[Towards eco-responsible medical devices : life cycle analysis of medicine cups]. / Vers un matériel hospitalier écoresponsable : exemple du gobelet à médicaments.

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. This article assessed the LCA of three medical cups to identify their specific strengths and weaknesses.

La santé humaine dépend largement de la santé environnementale, il est donc crucial d'évaluer l'impact environnemental des systèmes de santé eux-mêmes. L'analyse de cycle de vie (ACV) évalue et compare les impacts de produits ou processus sur : la santé humaine, le changement climatique, les écosystèmes et les ressources. Cet article présente l'ACV de trois modèles de gobelets à médicaments, identifiant les avantages et faiblesses de chacun.

[Do we all suffer from imposter syndrome?] / Souffrons-nous toutes et tous d'un syndrome d'imposture?

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. The Clance scale is a self-assessment tool used to measure the level of imposture experienced and, when appropriate, to assess the suffering caused. The aim of this article is to help recognise this syndrome, which is one way of preventing it.

Le syndrome d'imposture est largement répandu chez les médecins et les étudiant-e-s en médecine. Il est défini comme une expérience psychologique où l'individu, malgré des succès démontrés, doute de ses compétences et réussites et, ainsi, éprouve une crainte infondée d'être démasqué. D'importantes conséquences comme des troubles anxieux et/ou dépressifs associés à un burnout peuvent en découler. L'échelle de Clance est un outil d'autoévaluation permettant de mesurer le niveau d'imposture ressenti et, le cas échéant, d'en évaluer la souffrance engendrée. Le but de cet article est d'aider à reconnaître ce syndrome, ce qui constitue l'un des axes de sa prévention.

[Cockpit: a tool to support interprofessional communication and collaboration]. / Cockpit : un outil d'aide à la communication et à la collaboration interprofessionnelle.

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. Some hospitals, particularly in North America, have been using lean management concepts for some years, as an organizational aid and aiming at continuous improvement. A cockpit is a tool that aims at dedicating a space and a period of time to interprofessional communication and collaboration.

Au sein d'un hôpital, de nombreux corps de métiers travaillent ensemble dans un même but : la prise en charge optimale des patients. Ce défi nécessite une coordination et une communi­cation performantes ainsi qu'une bonne connaissance du travail de chacun. En raison d'un travail administratif en constante augmentation et d'un flux de patients important, le temps dédié à cette collaboration interprofessionnelle s'amenuise. Certains hôpitaux, notamment en Amérique du Nord, utilisent depuis quelques années des concepts issus du « lean management ¼, comme aide organisationnelle et dans une perspective d'amélioration continue. Un « cockpit ¼ ou « salle de pilotage ¼ est un outil qui a pour but de consacrer un espace et une période de temps à la communication et à la collaboration interprofessionnelle.

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. The first and the second follow-ups included 5038 and 4596 participants aged 40-80 years, respectively. Polypill eligibility was defined as having a high CVD risk as assessed by an absolute CVD risk ≥ 5% with the SCORE equation for Switzerland and/or presenting with CVD. Four polypill equivalents were defined: statin + any antihypertensive with (A) or without (B) aspirin; statin + calcium channel blocker (CCB) (C); and statin + CCB + angiotensin-converting enzyme inhibitor (D). The prevalence of polypill eligibility was 20.6% (95% CI 19.5-21.8) and 27.7% (26.5-29.1) in the first and second follow-up, respectively. However, only around one-third of the eligible 29.5% (95% CI 26.7-32.3) and 30.4% (27.9-33.0) respectively, already took the polypill equivalents. All polypill equivalents were more prevalent among men, elderly and in presence of CVD. After multivariable adjustment, in both periods, male gender was associated with taking polypill equivalent A (OR: 1.93; 95% CI 1.45-2.55 and OR: 1.67; 95% CI 1.27-2.19, respectively) and polypill equivalent B (OR: 1.52; 95% CI 1.17-1.96 and OR: 1.41; 95% CI 1.07-1.85, respectively). Similarly, in both periods, age over 70 years, compared to middle-age, was associated with taking polypill equivalent A (OR: 11.71; CI 6.74-20.33 and OR: 9.56; CI 4.13-22.13, respectively) and equivalent B (OR: 13.22; CI 7.27-24.07 and OR: 20.63; CI 6.51-56.36, respectively). Former or current smoking was also associated with a higher likelihood of taking polypill equivalent A in both periods. A large fraction of the population is eligible for the polypill, but only one-third of them actually benefits from an equivalent, and this proportion did not change over time.

