What is the place of mindfulness-based interventions in palliative care? A case study of a patient suffering from terminal metastatic pancreatic cancer

Olivier Bernard Published in the journal : September 2024 Category : Médecine Générale

Mindfulness-based interventions (MBIs) implemented in palliative care (PC) are illustrated here through a case study of a patient suffering from metastatic pancreatic cancer from his admission to the palliative unit until his death, including contact with his family.

Through a review of the literature on the concept of mindfulness and the various interventions that exist and have been used in PC, the article outlines those that were used in this case. Which MBIs have been studied and what benefits have been demonstrated for the caregiver, for the caregiver-patient relationship, and for the patient in a PC setting? The two main MBI formats, group and individual, are explored here through different authors as to their relevance for use.

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Expectations of general practitioners and pharmacists regarding health data communication: a cross-sectional survey in the Wallonia-Brussels Federation

Florent Guyaux (1), Annick Nonneman (2) Published in the journal : December 2023 Category : Médecine Générale

Objective

This study aims to explore the expectations of pharmacists and general practitioners (GPs) regarding the exchange of medi­cal data via health networks.

Methodology

A quantitative questionnaire study was conducted among pharmacists and general practitioners in the Wallonia-Brussels Federation (FWB). Data were analyzed using descriptive statistics.

Results

The questionnaire yielded a sample of 609 people. Overall, 83% of GPs wanted access to the medication dispensing history, 93% of pharmacists wanted to access the full Summarized Electronic Health Record (SUMEHR), and 62% of GPs favored sharing this SUMEHR with the pharmacists believing it would improve their collaboration and treatment control. However, less than 10% of GPs agreed with sharing more sensitive data such as medical reports or biological results, while 64% of doctors believed the indication for treatment should be shared with pharmacists on an optional basis. More than 70% of GPs and pharmacists preferred to use specific communication tools between themselves.

Conclusion

GPs and pharmacists are looking for health networks to facilitate communication, health data exchange, and access to medication history and patterns. Their underuse can be partially explained by insufficient knowledge of the tools, difficulty of access, bugs, respect for privacy, non-implementation of the tools in business software, time-consuming encoding and fear of judgment of drug prescriptions, or the transfer of the GP’s role to the pharmacist.

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New recommendations for the management of acute otitis media in primary care

Jan-Harm Keijzer (1), Saphia Mokrane (1,2), Paul Van Royen (3), Nicole Dekker (1), Martine Goossens (1), Olivier Vanderveken (4), An De Sutter (5), Rupal Mehta (6), Cécile Ducène (7), Alexandra Sousa (8), Monique Boulad (9) Published in the journal : October 2023 Category : Médecine Générale

This article is a summary of the recent update of the clinical practice guideline (CPG) on the management of acute otitis media (AOM) in general practice.

The CPG was developed with the participation of all relevant disciplines and according to an internationally recognized methodology for guideline development (Adapte procedure).

The elements of the medical history and clinical examination have limited diagnostic value and symptoms alone are not enough to make a diagnosis of AOM. The diagnostic hypothesis is based on the combination of these elements.

The doctor pays attention to the patient's experience and provides the necessary information to enable the patient to manage his/her disease properly (e.g., pain management, etc.). Shared decision making is a key point.

Antibiotics are justified in case of an unfavorable disease course and in the presence of major risk factors for complications. However, certain subgroups may benefit from antibiotic treatment.

Effective treatment (paracetamol or ibuprofen) of pain or fever has become the cornerstone of AOM management. More targeted antibiotic treatment is reserved for specific indications.

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Male Perpetrators of Domestic Violence. Qualitative Study on the Experience of Belgian General Practitioners in their Care

Antoine Chaumont (1), Yasmin Abid (2), Ségolène de Rouffignac (2) Published in the journal : April 2023 Category : Médecine Générale

Introduction
Despite the prevalence of domestic violence (DV) in Belgium, few studies have examined the role of general medicine practice in the management of perpetrators of DV. What is the experience of Belgian general practitioners in the management of male perpetrators of domestic violence?
Method
A qualitative study examined the history of Belgian general practitioners in the supervision of men who commit domestic violence. Through a snowball sampling and individual semi-directed interviews, we were able to collect information from five general practitioners. The heterogeneity of profiles in terms of gender, age, years of experience, type, and location of practice was preferred to obtain a rich and diversified sample. These five interviews were marked out by an interview guide and then strictly transcribed.
Results
Three main themes related to the physicians' experience were identified: [1] by what means do the physicians identify male perpetrators of violence against women (VAW) and how can they be considered as patients? Their identification is mostly made by the female victims. There is little self-identification by the perpetrators of VAW. This is a victim-centered approach. The importance of the therapeutic relationship with the male perpetrators of violence is emphasized. [2] The second theme highlights a generalized taboo among respondents towards male perpetrators of sexual violence, which has an impact on their treatment. It proposes communication and verbalization in order to include [3] general medicine in a network- centered system on the male perpetrators of violence. This system is necessary to provide support and adequate multidisciplinary management of male perpetrators of domestic abuse.
Conclusion
There is a general taboo around male perpetrators of DV. General medicine practice contributes to this taboo. There is a lack of responsibility on the part of general practitioners, leading to a poor care for male perpetrators of domestic abuse. A network system is essential for their appropriate management. Further studies are needed to evaluate the role of the front liners in preventing domestic violence.

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A 360-degree overview of the effects of alcohol consumption

Pauline Gérard, Thomas Calozet, Léo Moreau, Audrey Bonnelance, Thomas Orban Published in the journal : March 2023 Category : Médecine Générale

Report of the RESUMES symposium of 21/01/2023

This article summarizes the most relevant messages shared during the annual RESUMES asbl (Multidisciplinary Network for Scientific Exchange) symposium on alcohol consumption. This theme was addressed through 12 disciplines, such as gastroenterology, gynecology, internal medicine, general medicine, etc.

