[Covid-19 respiratory sequelae : Screening and management]. / Séquelles respiratoires liées au Covid-19 : dépistage et prise en charge.

Infection with SARS-CoV-2 can affect multiple organ systems with variable severity and is known to frequently have a major impact on the respiratory system. Symptoms may persist for several months after infection, and are associated with a reduction of lung function, diminished exercise capacity and anomalies on chest CT. Guidelines on the post-acute care of patients with SARS-CoV-2 are now available. Pulmonary rehabilitation plays a central role in the recovery of exercise capacity, notably in severe cases. The role of specific therapies, such as corticosteroids, anti-fibrotics and lung transplantation remains uncertain and needs to be evaluated on a case-by-case basis.

L'infection à SARS-CoV-2 conduit à une atteinte multisystémique de gravité variable, fréquemment avec un impact majeur sur le système respiratoire. Les symptômes peuvent persister plusieurs mois après l'infection initiale. Ils sont parfois associés à une diminution des fonctions pulmonaires et de la capacité à l'effort, ainsi qu'à des anomalies au CT-scan thoracique. Il existe actuellement des recommandations de suivi et de prise en charge des patients atteints par le Covid-19 pour la phase postaiguë. La réhabilitation pulmonaire joue un rôle central dans la récupération de la capacité d'effort, surtout dans les formes sévères. La place des traitements spécifiques des atteintes pulmonaires, notamment les corticostéroïdes, les antifibrotiques et la transplantation, reste encore incertaine et doit être considérée au cas par cas.

[The Internal medicine articles that struck us the most in 2020]. / L'année 2020 mise en perspective par les internistes hospitaliers.

2020 has continued to bring important progress in all areas of internal medicine, impacting our daily practice. From a shift to oral stepdown antibiotics in infectious endocarditis, to new indications for apixaban, SLGT-2 inhibitors and macrolide antibiotics, passing by the catheter-based renal denervation in hypertension, early paracentesis in cirrhosis and new diagnostic criteria in pulmonary embolism, internal medicine journals are full of novelties. Every year, the chief residents of internal medicine at the Swiss University Hospital of Lausanne meet up to share their readings: here is their selection of eleven articles, summarized and commented for you.

L'année 2020 a vu de notables progrès dans tous les domaines de la médecine interne, avec un impact important sur notre pratique quotidienne. Du passage à une antibiothérapie orale dans l'endocardite infectieuse, aux nouvelles indications pour l'apixaban, les inhibiteurs du SGLT2 (sodium-glucose co-transporteur de type 2) et les macrolides en passant par la dénervation rénale dans l'hypertension artérielle, la ponction d'ascite et les changements de critères diagnostiques de l'embolie pulmonaire, les nouveautés abondent dans la littérature. Chaque année, les chefs de clinique du Service de médecine interne du CHUV se réunissent pour partager leurs lectures : voici une sélection de onze articles choisis, revus et commentés pour vous.

[Strategies to improve physician satisfaction and well-being in 2018]. / Stratégies pour améliorer la satisfaction professionnelle et le bien-être du médecin en 2018.

Physician satisfaction and well-being are essential for work efficiency and patient quality of care. Improvements can be made on two levels. Physician-directed interventions are aimed at improving resilience and reduce stress. Organization-directed interventions should improve working conditions, through schedule reorganization, work procedures optimization and team spirit promotion. Best results are obtained with the combination of both types of intervention.

La qualité de la prise en charge et la sécurité des patients sont influencées par le degré de bien-être du médecin. Deux types d'approche permettent d'augmenter la satisfaction professionnelle et diminuer le risque d'épuisement ou burnout. La première vise l'amélioration des capacités individuelles de gestion du stress, de résilience et de communication par des mesures comme le mindfulness (pleine conscience) et les groupes de parole. La seconde approche est axée sur l'amélioration des conditions de travail, notamment par une réorganisation des horaires, une optimisation des méthodes de travail et la promotion d'un esprit d'équipe. Les bénéfices sont supérieurs en combinant ces deux types d'approche.

Prevalence of small airway dysfunction in the Swiss PneumoLaus Cohort.