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. Polypharmacy and EPP were defined as the concomitant prescription of five or more and ten or more drugs, respectively. Drug-drug interactions were defined as any combination of a drug metabolized by a cytochrome P450 or P-glycoprotein, and a drug considered as strong inductor or inhibitor of the corresponding enzyme was defined as a potential interaction. RESULTS: Three most commonly classes of drugs prescribed were "alimentary tract and metabolism (including insulins)," "nervous system," and "blood and blood forming organs." Polypharmacy decreased from 45% in 2009 to 41% in 2015, whereas EPP increased from 40% to 46%. In 2015, 13% of patients received 15 or more drugs. Age, coming from other health care settings, higher Charlson Index, number of comorbidities, and quartiles of length of stay were significantly and independently associated with PP and EPP. The risk of having at least one DDI decreased from 67.0% (95% confidence interval = 64.8-69.0) in 2009 to 59.3% (57.6-62.0) in 2015 (P < 0.001). Multivariate analysis showed number of drugs (odds ratio and 95% confidence interval = 3.68 [3.3-4.1], 9.39 [8.3-10.6], and 20.5 [17.3-28.4] for [5-9], [10-14], and 15+ drugs, respectively), gastrointestinal disease (3.13 [2.73-3.58]), and cancer (1.37 [1.18-1.58]) to be positively associated, and lung (0.82 [0.74-0.90]) and endocrinological (0.62 [0.52-0.74]) diseases to be negatively associated with risk of DDI. CONCLUSIONS: The pattern of drug prescription has changed and most prescribed groups increased during the study period. Excessive polypharmacy is increasing among hospital patients. The decrease in the overall risk of DDI could be due to an improved management of multidrug therapy.

[Medical students at the bedside of COVID-19 patients†: motivations and challenges]. / Étudiant·e·s en médecine engagé·e·s au chevet des patient·e·s hospitalisé·e·s pour COVID-19 - Motivations et enjeux.

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). In this article, we first give the floor to students who responded to our call. We conclude with important considerations in terms of students' clinical supervision. It is reminded that the involvement of students in the care of COVID-19 patients should only occur on a vo luntary basis.

La pandémie de COVID-19 met notre système de santé sous une pression exceptionnelle, au vu du nombre de patient·e·s atteint·e·s. Dans un contexte de ressources humaines médico-soignantes limitées, les étudiant·e·s en médecine avancé·e·s dans leur cursus représentent un renfort très précieux, rapidement mobilisable auprès des patient·e·s. C'est la démarche suivie en Suisse et ailleurs dans le monde par diverses structures ambulatoires ou services hospitaliers, dont le Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV). Dans cet article, nous donnons tout d'abord la parole aux étudiant·e·s qui ont répondu à notre appel. Nous terminons par des considérations importantes quant à l'accueil et l'accompagnement de ces étudiant·e·s. Il est rappelé que l'engagement d'étudiant·e·s auprès de patient·e·s souffrant de COVID-19 devrait se faire sur une base volontaire uniquement.

[Organizational Impacts and Clinical Challenges of the COVID-19 Pandemic on a Swiss Tertiary Internal Medicine Department]. / Impacts organisationnels et défis cliniques de la pandémie COVID-19 pour un service hospitalier de médecine interne universitaire.

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. In this new form, the Department had already taken care of 442 COVID-19 admissions by April 16, 2020. Alongside organizational challenges, clinical issues such as rapid respiratory distress, clinical suspicions with negative PCR and treatment uncertainties in the absence of sufficient evidence were overcome. Despite the peak of the pandemic appearing to have passed, the next phase could be just as complicated.

