Search

Copyright of Médecine is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Speculum examination is an intrusive practice in the clinical care of women. It requires privacy and patients may experience discomfort or anxiety related to the procedure, which can result in delays or avoidance of necessary healthcare. Speculum self-insertion originated in the United States in the 1970s as part of the self-help movement. However, this clinical practice is largely unknown among healthcare providers and has rarely been assessed. Aim This study investigates the women's views and healthcare providers' experiences of the self-insertion method. Method A qualitative study was conducted between December 2021 and October 2022, including fieldwork combining semi-structured interviews (10 women) and focus groups associated with individual interviews of 13 healthcare providers. The data collected were independently coded by 2 authors and analysed using an inductive approach and grounded theory method. Results Speculum self-insertion was described as a way to decrease discomfort and facilitate speculum insertion. Self-insertion was proposed as a means of allowing women to participate in the examination, reducing their vulnerability against power imbalances in the doctor–patient relationship. Both patients and healthcare providers have reported that speculum self-insertion is a method that can contribute to improving trust and communication during the examination. Conclusion The practice of speculum self-insertion during the consultation is an alternative to traditional practitioner insertion and may be offered to all women by any practitioner who wishes to use this technique. [ABSTRACT FROM AUTHOR]

Functional somatic syndromes, defined as a set of symptoms without a pathophysiological explanation, are frequently encountered in general medicine. The feeling of frustration present in both the patient and the physician, when dealing with these disorders, is evidence of a difficulty in the relationship between the patient and the physician. This qualitative study questions the specificities of the care-giver relationship during the management of functional somatic disorders in general medicine. This patients particularly seek a form of paternalism in the relationship. Aware of the "difficulty" they embody, they also adopt a protective attitude towards their physician, akin to reverse paternalism. The role of the diagnostic label, often described as positive for the patient, can also present risks within this fragile relationship. The management of patients with functional somatic disorders in general practice requires caregivers to identify the transferential emotions at play in the relationship. [ABSTRACT FROM AUTHOR]

The article reports that pregnant women who contract Covid-19 have a high risk of complications, hospitalizations and death higher risk than in non-pregnant women of the same age with Covid-19 and in uninfected pregnant women. Topics include examines there are also specific risks for the newborns of women infected with Sars-CoV-2 during pregnancy.

The article reports that due to demographic data, the general practitioner no longer chooses his patient base by considering that another caregiver will be able to follow up unaccompanied patients by himself, but knowing that the patient will probably remain unanswered to his request for care. Topics include considered at the heart of this tense situation, it seems urgent to question medical ethics at the risk of a violent reality for patients and practitioners.

Résumé: Les nouveaux Dispositifs Intra Utérins (DIU) en cuivre de type IUB, sont de petits dispositifs sphériques à mémoire de forme. Ils restent les dispositifs intra-utérins les plus onéreux du marché et ne sont pas pris en charge par l'Assurance Maladie. Aucune étude n'a montré leur supériorité sur les autres DIU en cuivre, tant sur l'efficacité contraceptive, que sur la tolérance. Les DIU de forme T restent la référence. The new copper intrauterine devices (IUDs), type IUB, are small spherical shape memory devices. They remain the most expensive intrauterine devices on the market and are not covered by the French health insurance system. No study has shown their superiority over the other copper IUDs in either contraceptive efficacy or safety. T-shaped IUDs remain the reference. [ABSTRACT FROM AUTHOR]

Résumé: Le sevrage est une des étapes inévitables de l'allaitement maternel. Les questions des patientes concernant sa gestion peuvent être rencontrées en consultation de médecine générale. Souvent les réponses pertinentes et fondées sur des données probantes peuvent manquer. Ce travail propose d'explorer les retours d'expériences des mères vis-à-vis du sevrage de l'allaitement maternel, mis en perspective des conseils apportés par les professionnels de santé en consultation. Weaning is one of the inevitable stages of breastfeeding. Patient questions regarding its management may be encountered in the general practice setting. Often relevant and evidence-based answers may be lacking. This work proposes to explore mothers' experiences of weaning from breastfeeding, put in perspective with the advice given by health professionals in consultation. [ABSTRACT FROM AUTHOR]

