[Medical informatics in response to COVID-19 The experience of the Service of Internal Medicine at CHUV]. / Informatique médicale en réponse au Covid-19 - L'expérience du Service de médecine interne du CHUV.

Medical informatics played a decisive role in the management of the health crisis linked to COVID-19, in particular for the support of hospital clinical, governance and communication activities. In this article, we present the experience of CHUV's Internal Medicine Service in these three areas, and analyse some critical points of our information system revealed by the crisis. The development, implementation, and maintenance of new IT tools during the crisis is a challenge. The involvement of medical informatics in the decision-making processes of hospitals and the training of healthcare professionals in this field are essential to strengthen the efficiency of information technologies and the innovation of our healthcare systems.

L'informatique médicale a joué un rôle déterminant dans la gestion de la crise sanitaire liée au Covid-19, notamment pour le support des activités cliniques hospitalières, de gouvernance et de communication. Nous exposons dans cet article l'expérience vécue au sein du Service de médecine interne du CHUV dans ces trois domaines et analysons certains points critiques de notre système d'information révélés par la situation de crise. Le développement, l'implémentation et la maintenance de nouveaux outils informatiques durant la crise constituent un réel défi. L'implication de l'informatique médicale au cœur des processus décisionnels des hôpitaux et la formation des professionnels de santé dans ce domaine sont essentielles pour renforcer l'efficience des technologies de l'information et l'innovation de nos systèmes de santé.

[Computerized clinical decision support for medication in the electronic health record]. / Aide à la prescription médicamenteuse grâce au dossier médical électronique.

Medication prescribing is a critical feature in the electronic health record (EHR). Computerized Clinical Decision Support (CCDS) for medication prescribing has the potential to improve quality of care, patient safety and reduce cost. However, its development, implementation, and maintenance in the clinical environment, are major challenges. We describe the basics of the CCDS in medication prescribing, the acquired experience of the last years at the Lausanne University Hospital (CHUV), and we expose the perspectives and future challenges in this domain.

La prescription médicamenteuse représente une fonction clé au sein du dossier médical électronique. L'aide à la prescription médicamenteuse, qui peut prendre différentes formes (alertes, sets d'ordres), a le potentiel d'améliorer la qualité, la sécurité et l'économicité des soins. Cependant, son développement, son implémentation dans les services cliniques et sa maintenance représentent des défis majeurs. Nous passons en revue ici les principes de l'aide à la prescription médicamenteuse, l'expérience acquise au CHUV ces dernières années, avant d'exposer les perspectives et défis dans ce domaine.

[Use of clinical practice guidelines in medicine : what's new ?] / Utilisation des recommandations pour la pratique clinique en médecine interne générale : quoi de neuf ?

Clinicians are confronted to an abundance of clinical practice guidelines (CPG). It has been proven for several pathologies that the use of guidelines improves quality of care by reducing mortality, the number of hospitalisations and the length of stay. Despite these proven benefits, adherence to CPGs remains low, mainly due to lack of awareness and familiarity with the guidelines, as well as lack of applicability and flexibility for elderly and comorbid patients. Since adherence to CPGs are influenced by their accessibility and format, informatics will certainly play an important role in the development and implementation of CPGs in the future. An online platform listing swiss CPGs is now available.

Les médecins sont confrontés à une abondance de recommandations pour la pratique clinique (RPC). Il a été prouvé pour plusieurs pathologies différentes que l'utilisation de RPC améliore les processus de soins, en diminuant la mortalité, le nombre d'hospitalisations et la durée de séjour. Malgré cela, les RPC restent peu utilisées, principalement en raison de la méconnaissance des recommandations existantes, ainsi que leur manque d'applicabilité et flexibilité chez les patients âgés et polymorbides. Sachant que le suivi des RPC est fortement influencé par leurs accessibilité et format, l'informatique aura certainement un rôle important à jouer dans le développement et l'implémentation des RPC à l'avenir. Une plateforme en ligne répertoriant des RPC suisses de qualité est désormais disponible.