La progression rapide du COVID-19 constitue un défi organisationnel pour tous les hôpitaux. Pour anticiper un afflux important de patients, le service de médecine interne du CHUV a ainsi augmenté ses forces de travail médico-soignantes et son nombre de lits de 65 % avec un soutien extraordinaire de toute l'institution. Pour opérer ces changements majeurs, l'organisation de crise mise en place s'est appuyée sur trois piliers : une cellule de conduite, des documents de pilotage et une communication interne. Sous cette nouvelle forme, le service a pris en charge 442 hospitalisations COVID-19 jusqu'au 16 avril 2020. Si les enjeux organisationnels ont été majeurs, la gestion des situations complexes, comme les manifestations respiratoires et les multiples incertitudes cliniques diagnostiques et thérapeutiques, ont été également une gageure. Le pic de la pandémie semble passé, mais la prochaine phase pourrait constituer un nouveau défi organisationnel.

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. The first study goal was to describe how the method could be used for inter-hospital comparison. The secondary goal was to learn about specific differences in the resident's working day structure in university and non-university hospital settings. DESIGN: Two separate time-motion studies. Trained peer-observers followed the residents during weekday day shifts with a tablet, able to record 22 different activities and corresponding context (with patient, phone, colleague or computer). SETTING: Internal medicine residencies at a university (May-July 2015) and a non-university (September-October 2016) community hospital. PARTICIPANTS: 28 residents (mean age: 29 years, average postgraduate training: 30 months) at university hospital, 21 residents (mean age: 30 years, average postgraduate training: 17 months) at non-university hospital. OUTCOMES: Time spent with patients and time dedicated to activities directly related to patients; description of main differences of time allocation between hospitals. RESULTS: Cumulatively 1051 hours of observation (566 (university hospital)+486 (non-university hospital)) and 92 day shifts (49+43) were evaluated. Daily working time was 11.5 versus 11.3 hours. A median daily period of 195 min (IQR 179-211, 27.9%) and 116 min (IQR 98-134, 17.2%) (p<0.001) was dedicated to direct patient care, respectively. CONCLUSIONS: We successfully identified differences potentially related to each hospital structure and organisation. Inter-hospital comparisons could help set up interventions aiming to improve workday structure and experience of residents.

[Analysis of chest x-rays, a systematic to remember]. / Analyse de la radiographie thoracique, une systématique à rappeler.

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. In addition, the observational and interpretive capabilities necessary for this task must be exercised, referring to the normal radiographic aspect. The objective of this article is to demonstrate the interpretation of pathological chest x-rays using clinical cases.

L'interprétation des radiographies thoraciques, qui s'intègre dans une prise en charge médicale globale, requiert une maîtrise spécifique, et ce malgré les performances prometteuses des logiciels d'intelligence artificielle. Des alternatives à cette modalité d'imagerie existent, en particulier le CT ultra-faible (low)-dose (CT-ULD) et l'ultrason (US) thoracique dans certaines indications, mais elles ne s'y substituent pas en routine clinique. Parmi les règles à respecter, une technique de lecture systématique est requise afin de réduire le risque d'erreur. De plus, les capacités d'observation et d'interprétation nécessaires à cette tâche doivent être exercées, et ce en référence à l'aspect radiographique normal. Cet article a pour objectif de démontrer l'interprétation de radiographies thoraciques pathologiques à l'aide de cas cliniques.

[The « Osler ¼ group : a new opportunity to think about « becoming a physician ¼]. / Le groupe « Osler ¼ : une nouvelle opportunité pour réfléchir sur le « devenir médecin ¼.

Issues of professionalism and professional identity formation, particularly amongst young doctors, have been the object of increasing attention. This is explained in part by the evolution of the hospital environment (specialization, shorter stays), as well as by the prevalence of physician burnout and suicide. In this context, the CHUV implemented a pilot project within the department of internal medicine aiming to support its residents in the construction of their professional identity. The Osler group convened 10 residents led by an attending physician and a senior resident from the internal medicine department as well as an attending physician of the liaison psychiatry department. The experience has been a success, with residents describing clear benefits of the group.