Résumé: La vitesse de sédimentation (VS) constituait un examen de base pour les médecins généralistes à la fin du XXe siècle comme marqueur de l'inflammation. Aujourd'hui encore, la VS est largement utilisée comme en témoignent les 14 millions de dosages en médecine ambulatoire en 2018. Pourtant, la VS est un marqueur peu spécifique maintenant concurrencé par d'autres dosages plus performants. Une revue systématique de la littérature a été réalisée entre le 30 mars 2020 et le 30 janvier 2022 ainsi qu'une analyse des recommandations des sociétés savantes. L' Evidence Based Medicine ne permet pas de justifier le dosage de la vitesse de sédimentation en pratique courante de médecine générale, même si elle reste possible dans quelques rares situations : Horton, Hodgkin, Polyarthrite rhumatoïde. La faible littérature scientifique sur l'utilisation de la VS en médecine générale et sa disparition progressive des référentiels des sociétés savantes justifient l'arrêt de l'utilisation de ce dosage en pratique courante. The blood sedimentation (BS) was a basic test for general practitioners at the end of the 20th century as a marker of inflammation. Today, the BS is still widely used, as evidenced by the 14 million determinations in ambulatory medicine in 2018. However, the BS is a non-specific marker that is now competing with other more efficient assays. A systematic review of the literature was carried out between 30 March 2020 and 30 January 2022 as well as an analysis of the recommendations of learned societies. Evidence Based Medicine does not justify the use of the blood sedimentation rate in general practice (even if it remains possible in a few rare situations: Horton, Hodgkin, rheumatoid arthritis). The limited scientific literature on the use of the BS in general practice and its gradual disappearance from the guidelines of learned societies justifies the cessation of the use of this assay in general practice. [ABSTRACT FROM AUTHOR]

Résumé: La réalisation systématique d'une échographie de datation avant une interruption volontaire de grossesse (IVG) illustre le développement d'une médecine technologique, parfois au détriment de la relation de soin. Cet article questionne la place de l'échographie considérée comme un « impératif scopique » au sein du parcours d'IVG pour les femmes et les soignants échographistes. Selon les femmes rencontrées, l'échographie peut avoir un rôle central dans le processus décisionnel de l'IVG ou au contraire n'être qu'une étape de plus, « banale », dans un long parcours jalonné de multiples rendez-vous médicaux. L'échographiste doit disposer d'une capacité d'adaptation aux attentes singulières de la patiente par rapport à cet examen. Cependant, autour d'un sujet aussi sensible que l'IVG, il n'est malheureusement pas toujours aisé de mettre de côté ses convictions personnelles et les stigmates de son passé professionnel. L'échographie de datation constitue une étape supplémentaire dans le « parcours de la combattante » des femmes en demande d'IVG. La simplification de ce parcours afin de limiter le nombre d'intervenants et de lieux d'accueil permettrait une amélioration de la prise en charge et une uniformisation des pratiques pour le bien-être de tous. The systematic performance of a dating ultrasound before a voluntary interruption of pregnancy illustrates the development of technological medicine, sometimes to the detriment of the care relationship. This article examines the place of ultrasound as a "scopic imperative" in the abortion process for women and ultrasound providers. According to the women we met, ultrasonography may have a central role in the abortion decision process or, on the contrary, it may be just another "banal" step in a long process marked by multiple medical appointments. The sonographer must be able to adapt to the patient's particular expectations regarding this examination. However, around a subject as sensitive as abortion, it is unfortunately not always easy to put aside personal convictions and the stigma of one's professional past. The dating ultrasound is an additional step in the "combatant's path" for women seeking an abortion. Simplifying this process in order to limit the number of providers and reception sites would improve care and standardize practices for the well-being of all. [ABSTRACT FROM AUTHOR]

Résumé: Une tension s'opère entre les différents protagonistes auprès d'un enfant en hospitalisation à domicile (HAD). Tous ces acteurs éprouvent un changement d'identité tout au long de ce processus. Des négociations constantes s'imposent pour que chacun trouve et assume sa place. Ce travail essaie d'éclairer ce risque de confusion identitaire, et de décrire comment il se négocie, s'équilibre, tant du côté des soignants que du côté des parents, tout au long de la prise en charge, grâce à la coordination de tous les acteurs par l'équipe de l'HAD pédiatrique. A tension arises between the different protagonists in the care of a child hospitalized at home (HAH). All these actors experience a change of identity throughout this process. Constant negotiations are necessary for each person to find and assume their place. This study attempts to shed light on this risk of identity confusion and to describe how it is negotiated and balanced, both on the part of the caregivers and the parents, throughout the care process, thanks to the coordination of all the players by the pediatric HAH team. [ABSTRACT FROM AUTHOR]

