A European view of diagnostic yield and appropriateness of colonoscopy.

Background/aims: This study's purpose was to examine the relationship between appropriateness criteria and diagnostic yield of colonoscopy.

Methodology: This observational study prospectively included consecutive patients referred for colonoscopy from 21 centers in 11 countries. Patient, center, and colonoscopy characteristics were collected.

Physicians' estimates of the 10 year cardiovascular risk in hypertensive patients: an evaluation in primary care physicians in training.

Objective: To evaluate how young physicians in training perceive their patients' cardiovascular risk based on the medical charts and their clinical judgment.

Design: Cross sectional observational study.

Setting: University outpatient clinic, Lausanne, Switzerland.

[Drug compliance in the elderly: determinants and support].

Drug adherence needs to be promoted in elderly patients taking multiple medications. Barriers to adherence are numerous and each barrier needs to be addressed specifically. Patients should be included in the therapeutic decision making process.

[The role of aspirin in the primary prevention of cardiovascular disease].

For persons without cardiovascular disease, the benefit of aspirin in primary prevention has been controversial until the recent publication of several major randomized controlled trials. Since then, several medical societies recommend that clinicians discuss aspirin prevention with adults at high cardiovascular risk. Patients with low cardiovascular risk are unlikely to benefit from aspirin, as potential harms (hemorrhagic strokes, gastrointestinal bleedings) may outweigh benefits.

Difficulties associated with outpatient management of drug abusers by general practitioners. A cross-sectional survey of general practitioners with and without methadone patients in Switzerland.

Background: In Switzerland, general practitioners (GPs) manage most of the patients receiving methadone maintenance treatment (MMT).

Methods: Using a cross-sectional postal survey of GPs who treat MMT patients and GPs who do not, we studied the difficulties encountered in the out-patient management of drug-addicted patients. We sent a questionnaire to every GP with MMT patients (556) in the French-speaking part of Switzerland (1,757,000 inhabitants).

[Mandatory continuing medical education: did the doctors follow the rule? A survey in the state of Vaud].

In 2000, after a deep controversy, the FMH decided to make continuous medical education (CME) compulsory for all physicians practicing in Switzerland. In this study we report the results of two surveys performed between 2000 and 2002 among physicians practicing in the state of Vaud. Our data show that the rule was successfully implemented by most practitioners, both primary care physicians and specialists.

[Is there a future for women and part-time doctors in primary care?].

We tried to understand the extent and the consequences of the feminization of medicine and of the upcoming of part-time jobs in primary care. In 2003, 52% of medical graduates are women, with an increase of 80% of women studying medicine and a decrease of 30% of men, since 1980. The women practice rather in group practices, in the cities and part-time.

[Information management skills: a practical guide in primary care medicine].

Evidence-Based Medicine has taught us how to evaluate the validity of medical information. At the present time, with the abundance of information available, a doctor often lacks the time needed to select and apply what medical literature suggests. Consequently a new paradigm is called for, namely that of Information Management.

[Should we detect osteoporosis, and how?].

Osteoporotic vertebral and hip fractures, which are very frequent among elderly, are associated to an excess of mortality, as well as to an important morbidity. In Switzerland, annual costs of in-patients' treatments of osteoporosis are beyond CHF 700 millions. As several effective treatments against osteoporosis are available, a systematic screening is justified.

[Are the guidelines for the management of hypertensive patients followed by primary care residents and fellows?].

Numerous international guidelines are published which define how hypertensive patients should be managed. Are these guidelines followed and applicable? We have assessed the quality of management of 225 hypertensive ambulatory patients followed by young fellows in teaching for primary care medicine. The control rate defined by a blood pressure < 140/90 mmHg was 32,4%.

[Alcohol and risk of coronary heart disease].

More than 60 prospective cohort studies have shown a consistent association between regular and moderate alcohol consumption and decrease in risk of coronary heart disease, ischemic stroke and heart failure by 20 to 40% as compared to heavy alcohol intake or drinking no alcohol. Lower protective effects were found in young, in women and in men living outside the Mediterranean area. Moreover, some biological characteristics of alcohol, particularly red wine, could interfere with the athero-thrombotic process and contribute to increase the plausibility for the protective effects of alcohol on cardiovascular diseases.

Pharmacology of valsartan, an angiotensin II receptor antagonist.

Valsartan is the second orally-active, non-peptide angiotensin II receptor blocker to reach the market in Europe and the USA for the treatment of hypertension. Preclinical studies have demonstrated that this blocker is specific for the AT(1) receptor and has no affinity for the angiotensin II AT(2) receptor. Experimentally, valsartan dose-dependently inhibits the vasoconstriction induced by angiotensin II and lowers blood pressure in renin-dependent models of hypertension.

