Transfert de connaissances en médecine : La médecine fondée sur les preuves et les médecins suisses installés, une étude transversale

Objectif Le but de ce travail était de décrire l'attitude des médecins suisses installés envers la médecine fondées sur les preuves ou EBM (evidence-based medicine), ainsi que d'éventuelles différences significatives parmi eux et de comparer les résultats avec ceux d'autres pays, afin d'évaluer l'implémentation d'EBM chez ces médecins. Méthode Ce travail est une étude transversale portant sur l'analyse de 4 questions : « Mon attitude à l'égard d'EBM est... », « A mon avis, l'attitude de mes collègues à l'égard d'EBM est... », « Pratiquer EBM améliore la prise en charge des patients » et « Je sais où trouver des informations de qualité pour tenir à jour mes connaissances médicales » venant du questionnaire « Transfert des connaissances en médecine» mené par l'IUMSP. La population cible est les médecins suisses installés des spécialités suivantes : Orthopédie et traumatologie, psychiatrie et psychothérapie, cardiologie et diabétologie ainsi que médecine interne générale et médecins praticiens. L'échantillon sélectionné est de 6400 médecins. Ils ont été contactés par courrier électronique ou postal. La collecte des résultats a eu lieu du 14 mai au 18 août 2014. Les résultats ont été traité de manière descriptive puis des différences significatives dans les réponses selon les modalités : genre, région linguistique, spécialité, âge ont été investiguées avec un test du Chi2 significatif à p<0.05. Résultats Il y a eu 985 médecins qui ont répondu (taux de participation de 15.4%). Les médecins suisses installés ont une attitude positive à 86% à l'égard d'EBM. Par contre, ils pensent que 73% de leurs collègues ont une attitude positive envers EBM. Ils sont 82% à être d'accord avec le fait que pratiquer EBM améliore la prise en charge des patients et 92% sont d'accord avec le fait de savoir où trouver des informations de qualité pour tenir à jour leurs connaissances médicales. Ces résultats se retrouvent dans les études similaires des autres pays. Les médecins suisses romands sont plus négatifs envers EBM. Les orthopédistes et traumatologues pensent que leurs collègues sont plus négatifs envers EBM. Les psychiatres osent moins répondre à propos de l'attitude supposée de leurs collègues. Les médecins femmes de Suisse romande sont moins d'accord avec le fait que pratiquer EBM améliore la prise en charge des patients. Les psychiatres sont moins d'accord avec le fait qu'ils savent où trouver des informations de qualités pour maintenir à jour leurs connaissances médicales. Les cardiologues et diabétologues, par contre, sont plus d'accord avec ce fait. Conclusion Malgré des différences significatives diffuses, les médecins installés suisses sont fortement favorables envers EBM et ce qu'elle apporte pour la prise en charge de leur patient. Ils sont également à l'aise pour trouver les informations nécessaires pour maintenir leurs connaissances médicales. Ce constat est retrouvé dans d'autres pays également. Le mouvement EBM qui a débuté pendant la seconde moitié du 20ème siècle s'est maintenant bien intégré dans les habitudes et pratiques des médecins installés suisses

The Degasperis-Procesi equation as a non-metric Euler equation

In this paper we present a geometric interpretation of the periodic Degasperis-Procesi equation as the geodesic flow of a right invariant symmetric linear connection on the diffeomorphism group of the circle. We also show that for any evolution in the family of $b$-equations there is neither gain nor loss of the spatial regularity of solutions. This in turn allows us to view the Degasperis-Procesi and the Camassa-Holm equation as an ODE on the Fr\'echet space of all smooth functions on the circle.Comment: 17 page

The geometry of a vorticity model equation

We provide rigorous evidence of the fact that the modified Constantin-Lax-Majda equation modeling vortex and quasi-geostrophic dynamics describes the geodesic flow on the subgroup of orientation-preserving diffeomorphisms fixing one point, with respect to right-invariant metric induced by the homogeneous Sobolev norm $H^{1/2}$ and show the local existence of the geodesics in the extended group of diffeomorphisms of Sobolev class $H^{k}$ with $k\ge 2$.Comment: 24 page

