Feasibility and acceptability of a primary care mentoring programme for undergraduate students.

Mentoring plays a crucial role in increasing the attractiveness of primary care careers for medical students. Based on a literature review and structured group discussions, the authors developed a primary care mentoring platform centred on undergraduate medical students' needs. All second- to sixth-year students were invited to enrol into the programme by choosing a mentor from an online platform, which was pilot tested during one academic year (2021-2022) with 16 mentors. Fifteen mentees enrolled into the pilot programme. The evaluation assessed the procedures' feasibility as well as the student-centeredness and acceptability of the programme. Mentees completed a quantitative survey evaluating satisfaction and the mentoring relationship's personal and content aspects. Mentors' feedback was collected during focus groups discussing the programme's acceptability and practical aspects. Both mentees and mentors expressed high levels of satisfaction with the programme. Mentees rated their mentoring relationships highly across most aspects. Mentees' content-related needs included postgraduate training, meeting an inspiring person, work-life balance, and questions about running a private practice. Mentors described the programme as a rewarding experience. They enjoyed the flexible structure that allowed them to adapt to the mentees' individual needs. Maintaining the relationship was mostly the mentors' responsibility. Further structured guidance from the programme coordinators was identified as potentially beneficial for future implementation. The findings highlight the feasibility and the advantages of a flexible, student-centred mentoring programme. The programme attracted students interested in primary care from all levels of undergraduate education. Such programmes may contribute to fostering students' interest in primary care careers.

[Tobacco use : guidelines for primary care physicians]. / Aide au sevrage tabagique : recommandations pour les médecins de premier recours.

Tobacco use affects about 25% of the population and is the most important modifiable risk factor for many diseases, namely cancers, cardiovascular and pulmonary diseases. The role of the primary care physician is essential in providing screening and brief intervention to all patients, particularly to those at higher risk. This will help them to quit smoking, or adopt risk reduction strategies, according to their own wish. The main interventions include motivational support, nicotine replacement therapy and other medications. Vaping has been proved to be efficient for tobacco withdrawal and is still studied as a risk reduction tool. At the moment, it is considered by some as twenty times less harmful than smoked tobacco.

La consommation de tabac concerne environ 25 % de la population et est le facteur de risque modifiable le plus important pour de nombreuses pathologies, dont les cancers et les atteintes cardiovasculaires et pulmonaires. Le rôle du médecin de premier recours est primordial dans le dépistage et l'intervention brève chez tous les patients, notamment ceux à plus haut risque, afin d'aider à l'arrêt de la consommation ou à la mise en place de mesures de réduction des risques, selon leur souhait. Les principales stratégies comprennent, en plus de l'accompagnement, les substituts nicotiniques et les approches médicamenteuses. Le vapotage a aujourd'hui démontré son efficacité pour l'arrêt du tabac et, tout en étant encore à l'étude comme moyen de réduction des risques du tabac, il est estimé comme étant jusqu'à vingt fois moins nocif que ce dernier.

[Detection and management of patients with clinical high risk for psychosis]. / Détection et prise en charge des patients avec états mentaux à risque de psychose.

This article explores best practices for managing patients with Clinical High Risk for psychosis with a particular focus on the role of general practitioners and pediatricians. It offers clear guidelines for the assessment and monitoring of these patients, highlighting early warning signs, screening tools, and appropriate interventions. Additionally, the article lists local resources available for healthcare professionals to ensure optimal and coordinated care. By providing this information, this article aims to equip general practitioners and pediatricians with the necessary knowledge to effectively identify and manage this patient profile, while connecting them to the appropriate available resources.

Cet article explore les meilleures pratiques pour la prise en charge des états mentaux à risque de psychose avec un accent particulier sur le rôle des généralistes et des pédiatres. Il propose des directives claires pour l'évaluation et le suivi de ces patients, en mettant en lumière les premiers signes avant-coureurs, les outils de dépistage et les interventions appropriées. En outre, l'article recense les ressources locales disponibles pour les professionnels de santé, afin d'assurer une prise en charge optimale et coordonnée. En fournissant ces informations, il vise à mieux armer les généralistes et pédiatres des connaissances nécessaires pour identifier et gérer efficacement ces patients, tout en les connectant aux ressources adéquates disponibles.

