Harmonization of training and assessment of medical specialists in physical and rehabilitation medicine across Europe - The contribution of the UEMS Board of Physical and Rehabilitation Medicine

Background.- The main goals of the European Board of Physical and Rehabili-tation Medicine (EBPRM), founded in 1991 as the third speciality board of theUnion of European Medical Specialists (UEMS), are to harmonize pre-graduate,post-graduate and continuous medical education in physical and rehabilitationmedicine (PRM) all over Europe. The harmonization of curricula of the medi-cal specialities and the assessment of medical specialists has become one of thepriorities of the UEMS and its working groups to which the EBPRM contributes.Action.- The EBPRM will continue to promote a specific minimal undergraduatecurriculum on PRM including issues like disability, participation and handicapto be taught all over Europe as a basis for general medical practice. The EBPRMwill also expand the existing EBPRM postgraduate curriculum into a detailedcatalogue of learning objectives. This catalogue will serve as a tool to boostharmonization of the national curricula across Europe as well as to structurethe content of the MCQ examination. It would be a big step forward towardsharmonization of European PRM specialist training if an important number ofcountries would use the certifying MCQ examination of the Board as a part ofthe national assessments for PRM specialists.

Robert Jütte (Ed.), Medical Pluralism. Past - Present - Future (Stuttgart, F. Steiner Verlag, 2013)

Initiée en anthropologie à la fin des années 1970, la notion de pluralisme médical se voit réappropriée par diverses disciplines des sciences humaines, à l'instar des treize contributions de cet ouvrage collectif édité par Robert Jütte. Historiens, sociologues et anthropologues y interviennent à la suite d'un colloque organisé en 2001 en Italie par l'Institut d'histoire de la médecine de la Fondation Robert Bosch et le Centre Italo-Tedesco pour l'Excellence européenne, en collaboration avec le Forum de dialogue Pluralismus in der Medizin. Encore très questionnée et souvent nuancée selon les contextes, la définition du pluralisme médical se situe quelque part entre le fait que différentes formes de soins existent simultanément et s'influencent les unes les autres, et le constat d'une popularité grandissante des médecines alternatives et complémentaires défiant l'hégémonie de la biomédecine - cette situation s'observant plus particulièrement dans les pays occidentaux. C'est dans ce dernier contexte que s'inscrit le volume, dont chacune des contributions examine le phénomène du pluralisme médical soit en Allemagne, en Italie, en France ou en Grande-Bretagne - avec une exception pour l'Inde. La profondeur diachronique adoptée par l'ouvrage, couvrant l'époque pré-moderne à nos jours, offre une exploration élargie des expériences thérapeutiques. Ainsi sont évoqués, d'une part, les tenants de la médecine dite orthodoxe ou conventionnelle, regroupant les praticiens officiels que sont les médecins académiques en première ligne, suivis des chirurgiens, barbiers, apothicaires et sages-femmes; d'autre part sont pris en compte les représentants des médecines complémentaires, alternatives, naturelles ou encore populaires - des homéopathes aux acupuncteurs en passant par les magnétiseurs et les magiciennes guérisseuses. La réflexion sur les concurrences et les complémentarités entre ces acteurs variés, qui fait consensus au sein des contributions, est développée sous divers aspects.

Continuing Medical Education Self-Assessment Questions Vol. 50, No. 2 - April 2014. Focal vibration in neurorehabilitation.

During the last decade, many studies have been carried out to understand the effects of focal vibratory stimuli at various levels of the central nervous system and to study pathophysiological mechanisms of neurological disorders as well as the therapeutic effects of focal vibration in neurorehabilitation. This review aimed to describe the effects of focal vibratory stimuli in neurorehabilitation including the neurological diseases or disorders like stroke, spinal cord injury, multiple sclerosis, Parkinson's' disease and dystonia. In conclusion, focal vibration stimulation is well tolerated, effective and easy to use, and it could be used to reduce spasticity, to promote motor activity and motor learning within a functional activity, even in gait training, independent from etiology of neurological pathology. Further studies are needed in the future well- designed trials with bigger sample size to determine the most effective frequency, amplitude and duration of vibration application in the neurorehabilitation.

Die Konstruktion einer medizinischen Disziplin und ihre Herausforderungen: die Orthopädie in der Schweiz im 19. und 20. Jahrhundert [The construction of a medical discipline and its challenges: Orthopedics in Switzerland during the 19th and 20th centuries].

