Recherche d’informations médicales sur internet par les internes et médecins généralistes en France‎ : des intentions à la pratique

Objectifs : Si Internet occupe désormais une place centrale dans la recherche d’information des médecins, il ne permet pas de répondre à toutes les problématiques posées en contexte clinique. L’objectif de cette étude était d’analyser les attitudes et comportements des internes et médecins généralistes français, au cours de leurs recherches d’informations médicales sur Internet : connaître les thèmes de leurs recherches, les obstacles rencontrés et les stratégies pour les contourner. Méthode : Étude qualitative par focus groups. Échantillonnage raisonné conduit au sein d’une population d’internes de médecine générale et de médecins généralistes, permettant d’assurer la variabilité de l’échantillon. Résultats : Cinq focus groups ont été analysés, regroupant les verbatims de 35 participants. Il existait une grande variété des thèmes de recherches couvrant toutes les compétences de la médecine générale. Les praticiens utilisaient une liste restreinte de sites, bien maîtrisés, permettant l’obtention rapide d’une réponse. La fiabilité intervenait peu dans le choix des sites, car difficile à évaluer selon les participants. Les critères d’évaluation étaient la présentation, l’apparence du site, l’ergonomie. Plus rarement intervenaient l’indépendance du secteur industriel, la mise à jour des données, le niveau de preuve, et les références des sources. L’objectif de la recherche était le plus souvent de confirmer les connaissances existantes. Les médecins utilisaient souvent Google en ayant conscience des conséquences sur la qualité de leurs recherches. Les stratégies de recherches variaient selon le temps disponible. Conclusion : Les pratiques médicales ont fortement évoluées ces dernières années. Le développement d’Internet facilite la recherche d’information, mais une amélioration des outils reste encore nécessaire. Une adaptation des sources de données, et le développement d’une « culture de recherche » facilitera la mise en place d’une médecine factuelle

Behavior and attitudes of residents and general practitioners in searching for health information: From intention to practice

International audiencePhysicians are increasingly encouraged to practice evidence-based medicine (EBM), and their decisions require evidence based on valid research. Existing literature shows a mismatch between general practitioners' (GPs) information needs and evidence available online. The aim of this study was to explore the attitudes and behavior of residents in general medicine and GPs when seeking medical information online

Comportement des internes et des généralistes dans la recherche d'informations de santé : de l'intention à la pratique

International audienceContexte: Les médecins généralistes sont désormais encouragés à pratiquer une médecine fondée sur les preuves ou evidence-based medicine (EBM). Cela consiste à combiner son expertise clinique aux données de la science, en tenant compte de la situation de soins et en intégrant les valeurs et les attentes du patient aux propositions qui lui seront faites. Beaucoup de données actualisées des connaissances médicales sont aujourd’hui accessibles par Internet. Il existe pourtant des freins à la recherche efficiente d’information médicale en ligne par le généraliste : le manque de temps ou de repères dans la navigation sur Internet ou la quantité trop importante d’informations à analyser

Association of LIfestyle for BRAin health risk score (LIBRA) and genetic susceptibility with incident dementia and cognitive decline

International audienceINTRODUCTION: Evaluating whether genetic susceptibility modifies the impact of lifestyle-related factors on dementia is critical for prevention.METHODS: We studied 5170 participants from a French cohort of older persons free of dementia at baseline and followed for up to 17 years. The LIfestyle for BRAin health risk score (LIBRA) including 12 modifiable factors was constructed at baseline (higher score indicating greater risk) and was related to both subsequent cognitive decline and dementia incidence, according to genetic susceptibility to dementia (reflected by the apolipoprotein E [APOE] ε4 allele and a genetic risk score [GRS]).RESULTS: The LIBRA was associated with higher dementia incidence, with no significant effect modification by genetics (hazard ratio for one point score = 1.09 [95% confidence interval, 1.05; 1.13]) in APOE ε4 non-carriers and = 1.15 [1.08; 1.22] in carriers; P = 0.15 for interaction). Similar findings were obtained with the GRS and with cognitive decline. DISCUSSION: Lifestyle-based prevention may be effective whatever the genetic susceptibility to dementia

Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study

Abstract Background For the elderly population living at home, the implementation of professional services tends to mitigate the effect of loss of autonomy and increases their quality of life. While helping in avoiding social isolation, home services could also be associated to different healthcare pathways. For elderly patients, Emergency Departments (EDs) are the main entrance to hospital where previous loss of autonomy is associated to worst hospital outcomes. Part of elderly patients visiting EDs are still admitted to hospital for having difficulties coping at home without presenting any acute medical issue. There is a lack of data concerning elderly patients visiting EDs assisted by home services. Our aim was to compare among elderly patients visiting ED those assisted by professional home services to those who do not in terms of emergency resources’ use and patients’ outcome. Methods A multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period on March 2016.Consecutive patients living at home aged ≥80 years were included. The primary objective was to assess the risk of mortality for patients assisted by professional home services vs. those who were not. Secondary objectives included admission rate and specific admission rate for “having difficulties coping at home”. The primary endpoint was in-hospital mortality. Cox proportional-hazards regression model was used to test the association between professional home services and the primary endpoint. Multi variables logistic regressions were performed to assess secondary endpoints. Results One thousand one hundred sixty-eight patients were included, median age 86(83–89) years old,32% were assisted by professional home services. The overall in-hospital mortality rate was 7%. Assisted patients had more investigations performed. Home services were not associated with increased in-hospital mortality (HR = 1.34;95%CI [0.68–2.67]), nor with the admission rate (OR = 0.92;95%CI [0.65–1.30]). Assisted patients had a lower risk of being admitted for “having difficulties coping at home” (OR = 0.59;95%CI [0.38–0.92]). Conclusion Professional home services which assist one-third of elderly patients visiting EDs, were not associated to lower in-hospital mortality or to an increased admission rate. Assisted patients were associated to a lower risk of being admitted for «having difficulties coping at home».Professional home services could result in avoiding some admissions and their corollary complications. Trial registration Clinicaltrial.gov - NCT02900391, 09/14/2016, retrospectively registered </jats:sec