[2014 literature findings in internal general medicine]. / Acquisitions thérapeutiques en médecine ambulatoire en 2014.

The usual treatment of venous ulcers may be associated with statins intake. Antibiotics have only marginal utility in acute bronchitis. The prescription of paracetamol seems to have no benefit in the treatment of acute lower back pain. The absence of antithrombotic prophylaxis for distal fractures of the lower limbs seems to be safe for patients' health. The treatment of atraumatic lesions of the rotator cuff in patients >55 years should remain conservative. Arthroscopic surgery of non-traumatic tear of the medial meniscus seems to have no benefit. The family environment seems to be a protective factor to the mental health of adolescents. Screening for colorectal cancer in patients >75 years would save lives.

[Ten years of literature review in general internal medicine--a first assessment]. / Dix ans de revue de la littérature en médecine interne générale--un premier bilan.

A group of family physicians in an outpatient clinic in Switzerland prospectively followed scientific literature for ten years. What to remember among the numerous articles retrieved and which paper really changed our practice? If many readings are quickly forgotten, some of them marked our minds and changed our habits. This article is a summary of our efforts to keep the essential tools in clinical practice.

[2012 literature findings in ambulatory internal medicine]. / Acquisitions thérapeutiques en médecine ambulatoire en 2012.

In 2012 several articles reported interesting findings for the ambulatory practice in internal general medicine. A negative rapid test for influenza does not rule out that diagnosis. A test assessing the walking speed in the elderly can help determining who would benefit from antihypertensive therapy. Antibiotic treatment has no benefit for acute uncomplicated rhinosinusitis and diverticulitis. Probiotics can reduce the risk of post-antibiotic diarrhea. Daily coffee intake could reduce mortality. Oral supplementation of calcium can be harmful to the cardiovascular system. Subclinical hyperthyroidism should be treated to prevent cardiovascular complications. Aspirin can prevent recurrences in case of a primary thromboembolic event. Local injection of corticosteroids under ultrasonographic guidance for plantar fasciitis can be a safe treatment. Ibuprofen can prevent acute mountain sickness.

[2011 findings from literature on general internal ambulatory medicine]. / Acquisitions thérapeutiques en médecine ambulatoire en 2011.

In 2011 several articles seemed significant for the practice of general medicine. Diagnosis of hypertension needs several measurements and may need 24-hour ambulatory blood pressure monitoring. Glycosylated hemoglobin is a reliable tool to diagnose diabetes mellitus. The ABCD2 score with neurological imaging help the triage of transient ischemic attacks. Pulmonary embolism can be treated as outpatient for low risk patients. Gluten-free diet may be tried in irritable bowel syndrome. Nitrofurantoin is a reasonable alternative for simple urinary tract infection in women, but antibiotics are not needed after drainage of an uncomplicated skin abscess. Subclinical thyroid dysfunction is a risk factor of osteoporosis in older men. Sequential use of MMSE and ACE scores is a promising approach to assess medical decision-making capacity.

[Acute low back pain in general practice medicine]. / La lombalgie aiguë en médecine de premier recours.

The practioner's first concern is knowing how to single out from the immense majority of situations susceptible to a favourable spontaneous evolution those patients with a bad prognostic necessitating reference to a specialist. We present in this paper the clinical steps designed to meet this challenge and a reminder of certain principles of patient diagnosis and care.

[Hiking and useful advices to patients (part 1)]. / Randonnée: conseils utites aux patients (1re partie).

The attraction of walking as a pastime has grown enormously in Switzerland over the past few years. Synonym of health and well-being, this activity carries some risks which more and more patients are questioning; answering these questions is not always obvious, so we wanted to tackle the subject. Risks linked to certain animals will be covered. One of these risks is insect stings, particularly wasps and bees. This is a major problem which affects the whole population and more seriously those who are allergic, accounting for around 5% of the population. Another problem: snake bites. In Switzerland, there are about 20-25 bites each year. Poisoning from these can be divided into two categories: local or systemic. The effects are multiple and diverse, ranging from renal failure to discrasia to hypovolemic shock. Pre-hospitalisation measures are of paramount importance in the treatment.

