Background. Tendinopathies are a type of musculoskeletal disorder, accounting for 12.6% of general practice consultationsprescribed for this condition. Several meta-analyses concerning their topical forms have been conducted, supporting their efficacy in relieving certain musculo-skeletal disorders, albeit with low levels of evidence quality.Objective. To assess the efficacy of topical NSAIDs in the management of tendinopathies.Methods. A systematic review of the literature was carried out by searching the main medical literature databases. Only randomised trials evaluating a topical NSAID against placebo in the treatment of tendinopathies were included. Their risk of bias was assessed using the RoB2 (risk of bias 2) method. The outcome measure assessed was improvement in pain on movement. The level of evidence from the RCTs (randomised controlled trials) was assessed using the REB (Rebuild the evidence base) method.Results. Four trials with a low risk of bias were included, covering four active substances. The trials on diclofenac epolamine, ketoprofen and niflumic acid were conclusive regarding the resolution of pain on movement. The trial on diclofenac alone was inconclusive regarding this outcome measure. The assessment of efficacy using the REB method concluded that there was ‘convincing evidence to be confirmed’ for diclofenac epolamine and niflumic acid, and a ‘signal’ to be confirmed for ketoprofen. It concluded that there was a lack of evidence for diclofenac alone, indomethacin, piroxicam and ibuprofen.Conclusion. Of all the topical NSAIDs available, only diclofenac epolamine and niflumic acid have established efficacy, with a sufficient level of evidence. These results should be confirmed by a second randomised clinical trial with a low risk of bias.
Jean Sébastien Cadwallader, Julie Gilles de la Londe, Christine Hassler, Massimiliano Orri, Nathalie Godart, Bruno Falissard, Caroline Huas
Introduction. Eating disorders, which are common in the general population, are associated with severe psychiatric and physical comorbidities. Early detection of EDs would improve the prognosis for patients with EDs. General practitioners (GPs) are often cited as the key players in the early detection of EDs, whilst the patients concerned do not seem to discuss this during consultations. There is little data to explain this discrepancy.Objective. To compare GPs’ perceptions of their care for patients with EDs with those of patients with EDs regarding the role of their GP in their care pathway and treatment.Methods. A qualitative study using a grounded theory approach. GPs participating in the General Practice Observatory’s database were recruited; they in turn recruited patients with eating disorders whom they were treating in their practices. Individual interviews were conducted, and a constant comparative analysis contrasting GP and patient perspectives, with triangulation by three researchers, was carried out.Results. 24 GPs and 6 female patients were interviewed. The four categories identified were: 1) Eating disorders: a condi-tion rarely encountered by GPs, despite the patients’ long-standing family and personal problems; 2) The encounter bet-ween the GP and the patient with an eating disorder: the clash between the two parties and the relief brought by the dis-closure of the disorder; 3) Managing the eating disorder on a day-to-day basis: the patients’ isolation and shame, and the GPs’ initial sense of helplessness; 4) A fundamental therapeutic alliance: the GP as a trusted figure, but with the risk of emotional dependence.Discussion. An impasse was observed between GPs feeling helpless and incompetent and patients experiencing shame and isolation. GPs appeared to adopt a biopsychosocial approach to patients with eating disorders, were able to draw on specific networks within tertiary care, and needed to address their own negative perceptions. It seems important to remind GPs of the need to identify low self-esteem in adolescents as a marker for eating disorders, and to utilise emotion-focused practice groups.
Manon Chabrat, Delphine Teigné, Aurélie Gaultier, Cédric Rat, Sandrine Hild
Background: The decision decision-aid (lamammo lamammo-etvous.fr) was designed to support women s decision on whether or not to take part in organised breast cancer screening (DOCS) via mammography.Objectives: To assess its acceptability among women and healthcare professionals. The secondary objective was to assess its impact on women s knowledge, decision decision-making conflict and intention to participate in DOCS.Method: A cross cross-sectional survey involving a beta test of the DA, conducted in France in 2023 at three health centres. Healthcare professionals (general practitioners, midwives and gynecologists) were involved. Women were invited to take part whilst waiting in the consultation room. The questionnaire for healthcare professionals assessed the acceptability and real real-world use of the DA. The questionnaire for women assessed acceptability, level of knowledge, decision conflict (DCS DCS-10) and intention to participate in the DOCS before and after readingthe DA.Results: 18 healthcare professionals and 55 women completed the questionnaires. Acceptability was good among both women and healthcare professionals. The tool was considered useful (66.7% of healthcare professionals and 77.6% of women), clear and relevant. Reading the DA significantly increased the women s level of knowledge (10.15 vs 12.18; p < 0.001), reduced decision decision-making conflict (20.19 vs 31.70; p < 0.001), and did not alter their motivation to participate in the DOCS (9.46 vs 9.41; p = 0.742). The evaluation revealed differences in perception between women and healthcare professionals: 50% of healthcare professionals consideredthe text too long, compared with only 10.2% of women ( p < 0.001). The information was perceived as biased against the DOCS by 38.9% of healthcare professionals, compared with 2.0% of women (p < 0.001).Conclusion: This acceptability study found that reading this DA, which was well well-received by healthcare professionals and women alike, significantly increased women s level of knowledge, reduced decision decision-making conflict, and did not alter their motivation to participate in the DOCS. These findings will need to be confirmed by larger larger scale studies.
