Physical activity and lung function association in a healthy community-dwelling European population.

BACKGROUND: The association of physical activity (PA) and lung function (LF) varies from no measurable effect to delayed LF decline. We assessed the association between accelerometery-assessed PA and LF in a sample of apparently healthy, community-dwelling subjects. METHODS: We included two cross-sectional studies using data from the PneumoLaus study (2014-17 and 2018-21), conducted in Lausanne, Switzerland. PA was assessed by accelerometry and categorised as inactivity, light, moderate or vigorous. Forced expiratory volume in 1 second (FEV1), forced volume capacity (FVC) and maximal mid-expiratory flow (MMEF) were measured by spirometry and expressed in percentage of predicted value (PV). RESULTS: Overall, 1'910 (54.7% women, 62.0 ± 9.7 years) and 1'174 (53.4% women, 65.8 ± 9.5 years) participants were included in the first and the second surveys, respectively. In both surveys, moderate and vigorous PA showed a weak but significant correlation with FEV1 in percentage (PV) (R = 0.106 and 0.132 for the first and 0.111 and 0.125 for the second surveys, p < 0.001). Similar correlations with FVC (p < 0.001) were found. Associations held irrespective of smoking status and remained after multivariable adjustment. Fewer associations were detected between LF and light PA or between MMEF and PA. CONCLUSION: Moderate and vigorous intensity PA are associated with increased LF regardless of smoking status in apparently healthy community-dwelling European population. These associations are statistically but not clinically significant due to the small correlation coefficients (R < 0.30), corresponding to a weak association.

Core stories of physicians on a Swiss internal medicine ward during the first COVID-19 wave: a qualitative exploration.

INTRODUCTION: The first COVID-19 wave (2020), W1, will remain extraordinary due to its novelty and the uncertainty on how to handle the pandemic. To understand what physicians went through, we collected narratives of frontline physicians working in a Swiss university hospital during W1. METHODS: Physicians in the Division of Internal Medicine of Lausanne University Hospital (CHUV) were invited to send anonymous narratives to an online platform, between 28 April and 30 June 2020. The analysed material consisted of 13 written texts and one audio record. They were examined by means of a narrative analysis based on a holistic content approach, attempting to identify narrative highlights, referred to as foci, in the texts. RESULTS: Five main foci were identified: danger and threats, acquisition of knowledge and practices, adaptation to a changing context, commitment to the profession, and sense of belonging to the medical staff. In physicians' narratives, danger designated a variety of rather negative feelings and emotions, whereas threats were experienced as being dangerous for others, but also for oneself. The acquisition of knowledge and practices focus referred to the different types of acquisition that took place during W1. The narratives that focused on adaptation reflected how physicians coped with W1 and private or professional upheavals. COVID-19 W1 contributed to revealing a natural commitment (or not) of physicians towards the profession and patients, accompanied by the concern of offering the best possible care to all. Lastly, sense of belonging referred to the team and its reconfiguration during W1. CONCLUSIONS: Our study deepens the understanding of how physicians experienced the pandemic both in their professional and personal settings. It offers insights into how they prepared and reacted to a pandemic. The foci reflect topics that are inherent to a physician's profession, whatever the context. During a pandemic, these foundational elements are particularly challenged. Strikingly, these topics are not studied in medical school, thus raising the general question of how students are prepared for the medical profession.

Vitamin supplements: Are they associated with immune status?

BACKGROUND & AIMS: Vitamins are essential nutrients, taken in very small amounts (0.01-100 mg a day). Associations between vitamin supplement intake or status and the immune system are far from consensual. Our aim was to understand the association between vitamin supplements and the immune system, namely regarding lymphocyte count and immunoglobulin levels against infectious pathogens. METHODS: Cross-sectional study using data from the first follow-up of the CoLaus|PsyCoLaus study (April 2009 to September 2012). Participants were categorized as vitamin users and non-users. Serostatus for 15 viruses, six bacteria, and one parasite was assessed. Data for inflammatory markers (hs-CRP, IL-1ß, IL-6, and TNF-α) and blood elements were also collected. RESULTS: Of the initial 5064 participants, 3769 (74.5 %, mean age 58.3 ± 10.5 years, 53.6 % women) were retained for serostatus. On bivariate analysis, participants taking vitamins presented with higher positivity levels in three markers and lower positivity levels in two, but those differences were no longer statistically significant after multivariable analysis. 4489 participants (88.6 %, mean age 57.7 ± 10.5 years, 53.2 % women) had data for inflammatory markers; no association was found between vitamin supplement use and inflammatory markers both on bivariate and multivariable analysis. Finally, 3349 participants (66.1 %, mean age 57.3 ± 10.3 years, 53.1 % women) had data for blood elements; on bivariate analysis, vitamin supplement users had lower levels of haemoglobin and lymphocytes, but those differences were no longer significant after multivariable adjustment. CONCLUSION: In this cross-sectional, population-based study, we found no association between vitamin supplement use and markers of immune status.

