Subject(s)
Attitude to Health , Uncertainty , Female , Humans , Male , Occupational Stress/etiology , Occupational Stress/psychology , Prognosis , Treatment OutcomeABSTRACT
The general internist cannot be a passive bystander of the anticipated medical revolution induced by precision medicine. This latter aims to improve the predictive and/or clinical course of an individual by integrating all biological, genetic, environmental, phenotypic and psychosocial knowledge of a person. In this article, national and international initiatives in the field of precision medicine are discussed as well as the potential financial, ethical and limitations of personalized medicine. The question is not to know if precision medicine will be part of everyday life but rather to integrate early the general internist in multidisciplinary teams to ensure optimal information and shared-decision process with patients and individuals.
L'interniste généraliste ne peut pas être un spectateur passif du bouleversement induit par la médecine de précision. Cette dernière vise à améliorer les aspects prédictifs ou l'évolution clinique d'une personne en intégrant toutes les connaissances biologiques et génétiques, environnementales, phénotypiques et psychosociales qui lui sont propres. Dans cet article, les initiatives nationales et internationales dans ce domaine sont abordées, ainsi que les potentiels enjeux financiers, éthiques et d'équité sociale. Cette médecine de précision fera partie de notre quotidien et il s'agit d'intégrer très tôt l'interniste généraliste dans des plateformes multidisciplinaires pour assurer les restitutions d'informations, les partages de décision, les incertitudes et ultimement contribuer au maintien de la santé de la population et améliorer la qualité des soins pour nos patients.
Subject(s)
General Practitioners/trends , Hyperlipoproteinemia Type II/genetics , Internal Medicine/trends , Long QT Syndrome/genetics , Precision Medicine , DNA Mutational Analysis , Humans , Hyperlipoproteinemia Type II/diagnosis , Incidental Findings , Long QT Syndrome/diagnosis , Male , Middle Aged , Physicians , Precision Medicine/methods , Precision Medicine/statistics & numerical data , WorkforceABSTRACT
The lack of clear recommendations makes optimal pain management difficult in patients with hepatic function impairment. This article reviews the evidence on commonly used analgesics (paracetamol, NSAIDs, opiates). Paracetamol can be safely used at low doses (2-3 grams per day) for a period not exceeding a few days. NSAIDs should be avoided because of their direct hepatic toxicity and an increased risk of life-threatening side-effects (hemorrhagic, renal). Glucuronoconjugated opiates should be preferred but all must be used carefully because of the risk of side effects. Dosage reduction and/or increased dose interval are often required.
Subject(s)
Analgesia/methods , Liver Diseases/complications , Pain/drug therapy , Acetaminophen/therapeutic use , Analgesia/adverse effects , Analgesics/administration & dosage , Analgesics/adverse effects , Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Humans , Liver Diseases/metabolism , Pain/complications , Pain/metabolism , Pain Management/adverse effects , Pain Management/methodsABSTRACT
Clostridium difficile infections (CDI) are a leading cause of antibiotic-associated and nosocomial diarrhea. Despite effective antibiotic treatments, recurrent infections are common. With the recent emergence of hypervirulent isolates of C. difficile, CDI is a growing epidemic with higher rates of recurrence, increasing severity and mortality. Fecal microbiota transplantation (FMT) is an alternative treatment for recurrent CDI. A better understanding of intestinal microbiota and its role in CDI has opened the door to this promising therapeutic approach. FMT is thought to resolve dysbiosis by restoring gut microbiota diversity thereby breaking the cycle of recurrent CDI. Since the first reported use of FMT for recurrent CDI in 1958, systematic reviews of case series and case report have shown its effectiveness with high resolution rates compared to standard antibiotic treatment. This article focuses on current guidelines for CDI treatment, the role of intestinal microbiota in CDI recurrence and current evidence about FMT efficacy, adverse effects and acceptability.
Subject(s)
Clostridioides difficile/pathogenicity , Enterocolitis, Pseudomembranous/microbiology , Intestines/microbiology , Microbiota , Anti-Bacterial Agents/adverse effects , Biological Therapy/adverse effects , Biological Therapy/methods , Enterocolitis, Pseudomembranous/diagnosis , Enterocolitis, Pseudomembranous/therapy , Feces/microbiology , Humans , Intestines/drug effects , Microbiota/drug effects , Recurrence , Risk Factors , Treatment Outcome , VirulenceABSTRACT
Clostridium difficile infections (CDI) represent 20-30% of diarrhea caused by antibiotics and relapse in more than 25% of cases after treatment with metronidazole or vancomycin. Given the high prevalence of CDI and the significant rate of recurrence despite successful initial treatment, CDI therapy represents a real challenge. A better understanding of the intestinal microbiota and its role in CDI opens the way to promising new therapeutic approaches, such as fecal transplantation. The studies published to date, although few, conclude a certain effectiveness of fecal transplantation in recurrent CDI. Further studies are needed to confirm its effectiveness, determine the long-term consequences as well as good administration practices.
Subject(s)
Clostridioides difficile/isolation & purification , Clostridium Infections/therapy , Diarrhea/therapy , Intestines/microbiology , Anti-Bacterial Agents/adverse effects , Clostridium Infections/epidemiology , Clostridium Infections/etiology , Diarrhea/microbiology , Feces/microbiology , Humans , RecurrenceABSTRACT
Lung cancer is a frequent cause of death in Western countries. The prognosis is dismal because the vast majority of cases presents to the physician at a stage that is not operable. Surgical resection of non small cell lung carcinoma when feasible offers the best chance for survival in carefully chosen patients. A preoperative physiologic assessment can help to identify those patients who are at increased risk for cancer resection. Using the algorithm proposed in this article, the primary care physician should be able to better select patients addressed for lung cancer surgery.
Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Physician's Role , Physicians, Family , Algorithms , Humans , Thoracic SurgeryABSTRACT
AIMS: It is unclear whether prescribing a higher amount of calories by enteral nutrition (EN) increases actual delivery. This prospective controlled study aimed at comparing the progression of EN of two study populations with different levels of calorie prescriptions, during the first 5 days of EN. METHODS: The daily calorie prescription of group 1 (n=346) was 25 and 20 kcal/kg body weight for women <60 and > or =60 years, respectively, and 30 and 25 kcal/kg body weight for men <60 and > or =60 years, respectively. The prescription of group 2 (n=148) was 5 kcal/kg body weight higher than in group 1. Calorie intakes were expressed as percentage of resting energy expenditure (REE) and protein intakes as percentage of requirements estimated as 1.2 g/kg body weight/day. Patients were classified as <60 and > or =60 years and as medical or surgical patients. Statistical analysis was performed with ANOVA for repeated measures. RESULTS: Calorie and protein deliveries increased in both groups independently of age and ward categories (P< or =0.0001). Group 2 showed faster progressions of calorie and protein intakes than group 1 in patients altogether (P< or =0.002), > or =60 years (P< or =0.01) and in surgical patients (P< or =0.02). Differences of calorie and protein intakes between day 1 and day 5 were significantly higher in group 2 than group 1 for patients altogether (75+/-61 vs. 56+/-54% of REE; 41+/-30 vs. 31+/-/-27% of protein requirements), those over 60 years (76+/-67 of REE vs. 52+/-59 of protein requirements) and surgical patients (81+/-52 vs. 58+/-57% of REE; 44+/-27 vs. 33+/-29% of protein requirements). CONCLUSIONS: Increasing the levels of EN prescriptions improved calorie and protein deliveries. While the mean energy delivery over 5 days was sufficient to cover requirements, the protein delivery by EN was insufficient, despite our nutritional support team.