Quality of life after pulmonary embolism: validation of the French version of the PEmb-QoL questionnaire.

BACKGROUND: The PEmb-QoL is a validated 40-item questionnaire to quantify health-related quality of life in patients having experienced pulmonary embolism (PE). It covers six health dimensions: frequency of complaints, activities of daily living limitations, work-related problems, social limitations, intensity of complaints, and emotional complaints. Originally developed in Dutch and English, we sought to prospectively validate the psychometric properties of a French version of the PEmb-QoL. METHODS: We performed a forward and backward translation of the English version of the PEmb-QoL into French. French-speaking consecutive adult patients with an acute, objectively confirmed PE admitted to the emergency department of a Swiss university hospital between 08/2009 and 09/2011 were recruited telephonically. We used standard psychometric tests and criteria to evaluate the acceptability, reliability, and validity of the French version of the PEmb-QoL. We also performed an exploratory factor analysis. RESULTS: Overall, 102 patients were enrolled in the study. The French version of the PEmb-QoL showed good reliability (internal consistency, item-total and inter-item correlations), reproducibility (test-retest reliability), and validity (convergent, discriminant) in French-speaking patients with PE. The exploratory factor analysis suggested three underlying dimensions: limitations in daily activity (items 4b-m, 5a-d), symptoms (items 1a-h and 7), and emotional complaints (items 9a-f and j). CONCLUSION: We successfully validated the French version of the PEmb-QoL questionnaire in patients with PE. Our results show that the PEmb-QoL is a valuable tool for assessing health-related quality of life after PE in French-speaking patients.

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

2013 was full of significant advances in all areas of medicine, which may have an impact on daily practice in general internal medicine. From salt and water restriction in heart failure to transfusion threshold in upper gastrointestinal bleeding and fecal infusion in Clostridium difficile colitis; from new data in resuscitation and persistent questions in palliative care and intensive care medicine, through pneumology, nephrology and endocrinology, the literature has been rich in new considerations. Each year, the residents of the Department of internal medicine of the University hospital of Vaud (CHUV) meet to share their most interesting readings. Thirteen of them are reviewed and commented here.

Quality of life after pulmonary embolism: Prospective validation of the German version of the PEmb-QoL questionnaire.

BACKGROUND: The Pulmonary Embolism Quality of Life questionnaire (PEmb-QoL) is a 40-item questionnaire to measure health-related quality of life in patients with pulmonary embolism. It covers six 6 dimensions: frequency of complaints, limitations in activities of daily living, work-related problems, social limitations, intensity of complaints, and emotional complaints. Originally developed in Dutch and English, we prospectively validated a German version of the PEmb-QoL. METHODS: A forward-backward translation of the English version of the PEmb-QoL into German was performed. German-speaking consecutive adult patients aged ≥18 years with an acute, objectively confirmed pulmonary embolism discharged from a Swiss university hospital (01/2011-06/2013) were recruited telephonically. Established psychometric tests and criteria were used to evaluate the acceptability, reliability, and validity of the German PEmb-QoL questionnaire. To assess the underlying dimensions, an exploratory factor analysis was performed. RESULTS: Overall, 102 patients were enrolled in the study. The German version of the PEmb-QoL showed a good internal consistency (Cronbach's alpha ranging from 0.72 to 0.96), item-total (0.53-0.95) and inter-item correlations (>0.4), and test-retest reliability (intra-class correlation coefficients 0.59-0.89) for the dimension scores. A moderate correlation of the PEmb-QoL with SF-36 dimension and summary scores (0.21-0.83) indicated convergent validity, while low correlations of PEmb-QoL dimensions with clinical characteristics (-0.16-0.37) supported discriminant validity. The exploratory factor analysis suggested four underlying dimensions: limitations in daily activities, symptoms, work-related problems, and emotional complaints. CONCLUSION: The German version of the PEmb-QoL questionnaire is a valid and reliable disease-specific measure for quality of life in patients with pulmonary embolism.