La securite des patients en pratique ambulatoire est compromise par les erreurs medicales. Ces er... more La securite des patients en pratique ambulatoire est compromise par les erreurs medicales. Ces erreurs doivent etre affrontees dans le cadre d'une approche systematique permettant d'en reduire au minimum les consequences pour le patient. Cette approche suppose la mise en place d'une nouvelle culture de l'erreur non stigmatisante et transparente envers le patient, comprenant un systeme de declaration des erreurs associe a une analyse en profondeur du systeme, a la recherche de causes enfouies et de barrieres de defense insuffisantes. Un outil de formation utile est le colloque de «situations critiques» ou les medecins sont encourages a declarer les evenements indesirables et les «quasi-evenements». Leur analyse s'accompagne d'un soutien valorisant les personnes concernees et permet de mettre en evidence les defauts du systeme dans l'institution ou le cabinet.
Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be ... more Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be related to iron deficiency without anemia. This simple disorder is easy to treat, provided that the diagnosis is correct. Several biological tests are available, but their interpretation is oftentimes problematic. Pre-analytical factors can interfere with measurements, normal values can change depending on suppliers, and, above all, results from different markers can be contradictory in some clinical situations. The aim of this article is to evaluate how the evolution of scientific knowledge and clinical trials can contribute to a better understanding and greater reliability in the diagnosis of iron deficiency
Handbook of Cannabis and Related Pathologies, 2017
The vast majority of epidemiological studies indicate that cannabinoids constitute the most frequ... more The vast majority of epidemiological studies indicate that cannabinoids constitute the most frequently encountered psychoactive substances in the blood of drivers who are drug-impaired and/or involved in accidents, and thus cannabis must be considered a serious problem for traffic safety. In order to better understand its effects on cognitive functions involved in the short-term ability to drive, experimental research has been conducted based on laboratory, simulator, or on-road studies and, more recently, brain imaging. According to the results reviewed in the present chapter, cannabis use has been shown to impair actual driving performance by increasing lane weaving and mean headway. It also impairs cognitive functions, including working memory, motor inhibition, and divided attention. However, several factors, including history of cannabis use, routes of administration and dose ranges, as well as study designs (eg, treatment blinding), explain some discrepancies. Moreover, the neurobiological mechanisms underlying the effects of cannabis on safe driving remain poorly understood, as does the correlation between body fluids (blood, oral fluid) concentrations and psychoactive effects of THC and its main active metabolites.
Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be ... more Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be related to iron deficiency without anemia. This simple disorder is easy to treat, provided that the diagnosis is correct. Several biological tests are available, but their interpretation is oftentimes problematic. Pre-analytical factors can interfere with measurements, normal values can change depending on suppliers, and, above all, results from different markers can be contradictory in some clinical situations. The aim of this article is to evaluate how the evolution of scientific knowledge and clinical trials can contribute to a better understanding and greater reliability in the diagnosis of iron deficiency.
Should we treat iron deficiency without anemia? The simple fact that the question can be formulat... more Should we treat iron deficiency without anemia? The simple fact that the question can be formulated already leads to controversies. During the past years, the development of a new formulation of intravenous iron has helped fuel the controversy. What is the situation in 2012? This article gives a practical point of view on the actual situation and provides indications on the use of new intravenous medications.
Driving requires integrating multiple motor, sensory, and cognitive skills. As people age, cognit... more Driving requires integrating multiple motor, sensory, and cognitive skills. As people age, cognition becomes increasingly vulnerable due to impairment and dementia. Older drivers suffering from dementia, even at an early stage, have been shown to be significantly more likely to develop unsafe driving. Primary care physicians have the difficult task to assess these persons' driving capacity. This paper briefly describes the consequences of altered cognition on driving capacity and proposes an algorithm to address this challenge.
During the year 2005, the chief residents of the University Medical Outpatient Clinic of Lausanne... more 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.