[Sex and gender issues in the organisation of tomorrow's medicine]. / Enjeux de sexe et de genre dans l'organisation de la médecine de demain.

Medicine is evolving with increasing feminization and the rise of part-time work. Women now outnumber men among graduates but are underrepresented in leadership roles and in the highest-paid specialties. To meet these economic and organisational challenges, this article proposes a number of courses of action. In addition to an overall increase in the number of medical training places to compensate for retirement and the development of interprofessional integrated care structures, support for academic promotion and management positions for women, as well as an increase in the financial value of professional and non-remunerated activities, are all solutions to be considered. These changes will ensure that medicine is inclusive, efficient and of high quality.

La médecine évolue avec une féminisation croissante et l'émergence de nouveaux modes de travail. Les femmes sont majoritaires parmi les diplômé-es mais sous-représentées aux postes de cadres et dans les spécialités à plus haut revenus. Pour répondre à ces défis économiques et organisationnels, cet article propose des pistes d'actions. En plus d'une augmentation globale des places de formation médicale pour pallier les départs en retraite et du développement de structures interprofessionnelles de soins intégrés, un soutien aux promotions académiques et aux positions de cadres pour les femmes ainsi qu'une revalorisation financière des activités professionnelles et non rémunérées sont autant de solutions à envisager. Ces changements assureront une médecine inclusive, de plus grande efficience et de qualité.

[Eco-competences for a sustainable medical practice]. / Les écocompétences pour une pratique de soins durable en cabinet.

Climate and environmental changes require primary care physicians to adapt their practices. This article presents resources and actions contributing to reduce the impact of medical practice by implementing the CanMEDS competences in an environmental perspective.

Les changements climatiques et environnementaux nécessitent une adaptation des pratiques de soins des médecins de premier recours (MPR). Cet article a pour but de présenter des ressources et actions concrètes ancrées dans le cadre des compétences CanMEDS et permettant de réduire l'impact environnemental de la pratique médicale en cabinet.

[Gender and sexual diversity medicine:ensuring equity in health care delivery]. / Médecine et diversité sexuelle et de genre : assurer l'équité dans les soins de santé.

The literature on the subject systematically shows that LGBTIQ+ people suffer from a worse health status than heterosexual and cisgender people. They are subject to more medical errors, discriminations, and delays in receiving care. They face many specific barriers in their access to care. Health institutions and health care professionals have the responsibility to adapt to the specific health needs of LGBTIQ+ people and to offer quality healthcare free from discrimination. This article highlights these barriers and proposes strategies to overcome them, both at individual and organisational levels.

Les études sur le sujet démontrent de manière systématique que les personnes LGBTIQ+ présentent un moins bon état de santé que la population hétérosexuelle et cisgenre. Elles sont plus souvent victimes d'erreurs médicales, de délais dans la prise en soins et de discrimination, et elles rencontrent des barrières spécifiques d'accès aux soins. Les institutions de santé et les professionnel-le-x-s y travaillant ont la responsabilité de s'adapter aux besoins de santé spécifiques aux personnes LGBTIQ+ afin de leur offrir des soins de qualité, inclusifs et libres de discrimination. Cet article a pour objectif de décrire ces barrières et de proposer des stratégies pour y remédier, tant au niveau individuel qu'organisationnel.

[What's new in addiction medicine in 2021 ?] / Addictions.

Addiction medicine is influenced by societal changes and the environment has an impact on addictive behaviors and how they are experienced. The COVID-19 pandemic has had an impact on addictive behaviors, some of which could be favorable, and others highlight vulnerabilities to be considered by clinicians. Recent legislative changes open possibilities to limit the negative impact of electronic lotteries. In a context favorable to a better acceptance of people of LGBTQIA+ diversity, research and training in addiction medicine also have a role to play. In view of advances in understanding the harmful effects of alcohol, it is necessary to adapt the perception of the risk, in order not to provoke the incomprehension in the population.

