Remodelling family medicine teaching at the University of Lausanne using a modified Delphi method.

BACKGROUND: In the context of implementing a new framework for pre-graduate medical education in Switzerland (PROFILES) and the ongoing reform of the medical curriculum at the Faculty of Biology and Medicine of the University of Lausanne, we set out to determine the priority teaching themes of family medicine and to collect expert opinions about the most appropriate teaching methods for family medicine. Such data would contribute to the production of a coherent family medicine teaching programme encompassing its specificities as well as future challenges facing medicine in general. METHOD: We mapped the current family medicine courses at the Faculty of Biology and Medicine to obtain an overview of current learning objectives and teaching content priorities. We classified and analysed the lessons using the PROFILES grid and the principles of family medicine described by the World Organization of Family Doctors (WONCA). Then we used a modified Delphi method with a selected panel of experts and two consensus rounds to prioritise objectives for family medicine teaching at the University of Lausanne. After choosing the top objectives/activities for family medicine, subgroups of experts then discussed what would be the best teaching methods for family medicine at the University of Lausanne. RESULTS: The mapping of family medicine teaching at the University of Lausanne showed that current teaching addresses most of the primary topics of family medicine education. The modified Delphi method allowed us to identify priority themes for teaching family medicine at the University of Lausanne: (1) take a medical history and clinical examination; (2) doctor-patient relationship / patient-centred care; (3) clinical reasoning; (4) interprofessional collaboration; (5) care planning/ documentation; (6) shared decision-making; (7) communication; (8) cost-effective care; (9) health promotion; (10) assessment of urgency. The discussion with the experts identified the strengths and weaknesses of the various teaching modalities in family medicine education. Teaching should be structured, coherent and show continuity. Clinical immersion and small group teaching were the preferred teaching modalities. CONCLUSION: This approach made it possible to create the guidelines for restructuring the family medicine teaching curriculum at the University of Lausanne.

[Selfcare to better manage musculoskeletal pain and chronic disease]. / Autogestion des douleurs musculosquelettiques et des maladies chroniques.

Self-management is a process in which the patient actively engages in the management of his or her disease, adapting to the resulting problems, and complying with behavioral changes. Its support will have beneficial effects, as well as an improvement in quality of life, and reasonable use of resources available for health. Exercise plays a central role in the self-management of a range of chronic diseases, including musculoskeletal conditions, one of the most prevalent conditions in Switzerland. However, physical activity and exercise are under-prescribed in chronic disease management. A combination of supervised strategies and digital devices in self-management coaching could maximize the effects of physical activity.

L'autogestion est un processus par lequel le patient s'engage activement dans la gestion de sa maladie, en changeant ses comportements pour faire face aux conséquences physiques et psychiques de celle-ci. Cela aura des effets bénéfiques sur sa qualité de vie et permettra de diminuer ses besoins en soins. L'exercice physique joue un rôle central dans l'autogestion des maladies chroniques parmi lesquelles les pathologies musculo-squelettiques constituent un motif fréquent de consultation en médecine de famille. L'autogestion est toutefois insuffisamment conseillée par les médecins dans le traitement des maladies chroniques, notamment par manque de connaissances. L'essor des dispositifs numériques permettant un coaching des patients pourrait être un levier motivateur supplémentaire pour les patients et les thérapeutes.

[Biomarker-guided antibiotics prescription for lower respiratory tract infections in primary care : CRP or PCT ?] / Prescription des antibiotiques guidée par les biomarqueurs en médecine de famille : CRP ou PCT ?

Lower respiratory tract infections are a frequent cause of excessive antibiotic prescription. The use of CRP and PCT has been evaluated by recent trials as a mean to assist antibiotic prescription. These studies suggest a safe reduction of antibiotic usage when prescription is guided by biomarkers. There is at the moment no evidence benefiting one of the biomarkers over the other, but a recent Swiss trial could suggest an added benefit for PCT. For now, PCT is less available, more expensive and not reimbursed. Democratization of its use, and/or clear thresholds for the use of CRP are additional ways that could participate to reduce excessive antibiotic prescription in primary care.