Primary care physicians' knowledge and attitudes towards genetic testing for breast-ovarian cancer predisposition

Background: Primary health care providers are expected to be directly involved in the genetic testing for cancer susceptibility. This study assessed physicians' knowledge, attitude and perception of their role towards testing for hereditary breast-ovarian cancer. Design: A mail-in survey was sent to all general practitioners, internists, obstetrician-gynecologists and oncologists in private practice in Geneva county, Switzerland. Questions included socio-demographic variables, knowledge about hereditary breast-ovarian cancer, attitude towards testing and assessment of their role in the pre- and post-test procedure. Results: Two hundred fifty-nine (65%) of four hundred questionnaires were returned of which two hundred forty-three (61%) were analysed. Response rates were similar between specialties; women answered more frequently. The majority of the respondents (87%) approved of genetic susceptibility testing. The most common objection to testing was the absence of approved strategies for the prevention and detection of early breast cancer. Most physicians felt they had an active part to play in the pre-test procedure, the disclosure of results, and especially the consultants' long-term care and support (99%). Physicians correctly answered a third (32%) of the knowledge questions. The abstention rate for individual items ranged from 13% to 60%. Scores varied by specialty. Oncologists were more knowledgeable than gynecologists, internists and general practitioners. Conclusions: The majority of the primary care physicians in this study have a favourable attitude and are ready to play a prominent role in genetic counseling and testing for breast-ovarian cancer predisposition. Defective knowledge scores, however, underline the need for targeted educational program

Solar/hydrogen systems assessment. Volume 1: Solar/hydrogen systems for the 1985 - 2000 time frame

Opportunities for commercialization of systems capable of producing hydrogen from solar energy were studied. The hydrogen product costs that might be achieved by the four selected candidate systems was compared with the pricing structure and practices of the commodity gas market. Subsequently, product cost and market price match was noted to exist in the small user sector of the hydrogen marketplace. Barriers to and historical time lags in, commercialization of new technologies are reviewed. Recommendations for development and demonstration programs designed to accelerate the commercialization of the candidate systems are presented

Pilot Experiments with Electrodialysis and Ozonation for the Production of a Fertilizer from Urine

Pilot tests were performed with a process combination of electrodialysis and ozonation for the removal of micropollutants and the concentration of nutrients in urine. In continuous and batch experiments, maximum concentration factors up to 3.5 and 4.1 were obtained, respectively. The desalination capacity did not decrease significantly during continuous operation periods of several weeks. Membrane cleaning after 195 days resulted in approximately 35% increase in desalination rate. The Yeast Estrogen Screen (YES), a bioassay that selectively detects oestrogenic compounds, confirmed that about 90% of the oestrogenic activity was removed by electrodialysis. HPLC analysis showed that ibuprofen was removed to a high extent, while other micropollutants were below the detection limit. In view of the fact that ibuprofen is among the most rapidly transported micropollutants in electrodialysis processes, this result indicates that electrodialysis provides an effective barrier for micropollutants. Standardised plant growth tests were performed in the field with the salt solution resulting from the treatment by electrodialysis and subsequent ozonation. The results show that the plant height is comparable to synthetic fertilisers, but the crop yield is slightly lower. The latter is probably caused by volatilisation losses during field application, which can be prevented by improved application technologies

Agrin isoforms and their role in synaptogenesis

Agrin is thought to mediate the motor neuron-induced aggregation of synaptic proteins on the surface of muscle fibers at neuromuscular junctions. Recent experiments provide direct evidence in support of this hypothesis, reveal the nature of agrin immunoreactivity at sites other than neuromuscular junctions, and have resulted in findings that are consistent with the possibility that agrin plays a role in synaptogenesis throughout the nervous system