[2023 scientific breakthroughs in ambulatory general internal medicine]. / Avancées scientifiques de 2023 en médecine interne générale ambulatoire.

The timing of taking antihypertensive medication does not have an impact on the cardiovascular plan. Geniculate block is an alternative to oral analgesic treatment for knee osteoarthritis. Feedback and audits are ineffective in reducing the inappropriate prescription of antibiotics in Switzerland. The intervention of community health professionals in collaboration with general practitioners allows for the control of arterial hypertension. In the case of peripheral facial paralysis, it is relevant to systematically consider performing magnetic resonance imaging. Aspirin is an alternative to enoxaparin in thromboembolic prophylaxis after surgery for a traumatic fracture. Walking 8,000 steps a few days a week reduces mortality. Opioids are not effective for acute neck and lower back pain.

Le moment de prise des antihypertenseurs n'a pas d'impact sur le plan cardiovasculaire. Le bloc géniculé est une alternative au traitement antalgique oral de la gonarthrose. Le feedback et les audits sont inefficaces dans la diminution de la prescription inappropriée d'antibiotiques en Suisse. L'intervention de professionnelsa de santé communautaire en collaboration avec des généralistes permet de contrôler l'hypertension artérielle. Lors d'une paralysie faciale périphérique, il s'avère pertinent de réfléchir de manière systématique à la réalisation d'une IRM. L'aspirine est une alternative à l'énoxaparine dans la prophylaxie thromboembolique après la chirurgie d'une fracture traumatique. Marcher 8000 pas quelques jours par semaine diminue la mortalité. Les opioïdes ne sont pas efficaces pour les cervicalgies et les lombalgies aiguës.

[MedEscapeRoom: an innovative learning method at Unisanté. A course offered as part of pre-graduate medical training]. / MedEscapeRoom : méthode d'apprentissage innovante à Unisanté. Un enseignement proposé dans la formation médicale prégraduée.

Teaching methods in the health sciences are evolving with societal changes and the needs of new generations. Gamification in the field of medical education is a fast-growing theme. The use of games in medical training activities engages participants in problem-solving by amplifying their emotional experience and promotes adult learning. At Unisanté (Centre for Primary Care and Public Health of the University of Lausanne), the MedEscapeRoom, an escape game on the outpatient management of acute vertigo, has been developed as a new teaching tool in undergraduate medical education through an exploratory approach and continuous improvement cycles. This article describes the development and evaluation of this pioneering teaching tool.

Les méthodes pédagogiques dans le domaine des sciences de la santé évoluent avec les changements sociétaux et les besoins des nouvelles générations. La ludification dans le domaine de la pédagogie médicale est une thématique en pleine expansion. Le recours au jeu lors des activités de formation médicale permet un engagement des participantes à la résolution de problèmes par l'amplification de l'expérience émotionnelle et favorise l'apprentissage de l'adulte. À Unisanté, Centre universitaire de médecine générale et santé publique à Lausanne, le MedEscapeRoom, un jeu d'évasion sur la prise en charge ambulatoire du vertige aigu, a été développé comme un nouvel outil pédagogique impliquant une démarche exploratoire et des cycles d'amélioration continue. Cet article décrit le développement et l'évaluation de cet enseignement pionnier.

[Febrile rash in adult patients. Which diagnoses should we evoke in ambulatory care?] / Rash cutané fébrile chez l'adulte. Quels diagnostics évoquer en médecine ambulatoire?

The diagnostic approach to febrile skin eruptions in adults requires a systematic methodology, combining an accurate history with careful clinical evaluation. The most frequent etiologies of febrile exanthem in the immunocompetent patient can be categorized as infectious (viral or bacterial) or non-infectious (toxidermia, connectivitis or vasculitis). Mononucleosis, primary HIV infection, secondary syphilis, disseminated gonococcemia and exanthematous drug eruption, are mentioned in detail in this article due to the difficulty of establishing a diagnosis in ambulatory medicine. A clinical vignette is presented to illustrate the reasoning in primary care, with recourse to further investigations depending on the clinical course.