Les infections respiratoires basses sont une cause fréquente de prescription inappropriée d'antibiotiques en médecine de famille. L'utilisation de la CRP et de la procalcitonine (PCT) a été évaluée par plusieurs études comme moyen de guider la prescription d'antibiotiques. Ces études suggèrent une diminution sûre de la prescription lorsque l'utilisation est guidée par des biomarqueurs. Il n'y a pour l'instant pas d'évidence en faveur d'une supériorité d'un biomarqueur mais une étude suisse pourrait suggérer un effet additionnel de la PCT. Pour l'instant, elle est moins facilement accessible, plus chère et non remboursée. La démocratisation de son utilisation et/ou la définition de seuils clairs pour l'utilisation de la CRP pourraient aider à diminuer la prescription excessive d'antibiotiques en ambulatoire.

An Online Influenza Surveillance System for Primary Care Workers in Switzerland: Observational Prospective Pilot Study.

BACKGROUND: A better understanding of the influenza epidemiology among primary care workers could guide future recommendations to prevent transmission in primary care practices. Therefore, we designed a pilot study to assess the feasibility of using a work-based online influenza surveillance system among primary care workers. Such an approach is of particular relevance in the context of the coronavirus disease (COVID-19) pandemic, as its findings could apply to other infectious diseases with similar mechanisms of transmission. OBJECTIVE: This study aims to determine the feasibility of using a work-based online influenza surveillance system for primary care workers in Switzerland. METHODS: Physicians and staff of one walk-in clinic and two selected primary care practices were enrolled in this observational prospective pilot study during the 2017-2018 influenza season. They were invited to record symptoms of influenza-like illness in a weekly online survey sent by email and to self-collect a nasopharyngeal swab in case any symptoms were recorded. Samples were tested by real-time polymerase chain reaction for influenza A, influenza B, and a panel of respiratory pathogens. RESULTS: Among 67 eligible staff members, 58% (n=39) consented to the study and 53% (n=36) provided data. From the time all participants were included, the weekly survey response rate stayed close to 100% until the end of the study. Of 79 symptomatic episodes (mean 2.2 episodes per participant), 10 episodes in 7 participants fitted the definition of an influenza-like illness case (attack rate: 7/36, 19%). One swab tested positive for influenza A H1N1 (attack rate: 3%, 95% CI 0%-18%). Swabbing was considered relatively easy. CONCLUSIONS: A work-based online influenza surveillance system is feasible for use among primary care workers. This promising methodology could be broadly used in future studies to improve the understanding of influenza epidemiology and other diseases such as COVID-19. This could prove to be highly useful in primary care settings and guide future recommendations to prevent transmission. A larger study will also help to assess asymptomatic infections.

[Selft-test kits on the high street, really useful ?] / Autotests en vente libre, vraiment utiles ?

Today, there are more and more self-test kits available on the high street. With a few exceptions (HIV, FIT), it is currently unclear whether they are effective, neither beneficial for the consumer, nor useful for the Swiss healthcare system. Is there a favorable impact for the health system? This article tries to help doctors find their way among the many self-test available, providing them a reading grid and recommendations for their patients.

À l'heure actuelle, il existe de nombreux tests de dépistage que l'on peut acheter en vente libre et réaliser soi-même. Hormis quelques exceptions (VIH, FIT), il n'est actuellement pas clair si leur utilisation est réellement bénéfique pour le consommateur et si un impact favorable peut être attendu en termes de santé publique. Après avoir posé quelques éléments de définitions et de situations, cet article cherche à donner des pistes aux médecins quant à une telle offre, en leur proposant une grille de lecture critique et des recommandations possibles pour leurs patients.

[Skin ulcers in a returning traveler]. / Une lésion cutanée pas si exotique.

