Revue médicale suisse
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Revue médicale suisse · Aug 2006
Review[Emergency department overcrowding: a legitimate reason to refuse access to urgent care for non-urgent patients?].
Non-urgent cases represent 30-40% of all ED consults; they contribute to overcrowding of emergency departments (ED), which could be reduced if they were denied emergency care. However, no triage instrument has demonstrated a high enough degree of accuracy to safely rule out serious medical conditions: patients suffering from life-threatening emergencies have been inappropriately denied care. ⋯ More recent data suggest that in fact most patients consult for appropriate urgent reasons, or have no alternate access to urgent care. The safe reduction of overcrowding requires a reform of the healthcare system based on patients' needs rather than access barriers.
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Revue médicale suisse · Jun 2006
Review[Spinal opioids: mechanisms of action and chronic pain management].
The efficacy of spinal opioids is well known, the analgesia is potent and long lasting, due to the central localization of the opioid receptors. The analgesia is intimately related to the inhibition of the nociceptive signal in the spinal cord but side effects are mainly mediated by the activation of the mu opioid receptor in the brain and the brain stem. Only a limited number of controlled clinical studies compared systemic versus spinal administration of morphine in chronic pain patients, and the real benefit for the intrathecal route remains controversial. Implanted devices for a continuous intrathecal delivery of opioids should be prescribed only to patients with intractable chronic pain for which conventional methods were previously ineffective.
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Revue médicale suisse · May 2006
Review[The Polypill: between myths and reality in the treatment of type 2 diabetes mellitus].
The Polypill: between myths and reality in the treatment of type 2 diabetes mellitus The concept of "Polypill" was developed from modeling analyses and the data were extracted from randomized-control trials and epidemiological studies. This "Polypill" should be a combination of three antihypertensive drugs associated to aspirin, a statin and folic acid. This "Polypill" would allow to reduce of more than 80% the cardiovascular events. ⋯ Numerous positive and negative reactions showed themselves further to this publication. Other approaches based on the change of lifestyle seem so effective. Nevertheless, to have a really effective approach the therapeutic educational dimension should be also included in the basic strategy.