L'approche diagnostique des éruptions cutanées fébriles chez l'adulte exige une méthodologie systématique, alliant une anamnèse précise et une évaluation clinique attentive. Les étiologies les plus fréquentes de l'exanthème fébrile chez le patient immunocompétent peuvent être catégorisées en infectieuses (virus ou bactéries) ou non infectieuses (toxidermies, connectivites ou vasculites). La mononucléose, la primo-infection par le VIH, la syphilis secondaire, la gonococcémie disséminée et la toxidermie médicamenteuse sont abordées spécifiquement et en détail dans cet article en raison de la difficulté à établir un diagnostic en médecine ambulatoire. Une vignette clinique est présentée pour illustrer le raisonnement en médecine de première ligne avec le recours à des investigations complémentaires selon l'évolution clinique.

Effects of a Multimodal Transitional Care Intervention in Patients at High Risk of Readmission: The TARGET-READ Randomized Clinical Trial.

Importance: Hospital readmissions are frequent, costly, and sometimes preventable. Although these issues have been well publicized and incentives to reduce them introduced, the best interventions for reducing readmissions remain unclear. Objectives: To evaluate the effects of a multimodal transitional care intervention targeting patients at high risk of hospital readmission on the composite outcome of 30-day unplanned readmission or death. Design, Setting, and Participants: A single-blinded, multicenter randomized clinical trial was conducted from April 2018 to January 2020, with a 30-day follow-up in 4 medium-to-large-sized teaching hospitals in Switzerland. Participants were consecutive patients discharged from general internal medicine wards and at higher risk of unplanned readmission based on their simplified HOSPITAL score (≥4 points). Data were analyzed between April and September 2022. Interventions: The intervention group underwent systematic medication reconciliation, a 15-minute patient education session with teach-back, a planned first follow-up visit with their primary care physician, and postdischarge follow-up telephone calls from the study team at 3 and 14 days. The control group received usual care from their hospitalist, plus a 1-page standard study information sheet. Main Outcomes and Measures: Thirty-day postdischarge unplanned readmission or death. Results: A total of 1386 patients were included with a mean (SD) age of 72 (14) years; 712 (51%) were male. The composite outcome of 30-day unplanned readmission or death was 21% (95% CI, 18% to 24%) in the intervention group and 19% (95% CI, 17% to 22%) in the control group. The intention-to-treat analysis risk difference was 1.7% (95% CI, -2.5% to 5.9%; P = .44). There was no evidence of any intervention effects on time to unplanned readmission or death, postdischarge health care use, patient satisfaction with the quality of their care transition, or readmission costs. Conclusions and Relevance: In this randomized clinical trial, use of a standardized multimodal care transition intervention targeting higher-risk patients did not significantly decrease the risks of 30-day postdischarge unplanned readmission or death; it demonstrated the difficulties in preventing hospital readmissions, even when multimodal interventions specifically target higher-risk patients. Trial Registration: ClinicalTrials.gov Identifier: NCT03496896.

Potentially Avoidable Hospitalizations by Asthma and COPD in Switzerland from 1998 to 2018: A Cross-Sectional Study.

Potentially avoidable hospitalizations (PAH) are commonly used as an indicator for healthcare quality and primary care performance. However, data are usually presented in a restricted timeframe and for a specific region, limiting the identification of trends and national patterns. We aimed in this study to calculate rates, identify clinical determinants, and estimate costs of PAH for two frequent lung diseases (asthma and COPD) in Switzerland between 1998 and 2018 using hospital discharge data available for patients aged ≥20 years. PAH were defined according to the Health Care Quality Indicators Project (HCQIP) from the Organisation for Economic Co-operation and Development (OECD). The distribution of PAH in seven administrative regions (Leman, Mittelland, Northwest, Zurich, Eastern, Central, and Ticino) was calculated, along with PAH-associated total hospital days and Diagnosis-Related Group (DRG) estimated costs. Totals of 25,260 PAH for asthma and 135,069 PAH for COPD were identified in the 20-year period. The standardized rates of PAH per 100,000 people for asthma fluctuated from 18.7 in 1998 to 22.5 on 2018. The standardized rates of PAH per 100,000 people from COPD almost doubled from 77.4 in 1998 to 142.7 in 2018. In 2018, the estimated total costs of PAH amounted to 7.7 million CHF for asthma and 91.2 million CHF for COPD. We conclude that PAH for asthma and COPD represent a significant and unnecessary burden and costs of hospitalizations in Switzerland.

