[Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. / Examen pelvien en gynécologie et obstétrique : recommandations pour la pratique clinique.

OBJECTIVE: To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS: A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS: The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS: The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS: The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.

[Family pharmacy: survey of a sample of patients in Midi-Pyrénées]. / La pharmacie familiale : enquête auprès d'un échantillon de patients en Midi-Pyrénées.

OBJECTIVE: Possession of drugs at home in the family pharmacy and self-medication are at risk. METHOD: Appraisal based upon an analysis of 247 questionnaires completed by patients and 116 questionnaires completed by general practitioners in the French department of Haute Garonne (Southwestern, France). RESULTS: Two hundred and forty-four patients were involved in the study. In 80% of cases, women were in charge of family pharmacy who was located in 66% of cases in a unsecurise room and could be reached by children in 17% of cases. Drugs most frequently found: antiseptics (97%), paracetamol (91%), anti-inflammatory drugs (68%), anti-diarrhea (60%). For the physicians 52 useable questionnaires, 80% of physician were confronted with one of three risks: self-medication, drug autolysis, poisoning in children. CONCLUSION: Women are the referent of the family pharmacy. The doctors seem best placed to a message of prevention through minimal advice.

[Applicability of the HYVET study in primary care practice. Results of a preliminary cross-sectional study]. / Applicabilité de l'étude HYVET en pratique courante de soins primaires. Résultats d'une etude transversale préliminaire.

OBJECTIVE: The management of high blood pressure after 80 years is an issue in general practice. In 2008, the HYVET study supported the benefit and security of antithypertensive therapy in that population. In a preliminary study, we compared the characteristics of hypertensive patients over 80 years seen in daily practice to those included in the HYVET study: is the HYVET message transferable to daily practice? MATERIAL AND METHOD: A transversal study was conducted in 2008. We offered general practitioners working in private practices to collect demographic and clinical characteristics, medical history, dependence level and treatments of hypertensive patients over 80 years seen in consultation or during home visits. RESULTS: Twelve investigators included 128 patients. Age and sex were close to those in the HYVET study. Contrary to the HYVET study, almost all of our patients (99%) were already treated, out of which approximately 80% received a polytherapy. Moreover, in our population, the prevalence of diabetes was three times higher, and our patients presented history of cardiovascular diseases. Nearly one third were dependent or presented cognitive disorders, which were exclusion criteria in the HYVET study. CONCLUSION: These results suggest that antihypertensive treatments are already commonly prescribed in patients over 80 years in general medicine. The marked increase in iatrogenic risk factors in the studied population makes it difficult to apply the conclusions of the HYVET study regarding the safety of antihypertensive treatments. These conclusions remain to be confirmed by a new transversal study developed during the second semester 2010.