Revue médicale de Bruxelles
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The definition of burn-out the most often cited and proposed by Maslach and Jackson, clarifies the three cardinal symptoms affecting doctors, namely, emotional exhaustion, with depersonalization of their patients and reduction of the feeling of personal accomplishment. The causes of this phenomenon are relatively well-known: individual psychological factors, stressful factors intrinsic to the medical practice and finally extrinsic factors related to the professional environment and its organization. The purpose of this review is to estimate the prevalence of burnout within the population of Belgian family physicians and to understand both individual and societal consequences. ⋯ There are also arguments demonstrating the fact that this disorder amongst general practitioners influences negatively the quality of care, their cost, but also medical demography of primary care with as a corollary a questioning of the viability of the health care system as we know it. At the time of writing this article, the Belgian Health Care Knowledge Centre (KCE) is completing, at the request of the Belgian Ministry (SPF) of Health a study entitled "Burn Out of General Practitioners: which prevention, which solutions" whose goal is to make recommendations for the prevention and support of this issue. To measure the real impact of the solutions eventually implemented, we need to create a tool for a regular assessment of the prevalence of this problem in our country.
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Immunizations are extremely efficient in prevention of diseases with a lethal potential. Healthy adults, pregnant women and patients suffering from chronic diseases may have a different benefit from vaccine available in our country. Numerous health problems need to be addressed during a short consultation, relegating immunization to a position of secondary importance. This paper will address the issue of immunization in special circumstances such as: healthy adults, pregnant women, HIV-infected patients, patients with end-stage renal disease, patients with chronic liver diseases and solid organ transplant candidates and recipients.
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The number needed to treat (NNT) is a valuable information in treatment decisions. This is the result of a calculation based on published data, collected from an intervention study. NNT is the inverse of the absolute risk reduction (1/ARR) between two treatment options. ⋯ In the process of medical decision making, the NNT must be balanced with the safety profile of the treatment (represented by the number needed to harm, or NNH), the costs and stress associated with it. It is possible to calculate a NNT and its confidence interval, from the published data of a clinical study. Some authors report the NNT in the text of the publication.
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For many years the airway clearance techniques used in chest physical therapy were assimilated with the singular technique of postural drainage, percussions and vibrations. However the side effects and counter indications and the lack of scientific proof regarding this technique have forced reflection and development of other techniques more comfortable and without deleterious effects. If all these techniques show a high efficiency in terms of improved mucociliary clearance, the literature is unanimous on how little effect these techniques have in the short and the long-term with regards to lung function and arterial blood gases. ⋯ As the cornerstone in the management of cystic fibrosis, the efficiency of the bronchial hygiene techniques are in general poorly documented in the management of the non-cystic fibrosis bronchiectasis, bronchitis or emphysema. The use of the chest physical therapy seems more to do with the interpretation of the imagery and symptomatology. The airway clearance techniques should be individualised according to symptoms, the amount of expectorated mucus and the objectives signs of secretions retention or subjective signs of difficulty expectorating secretions with progression of the disease.
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Burn-out is a more and more dominant phenomenon in our society. A society where the work is set up as a fundamental value, according with a cult of performances. Badly live a stress is considered as a defeat. ⋯ But it is a means to envisage differently its relationship with the work and to set up mechanisms of protection. The Belgian social security, besides the compensation of stop for disease, also offers solutions of rehabilitations by the half-time resumption or the professional reorientation. A collaboration between the general practitioner, the specialists, the mutual insurance doctor and the occupational physician, allows a reintegration in the world of the work, after a time of reflection.