Considering that at least 25% of the population consumes alcohol in a risky or even excessive way, each health professional is regularly confronted with the consequences of alcohol consumption, which this article attempts to review in its multiple dimensions and in a practical way.

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Primary care medicine in the management of the SARS-CoV-2 pandemic: international perspectives

Published in the journal : December 2022 Category : Médecine Générale

Why such a symposium?

In the winter of 2021, when the beginnings of a possible way out of the Covid-19 crisis were appearing, many of us made the same observation: primary care medicine, that is medicine that goes from individual or group medical practices to large urban policlinics and nursing homes, has certainly played an important role in the management of the pandemic, but its potential has been insufficiently exploited, particularly by the authorities in charge of public decisions. This observation has been confirmed by international bodies such as the WHO and the OECD. We therefore felt that it would be interesting to take our heads off the wheel, to distance ourselves from all of our activities deployed during the pandemic (care, screening, vaccination, etc.) and to organize an exchange of experiences in order to build a body of knowledge and propose recommendations in four countries: Belgium, Canada, France and Switzerland. The commonalities shared by these four countries, whether at the historical (thank you Napoleon!), linguistic, cultural, societal, academic and of course health system levels (universal coverage, private and/or public insurers, among others), facilitate such an exchange dynamic.

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Bariatric surgery, from dream to reality: How do patients experience obesity management based on bariatric surgery?

Charline Bronchain (1), Thérèse Leroy (2), Ségolène de Rouffignac (3) Published in the journal : October 2022 Category : Médecine Générale

Due to the increasing prevalence of obesity, bariatric surgery has become an effective treatment option, resulting in a significant weight loss and reduction in associated comorbidities. Nevertheless, this procedure is an invasive therapeutic act, inducing rapid physical and psychological changes and requiring serious post-operative discipline. Seven patients who had undergone bariatric surgery were interviewed via individual semi-structured interviews. These were aimed to better understand their experiences and clarify the role that the general practitioner could play in managing obesity through bariatric surgery. The qualitative analysis of the testimonies reveals different emotional phases that patients may go through once the surgical process has been performed. The general practitioner (GP), present on the front line, exerts a crucial role in accompanying the patients through the associated changes and identifying the early signs of psychological suffering, provided that the GP is continuously attentive to the patient’s emotional evolution. In addition, the GP could be a relay contact concerning the help that is available by informing the patient about it.

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To understanding the experience made by a caregiver for an elderly subject requiring care in order to better appreciate the function of the general practitioner in this field

Lionel Roux, Delphine Nury, Ségolène de Rouffignac Published in the journal : May 2021 Category : Médecine Générale

Informal caregivers of dependent elderly persons are currently increasing in number in Belgium. Because of the physical or mental burden induced by their role, they are vulnerable. Nine informal caregivers with varied profiles were questioned using semi-structured individual interviews, which were aimed to better understand their experiences and clarify the place that the general practitioner could assume in this environment. Analysis of the testimonies clearly reveals a physical and psychological interdependence between both the caregiver and elderly person, which may at the origin of numerous disagreements within the dyad, along with the lack of a centralized referral system of professional helpers. The general practitioner, who is in the first-line of care, could play a key role in the early identification of the caregiver’s suffering, provided he relies on a proactive approach. The general practitioner could also centralize the available help, while always informing both the caregiver and elderly person.

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Maintaining the cold chain in general medicine

Aurore Girard Published in the journal : October 2020 Category : Médecine Générale

Keeping vaccines requires maintaining the cold chain, which commonly exhibits weaknesses, even in more developed countries. However, the exposure of most vaccines to high temperatures results in some degree of degradation. Moreover, the freezing itself can cause an immediate vaccine degradation. In this context, the conservation of vaccines in the refrigerator at a constant temperature between 2 and 8 °C is a required framework for the general practitioner, which is designed to preserve the vaccines’ properties. The main characteristics of suitable refrigerators must combine the maintenance of temperature (between 2 and 8 °C), an equal temperature distribution, the availability of an evaporator that prevents freezing, a very rapid temperature recovery device, as well as forced air circulation. Domestic refrigerators may suffice for storing small volumes of vaccines. They must display the minimum characteristics required for good storage conditions and undergo the adaptations necessary to their proper use. Additionally, regular temperature monitoring and reporting must be performed using an outdoor thermometer with a probe. These easily manageable elements enable vaccines to be stored in good conditions, with the eventual outcome of optimizing vaccine coverage of the population.

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COVID-19 in primary care medicine

Cassian Minguet Published in the journal : May 2020 Category : Médecine Générale

The COVID-19 pandemic has had and still has a remarkable impact on general medicine in Belgium. From the day the first Belgian case was diagnosed on February 4, 2020 until the beginning of de-containment- three full months have passed during which general medicine needed to re- structure itself more effectively to be able to speak up with one voice, adapted itself by switching to telemedicine during the population’s confinement period, and constantly developed updated management procedures. In the first month, general practitioners (GPs) did not expect a pandemic of this magnitude to occur. In the second month, things accelerated and GPs’ offices closed their doors, with GPs applying themselves the procedures they helped convey to their patients over the phone. By the third month, while suspicious cases sharply dropped, procedures needed to be strengthened. The situation is more difficult in nursing homes. Within 3 months, relations with patients, colleagues, paramedics, and institutions were, there, entirely altered. In other countries as well, there has been a profound change that is likely to profoundly impact medical practices in the long term. On the eve of a new phase consisting of progressive de-containment, general medicine is now properly prepared to assume its role of an essential player in the fight against coronavirus in the wider community.

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