Résumé: La méditation de pleine conscience existe depuis maintes années dans la culture orientale et particulièrement dans le bouddhisme. Aujourd'hui importée dans les sociétés occidentales, elle a connu une laïcisation de sa pratique. Elle est désormais utilisée en tant qu'outil dans la promotion du bien-être et les études concernant ses effets sur la santé ne cessent d'augmenter. Ce travail explore les raisons qui poussent certaines personnes à se tourner vers la méditation. Changer sa relation aux événements négatifs du quotidien est une des principales raisons ayant conduit ces personnes à méditer. Les principales difficultés rencontrées concernent l'assiduité nécessaire à la pratique. Les bénéfices décrits par les participants sur le plan de l'anxiété, des troubles du sommeil, de la douleur ou simplement de leur regard sur le monde sont devenus sources de motivation. Meditation has existed for many years in Eastern culture and particularly in Buddhism. Today, it has been imported into Western societies and its practice has been secularized. It is now used as a tool to promote well-being (mindfulness-based stress reduction) and studies on its effects on health are increasing. This work explores the reasons why some people turn to meditation. Changing one's relationship to negative everyday events is one of the main reasons that people turn to meditation. The main difficulties encountered were related to the regularity of the practice. The benefits described by the participants in terms of anxiety, sleep disorders, pain or simply their view of the world have become a source of motivation. [ABSTRACT FROM AUTHOR]

Firefighters' activities increase the risk of sudden cardiac events. The main objective of this study was to describe the Loire firefighters' cardiovascular risk factors according to their cardiovascular risk and to their professional status. A retrospective study of the entire population of firefighters of the Loire department was conducted. Risk factors derived from the data collected during the occupational health follow-up medical examinations were described and the cardiovascular risk was assessed for 417 firefighters. The most frequent cardiovascular risk factors were: overweight and obesity (62.1%), high blood pressure (27.8%) and active smoking (16,1%). There were no significant differences between career firefighters and volunteers. The prevalence of risk factors for cardiovascular diseases is less than in the general population. Obesity remains the most common risk factor, especially among firefighters with high cardiovascular risk. [ABSTRACT FROM AUTHOR]

Résumé: Cette enquête sociologique explore les perspectives des sujets, acteurs de la recherche en santé. Il aborde les spécificités du binôme sujet/médecin généraliste traitant à partir du point de vue des sujets avant de questionner les potentielles implications de cet investissement dans la recherche sur le soin au quotidien. Il propose de restituer quelques trajectoires singulières de l'implication de ces volontaires « cobayes » afin de comprendre pourquoi les usagers acceptent d'entrer dans la recherche en santé. This sociological survey explores the perspectives of the subjects, actors of health research. It discusses the specificities of the binomial subject/general practitioner treating from the point of view of the subjects before questioning the potential implications of this investment in research on daily care. It proposes to reconstruct some of the singular trajectories of the involvement of these "guinea-pig" volunteers in order to understand why users agree to participate in health research. [ABSTRACT FROM AUTHOR]

Résumé: Le cancer du sein est le plus souvent traité par chimiothérapie. L'objectif de cette étude était de quantifier et analyser le retentissement sur la qualité de vie (QDV) des effets indésirables (EI) de la chimiothérapie chez des patientes traitées pour un cancer du sein. Une étude descriptive transversale, quantitative, par auto-questionnaire a été réalisée de juin à décembre 2018 auprès de patientes traitées par chimiothérapie et suivies en région Auvergne-Rhône-Alpes. La QDV a été mesurée au moyen des échelles EORTC, QLQC30 et MIF20. Quatre-vingt-deux questionnaires ont été analysés. En moyenne un an après la fin de la chimiothérapie, la QDV globale des participantes est satisfaisante et s'élève à 66/100. Le score de fatigue est assez élevé à 70,85/100 (MIF20). Cette étude met en évidence la persistance de cette fatigue et l'impact non négligeable des anthracyclines sur la QDV des patientes. Le retentissement immédiat et prolongé de ces traitements devrait conduire à l'utilisation de thérapeutique ayant moins d'EI. Breast cancer is most often treated with chemotherapy. The objective of this study was to quantify and analyze the impact of chemotherapy adverse events (AE) on quality of life (QOL) in patients treated for breast cancer. A descriptive, cross-sectional, quantitative, self-report study was conducted from June to December 2018 in patients treated with chemotherapy and followed in the Auvergne-Rhône-Alpes region. QOL was measured using the EORTC, QLQC30 and MIF20 scales. Eighty-two questionnaires were analyzed. On average, one year after the end of chemotherapy, the overall QOL of the participants was satisfactory and amounted to 66/100. The fatigue score is quite high at 70.85/100 (MIF20). This study highlights the persistence of this fatigue and the significant impact of anthracyclines on patients' QOL. The immediate and prolonged impact of these treatments should lead to the use of therapies with fewer AE. [ABSTRACT FROM AUTHOR]