Effectiveness of Transition Care Intervention Targeted to High-Risk Patients to Reduce Readmissions: Study Protocol for the TARGET-READ Multicenter Randomized-Controlled Trial.

Hospital readmissions within 30 days represent a burden for the patients and the entire health care system. Improving the care around hospital discharge period could decrease the risk of avoidable readmissions. We describe the methods of a trial that aims to evaluate the effect of a structured multimodal transitional care intervention targeted to higher-risk medical patients on 30-day unplanned readmissions and death. The TARGET-READ study is an investigator-initiated, pragmatic single-blinded randomized multicenter controlled trial with two parallel groups. We include all adult patients at risk of hospital readmission based on a simplified HOSPITAL score of ≥4 who are discharged home or nursing home after a hospital stay of one day or more in the department of medicine of the four participating hospitals. The patients randomized to the intervention group will receive a pre-discharge intervention by a study nurse with patient education, medication reconciliation, and follow-up appointment with their referring physician. They will receive short follow-up phone calls at 3 and 14 days after discharge to ensure medication adherence and follow-up by the ambulatory care physician. A blind study nurse will collect outcomes at 1 month by phone call interview. The control group will receive usual care. The TARGET-READ study aims to increase the knowledge about the efficacy of a bundled intervention aimed at reducing 30-day hospital readmission or death in higher-risk medical patients.

[2022 scientific breakthroughs in ambulatory general internal medicine]. / Avancées scientifiques de 2022 en médecine interne générale ambulatoire.

In patients aged 65 or older, the risk of dementia decreases with cataract surgery. Mental stress doubles the risk of a cardiac event in patients with stable coronary artery disease. The one-legged stance performance estimates total mortality in patients 50 years or older. Patients with chronic pain benefit from treatment with dronabinol or nabiximols. Salt substitutes are an alternative to regular salt in hypertensive patients aged 60 years or more. The promotion of physical activity in the office is effective in reducing sedentary behavior. Music has a favorable impact on the mental dimensions of quality of life. Colonoscopies performed on patients aged 75 years or more have a higher risk of non-gastrointestinal complications than gastrointestinal complications.

Chez les patients de 65 ans ou plus, le risque de démence diminue après une chirurgie de la cataracte. Le stress mental double le risque d'événements cardiaques chez des patients avec une coronaropathie stable. La station monopodale effectuée au cabinet permet d'estimer la mortalité totale chez les patients de 50 ans ou plus. Ceux souffrant de douleurs chroniques bénéficient d'un traitement par dronabinol ou nabiximols. Les substituts de sel sont une alternative au sel ordinaire chez les hypertendus de 60 ans ou plus. La promotion de l'activité physique au cabinet est efficace dans la diminution de la sédentarité. La musique a un impact favorable sur les dimensions mentales de la qualité de vie. Les coloscopies effectuées chez les patients de 75 ans ou plus présentent un risque supérieur de complications non gastro-intestinales comparativement à celles gastro-intestinales.

Diagnostic Performance of Individual Symptoms to Predict SARS-CoV-2 RT-PCR Positivity and Symptom Persistence among Suspects Presenting in Primary Care during the First Wave of COVID-19.

