Revue médicale de Bruxelles
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Comparative Study
[Capitation contract financing of primary health care: a possible alternative to traditional payment for service--part 1].
Worldwide health systems are faced with additive and complex problems: a cost containment willingness, growing expenses for the health care budgets particularly in relation with the new technologies, questioning about true quality of provided care from results indicators. Health care financing is one of the major determinants of the nature and the comprehensive quality of the system: its aim to promote suitable processes and behaviors, to dissuade inadequate ones, in a context of efficiency (efficacy with minimal cost), as for politic decidors, as for the patients, as for the providers, as for the insurers/funders. A comparative and critical approach of the international scientific literature shows that partial fixed capitation payment is an interesting alternative for the total fee for service. Taking into account many experiences, a proposal for a cumulated financing for the practices is made: a structural part, a fixed capitation payment (the most important), a fee for service one, a target payment one, and a patient personal participation.
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Opioid analgesics are widely acknowledged as the most important drugs for the treatment of chronic cancer pain. Although these drugs can in most cases control severe pain, even when they are used appropriately, they may produce new symptoms or exacerbate preexisting symptoms, most notably nausea and somnolence. The combination of severe pain, anorexia, chronic nausea, asthenia, and somnolence is a frequent finding in patient with advanced cancer. ⋯ Many drugs, such as nonsteroidal antiinflammatory agents, tricyclic antidepressants, corticosteroids, benzodiazepines, amphetamines, antiemetics, oral local anesthetics and bisphosphonates have been suggested to have adjuvant analgesic effects. Unfortunately, most of the evidence for the effects of these drugs is anedoctal. Controlled clinical trials are badly needed to precise the indications and the risk/benefit ratios of these agents, some of which have significant toxicity and could potentially aggravate narcotics toxicity.
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The European Union and the European Council are interested in the phenomenon "Homoeopathy". At the initiative of a member of the European Parliament, Mr. Paul LANNOYE, the European Commission created a study group with the aim to answer the question: "Is Homoeopathy researchable?" After 18 month, the group, including conventional pharmacologists and researchers using daily homoeopathy, answered affirmatively to the question. ⋯ About basic research more publications are available and positive results are regular. One third of the publications were published in peer reviewed international journals. Today a sound scientific hypothesis can be drawn up about working mecanisms of homoeopathic dilutions.
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We report on a case of a 66 years-old patient suffering weight loss and lumbar pain, localized at L2-L3. A spondylodiscitis was revealed by CT and MRI; intervertebral disc puncture was positive for Pneumococcus Pneumoniae. The clinical evolution was good with the anti-bacterial treatment, while the patient developed a synostosis L2-L3. Incidence, bacteriology, imaging and therapy of spondylodicitis are discussed.