Revue De Medecine Interne最新文献

{"title":"AI in medical training: who decides?","authors":"Thomas Barba, Arnaud Hot","doi":"10.1016/j.revmed.2026.09.009","DOIUrl":"10.1016/j.revmed.2026.09.009","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Page 528"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumonie d’inhalation : synthèse pratique et perspectives à la lumière des recommandations 2025","authors":"Léa Vieilledent,&nbsp;Alain Putot,&nbsp;Adrien Barraud,&nbsp;Virginie Prendki,&nbsp;Thibaut Fraisse","doi":"10.1016/j.revmed.2025.12.005","DOIUrl":"10.1016/j.revmed.2025.12.005","url":null,"abstract":"<div><div>Aspiration pneumonia is a specific respiratory infection. It is frequent and severe, and represents a pressing issue given the growing ageing population. For the first time, French guidelines clarify how to manage this infection. We therefore wanted to present a revised review on this topic. The main aim is to highlight strategic elements based on pathophysiology. Diagnosis is based on clinical and radiological criteria; however, the aspiration event remains difficult to define. Biological tests are still important for follow-up and evaluating the impact of the disease on different organ systems. Microbiological examinations should not be performed systematically, but only under specific conditions. Antibiotherapy is based on simple principles: amoxicillin-clavulanic acid is the first-line treatment, administered orally wherever possible, and metronidazole should not be used. A careful analysis of the context and risk factors is essential for effective prevention. This is a multimodal and multidisciplinary approach involving rehabilitation, nutritional care and oral hygiene.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Pages 538-546"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection spontanée du liquide d’ascite : mise au point","authors":"Jackie Bitton,&nbsp;Leyla Rhabbour,&nbsp;Virginie Zarrouk,&nbsp;Olivier Roux","doi":"10.1016/j.revmed.2026.04.006","DOIUrl":"10.1016/j.revmed.2026.04.006","url":null,"abstract":"<div><div>Spontaneous bacterial peritonitis is a severe complication in patients with cirrhosis and remains a major cause of hospitalization and mortality. Early diagnosis is essential and relies on ascitic fluid analysis showing a polymorphonuclear neutrophil count greater than 250/mm³. Prompt initiation of antibiotic therapy combined with albumin infusion has markedly improved patient outcomes, leading to a significant reduction in mortality since the condition was first described. The aim of this review is to provide an updated synthesis of best practices in the diagnosis, treatment, and prevention of spontaneous bacterial peritonitis, considering recent changes in bacterial epidemiology.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Pages 547-553"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Déterminants historiques, pédagogiques et organisationnels des formations en médecine. Regards croisés France–Québec","authors":"Pierre Pottier,&nbsp;Nicolas Belhomme,&nbsp;Louis-Philippe Thibault-Lemyre,&nbsp;Nicolas Fernandez,&nbsp;Claude-Julie Bourque,&nbsp;Ahmed Moussa","doi":"10.1016/j.revmed.2026.07.004","DOIUrl":"10.1016/j.revmed.2026.07.004","url":null,"abstract":"<div><div>This review aims to clarify the historical foundations and the pedagogical and organizational specificities of the French and Quebec medical education systems through a narrative and comparative analysis of the available literature. In France, medical curricula have primarily been shaped by political and institutional reforms, which have influenced medical pedagogy without being explicitly grounded in any specific educational theory. In Canada, by contrast, medical education has been conceived as an educational construct informed by the dominant educational theories available at the time of curricular development. In France, medical education has largely remained based on a Flexnerian model centred on transmissive teaching, large-group instruction, and a predominantly biomedical and disciplinary approach. At the Université de Montréal, however, students are engaged from the outset in interactive team-based and transdisciplinary learning, integrating both biomedical and social dimensions within a clearly socio-constructivist pedagogical framework. The competency-based approach emerged in France nearly two decades later than in Quebec, notably through the adoption of the seven competency domains derived from the Canadian “CanMEDS flower” framework and through the implementation of formative and summative OSCEs, which constitute one of its most tangible expressions. This historical, epistemological, institutional, and pedagogical overview of medical education in France and Quebec helps clarify the differences and similarities currently observed between the two educational systems and provides a better understanding of how, and under what conditions, the French system may draw inspiration from Quebec models.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Pages 565-575"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issue Contents","authors":"","doi":"10.1016/S0248-8663(26)00751-4","DOIUrl":"10.1016/S0248-8663(26)00751-4","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Pages e19-e20"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149175846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence de-skills, under-skills, or never-skills humans? Consider this differently for older versus younger physicians","authors":"Shigeki Matsubara","doi":"10.1016/j.revmed.2026.08.003","DOIUrl":"10.1016/j.revmed.2026.08.003","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Pages 526-527"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyse des caractéristiques et de la performance de la nouvelle docimologie au cours des épreuves dématérialisées nationales d’entraînement inter-facultaires du 2e cycle des études médicales","authors":"Jérôme Hadjadj,&nbsp;Laurent Chouchana,&nbsp;Emmanuel Babin,&nbsp;Louise Basmaciyan,&nbsp;Claire Bonneau,&nbsp;Jean-David Bouaziz,&nbsp;Nathalie Costedoat-Chalumeau,&nbsp;Nicolas De Prost,&nbsp;Jean-Paul Fournier,&nbsp;Florence Jeny,&nbsp;Laure Joly,&nbsp;Laurent Karila,&nbsp;Damien Legallois,&nbsp;Paul-Ursmar Milliez,&nbsp;Cindy Neuzillet,&nbsp;Alexia Rouland,&nbsp;Pascale Vergne-Salle,&nbsp;Hadrien Winiszewski,&nbsp;Nicolas Noel,&nbsp;Damien Roux,&nbsp;Fleur Cohen-Aubart","doi":"10.1016/j.revmed.2026.08.002","DOIUrl":"10.1016/j.revmed.2026.