This study aimed to estimate the diagnostic performance of patient symptoms and to describe the clinical course of RT-PCR-positive compared with RT-PCR-negative patients in primary care. Symptomatic COVID-19 suspects were assessed clinically at the initial consultation in primary care between March and May 2020, followed by phone consultations over a span of at least 28 days. Sensitivity and specificity were estimated for each symptom using the initial RT-PCR result as a reference standard. The proportions of symptomatic patients according to the RT-PCR test results were compared over time, and time to recovery was estimated. Out of 883 patients, 13.9% had a positive RT-PCR test, and 17.4% were not tested. Most sensitive symptoms were cough, myalgia, and a history of fever, while most specific symptoms were fever for ≥4 days, hypo/anosmia, and hypo/ageusia. At the final follow up (median time 55 days, range 28-105 days), 44.7% of patients still reported symptoms in the RT-PCR-positive group, compared with 18.3% in the negative group (p < 0.001), mostly with hypo/anosmia (16.3%), dyspnea (12.2%), and fatigue (10.6%). The discriminative value of individual symptoms for diagnosing COVID-19 was limited. Almost half of the SARS-CoV-2-positive patients still reported symptoms at least 28 days after the initial consultation.

Antigen rapid tests, nasopharyngeal PCR and saliva PCR to detect SARS-CoV-2: A prospective comparative clinical trial.

BACKGROUND: Nasopharyngeal antigen Rapid Diagnostic Tests (RDTs), saliva RT-PCR and nasopharyngeal (NP) RT-PCR have shown different performance characteristics to detect patients infected by SARS-CoV-2, according to the viral load (VL)-and thus transmissibility. METHODS: In October 2020, we conducted a prospective trial involving patients presenting at testing centres with symptoms of COVID-19. We compared detection rates and performance of RDT, saliva PCR and nasopharyngeal (NP) PCR, according to VL and symptoms duration. RESULTS: Out of 949 patients enrolled, 928 patients had all three tests performed. Detection rates were 35.2% (95%CI 32.2-38.4%) by RDT, 39.8% (36.6-43.0%) by saliva PCR, 40.1% (36.9-43.3%) by NP PCR, and 41.5% (38.3-44.7%) by any test. For those with viral loads (VL) ≥106 copies/ml, detection rates were 30.3% (27.3-33.3), 31.4% (28.4-34.5), 31.5% (28.5-34.6), and 31.6% (28.6-34.7%) respectively. Sensitivity of RDT compared to NP PCR was 87.4% (83.6-90.6%) for all positive patients, 94.5% (91.5-96.7%) for those with VL≥105 and 96.5% (93.6-98.3%) for those with VL≥106. Sensitivity of STANDARD-Q®, Panbio™ and COVID-VIRO® Ag tests were 92.9% (86.4-96.9%), 86.1% (78.6-91.7%) and 84.1% (76.9-89.7%), respectively. For those with VL≥106, sensitivity was 96.6% (90.5-99.3%), 97.8% (92.1-99.7%) and 95.3% (89.4-98.5%) respectively. No patient with VL<104 was detected by RDT. Specificity of RDT was 100% (99.3-100%) compared to any PCR. RDT sensitivity was similar <4 days (87.8%, 83.5-91.3%) and ≥4 days (85.7%, 75.9-92.6%) after symptoms onset (p = 0.6). Sensitivity of saliva and NP PCR were 95.7% (93.1-97.5%) and 96.5% (94.1-98.1%), respectively, compared to the other PCR. CONCLUSIONS: RDT results allow rapid identification of COVID cases with immediate isolation of most contagious individuals. RDT can thus be a game changer both in ambulatory care and community testing aimed at stopping transmission chains, and even more so in resource-constrained settings thanks to its very low price. When PCR is performed, saliva could replace NP swabbing. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT04613310 (03/11/2020).

[Optimizing the therapeutic adherence in ambulatory care The link between patients, home care nurses, pharmacists and physicans]. / Optimiser l'adhésion médicamenteuse en ambulatoire - Interconnexion entre patients, infirmiers à domicile, pharmaciens et médecins.