[Hiking and useful advices to patients: part II]. / Randonnée: conseils utites aux patients (2e partie).

The attraction of walking as a pastime has grown enormously in Switzerland over the past few years. Synonym of health and wellbeing, this activity carries some risks which more and more patients are questioning; answering these questions is not always obvious, so we wanted to tackle the subject. This second section concerns risks linked to food which can be found in the forest. Echinococcosis is an underestimated parasite which affects a large proportion of foxes in Switzerland. This infectious disease can also affect man following contamination which usually occurs through eating berries. Prevention is the most effective way to avoid poisoning by mushrooms. In case of poisoning, the physician must try and determine the toxidrome. The key element is the length of time before symptoms develop. Treatment is always symptomatic, using activated charcoal.

[Innovations in ambulatory care]. / Nouveautés en médecine ambulatoire.

During 2008, we selected 8 studies of interest. It seems important to continue to treat high tension for old patients. To give a good medication against pain, to maintain activity and to reassure patient is the treatment for acute back pain; surgery for spinal stenosis has better results than other treatments at two years of evolution. Pregabalin seems to provide clinically benefit to patients with fibromyalgia. Helicobacter pylori test and treat has the same results than proton pomp inhibitor in initial management of dyspepsia; extending triple therapy beyond 7 days is unlikely to be a clinical useful strategy. Syphilis testing algorithms using treponemal tests for initial screening could be inversed. Finally, selective reporting of clinical trials results for antidepressant are relatively frequent.

[Innovations in ambulatory care: screening, treatment and iatrogenicity]. / Nouveautés en médecine ambutatoire: dépistage, traitement et iatrogénicité.

This year we have selected six studies useful for the day to day practice. A mammography in women 40 to 49 years of age should be evaluated taking into account the patient's profile and the possible risks and benefits of this exam. In patients over 65 years of age, a systematic atrial fibrillation screening, with pulse rate measuring then ECG (if irregular beat) should be realised on a regular basis. The risks for complications following colonoscopies do exist, especially after biopsies/polypectomies and this risk should be discussed. Long term proton pump inhibitor treatment is a risk factor for hip fracture. It is important to treat high blood pressure problems in the elderly, but the orthostatic risks should be adressed. A corticoid treatment started quickly for Bell's palsy is efficient.

[News in internal ambulatory medicine]. / Médecine interne générale ambulatoire.

Since 2005, the chief residents of the University Outpatient Clinic of Lausanne have established a database of articles chosen from miscellaneous reviews and electronic journals and selected for their scientific value and practical usefulness. This first review is based on articles published in 2006 and covering five topics useful for the primary care physician: chronic daily headaches are frequent in women, isolated vertigo is only exceptionally a sign of stroke and a bipolar disorder must be investigated in case of depression. HIV testing in a medical setting is at present more satisfactory than rapid HIV testing at home and finally watchful waiting of inguinal hernia is possible in asymptomatic or pauci-symptomatic men.

[Therapy and internal medicine]. / Thérapeutique et médecine interne générale.

This review is based on five articles published in 2006 and dealing with therapies in general internal medicine: in case of acute non complicated rhino-sinusitis, the use of topical corticoids in mono-therapy is indicated; cross-reactivity between penicillins and cephalosporins is less frequent than established so far. In our daily practice we should be more "pro-active" in prescribing probiotics which have proved their efficacy in the prevention of antibiotic-associated diarrhoeas; an antibiotic treatment of three days is recommended in case of non complicated cystitis in women less than 65 years of age. Finally, every patient treated with bisphosphonates must be regularly followed by a dentist.

