[No education without feedback: why and how to give it in the clinical setting]. / Pas d'enseignement sans feedback : pourquoi et comment le donner en milieu clinique.

The number of medical students and doctors in training is growing, particularly in private practices due to the promotion of the internal medicine and primary care curriculum. Therefore, doctors increasingly find themselves in a teaching role with the responsibility to give feedback to the people in training. This article aims to give the definition of feedback and to review the reasons for its central role in pre- and postgraduate medical education. We describe the opportunities and barriers to giving feedback, how to make it effective and present a selection of frequently used feedback models.

Le nombre d'étudiants en médecine et médecins en formation est en augmentation, particulièrement au cabinet dans le cadre de la promotion de la filière de médecine interne générale et de premier recours. De plus en plus de médecins se retrouvent donc dans un rôle d'enseignants avec la responsabilité de donner des feedbacks aux personnes en formation. Le but de cet article est de donner la définition du feedback et de rappeler les raisons pour lesquelles il occupe une place centrale dans l'éducation médicale. Nous décrivons ensuite les opportunités mais aussi les barrières pour donner un feedback, comment le rendre efficace et présentons quelques modèles fréquemment utilisés.

[Management of opioid-induced constipation : the old and the new]. / Gestion de la constipation induite par les opioïdes : les anciens et les modernes.

The use of opioids has increased over the past 20 years. Among their side effects, constipation is probably the most common. Managing opioid-induced constipation primarily involves laxatives from the onset and addressing any additional causes of constipation. The laxatives of choice for this condition are, firstly, macrogol, followed by stimulant laxatives. If these first-line measures fail, peripheral mu-opioid receptor agonists (PAMORA) can be considered ; however, their coverage by Swiss health insurances remains limited to date.

L'utilisation des opioïdes a augmenté durant ces vingt dernières années. Parmi leurs effets secondaires, la constipation est probablement le plus courant. La gestion de la constipation induite par les opioïdes repose principalement sur l'administration de laxatifs dès leur introduction et le contrôle de causes surajoutées de constipation. Les laxatifs de choix dans cette indication sont en premier lieu le macrogol puis les laxatifs stimulants. En cas d'échec de ces mesures et traitements, des agonistes périphériques des récepteurs mu (PAMORA) peuvent être discutés, bien que leur prise en charge par les assurances sociales reste à ce jour limitée.

[Integrative medicine: what's new in 2023]. / Médecine intégrative : ce qui a changé en 2023.

To illustrate the news of 2023 in integrative medicine, the authors summarized four particularly relevant studies. The first highlights one of the foundational principles of integrative medicine, describing the importance of respecting patient preference in the choice of a therapeutic approach, promoting their «empowerment¼. The second article proposes methodological recommendations to improve the scientific value of studies assessing the efficacy and mechanisms of non-pharmacological approaches. Finally, the last two articles are randomized studies designed to either demonstrate the feasibility and effect of hypnosis in geriatrics, or evaluate the efficacy of a several combined complementary approaches for cancer-related fatigue.

Dans cette nouvelle édition consacrée aux nouveautés en médecine intégrative, les auteurs ont choisi de résumer quatre études particulièrement pertinentes parmi les articles publiés en 2023. La première souligne l'un des principes fondateurs de la médecine intégrative en décrivant l'importance du respect de la préférence du patient dans le choix d'une approche thérapeutique, favorisant leur « empowerment ¼. La deuxième propose des recommandations méthodologiques afin d'améliorer la valeur scientifique des études de l'efficacité et des mécanismes d'approches non pharmacologiques. Enfin, les deux dernières sont des études randomisées visant à démontrer, d'une part, la faisablité et l'effet de l'hypnose en gériatrie et, d'autre part, l'efficacité d'une combinaison d'approches complémentaires pour lutter contre la fatigue liée au cancer.

[Selected novelties for hospital based internal medicine]. / Nouveautés en médecine interne hospitalière.

In this selective overview of articles, we describe new concepts, therapeutic measures and pharmacological agents that may modify current practice in clinical internal medicine. Novelties for the management of cardiovascular disease, such as heart failure, hypoxemic respiratory failure, nosocomial pneumonia and certain allergies are discussed.

À travers quelques articles et études choisis, cet article décrit de nouveaux concepts, mesures thérapeutiques et agents pharmacologiques pouvant modifier les pratiques courantes en médecine interne. Des notions concernant la gestion de maladies cardiovasculaires telles que l'insuffisance cardiaque, les décompensations respiratoires hypoxémiques, les pneumonies nosocomiales et la gestion d'allergies y figurent au premier plan.

Brain functional connectivity alterations associated with neuropsychological performance 6-9 months following SARS-CoV-2 infection.