The World Health Organization (WHO) considers medication safety as one of the main areas for improvement in patient safety. Treatment adherence, as a dynamic process that evolves through time or life circumstances, is of paramount importance, since it depends on a number of factors that health care professionals need to approach comprehensively during patient follow-up. In this article, we describe the tools available to general practitioners or specialist physicians, in collaboration with pharmacists and home care nurses, to optimize medication adherence in an ambulatory setting. An interprofessional approach between providers allows adequate support to patients by empowerment, treatment adjustments and optimization, based on shared common goals.

La problématique de la sécurité des médicaments est l'une des thématiques prioritaires pour l'OMS en matière d'amélioration de la sécurité des patients. L'adhésion au traitement est un processus dynamique qui est au centre de cette problématique, en raison de nombreux éléments qui doivent être pris en compte par les professionnels de la santé durant le suivi d'un patient. Cet article décrit des outils qui s'offrent au médecin généraliste ou spécialiste, en collaboration avec le pharmacien et l'infirmier exerçant au domicile du patient, pour optimiser l'adhésion médicamenteuse. Une approche interprofessionnelle entre prestataires de soins permet un soutien adéquat aux patients via l'empowerment, les adaptations du traitement et l'optimisation, sur la base des objectifs communs partagés.

Pandémie de Covid-19: Quel enseignement prégradué/facultaire?

Encourager l'enseignement prégradué des connaissances et compétences néces­saires à la gestion d'une crise systémique.

[Prescription of opioids in general practice for chronic non-cancerous pain]. / Prescription des opioïdes en médecine générale pour les douleurs chroniques non cancéreuses.

The prescription of opioids for chronic pain has increased constantly since the turn of the 21st century in industrialized countries. In 2017, the United States consider the "opioid crisis" as a national public health emergency. Similar trends have been observed in Switzerland, which was, in 2015, the 7th largest consumer of opioids in the world. In Switzerland, there are many intra-hospital recommendations, which are not necessarily applicable in primary care and the latest expert recommendations date from 2005. Therefore, it seems relevant to summarize the current recommendations, useful in general practice on the prescription of opioids in the context of chronic non-cancer pain.

La prescription d'opioïdes pour le traitement des douleurs chroniques a fortement augmenté depuis le début du 21e siècle dans les pays industrialisés. En 2017, les États-Unis considèrent la «crise des opioïdes¼ comme une urgence nationale de santé publique. La Suisse a aussi vu une augmentation de leur usage et en 2015, elle était le 7e plus grand consommateur au monde d'opioïdes par habitant. En Suisse, il existe de nombreuses recommandations hospitalières, qui ne sont pas forcément applicables en médecine générale, et les dernières recommandations d'experts datent de 2005. Il semble dès lors pertinent de résumer les recommandations actuelles, utiles en médecine générale sur la prescription d'opioïdes dans le contexte de douleurs chroniques non cancéreuses.

Effect of acute iron infusion on insulin secretion: A randomized, double-blind, placebo-controlled trial.

Background: Chronic exposure to high iron levels increases diabetes risk partly by inducing oxidative stress, but the consequences of acute iron administration on beta cells are unknown. We tested whether the acute administration of iron for the correction of iron deficiency influenced insulin secretion and the production of reactive oxygen species. Methods: Single-center, double-blinded, randomized controlled trial conducted between June 2017 and March 2020. 32 women aged 18 to 47 years, displaying symptomatic iron deficiency without anaemia, were recruited from a community setting and randomly allocated (1:1) to a single infusion of 1000 mg intravenous ferric carboxymaltose (iron) or saline (placebo). The primary outcome was the between group mean difference from baseline to day 28 in first and second phase insulin secretion, assessed by a two-step hyperglycaemic clamp. All analyses were performed by intention to treat. This trial was registered in ClinicalTrials.gov NCT03191201. Findings: Iron infusion did not affect first and second phase insulin release. For first phase, the between group mean difference from baseline to day 28 was 0 µU × 10 min/mL [95% CI, -22 to 22, P = 0.99]. For second phase, it was -5 µUx10min/mL [95% CI, -161 to 151; P = 0.95] at the first plateau of the clamp and -249 µUx10min/mL [95% CI, -635 to 137; P = 0.20] at the second plateau. Iron infusion increased serum ascorbyl/ascorbate ratio, a marker of plasma oxidative stress, at day 14, with restoration of normal ratio at day 28 relative to placebo. Finally, high-sensitive C-reactive protein levels remained similar among groups. Interpretation: In iron deficient women without anaemia, intravenous administration of 1000 mg of iron in a single sitting did not impair glucose-induced insulin secretion despite a transient increase in the levels of circulating reactive oxygen species. Funding: The Swiss National Science Foundation, University of Lausanne and Leenaards, Raymond-Berger and Placide Nicod Foundations.