(ENGLISH VERSION BELOW) Dieser Beitrag fügt sich in eine post-doktorale Forschung über die Geschichte der Orthopädie ein, die unter dem Mandat des Centre Hospitalier Universitaire Vaudois (CHUV) geleitet wird und teilerweise auf die Archiv der Schweizerischen Gesellschaft für Orthopädie (aktuelle Swiss Orthopaedics) beruht. Die Autorin untersucht die Herausforderungen, welche die Geschichte der Orthopädie in der Schweiz prägten und berücksichtigt dabei die Anpassungsstrategien einer medizinischen und technischen Disziplin in einer sich wandelnden Gesellschaft. Zusammenfassung der Beitrag und Informationen auf der Website der Zeitschrift: http://econtent.hogrefe.com/toc/tum/72/7 This article is inspired by a post-doctorale research about the history of orthopedics, mandated by the Centre Hospitalier Universitaire Vaudois (CHUV), and partly supported by the Archiv of the Swiss Society of Orthopedics (nowadays Swiss Orthopaedics). By examining the implications that have shaped the history of orthopedics in Switzerland, the author seeks to shed light on the strategies that were implemented in adopting a medical and technical discipline within a transforming society. Summary of the article and information on the journal's website: http://econtent.hogrefe.com/toc/tum/72/7

Continuing Medical Education Self-Assessment Questions Vol. 50, No. 1 - January 2014. Actual evidence in the medical approach to adolescents with idiopathic scoliosis

Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve ado- lescents (AIS). The prevalence for AIS is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to surgery. Physical and rehabilitation medicine (PRM) plays a primary role in the so-called conservative treatment of adolescents with AIS, since all the therapeutic tools used (exercises and braces) fall into the PRM domain. According to a Cochrane systematic review there is evidence in favor of bracing, even if it is of low quality. Another shows that there is evidence in favor of exercises as an adjunctive treatment, but of low quality. Three meta-analysis have been published on bracing: one shows that bracing does not reduce surgery rates, but studies with bracing plus exercises were not included and had the highest effectiveness; another shows that full time is better than part-time bracing; the last focuses on observational studies following the SRS criteria and shows that not all full time rigid bracing are the same: some have the highest effectiveness, others have less than elastic and nighttime bracing. Two very important RCTs failed in recruitment, showing that in the field of bracing for scoliosis RCTs are not accepted by the patients. Consensuses by the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) show that there is no agree- ment among experts either on the best braces or on their biomechanical action, and that compliance is a matter of clinical more than patients' behavior (there is strong agreement on the management criteria to achieve best results with bracing). A systematic review of all the existing studies shows effectiveness of exercises, and that auto-correction is the main goal of exercises. A systematic review shows that there are no studies on manual treatment. Research on conservative treat- ment of AIS has continuously decreased since the 1980s, but this trend changed only recently. The SOSORT Guidelines offers the actual standard of conservative care.

Nursing discharge planning for older medical inpatients in Switzerland: A cross-sectional study.

Nursing discharge planning for elderly medical inpatients is an essential element of care to ensure optimal transition to home and to reduce post-discharge adverse events. The objectives of this cross-sectional study were to investigate the association between nursing discharge planning components in older medical inpatients, patients' readiness for hospital discharge and unplanned health care utilization during the following 30 days. Results indicated that no patients benefited from comprehensive discharge planning but most benefited from less than half of the discharge planning components. The most frequent intervention recorded was coordination, and the least common was patients' participation in decisions regarding discharge. Patients who received more nursing discharge components felt significantly less ready to go home and had significantly more readmissions during the 30-day follow-up period. This study highlights large gaps in the nursing discharge planning process in older medical inpatients and identifies specific areas where improvements are most needed.