Impact of Mediterranean Diet on Lipid Composition in the Colaus-PsyColaus Study.

High adherence to the Mediterranean diet (MD) has been associated with lower incidence of cardiovascular disease, increased HDL-cholesterol levels, and decreased triglycerides (TG), and total and LDL cholesterol levels. We aimed to assess the association of MD adherence at baseline with the lipid profile both cross-sectionally and prospectively in a sample of apparently healthy community-dwelling subjects. We conducted three cross-sectional studies using data from follow-ups 1 (FU1, 2009-2012), 2 (FU2, 2014-2017), and 3 (FU3, 2018-2021) of CoLaus|PsyCoLaus, a population-based sample from Lausanne, Switzerland. Dietary intake was assessed with a food frequency questionnaire. Two MD scores (Trichopoulou and Vormund) were computed, ranging from 0 (low) to 9 (high). In total, LDL and HDL cholesterol and TG were assessed. Incident dyslipidemia was defined as hypolipidemic treatment at FU2 or FU3. Overall, 4249 participants from FU1 (53.7% women, 57.6 ± 10.5 years, Trichopoulou 4.0 ± 1.5, Vormund 4.7 ± 1.9) were included. Neither MD score correlated significantly with the lipid markers and similar results were obtained according to the hypolipidemic status. Among the 3092 untreated FU1 participants with FU2 and FU3 data, 349 (11.3%) developed dyslipidemia by FU2 or FU3. No difference in MD scores was found between participants who developed dyslipidemia and those who did not (4.1 ± 1.5 vs. 4.0 ± 1.5 and 4.8 ± 1.8 vs. 4.8 ± 1.9 for Trichopoulou and Vormund, respectively, p > 0.05). Finally, no associations were found between MD score and lipid changes at 5 or 10 years. Contrary to other studies, adherence to MD at baseline did not show any significant effects on lipid composition/incident dyslipidemia in Colaus|PsyCoLaus participants.

[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.

Association between Mediterranean Diet and Type 2 Diabetes: Multiple Cross-Sectional Analyses.

AIM: To assess whether the Mediterranean diet (MD) is associated with lower levels of type 2 diabetes (T2D) in a non-Mediterranean population. METHODS: Cross-sectional analysis of follow-ups 1 (FU1, 2009-2012, n = 4398, 45.7% men, 57.7 ± 10.5 years), 2 (FU2, 2014-2017, n = 3154, 45.0% men, 61.7 ± 9.9 years), and 3 (FU3, 2018-2021, n = 2394, 45.2% men, 65.0 ± 9.6 years) of the Colaus|PsyCoLaus study (Lausanne, Switzerland). Two MD scores (Trichopoulou, noted MD1, and Sofi, noted MD2) were calculated using participants' dietary data. T2D was defined as a fasting plasma glucose ≥7 mmol/L and/or the presence of an antidiabetic drug treatment. RESULTS: Participants with the highest MD adherence had a higher educational level, a lower BMI, were less frequent smokers, presented less frequently with hypertension, and were more frequent alcohol consumers. After multivariable adjustment, no differences were found between participants with and without T2D regarding MD scores: 3.93 ± 0.07 vs. 3.97 ± 0.02; 4.08 ± 0.10 vs. 3.98 ± 0.03, and 3.83 ± 0.11 vs. 3.97 ± 0.03, respectively, for the MD1 score in FU1, FU2, and FU3. In addition, no association was found between adherence to MD and T2D: odds ratio (and 95% confidence interval) for medium and high relative to low adherence to MD1: 0.87 (0.68-1.10) and 0.89 (0.64-1.24) in FU1, 1.04 (0.76-1.42) and 1.07 (0.68-1.67) in FU2, and 0.73 (0.53-1.03) and 0.61 (0.37-1.02) in FU3, respectively. Corresponding results for MD2 were 0.90 (0.70-1.15) and 1.03 (0.69-1.53) in FU1, 1.16 (0.82-1.63) and 1.40 (0.81-2.41) in FU2, and 0.93 (0.65-1.34) and 0.55 (0.28-1.08) in FU3. CONCLUSION: We found no association between Mediterranean diet adherence and T2D in a non-Mediterranean population.

