Ville, tourisme et transport : la Compagnie du chemin de fer Lausanne-Ouchy (1869-1914)

Inauguré le 16 mars 1877, le chemin de fer entre Lausanne et le petit port touristique d'Ouchy constitue une entreprise aux dimensions techniques et financières pharaoniques. Premier funiculaire à câble de Suisse, le Lausanne-Ouchy est aussi le premier au monde à être équipé d'un système de traction hydraulique. L'objectif de cette contribution n'est toutefois pas d'analyser les conditions de réalisation de cet exploit technologique, mais la naissance et l'évolution d'une compagnie de transport étroitement liée à l'établissement du système touristique lausannois. La demande de mobilité créée par l'afflux d'étrangers et l'apport des milieux touristiques au capital sont en effet indispensables à la création et à la survie de l'entreprise, dont la santé financière reste longtemps problématique. En retour, le funiculaire modifie le système de transport régional et national, donnant d'importantes impulsions au développement touristique.

Improving breast cancer education: the case of an evolving multidisciplinary module for undergraduate medical students (lausanne medical school, 1993-2008).

Breast cancer is a public health issue in numerous countries. Multidisciplinary collaboration is required for patient care, research, and also education of future physicians. This paper uses Kern's framework for curriculum design to demonstrate how a breast diseases module for undergraduate medical students created in 1993 evolved over 15 years. The main outcomes of program refinements were better integrated course content, the development of electronic course documents, and implementation of computer-aided small group learning. A main future challenge is to further develop efficient instructional strategies in line with well-defined learning needs for undergraduate students.

Bone mineral density (BMD), micro-architecture estimation (TBS) and vertebral fracture assessment (VFA) extracted from a single DXA device in combination with clinical risk factors improve significantly the identification of women at high risk of fracture.

Osteoporosis (OP) is a systemic skeletal disease characterized by a low bone mineral density (BMD) and a micro-architectural (MA) deterioration. Clinical risk factors (CRF) are often used as a MA approximation. MA is yet evaluable in daily practice by the trabecular bone score (TBS) measure. TBS is very simple to obtain, by reanalyzing a lumbar DXA-scan. TBS has proven to have diagnosis and prognosis values, partially independent of CRF and BMD. The aim of the OsteoLaus cohort is to combine in daily practice the CRF and the information given by DXA (BMD, TBS and vertebral fracture assessment (VFA)) to better identify women at high fracture risk. The OsteoLaus cohort (1400 women 50 to 80 years living in Lausanne, Switzerland) started in 2010. This study is derived from the cohort COLAUS who started in Lausanne in 2003. The main goal of COLAUS is to obtain information on the epidemiology and genetic determinants of cardiovascular risk in 6700 men and women. CRF for OP, bone ultrasound of the heel, lumbar spine and hip BMD, VFA by DXA and MA evaluation by TBS are recorded in OsteoLaus. Preliminary results are reported. We included 631 women: mean age 67.4 ± 6.7 years, BMI 26.1 ± 4.6, mean lumbar spine BMD 0.943 ± 0.168 (T-score − 1.4 SD), and TBS 1.271 ± 0.103. As expected, correlation between BMD and site matched TBS is low (r2 = 0.16). Prevalence of VFx grade 2/3, major OP Fx and all OP Fx is 8.4%, 17.0% and 26.0% respectively. Age- and BMI-adjusted ORs (per SD decrease) are 1.8 (1.2-2.5), 1.6 (1.2-2.1), and 1.3 (1.1-1.6) for BMD for the different categories of fractures and 2.0 (1.4-3.0), 1.9 (1.4-2.5), and 1.4 (1.1-1.7) for TBS respectively. Only 32 to 37% of women with OP Fx have a BMD < − 2.5 SD or a TBS < 1.200. If we combine a BMD < − 2.5 SD or a TBS < 1.200, 54 to 60% of women with an osteoporotic Fx are identified. As in the already published studies, these preliminary results confirm the partial independence between BMD and TBS. More importantly, a combination of TBS subsequent to BMD increases significantly the identification of women with prevalent OP Fx which would have been misclassified by BMD alone. For the first time we are able to have complementary information about fracture (VFA), density (BMD), micro- and macro architecture (TBS and HAS) from a simple, low ionizing radiation and cheap device: DXA. Such complementary information is very useful for the patient in the daily practice and moreover will likely have an impact on cost effectiveness analysis.

