La Revue de médecine interne
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The objective of this short narrative literature review is to highlight the different difficulties encountered by medical doctor in the daily use of EMR. We show that these are not simple transitional phenomena related to a "resistance to change", but rather the fact of a deeper and unfinished transformation. ⋯ Our question concerns the compatibility of the multiple objectives of EMR, the potential influence of computerization on the steps of entering and consulting medical information, the impact on the clinical reasoning, the reality of assistance to medical "performance". The question is not so much what EMRs do less well than the paper record, but to provide insights into how tomorrow's EMRs will do better than today's.
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Patients with sickle cell trait (SCT) are commonly considered as asymptomatic carriers. However, some clinical manifestations may occur. ⋯ SCT may cause acute ischemic complications in a context of prolonged hypoxia or dehydration. The most commonly reported are the splenic infarct and the renal papillary necrosis. A study of hemoglobin should be considered in these clinical situations in patients with compatible ethnic origin.
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To investigate the clinical features of venous thrombosis in patients with Behçet's disease and to determine the patients at high risk for this complication. ⋯ Compared to patients without venous thrombosis, patients with Behcet's disease with venous thrombosis are younger, are predominantly male, have a lower frequency of ocular and articular involvement and present an unusual topography of the thrombosis.
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The ageing of the population leads health professionals to question the tolerance and the effectiveness of the different biotherapies used in autoimmune diseases. Due to the exponential increase of biotherapies and their indications, several studies have been carried out to evaluate their impact on elderly patients suffering from autoimmune disease. However, these studies are still too few to take into account all the different specificities of elderly patients and their comorbidities; prescribers are therefore hesitant with their introduction after 75 years or even 65. ⋯ This focus aims to remind of the adaptations and contraindications of the different biological disease-modifying anti-rheumatic drugs for geriatric population, and improve their uses since the treatments for these patients are sometimes not enough. Here we resume the methods allowing supervisors to identify errors of clinical reasoning in medical students and interns and we explain remediation techniques adapted to the types of error identified. Access to short illustrative videos of a MOOC (Massive Open On line Course) devoted to the supervision of clinical reasoning constitutes practical help for supervisors who are not expert in the complexity of medical pedagogy at the bedside.