joint, or extrinsic.

[2010 findings from literature on general internal ambulatory medicine].

From our reading over the current year 2010 we have singled out 8 items which seem to us significant for the practice of medicine. Small doses of colchicine are useful in the treatment of gout. No efficacious treatment for muscular cramps can be recommended.