Cross-sectional study on patient-physician aggression in Belgium: physician characteristics and aggression types.

OBJECTIVES: The aim of this Belgian research study was to describe the characteristics of physicians who are at increased risk for patient-physician aggression. Second, aggression subtypes were described and data were provided on the prevalence of patient-physician aggression in Belgium. DESIGN: Cross-sectional survey. SETTING: Primary and secondary care inside and outside hospitals. PARTICIPANTS: Any physician who had worked in Belgium for the preceding 12 months was eligible to participate (n=34 648). MAIN OUTCOME MEASURES: An online, original questionnaire was used to obtain physician characteristics (eg, age, sex, native language), department, working conditions and contact with aggressive patients during their career and during the preceding 12 months. RESULTS: The questionnaire was completed by 4930 participants and 3726 (76%) were valid to take into account for statistics. During the preceding 12 months, 37% had been victims of aggression: 33% experienced verbal aggression, 30% psychological, 14% physical and 10% sexual. Multiple answers were allowed. Women and younger physicians were more likely to experience aggression. Psychiatric departments and emergency departments were the settings most commonly associated with aggression. Physicians who provided primarily outpatient care were more subject to aggression. CONCLUSION: Belgian physicians experience several forms of aggression. Those most at-risk of aggression are young and female physicians who work in outpatient, emergency or psychiatric settings.

Alzheimer's disease and driving: review of the literature and consensus guideline from Belgian dementia experts and the Belgian road safety institute endorsed by the Belgian Medical Association.

Alzheimer's disease (AD) is a highly prevalent condition and its prevalence is expected to further increase due to the aging of the general population. It is obvious that the diagnosis of AD has implications for driving. Finally, driving discussions are also emotionally charged because driving is associated with independence and personal identity. However, it is not clear how to implement this in clinical practice and the Belgian law on driving is rather vague in its referral to neurodegenerative brain diseases in general nor does it provide clear-cut instructions for dementia or AD compared to for example driving for patients with epilepsy and as such does not prove to be very helpful. The present article reviews what is known from both literature and existing guidelines and proposes a consensus recommendation tailored to the Belgian situation agreed by both AD experts and the Belgian Road Safety Institute endorsed by the Belgian Medical Association. It is concluded that the decision about driving fitness should be considered as a dynamic process where the driving fitness is assessed and discussed early after diagnosis and closely monitored by the treating physician. The diagnosis of AD on itself definitely does not imply the immediate and full revocation of a driving license nor does it implicate a necessary referral for a formal on-road driving assessment. There is no evidence to recommend a reduced exposure or a mandatory co-pilot. A MMSE-based framework to trichotomise AD patients as safe, indeterminate or unsafe is presented. The final decision on driving fitness can only be made after careful history taking and clinical examination, neuropsychological, functional and behavioral evaluation and, only for selected cases, a formal assessment of driving performance.

Influence of bouncing and assisted autogenic drainage on acid gastro-oesophageal reflux in infants.

OBJECTIVES: To determine the influence of modern airway clearance techniques using assisted autogenic drainage (AAD), whether or not combined with bouncing, on acid gastro-oesophageal reflux (GOR) in infants <1 year. METHODS: In this controlled trial with intra-subject design infants were studied using oesophageal pH monitoring over 24 h, during which they received one 15 min session of bouncing, AAD or bouncing combined with AAD (BAAD). The number of reflux episodes (RE) and the refluxindex (RI) were the outcome measures. The results obtained during (T15) and 15 min after the intervention (T30) were compared to a period of 15 min before treatment (T0). RESULTS: The results of 150 infants, evenly distributed over the three treatment groups, were analyzed. No significant differences were found in number of RE at T15 and T30 compared to T0 in the bouncing group (P = 0.42), the AAD group (P = 0.14), and the BAAD group (P = 0.91). RI was significantly lower in the AAD group at T15 compared to T0 (P < 0.01). No differences in RI were found in the bouncing group (P = 0.28), nor in the BAAD group (P = 0.81). CONCLUSION: Bouncing, AAD and BAAD do not induce, nor aggravate acid GOR in infants under the age of 1 year.

Influence of respiratory physiotherapy on gastro-oesophageal reflux in infants: A systematic review.