The article examines decision-making and prescription aid tools used by doctors. It mentions no decision-making tool could replace or replace the physician's experience and the patient's perspective, two essential dimensions of Evidence Based Medicine. It also mentions the role played by artificial intelligence in decision-making.

Résumé: L'allaitement maternel (AM) est un événement de vie qui peut survenir au cours de la formation des futures professionnelles de médecine générale. Cet article explore comment les internes de médecine générale mettent en place et vivent l'allaitement maternel au cours du Diplôme d'Études Spécialisées, et quel impact cela peut-il avoir sur leur pratique ? La confrontation au système de soins, pour ces internes au cours de l'AM, peut être génératrice d'angoisse ou de conflit. Du fait de leurs connaissances médicales, elles évincent assez rapidement les conseils déstabilisants. Il se crée ainsi une expertise profane nouvelle sur l'AM. Cette expérience d'AM influence leur formation médicale, et réciproquement les contraintes liées à la formation ont un impact sur leur projet d'AM. A la suite de cette expérience, l'expertise profane se positionne au service de l'expertise médicale dans une approche respectant les principes de l' Evidence Based Medicine et centrée sur le patient. Breastfeeding (BF) is a life event that can occur during the training of future general medical professionals. This article explores how residents initiate and experience BF during the Specialist Diploma, and what impact this may have on their practice. Confrontation with the health care system for these residents during BF can be a source of anxiety or conflict. Because of their medical knowledge, they are able to oust destabilising advice fairly quickly. This creates new lay expertise on BF. This BF experience influences their medical training, and conversely the constraints of training have an impact on their BF project. As a result of this experience, lay expertise is positioned at the service of medical expertise in an approach that respects the principles of Evidence Based Medicine and focuses on the patient. [ABSTRACT FROM AUTHOR]

Résumé: En France le cancer du sein est selon son type et son stade, traité par chimiothérapie. Ce traitement engendre des effets indésirables (EI) notables. L'objectif de cette étude était de quantifier la survenue d'EI, chez les patientes traitées par chimiothérapie pour cancer du sein, analyser leurs retentissements et les recours utilisés pour les contrôler. Une enquête quantitative, déclarative, multicentrique, rétrospective, a été réalisée par auto-questionnaire anonyme auprès de patientes traitées par chimiothérapie pour cancer du sein en région Auvergne-Rhône-Alpes. In France breast cancer is, depending on its type and stage, treated with chemotherapy. This treatment produces significant side effects (AEs). The objective of this study was to quantify the occurrence of AE in patients treated with chemotherapy for breast cancer, analyze their repercussions and the remedies used to control them. A quantitative, declarative, multicenter, retrospective survey was carried out by anonymous self-questionnaire among patients treated with chemotherapy for breast cancer in the Auvergne-Rhône-Alpes region. [ABSTRACT FROM AUTHOR]

Résumé: En collaboration avec les équipes de SMUR, les infirmiers sapeurs-pompiers (ISP) participent activement aux missions de secours d'urgence aux personnes grâce notamment aux protocoles infirmiers de soins d'urgence (PISU), au nombre de 24 au sein du service départemental d'incendie et de secours de la Loire (SDIS 42). Cette évaluation des pratiques professionnelles ouvre sur des questions d'organisation des soins d'urgence pré hospitalière. In collaboration with the emergency mobile units, fire-fighting nurses actively participate in rescue missions' thanks in particular to the 24 emergency care nursing protocols within the Loire departmental fire and emergency service. This assessment of professional practices opens up questions about the organization of pre-hospital emergency care. [ABSTRACT FROM AUTHOR]