Neuropsychological deficits and brain damage following SARS-CoV-2 infection are not well understood. Then, 116 patients, with either severe, moderate, or mild disease in the acute phase underwent neuropsychological and olfactory tests, as well as completed psychiatric and respiratory questionnaires at 223 ± 42 days postinfection. Additionally, a subgroup of 50 patients underwent functional magnetic resonance imaging. Patients in the severe group displayed poorer verbal episodic memory performances, and moderate patients had reduced mental flexibility. Neuroimaging revealed patterns of hypofunctional and hyperfunctional connectivities in severe patients, while only hyperconnectivity patterns were observed for moderate. The default mode, somatosensory, dorsal attention, subcortical, and cerebellar networks were implicated. Partial least squares correlations analysis confirmed specific association between memory, executive functions performances and brain functional connectivity. The severity of the infection in the acute phase is a predictor of neuropsychological performance 6-9 months following SARS-CoV-2 infection. SARS-CoV-2 infection causes long-term memory and executive dysfunctions, related to large-scale functional brain connectivity alterations.

A GP's clinical reasoning in the context of multimorbidity: beyond the perception of an intuitive approach.

INTRODUCTION: GP's clinical reasoning processes in the context of patients suffering from multimorbidity are often a process which remains implicit. Therefore, the goal of this case study analysis is to gain a better understanding of the processes at play in the management of patients suffering from multimorbidity. METHODS: A case study analysis, using a qualitative thematic analysis was conducted. This case follows a 54-year-old woman who has been under the care of her GP for almost 10 years and suffers from a number of chronic conditions. The clinical reasoning of an experienced GP who can explicitly unfold his processes was chosen for this case analysis. RESULTS: Four main themes emerged from this case analysis: The different roles that GPs have to manage; the GP's cognitive flexibility and continual adaptation of their clinical reasoning processes, the patient's empowerment, and the challenges related to the collaboration with specialists and healthcare professionals. CONCLUSION: This could help GPs gain a clearer understanding of their clinical reasoning processes and motivate them to communicate their findings with others during clinical supervision or teaching. Furthermore, this may emphasize the importance of valuing the role of the primary care physician in the management of multimorbid patients.

Risk of Reinfection After Seroconversion to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Population-based Propensity-score Matched Cohort Study.

BACKGROUND: Serological assays detecting anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies are being widely deployed in studies and clinical practice. However, the duration and effectiveness of the protection conferred by the immune response remains to be assessed in population-based samples. To estimate the incidence of newly acquired SARS-CoV-2 infections in seropositive individuals as compared to seronegative controls, we conducted a retrospective longitudinal matched study. METHODS: A seroprevalence survey including a representative sample of the population was conducted in Geneva, Switzerland, between April and June 2020, immediately after the first pandemic wave. Seropositive participants were matched one-to-two to seronegative controls, using a propensity-score including age, gender, immunodeficiency, body mass index (BMI), smoking status, and education level. Each individual was linked to a state-registry of SARS-CoV-2 infections. Our primary outcome was confirmed infections occurring from serological status assessment to the end of the second pandemic wave (January 2021). RESULTS: Among 8344 serosurvey participants, 498 seropositive individuals were selected and matched with 996 seronegative controls. After a mean follow-up of 35.6 (standard deviation [SD] 3.2) weeks, 7 out of 498 (1.4%) seropositive subjects had a positive SARS-CoV-2 test, of whom 5 (1.0%) were classified as reinfections. In contrast, the infection rate was higher in seronegative individuals (15.5%, 154/996) during a similar follow-up period (mean 34.7 [SD 3.2] weeks), corresponding to a 94% (95% confidence interval [CI]: 86%- 98%, P < .001) reduction in the hazard of having a positive SARS-CoV-2 test for seropositives. CONCLUSIONS: Seroconversion after SARS-CoV-2 infection confers protection against reinfection lasting at least 8 months. These findings could help global health authorities establishing priority for vaccine allocation.

One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals.

BACKGROUND: Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors. OBJECTIVE: The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative. METHODS: From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date. RESULTS: At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history. CONCLUSION: SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

[Healing communication: Therapeutic communication in internal medicine]. / La « communication thérapeutique ¼ en médecine interne.

Caregiver-patient communication is a central element of the therapeutic relationship and a powerful placebo. While poorly adapted communication can have harmful effects, adequate communication offers many benefits for the patient and the caregiver. Therapeutic communication (TC), a set of strategies inspired by clinical hypnosis, is easy to learn and apply. In addition to reinforcing an empathetic attitude, TC appears to be effective in various clinical situations, particularly for its effects on pain and anxiety. In order to better understand the interest of CT in internal medicine, we have conducted a literature review on its efficacy during different medical procedures.

