Revue médicale de Bruxelles
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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.
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Febrile neutropenia is an important cause of fever in the cancer patient. When he/she is undergoing chemotherapy, the priority is to exclude that complication because it requires rapid administration of empiric broad-spectrum antibiotics. We have studied the rate and characteristics of febrile neutropenia in cancer patients consulting in a emergency department. ⋯ In conclusion, our study shows that febrile neutropenia is frequent in ambulatory cancer patients presenting with fever and that in the majority of the cases, it is associated with a low risk. In such a situation, ambulatory management is more and more often considered or, at least, a rapid discharge after a short admission in case of low risk febrile neutropenia. In that context, the role of the general practioner has to be emphasised and to facilitate the outpatient management, we propose an algorithm that requires validation.
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A conflict of interest is a delicate situation where a person with a confidence role like a physician has professional or personal interests competing with the mission he/she has received, making him difficult to perform his/her duty with impartiality. Commercial or financial conflicts of interest of a physician can be personal and direct (gifts, travels, honoraries, consultant fees, etc.) or indirect (in relationship with those of the family or of the institution). There are also non financial conflicts of interest such as the anonymous peer review of the work performed by a friend or a competitor. ⋯ The physicians have difficulties for accepting disclosing their conflict of interest. In this article, the literature published on the topic is reviewed as well as the main biases they can induce and the mistakes made by the physicians who do not declare their conflicts. Measures that can be taken to reduce their impact such as the declaration of conflicts of interest are discussed.