Comparison of five different risk scores to predict incident type 2 diabetes in the Swiss HIV cohort study.

OBJECTIVE: People with HIV (PWH) have a higher risk of type 2 diabetes (T2D) than HIV-negative individuals. In the general population, diabetes risk scores are used to identify persons at risk of developing T2D, but little is known regarding their performance in PWH. DESIGN: Assessment of the capacity of five diabetes risk scores to predict T2D in PWH. METHODS: A prospective study including all Swiss HIV cohort study (SHCS) participants followed between 2009 and 2019. Five diabetes risk scores were assessed: FINDRISC versions 1 and 2, Balkau, Swiss Diabetes Association (SDA), and Kraege. RESULTS: Three thousand eight hundred fifty-three T2D-free PWH (78.5% men, 39.9 ±â€Š11.3 years) were included. After a median follow-up of 4.8 years (interquartile range 2.2-7.8), 62 participants (1.6%) developed T2D, corresponding to an incidence rate of 3.18 per 1000 person-years (95% confidence interval = 2.47-4.08). Participants who developed T2D were older (48.7 ±â€Š12.4 vs. 39.8 ±â€Š11.2 years), more likely to be obese (22.6% vs. 7.4%), abdominally obese (9.7% vs. 1.5%), and to have a family history of diabetes (32.3% vs. 19.1%) than those without T2D. The AUC for incident T2D ranged between 0.72 (Kraege 16) and 0.81 (SDA, FINDRISC2 and Balkau). Sensitivity ranged between 3.2% (Balkau) and 67.7% (FINDRISC1) and specificity between 80.9% (FINDRISC1) and 98.3% (Balkau). Positive predictive values of all scores were below 20%, while negative predictive values were above 98%. CONCLUSION: Our study shows that the performance of conventional diabetes risk scores in PWH is promising, especially for Balkau and FINDRISC2, which showed good discriminatory power. These scores may help identify patients at a low risk of T2D in whom careful assessment of modifiable T2D risk factors can be spared.

[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.

Risk stratification for hospital-acquired venous thromboembolism in medical patients (RISE): Protocol for a prospective cohort study.

BACKGROUND: Hospital-acquired venous thromboembolism (VTE) is one of the leading preventable causes of in-hospital mortality. However, its risk assessment in medically ill inpatients is complicated due to the patients' heterogeneity and complexity of currently available risk assessment models (RAMs). The simplified Geneva score provides simplicity but has not yet been prospectively validated. Immobility is an important predictor for VTE in RAMs, but its definition is inconsistent and based on subjective assessment by nurses or physicians. In this study, we aim to prospectively validate the simplified Geneva score and to examine the predictive performance of a novel and objective definition of in-hospital immobilization using accelerometry. METHODS AND ANALYSIS: RISE is a multicenter prospective cohort study. The goal is to recruit 1350 adult inpatients admitted for medical illness in three Swiss tertiary care hospitals. We collect data on demographics, comorbidities, VTE risk and thromboprophylaxis. Mobility from admission to discharge is objectively measured using a wrist-worn accelerometer. Participants are followed for 90 days for the occurrence of symptomatic VTE (primary outcome). Secondary outcomes are the occurrence of clinically relevant bleeding, and mortality. The evolution of autonomy in the activities of daily living, the length of stay, and the occurrence of readmission are also recorded. Time-dependent area under the curve, sensitivity, specificity, and positive and negative predictive values are calculated for each RAM (i.e. the simplified and original Geneva score, Padua, and IMPROVE score) with and without the objective mobility measures to assess their accuracy in predicting hospital-acquired VTE at 90 days. ETHICS AND EXPECTED IMPACT: The ethics committee approved the protocol and the study was registered on ClinicalTrials.gov as NCT04439383. RISE has the potential to optimize VTE risk stratification, and thus to improve the quality of care of medically hospitalized patients.