La communication soignant-e/soigné-e est un élément central de la relation thérapeutique et un puissant placebo dont il serait dommage de se priver. Mal adaptée, elle peut avoir des effets néfastes, efficace, elle offre de nombreux bénéfices pour les patient-e-s et soignant-e-s. La communication thérapeutique (CT), un ensemble de stratégies inspirées de l'hypnose clinique, est facile à apprendre et à appliquer. En plus de renforcer une attitude empathique, la CT semble efficace dans diverses situations cliniques, notamment pour ses effets sur la douleur et l'anxiété. Dans le but de mieux comprendre l'intérêt de la CT en médecine interne, nous avons effectué une revue de littérature démontrant son utilisation lors de gestes techniques auxquels les patient-e-s sont fréquemment confronté-e-s.

[Psychological health and cardiovascular disease : interdependency and therapeutic opportunities]. / Corpus sanum in mente sana : stratégies de promotion de la santé psychique en cas de pathologie cardiovas.

Despite progress in primary and secondary prevention, pharmacological and device-based therapies, cardiovascular disease remains a leading cause of morbidity and mortality worldwide. The specifics of cardiac disorders being in the spotlight, less attention has been given to psychological health and its interdependent relation to cardiovascular disease. Psychological health issues can contribute to increase cardiovascular disease risk, and cardiovascular disease itself can promote development of mental health issues. Psychological health in patients with cardiovascular disease represents an underexplored opportunity for intervention, an endeavour that could be designed as behavioural cardiology, which would be synergistic with efforts aimed at primary and secondary prevention.

Malgré les progrès réalisés en prévention primaire et secondaire ainsi qu'en termes de traitements pharmacologiques et de dispositifs médicaux, les pathologies cardiovasculaires restent la cause principale de morbidité et de mortalité à travers le monde. L'attention médicale portant particulièrement sur les pathologies cardiaques elles-mêmes, la santé mentale du patient peut être l'objet d'une attention insuffisante. Les souffrances psychiques contribuent à une augmentation du risque de pathologie cardiovasculaire et, réciproquement, une pathologie cardiovasculaire rend vulnérable et peut favoriser l'apparition d'un trouble psychique. La prise en charge globale du sujet cardiopathe, en particulier de son vécu intrapsychique, représente une opportunité d'intervention largement sous-exploitée. Cette discipline, nommons-la cardiologie comportementale, pourrait être menée en parallèle des mesures de prévention primaire et secondaire.

[Use of hypnosis in chronic pain : a setting in motion]. / Utilisation de l'hypnose lors de douleurs chroniques : une mise en mouvement.

The biopsychosocial complexity of chronic pain requires a multimodal approach of which hypnosis is one. Its effectiveness is increasingly proven by studies using functional neuroimaging, as well as clinical studies in various etiologies of chronic pain. The goal of hypnosis is to restore the patient to an active role where, during the sessions, he will discover his creative capacities allowing him to temporarily modify or even significantly reduce painful sensations. Regular practice of self-hypnosis amplifies and anchors these changes. Gradually, hypnosis allows patients to regain both physical and mental mobility.

La complexité biopsychosociale des douleurs chroniques impose une approche multimodale dont l'hypnose fait partie. Son efficacité est de plus en plus prouvée par des études utilisant la neuro-imagerie fonctionnelle, ainsi que des études cliniques dans diverses étiologies de douleurs chroniques. Le but de l'hypnose est de redonner au patient un rôle actif où, au cours des séances, il découvrira ses capacités créatrices lui permettant de modifier, voire de nettement réduire temporairement les sensations douloureuses. La pratique régulière de l'autohypnose amplifie et ancre ces modifications. Progressivement, l'hypnose permet aux patients de retrouver une mobilité tant physique que psychique.

[COVID-19-related acute encephalopathy: physiopathological hypothesis]. / Encéphalopathie aiguë et Covid-19: hypothèses physiopathologiques.

Acute encephalopathy is one of the most frequent neurological complication in patients hospitalized for COVID-19. Electrolyte imbalance, drugs, and hypoxemia can all affect brain homeostasis, leading to acute cognitive dysfunction and direct implications of the SARS-CoV-2 are not completely understood. Neurological complications of SARS-CoV-2 infection are poorly understood: an inflammatory insult to the endothelium affecting the blood-brain barrier may explain the clinical presentation, but other hypotheses including direct viral damage or an immune-mediated reaction are also suggested. Among these various potential mechanisms, often combined, the controversy remains.

