[Pulmonary effects of inhaled cannabis]. / Conséquences respiratoires de l'inhalation de cannabis.

The respiratory consequences of cannabis inhalation remain poorly understood. The main challenges are the biases due to the combined consumption of tobacco and to the various consumption modalities. While some similarities can be drawn between cannabis and tobacco, such as certain carcinogenic components present in their smoke, as well as the clinical chronic bronchitis, the pulmonary repercussion of these two substances differ in several aspects. It should be remembered that research on cannabis benefits from less hindsight than that of tobacco and concerns a younger population, opening up the need for further research. This article aims to offer an overview of current knowledge.

Les conséquences respiratoires de l'inhalation de cannabis restent peu connues à ce jour. La difficulté principale de la recherche dans ce domaine est inhérente à la consommation conjointe de tabac et aux diverses modalités de consommation. Bien qu'il existe certaines similitudes entre les toxicités du cannabis et du tabac, dues notamment à certains composants carcinogènes de leur fumée, ainsi qu'un tableau clinique de bronchite chronique commun, les répercussions pulmonaires de ces deux substances se distinguent sur plusieurs points. Il convient de rappeler que l'évaluation des conséquences respiratoires du cannabis bénéficie de moins de recul que celle du tabac et concerne une population plus jeune, nécessitant des études supplémentaires. Cet article dresse l'état des lieux des connaissances actuelles.

[Role of point-of-care ultrasonography in the management of heart failure]. / Rôle de l'échographie ciblée dans la prise en charge de l'insuffisance cardiaque.

Heart failure is a common disease and one of the main reasons of hospital admission. It is a rich research field, marked by regular novelties in the management of heart failure. In the last decades point-of-care ultrasonography has been more prominent in internal medicine, particularly for the management of heart failure. A structured training is required to acquire core competencies. In heart failure, this bedside tool includes focused lung, cardiac and vascular ultrasonography. The combination of these modalities raises diagnostic accuracy, reduce time to diagnosis in dyspneic patients and plays a role in adaptation of decongestive therapy.

L'insuffisance cardiaque est une pathologie fréquente et l'un des principaux motifs d'admission à l'hôpital. La recherche clinique, riche dans ce domaine, marque régulièrement le paysage médical de nouveautés dans sa prise en charge. L'échographie ciblée s'est développée de manière importante ces dernières années en médecine interne, en particulier pour la prise en charge de l'insuffisance cardiaque. L'apprentissage de celle-ci nécessite une formation structurée pour l'acquisition des compétences de base, permettant l'exploration ciblée du cœur, des vaisseaux et de l'appareil pleuropulmonaire au lit du patient. La combinaison de ces modalités améliore la précision diagnostique, diminue le délai diagnostique lors de dyspnée, et joue un rôle dans l'adaptation du traitement décongestif.

[Hospital pathway of complex patients in a medical service of a local Hospital]. / Trajectoire hospitalière des patients complexes dans un service de médecine d'un hôpital régional.

In the current Swiss medical system, hospital care is provided by both university hospitals and so-called « peripheral ¼ hospitals. While university hospitals offer advanced technology and a wide range of medical specialists, how is care organized within the smaller, less complex structure of a peripheral hospital ? In emergencies, although patients usually go to their local hospital, they should not be exposed to lower quality care. Quality treatment is guaranteed by a well-organized structure, supported by a competent team of general doctors and specialists who have access to advanced technology. This article illustrates the journey of a typical patient presenting several common problems that make his case complex to manage, and also illustrates how the internal medicine department of a peripheral hospital operates.

En Suisse, les soins hospitaliers sont dispensés par des centres universitaires et des hôpitaux dits «périphériques¼. Alors qu'un hôpital universitaire offre un plateau technique avancé et dispose d'un panel de médecins spécialistes, comment s'organisent les soins au sein d'un hôpital périphérique ? Les patients se présentent généralement dans l'hôpital le plus proche de leur domicile, et cela ne devrait pas les exposer à des soins de moindre qualité. L'organisation associant les généralistes hospitaliers aux spécialistes disponibles et la collaboration avec les hôpitaux universitaires garantit des soins de qualité. Cet article illustre le parcours d'un patient ordinaire avec plusieurs problèmes courants rendant la prise en charge complexe, ainsi que l'activité d'un service de médecine interne hospitalier d'un hôpital périphérique.

