[Prevention recommendations for transgender persons]. / Recommandations de prévention chez les personnes transgenres.

Transgender people are at risk of being in worse health than the cisgender population. On the one hand, they encounter specific health problems, mostly related to the impact of minority stress on their mental and somatic health. On the other hand, the preventive recommendations usually do not account for gender-affirming hormonal or surgical treatments that can alter their biologic or anatomic risk profile. The health of transgender people is an area in which research is yet sparse, professionals seldom trained, and where uncertainty remains. The aim of this review article is to summarize the current state of knowledge and propose recommendations for clinical practice.

Les personnes transgenres sont à risque d'avoir une moins bonne santé que la population cisgenre. D'une part, elles rencontrent des problématiques de santé spécifiques, majoritairement en lien avec l'impact du stress minoritaire sur leur santé mentale et somatique. D'autre part, les conseils de prévention habituels ne prennent que rarement en compte l'éventuel recours à des traitements hormonaux ou chirurgicaux d'affirmation de genre pouvant modifier les profils de risque sur les plans biologiques ou anatomiques. La prévention chez les personnes transgenres est une thématique pour laquelle la recherche est peu fournie, les professionnel-le-s peu formé-e-s et l'incertitude présente. Cet article a pour objectif de faire le point sur l'état actuel des connaissances et de proposer des recommandations pour la pratique clinique.

[Deep vein thrombosis: new developments and recommendations for the primary care physician]. / Thrombose veineuse profonde : nouveautés et recommandations pour le médecin de premier recours.

The management of deep vein thrombosis is becoming more specific in terms of diagnostic methods and drug treatments. The use of the dichotomous Wells' score is now established. The indications for direct oral anticoagulants have expanded. Prevention and management of the post-thrombotic syndrome are based on compression socks. Their use is individualized and needs repeated assessments in time. This article presents the latest developments and outlines principles involved in the management of superficial, distal and deep vein thrombosis in primary care.

La prise en charge de la thrombose veineuse profonde se précise en termes de méthode diagnostique et de traitements médicamenteux. L'utilisation du score de Wells dichotomique s'est imposée et les indications des anticoagulants oraux se sont élargies. Le port de bas de compression pour la prévention et la prise en charge du syndrome post-thrombotique est maintenant individualisé et basé sur une évaluation répétée dans le temps. Cet article présente ces dernières nouveautés et expose les éléments nécessaires à la prise en charge des thromboses superficielles, distales et profondes en médecine de premier recours.

[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.

[The combination of GLP-1 analogs and SGLT2 inhibitors : new perspectives ?] / Association des analogues du GLP-1 et des inhibiteurs du SGLT2 : de nouvelles perspectives ?

Type 2 diabetes therapy has expanded considerably over the last decade. Two anti-diabetic therapeutic groups, which are GLP-1 (glucagon-like peptide-1) receptor agonists and SGLT2 inhibitors (sodium-glucose co-transporter-2), have shown efficacy not only on glycemic control but also on weight and other parameters that will be detailed in this article. Cardiovascular safety studies for two of these molecules were shown for the first time to decrease overall and cardiovascular mortality. The combination of these two therapeutic classes provides a logical solution due to their different mechanisms of action. The DURATION-8 study designed to demonstrate the benefits of this combination will also be discussed in this article.

La thérapie du diabète de type 2 s'est considérablement élargie les dix dernières années. Deux groupes thérapeutiques antidiabétiques, qui sont les analogues du GLP-1 et les inhibiteurs du SGLT2 ont montré une efficacité non seulement sur le contrôle glycémique mais aussi sur le poids et sur d'autres paramètres cliniques et biologiques qui seront détaillés dans cet article. Les études de sécurité cardiovasculaire pour deux de ces molécules ont montré pour la première fois une baisse de la mortalité globale et cardiovasculaire. La combinaison de ces deux classes thérapeutiques offre une solution logique de par leurs différents mécanismes d'action. L'étude DURATION-8 conçue pour démontrer le bienfait de cette combinaison sera aussi discutée dans cet article.

Multimorbidity and clinical reasoning through the eyes of GPs: a qualitative study.

OBJECTIVES: Despite the high prevalence of patients suffering from multimorbidity, the clinical reasoning processes involved during the longitudinal management are still sparse.This study aimed to investigate what are the different characteristics of the clinical reasoning process clinicians use with patients suffering from multimorbidity, and to what extent this clinical reasoning differs from diagnostic reasoning. DESIGN: Given the exploratory nature of this study and the difficulty general practitioners (GPs) have in expressing their reasoning, a qualitative methodology was therefore, chosen. The Clinical reasoning Model described by Charlin et al was used as a framework to describe the multifaceted processes of the clinical reasoning. SETTING: Semistructured interviews were conducted with nine GPs working in an ambulatory setting in June to September 2018, in Geneva, Switzerland. PARTICIPANTS: Participants were GPs who came from public hospital or private practice. The interviews were transcribed verbatim and a thematic analysis was conducted. RESULTS: The results highlighted how some cognitive processes seem to be more specific to the management reasoning.Thus, the main goal is not to reach a diagnosis, but rather to consider several possibilities in order to maintain a balance between the evidence-based care options, patient's priorities and maintaining quality of life. The initial representation of the current problem seems to be more related to the importance of establishing links between the different pre-existing diseases, identifying opportunities for actions and trying to integrate the new elements from the patient's context, rather than identifying the signs and symptoms that can lead to generating new clinical hypotheses. The multiplicity of options to resolve problems is often perceived as difficult by GPs. Furthermore, longitudinal management does not allow them to achieve a final resolution of problems and that requires continuous review and an ongoing prioritisation process. CONCLUSION: This study contributes to a better understanding of the clinical reasoning processes of GPs in the longitudinal management of patients suffering from multimorbidity. Through a practical and accessible model, this qualitative study offers new perspectives for identifying the components of management reasoning. These results open the path to new research projects.