Les dysthyroïdies en médecine de premier recours [Thyroid dysfunction in primary care medicine].

Thyroid function tests include the measuring of the thyroid stimulating hormone (TSH) and free thyroxine (T4) in the case of abnormal TSH. These tests are frequently performed in primary care medicine since many clinical situations can be suggestive of dysthyroidism, as for example fatigue, depressive states or cardiac arthmia. In the case of subclinical thyroid dysfunction, the indications for treatment are controversial there being a lack of significant randomised studies. For primary care physicians faced with abnormal thyroid function tests we propose a diagnostic approach, clinical recommendations, and indications for referral to the specialist.

Compas : stratégies de prise en charge clinique : médecine interne générale ambulatoire

En 36 chapitres, concis et efficaces, cet ouvrage propose des repères pour la prise en charge des patients adultes en médecine générale et en médecine interne ambulatoire. Les thèmes ont été choisis en fonction des besoins exprimés par les médecins en formation. Chaque chapitre propose une stratégie diagnostique et thérapeutique dans une perspective d'usage rationnel des ressources du système de santé, en tenant compte des données les plus récentes de la médecine basée sur les preuves. Ce livre confirme que la pratique de la médecine reste un subtil assemblage des connaissances scientifiques, de l'expertise clinique et des valeurs du patient.

Se former à l'entretien motivationnel pour aider ses patients à changer: Les étudiants en médecine le confirment [Learning motivational interviewing to help patients change their health-related behaviors: medical students confirm it].

At the Lausanne University, 5th year medical students were trained in Motivational interviewing (MI). Eight hours of training improved their competence in the use of this approach. This experience supports the implementation of MI training in medical schools. Motivational interviewing allows the health professional to actively involve the patient in this behavior change process (drinking, smoking, diet, exercise, medication adherence, etc.), by encouraging reflection and reinforcing personal motivation and resources.

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

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.

Hégémonie du modèle de l'autisme: carrefour epistémologique entre médecine, familles et politique [Hegemonic model of autism: epistemological crossroads between medicine, family and politics].

The aim of this article is to make a contribution to the regional reflection with regard to autism spectrum disorders (ASDs) at a key moment in which the authorities are requested by the users, professionals in the fields of health, pedagogy and education to put forward a structured answer to a multitude of expressed needs. The question for the creation of a competence pole of an academic tertiary level is posed in order to advise in the best possible way the families who do not know how to orient themselves in the maze and contradictions of the proposed solutions and to help the professionals who are submerged by an ever increasing demand of services exceeding the means of the existing institutions and who cannot justify their choices among the various existing theoretical and scientific models.

La cohorte sepsis lausannoise: une opportunité de développer la recherche dans le Réseau latin de médecine intensive [Lausanne Cohort of septic patients as an opportunity to develop multidisciplinary research within the Swiss Latin Network of Intensive Care Medicine]

Despite recent medical progresses in patient support, the mortality of sepsis remains high. Recently, new supporting strategies were proposed to improve outcome. Whereas such strategies are currently considered as standard of care, their real impact on mortality, morbidity, length of stay, and hence, health care resources utilization has been only weakly evaluated so far. Obviously, there is a critical need for epidemiologic surveys of sepsis to better address these major issues. The Lausanne Cohort of septic patients aims at building a large clinical, biological and microbiological database that will be used as a multidisciplinary research platform to study the various pathogenic mechanisms of sepsis in collaboration with the various specialists. This could be an opportunity to strengthen the collaboration within the Swiss Latin network of Intensive Care Medicine.

Défis et opportunités liés a la création d'une société unique de spécialistes en médecine interne générale en 2015 [Challenges and opportunities related to the creation of a unique society of specialists in general internal medicine in 2015].

A common training plan in general internal medicine was a brave enterprise started in 2011 in accordance with the common objectives of the Swiss Society of General Medicine and the Swiss Society of Internal Medicine. The next challenge will be the dissolution of the two Societies and therefore the creation of an unique new association in 2015. This is an extraordinary opportunity to bring together the specific qualities of each association and to create a new society. Issues, objectives and secondary benefits expected from the creation of the largest national society of a medical discipline are explored as a joint discussion in this article.