[Swiss and tropical snakebites: the clinical management].

With increasing trips to tropical areas, as well as a high number of venomous snake holders in the country, the frequency of snake bites is likely to increase. Even if in 50 % of cases, the bites do not lead to clinical envenoming, rapid and effective management is essential to successful treatment, which includes supply with the polyvalent or specific antivenom and recognition of the signs and symptoms justifying its administration. We will deal here mainly with local and tropical snake envenoming that Swiss practitioners could encounter in their offices or the emergency rooms and propose scenarios according to the syndromes.

[Multidrug-resistant bacteria and travel].

Antimicrobial resistance is a global problem which affects also tropical countries. Travelers to these regions expose themselves to the risk of being colonised and infected with multidrug-resistant bacteria. The region visited, the occurrence of diarrhoea and the use of antibiotics are the principal risk factors leading to colonisation with multidrug-resistant Enterobacteriaceae, which can affect up to 80% of travellers.

Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial.

Background: Escherichia coli infections are increasing worldwide in community and hospital settings. The E coli O-antigen is a promising vaccine target. We aimed to assess the safety and immunogenicity of a bioconjugate vaccine containing the O-antigens of four E coli serotypes (ExPEC4V).

A systematic review of passive exposure to cannabis.

Passive exposure to cannabis smoke may induce effects on behavior and psychomotor skills, and have legal consequences, including the risk of being falsely considered as a cannabis user. This can become a concern, especially in occupational contexts or when driving vehicles. In order to enable a differentiation between a passive and an active exposure to cannabis and to limit the likeliness to be detected positive following passive exposure, this review identified specific biomarkers of passive exposure in urine, blood, oral fluid, hair, and sebum.

Safety and immunogenicity of a chimpanzee adenovirus-vectored Ebola vaccine in healthy adults: a randomised, double-blind, placebo-controlled, dose-finding, phase 1/2a study.

Background: The ongoing Ebola outbreak led to accelerated efforts to test vaccine candidates. On the basis of a request by WHO, we aimed to assess the safety and immunogenicity of the monovalent, recombinant, chimpanzee adenovirus type-3 vector-based Ebola Zaire vaccine (ChAd3-EBO-Z).

Methods: We did this randomised, double-blind, placebo-controlled, dose-finding, phase 1/2a trial at the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Care and Do Not Harm: Possible Misunderstandings With Quaternary Prevention (P4) Comment on "Quaternary Prevention, an Answer of Family Doctors to Over Medicalization".

The discussion between general practitioners (GPs) and healthcare delivery organizations necessitates a common language. The presentation of the 4 types of GP's activities, opens dialogue but can lead to possible misunderstandings between the micro- and macro-level of the healthcare system. This commentary takes 4 examples: costs reduction by P4, priority of beneficence or nonmaleficence, role of evidence-based medicine (EBM) and use of a constructivist model.

[Skin ulcers in a returning traveler].

We present the case of a 71 year old man returning from a back-packer trip in exotic countries. He presented several non-healing legs ulcers for three months. After many investigations, the bacterial culture gave us the answer.

Mefloquine at the crossroads? Implications for malaria chemoprophylaxis in Europe.

Since its introduction to the market in 1985, mefloquine has been used for malaria chemoprophylaxis by more than 35 million travellers. In Europe, in 2014, the European Medicines Agency (EMA) issued recommendations on strengthened warnings, prescribing checklists and updates to the product information of mefloquine. Some malaria prevention advisors question the scientific basis for the restrictions and suggest that this cost-effective, anti-malarial drug will be displaced as a first-line anti-malaria medication with the result that vulnerable groups such as VFR and long-term travellers, pregnant travellers and young children are left without a suitable alternative chemoprophylaxis.

Patients satisfaction in an academic walk-in centre: a new model of residents training achieved by family doctors.

Background: Walk-in centres may improve access to healthcare for some patients, due to their convenient location and extensive opening hours, with no need for an appointment. Herein, we describe and assess a new model of walk-in centre, characterised by care provided by residents and supervision achieved by experienced family doctors. The main aim of the study was to assess patients' satisfaction about the care they received from residents and their supervision by family doctors.

Finding the right interactional temperature: do colder patients need more warmth in physician communication style?

Being aware of which communication style should be adopted when facing more difficult patients is important for physicians; it can help prevent patient reactions of dissatisfaction, mistrust, or non-adherence that can be detrimental to the process of care. Past research suggests that less agreeable patients are especially critical towards, and reactive to, their physician's communication style, compared to more agreeable patients. On the basis of the literature, we hypothesized that less agreeable patients would react more negatively than agreeable patients to lower levels of affiliativeness (i.

[Community pharmacy and general internal medicine are at the same crossroads: some opportunities should be seized].

The medicines give some symptoms relief and save lives every day. However, the responsible use of medicines is not definitively attained for the modern health systems. The shortcomings in this area are the cause of major negative clinical outcomes for the patients and the cause of additional cost for the health financing system.

[The complexity of the diabetic peripheral neuropathy: propositions for therapeutic educational interventions].

The complexity of the Diabetic Peripheral Neuropathy: Propositions for Therapeutic Educational Interventions. Peripheral Diabetic Neuropathy is undoubtly a major health problem. The existence of different perceptions between the health care provider and the patient about the development process of the foot ulcer limits the efficacy of the prevention strategies or the healing process.

[Physicians-pharmacists quality circles: shared responsibility of the freedom of prescription].

Physicians-pharmacists quality circles (PPQCs) were introduced in 1997-98 by visionary healthcare practitioners of the French-speaking part of Switzerland with the aim to improve the quality of drug prescription. Indeed the challenge is to manage the 7917 brand names of the Swiss drug market (2010), including 19793 different dosages, galenic formulations and packaging. The impact of these PPQCs on the containment of drug costs and on drug prescribing profiles has been demonstrated and has led to their spread throughout Switzerland.

[Migration without borders, but...barriers of meaning].

Immigration, a political, economic, demographic, social and ethic, as well as a medical issue, continues. Among migrants, asylum seekers, refugees and undocumented immigrants are characterised by their vulnerability, particularly related to their health status. Western physicians are more and more frequently confronted to "colorful" and often vulnerable patients.

[How frequent are cardiovascular diseases a cause of work absenteeism and of disability in Switzerland?].

Cardiovascular diseases (CVD) are a major cause of morbidity and mortality in industrialized countries, and also in Switzerland. In 2004/2005, CVD were in first line of all medical diagnosis by primary care physicians (12.4%) and of all causes of hospitalisation (9.

Clinical evaluation of IDAS II, a new electronic device enabling drug adherence monitoring.

Objective: The goal of this study was to evaluate clinically the acceptability of the IDAS II (Intelligent Drug Administration System), a new electronic device that enables drug adherence monitoring.

Methods: IDAS II was compared to another electronic monitor, the Medication Event Monitoring System (MEMS) in a randomised two-way cross-over study involving 24 hypertensive patients treated with irbesartan. Patients used each device for 2 months.