ABSTRACT
The knowledge in internal medicine is constantly and so rapidly evolving that practices have to be updated and adjusted to recent scientific rules, in order to improve quality and efficiency in the day to day activities. Residents in the Service of internal medicine of the Lausanne University present several relevant papers published in 2012, whose results are susceptible to change the daily hospital practices. From modest impacts to real revolution, a variety of subjects are discussed in the perspective of evidence based medicine.
Subject(s)
Cardiovascular Diseases/therapy , Lung Diseases/therapy , Cardiovascular Diseases/diagnosis , Critical Pathways , Humans , Internal Medicine , Pyelonephritis/drug therapy , Sepsis/therapy , Status Epilepticus/drug therapy , Stroke/prevention & controlABSTRACT
The year 2011 was full of significant advances in all areas of medicine. Whether small or large issues, they all have an impact on daily practice in general internal medicine. For example, intravenous administration of diuretics in heart failure shows no benefit. But double dose may improve symptoms faster. Direct Xa inhibitors are emerging as alternative to anti-vitamin K. beta-blockers reduce overall mortality in COPD and do not worsen lung function significantly. Each year, the chief residents from the Department of internal medicine at the University hospital of Lausanne meet to share their readings. Twelve new therapeutic considerations of 2011 are reviewed here.
Subject(s)
Internal Medicine/trends , Internship and Residency , Hospitals, University , Humans , SwitzerlandABSTRACT
The recent ACCORD and DIAD studies revealed results which could modify treatments and the screening of diabetes vascular complications. Indeed, ACCORD shows no benefit on the prevention of diabetes vascular complications by aggressive treatment of hypertension or the combined treatment of the dyslipidemia. The intensive treatment of the blood glucose, if associated with severe hypoglycemias, increases mortality. DIAD revealed 20% of silent myocardial ischaemia in diabetic patients but no beneficial effect on the cardiovascular mortality. A careful reading of these studies in the light of long term studies such as UKPDS and STENO reveals that these negative results are generated by a too short follow-up and too aggressive objectives. The long term studies reveal that more realistic objectives remain beneficial.
Subject(s)
Coronary Disease/diagnosis , Coronary Disease/etiology , Diabetes Mellitus, Type 2/complications , Coronary Disease/epidemiology , Coronary Disease/prevention & control , Dyslipidemias/complications , Dyslipidemias/drug therapy , Evidence-Based Medicine , Fenofibrate/therapeutic use , Humans , Hypertension/complications , Hypertension/drug therapy , Hypolipidemic Agents/therapeutic use , Mass Screening , Randomized Controlled Trials as Topic , Risk FactorsABSTRACT
Evidence-based medicine has enabled to approach disease in a more rational and scientific way. Clinical research has identified behaviours and risk factors that could cause disease often "silent" at the beginning, such as diabetes. Despite the clear impact of these evidences on public health, it seems that the individual risk perception level remains weak. To mention as well, the health professionals very often have a different views, which makes it difficult to communicate the risk with patients. In this article we describe the principles of risk perception, the diabetes related risk perception concerning cardiovascular complications, and suggest some practical strategies and tools which could improve risk communication in the everyday practice.
Subject(s)
Cardiovascular Diseases/etiology , Communication , Diabetes Complications , Patient Education as Topic , Diabetes Mellitus, Type 2/complications , Evidence-Based Medicine , Health Knowledge, Attitudes, Practice , Humans , Perception , Physician-Patient Relations , Risk Assessment , Risk Factors , Risk-TakingABSTRACT
The aim of this article is to propose an anthropological point of view about informed consent in medicine. This quest for legitimacy should be read as a relational and social construction. In the heart of clinical complexity we find on one side various techniques employed by the medical community to validate research and to obtain the consent of patients. On the other side patients offer plural and subjective answers due to the doctor patient hierarchical and long relationship. Between constraints and freedoms, informed consent brings to light social relation.
Subject(s)
Biomedical Research/ethics , Informed Consent , Humans , Physician-Patient Relations/ethics , Social ResponsibilityABSTRACT
The seroprevalence of chickenpox in countries with temperate climate is very high among young people. Only 4% of the infections occur in adults but the clinical course is usually more severe than in children. In adults, The mortality is approximately 40 times higher and the complication rate 25 times higher than in children. Pneumonia is the most frequent complication in adults and may be extremely severe in immunocompromised patients and in pregnant women. Pneumonia must be promptly treated with intravenous aciclovir. Vaccination is indicated in young seronegative patients with supplemental risk factors for severe complications. It is also effective post exposure, preventing or modifying the illness course in up to 90% of exposed people if given within 3 days. Immunoglobulins may be effective as late as 96 hours after exposure. They are frequently used for exposed people at high risk of severe disease, when varicella vaccine is contraindicated.
