Revue médicale suisse
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Revue médicale suisse · Nov 2010
[Electromagnetic navigation bronchoscopy for the assessment of peripheral lung nodules].
Among recent technological progress, electromagnetic navigational bronchoscopy (ENB), based on the principle of "GPS", allows the bronchoscopist to reach parenchymal lesions situated beyond the field of regular bronchoscopy. Compared to CT-scan guided transthoracic needle aspiration, the yield is lower (65%). ⋯ Moreover, the yield remains stable also for cases associated to a lower yield of the transthoracic approach (small and/or deep and/or benign lesion). Beyond the diagnosis of peripheral lung nodules, ENB (alone or in combination with endobronchial ultrasound) is also an efficient and safe tool for disease staging by simultaneous (during the same procedure) sampling of associated hypermetabolic lymph nodes.
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Revue médicale suisse · Nov 2010
[Idiopathic interstitial pneumonia: classification and diagnostic work-up].
Idiopathic interstitial pneumonias represent a group of complex lung diseases among which the most frequent types are idiopathic pulmonary fibrosis (IPF), idiopathic non-specific interstitial pneumonia (idiopathic NSIP), and cryptogenic organizing pneumonia (COP). Clinicians may rely on a precise classification of these diseases from an America-European consensus that has been published in 2002. However it appears that diagnosis should always be confirmed by a multidisciplinary team discussion with experience in the field. There are generally tremendous prognostic and therapeutic implications for the patient.
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Revue médicale suisse · Nov 2010
[Non invasive ventilation outside of the intensive care: principles and modalities].
Non invasive ventilation encompasses all techniques of ventilatory support which do not require an endotracheal approach. Interfaces are available for coping with most situations, with an acceptable control of leaks, of patient comfort, even in severely ventilator dependant subjects. ⋯ Pressure assisted ventilation with PEEP (bi-level positive airway pressure) has become in most centres the "default approach". A thorough understanding of modes and settings is required for optimal adjustment of NIV, patient comfort and treatment efficacy.
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Revue médicale suisse · Nov 2010
Review[Role of C-reactive protein in the diagnosis, prognosis and follow-up of community-acquired pneumonia].
Community-acquired pneumonia (CAP) is a major clinical problem in terms of morbidity, mortality, and use of hospital resources. It is well recognized that a delay in making the diagnosis and instituting appropriate antibiotic treatment is associated with an increased mortality. ⋯ But its usefulness is not known. The aim of this systematic review was to evaluate the usefulness of CRP in the diagnosis, prognosis and follow-up of CAP.
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Revue médicale suisse · Nov 2010
[The new postgraduate training program in general internal medicine: implications for the primary care physician].
The Swiss postgraduate training program in general internal medicine is now designed as a competency-based curriculum. In other words, by the end of their training, the residents should demonstrate a set of predefined competences. Many of those competences have to be learnt in outpatient settings. ⋯ The mini-CEX (mini-Clinical Evaluation eXercise) is the assessment tool proposed by the Swiss institute for postgraduate and continuing education. The mini-CEX is based on the direct observation of the trainees performing a specific task, as well as on the ensuing feedback. This article aims at introducing our colleagues in charge of residents to the mini-CEX, which is a useful tool promoting the culture of feedback in medical education.