[Post-graduate education in internal medicine : what do residents want ?] / Formation postgraduée en médecine interne : que veulent les médecins en formation ?

The post-graduate education course in general internal medicine - which leads to the accreditation as a specialist - is established by l'Institut Suisse de Formation médicale (ISFM), one of the organs of the FMH (Federatio Medicorum Helveticorum) in collaboration with the Swiss Society of General Internal Medicine (SSGIM). This program sets inter alia the necessary learning steps and defines which tools are efficient in monitoring the teaching program. The specific goals defined in the course are not, however, easily reached, specifically in the internal medicine services of hospitals that are subject to organisational constraints. This is strongly highlighted in the assessments made by residents during these training years. It, therefore, seems necessary to implicate the residents more actively in the definition of the goals of their training to maintain and continuously improve the quality of their post-graduate education.

Le programme de formation postgraduée en médecine interne générale, qui permet l'obtention du titre de spécialiste est établi par l'Institut suisse de formation médicale (ISFM), organe de la FMH (Fédération des médecins suisses) en collaboration avec la Société suisse de médecine interne générale (SSMIG). Celui-ci fixe notamment les étapes nécessaires de la formation et définit les outils permettant d'en évaluer la qualité. Toutefois, les objectifs spécifiques décrits ne sont pas toujours aisément atteignables, en particulier dans les services hospitaliers, pour des raisons notamment organisationnelles. Ceci ressort clairement des évaluations effectuées en cours de formation par les médecins assistants, et c'est pourquoi une implication plus active des médecins en formation dans l'organisation de la formation post-graduée en médecine interne paraît indispensable pour le maintien et l'amélioration de sa qualité.

Gait speed is associated with death or readmission among patients surviving acute hypercapnic respiratory failure.

OBJECTIVES: Death or hospital readmission are frequent among patients surviving acute hypercapnic respiratory failure (AHRF). Severity scores are not valid to predict death or readmission after AHRF. Gait speed, a simple functional parameter, has been associated with hospital admission and death in the general population. The purpose of this study is to highlight an association between gait speed at hospital discharge and death or readmission among AHRF survivors. DESIGN: Secondary analysis of a prospective cohort study. SETTINGS: Single Swiss tertiary hospital, pulmonary division. PARTICIPANTS: Patients were prospectively recruited to form a cohort of patients surviving AHRF in the intensive care unit between January 2012 and May 2015. OUTCOME MEASURE: Gait speed was derived from a 6 min walking test (6MWT) before hospital discharge. All predictive variables were prospectively collected. Death or hospital readmission were recorded for 6 months. Univariate and multivariate analyses were performed to evaluate the association between predictive variables and death or hospital readmission. RESULTS: 71 patients performed a 6MWT. 34/71 (48%) patients died or were readmitted to the hospital during the observation period. Median gait speed was 0.7 (IQR 0.3-1.0) m/s. At 6 months, 66% (25/38) of slow walkers (gait speed <0.7 m/s) and 27% (9/33) of non-slow walkers died or were readmitted to the hospital (p=0.002). In univariate analysis, gait speed was associated with death or readmission (HR 0.41; 95% CI 0.19 to 0.90, p=0.025). In a multivariate model adjusted for age, gender, body mass index, forced expired volume, heart failure and home mechanical ventilation, gait speed remained the only variable associated with death or readmission (multivariate HR: 0.35; 95% CI 0.14 to 0.88, p=0.025). CONCLUSION: This study suggests that a simple functional parameter such as gait speed is associated with death or hospital readmission in patients surviving AHRF. TRIAL REGISTRATION NUMBER: NCT02111876.