We present the case of a 71 year old man returning from a back-packer trip in exotic countries. He presented several non-healing legs ulcers for three months. After many investigations, the bacterial culture gave us the answer.

[Doctor, I have pain and pins and needles in my legs at night]. / "Docteur, j'ai mal et des fourmis dans les jambes le soir...".

Restless legs syndrome (RLS) is a frequent chronic condition. It causes discomfort in the lower limbs with an urge to move the legs and sometimes paresthesias. It's frequently associated with sleep and mood disorders causing a significant impact on quality of life. There are four clinical criteria to diagnose it. Treatment includes management of reversible factors and if needed symptomatic treatment. Depending on symptoms severity, non-drug measures can be tried. First-line medication treatment should be dopaminergic agonists. Second-line treatments include, anticonvulsivants (gabapentine), benzodiazepine (clonazepam) or opioids based on predominant symptoms. Difficult cases should be referred to a specialist.

Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial.

BACKGROUND: Iron deficiency without anemia is related to adverse symptoms that can be relieved by supplementation. Since a blood donation can induce such an iron deficiency, we investigated the clinical impact of iron treatment after a blood donation. METHODS: One week after donation, we randomly assigned 154 female donors with iron deficiency without anemia, aged below 50 years, to a four-week oral treatment of ferrous sulfate versus a placebo. The main outcome was the change in the level of fatigue before and after the intervention. Aerobic capacity, mood disorder, quality of life, compliance and adverse events were also evaluated. Hemoglobin and ferritin were used as biological markers. RESULTS: The effect of the treatment from baseline to four weeks of iron treatment was an increase in hemoglobin and ferritin levels to 5.2 g/L (P < 0.01) and 14.8 ng/mL (P < 0.01), respectively. No significant clinical effect was observed for fatigue (-0.15 points, 95% confidence interval -0.9 points to 0.6 points, P = 0.697) or for other outcomes. Compliance and interruption for side effects was similar in both groups. Additionally, blood donation did not induce overt symptoms of fatigue in spite of the significant biological changes it produces. CONCLUSIONS: These data are valuable as they enable us to conclude that donors with iron deficiency without anemia after a blood donation would not clinically benefit from iron supplementation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00981877.

The impact of iron supplementation efficiency in female blood donors with a decreased ferritin level and no anaemia. Rationale and design of a randomised controlled trial: a study protocol.

BACKGROUND: There is no recommendation to screen ferritin level in blood donors, even though several studies have noted the high prevalence of iron deficiency after blood donation, particularly among menstruating females. Furthermore, some clinical trials have shown that non-anaemic women with unexplained fatigue may benefit from iron supplementation. Our objective is to determine the clinical effect of iron supplementation on fatigue in female blood donors without anaemia, but with a mean serum ferritin < or = 30 ng/ml. METHODS/DESIGN: In a double blind randomised controlled trial, we will measure blood count and ferritin level of women under age 50 yr, who donate blood to the University Hospital of Lausanne Blood Transfusion Department, at the time of the donation and after 1 week. One hundred and forty donors with a ferritin level < or = 30 ng/ml and haemoglobin level >/= 120 g/l (non-anaemic) a week after the donation will be included in the study and randomised. A one-month course of oral ferrous sulphate (80 mg/day of elemental iron) will be introduced vs. placebo. Self-reported fatigue will be measured using a visual analogue scale. Secondary outcomes are: score of fatigue (Fatigue Severity Scale), maximal aerobic power (Chester Step Test), quality of life (SF-12), and mood disorders (Prime-MD). Haemoglobin and ferritin concentration will be monitored before and after the intervention. DISCUSSION: Iron deficiency is a potential problem for all blood donors, especially menstruating women. To our knowledge, no other intervention study has yet evaluated the impact of iron supplementation on subjective symptoms after a blood donation. TRIAL REGISTRATION: NCT00689793.