L'apport du patient simulé dans l'apprentissage de la relation médecin-malade: résultats d'une évaluation préliminaire

Contexte : Les étudiants de 4° année des études de médecine à la faculté de biologie et de médecine de Lausanne bénéficient d'un enseignement des habiletés à la communication médecin-malade, ayant recours à un patient simulé joué par un comédien. But : Évaluer la pertinence de cette méthode active dans l'optique de renforcer cet enseignement dans le curriculum. Méthodes : Un questionnaire demande aux étudiants d'apprécier leurs apprentissages, ainsi que le dispositif d'enseignement. Un autre questionnaire évalue les compétences de l'étudiant qui mène l'entretien par l'étudiant lui-même (étudiant actif), par les étudiants observateurs, par l'enseignant et par le patient simulé. Résultats : Ce dispositif d'enseignement est apprécié des étudiants et permet aux étudiants qui ont mené l'entretien et aux étudiants observateurs d'en tirer un bénéfice. Les étudiants actifs ont tendance à évaluer leurs compétences d'entretien plus négativement que ne le font l'enseignant, le comédien et les étudiants observateurs .Conclusion : Ce dispositif d'enseignement est perçu comme pertinent par l'ensemble des participants, mais devrait être renforcé pour donner à chaque étudiant l'occasion de participer activement à l'entrevue simulée. -- Context: 4th year medicine students at the Faculty of Biology and Medicine of Lausanne were taught to develop patient-doctor communication skills, using a simulated patient played by an actor. Objective: To assess the relevance of this active method in the perspective of reinforcing this teaching approach in the curriculum. Method: This new form of teaching was assessed by questionnaires filled by all participants, i.e. students involved in the communication (active student), students who were bystanders (observer students), the tutor, as well as the actor. Results: This teaching approach was appreciated from all students, active and observer, allowing them to gain benefit from the interview on communication skills acquirement. The active students assessed their communication skills more negatively than did the teacher, the actor and the observer students. Conclusion: This teaching method seems to be relevant for all participants and should be reinforced to give the opportunity for each student to participate as an active student.

The place preference task: a new tool for studying the relation between behavior and place cell activity in rats

This study describes a task that combines random searching with goal directed navigation. The testing was conducted on a circular elevated open field (80 cm in diameter), with an unmarked target area (20 cm in diameter) in the center of 1 of the 4 quadrants. Whenever the rat entered the target area, the computerized tracking system released a pellet to a random point on the open field. Rats were able to learn the task under light and in total darkness, and on a stable or a rotating arena. Visual information was important in light, but idiothetic information became crucial in darkness. Learning of a new position was quicker under light than in total darkness on a rotating arena. The place preference task should make it possible to study place cells (PCs) when the rats use an allothetic (room frame) or idiothetic (arena frame) representation of space and to compare the behavioral response with the PCs' activity.

My older sibling was drunk - younger siblings' drunkenness in relation to parental monitoring and the parent-adolescent relationship.

This study explored the links between having older siblings who get drunk, satisfaction with the parent-adolescent relationship, parental monitoring, and adolescents' risky drinking. Regression models were conducted based on a national representative sample of 3725 8th to 10th graders in Switzerland (mean age 15.0, SD = .93) who indicated having older siblings. Results showed that both parental factors and older siblings' drinking behaviour shape younger siblings' frequency of risky drinking. Parental monitoring showed a linear dose-response relationship, and siblings' influence had an additive effect. There was a non-linear interaction effect between parent-adolescent relationship and older sibling's drunkenness. The findings suggest that, apart from avoiding an increasingly unsatisfactory relationship with their children, parental monitoring appears to be important in preventing risky drinking by their younger children, even if the older sibling drinks in such a way. However, a satisfying relationship with parents does not seem to be sufficient to counterbalance older siblings' influence.

Evolutionary rates of Jurassic ammonites in relation to sea-level fluctuations

An analysis is presented of the diversity and faunal turnover of Jurassic ammonites related to transgressive /regressive events. The data set contained 400 genera and 1548 species belonging to 67 ammonite zones covering the entire Jurassic System. These data were used in the construction of faunal turnover curves and ammonite diversities, that correlate with sea-level fluctuation curves. Twenty-four events of ammonite faunal turnover are analyzed throughout the Jurassic. The most important took place at the Sinemurian-Carixian boundary, latest Carixian-Middle Domerian, Domerian-Toarcian boundary, latest Middle Toarcian-Late Toarcian, Toarcian-Aalenian boundary, latest Aalenian-earliest Bajocian, latest Early Bajocian-earliest Late Bojocian, Early Bathonian-Middle Bathonian boundary, latest Middle Bathonian-earliest Late Bathonian, latest Bathonian-Early Callovian, earliest Early Oxfordian-Middle Oxfordian, earliest Late Oxfordian-latest Oxfordian, latest Early Kimmeridgian, Late Kimmeridgian, middle Early Tithonian and Early Tithonian-Late Tithonian boundary. More than 75 percent of these turnovers correlate with regressive-transgressive cycles in the Exxon, and /or Hallam's sea-level curves. Inmost cases the extinction events coincide with regressive intervals, whereas origination and radiation events are related to transgressive cycles. The turnovers frequently coincide with major or minor discontinuities in the Subbetic basin (Betic Cordillera).