La médecine des addictions est liée aux enjeux sociétaux actuels, et l'environnement joue un rôle important sur les comportements addictifs et comment ils sont vécus. La pandémie de Covid-19 a eu un impact sur les comportements addictifs, dont certains pourraient être positifs et d'autres mettent en lumière des vulnérabilités à prendre en compte en clinique. Les récents changements législatifs ouvrent des possibilités pour limiter l'impact négatif des loteries électroniques. Dans le contexte favorable à une meilleure acceptation des personnes issues de la diversité LGBTQIA+ (lesbienne, gay, bisexuel·le, transgenre, queer, intersexe et asexuel·le ou aromantique), la recherche et la formation en médecine des addictions ont aussi un rôle à jouer. Au vu des avancées dans la connaissance des effets nocifs de l'alcool, il est nécessaire d'adapter la perception du risque, afin de ne pas susciter l'incompréhension de la population.

Scientific publications in internal medicine and family medicine: a comparative cross-sectional study in Swiss university hospitals.

BACKGROUND: Family medicine is a relatively new academic medical discipline. We aimed to compare the main bibliometric indices of hospital-based senior physicians practicing internal medicine versus family medicine in Switzerland. METHODS: We conducted this cross-sectional study in March 2020. We selected all hospital-based senior physicians practicing internal medicine or family medicine in the six Swiss university hospitals. Using Web of Science, after removing from both groups of physicians the 5% with the highest number of publications, we extracted the number of publications, the number of publications per year, the number of citations, the number of citations per year, the number of citations per publication and the h-index. We compared the data between the two groups using negative binomial regressions and the proportion of physicians having at least one publication using chi-square tests. RESULTS: We included 349 physicians in the study (internal medicine: 51%, men: 51%). The median number of publications was three [interquartile range (IQR) = 18], the median number of citations was nine (IQR = 158) and the median h-index was one (IQR = 5). All bibliometric indices were similar in both groups, as was the proportion of physicians having at least one publication (family medicine: 87% versus 82%, P = 0.15). CONCLUSIONS: We found no association between the bibliometric indices and the medical specialty. Further studies are needed to explore other important indicators of academic output, such as those more specifically assessing its quality and scientific importance.

[Bias in the consultation : What tools for the clinician ?] / Biais dans la consultation : quels outils pour le·la clinicien·ne ?

Implicit biases are a daily occurrence during medical consultations. Biases disrupt the clinical judgment and modify the attitude of the practitioner. They are a source of medical errors and they impact negatively all indicators of quality of care. Biases are rooted in collective stereotypes and individual prejudice and can contribute to sexual harassment and discrimination. Developing strategies to reduce stereotypes and their impact must be a part of any program targeting sexual harassment, sexism or discrimination of any kind. This article offers an understanding of the essence of biases, based on complex cognitive processes, and proposes strategies to increase awareness at the individual and collective level.

Les biais implicites sont quotidiens lors de la consultation médicale. Perturbant le jugement clinique et l'attitude des professionnel·le·s, ils peuvent être à l'origine d'erreurs médicales et avoir un impact négatif sur l'ensemble des indicateurs de qualité des soins. Les biais peuvent avoir pour source les stéréotypes ancrés dans la société ou les préjugés de chacun·e et aboutir à une forme de discrimination. L'élaboration de stratégies permettant de réduire les stéréotypes fait donc partie intégrante de la lutte contre le harcèlement sexuel et toutes sortes de discriminations. Cet article propose des outils de compréhension de l'essence des biais, basée sur des processus cognitifs complexes, et une gamme de stratégies offrant un renforcement de la prise de conscience à l'échelle individuelle et collective pour en diminuer l'impact.

Performance of machine translators in translating French medical research abstracts to English: A comparative study of DeepL, Google Translate, and CUBBITT.

