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Résumé: Si pour favoriser l'accès aux soins en médecine générale, et en améliorer la qualité, il est indispensable de libérer du temps médical, la question du choix du type de secrétariat est essentielle. L'objectif de cet article est de préciser la place du secrétariat physique en médecine générale, en s'intéressant tout particulièrement à l'analyse de la relation triangulaire entre médecin, patient et secrétaire. Pour cela, il s'appuie sur les résultats de trois études qualitatives menées par entretiens individuels et focus groupes, dans le cadre de thèses d'exercice en médecine générale. Ces études s'intéressent aux attentes et points de vue des différents acteurs (médecins, patients, secrétaires) en matière de secrétariat médical. While it is essential to free up medical time in order to promote access to care in general medicine and improve its quality, the question of choosing the type of secretariat is essential. The objective of this article is to clarify the place of the physical secretariat in general medicine, by paying particular attention to the analysis of the triangular relationship between doctor, patient and secretary. For this, it relies on the results of three qualitative studies carried out by individual interviews and focus groups, as part of exercise theses in general medicine. These studies are interested in the expectations and points of view of the different actors (doctors, patients, secretaries) in terms of medical secretarial [ABSTRACT FROM AUTHOR]

Objective: To determine all cause mortality and deaths from cardiovascular events related to intensive glucose lowering treatment in people with type 2 diabetes., Design: Meta-analysis of randomised controlled trials., Data Sources: Medline, Embase, and the Cochrane database of systematic reviews., Study Selection: Randomised controlled trials that assessed the effect of intensive glucose lowering treatment on cardiovascular events and microvascular complications in adults (≥ 18 years) with type 2 diabetes., Data Extraction: Primary end points were all cause mortality and death from cardiovascular causes. Secondary end points were severe hypoglycaemia and macrovascular and microvascular events. Synthesis of results Results are reported as risk ratios with 99% confidence intervals. Statistical heterogeneity between trials was assessed with χ(2), τ(2), and I(2) statistics. A fixed effect model was used to assess the effect on the outcomes of intensive glucose lowering versus standard treatment. The quality of clinical trials was assessed by the Jadad score., Results: 13 studies were included. Of 34,533 patients, 18,315 received intensive glucose lowering treatment and 16,218 standard treatment. Intensive treatment did not significantly affect all cause mortality (risk ratio 1.04, 99% confidence interval 0.91 to 1.19) or cardiovascular death (1.11, 0.86 to 1.43). Intensive therapy was, however, associated with reductions in the risk of non-fatal myocardial infarction (0.85, 0.74 to 0.96, P<0.001), and microalbuminuria (0.90, 0.85 to 0.96, P<0.001) but a more than twofold increase in the risk of severe hypoglycaemia (2.33, 21.62 to 3.36, P<0.001). Over a treatment period of five years, 117 to 150 patients would need to be treated to avoid one myocardial infarction and 32 to 142 patients to avoid one episode of microalbuminuria, whereas one severe episode of hypoglycaemia would occur for every 15 to 52 patients. In analysis restricted to high quality studies (Jadad score >3), intensive treatment was not associated with any significant risk of reductions but resulted in a 47% increase in risk of congestive heart failure (P<0.001)., Conclusions: The overall results of this meta-analysis show limited benefits of intensive glucose lowering treatment on all cause mortality and deaths from cardiovascular causes. We cannot exclude a 9% reduction or a 19% increase in all cause mortality and a 14% reduction or a 43% increase in cardiovascular death. The benefit:risk ratio of intensive glucose lowering treatment in the prevention of macrovascular and microvascular events remains uncertain. The harm associated with severe hypoglycaemia might counterbalance the potential benefit of intensive glucose lowering treatment. More double blind randomised controlled trials are needed to establish the best therapeutic approach in people with type 2 diabetes.

Background: The recommendations of the French consensus (Lille 1990) advise the stop of the tracking by cervical smears of cancer at 65-years-old, if the former follow-up were regular and if the last two smears were normal. 33% cervical cancers are after 65-years-old., Aim: How many pathological smears are after 65 years?, Method: Descriptive, retrospective study analyzing the results of 12339 smears of women of more than 65 years, carried out during one year in the same laboratory of anatomo-pathology. They were analysed with Bethesda's system., Results: 2.67% of smears are of insufficient quality (CI 95%: 2, 46%; 3%); 2.43% of smears are pathological (CI 95%: 2, 2%; 2, 7%). That pathological smear's rate is comparable to the one found among women of less than 65-years-old (2 to 3%). The squamous cell carcinoma's rate is more important in this group., Conclusion: This work encourages us to continue smear's practice among women of more than 65 years.