De la relation pharmaciens-usagers : reconfigurations et négociations dans une pharmacie suisse

À partir d'entretiens et d'observations réalisés dans une pharmacie de garde de Suisse romande, cette étude explore les relations que les pharmaciens d'officine entretiennent avec les usagers. Dans un contexte de démocratisation des savoirs relatifs à la santé, l'enquête effectuée montre que cette relation se reconfigure, selon la nature du problème de santé, au profit d'une plus grande autonomie des usagers. En effet, dans certaines situations, les usagers peuvent exprimer le désir de se passer de la compétence du pharmacien. Mais, dans d'autres circonstances, bien que s'efforçant de s'adapter aux demandes des usagers, les professionnels peuvent réaffirmer leur autorité d'expert si le problème soulevé ou les médicaments désirés nécessitent plus de vigilance. La relation pharmacien-usager oscille donc dans une négociation constante selon la marge de manoeuvre dont, dans une situation donnée, les uns et les autres disposent.

Impact of a board-game approach on current smokers: a randomized controlled trial.

ABSTRACT: BACKGROUND: The main objective of our study was to assess the impact of a board game on smoking status and smoking-related variables in current smokers. To accomplish this objective, we conducted a randomized controlled trial comparing the game group with a psychoeducation group and a waiting-list control group. METHODS: The following measures were performed at participant inclusion, as well as after a 2-week and a 3-month follow-up period: "Attitudes Towards Smoking Scale" (ATS-18), "Smoking Self-Efficacy Questionnaire" (SEQ-12), "Attitudes Towards Nicotine Replacement Therapy" scale (ANRT-12), number of cigarettes smoked per day, stages of change, quit attempts, and smoking status. Furthermore, participants were assessed for concurrent psychiatric disorders and for the severity of nicotine dependence with the Fagerström Test for Nicotine Dependence (FTND). RESULTS: A time × group effect was observed for subscales of the ANRT-12, ATS-18 and SEQ-12, as well as for the number of cigarettes smoked per day. At three months follow-up, compared to the participants allocated to the waiting list group, those on Pick-Klop group were less likely to remain smoker.Outcomes at 3 months were not predicted by gender, age, FTND, stage of change, or psychiatric disorders at inclusion. CONCLUSIONS: The board game seems to be a good option for smokers. The game led to improvements in variables known to predict quitting in smokers. Furthermore, it increased smoking-cessation rates at 3-months follow-up. The game is also an interesting alternative for smokers in the precontemplation stage.

Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double-blind placebo-controlled trial.

OBJECTIVE: To evaluate the effectiveness of 200 mg of daily vaginal natural progesterone to prevent preterm birth in women with preterm labour. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. SETTING: Twenty-nine centres in Switzerland and Argentina. POPULATION: A total of 385 women with preterm labour (24(0/7) to 33(6/7)  weeks of gestation) treated with acute tocolysis. METHODS: Participants were randomly allocated to either 200 mg daily of self-administered vaginal progesterone or placebo within 48 hours of starting acute tocolysis. MAIN OUTCOME MEASURES: Primary outcome was delivery before 37 weeks of gestation. Secondary outcomes were delivery before 32 and 34 weeks, adverse effects, duration of tocolysis, re-admissions for preterm labour, length of hospital stay, and neonatal morbidity and mortality. The study was ended prematurely based on results of the intermediate analysis. RESULTS: Preterm birth occurred in 42.5% of women in the progesterone group versus 35.5% in the placebo group (relative risk [RR] 1.2; 95% confidence interval [95% CI] 0.93-1.5). Delivery at <32 and <34 weeks did not differ between the two groups (12.9 versus 9.7%; [RR 1.3; 95% CI 0.7-2.5] and 19.7 versus 12.9% [RR 1.5; 95% CI 0.9-2.4], respectively). The duration of tocolysis, hospitalisation, and recurrence of preterm labour were comparable between groups. Neonatal morbidity occurred in 44 (22.8%) cases on progesterone versus 35 (18.8%) cases on placebo (RR: 1.2; 95% CI 0.82-1.8), whereas there were 4 (2%) neonatal deaths in each study group. CONCLUSION: There is no evidence that the daily administration of 200 mg vaginal progesterone decreases preterm birth or improves neonatal outcome in women with preterm labour.

Electron microscopy of RecA-DNA complexes: Two different states, their functional significance and relation to the solved crystal structure

Seven different electron microscopy techniques habe been employed to study the RecA protein of E. coli. This review provides a summary of the conclusions that have been drawn from these studies, and attempts to relate these observations to models for the role of RecA protein in homologous recombination.