PURPOSE: To provide a survey on the literature concerning the influence of respiratory physiotherapy on gastro-oesophageal reflux (GOR) in infants and young children. METHODS: Electronic databases (Pubmed, Web of Science, PEDro) and reference lists of articles and narrative reviews were searched. Articles were included when infants and small children underwent oesophageal pH monitoring or pH-multichannel intraluminal impedance monitoring while respiratory physiotherapy was administered. Descriptive analysis was performed and two researchers scored the methodological quality of these studies. RESULTS: Out of 985 articles, seven (six English, one French) have been included, In total 277 patients were involved, 71 with cystic fibrosis. Depending on the technique used, four studies showed GOR to be aggravated during therapy, three studies reported no effect. CONCLUSION: The evidence is not conclusive on whether respiratory physiotherapy induces or aggravates GOR in infants and small children. Age, disease, and treatment options play an important role. More specific research, also focussing on the influence of respiratory physiotherapy on non-acid reflux and the impact of recently developed airway clearance techniques (ACT's) on GOR is necessary.

Oocyte banking for anticipated gamete exhaustion (AGE) is a preventive intervention, neither social nor nonmedical.

The scope of female fertility preservation through cryopreservation of oocytes or ovarian cortex has widened from mainly oncological indications to a variety of fertility-threatening conditions. So far, no specific universally accepted denomination name has been given to cryopreservation of oocytes or ovarian cortex for the prevention of age-related fertility decline. We argue that the commonly used phrases 'social' and 'nonmedical freezing' to denote the indication for cryopreservation are not entirely correct. We suggest 'AGE banking', as this has not only the advantage of being catchy but also depicts the exact indication for the strategy, anticipated gamete exhaustion.

The perception of patients' rights among Belgian population.

The aim of this study was to explore the knowledge and perception of specific patients' rights and the problems experienced with their fulfilment among the Belgian population. Participants were recruited through patient association groups and health insurance companies. They completed an Internet-based questionnaire with 20 questions concerning patients' rights. In total, 309 persons completed all questions. The mean age of participants was 46 years (SD = 15), 58% of them were women. Participants judged patients' rights concerning the end of life (88%), affordable health care (87%) and information about health status (85%) as the most important issues. Participants particularly showed concern about their legal rights for care offered in the patients' own language (21%), euthanasia (15%) and affordable health care (14%). The most important problems experienced so far were related to care offered in the patients' own language (12%), affordable health care (11%) and access to their medical file (7%).

Detection, diagnosis, and prevention of child abuse: the role of the pediatrician.

It is the pediatrician's role to promote the child's well-being and to help parents raise healthy, well-adjusted children. Today's pediatricians are confronted with a patient population in which there is a high prevalence of child abuse in its different presentations (physical, sexual, and psychological abuse and/or neglect). The immediate and long-term consequences of child abuse often are lifelong and even life-threatening in its most dramatic presentation. Unfortunately, detection of child abuse remains a difficult challenge for many physicians but also for the "well-trained" pediatrician, leaving many abused children unreported. This paper addresses the important role pediatricians can play in the detection, diagnosis, and prevention of child maltreatment.

Informative privacy and confidentiality for adolescents: the attitude of the Flemish paediatrician anno 2010.

Confidentiality is a major issue in adolescent healthcare, and its perceived absence may be the main barrier for an adolescent to seek medical care. Little is known about the right on informative privacy and confidentiality for adolescents in Belgium, although these rights are unambiguously foreseen in the law on patients' rights since 2002. There are no data available regarding the introduction of a private moment with the physician during a consultation, about the nature and the quantity of information made available to parents by the paediatricians regarding the health situation of adolescents and about the existence of procedures with regard to these matters. The purpose of this study is to map out the current interpretation and the attitude of the paediatrician with regard to the right to confidentiality and informative privacy. The answers of 117 Flemish paediatricians to an anonymous questionnaire were analyzed. An unaccompanied medical visit is not frequent in Belgium (only 1%). Only 35.1% of the paediatricians systematically offer the possibility to have a private conversation with an adolescent. Almost 80% of the paediatricians render, as a rule, all information to the parents. Parents are informed about sensible information regarding psychosocial aspects, including data concerning sexual behaviour, in not less than 83.2% of the consultations by adolescents. Only in 2.9% no information is given to the parents. The paediatricians employ only for 13% the procedures regarding confidentiality for minors. This study reveals that Flemish paediatricians have a paternalistic attitude concerning the right on confidentiality and informative privacy, which is not in line with the Belgian legislation. Paediatricians offer only seldom the possibility for a private conversation to the adolescent. The small incidence of unaccompanied medical consultations contributes to this. Proper application of the legal context, the handling of the watertight procedures and the necessary communication in this respect is indispensable for the confidence and will lower the barrier for adolescents to use the healthcare system.