Gefäßchirurgische Ausbildung in endovaskulärer Technik in Lausanne

Between 1995 and 2005, the number of aortic aneurysms treated annually using endovascular techniques (EVAR) increased from 0 to 50, including all aortic stages. Our organization includes a large team of surgeons, a stock of three complete families of endoprostheses (straight, conical and bifurcated), a mobile trolley with accessories (arterial introducer/introducer sheath, guide wire, catheters, balloons, etc.) and an appliance on wheels for intravascular ultrasound examination (IVUS). This appliance, together with a mobile fluoroscopy device (c-arm), allows endovascular aneurysms analysis of every operating room in our institution, usually without angiography or the use of contrast medium. In general, we are therefore not depending on substantial preoperative imaging in order to identify candidates for endovascular aneurysms repair and can treat abdominal and thoracic aortic ruptures without delay. For endovascular aortic aneurysms repair we distinguish between process steps on the one hand (determining indications, imaging of the access vessels, measurement using IVUS and road mapping via fluoroscopy, selection of implant, implant insertion, positioning, setting the implant, determining success, reconstruction of the access vessel and follow-up) and the level of competence on the other (assistant, senior and directing physicians). Our ultrasound supported technique for endovascular aneurysms repair has been successfully brought to other hospitals using an IVUS transporter and telementoring.

From geriatric service to primary care: a retrospective pharmaceutical analysis of the medical prescription

Introduction The population of elderly persons is increasing andnegative outcomes due to polymedication are frequent. Discrepanciesin information about medication are frequent when older persons aretransitioning from hospital to home, increasing the risk of hospitalreadmission. The aims of this study were a) to determine discrepanciesin medical regimen indicated in two official discharge documents(DS = discharge summary, DP=discharge prescription); b) to characterizethe pharmacotherapy prescribed in older patients dischargedfrom a geriatric service.Materials & Methods Elderly patients (N=230) discharged from thegeriatric service (CHUV, Lausanne) over a 6-month period (January toJune 2009) were selected. Community pharmacists compared DS andDP to identify discrepancies including (a) drugs' name; (b) schedule ofadministration, dosage, frequency, prn prescription, treatment durationand galenic formulation. Beers' criteria were applied to identifypotentially inappropriate drugs and a descriptive analysis of drug costs,prescription profiles and generics were also performed.Results On average, patients were 82 ± 7 years old and stayed23.0 ± 11.6 days in the geriatric service. The delay between the datesof patient's discharge with the DP and the sending of the DS to hisgeneral physician averaged 14.0 ± 7.5 days (range 1-55). The DPhad an average of 10.0 ± 3.3 drugs (range 2-19). 77% of patients hadat least one discrepancy. A drug was missing on the DS in 57.8% ofpatients and 19.6% had a missing prn prescription. Among the 2312drugs prescribed, 3% belonged to Beers' list. They were prescribed to61 patients (26.5%), with 6 patients cumulating two Beers' potentiallyinappropriate drugs in their treatment. Analgesics (85% of thepatients), anticoagulants (80%), mineral supplements (77%), laxatives(52%) and antihypertensives (46%) were the drug classes most frequentlyprescribed. Mean costs of treatment as per DP was160.4 ± 179.4 Euros. Generic prescription represented more than 5%of the costs for 3 therapeutic classes (cholesterol-lowering agents(64%), antihypertensives (50%) and antidepressants (47%)).Discussion & Conclusion The high discrepancy rate between medicationlisted in the DP and the DS highlights a need for safetyimprovement. Potential benefits are expected from reinforced pharmacist-physician collaboration in transition from hospital to primarycare. In addition, even though Beers' criteria are questionable, thedrugs prescribed in this already fragile population, and the potentialopportunities of economical optimizations, are advocating thedevelopment and the scientific evaluation of a structured advancedcollaborative pharmacy practice service. This foresees improvedeffectiveness, safety and efficiency in the medication management ofelderly persons.

Résistances tacites face à la requalification d'un quartier urbain en voie de gentrification : Regard à partir du quartier Le Maupas, Lausanne.