Résumé: La prise en charge du patient diabétique de type 2 (DT2) s'articule autour de deux grands axes : médicamenteux et hygiéno-diététique. Ce dernier repose sur l'éducation thérapeutique du patient (ETP) qui vise à faire acquérir au patient des compétences et le rendre plus autonome dans la gestion de la maladie au quotidien. Les MG considèrent en majorité mettre en œuvre de l'ETP et connaissent globalement bien les structures qui la dispensent. Plusieurs difficultés viennent néanmoins freiner le recours à l'ETP : manque de coordination, sollicitation dépendante de la motivation des patients, lourdeur administrative, absence de financement adapté. Selon les MG, une ETP efficiente ne peut être délivrée par le médecin seul au vu de ces contraintes actuelles du système de santé, mais doit reposer sur l'aide d'un autre acteur du soin. The management of type 2 diabetes (T2D) consists of two therapeutic lines: Drugs and lifestyle. The latter is based on therapeutic patient education (TPE) which is a means for patients to acquire knowledge and independence in the management of their pathology. Most of GPs consider providing adequate TPE and are overall aware of PE structures. However, many challenges arise such as a lack of coordination, dependency of patient's motivation, administrative hassle, and a lack of appropriate funding. According to GPs, an effective TPE cannot rely only on the physician due to constraints of the current healthcare system but should be supported by other healthcare operators. [ABSTRACT FROM AUTHOR]

The patients seem to expect a lot from their general practitioner (GP) in terms of medical information (MI). The waiting room of the GP represents the first step before consulting; it is sometimes used to provide this information. This study proposes to explore the perception of the patients of MI delivered in the waiting room of the GP. The medical information received is affected by several factors. When the relationship between a GP and his patient is satisfactory, the transmission of information is easier. Depending on the reason for consulting or if they think they wait for too long, the patients can feel anxieties or unpleasantness while waiting so that it is not the right moment for them to get informed. The social interactions in the waiting room can interfere with the perception of information. According to the patients, their GP should be more involved and control this information that should be in limited quantity, in a dedicated space, updated on new topics, preventive or referring to the local associations. It must not be imposed but proposed in the continuity of the patient-doctor relationship. [ABSTRACT FROM AUTHOR]

Introduction: With the rarefaction of home medical visits, prehospital emergencies are ensured by the Mobile Emergency and Resuscitation Structures (SMUR) and the Firemen accompanied by Firefighters Nurses (FfNs)., Purpose of Research: The main objective of this work is to describe the pathologies managed by the FfNs of the Loire district according to their International Classification of Primary Care version 2 and the Clinical Classification of Diseases of the initial SMUR during all interventions performed in 2019. The secondary objective will be to determine the associated Emergency Care Nursing Protocols (PISU)., Results: Among the 2969 interventions and 5036 PISU performed, trauma and polytrauma are the most common pathologies treated. Outside of trauma, the most frequent conditions are chest pain, carbon monoxide poisoning, and cardiopulmonary arrest (CPA). Analgesic protocols are the most used PISU and in second place comes the absence of PISU application, chest pain protocols, adult CPA and glucose administration., Conclusions: FfNs occupy an increasingly important place in the French rescue chain. Thanks to a wide range of interventions and a great autonomy of action, they make it possible to greatly limit the number of SMUR medical teams leaving the hospital, especially in situations that do not require a doctor immediately.

Aim: In France, cervical cancer screening has led to a decrease in mortality, though it could be optimized by improving the management of abnormal cytology. The aim was to evaluate the follow-up of women with abnormal Pap smear prescribed by an ambulatory health professional, compared to the ANAES guidelines of 2002., Method: Quantitative monocentric and retrospective study of 120 women with abnormal Pap smear performed before October 2014 in the French department of the Loire., Results: 114 abnormal Pap smear follow-ups of women between the ages of 18 and 75 have been analyzed. Cytological abnormalities were spread among 90 ASC-US (79%), 16 LSIL (14%), 6 HSIL (5,3%) and 2 ASC-H (1,7%). Compared to the ANAES guidelines, 52% of follow-ups were incomplete, 24% were comprehensive with too long of a delay, and 24% were guidelines compliant. Women under 29 were more likely to have an incomplete follow-up: OR 0,306 [0,116-0,805]., Conclusion: In our sample, the analysis of the follow-ups of women with abnormal Pap smear has reflected over screening and lack of conformity, eventually allowing the screened lesion to progress towards cancer. A national screening program could help to improve the quality of a follow-up for these women.