[Atrial fibrillation: 2023 novelties for the general practitioner]. / Fibrillation auriculaire : nouveautés 2023 pour la médecine de premier recours.

Atrial fibrillation (AF) is the most frequent tachyarrhythmia with a significant morbimortality. The diagnosis is based on a 12 lead ECG. New technologies such as connected watches have shown similar sensibility and specificity. The new 4S scheme (Stroke risk, Symptoms, Severity of AF burden and Substrate) allows a global evaluation. Rhythm control mainly by catheter ablation is increasingly indicated. Management of cardiovascular risk factors is an essential part of the treatment of these patients.

La fibrillation auriculaire (FA) est la tachyarythmie la plus fréquente avec une morbimortalité conséquente. Le diagnostic se fait généralement par un ECG 12 pistes. Cependant, de nouvelles technologies, comme les montres connectées, ont montré d'excellents résultats avec une sensibilité et spécificité équivalentes. L'algorithme des 4S (risque d'AVC (stroke risk), sévérité des symptômes (symptoms), temporalité de la FA (severity of AF burden) et comorbidités (substrate)) permet une évaluation globale de la FA propre à chaque patient. L'indication à la stratégie de contrôle du rythme, principalement l'ablation par cathéter, devient plus fréquente. Le contrôle des facteurs de risque cardiovasculaire fait partie intégrante du traitement.

[Teaching conflicts of interest with industry as a « role model ¼]. / Enseigner les conflits d'intérêts avec l'industrie ­ l'importance du « modèle de rôle ¼.

General practitioners should be trained to teach their student about conflicts of interest with the private sector. Beyond the common issues linked to biomedical research and publications, the daily repercussions of these conflicts of interest on medical practice and prescribing must be recognized, whether it be about medical representatives, gifts, or continuing medical education. Only with a complete understanding of these daily challenges to professional ethics will it be possible to represent an appropriate "role model" for students.

Les médecins de famille doivent savoir enseigner aux étudiantes les enjeux concrets des conflits d'intérêts avec l'industrie. S'il est essentiel de connaître en amont l'importance de ces conflits dans la recherche et les publications biomédicales, il est tout aussi crucial de mesurer les implications pratiques de conflits rencontrés dans la pratique quotidienne, qu'il s'agisse de rendez-vous avec les représentantes médicauxales, de cadeaux offerts par l'industrie, ou encore de financement privé pour la formation continue. C'est par la connaissance de ces influences quotidiennes et la mise en œuvre d'un code de conduite strict dans leur pratique que les médecins de famille, comme « modèles de rôle ¼ possibles, peuvent transmettre une approche déontologique solide aux étudiantes sur la question des conflits d'intérêts avec l'industrie.

Awaking insomnia: sleeplessness in the 19th century through medical literature.

Sleep disorders have received growing public and scientific attention in the last decades. Scientific research and publications on sleeplessness are ongoing and considerable progress has been made on the medical understanding of sleep. And yet, insomnia affects an ever-growing number of people around the globe and remains both a difficult and common complaint general practitioners have to deal with on a daily basis. Sleeplessness is not new, although its transformation from a state of accepted wake to that of exasperating insomnia is a relatively recent transition in which, this article argues, Western medicine took an active part. In the 19th century, the theorisation of different nervous disorders and later of neurasthenia shaped the transformation of insomnia from a constituent of everyday life into a pathology. Based on research in French medical journals published in the second half of the 19th century, this article retraces a succession of medical paradigms for sleeplessness, including 'symptomatic insomnia', 'nervous insomnia' and interestingly, 'insomnia' as a key element in neurasthenia theories. The analysis of medical discourse in all successive theories reveals the decisive influence of physicians in the medicalisation of insomnia, their sociocultural representations echoing patient's complaints as well as professional imperatives.

"Alcochoix+": controlled drinking within a structured programme - a cohort study in Switzerland.

AIMS OF THE STUDY: Controlled drinking as a therapy goal for problematic alcohol use is still a matter for debate, especially with regard to dependent drinkers. Furthermore, few structured controlled drinking programmes have been evaluated. The aim of this study was to observe the evolution of excessive and dependent drinkers in a French-language six-step controlled drinking programme called “Alcochoix+”. METHODS: This was a cohort study of patients in four centres in the French-speaking part of Switzerland who were enrolled between May 2010 and September 2011, and evaluated before and up to 1 year after completion of the programme, according to criteria such as drinking habits, evolution of the Alcohol Use Disorder Identification Test (AUDIT) score and quality of life indicators. We considered the patients who chose not to be followed up to have unchanged alcohol consumption. RESULTS: Recruitment was slow: 60 persons were enrolled, mostly middle-aged men, with excessive alcohol use / moderate alcohol dependence (median AUDIT score 20.5, median weekly alcohol consumption 350 g). Thirty-four participants (56.7%) completed the programme and their median weekly alcohol reduction was 160 g. The mean AUDIT score decreased to 14.1 points. Several aspects of quality of life improved. Changes were stable 1 year after the programme. Expressed satisfaction with the programme was high. CONCLUSIONS: This six-step structured controlled drinking programme designed for excessive drinkers also attracted moderately dependent drinkers. Those who had participated fully in the study significantly reduced their alcohol consumption, with a slight improvement in their quality of life. Future studies should identify the barriers to problem drinkers integrating controlled drinking programmes, and to underline the role of these programmes for moderately dependent drinkers.