The farmer's lung disease : occupational medicine input

Background: Although there has been an abundant literature in recent years about farmer's lung disease, few addressed occupational measures able to maintain the farmer in his work. Nevertheless we know now that most of the farmers can be kept at the workplace by the way of occupational preventive measures. Methods: This matter is discussed from a case report. A farmer affected by the farmer's lung disease was sent to us by his pneumologist, in order to estimate the possibility of maintaining him in his job and to determine relevant changes at his workplace to minimize risk of exposure to dust antigen. This approach required a visit to the workplace by occupational physician and hygienist. Results: The visit of the workplace pointed out different habits and architectural particularities which were potential sources of exposure. The two main proposed measures to reduce the risk, were to wear respiratory masks while working inside the barn, such as preparing hay, feeding the cattle or sweeping the floor, and to build a direct access from the bathroom (shower and toilet) to the outside, allowing to go out of the barn after taking a shower and changing, without risk of being contaminated again. Although upgrading the shower-toilet is not yet completed to date, the already performed modifications led currently to significant clinical improvements, despite the risk of exposure was high since the animals were in the barn for more than two months. Conclusion: The treatment of the farmer's lung disease must be multidisciplinary involving general practitioner, pneumologist, occupational hygienist and occupational physician.

Gériatrie [What's new in geriatric medicine]

Several studies clarified the role of different interventions such as vitamine D replacement, denosumab treatment, and vertebroplasty in the prevention and management of falls and fractures. A trial tested the effectiveness of pharmaceutical assistance at the time of discharge, emphasizing the potential benefits for the patients and the health care system. Syncopal episodes frequently lead to hospital admission. A retrospective study evaluated the diagnostic yield of different tests and emphasized the importance to actively seek orthostatic hypotension in older patients. Finally, advances remain modest in the field of dementias.

Report on a review of certain expenditures made by the Iowa Department of Public Health, including the Iowa Board of Pharmacy, the Iowa Dental Board, the Iowa Board of Medicine, and the Iowa Board of Nursing, from July 1, 2011 through August 31, 2014

Report on a review of certain expenditures made by the Iowa Department of Public Health, including the Iowa Board of Pharmacy, the Iowa Dental Board, the Iowa Board of Medicine, and the Iowa Board of Nursing, from July 1, 2011 through August 31, 2014

Terrorisme et médecins de premier recours: le risque chimique [Terrorism and medicine of first aid: chemical risk].

Cet article décrit, à l'intention des mdéecins de rpremier recours, les principes de base d'une action de secours lors d'un attentat (ou d'un accident) chimique impliquant de nombreuses victimes intoxiquées et/ou contaminées.

Médecine d'urgence [Emergency medicine: updates 2013].

New evidences published this year are susceptible to change the management of several medical emergencies. Combined antiplatelet therapy might be beneficial for the management of TIA or minor stroke and rapid blood pressure lowering might improve the outcome in patients with intracerebral hemorrhage. A restrictive red cell transfusion strategy is indicated in case of upper digestive bleeding and coagulation factors concentrates are superior to fresh frozen plasma for urgent warfarin reversal. Prolonged systemic steroid therapy is not warranted in case of acute exacerbation of BPCO, and iterative physiotherapy is not beneficial after acute whiplash. Finally, family presence during cardiopulmonary resuscitation may reduce post-traumatic stress disorder among relatives.

Acquisitions thérapeutiques en médecine ambulatoire en 2013 [2013 literature findings in internal general medicine].

The prescribing of antibiotics for uncomplicated skin abscesses and diverticulitis has no benefit. Some antibiotics are more at risk of causing a Clostridium difficile infection. The tests used to exclude a history of a penicillin allergy are safe. A threshold of D-dimer adjusted for the age significantly improves the specificity of the test without affecting the sensitivity. The prescription of paraclinics tests is not an effective "treatment" for the patient's anxiety. In the sleep apnea syndrome, treatment with CPAP (Continuous positive airway pressure) appears to have more benefits compared to the mandibular advancement prosthesis. The work of primary care physicians can be supported by the work of advanced practice nurses. The limitation placed on the working hours of doctors in hospitals seems to affect their ability to spend time with their patients.

Pluralité des corps. 1. Les corps de La medicine [Multifaceted body. I. The bodies of medicine].