Medical nutrition in oncology : potential solution for managing malnutrition in cancer patients in Switzerland

The objective of this study is to: - Describe the cancer related complications, prevalence and economic burden of cancer; - Provide the review of the studies that have been done until now proving that specialized nutrition; can improve quality of life (QoL), shorten the length of hospital stay and reduce overall cost of patients care; - Describe different types of specialized nutritional support and tools/ guidelines used for nutritional screening; - Justify the use of specialized nutrition as an integral part of cancer treatment [Author, p. 6] [Contents] 3. General overview of cancer. 4. Specialized nutritional support and nutritional screening. 4.4 European guidelines for nutritional screening [Screening tools: Malnutrition Universal Screening Tool (MUST); Nutritional Risk Screening (NRS-2002); Mini Nutritional Assessment (MNA)]. 5. Implementation of nutritional support in Swiss hospitals as an integral part of oncology treatment. 5.1 Nutritional guidelines used in Switzerland. 5.2 Status of prevention of malnutrition in cancer patients in Swiss hospitals. 5.3 Malnutrition in Swiss hospitals: medical costs and potential economies. 5.4 Recommendations for implementation of nutritional guidelines and nutritional support in Swiss hospitals.

Au sortir de l'hôpital, comment renforcer la continuité de la prise en charge médicale [Discharge from hospital: how to improve continuity of medical care?].

Early readmission is the major success indicator of the transition between hospital and home. Patients admitted with heart failure reach a 20% rate. Potentially avoidable readmissions, defined as unpredictable and related to a known condition during index hospitalization, represent the improvement margin. For these latter, implementation of specific interventions can be effective. Complex interventions on transition, including several modalities and seeking to encourage patient autonomy seem more effective than others. We describe two models: a pragmatic one developed in a regional hospital, and a more complex one developed in a university hospital during the LEAR-HF study. In both cases, it is imperative to work on "medical liability": should it extend beyond discharge up to the threshold of the private practice?

Chlamydiaceae family, Parachlamydia spp., and Waddlia spp. in porcine abortion.

At present, despite extensive laboratory investigations, most cases of porcine abortion remain without an etiological diagnosis. Due to a lack of recent data on the abortigenic effect of order Chlamydiales, 286 fetuses and their placentae of 113 abortion cases (1-5 fetuses per abortion case) were investigated by polymerase chain reaction (PCR) methods for family Chlamydiaceae and selected Chlamydia-like organisms such as Parachlamydia acanthamoebae and Waddlia chondrophila. In 0.35% of the cases (1/286 fetuses), the Chlamydiaceae real-time PCR was positive. In the Chlamydiaceae-positive fetus, Chlamydia abortus was detected by a commercial microarray and 16S ribosomal RNA PCR followed by sequencing. The positive fetus had a Porcine circovirus-2 coinfection. By the Parachlamydia real-time PCR, 3.5% (10/286 fetuses of 9 abortion cases) were questionable positive (threshold cycle values: 35.0-45.0). In 2 of these 10 cases, a confirmation by Chlamydiales-specific real-time PCR was possible. All samples tested negative by the Waddlia real-time PCR. It seems unlikely that Chlamydiaceae, Parachlamydia, and Waddlia play an important role as abortigenic agents in Swiss sows.

Evidence for Parachlamydia in bovine abortion.

Bovine abortion of unknown infectious aetiology still remains a major economic problem. In this study, we focused on a new possible abortigenic agent called Parachlamydia acanthamoebae. Retrospective samples (n=235) taken from late-term abortions in cattle were investigated by real-time diagnostic PCR for Chlamydiaceae and Parachlamydia spp., respectively. Histological sections of cases positive by real-time PCR for any Chlamydia-related agent were further examined by immunohistochemistry using specific antibodies. Chlamydophila abortus was detected only in three cases (1.3%) by real-time PCR and ArrayTube Microarray playing a less important role in bovine abortion compared to the situation in small ruminants in Switzerland. By real-time PCR as many as 43 of 235 (18.3%) cases turned out to be positive for Parachlamydia. The presence of Parachlamydia within placental lesions was confirmed in 35 cases (81.4%) by immunohistochemistry. The main histopathological feature in parachlamydial abortion was purulent to necrotizing placentitis (25/43). Parachlamydia should be considered as a new abortigenic agent in Swiss cattle. Since Parachlamydia may be involved in lower respiratory tract infections in humans, bovine abortion material should be handled with care given the possible zoonotic risk.

Parachlamydia spp. and related Chlamydia-like organisms and bovine abortion.

Chlamydophila abortus and Waddlia chondrophila cause abortion in ruminants. We investigated the role of Parachlamydia acanthamoebae in bovine abortion. Results of immunohistochemical analyses were positive in 30 (70%) of 43 placentas from which Chlamydia-like DNA was amplified, which supports the role of Parachlamydia spp. in bovine abortion.