[Artificial Intelligence in internal medicine†: development of a model predicting length of stay for non-elective admissions]. / Intelligence artificielle en médecine interne†: développement d'un modèle prédictif des durées de séjour.

Efficient management of hospitalized patients requires carefully planning each stay by taking into account patients' pathologies and hospital constraints. Therefore, the ability to accurately estimate length of stays allows for better interprofessional tasks coordination, improved patient flow management, and anticipated discharge preparation. This article presents how we built and evaluated a predictive model of length of stay based on clinical data available upon admission to a division of internal medicine. We show that Machine Learning-based approaches can predict lengths of stay with a similar level of accuracy as field experts.

Une prise en charge efficiente des patients nécessite une planification minutieuse des soins en fonction de la pathologie et des contraintes hospitalières. Dans ce contexte, une estimation de la durée de séjour permet de mieux coordonner les tâches interprofessionnelles, de gérer le flux des patients et d'anticiper la préparation à la sortie. Cet article présente la construction et l'évaluation d'un modèle prédictif de la durée de séjour à l'aide de données cliniques présentes à l'admission dans un service de médecine interne universitaire. Nous démontrons que les approches basées sur le Machine Learning sont capables de prédire des durées de séjour avec une performance similaire à celle des professionnels.

[Immune-related adverse events of checkpoint inhibitors: an internist/general practitioner's point of view]. / Effets indésirables immunomédiés des inhibiteurs de points de contrôle immunitaire: point de vue de l'interniste.

Immune checkpoint inhibitors have radically changed oncology by significantly improving prognosis and survival of many patients, even at an advanced or metastatic stage. Some patients undergoing immunotherapy develop adverse immune-related events, presenting a toxicity spectrum that can affect any organ, separately or simultaneously, with different intensities depending on the treatment used and patient characteristics. We hereby suggest a diagnostic and therapeutic approach that any internist, general practitioner or emergency doctor should have facing digestive, cardiac and pulmonary toxicities.

Les inhibiteurs de points de contrôle immunitaire (IPCI) ont radicalement changé la prise en charge oncologique en améliorant significativement le pronostic ainsi que la survie de nombreux patients, même à un stade avancé ou métastatique. Une partie des patients traités peuvent développer des effets indésirables immunomédiés avec un spectre de toxicités pouvant atteindre tous les organes, de façon isolée ou simultanée, avec une sévérité et une chronologie variables en fonction du traitement utilisé et des caractéristiques de chaque patient. Nous proposons ici la conduite à tenir du médecin interniste, généraliste ou urgentiste devant les toxicités digestives, cardiaques et pulmonaires.

Accelerometry assessed physical activity of older adults hospitalized with acute medical illness - an observational study.

BACKGROUND: In a hospital setting and among older patients, inactivity and bedrest are associated with a wide range of negative outcomes such as functional decline, increased risk of falls, longer hospitalization and institutionalization. Our aim was to assess the distribution, determinants and predictors of physical activity (PA) levels using wrist-worn accelerometers in older patients hospitalized with acute medical illness. METHODS: Observational study conducted from February to November 2018 at an acute internal medicine unit in the University hospital of Lausanne, Switzerland. We enrolled 177 patients aged ≥65 years, able to walk prior to admission. PA during acute hospital stay was continuously recorded via a 3D wrist accelerometer. Clinical data was collected from medical records or by interview. Autonomy level prior to inclusion was assessed using Barthel Index score. PA levels were defined as < 30 mg for inactivity, 30-99 mg for light and ≥ 100 for moderate PA. Physically active patients were defined as 1) being in the highest quartile of time spent in light and moderate PA or 2) spending ≥20 min/day in moderate PA. RESULTS: Median [interquartile range - IQR] age was 83 [74-87] years and 60% of participants were male. The median [IQR] time spent inactive and in light PA was 613 [518-663] and 63 [30-97] minutes/day, respectively. PA peaked between 8 and 10 am, at 12 am and at 6 pm. Less than 10% of patients were considered physically active according to definition 2. For both definitions, active patients had a lower prevalence of walking aids and a lower dependency level according to Barthel Index score. For definition 1, use of medical equipment was associated with a 70% reduction in the likelihood of being active: odds ratio (OR) 0.30 [0.10-0.92] p = 0.034; for definition 2, use of walking aids was associated with a 75% reduction in the likelihood of being active: OR = 0.24 [0.06-0.89], p = 0.032. CONCLUSION: Older hospitalized patients are physically active only 10% of daily time and concentrate their PA around eating periods. Whether a Barthel Index below 95 prior to admission may be used to identify patients at risk of inactivity during hospital stay remains to be proven.