Le corps humain est l'objet privilégié d'action de la médecine, mais aussi réalité vécue, image, symbole, représentation et l'objet d'interprétation et de théorisation. Tous ces éléments constitutifs du corps influencent la façon dont la médecine le traite. Dans cette série de trois articles, nous abordons le corps sous différentes perspectives : médicale (1), phénoménologique (2), psychosomatique et socio-anthropologique (3). Ce premier article traite des représentations du corps en médecine, dont nous décrivons quatre types distincts, qui renvoient à autant de démarches scientifiques spécifiques et de formes de légitimité clinique : le corps-objet de l'anatomie, le corps-machine de la physiologie, le corps cybernétique de la biologie et le corps statistique de l'épidémiologie. The human body is the object upon which medicine is acting, but also lived reality, image, symbol, representation and the object of elaboration and theory. All these elements which constitute the body influence the way medicine is treating it. In this series of three articles, we address the human body from various perspectives: medical (1), phenomenological (2), psychosomatic and socio-anthropological (3). This first article discusses four distinct types of representation of the body within medicine, each related to a specific epistemology and shaping a distinct kind of clinical legitimacy: the body-object of anatomy, the body-machine of physiology, the cybernetic body of biology, the statistical body of epidemiology.

The Lausanne Institutional Biobank: a new resource to catalyse research in personalised medicine and pharmaceutical sciences.

Breakthrough technologies which now enable the sequencing of individual genomes will irreversibly modify the way diseases are diagnosed, predicted, prevented and treated. For these technologies to reach their full potential requires, upstream, access to high-quality biomedical data and samples from large number of properly informed and consenting individuals and, downstream, the possibility to transform the emerging knowledge into a clinical utility. The Lausanne Institutional Biobank was designed as an integrated, highly versatile infrastructure to harness the power of these emerging technologies and catalyse the discovery and development of innovative therapeutics and biomarkers, and advance the field of personalised medicine. Described here are its rationale, design and governance, as well as parallel initiatives which have been launched locally to address the societal, ethical and technological issues associated with this new bio-resource. Since January 2013, inpatients admitted at Lausanne CHUV University Hospital have been systematically invited to provide a general consent for the use of their biomedical data and samples for research, to complete a standardised questionnaire, to donate a 10-ml sample of blood for future DNA extraction and to be re-contacted for future clinical trials. Over the first 18 months of operation, 14,459 patients were contacted, and 11,051 accepted to participate in the study. This initial 18-month experience illustrates that a systematic hospital-based biobank is feasible; it shows a strong engagement in research from the patient population in this University Hospital setting, and the need for a broad, integrated approach for the future of medicine to reach its full potential.

Capturing epidermal stemness for regenerative medicine.

The skin is privileged because several skin-derived stem cells (epithelial stem cells from epidermis and its appendages, mesenchymal stem cells from dermis and subcutis, melanocyte stem cells) can be efficiently captured for therapeutic use. Main indications remain the permanent coverage of extensive third degree burns and healing of chronic cutaneous wounds, but recent advances in gene therapy technology open the door to the treatment of disabling inherited skin diseases with genetically corrected keratinocyte stem cells. Therapeutic skin stem cells that were initially cultured in research or hospital laboratories must be produced according strict regulatory guidelines, which ensure patients and medical teams that the medicinal cell products are safe, of constant quality and manufactured according to state-of-the art technology. Nonetheless, it does not warrant clinical efficacy and permanent engraftment of autologous stem cells remains variable. There are many challenges ahead to improve efficacy among which to keep telomere-dependent senescence and telomere-independent senescence (clonal conversion) to a minimum in cell culture and to understand the cellular and molecular mechanisms implicated in engraftment. Finally, medicinal stem cells are expansive to produce and reimbursement of costs by health insurances is a major concern in many countries.

Médecine de l'adolescence. Consultation garçons [Adolescent medicine male clinic]

The vast majority of Swiss adolescents see a physician at least once a year. However, a sizeable proportion of them indicate that they don't have the opportunity to address their own concerns and problems. While female adolescents have access to health care in the field of sexual and reproductive health through family planning clinics, this is not the case of adolescent males. The "clinic for boys only" is an open space for adolescent males where they can bring questions and health problems related to their body, their growth and their puberty, just as their difficulties and their fears regarding their normality, their sexuality, their feelings, sexual dysfunctions and questions related to violence within the couple. They can also get information/treatment in the area of sexually transmitted infections.

La lombalgie aiguë en médecine de premier recours [Acute low back pain in general practice medicine].

The practioner's first concern is knowing how to single out from the immense majority of situations susceptible to a favourable spontaneous evolution those patients with a bad prognostic necessitating reference to a specialist. We present in this paper the clinical steps designed to meet this challenge and a reminder of certain principles of patient diagnosis and care.