L'encéphalopathie aiguë est l'une des principales complications neurologiques des patients hospitalisés pour un Covid-19. Si les complications électrolytiques, les différents traitements et l'hypoxémie ont un effet sur l'homéostasie cérébrale entraînant une perturbation de la cognition, les conséquences cérébrales directes ou indirectes du SARS-CoV-2 ne sont pas complètement élucidées. L'implication du virus entraînant une atteinte endothéliale des vaisseaux cérébraux pourrait participer à cette encéphalopathie, via une fragilisation de la barrière hémato-encéphalique et un passage facilité des cytokines pro-inflammatoires. L'atteinte virale directe ou la réaction autoimmune secondaire ont également été invoquées. Face aux multiples mécanismes physiopathologiques possibles pouvant expliquer cette encéphalopathie, le débat est ouvert.

Listeria monocytogenes infectious periaortitis: a case report from the infectious disease standpoint.

BACKGROUND: Endograft infection is a rare but extremely dangerous complication of aortic repair (25-100% of mortality). We describe here the first case of Listeria monocytogenes abdominal periaortitis associated with a vascular graft. We also discuss the differential diagnosis of periaortitis and provide a literature review of L. monocytogenes infectious aortitis. CASE PRESENTATION: Nine months after endovascular treatment of an abdominal aortic aneurysm (abdominal stent graft), a 76-year-old man was admitted for severe abdominal pain radiating to the back. Laboratory tests were normal apart from elevated C-reactive protein (CRP). Injected abdominal computed tomography (CT) showed infiltration of the fat tissues around the aortic endoprosthesis and aneurysmal sac expansion; positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) showed a hypermetabolic mass in contact with the endoprosthesis. Blood cultures were negative. At surgical revision, an infra-renal peri-aortic abscess was evident; post-operative antibiotic therapy with ciprofloxacin and doxycycline was started. Cultures of intraoperative samples were positive for L. monocytogenes. Results were further confirmed by a broad-range polymerase chain reaction (PCR) and next-generation sequencing. Antibiotic treatment was switched to intravenous amoxicillin for 6 weeks. Evolution was uneventful with decrease of inflammatory parameters and regression of the abscess. CONCLUSION: An etiologic bacterial diagnosis before starting antibiotic therapy is paramount; nevertheless, culture-independent methods may provide a microbiological diagnosis in those cases where antimicrobials are empirically used and when cultures remain negative.

[Diphtheria: new clinical presentations of an old disease]. / Diphtérie†: nouvelle présentation clinique d'une ancienne maladie.

Diphtheria is reappearing in a typical cutaneous form where pre-existing skin lesions (wounds or insect bites) become pustular and turn into painful non-healing ulcers. This form is more common among migrants and disadvantaged populations. Lesions can be caused by strains of toxigenic and non-toxigenic Corynebacteria and among them the famous Corynebacterium diphtheriae. In this paper we review diphtheria's clinical presentations and pathogenesis, as well as methods of diagnosis, treatment and prevention.

La diphtérie réapparaît sous une forme cutanée typique : des lésions préexistantes (plaies ou piqûres d'insectes) deviennent pustuleuses et se transforment rapidement en ulcères douloureux ne cicatrisant pas. Ce tableau se retrouve plus fréquemment chez les migrants, mais aussi au sein de populations défavorisées, et chez des voyageurs en retour de zones d'endémie. Les lésions peuvent être causées par des souches de corynébactéries toxinogènes ou non, et parfois liées à d'autres espèces que le fameux Corynebacterium diphtheriae. Cet article rappelle les présentations cliniques, le rôle des pathogènes ou de leurs toxines ainsi que les méthodes de diagnostic, traitement et prévention.

Chemotherapy-induced Takotsubo cardiomyopathy, a case report and review of the literature.

BACKGROUND: Several chemotherapy molecules, monoclonal antibodies and tyrosine kinase inhibitors, have been linked to Takotsubo cardiomyopathy (TC). CASE PRESENTATION: In this article, we describe the case of a 45-year-old woman who developed TC after receiving an intra-arterial and intra-venous polychemotherapy for locally advanced epidermoid carcinoma of the anal canal. This is the first described case of TC associated with intra-arterial chemotherapy. CONCLUSIONS: A review of the literature points to 5-fluorouracil as the most common molecule associated with TC and highlights the potential risk associated with rechallenging patient with the same drug.

[Clostridia: toxin masters. Botulism: from botox to sausages?]. / Clostridia: maîtres en toxines. Le botulisme: du botox au saucisson?

Clostridia are ubiquitous Gram-positive bacteria whose toxins are responsible for serious diseases. In this article we report a case of foodborne botulism we have recently managed. Moreover, we briefly describe the major clinical syndromes caused by different species of Clostridium (except for C. difficile infections, as this subject has been previously extensively reviewed in this journal). Botulism causes a flaccid paralysis starting with cranial nerves. Administration of botulism anti-toxin should be rapidly considered as soon as botulism is suspected, as prognosis is largely dependent on timely treatment; alerting the public health authorities is equally important. In Switzerland botulinum antitoxin can be obtained from the pharmacy of the Swiss Army.