Post­COVID­19 Syndrome in Outpatients: a Cohort Study.

BACKGROUND: After mild COVID-19, some outpatients experience persistent symptoms. However, data are scarce and prospective studies are urgently needed. OBJECTIVES: To characterize the post-COVID-19 syndrome after mild COVID-19 and identify predictors. PARTICIPANTS: Outpatients with symptoms suggestive of COVID-19 with (1) PCR-confirmed COVID-19 (COVID-positive) or (2) SARS-CoV-2 negative PCR (COVID-negative). DESIGN: Monocentric cohort study with prospective phone interview between more than 3 months to 10 months after initial visit to the emergency department and outpatient clinics. MAIN MEASURES: Data of the initial visits were extracted from the electronic medical file. Predefined persistent symptoms were assessed through a structured phone interview. Associations between long-term symptoms and PCR results, as well as predictors of persistent symptoms among COVID-positive, were evaluated by multivariate logistic regression adjusted for age, gender, smoking, comorbidities, and timing of the survey. KEY RESULTS: The study population consisted of 418 COVID-positive and 89 COVID-negative patients, mostly young adults (median age of 41 versus 36 years in COVID-positive and COVID-negative, respectively; p = 0.020) and healthcare workers (67% versus 82%; p = 0.006). Median time between the initial visit and the phone survey was 150 days in COVID-positive and 242 days in COVID-negative patients. Persistent symptoms were reported by 223 (53%) COVID-positive and 33 (37%) COVID-negative patients (p = 0.006) and proportions were stable among the periods of the phone interviews. Overall, 21% COVID-positive and 15% COVID-negative patients (p = 0.182) attended care for this purpose. Four surveyed symptoms were independently associated with COVID-19: fatigue (adjusted odds ratio 2.14, 95% CI 1.04-4.41), smell/taste disorder (26.5, 3.46-202), dyspnea (2.81, 1.10-7.16), and memory impairment (5.71, 1.53-21.3). Among COVID-positive, female gender (1.67, 1.09-2.56) and overweight/obesity (1.67, 1.10-2.56) were predictors of persistent symptoms. CONCLUSIONS: More than half of COVID-positive outpatients report persistent symptoms up to 10 months after a mild disease. Only 4 of 14 symptoms were associated with COVID-19 status. The symptoms and predictors of the post-COVID-19 syndrome need further characterization as this condition places a significant burden on society.

[2021 scientific breakthroughs in ambulatory general internal medicine]. / Avancées scientifiques 2021 en médecine interne générale ambulatoire.

Psychotherapy diminishes depression relapses when antidepressants are reduced or stopped. Delayed antibiotic therapy is effective and safe while treating community-acquired respiratory infection. Physical rehabilitation after hospitalization due to acute cardiac decompensation is useful in frail patients. Six hours of sleep appears to be associated with a higher risk of dementia in people aged 50-70 years. Patients modify healthcare use after losing their referring physician. Screening for atrial fibrillation in healthy patients aged 65 or older is not beneficial. Physicians' ECG reading skills decrease in the absence of regular training. Patients hospitalized with COVID-19 are often clinically, psychologically, and economically impacted.