Quand un vent de changement souffle sur une ville, comment les quartiers qui la composent résistent-ils ? Le Maupas, une portion de la ville de Lausanne, présente les signes précurseurs d'un quartier en voie de gentrification. L'adoption dans cette recherche d'une approche praxéologique des espaces publics urbains implique une définition de ce phénomène, capable de rendre compte de ses caractéristiques dynamique et processuelle. Il s'agit d'étudier l'impact des aménagements urbains et de leurs usages. Je propose ici de recourir à des éléments en rapport avec la culture, la mobilité et la convivialité, afin de fournir un éclairage sur les tendances que peut prendre le quartier du Maupas. Ces tendances ne s'accomplissent pas sans quelques résistances explicites et tacites capables de contrecarrer, ou du moins ralentir la reclassification en cours. « Le Maupas » is part of the city of Lausanne. Because of some precursory signs, this neighbourhood is considered to be in the process of gentrification. This article deals with a praxeologic approach. It involves a dynamic conception of the urban public spaces and of gentrification. Studying the culture, the mobility and the conviviality features of « le Maupas », I try to highlight how social uses of urban settings manage resistance to change.

Biotechnology in Lausanne: the Rh D project.

Hemolytic disease of the newborn is an often fatal condition of some newborn babies due to the immunogenicity of their Rh D positive erythrocytes in the Rh D negative mother. This condition can be prevented by injecting anti-Rh D antibodies. The current source of these antibodies is blood from immunized human donors. In order to avoid problems with limited supply and donor safety, the Rh D project was set up to develop recombinant monoclonal anti-Rh D antibodies as a possible replacement. In a multidisciplinary collaboration between the Zentrallaboratorium Blutspendedienst (ZlB) of the Swiss Red Cross, the Center of Biotechnology of the University and the EPFL (CBUE), and the Institute of Chemical and Biochemical Engineering (EPFl), co-funded by the Swiss National Science Foundation and ZLB, a candidate monoclonal anti-Rh D antibody has been selected, expressed in CHO cells, and a manufacturing process for large-scale production has been developed.

Résultats de la chirurgie des adénomes hypophysaires non fonctionnels de découverte fortuite : étude multicentrique entre Lyon et Lausanne

Introduction.- La découverte fortuite d'un adénome hypophysaire pose le diagnostic d'incidentalome. Un traitement s'impose en cas d'hypersécrétion et/ou troubles visuels. La conduite à tenir, chirurgie ou surveillance, est discutable en l'absence de symptômes et/ou en présence d'une insuffisance antéhypophysaire (IAH) seule pour les incidentalomes hypophysaires non fonctionnels (IHNF). Dans ce travail multicentrique rétrospectif, nous avons étudié le devenir post-chirurgical d'une série d'IHNF asymptomatiques ou ne présentant qu'une IAH. Matériel et méthodes.- Durant la période 2001-2011, parmi les 853 patients opérés d'un adénome hypophysaire par voie transsphénoïdale, les cas d'IHNF étaient sélectionnés. Tous les patients étaient explorés en pré- et postopératoire à 3, 6 et tous les 12 mois avec explorations endocriniennes, ophtalmologique, et radiologique (IRM sans et avec contraste). Les résultats étaient jugés sur le bilan postopératoire à 6 mois (qualité de résection par IRM, résultats endocriniens, ophtalmologiques, morbidité postopératoire). Résultats ou cas rapporté.- Sur 66 IHNF, 34 (52 %) étaient asymptomatiques ou en IAH seule. La céphalée était à l'origine du bilan dans 44 %. Il s'agissait de macroadénomes (hauteur médiane : 18 mm, Knosp 0-1 : 27 %, Knosp 2 : 38 %, Knosp 3 : 32 %, Knosp 4 : 3 %). Neuf patients étaient en IAH. En postopératoire, l'exérèse était totale dans 76 %. Aucun patient n'était aggravé sur le plan visuel. Sur le plan endocrinien, 33 % des patients avec IAH étaient normalisés, 11,5 % améliorés, 44 % stables et 11,5 % aggravés. Les sujets sans IAH étaient aggravés dans 16 %. La morbidité comportait aussi 3 % de fistules de LCR, 3 % de diabète insipide et 3 % de méningite. Il n'y avait pas de différence significative avec la population d'IHNF symptomatiques en termes de qualité d'exérèse, de morbidité mais globalement les résultats ophtalmologiques et endocriniens étaient supérieurs. Conclusion.- Des études ont montré que 67 % des IHNF devenaient symptomatiques avec 12 % de risque d'apoplexie pituitaire sur une période de 5 ans. Cet argument allié à l'absence de morbidité ophtalmologique rend raisonnable la proposition d'une chirurgie d'exérèse précoce donnant de meilleurs résultats fonctionnels pour les IHNF asymptomatiques.