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The transition from the French national ranking exam (ECN) to the new fully digital national exam (EDN) has changed evaluation methods by diversifying assessment approaches. This study aimed to evaluate the characteristics of an inter-university EDN-type practice exam.</div></div><div><h3>Methods</h3><div>We included questions from the EDN practice sessions conducted in April 2024 across 12 French medical universities. Data collected for each question included: context and question type, theme, specialty, Bloom's taxonomy level, knowledge rank, success rate, and discrimination index.</div></div><div><h3>Results</h3><div>Of the 324 questions included in the mixed-format exams administered to students, 304 were analyzed. Multiple-choice questions (MRQs) accounted for 48% of the questions, followed by single-best-answer questions (SRQs, 17%) and short-answer questions (SAQs, 13%). Medical specialties were the most represented (82%). Most questions targeted level A of knowledge (65%) and Bloom's level 2 (53%). The overall success rate was 44%. SAQs showed the highest discriminatory capacity compared to other types. An inverted U-shaped relationship was observed between question success rate and discrimination index: questions with intermediate success rates (45–65%) best discriminated between students.</div></div><div><h3>Conclusion</h3><div>Despite greater diversity in assessment methods introduced by the new reform, MRQs remain predominant in interfaculty practice exams EDN-type exams. SAQs provide stronger discriminatory power. These findings highlight the value of expanding assessment formats to strengthen the validity of the EDN.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Pages 529-537"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Porphyrie aiguë intermittente : quand l’errance diagnostique met en jeu la santé du patient","authors":"Guillaume Labarthe,&nbsp;Anne Galinier,&nbsp;Florence Rulquin,&nbsp;Anne Pavy Le Traon,&nbsp;Julien Maquet,&nbsp;Thibaut Jamme","doi":"10.1016/j.revmed.2026.05.005","DOIUrl":"10.1016/j.revmed.2026.05.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute intermittent porphyria is a rare genetic disorder characterized by an enzyme deficiency in heme synthesis, causing an accumulation of neurotoxic precursors. Its clinical symptoms include abdominal and/or lumbar pain, reddish-brown urine, and neuropsychiatric signs.</div></div><div><h3>Observation</h3><div>We report the case of a young female patient who presented with several episodes of intense low back pain followed by confusion, visual hallucinations, epileptic seizures, and severe dysautonomia with hypotension and impaired alertness. The diagnosis was established after several weeks of investigation, one year after the onset of symptoms. The course of the disease was marked by an early relapse without any triggering factor, which led to treatment with givosiran, which was spectacularly successful. Treatment-induced hyperhomocysteinemia was successfully corrected with pyridoxine.</div></div><div><h3>Conclusion</h3><div>It is essential to be aware of the epidemiology, risk factors, and suggestive symptoms of this potentially serious treatable disease to reduce diagnostic uncertainty, limit long-term complications, and improve prognosis.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Pages 554-558"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients similaires : quand le raisonnement de l’interniste rencontre l’intelligence artificielle","authors":"Guillaume Faure,&nbsp;Xavier Tannier,&nbsp;Christel Gerardin","doi":"10.1016/j.revmed.2026.05.011","DOIUrl":"10.1016/j.revmed.2026.05.011","url":null,"abstract":"<div><div>Internal medicine manages patients with multiple comorbidities or rare diseases, for whom the scientific literature often provides limited guidance. Patient similarity search aims to identify, within a medical database, individuals whose clinical, biological, morphological and longitudinal profile is close enough to that of a given patient for their experience to inform clinical care. This approach extends the analogical reasoning familiar to clinicians. The growth of health data warehouses and recent advances in artificial intelligence, now make it possible to automate this search and integrate heterogeneous data sources. Applications include diagnostic support, prognostic evaluation, treatment personalization and clinical trial recruitment. Although intuitive and explainable, this approach faces technical limitations and a risk of automation bias, justifying regulatory oversight and appropriate physician training.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Pages 576-580"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Déqualification médicale : le coût caché des algorithmes","authors":"Thomas Barba,&nbsp;Arnaud Hot","doi":"10.1016/j.revmed.2026.06.011","DOIUrl":"10.1016/j.revmed.2026.06.011","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 10","pages":"Pages 523-525"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}