[Primary care in general internal medicine: relevant information in 2005]. / Médecine interne générale ambulatoire: quelques enseignements de la littérature en 2005.

During the year 2005, the chief residents of the University Medical Outpatient Clinic of Lausanne have done a database of useful articles for daily practice, scientifically validated and with excellent didactic quality, from 10 electronic journals. They have used those selected articles in personal meetings between the chief residents on a regular basis and the possibility to access the database by the junior physicians. Six of these articles concerning different topics (depression, tuberculosis detection, anticoagulation at home, cholinesterase inhibitors, insomnia and therapies, transdermal nitroglycerin and tendinopathies) are presented.

[Information management skills: a practical guide in primary care medicine]. / Maîtrise de l'information médicale en médecine de premier recours: quelques conseils.

Evidence-Based Medicine has taught us how to evaluate the validity of medical information. At the present time, with the abundance of information available, a doctor often lacks the time needed to select and apply what medical literature suggests. Consequently a new paradigm is called for, namely that of Information Management. In order to reconcile evidence with the principle of reality, a carefully measured use of medical literature has become necessary. The information consulted must not only be valid, but relevant to the context of the patient and must be easily accessible. The article under consideration offers some indication as to how to improve the management of information on a day to day basis through a system of up-dating by email newsletters and by the advantageous use of prefiltered medical literature.

Failure in measuring gas exchange in the ICU.

OBJECTIVE: This study was performed on patients after coronary artery bypass surgery, and in healthy volunteers to assess discrepant oxygen consumption (VO2) measurement between indirect calorimetry and Fick methods. Further evaluations were performed to point out the technical failure. METHODS: In this prospective study, the VO2 was assessed in the patients using a commercial indirect calorimeter and the reverse Fick method. This calorimeter does not directly measure gas flow, but it assumes a constant preset flow. Bench testing of the calorimeter was performed in spontaneous and respirator mode using a reference calorimeter in healthy volunteers. RESULTS: An important overestimation of VO2 and carbon dioxide production (VCO2) of approximately 30% was found in both groups. The actual flow was lower than the preprogrammed value. This lead to spuriously high fractions of carbon dioxide and low fraction of oxygen. VCO2 and VO2, calculated with the overestimated gas flow value were overestimated, while respiratory quotient remained unchanged. Technical check-up revealed leaks in the mixing chamber and in the sampling lines. CONCLUSION: Indirect calorimetry is a useful clinical tool, but the investigator has to be very attentive to all potentially interfering factors and hazards.

Noninvasive assessment of in vivo glycogen kinetics in humans: effect of increased physical activity on glycogen breakdown and synthesis.

In vivo glycogen kinetics was estimated with the simultaneous use of indirect calorimetry and tracer technology in healthy humans during 24-h periods with low or moderate physical activity (1 or 3 exercise sessions each day). Two 13C-carbohydrates meals were administered at 9.30 a.m. and 1.30 p.m., and one 12C-carbohydrates meal at 6.30 p.m. Net carbohydrate oxidation (net CHO ox) was measured over a 24 h period by indirect calorimetry and oxidation of 13C-labelled carbohydrates (13C CHO ox) was estimated from 13CO2 production. Glycogen breakdown, assessed for the period 8.15 a.m.-6.30 p.m. as the difference between net CHO ox and 13C CHO ox, was increased 1.6 times with three exercise sessions [123.3 (SEM 8.0) g] versus one session [77.9 (SEM 7.7) g, P < 0.0001]. Carbohydrate balances over 24 h were close to zero under both conditions, indicating that glycogen breakdown was matched by an equivalent glycogen synthesis. It was concluded that simultaneous use of indirect calorimetry and tracer technology may make possible the estimation of glycogen kinetics in humans. Moderate physical activity enhanced both glycogen breakdown and synthesis. This stimulation of glycogen metabolism may therefore play a role in the enhanced insulin sensitivity induced by physical exercise.