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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Hypermobile Ehlers– Danlos syndrome: overview of signs, symptoms, and treatments after a thwarted history

Stéphane Daens Published in the journal : October 2018 Category : Actualités du médecin généraliste

Ehlers-Danlos syndrome (EDS) is the most common inherited connective tissue disorder, primarily affecting collagen and estimated to concern 1 or 2% of the general population. A set of new criteria and nosology was published in 2017. The hypermobile EDS (hEDS) subtype is a multi-systemic disease that can affect all organs. Patients suffer from many clinical signs and diversified symptoms.

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SGLT-2 inhibitors in type 2 diabetes care

Martin Buysschaert, Vanessa Preumont (1) Published in the journal : October 2018 Category : Actualité thérapeutique

SGLT-2 inhibitors (gliflozins) are a new therapeutic class for managing Type 2 diabetes, acting by their glucoretic effect. Along with their glycemic action, these agents likewise exhibit cardiovascular and renal benefits.

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PCSK9 inhibitors in therapeutic arsenal of cardiovascular risk management

Olivier S. Descamps Published in the journal : October 2018 Category : Actualité thérapeutique

In clinical practice, it may at times prove difficult to attain the recommended LDL cholesterol levels due to either high initial levels or low drug tolerance. The 2003 discovery of a new protein named PCSK9 (proprotein convertase subtilisin/kexine Type 9), involved in the metabolism of LDL particles, led to the development of several monoclonal antibodies that neutralize this protein (evolocumab from Amgen, alirocumab from Sanofi/REGENERON, and bocozicumab from Pfizer). When combined with statins and ezetimibe, these agents cause a highly significant reduction in LDL cholesterol levels, associated with very good safety profiles and tolerance, along with significant benefits in terms of cardiovascular prevention. Therefore, they constitute an additional therapeutic strategy to help patients reach their LDL cholesterol targets, especially those with severely elevated cholesterol levels, as observed in familial hypercholesterolemia cases.

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Affective, relational, and sexual life of people with disabilities: resources to inform and get informed

Virginie Koopmans(1), Marie-Aude Moreau(1), Joëlle Berrewaerts(1), Nathalie Michaux Published in the journal : September 2018 Category : Congrès de médecine sexuelle

This article provides ideas to all health professionals willing to advise people with disabilities about their affective, relational, and sexual life. After presenting the Handicap and Sexuality Resource Center (Namur, Belgium), an institution present throughout the Walloon territory, several resources will be explored (evenings with institutions, educational tools, websites, etc.). Nowadays, this issue is more often taken into consideration. However, existing needs are still far from being met..

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Cancer and sexuality

Marie Nuytten, Laurence Faugeras, Lionel D’Hondt Published in the journal : September 2018 Category : Congrès de médecine sexuelle

Sexual repercussions of cancer and its treatments have long been considered of minor importance. However, the sexual dimension of cancer patients has recently been given particular consideration, resulting in an increased scientific interest and the development of international guidelines. In this paper, we detail the main sexual disorders encountered by both male and female cancer patients. Women are mostly affected by dyspareunia and decreased libido, while erectile dysfunction and decreased libido are predominant in men. These disorders may have a major impact on the couple’s life. We also describe the sexual adverse effects induced by the different cancer treatments and provide some advices and nonpharmacological treatments to manage them.

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How to address sexuality with a couple?

Christine Reynaert(1), Thomas Dubois(1), Marcello Di Gregorio(2), Nathalie Michaux(3) Published in the journal : September 2018 Category : Congrès de médecine sexuelle

Working with the couple is of real interest in many medical situations, and particularly in the field of sexology. This article highlights the benefits of working with the couple, proposes different communication strategies, and comes to the conclusion that working in the relational system of patients is part of medical practice.

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How to address sexuality with a woman during medical consultation?

Nathalie Michaux(1), Maria-Laura Marotta(2), Marcelo Di Gregorio(3), Christine Reynaert(4) Published in the journal : September 2018 Category : Congrès de médecine sexuelle

This article explains in a very concrete way how to approach sexuality with a female patient during a consultation, irrespective of the medical specialty.

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How to address sexuality with a man?

Marcelo Di Gregorio MD1, Francis Lorge MD(1), Christine Reynaert MD(2), Nathalie Michaux MD(3) Published in the journal : September 2018 Category : Congrès de médecine sexuelle

a sexological consultation is a delicate task that requires a specific approach. The first difficulty in managing a sexual problem is to get the issue on the table. Patients visit their physician because of problems concerning sexuality/ sexual activity and their consequences. The question is whether general practitioners prefer to avoid answering these questions or if they are willing to respond actively. If so, to what extent are they able to answer the patient’s question? And would they agree to attend specific training courses and to work in collaboration with specialists within a network system. This work’s aim was to provide tools for acquiring and mastering specific medical knowledge and practical skills regarding male sexual disorders (erectile dysfunction, ejaculation and libido disorders) and to facilitate the acquisition of communication skills for the consultation (doctor / patient relationship). 

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