BACKGROUND: Non-English speaking researchers may find it difficult to write articles in English and may be tempted to use machine translators (MTs) to facilitate their task. We compared the performance of DeepL, Google Translate, and CUBBITT for the translation of abstracts from French to English. METHODS: We selected ten abstracts published in 2021 in two high-impact bilingual medical journals (CMAJ and Canadian Family Physician) and used nine metrics of Recall-Oriented Understudy for Gisting Evaluation (ROUGE-1 recall/precision/F1-score, ROUGE-2 recall/precision/F1-score, and ROUGE-L recall/precision/F1-score) to evaluate the accuracy of the translation (scores ranging from zero to one [= maximum]). We also used the fluency score assigned by ten raters to evaluate the stylistic quality of the translation (ranging from ten [= incomprehensible] to fifty [= flawless English]). We used Kruskal-Wallis tests to compare the medians between the three MTs. For the human evaluation, we also examined the original English text. RESULTS: Differences in medians were not statistically significant for the nine metrics of ROUGE (medians: min-max = 0.5246-0.7392 for DeepL, 0.4634-0.7200 for Google Translate, 0.4815-0.7316 for CUBBITT, all p-values > 0.10). For the human evaluation, CUBBITT tended to score higher than DeepL, Google Translate, and the original English text (median = 43 for CUBBITT, vs. 39, 38, and 40, respectively, p-value = 0.003). CONCLUSION: The three MTs performed similarly when tested with ROUGE, but CUBBITT was slightly better than the other two using human evaluation. Although we only included abstracts and did not evaluate the time required for post-editing, we believe that French-speaking researchers could use DeepL, Google Translate, or CUBBITT when writing articles in English.

Clinical usefulness of D-dimer testing in cancer patients with suspected pulmonary embolism.

Limited data are available about the diagnostic value of D-dimer testing in cancer patients with clinically suspected pulmonary embolism (PE). Therefore, we evaluated i) the safety and clinical usefulness of an ELISA D-dimer test to rule out PE in cancer patients compared with non-cancer patients and ii) whether adopting a higher D-dimer cut-off value might increase the usefulness of D-dimer in cancer patients. We analysed data from two outcome studies which enrolled 1,721 consecutive patients presenting in the emergency department with clinically suspected PE. Presence of an active malignancy was abstracted from the database. All patients underwent a sequential diagnostic work-up including an ELISA D-dimer test and a 3-month followup. Sensitivity and predictive value (NPV) were 100% in both cancer and non-cancer patients. PE was ruled out by a negative D-dimer test in 494/1,554 (32%) patients without cancer, and in 18/164 (11%) patients with a malignancy. At cut-off values varying from 500 to 900 microg/l, the sensitivity was unchanged (100%, 95% CI: 93% to 100%) and the specificity increased from 16% (95% CI: 11% to 24%) to 30% (95% CI: 22% to 39%). The 3-month thromboembolic risk was 0% (95% CI: 0% to 18%) in cancer patients with a negative D-dimer test. ELISA D-dimer appears safe to rule out pulmonary embolism in cancer patients but it is negative in only one of ten patients at the usual cut-off value. Increasing the cut-off value of D-dimer in cancer patients might increase the test's clinical usefulness.

[Prophylaxis after HIV exposure]. / Prophylaxie post-exposition au VIH.

Since the advent of antiretroviral treatment against HIV, their use as post-exposure prophylaxis, in health care workers as well as after non professional exposures, is still increasing. Although their efficacy is well documented in selected indications, one should always keep in mind that in most exposures, the risk of side effects and the cost of such an intervention is probably much higher than the low probability of HIV transmission. By balancing the risks and the potential benefits of post-exposure prophylaxis against HIV after a given exposure, if needed with help from a specialist, overprescription can in this way be avoided. The patient's fear about having contracted HIV should finally not drive one to forget the risk of transmission of other communicable disease, like viral hepatitis, tetanus and STD.