Background: Recent evidence identified exposure to particulate matter of size ≤2.5 µm (PM2.5) as a risk factor for high prevalence of small airway dysfunction (SAD). We assessed the prevalence of SAD in a European region with low air pollution levels. Methods: SAD was defined as a maximum mid-expiratory flow (MMEF) <65% of predicted value (PV) or MMEF 65 years only. In an area where ambient PM2.5 concentration was <15 µg·m-3 during the observation period (2010 and 2020), ≥72% of participants with SAD were ever-smokers. Conclusions: The observed low prevalence of SAD of 5.0-12.7% depending on criteria employed may be related to lower PM2.5 exposure. Smoking was the main factor associated with SAD in an area with low PM2.5 exposure. Employing a MMEF threshold <65% PV carries a risk of SAD overdiagnosis in elderly individuals.

Risk stratification for hospital-acquired venous thromboembolism in medical patients (RISE): Protocol for a prospective cohort study.

BACKGROUND: Hospital-acquired venous thromboembolism (VTE) is one of the leading preventable causes of in-hospital mortality. However, its risk assessment in medically ill inpatients is complicated due to the patients' heterogeneity and complexity of currently available risk assessment models (RAMs). The simplified Geneva score provides simplicity but has not yet been prospectively validated. Immobility is an important predictor for VTE in RAMs, but its definition is inconsistent and based on subjective assessment by nurses or physicians. In this study, we aim to prospectively validate the simplified Geneva score and to examine the predictive performance of a novel and objective definition of in-hospital immobilization using accelerometry. METHODS AND ANALYSIS: RISE is a multicenter prospective cohort study. The goal is to recruit 1350 adult inpatients admitted for medical illness in three Swiss tertiary care hospitals. We collect data on demographics, comorbidities, VTE risk and thromboprophylaxis. Mobility from admission to discharge is objectively measured using a wrist-worn accelerometer. Participants are followed for 90 days for the occurrence of symptomatic VTE (primary outcome). Secondary outcomes are the occurrence of clinically relevant bleeding, and mortality. The evolution of autonomy in the activities of daily living, the length of stay, and the occurrence of readmission are also recorded. Time-dependent area under the curve, sensitivity, specificity, and positive and negative predictive values are calculated for each RAM (i.e. the simplified and original Geneva score, Padua, and IMPROVE score) with and without the objective mobility measures to assess their accuracy in predicting hospital-acquired VTE at 90 days. ETHICS AND EXPECTED IMPACT: The ethics committee approved the protocol and the study was registered on ClinicalTrials.gov as NCT04439383. RISE has the potential to optimize VTE risk stratification, and thus to improve the quality of care of medically hospitalized patients.

Impact of smoking on sleep macro- and microstructure.

OBJECTIVES: Existing data suggest that smoking may be associated with sleep disturbances. This study aimed to determine the association between smoking and both subjective and objective sleep quality. METHODS: Cross-sectional analysis of sleep characteristics in 3233 participants from the population-based CoLaus-HypnoLaus cohort (52.2% women, mean age 56.6 ± 10.2 years) who completed questionnaires on sleep quality, of whom 1489 (46%) had a full polysomnography. Smoking data were self-reported; participants were classified by smoking status as current, former or never smokers. Primary outcomes were subjective sleep quality assessed by sleep questionnaires, and objective sleep quality based on polysomnography (sleep macrostructure), including power spectral analysis of the electroencephalogram on C4 electrode (sleep microstructure), quantifying the relative amount of delta power (1-4 Hz), a marker of sleep depth, and arousal-associated alpha power (8-12 Hz). RESULTS: Current smokers had a shift toward faster sleep electroencephalogram activity with lower delta power in non-REM sleep compared with former and never smokers (-2.8 ± 0.4% and -2.4 ± 0.4%, respectively; both p < 0.001) and higher alpha power (+0.8 ± 0.2%; p < 0.001) compared with never smokers. There was a dose-dependent negative association between electroencephalogram delta power and smoking intensity (r2 = -1.2 [-1.9, -0.5]; p = 0.001). Additionally, mean nocturnal oxygen saturation was lower in current smokers. CONCLUSIONS: Current smokers had decreased objective sleep quality, with a dose-dependent association between smoking intensity and decrease in electroencephalogram delta power during non-REM sleep, in addition to an increase in alpha power. Considering the importance of sleep quality for wellbeing and health, these results provide further data to support smoking cessation.