L'acquisition du référentiel technique pastoral et les potentialités fourragères du pâturage de Mouriaye.

International audienc

« C’est normal qu’on mollisse ou qu’on vieillisse » : faut-il aborder le déclin fonctionnel avec les personnes âgées en médecine de famille ?

Pour répondre au vieillissement de la population, des initiatives de dépistage et de prise en charge des problèmes de santé liés à l’âge sont mises en place, notamment en médecine de famille. Les résultats préliminaires d’une étude qualitative suggèrent que les personnes âgées sont ambivalentes face à la notion d’anticipation des problèmes, tendent à les banaliser et à être réticentes à en parler spontanément à leur médecin. Cependant, elles trouvent pertinent que ce dernier aborde le sujet avec des questions spécifiques, ceci permettant d’initier une discussion sur des problématiques sensibles. Les possibilités de prise en charge des syndromes gériatriques et du déclin fonctionnel semblent peu connues des patient-e-s. Le dépistage permet donc d’aborder ces problématiques et d’informer les patient-e-s au sujet de solutions existantes. [Among the health strategies to respond to the aging of the population, initiatives for the screening and management of age-related health issues are implemented, including in family medicine. Preliminary results of a qualitative study suggest that elderly people are ambivalent about anticipating age-related issues, tend to trivialize them and to be reluctant to discuss them spontaneously with their doctors. However, they find relevant that their family doctor brings up the topic with specific questions, because that allows initiating a discussion about some of these sensitive issue. It appears that the awareness of the existing management of geriatric syndromes and functional decline possibilities is rather low. A screening initiative is therefore an opportunity to address these different issues and to inform patients about existing solutions.]]]> fre oai:serval.unil.ch:BIB_7917561D1F2C 2022-05-07T01:20:55Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_7917561D1F2C Good and Bad Days: Fluctuations in the Burden of Informal Dementia Caregivers, an Experience Sampling Study. info:doi:10.1097/NNR.0000000000000243 info:eu-repo/semantics/altIdentifier/doi/10.1097/NNR.0000000000000243 info:eu-repo/semantics/altIdentifier/pmid/29095373 Pihet, S. Moses Passini, C. Eicher, M. info:eu-repo/semantics/article article 2017 Nursing research, vol. 66, no. 6, pp. 421-431 info:eu-repo/semantics/altIdentifier/eissn/1538-9847 urn:issn:0029-6562 <![CDATA[Informal dementia caregivers (IDCs) are often confronted with important fluctuations in care-related burden, commonly described as "good and bad days." These fluctuations are overlooked by traditional questionnaires focusing on the average experience. The experience sampling method (ESM) is based on the repeated collection of data in everyday life, thereby allowing the description of day-to-day fluctuations in IDC burden, and the identification of their correlates. ESM studies are still scarce among IDCs, with none focusing on day-to-day fluctuations in burden. This ESM study aimed to examine day-to-day fluctuations in the burden of IDCs and test their associations with six moment-to-moment predictors. Primary IDCs (N = 26, median age = 68 years, 77% women, 73% spouses) volunteered to answer questions about their daily burdens, patients' memories and behavioral problems (MBP), caregivers' MBP-related distress, psychological distress, self-efficacy and positive affects, and relationship quality; volunteers did this every evening for 2 weeks on a touchpad, resulting in 206 measures. Data were analyzed with multilevel linear regression. Day-to-day fluctuations covered about two thirds of the total variance for most study variables. All six predictors had a significant bivariate relation with daily burden, explaining 15%-32% of its fluctuations, with significant differences between caregivers in the strength of these relations. The best multivariate model explained 51% of the day-to-day fluctuations in burden. It included caregiver MBP-related distress, psychological distress, and relationship quality. This innovative study of IDC burden shows that day-to-day fluctuations are an important part of caregivers' real-life experiences and that half of this variability is predicted by currently understudied factors. Inviting caregivers to monitor clinical outcomes daily over 1 or 2 weeks could help tailor interventions to their individual needs and also empower them

Adult native septic arthritis: a review of 10 years of experience and lessons for empirical antibiotic therapy.

Objectives To review the epidemiology of native septic arthritis to establish local guidelines for empirical antibiotic therapy as part of an antibiotic stewardship programme. Methods We conducted a 10 year retrospective study based on positive synovial fluid cultures and discharge diagnosis of septic arthritis in adult patients. Microbiology results and medical records were reviewed. Results Between 1999 and 2008, we identified 233 episodes of septic arthritis. The predominant causative pathogens were methicillin-susceptible Staphylococcus aureus (MSSA) and streptococci (respectively, 44.6% and 14.2% of cases). Only 11 cases (4.7%) of methicillin-resistant S. aureus (MRSA) arthritis were diagnosed, among which 5 (45.5%) occurred in known carriers. For large-joint infections, amoxicillin/clavulanate or cefuroxime would have been appropriate in 84.5% of cases. MRSA and Mycobacterium tuberculosis would have been the most frequent pathogens that would not have been covered. In contrast, amoxicillin/clavulanate would have been appropriate for only 75.3% of small-joint infections (82.6% if diabetics are excluded). MRSA and Pseudomonas aeruginosa would have been the main pathogens not covered. Piperacillin/tazobactam would have been appropriate in 93.8% of cases (P &lt; 0.01 versus amoxicillin/clavulanate). This statistically significant advantage is lost after exclusion of diabetics (P = 0.19). Conclusions Amoxicillin/clavulanate or cefuroxime would be adequate for empirical coverage of large-joint septic arthritis in our area. A broad-spectrum antibiotic would be significantly superior for small-joint infections in diabetics. Systematic coverage of MRSA is not justified, but should be considered for known carriers. These recommendations are applicable to our local setting. They might also apply to hospitals sharing the same epidemiology

Do ultra-runners in a 24-h run really dehydrate?