[Diagnosis of malaria in general practice: dealing with uncertainty].

Malaria is the disease to exclude when dealing with a patient coming back from an endemic area with fever. We need reliable diagnostic tools with negative likelihood ratio (LR-) close to zero (-> high negative predictive value). Ideally, a microscopical examination (ME) (thick and thin film) should be done, with or without a rapid diagnostic test (RDT).

[Pre- and post-exposure rabies prophylaxis: who to vaccinate and how?].

Switzerland is rabies free since 1996 (except bats). However sporadic cases in animals (imported dogs and local bats essentially) may occur from time to time. The disease is always fatal, which implies special attention when someone gets bitten or scratched by a wild or unknown animal, not only in a country with a high endemicity, but also in Switzerland.

[HIV and travel].

Since the introduction of antiretroviral therapy (ART), persons living with HIV (PLHIV) are traveling more frequently and international travel has become much safer. Specific concerns include the safety of ART during travel, drug adherence and interactions. The simultaneous administration of ART and antimalarial drugs is a challenge, considering the lack of reliable data.

Patients who attend a private practice vs a university outpatient clinic: how do they differ?

Background: Although interpersonal continuity is commonly assumed to be essential for care, some patients prefer to attend a university outpatient clinic where physicians change regularly and interpersonal continuity of care is not ensured.

Objectives: The aim of this exploratory study was to evaluate the differences between patients attending a university outpatient clinic and patients frequenting a private practice, explore their patterns of care-seeking and their understanding of continued care.

Methods: We conducted a cross-sectional study of patients attending the university medical outpatient clinic (OC) in Lausanne, Switzerland and ten randomly selected private general practices (PP).

Factors affecting the outcome of orthograde root canal therapy in a general dentistry hospital practice.

Objective: The goal of this study was to weigh the impact of patient-related, tooth-related, and treatment-related factors on therapy outcome in a series of consecutive patients.

Study Design: Eighty-four patients were included. Of these, 66 (79%) were available for recall after > or = 30 months (mean = 46 months).

Chronic Sialadenitis revealing hepatitis C: a case report.

One 53-year-old male was referred with a history of sensitive peripheral neuropathy and Raynaud disease leading to suspect a Sjögren syndrome (SS). Labial salivary gland biopsy shown the classical features of chronic lymphocytic sialadenitis. As clinical and immunologic tests were positive, we conclude to a chronic lymphocytic sialadenitis simulating SS.

[Investigating fever after travel].

Two questions are crucial in the evaluation of fever in returning travellers, i.e. "Where have you been?" and "When did you go and when did you return from your trip?".

[Individual and relational approach to bereavement].

Loss is viewed as un event that can profoundly and sometimes traumatically challenge one's assumptions about the meaning of the life and about the world. The nature of the bereavement, as human experience, must be known by the physician. The people story of loss suggest a complex process of adaptation to a changed reality, a process that is at the same time personal, familial, social and cultural.

Monitoring compliance in resistant hypertension: an important step in patient management.

Poor compliance with antihypertensive drug regimens is one recognized cause of inadequate blood pressure control. Compliance is difficult to measure, so poor adherence to treatment remains largely undiagnosed in clinical practice. When the therapeutic response to a drug is not the one expected, it is a major challenge for many physicians to decide whether the patient is a non-responder or a non-complier.

Patient expectations at a multicultural out-patient clinic in Switzerland.

Background: Recognizing patient expectation is considered as an important objective for primary care physicians. A number of studies suggest that failure to identify patient expectations can lead to patient dissatisfaction with care, lack of compliance and inappropriate use of medical resources. It has been suggested that identifying patient expectations in multicultural contexts can be especially challenging.

Topiramate in benzodiazepine withdrawal.

There is an increasing interest in anticonvulsants for the treatment of benzodiazepine withdrawal symptoms. The new anticonvulsant compound topiramate seems to be an especially promising drug for this indication. It acts, among others, as an AMPA antagonist, which may be responsible in part for its anticonvulsant efficacy, but may also modulate the withdrawal-induced activation of noradrenergic neurons in the locus coeruleus, which are related to some behavioural effects of benzodiazepine withdrawal.

[Vaccines against poverty].

In spite of major technological advances during the past ten years, the gap between rich and poor countries remains considerable. Among the 10.5 million children deaths in 1995, 99% occurred in developing countries and 1% in industrialised ones.