[Physicians-pharmacists quality circles: shared responsibility of the freedom of prescription]. / Cercles de qualité médecins-pharmaciens, pour une responsabilité partagée de la liberté de 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. PPQCs provide clear educational benefits and have thus been accredited by various continuous education bodies. In this article, participating physicians and pharmacists share their vision and illustrate how they work and influence the safety and efficiency of drug prescription, a routine process complex enough to warrant sharing of its burden in a constructive interdisciplinary collaboration.

[Adaptation of clinical practice guidelines--the example of cantonal Diabetes Program]. / Adaptations des recommandations pour la pratique clinique: l'exemple du Programme cantonal Diabète de Vaud.

With the growing number of scientific publications, practitioners can use scientific knowledge synthesis, including Clinical Practice Guidelines (CPG). The practical use of a CPG implies considering the context, that is the local healthcare system and the patient. Thus, the CPG can never replace the expertise of the practitioner! Diabetes is a wide public health issue and the canton of Vaud established the cantonal Diabetes Program (cDP), to optimize the care of diabetic patients. The cDP has many projects including the adaptation of reliable CPG to local needs. We present the pros and cons of the CPG in the cDP and the methods to adapt it to the regional healthcare context, and also at an individual level.

[Scientific research in family medicine: practitioners' experience, barriers and needs]. / Recherche scientifique en médecine de famille: expériences, barrières et besoins des praticiens.

Scientific data from family medicine are relevant for the majority of the population. They are therefore essential from an ethical and public health perspective. We need to promote quality research in family medicine despite methodological, financial and logistic barriers. To highlight the strengths and weaknesses of research in family medicine in the French-speaking part of Switzerland we asked practitioners from this region to share their experience, critics and needs in relation to research. This article summarizes their contribution in light of the international literature.

Simultaneous nutritional cognitive--behavioural therapy in obese patients.

The most important problem in cognitive-behavioural therapies for obese patients is to initiate weight loss without reinforcing the eating-behavioural disorders. We propose to assess the cognitive-behavioural therapy in obese patients suffering from eating disorders with and without combining a nutritional approach based on fat information. The patients (n = 60) have followed a group treatment of 12 weekly cognitive-behavioural therapy sessions with or without a combined nutritional approach mainly focused on fat restriction. The scores for depression (P < 0.01), anxiety (P < 0.01) and eating disorders (P < 0.001) are significantly and similarly improved with both types of treatments. The mean weight loss is significant (P < 0.001) only after a combined nutritional cognitive-behavioural approach. The Eating Disorders Inventory (EDI) subgroup 'Drive for thinness' remains only in a combined therapy (ANOVA P < 0.01), which could explain the weight loss that only occurs in this group. Finally, the association between a cognitive-behavioural therapy and a nutritional learning process improves the anxiety and depression related to eating disorders as well as the weight loss.

[Association of a giant Meckel's diverticulum and Crohn disease of the neighboring intestinal segments]. / Association d'un diverticule de Meckel géant et d'une maladie de Crohn des segments de grêle avoisinants.

We report the case of a 51-year old patient presenting a giant Meckel's diverticulum associated with Crohn's disease in the proximal and the distal segments. The voluminous diverticulum had already been demonstrated by radiographies at the age of 28 years. Late symptoms were signs of partial obstruction and malabsorption.