Background: Loss of body mass during a 24-h run was considered to be a result of dehydration. Aims: We intended to quantify the decrease in body mass as a loss in fat mass or skeletal muscle mass and to quantify the change in hydration status. Methods: Body mass, fat mass, skeletal muscle mass, haematocrit, plasma sodium and urinary specific gravity were measured in 15 ultra-marathoners in a 24-h run. Results: Body mass decreased by 2.2kg (p=0.0009) and fat mass decreased by 0.5kg (p=0.0084). The decrease in body mass correlated to the decrease in fat mass (r=0.72, p=0.0024). Urinary specific gravity increased from 1.012 to 1.022g/mL (p=0.0005). Conclusions: The decrease in body mass and the increase in urinary specific gravity indicate dehydration. The decrease in body mass was correlated to the decrease in fat mass and therefore not only due to dehydratio

Studenten am Hausärzte-Kongress in Arosa

Medizinstudenten an einem Hausärztekongress? Vor 10 Jahren noch undenkbar, heute eine Realität. Dieser Beitrag schildert kurz die Entwicklung des «Studentenprojekts » am H ausärzte-Kongress Arosa und zeigt, dass ein innovatives Weiterbildungsformat auch bei angehenden Ärzten Interesse wecken kann

PHP64 Reorganisation of Hospital Emergency Services: A Business Case for Quality Improvement

In Switzerland, emergency care has no gatekeeping system and emergency wards are increasingly overcrowded by walk-in patients. This leads to inefficient use of spezialised resources. Treatment costs are paid by public sources and, beyond some co-payment, reimbursed by health care insurances via tariffs. Given the problems above, a public hospital (Stadtspital Waid; Zurich; catchment population 180'000 people) reorganised its emergency service in 2008. A nurse led triage system and a General Practitioner-led emergency service was implemented beside the conventional emergency ward

Tibial or hip BMD predict clinical fracture risk equally well: results from a prospective study in 700 elderly Swiss women

Summary: In a randomly selected cohort of Swiss community-dwelling elderly women prospectively followed up for 2.8 ± 0.6years, clinical fractures were assessed twice yearly. Bone mineral density (BMD) measured at tibial diaphysis (T-DIA) and tibial epiphysis (T-EPI) using dual-energy X-ray absorptiometry (DXA) was shown to be a valid alternative to lumbar spine or hip BMD in predicting fractures. Introduction: A study was carried out to determine whether BMD measurement at the distal tibia sites of T-EPI and T-DIA is predictive of clinical fracture risk. Methods: In a predefined representative cohort of Swiss community-dwelling elderly women aged 70-80years included in the prospective, multi-centre Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture risk (SEMOF) study, fracture risk profile was assessed and BMD measured at the lumbar spine (LS), hip (HIP) and tibia (T-DIA and T-EPI) using DXA. Thereafter, clinical fractures were reported in a bi-yearly questionnaire. Results: During 1,786 women-years of follow-up, 68 clinical fragility fractures occurred in 61 women. Older age and previous fracture were identified as risk factors for the present fractures. A decrease of 1 standard deviation in BMD values yielded a 1.5-fold (HIP) to 1.8-fold (T-EPI) significant increase in clinical fragility fracture hazard ratio (adjusted for age and previous fracture). All measured sites had comparable performance for fracture prediction (area under the curve range from 0.63 [LS] to 0.68 [T-EPI]). Conclusion: Fracture risk prediction with BMD measurements at T-DIA and T-EPI is a valid alternative to BMD measurements at LS or HIP for patients in whom these sites cannot be accessed for clinical, technical or practical reason

Consumers on critique: a survey of classical music listeners’ engagement with professional music reviews

Music criticism has a long tradition as a leading agent in the classical music discourse. However, some people question its function in the contemporary music market. We explored the topicality of classical music critique by asking: Who reads professional reviews today? And what do readers expect from review? Through an online survey (English/German), we profiled the listening habits of classical music listeners (N = 1200) and their engagement with professional reviews. Our participants were more actively engaged with music, but contrary to the ‘highbrow’ stereotype, not more highly musically trained than the general population. They consumed music and opinion sources in a variety of ways. Approximately two-thirds (n = 741) of the participants had recently engaged with professional reviews, which were perceived as the most useful form of opinion, followed by short written commentaries and, lastly, ratings. A multiple logistic regression model suggested that the typical consumer of professional music critique was older with higher levels of musical engagement and education, had a higher inclination to purchase music and lower usage of streaming services, and had a preference for detailed reviews from traditional sources (e.g. newspapers). According to review readers, reviews should cover a variety of topics and offer evaluations underpinned with reasons. Reviewers should be constructive, open-minded, respectful, and well informed; their professional background was less relevant. Professional reviews should not necessarily provide a recommendation on what to buy, but rather guide listeners’ musical appreciation and understanding. Professional criticism still has an audience, although more so among older, musically educated listeners. Critics need to explore various channels in order to connect to a new generation of classical music listeners