Les enjeux de professionnalisme et d'identité professionnelle chez les médecins font l'objet d'un intérêt croissant, en raison des évolutions du milieu hospitalier (spécialisation, raccourcissement de la durée de séjour) ainsi que de phénomènes comme le burn-out ou le suicide. C'est dans ce contexte que le CHUV a mis en place un projet pilote dans le Service de médecine interne (SMI) pour soutenir les médecins assistants dans la construction de leur identité professionnelle, valoriser la transmission de l'expérience clinique et leur offrir un espace de parole et d'échange. Le groupe « Osler ¼ a ainsi réuni dix assistants pour des rencontres animées par un médecin cadre et une cheffe de clinique du SMI, ainsi qu'un médecin cadre du Service de psychiatrie de liaison. L'expérience a été un succès, les assistants exprimant clairement les bienfaits du groupe, notamment quant à leur rapport au métier.

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 SLC19A2 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 7.6 g/dL, leucocytes 2.9×109/L, thrombocytes 6×109/L) revealed by dyspnoea. Investigations excluded coagulopathy, a recent viral infection, vitamin and iron deficiencies, and a malignant process. We later found out that thiamine treatment had been discontinued 5 weeks before, due to prescription error. Parenteral thiamine administration resulted in the recovery of haematopoiesis within 3 weeks. Pancytopenia is uncommon in patients with TRMA. Pre-existing medullary impairment caused by the patient's daily antipsychotic medications or the natural course of the syndrome may explain the severity of the laboratory findings in our patient.

[When the ward overflows : the impact of outlying beds on patient care]. / Quand le service déborde : impact de la satellisation des patients sur leur prise en charge.

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. Outlying is used daily in the CHUV hospital and new strategies are elaborated to manage patient flow, especially during the flu epidemic. The purpose of this article is to review the literature on this subject.

En raison du manque chronique de lits dans les hôpitaux, les patients sont souvent hospitalisés dans des services satellites, différents de celui du médecin responsable de la prise en charge. Les hospitalisations en lit satellite augmentent le risque thromboembolique, les infections nosocomiales, les chutes et les états confusionnels dans la population gériatrique, ainsi que la morbidité et la mortalité. Les patients satellisés séjournent plus longuement que les autres aux urgences et leurs documents de sortie sont disponibles plus tardivement. Les hospitalisations en lit satellite sont quotidiennes au CHUV et de nouvelles stratégies de prise en charge du flux de patients, notamment lors des épidémies de grippe saisonnière, doivent être développées.

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. Polypharmacy was defined by the regular use of five or more drugs. RESULTS: Polypharmacy was reported by 580 participants [11.8%, 95% confidence interval (10.9; 12.6)]. Participants on polypharmacy were significantly older (mean ± standard deviation: 66.0 ± 9.1 vs. 56.6 ± 10.1 years), more frequently obese (35.9% vs. 14.7%), of lower education (66.6% vs. 50.7%) and former smokers (46.7% vs. 36.4%) than participants not on polypharmacy. These findings were confirmed by multivariate analysis: odds ratio and (95% confidence interval) for age groups 50-64 and 65-81 relative to 40-49 years: 2.90 (2.04; 4.12) and 10.3 (7.26; 14.5), respectively, p for trend < 0.001; for low relative to high education: 1.56 (1.17; 2.07); for overweight and obese relative to normal weight participants: 2.09 (1.65; 2.66) and 4.38 (3.39; 5.66), respectively, p for trend < 0.001; for former and current relative to never smokers: 1.42 (1.14, 1.75) and 1.63 (1.25, 2.12), respectively, p for trend < 0.001. CONCLUSION: One out of nine participants of our sample is on polypharmacy. Increasing age, body mass index, smoking and lower education independently increase the likelihood of being on polypharmacy.

[Delegation of medico-administrative tasks : what do medical interns and secretaries think?] / Délégation des tâches médico-administratives : perspectives croisées entre médecins assistants et secrétaires.

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. Added to multiple overtime, this reduces physicians' and secretaries' work satisfaction. This article describes the context and development of delegating medico-administrative tasks to secretaries in our department of internal medicine.

L'activité hospitalière des médecins en formation se compose principalement de contacts directs avec les patients, de tâches indirectement liées au patient, essentiellement administratives, et de formations pratique et théorique. A l'heure de la numérisation, une importante activité administrative sans valeur médicale ajoutée remplit encore leur quotidien. Parallèlement, l'activité des secrétaires médicales se cloisonne, avec des bureaux éloignés des médecins et des tâches se limitant souvent à la finalisation de lettres de sortie. Ajoutés au cumul d'heures supplémentaires, ces éléments diminuent la satisfaction des médecins et des secrétaires dans leur travail. Cet article décrit le contexte et la mise en œuvre d'une délégation de tâches médico-administratives à des secrétaires de médecins dans notre service de médecine interne hospitalière.