[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.

Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients.

Importance: The effects of in-hospital physical activity (PA) on outcomes among elderly patients has seldom been assessed. Objectives: To assess PA levels among elderly patients hospitalized for acute medical illness and to examine the association between PA levels and functional decline and other clinical outcomes at discharge. Design, Setting, and Participants: This monocentric cohort study was performed among patients 65 years or older who were admitted for acute medical illness to the internal medicine ward of Lausanne University Hospital, Lausanne, Switzerland, from February 1 through November 30, 2018. Data were analyzed from January 1 through December 2, 2019. Exposures: Daytime and 24-hour PA levels assessed via wrist accelerometers and measured in millig units (mG; 1 mG = 9.80665 × 10-3 m/s2). Mean Outcomes and Measures: Functional decline (defined as a ≥5-point decrease in the modified Barthel Index), risk of bedsores, length of stay (LOS), and inability to return home. Results: A total of 177 patients (106 [59.9%] men; median age, 83 [interquartile range, 74-87] years) were included. Lower mean (SD) PA levels were found in patients using walking aids before admission (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [3] vs 11 [5] mG), those admitted for a reason associated with functional decline (daytime, 12 [6] vs 14 [7] mG; 24-hour, 10 [4] vs 11 [4] mG), or those prescribed physiotherapy (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [4] vs 12 [5] mG). At discharge, functional decline was found in 63 patients (35.6%; 95% CI, 25.6%-43.1%), bedsore risk in 78 (44.1%; 95% CI, 36.6%-51.7%), and inability to return home in 82 (46.3%; 95% CI, 38.8%-54.0%). After multivariate analysis, no association was found between PA levels and functional decline (multivariable-adjusted mean [SE], 13 [1] vs 13 [1] mG for daytime levels [P = .69] and 10 [1] vs 11 [1] mG for 24-hour PA levels [P = .45]) or LOS (Spearman rank correlation, ρ = -0.06 for daytime PA levels [P = .93] and -0.01 for 24-hour PA levels [P = .52]). Patients at risk of bedsores had significantly lower PA levels than those not at risk (multivariable-adjusted mean [SE], 12 [1] vs 15 [1] mG for daytime PA levels [P = .008]; 10 [1] vs 12 [1] mG for 24-hour PA levels [P = .01]). Patients able to return home had significantly higher PA levels than those institutionalized (multivariable-adjusted mean [SE], 14 [1] vs 12 [1] mG for daytime PA levels [P = .04]; 11 [1] vs 10 [1] mG for 24-hour PA levels [P = .009]). Conclusions and Relevance: In this study, lower in-hospital daytime and 24-hour PA levels were associated with risk of bedsores and inability to return home on discharge. These findings are important given that one-third of elderly patients present with hospital-acquired functional decline.

Validation of Seven Type 2 Diabetes Mellitus Risk Scores in a Population-Based Cohort: The CoLaus Study.

AIM: To assess the validity of seven type 2 diabetes mellitus (T2DM) risk scores in predicting the 10-year incidence of T2DM in a Swiss population-based study. METHODS: The prospective study included 5131 participants (55% women, age range 35 to 75 years) living in Lausanne, Switzerland. The baseline survey was conducted between 2003 and 2006, and the average follow-up was 10.9 years. Five clinically-based scores (the Balkau, Kahn clinical, Griffin, Swiss Diabetes Association [SDAS], and Finnish Diabetes Risk Score [FINDRISC]) and two clinically and biologically based scores (the Kahn CB and Wilson) were tested. RESULTS: 405 (7.9%) participants developed T2DM. The overall prevalence of participants at high risk ranged from 13.7% for the Griffin score to 43.3% for the Balkau score. The prevalence of participants at high risk among those who developed T2DM ranged from 34.6% for the Griffin score to 82.0% for the Kahn CB score. The Kahn CB score had the highest area under the ROC (value and 95% confidence interval: 0.866 [0.849-0.883]), followed by the FINDRISC (0.818 [0.798-0.838]), while the Griffin score had the lowest (0.740 [0.718-0.762]). Sensitivities and specificities were above 70%, except for the Griffin and the Kahn C scores (for sensitivity) and the Balkau score (for specificity). The numbers needed to screen ranged from 15.5 for the Kahn CB score to 36.7 for the Griffin score. CONCLUSION: The Kahn CB and the FINDRISC scores performed the best out of all the scores. The FINDRISC score could be used in an epidemiological setting, while the need for blood sampling for the Kahn CB score restricts its use to a more clinical setting.

