Revue médicale de Bruxelles
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Preoperative fasting is a currently adopted measure since Mendelson's report pertaining to aspiration pneumonia as a cause of death following general anesthesia. From a metabolic point of view fasting is detrimental because surgery in itself causes a state of hypercatabolism and hyperglycemia as a result of insulinresistance. Preoperative fasting has become almost obsolete in certain elective surgical procedures. In these cases the use of clear liquids is now well established and this paper focuses on the safe use of clear fluids, postoperative insulinresistance, patient comfort and postoperative outcome as well as its effect on the length of stay.
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The article tells the evolution of the terminology concerning non heart beating donors during the two last decades and describes summarily the procedure of organ retrieval after controlled cardiac arrest. We then consider the various ethical problems created by this practice. We discuss in detail therapeutic withdrawal, the treatment of the donor during the agonal period, death certification, the doctor's conflict of interests, the presence of the family at the time of death, the quality of the organs and organ retrieval after euthanasia.
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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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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.
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Huntington's disease is caused by an abnormal CAG expansion within the gene encoding Huntingtin which induces a major cortico-striatal degeneration as well as motor and cognitive impairments. Since the discovery of the present mutation, a number of experimental data have been collected to uncover the physiopathological consequences of mutated Huntingtin expression. Here, we review the therapeutic challenges of Huntington's disease.