Publication of november-december 2024

  • At the Heart of Current Medical Challenges

 

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Geriatry

Dynamic care project: prevention is better than… Between life...

Palliative care is recognized as a way to improve the quality of life and satisfaction of patients and their families, and even to optimize the use of health care services. However, it is implemented too little and too late for people with advanced chronic illnesses – and even more so for those suffering from non-cancer diseases. One of the main reasons for this is the “prognostic paralysis” that physicians face. Progressive chronic illnesses actually tend to have unpredictable trajectories, making it uncertain when the time is right to initiate end-of-life discussions. Various tools are available to help general practitioners identify patients who would benefit from a palliative approach, initiate such discussions, and assess potential unmet needs. Other tools exist to guide highly emotional conversations, to which physicians should add communication training to acquire the skills necessary to lead these complex discussions.

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Gynécologie

What’s new in contraception?

Physicians have an important role to play in the choice of a contraceptive method and in advising of their patients, who are strongly influenced by social media. They need to keep up to date with the latest developments in this area.

This article reviews the novelties in female and male contraceptives that have been commercialized these last five years and, to a limited extent, those expected in the future.

The progestogen-only pill containing drospirenone and the estro-progestogen pill containing estetrol are the main innovations in female contraception.

There has been a lot of research on male contraceptives for many years, which has not yet resulted in new products on the market. Thermal male contraception is not recognized, but is increasingly used by our patients.

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Oncologie médicale

First-line treatment in metastatic clear cell renal cell...

Metastatic clear cell renal cell carcinoma (ccRCC) is a major challenge for clinicians. Although immunotherapy has revolutionized the management of patients with ccRCC, responses remain inconsistent and often transient, ultimately leading to therapeutic resistance. As a result, new strategies have been developed involving novel molecules with innovative mechanisms of action. This review sheds light on the pathogenic mechanisms and the advances in therapeutic strategies for metastatic ccRCC.

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Nephrology

Cystic kidney diseases: beyond autosomal dominant polycystic...

In this article, we discuss the differential diagnosis of cystic kidney diseases based on a case of oro-facio-digital syndrome type 1. Establishing the correct diagnosis requires a multidisciplinary approach that includes clinical, radiologic, and genetic evaluations to better understand the prognosis, renal and extra-renal management, and specific genetic implications of each disease. Our case illustrates the importance of a detailed personal and family history taking and the significant diagnostic input provided by new genetic sequencing techniques.

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Nephrology

From screening to management of chronic kidney disease, we can...

Despite being a major public health problem, chronic kidney disease is often underdiagnosed. Measurement of glomerular filtration rate and albuminuria should be offered regularly to patients with comorbidities such as diabetes, hypertension, and/or cardiovascular disease. Early diagnosis of chronic kidney disease is essential for optimal management, especially given the availability of new therapies aimed at reducing the risk of progression and the occurrence of cardiovascular complications.

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Banque de sang

Transfusion safety: when we say 2, it’s 2!

Patient identification is an essential step in hospital risk management and a key factor in transfusion safety. When taking a blood sample, the probability of mistaking a person’s identity is estimated at around 1/2,000. This can lead to diagnostic errors and/or inappropriate therapeutic patient management. In addition, the impact in terms of transfusion safety is major because mistaken identity can lead to ABO incompatibility, which can be fatal, as will be explained below. The causes of identitovigilance errors are diverse, but human factors are predominant. As part of the risk management process, various measures can be implemented to reduce the risk of WBIT (Wrong Blood in Tube): determining a patient’s blood group using two samples taken at different times plays a very important role. Staff training, adherence to procedures, and incident analysis are also essential and valuable tools. Finally, patient involvement in the safety of their care must become a “standard of care”.

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STOPP/START.v2

The tool STOPP / START.v2 allows evaluation of drug treatments prescribed to patients age 65 and older.

 

This tool, designed for all care settings, stimulates thinking and challenging medication taken by patients, especially drugs forcardiovascular and nervous system.

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