La psychothérapie diminue les rechutes de dépression lors de la réduction ou de l'arrêt des antidépresseurs. En cas d'infection respiratoire communautaire, l'antibiothérapie retardée est efficace et sûre. La réadaptation physique après une décompensation cardiaque aiguë est utile chez les patients fragiles. Un sommeil de 6 heures semble être associé à un risque plus élevé de démence chez les personnes de 50 à 70 ans. Les patients modifient le recours aux soins de santé après la cessation d'activité de leur médecin référent. La recherche de fibrillation auriculaire chez les patients de 65 ans ou plus en bonne santé n'est pas bénéfique. Les compétences médicales de lecture d'ECG diminuent en l'absence de formation régulière. Les patients hospitalisés pour un Covid-19 sont souvent impactés aux niveaux clinique, psychologique et économique.

[Community-based medical practice. New academic teaching through a mass COVID-19 screening]. / Pratique médicale communautaire - Un nouvel enseignement universitaire à l'occasion d'un dépistage de masse de Covid-19.

Clusters of COVID-19 cases emerged during the months of December 2020 and January 2021 in the Vaud Alps. This epidemiological situation was worrying, as it appeared before a winter holiday period. In view of this epidemiological risk, the cantonal authorities decided to carry out mass screening in three communes from 5 to 13 February 2021 in addition to the standard measures in place. Seeing an opportunity to create innovative university teaching, Unisanté set up a new course for medical students of the University of Lausanne called Community Medical Practice. This immersion in the practice of public health enabled some thirty students to carry out several activities (clinical, research and epidemiological) in a unique pandemic context.

L'émergence de clusters de cas de Covid-19 a été constatée de décembre 2020 à janvier 2021 dans les Alpes vaudoises. Cette situation épidémiologique est devenue préoccupante, puisqu'elle est apparue avant une période de vacances hivernales. Face à ce risque épidémiologique, les autorités cantonales ont décidé d'effectuer un dépistage de masse, du 5 au 13 février 2021, dans trois communes en complément des mesures en vigueur. Voyant l'occasion de créer un exercice pédagogique novateur, Unisanté a mis en place un nouvel enseignement destiné aux étudiant·e·s de médecine de l'université de Lausanne, nommé Pratique médicale communautaire. Cette immersion dans la pratique de santé publique a permis à une trentaine d'étudiant·e·s d'exercer plusieurs activités (cliniques, de recherche et épidémiologiques) dans un contexte unique de pandémie.

[Mass testing for Covid-19 : what can we learn from real-world implementation ?] / Dépistage de masse du Covid-19 : quelles leçons tirer des récentes expériences ?

While several modelling studies suggest mass testing for SARS-CoV-2 could be effective, real-world attempts at implementation have not been sufficient to evaluate its contribution to controlling the pandemic. To slow the spread of the virus, a mass-testing campaign would need frequent testing over a prolonged period with high rates of participation, all while maintaining public health measures. Screening seems more useful for targeted populations or high-risk events (businesses, teaching facilities, public or private institutions, sporting or cultural events). With their low cost and rapid results, rapid tests should be favored for these interventions.

Bien que des modélisations de dépistage de masse pour le SARS-CoV-2 suggèrent une certaine efficacité, leur réalisation en pratique n'a, à ce jour, pas été confirmée et leur potentiel impact en termes de contrôle sur la pandémie reste à démontrer. Pour espérer endiguer la propagation du virus, il faut réaliser un dépistage fréquent, sur une période prolongée, et atteindre un taux de participation très élevé, cela tout en maintenant les mesures sanitaires. Le dépistage semble toutefois envisageable s'il est ciblé sur une population ou un événement à risque (entreprises, lieux de formation, établissements publics ou privés, manifestations sportives ou culturelles). De par leur faible coût et leur rendu rapide du résultat, les tests rapides sont à favoriser pour de telles stratégies interventionnelles de dépistage.