Revue medicale suisse最新文献

The major challenges facing our healthcare system foster the emergence of new inter-professional roles such as the Specialized Nurse Practitioner. These professionals, recognized by a legal framework, hold advanced practice medical and nursing skills obtained after a 120-credit Master's-level university training. In 2018, the Emergency Department (ED) of the Centre Hospitalier Universitaire Vaudois was one of the first departments in Switzerland to implement such a role. Three years on, their clinical expertise and the developments in research, training and clinical projects make these professionals major assets in meeting the complex needs of patients and ED teams.

Racism remains a major obstacle in access to quality healthcare. Understanding the concept and definition of racism in healthcare remains unclear for many. This first article in a series on racism in health care, aims to clarify the different forms of racism in health care, their influence on access to health care, and propose measures to limit their influence in the care of racialized groups.

When a deep vein thrombosis (DVT) is suspected, management should begin with a well-defined diagnostic approach based on clinical evaluation and pre-test probability, D-dimer testing, and venous ultrasound. Once the diagnosis is confirmed, it is important to differentiate between proximal and distal DVT, as their treatment strategies differs. While numerous robust studies with a high level of evidence are available for proximal DVT, the optimal management of distal DVT remains debated. Overall, treatment is based on elastic compression and therapeutic anticoagulation, with direct oral anticoagulants used in most cases. The duration of anticoagulation mainly depends on the risk of venous thromboembolism recurrence.

Tumor lysis syndrome is a metabolic emergency resulting from a massive destruction of cancer cells. This is often associated with hematological malignancies, such as non-Hodgkin's lymphoma and acute leukemia, but the incidence tends to increase for solid tumors with the development of oncological treatments. Due to a poor prognosis, it is essential to recognize this syndrome early. In this article, we review the physiopathology, preventive strategies and treatments. A case of tumor lysis syndrome in the context of small cell lung carcinoma is described as an example.

Gender dysphoria, which describes the distress related to the incongruence between a transgender person's experienced gender and their assigned sex at birth, can be alleviated by specific treatments, notably through gender-affirming hormone therapy and surgeries. Transgender people suffer from an excess of cardiovascular and thrombotic risk, of multifactorial origin and influenced by hormonal therapies and surgeries. In this article, we describe the basis of hormonal treatments for transgender people. The associated thrombotic and cardiovascular risks are detailed, along their mechanisms. Finally, the clinical situations and patient profiles requiring a specialized consultation when making decisions about gender-affirming treatment are discussed.

Abnormal uterine bleeding (AUB) are common in adolescents and young adults. They may be secondary to inherited bleeding disorders such as von Willebrand disease or platelet function disorders. These conditions are often under-recognized, leading to diagnostic delays and inadequate management. Treatments include hormonal and hemostatic options, tailored to the individual patient's needs and underlying hemostatic disorder. A coordinated approach between gynecologists, pediatricians, and hemostasis specialists is crucial to optimize management and improve patients' quality of life. This article explores the epidemiology, diagnostic approach, and multidisciplinary management of AUB in people with inherited bleeding disorders.

Historically known as idiopathic carotidynia or Fay syndrome, Transient Perivascular Inflammation of the Carotid artery (TIPIC) is a rare condition characterized by inflammation and pain in the carotid artery. Its diagnosis involves a specific clinico-radiological presentation. It is important to be aware of this rare diagnosis given its benign evolution and more serious differential diagnoses. This article reviews this entity through the case of a 37-year-old woman who presented with headache and left neck pain and was diagnosed with TIPIC syndrome.