The diagnostic significance of clinical symptoms/signs of influenza has mainly been assessed in t... more The diagnostic significance of clinical symptoms/signs of influenza has mainly been assessed in the context of controlled studies with stringent inclusion criteria. There was a need to extend the evaluation of these predictors not only in the context of general practice but also according to the duration of symptoms and to the dynamics of the epidemic. A prospective study conducted in the Medical Outpatient Clinic in the winter season 1999-2000. Patients with influenza-like syndrome were included, as long as the primary care physician envisaged the diagnosis of influenza. The physician administered a questionnaire, a throat swab was performed and a culture acquired to document the diagnosis of influenza. 201 patients were included in the study. 52% were culture positive for influenza. By univariate analysis, temperature >37.8 degrees C (OR 4.2; 95% CI 2.3-7.7), duration of symptoms <48 hours (OR 3.2; 1.8-5.7), cough (OR 3.2; 1-10.4) and myalgia (OR 2.8; 1.0-7.5) were associate...
Background Major depression, although frequent in primary care, is commonly hidden behind multipl... more Background Major depression, although frequent in primary care, is commonly hidden behind multiple physical complaints that are often the first and only reason for patient consultation. Major depression can be screened by two validated questions that are easier to use in primary care than the full Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. A third question, called the 'help' question, improves the specificity without apparently decreasing the sensitivity of this screening procedure. We validated the abbreviated screening procedure for major depression with and without the 'help' question in primary care patients managed for a physical complaint. Methods This diagnostic accuracy study used data from the SODA (for 'SOmatisation Depression Anxiety') cohort study conducted by 24 general practitioners (GPs) in western Switzerland that included patients over 18 years of age with at least a single physical complaint at i...
Background Mental disorders in primary care patients are frequently associated with physical comp... more Background Mental disorders in primary care patients are frequently associated with physical complaints that can mask the disorder. There is insufficient knowledge concerning the role of anxiety, depression, and somatoform disorders in patients presenting with physical symptoms. Our primary objective was to determine the prevalence of depression, anxiety, and somatoform disorders among primary care patients with a physical complaint. We also investigated the relationship between cumulated psychosocial stressors and mental disorders. Methods We conducted a multicentre cross-sectional study in twenty-one private practices and in one academic primary care centre in Western Switzerland. Randomly selected patients presenting with a spontaneous physical complaint were asked to complete the self-administered Patient Health Questionnaire (PHQ) between November 2004 and July 2005. The validated French version of the PHQ allowed the diagnosis of mental disorders (DSM-IV criteria) and the anal...
La securite des patients en pratique ambulatoire est compromise par les erreurs medicales. Ces er... more La securite des patients en pratique ambulatoire est compromise par les erreurs medicales. Ces erreurs doivent etre affrontees dans le cadre d'une approche systematique permettant d'en reduire au minimum les consequences pour le patient. Cette approche suppose la mise en place d'une nouvelle culture de l'erreur non stigmatisante et transparente envers le patient, comprenant un systeme de declaration des erreurs associe a une analyse en profondeur du systeme, a la recherche de causes enfouies et de barrieres de defense insuffisantes. Un outil de formation utile est le colloque de «situations critiques» ou les medecins sont encourages a declarer les evenements indesirables et les «quasi-evenements». Leur analyse s'accompagne d'un soutien valorisant les personnes concernees et permet de mettre en evidence les defauts du systeme dans l'institution ou le cabinet.
Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be ... more Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be related to iron deficiency without anemia. This simple disorder is easy to treat, provided that the diagnosis is correct. Several biological tests are available, but their interpretation is oftentimes problematic. Pre-analytical factors can interfere with measurements, normal values can change depending on suppliers, and, above all, results from different markers can be contradictory in some clinical situations. The aim of this article is to evaluate how the evolution of scientific knowledge and clinical trials can contribute to a better understanding and greater reliability in the diagnosis of iron deficiency
Handbook of Cannabis and Related Pathologies, 2017
The vast majority of epidemiological studies indicate that cannabinoids constitute the most frequ... more The vast majority of epidemiological studies indicate that cannabinoids constitute the most frequently encountered psychoactive substances in the blood of drivers who are drug-impaired and/or involved in accidents, and thus cannabis must be considered a serious problem for traffic safety. In order to better understand its effects on cognitive functions involved in the short-term ability to drive, experimental research has been conducted based on laboratory, simulator, or on-road studies and, more recently, brain imaging. According to the results reviewed in the present chapter, cannabis use has been shown to impair actual driving performance by increasing lane weaving and mean headway. It also impairs cognitive functions, including working memory, motor inhibition, and divided attention. However, several factors, including history of cannabis use, routes of administration and dose ranges, as well as study designs (eg, treatment blinding), explain some discrepancies. Moreover, the neurobiological mechanisms underlying the effects of cannabis on safe driving remain poorly understood, as does the correlation between body fluids (blood, oral fluid) concentrations and psychoactive effects of THC and its main active metabolites.
Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be ... more Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be related to iron deficiency without anemia. This simple disorder is easy to treat, provided that the diagnosis is correct. Several biological tests are available, but their interpretation is oftentimes problematic. Pre-analytical factors can interfere with measurements, normal values can change depending on suppliers, and, above all, results from different markers can be contradictory in some clinical situations. The aim of this article is to evaluate how the evolution of scientific knowledge and clinical trials can contribute to a better understanding and greater reliability in the diagnosis of iron deficiency.
Should we treat iron deficiency without anemia? The simple fact that the question can be formulat... more Should we treat iron deficiency without anemia? The simple fact that the question can be formulated already leads to controversies. During the past years, the development of a new formulation of intravenous iron has helped fuel the controversy. What is the situation in 2012? This article gives a practical point of view on the actual situation and provides indications on the use of new intravenous medications.
Driving requires integrating multiple motor, sensory, and cognitive skills. As people age, cognit... more Driving requires integrating multiple motor, sensory, and cognitive skills. As people age, cognition becomes increasingly vulnerable due to impairment and dementia. Older drivers suffering from dementia, even at an early stage, have been shown to be significantly more likely to develop unsafe driving. Primary care physicians have the difficult task to assess these persons' driving capacity. This paper briefly describes the consequences of altered cognition on driving capacity and proposes an algorithm to address this challenge.
During the year 2005, the chief residents of the University Medical Outpatient Clinic of Lausanne... more 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.
The diagnostic significance of clinical symptoms/signs of influenza has mainly been assessed in t... more The diagnostic significance of clinical symptoms/signs of influenza has mainly been assessed in the context of controlled studies with stringent inclusion criteria. There was a need to extend the evaluation of these predictors not only in the context of general practice but also according to the duration of symptoms and to the dynamics of the epidemic. A prospective study conducted in the Medical Outpatient Clinic in the winter season 1999-2000. Patients with influenza-like syndrome were included, as long as the primary care physician envisaged the diagnosis of influenza. The physician administered a questionnaire, a throat swab was performed and a culture acquired to document the diagnosis of influenza. 201 patients were included in the study. 52% were culture positive for influenza. By univariate analysis, temperature >37.8 degrees C (OR 4.2; 95% CI 2.3-7.7), duration of symptoms <48 hours (OR 3.2; 1.8-5.7), cough (OR 3.2; 1-10.4) and myalgia (OR 2.8; 1.0-7.5) were associate...
Background Major depression, although frequent in primary care, is commonly hidden behind multipl... more Background Major depression, although frequent in primary care, is commonly hidden behind multiple physical complaints that are often the first and only reason for patient consultation. Major depression can be screened by two validated questions that are easier to use in primary care than the full Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. A third question, called the 'help' question, improves the specificity without apparently decreasing the sensitivity of this screening procedure. We validated the abbreviated screening procedure for major depression with and without the 'help' question in primary care patients managed for a physical complaint. Methods This diagnostic accuracy study used data from the SODA (for 'SOmatisation Depression Anxiety') cohort study conducted by 24 general practitioners (GPs) in western Switzerland that included patients over 18 years of age with at least a single physical complaint at i...
Background Mental disorders in primary care patients are frequently associated with physical comp... more Background Mental disorders in primary care patients are frequently associated with physical complaints that can mask the disorder. There is insufficient knowledge concerning the role of anxiety, depression, and somatoform disorders in patients presenting with physical symptoms. Our primary objective was to determine the prevalence of depression, anxiety, and somatoform disorders among primary care patients with a physical complaint. We also investigated the relationship between cumulated psychosocial stressors and mental disorders. Methods We conducted a multicentre cross-sectional study in twenty-one private practices and in one academic primary care centre in Western Switzerland. Randomly selected patients presenting with a spontaneous physical complaint were asked to complete the self-administered Patient Health Questionnaire (PHQ) between November 2004 and July 2005. The validated French version of the PHQ allowed the diagnosis of mental disorders (DSM-IV criteria) and the anal...
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