1,721,544 research outputs found
Polypharmacie chez les patients âgés : peut-on arrêter certains médicaments? [editorial].
No full textGuidelines for thyroid disorders in older people outdated
Full text linkDie Standard-Therapie bei Unterfunktion der Schilddrüse sind Tabletten, welche das Schilddrüsenhormon ersetzen. Die Ergebnisse der bisher grössten Studie zum Thema, welche heute im New England Journal of Medicine veröffentlicht werden, stellen diese Praxis nun aber infrage.Le traitement actuel par substitution hormonale d’une baisse de la fonction thyroïdienne est remis en question. Publiée dans le journal scientifique The New England Journal of Medicine, la plus grande étude réalisée à ce jour, montre que cette pratique médicale n’apporte pas de bénéfice.The standard treatment for a mildly underactive thyroid gland is thyroid hormone substitution with tablets. The results of the yet largest study today published in The New England Journal of Medicine, however, question the benefits of this practice
Evidence and controversies regarding the screening for subclinical hypothyroidism in patients with cardiovascular disease.
No full textQuality improvement in primary care: toward the provision of safe, high value, patient-centered, sustainable, and data-informed care.
No full textIn Switzerland, due to the growth and ageing of population, primary health care needs are increasing, especially for the management of chronic diseases and multimorbidity. Physicians are keen to improve the quality of care for their patients, and several inspiring initiatives have been conducted to monitor or improve the quality and safety of primary care in Switzerland. However, most of these initiatives were local and not funded on a sustained basis. Currently, there is no comprehensive approach of quality improvement (QI) in primary care and the culture of QI remains relatively weak, especially regarding monitoring and external accountability. There has never been a national QI program in primary care. Further, there is no national monitoring of quality and safety in primary care, including to track low value care and linked avoidable healthcare costs. We therefore recommend building a national strategy aiming to (1) set up a monitoring system for the quality and safety of primary care, (2) strengthen a culture of QI in primary care, (3) improve the quality of primary care through evidence-based and monitored interventions, (4) reduce low value care, and (5) support experiments to test QI initiatives. This strategy should be defined with citizens, patients, primary care physicians, allied health care providers (e.g., pharmacists), experts in health monitoring, health insurers, and health authorities, under the aegis of medico-scientific institutions with expertise in primary care as well as healthcare research and monitoring. Such a strategy would be key toward the provision of safe, high value, patient-centered, sustainable, and data-informed care
Recommandations de prise en charge des dyslipidemies en 2016 en Suisse.
No full textDiscordance between American guidelines and the "Swiss medical Board" position regarding treatment of dyslipidemia raised many questions. While benefits of statins are clear in secondary prevention, care should be individualised according to PROCAM cardiovascular risk score adapted to Switzerland in primary prevention. Lifestyle modification should be the first line therapy and a drug therapy is an option in high or intermediate risk, but not anymore in low cardiovascular risk. Familial dyslipidemia, often identified only after first cardiovascular event, should not be missed, as particular care is needed and riskscores cannot be used in this situation. Statins adverse effects remain a challenge in daily clinical practice.La discordance entre les recommandations américaines et la prise de position restrictive du « Swiss Medical Board » sur la prise en charge des dyslipidémies a soulevé de nombreuses questions. Alors que le bénéfice des statines est clair en prévention secondaire, il faut individualiser l’approche selon le score de risque cardiovasculaire de PROCAM, adapté à la Suisse en prévention primaire. Les modifications du style de vie sont prioritaires et un traitement médicamenteux est une option lors de risque élevé ou intermédiaire mais n’est plus recommandé lors de risque faible. Il ne faut pas manquer les dyslipidémies familiales, souvent identifiées qu’après le premier événement cardiovasculaire et nécessitant une prise en charge particulière, les scores de risque n’étant pas fiables dans ces maladies. Les effets indésirables des statines restent un défi au quotidien
Inhibiteurs de la PCSK9 : un nouveau traitement pour l’hypercholestérolémie
No full textThe proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors appear to represent an important development in the management of hypercholesterolemia. US Food and Drug Administration and European Medicines Agency approved alirocumab and evolocumab, injected drugs administered subcutaneously every 2 or 4 weeks, for patients with hypercholesterolemia, such as those who not reached the cholesterol targets or those with intolerance to statin, especially in secondary prevention or familial hypercholesterolemia. This decision is based on several clinical trials suggesting that these drugs have a powerful effect on levels of LDL-cholesterol with an acceptable safety compared to placebo. Large clinical studies are currently performed to assess the impact of PCSK9 inhibitors on major adverse cardiovascular events in secondary prevention.Le traitement de l’hypercholestérolémie entre dans une nouvelle phase de développement avec la mise sur le marché prochaine des inhibiteurs de la proprotéine convertase subtilisine/kexine de type 9 (PCSK9). La Food and Drug Administration (FDA) et l’Agence européenne des médicaments (EMA) ont approuvé récemment l’alirocumab et l’évolocumab, des anticorps monoclonaux injectables par voie sous-cutanée toutes les deux ou quatre semaines contre la PCSK9, pour le traitement de l’hypercholestérolémie chez les patients avec une intolérance ou une réponse insuffisance aux statines, surtout en prévention secondaire ou en cas d’hypercholestérolémie familiale. Cette décision est basée sur plusieurs essais cliniques montrant que les inhibiteurs de la PCSK9 baissent le LDL-cholestérol comparés au placebo, alors que les études sont en cours pour évaluer l’impact sur les événements cardiovasculaires
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