This editorial highlights the growing academic recognition and development of primary healthcare in France. It explains how professions such as general practice, nursing, midwifery, physiotherapy, and patient partnerships are becoming fully integrated into universities and research. The article also emphasizes the shift toward coordinated, multidisciplinary care to improve patient outcomes and healthcare efficiency. Despite ongoing challenges, these reforms are strengthening collaboration among healthcare professionals. The launch of the French Academic Journal of Primary Care (FAJPC) aims to promote research, innovation, and international collaboration in primary care.
Introduction. In 2021, the French College of General Practice called on general practitioners to incorporate environmental considerations into their clinical practice. Objective. To incorporate environmental risk data for drugs listed in the 5th edition of the 'Guide to Therapeutics in General Medicine' published by the National College of General Practitioners, using the Hazard Score. Method. The environmental impact of the selected drugs was assessed using a Hazard Score ranging from 0 to 9, available through Janusinfo.se. Developed independently of pharmaceutical manufacturers this Swedish score incorporates three dimensions: environmental persistence, bioaccumulation in fatty tissues and toxicity to aquatic organisms. For drugs without an available Hazard Score, the ten most frequently prescribed drugs in France in 2023 were identified. A literature review was carried out to assign a rating ranging from A (low environmental impact) to C (high impact). Results. Six hundred and sixty-four drugs were included. A Hazard Score was assigned to 297 drugs (44.7%). The average Hazard Score was 3.15. Ninety-seven drugs (32.7%) had a Hazard Score of 0. Among the 367 drugs without a Hazard Score (55.3%), phloroglucinol was graded B. Codeine, prednisolone, alprazolam, oxazepam, amoxicillin and clavulanic acid, tramadol, and methadone were graded C. No grade was given to zopiclone and nefopam. Conclusion. This evaluation provides general practitioners with ecological risk data, facilitating environmentally conscious prescribing practices. Integrating such information into prescribing resources represents a crucial step towards sustainable medical practice.
Vladimir Druel, Magalie Berges, Pauline Munier, Elodie Belot, Marion Bergeaut, Julie Dupouy, Marie-Ève Rougé-Bugat
Background. The diagnosis of cancer is communicated to a patient during a consultation designed to deliver the news, which incorporates a structured timeline and a multidisciplinary approach. However, prior to the start of oncological care, the patient will need to consult their general practitioner (GP). The GP is involved in the early stages of the diagnostic pathway, carrying out screening, identifying symptoms and coordinating the pathway. This consultation prior to the diagnosis, known as the ‘pre-disclosure consultation, has been little studied. Objec-tive: To determine the content of the ‘pre-disclosure’ consultation carried out by GPs in practice. Method. A retrospective quantitative study was conducted using a questionnaire among GPs who referred pa-tients who had a cancer disclosure consultation between 1 October and 31 December 2017 in Toulouse, France. The online questionnaire comprised 34 closed-ended questions and one open-ended question. Data analysis was descriptive. Results. Of the 174 patient records selected, corresponding to 174 different GPs, 81 GPs responded. Fifty-four had carried out a ‘pre-disclosure’ consultation (89% lasting more than 15 minutes, 26% more than 30 minutes). Half mentioned supportive care; almost all considered it helpful for coming to terms with the illness, and 85 per cent limited the information in order to deliver the news in stages. Conversely, 27 of the GPs had not given a ‘pre-disclosure’, half of whom would have liked to have done so Conclusion. The ‘pre-disclosure’ is carried out informally. GPs take the time to organise this consultation and tailor it to the patient. However, a lack of information and the isolation of GPs complicate the ‘pre-disclosure’. Integrating it into the disclosure process could improve the coordination of care. Structuring the ‘pre-disclosure’ using appropriate tools and providing better support for GPs is necessary to support patients.