[Internal medicine, seen from the mouth]. / La médecine interne vue depuis la bouche.

Many diseases affect the oral cavity. Therefore, the mouth is an organ that internists should observe carefully. Hereafter we present five illustrations of oral semiology that reflect a systemic condition: a strawberry tongue, an ulceration, a labial lesion, a gingival hyperplasia and a gingival hyperpigmentation. Each time, a differential diagnosis is to be considered, potentially allowing the identification of severe diseases.

Un grand nombre de pathologies ont une répercussion sur la sphère buccale. Pour l'interniste, la bouche est par conséquent un organe à observer soigneusement. Nous présentons cinq illustrations de sémiologie buccale qui traduisent une affection systémique : une langue framboisée, une ulcération, une lésion labiale, une hyperplasie gingivale et une hyperpigmentation gingivale. À chaque fois, un diagnostic différentiel doit être évoqué, permettant potentiellement l'identification de maladies sévères.

Development and multi-cohort validation of a clinical score for predicting type 2 diabetes mellitus.

BACKGROUND AND AIMS: Many countries lack resources to identify patients at risk of developing Type 2 diabetes mellitus (diabetes). We aimed to develop and validate a diabetes risk score based on easily accessible clinical data. METHODS: Prospective study including 5277 participants (55.0% women, 51.8±10.5 years) free of diabetes at baseline. Comparison with two other published diabetes risk scores (Balkau and Kahn clinical, respectively 5 and 8 variables) and validation on three cohorts (Europe, Iran and Mexico) was performed. RESULTS: After a mean follow-up of 10.9 years, 405 participants (7.7%) developed diabetes. Our score was based on age, gender, waist circumference, diabetes family history, hypertension and physical activity. The area under the curve (AUC) was 0.772 for our score, vs. 0.748 (p<0.001) and 0.774 (p = 0.668) for the other two. Using a 13-point threshold, sensitivity, specificity, positive and negative predictive values (95% CI) of our score were 60.5 (55.5-65.3), 77.1 (75.8-78.2), 18.0 (16.0-20.1) and 95.9 (95.2-96.5) percent, respectively. Our score performed equally well or better than the other two in the Iranian [AUC 0.542 vs. 0.564 (p = 0.476) and 0.513 (p = 0.300)] and Mexican [AUC 0.791 vs. 0.672 (p<0.001) and 0.778 (p = 0.575)] cohorts. In the European cohort, it performed similarly to the Balkau score but worse than the Kahn clinical [AUC 0.788 vs. 0.793 (p = 0.091) and 0.816 (p<0.001)]. Diagnostic capacity of our score was better than the Balkau score and comparable to the Kahn clinical one. CONCLUSION: Our clinically-based score shows encouraging results compared to other scores and can be used in populations with differing diabetes prevalence.

[The internal medicine articles that struck us the most in 2018]. / L'année 2018 mise en perspective par les internistes hospitaliers.

2018 has continued to bring important progress in all areas of internal medicine, impacting our daily practice. From bezafibrate in primary biliary cholangitis to the new Clostridioides difficile guidelines, passing by use of procalcitonine, cristalloids, copeptin and how to administer furosemide, internal medicine journals are full of novelties. Every year, the chief residents of the CHUV internal medicine ward meet up to share their readings : here is their selection of 12 articles, chosen, summarized and commented for you.

L'année 2018 a vu d'importants progrès dans tous les domaines de la médecine interne, avec un impact important sur notre pratique quotidienne. Du bézafibrate dans la cholangite biliaire primitive aux nouvelles recommandations pour le traitement du Clostridioides difficile en passant par l'utilisation de la procalcitonine, des cristalloïdes, de la copeptine et du mode d'administration du furosémide, les nouveautés abondent dans la littérature. Chaque année, les chefs de clinique du Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV) se réunissent pour partager leurs lectures : voici une sélection de 12 articles choisis, revus et commentés pour vous.