Direct Oral Anticoagulants : recommendations for the general practitioner

Cédric Hermans Published in the journal : October 2018 Category : Actualité thérapeutique

Direct oral anticoagulants (DOACs) represent one of the greatest therapeutic innovations of the last decades. Their effectiveness and safety have been clearly demonstrated in a large number of indications. The main precautions for use have been identified. While initially limited to specialists, the prescription of DOACs is now part of the daily practice of many general practitioners. This article reviews, in a concise and practical way, some essential information about DOACs that are useful for any general practitioner.

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Social accountability in health

Ségolène de Rouffignac(1), Nicolas Pierre(2), Kelly Tchomba Djuiko(3), Dominique Pestiaux(4) Published in the journal : October 2018 Category : Société et pédagogie

A jeopardized healthcare system, a generation looking for sense in life and work, a growing gap between the population’s needs and health resources... Social accountability is a concept designed to stimulate reflection and action in favor of a health policy that is more coherent, effective, and equitable. Of course, while this responsibility is primarily in the realm of politicians and health managers, it also concerns universities, health professionals, and communities themselves. The scope of application of this accountability is broad: From ecology to health, it is essential to answer the current problems. By fostering dialogue and partnership among the different actors, the solutions should focus on unity for action rather than fragmentation, guided by values of quality, equity, relevance, and cost-effectiveness. Social accountability invites us to step out of our comfort zone by showing a capacity of reflection, adaptation, and action in order to meet the present society’s needs.


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Clinical elements in guiding the prescription of blood tests

Catherine Fillée(1), Marianne Philippe(2) Published in the journal : October 2018 Category : Examens complémentaires

For many years, there has been a plentiful literature focused on the correct prescription of laboratory tests. Clinical biology indeed plays a major role in patient diagnosis and follow-up.

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Doctor, I need a check-up. Adults asking for a check-up in general practice

Cassian Minguet Published in the journal : October 2018 Category : Examens complémentaires

The check-up request, or health check, is common in adult patients seen in general practice. Although evidence of its usefulness in terms of morbidity and mortality is scarce or nonexistent, it is much more a question of satisfying the patient's request. Some authors recommend repeating regularly health check-ups, which are referred to as “periodic health examination of adults”. The health check-up procedure consists in a history-taking beginning with an openended question regarding the patient’s family and personal history, immunization status, as well as environmental and occupational risk factors, along with a clinical examination. In case of positivity, para-clinical examinations may be indicated in accordance with evidencebased medicine (EBM) data. Preventive measures may be proposed, also based on EBM data. These are available in the literature and on the Internet. The Electronic Preventive Services Selector (ePSS) is an easy-to-use Internet tool designed to help frontline practitioners and offered by the U.S. Preventive Services Task Force. For example, the screening, counseling, and preventive medications recommended and not recommended by the ePSS are presented for a 50-year-old man who is asymptomatic, non-smoker and sexually active. In conclusion, there is no standard health check-up; health check-up is much more a general practice consultation where the physician’s role is to be exhaustive in his anamnestic approach, his clinical examination and his knowledge of recommended preventive actions.

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Burnout in general practice consultation

Philippe Heureux Published in the journal : October 2018 Category : Actualités du médecin généraliste

This article presents burnout from a “phenomenological” perspective, as it can be perceived by the general practitioner. It points out the difficulties encountered by general practitioners in knowing which attitude to adopt towards patients with work-related suffering. These reflections are seen in the light of the changes of contemporary society.

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Doctor, I feel pain in my chest

Shakeel Kautbally, François Simon, Alisson Slimani, Christophe Beauloye Published in the journal : October 2018 Category : Examens cliniques

In general practice, chest pain is a very common clinical complaint. The general practitioner’s decision to refer a patient to hospital is mainly based on chest pain characterization, patient's cardiovascular history, as well as electrocardiographic and hemodynamic changes. Acute coronary syndrome (ACS) remains the main diagnostic challenge. In this case, a coronary angiography must generally be performed, but the delay will depend on the type of ACS. ST-segment elevation myocardial infarction (STEMI) requires rapid transport to the emergency room, given that the time to reperfusion (time span from diagnosis to coronary reperfusion, ideally <60 min) determines the patient’s prognosis. Patients with non-ST segment infarction (NSTE-ACS) should undergo angiography within 24 to 72 hours. Platelet inhibitors (aspirin and P2Y12 receptor inhibitors) are the cornerstone of pharmacological treatment. They are generally administered over 1 year. Beyond initial diagnosis, the general practitioner also plays a crucial role in ensuring continuity of care following hospitalization, since these patients are at high risk of relapse.

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Doctor, my head is spinning…

Naïma Deggouj(1), Daniel Moens(2), Daniele De Siati(1) Published in the journal : October 2018 Category : Examens cliniques

When contacted by a patient suffering from acute vertigo or dizziness, the general practitioner needs easy clinical tools enabling him to screen for urgent and life-threatening central vestibular disorders in a timely and reliable manner. Some subjective complaints are red flags that indicate the need for a rapid medical examination before a possible referral to a neurology emergency unit. Using the HINTS tool must be further promoted, given that it proved to be specific and sensitive in detecting central vestibular disorders. After a review of the subjective symptoms and clinical signs that evoke central vestibular disorders, the article presents the most frequent peripheral vestibular disorders.

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Role of Mindfulness-Based Interventions (MBI) in general practice : case of an adolescent suffering from fatigue with school dropout

Olivier Bernard Published in the journal : October 2018 Category : Stratégies

A mother makes an appointment at her general practitioner’s (GP) clinic for her son who complains about fatigue and has dropped out of school. After a reassuring anamnesis, clinical examination, and blood tests, the process analysis highlights avoidance behavior.

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General practice and emergency medical services

Eric Marion Published in the journal : October 2018 Category : Stratégies

General practice is not a big user of emergency medical services, with less than 10% of phone calls coming from patients’ home. However, it has a key role to play in the proper functioning of the “acute cardiology” and stroke departments through patient education and rapid dialing of the 112 emergency number.

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Rational use of antibiotics in adults in general practice – from the right diagnosis to the right treatment duration

Sophie Paternostre (1), Leila Belkhir (1), Jean-Cyr Yombi (1) Published in the journal : October 2018 Category : Actualité thérapeutique

Respiratory, urinary, and cutaneous infections make up a significant proportion of general practice consultations. Few new antibiotics are available on the market and given the increase of multiresistant bacteria, a rational use of antibiotics proves necessary. Rhinopharyngitis, rhinosinusitis, and bronchitis are most often of viral origin, and treatment is therefore symptomatic. Antibiotics are only required in case of suspected bacterial superinfection, in which case treatment duration is 5 days. Among urinary tract infections, a distinction should be made between complicated and uncomplicated infections, while taking into account some specific risk factors. Both can be complicated by severe sepsis. Escherichia coli remains the predominant uropathogen. There is an increase in multiresistant bacteria, even in the community. Asymptomatic bacteriuria (AB) is common, especially among elderly people. Screening and treatment of AB are indicated only in pregnant women and patients undergoing urinary tract instrumentation with a risk of mucosal bleeding. Skin infections, such as impetigo, do not always require systemic antibiotics. This article is aimed at supplementing and updating the data of an article on the rational use of antibiotics in general medicine published in 2015 in the same journal. It additionally includes recent data on the management of pneumonia, pertussis, and skin infections.

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