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 52.6 ± 10.6 years) from the population of Lausanne, Switzerland. Polypharmacy was defined by the regular use of ≥5 drugs. Four categories of change were defined: never (no polypharmacy at baseline and follow-up), initiating (no polypharmacy at baseline but at follow-up), maintaining, or quitting. RESULTS: Polypharmacy increased from 7.7% at baseline to 15.3% at follow-up. Cardiovascular drugs were the most prescribed medicines at baseline and follow-up. Gender, age, obesity, smoking, previously diagnosed hypertension, or diabetes or dyslipidemia were significantly and independently associated with initiating and maintaining polypharmacy. CONCLUSION: In a population-based sample, prevalence of polypharmacy doubled over a 5.6-year period. The main determinants of initiating polypharmacy were age, overweight and obesity, smoking status, and previously diagnosed cardiovascular risk factors.

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. METHODS: In a large Swiss academic university hospital, we conducted, between May 26 and July 24, 2015 a time-motion study to assess how residents in general internal medicine organize their working day. RESULTS: We observed 49 day and 17 evening shifts of 36 residents, amounting to 697 working hours. During day shifts, residents spent 5.4 hours using a computer (mean total working time: 11.6 hours per day). On average, residents switched 15 times per hour from a task to another. Task-switching peaked between 8:00-9:00 and 16:00-17:00. Task-switching was not associated with resident's characteristics and no association was found between task-switching and extra hours (Spearman r = 0.220, p = 0.137 for day and r = 0.483, p = 0.058 for evening shifts). Computer usage occurred more frequently at the beginning or ends of day shifts and was associated with decreased overall task-switching. CONCLUSION: Task-switching occurs very frequently during resident's working day. Despite the fact that residents used a computer half of their working time, computer usage was associated with decreased task-switching. Whether frequent task-switches and computer usage impact the quality of patient care and resident's work must be evaluated in further studies.

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. SETTING: Internal medicine residency at a university hospital in Switzerland, May to July 2015. PARTICIPANTS: 36 internal medicine residents with an average of 29 months of postgraduate training. MEASUREMENTS: Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. RESULTS: Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. LIMITATION: The study involved a small sample from 1 institution. CONCLUSION: At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. PRIMARY FUNDING SOURCE: Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.

[From incident-reporting to morbidity and mortality rounds]. / Evénements indésirables en médecine interne : du recueil d'événements au colloque morbidité-mortalité.

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. Some are then chosen for their impact and improvement potential and presented to hospital staff at monthly morbidity and mortality (M&M) conferences or published as clinical cases. This puts emphasis on the reporting process and on suggested practical changes. The current challenge is to transform these ideas into daily improvements and to find the necessary resources to report and analyze the more complex incidents.

Introduite en 2015, la gestion des événements critiques et indésirables recueillis par un système informatisé (application informatique RECI) se poursuit dans notre service, avec un intérêt constant des collaborateurs (1 événement / 100 jours d'hospitalisation, soit presque 2 événements / jour). Tous les événements sont analysés. Quelques-uns, choisis selon leur impact et leur potentiel d'amélioration pratique, sont transmis aux collaborateurs sous forme de colloques morbidité-mortalité (M&M) ou de vignettes cliniques. Ceci permet de valoriser les signalements et de proposer des modifications pratiques. Le défi actuel consiste à transformer ces propositions en actions concrètes et à trouver les ressources nécessaires pour la déclaration et l'analyse des situations les plus compliquées.

[General internal medicine in hospital practice: the year 2013 put into perspective by residents]. / Médecine interne générale en pratique hospitalière: l'année 2013 mise en perspective par les chefs de clinique.

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. Thirteen of them are reviewed and commented here.

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. SHML should be considered routinely among the differential diagnoses in young patients with arthritis and large lymphadenopathies. There is no consensus regarding the treatment. In our patient, conventional disease-modifying antirheumatic drugs followed by 3 months of adalimumab then 3 months of etanercept had no effect on the symptoms.