Belgian Doctors Research Articles

De Spaanse griep van 1918: een verslag door toenmalige artsen in België

The Spanish flu of 1918: a report by physicians from that period in Belgium The article L'épidémie de grippe à l'armée de campagne belges (mai-décembre 1918), written by Belgian army doctors and published in 1919 in the Archives Médicales Belges, is an exceptional report on the Spanish flu of 1918 in Belgium. In April-May 1918, the flu was benign, but from late September this changed and in October and November, severe pneumonias appeared as a complication. Particularly the rapidly evolving hemorrhagic pneumonias were lethal. Various symptoms were described, including the pronounced cyanosis in the face and extremities, which occurred in 2 stages. The severity of the bronchopneumonia was explained by the virulence of the infecting germs and the extension of the lung lesions. The inhaled dose of the infectious agent and the respiration mode would also play a role. The process of cardiovascular collapse in influenza pneumonia was described. A number of hypotheses about the causative agent of the flu have been put forward. At that time, however, the flu virus had not yet been discovered. Several scientists considered the Pfeiffer bacillus (current name: Haemophilus influenzae) to be the cause of the flu. Diplococci were also mentioned. Others said the flu was caused by a ‘virus’ that was too small to be seen with a microscope. Various treatments and even vaccine tests were tried during the pandemic. The results were, however, disappointing. As a general preventive measure, people were urged to cover their mouths and noses with a handkerchief during coughing fits.

Entretiens avec trois enseignants en pédagogie active (plus particulièrement decrolyenne):leurs méthodes permettraient-elles de construire des savoirs raisonnés?

The text proposes a cross-analysis of the pedagogical principles of Ovide Decroly – a Belgian doctor and pedagogue who is part of the New Education movement –, the legal requirements for teaching history in primary schools in the Frenchspeaking part of the country, and the elements collected during interviews and observations of teachers working in schools with so-called ‘active’ pedagogies. Through these elements, the aim is to question the knowledge under construction and to characterize it with regard to the knowledge derived from the discipline of history.

Survey COVID-19 first peak 2020

Background: In Belgium, the first peak of COVID-19 was observed between March and April 2020. This represented more than 300 deaths a day beginning April and more than 1500 new cases every day during this period. Aims: This retrospective observational survey of the practice of Homeopathic Medical Doctors in Belgium has been conducted to check Belgian Homeopathic Doctors (HMD) have treated their patients presenting mild symptoms of COVID-19. Methodology: 6 HMDs accepted to provide data from all consecutive cases treated for COVID-19 symptoms in March and April 2020. This systematic retrospective data collection was compared with information from a free exchange HMDs’ forum. 13 HMDs regularly participated in this forum. Results and discussion: this survey included 313 patients presenting mild COVID-19 symptoms. The efficiency score (healing of symptoms in less than eight days) is relevant for 83,1% of these patients. The average duration of COVID-19 symptoms is 20 days. The four most used homeopathic medicines (Bryonia alba/Arsenicum album/Phosphorus/Gelsemium sempervirens) were prescribed to 66% of them. 1,3% needed hospitalization for some time. Not any loss of chance to cure occurred for patients that used homeopathy for COVID-19 symptoms. Market data also reveals that homeopathy has been largely used to prevent and heal during the early peak of COVID-19 in Belgium. This survey allows us to conclude that during such an epidemic situation for which no effective therapy exists and no vaccination is possible, homeopathy should be considered a valuable approach.

Implementation of Primary Palliative Care in five Belgian regions: A qualitative study on early identification of palliative care needs by general practitioners

Background To deliver optimal palliative care, a Care Pathway for Primary Palliative Care (CPPPC) was developed. This CPPPC was implemented by general practitioners (GPs) in territories of five Belgian palliative care networks (2014–2016). Belgian doctors have much therapeutic freedom, and do not commonly follow guidelines. Objectives To assess how palliative care was provided by GPs before the CPPPC and its implementation project were presented publicly. Methods Between 2013 and 2015, seven focus groups with GPs were conducted. Participants included 15 GPs in three French-speaking focus groups and 26 GPs in four Dutch-speaking focus groups, with diversity for age, gender, palliative care experience and practice context. Some GPs implemented the CPPPC later. Results GPs considered each palliative care case unique and disliked strict protocols. However, they expressed a need for peer review and reflective frameworks. GPs felt it is important to identify palliative care patients ‘timely’, but found this difficult. Screening methods help, but are not widely used. GPs struggled most with identifying palliative care needs in non-oncological patients. Bad news breaking was considered difficult. Continuity of care was considered very important. However, advance care planning seemed more widely practised by Dutch-speaking GPs than by French-speaking GPs. The taboo of palliative care provoked emotional discussions. Conclusion Palliative care frameworks which help GPs to deliver ‘tailor-made’ care have more chance to be adopted than strict protocols. GPs should be given education for bad news breaking. Palliative care and advance care planning practices differ locally: guideline dissemination plans should respect these local differences.

My Unexpected Journey to Psychiatry

My Unexpected Journey to Psychiatry

100th Anniversary of Jules Bordet's Nobel Prize: Tribute to a Founding Father of Immunology.

The 100th Anniversary of the Nobel Prize in Physiology or Medicine 1919 awarded to Jules Bordet offers the opportunity to underline the contributions of this Belgian doctor to the blooming of immunology at the end of the nineteenth century at the Institut Pasteur de Paris. It is also the occasion to emphasize his achievements as director of the Institut Pasteur du Brabant and professor at the Université libre de Bruxelles. Both in France and Belgium, he developed a holistic vision of immunology as a science at the crossroads of chemistry, physiology, and microbiology.

Gods or Monsters? Non-Explicit Consent in the hastening of deaths by Intensivists in Belgium

The Belgian Euthanasia Act of 2002 (The Act), amended in 2014 to include the Minor Act (The Minor Act), has drawn international criticisms for its liberal laws and practices regarding Euthanasia. This research study is a response to media allegations that the liberal laws on euthanasia has encouraged doctors to adopt a paternalistic approach towards their patients by terminating their lives without their explicit consent, i.e. engaging in involuntary Euthanasia. Although in theory, only voluntary euthanasia (explicit patient request and therefore consent) is permitted in Belgium, the media allegations implied that in practice, involuntary euthanasia (no explicit patient request and therefore no consent) is practiced, especially in the Intensive Care Units (ICUs) in Belgium. One major criticism is that because of its liberal laws, Belgian doctors are killing patients without their non-explicit consent. Specifically, it is alleged that Intensivists are shortening lives or hastening the deaths of their patients without their non-explicit consent in the ICUs in the Wallonia Region in Belgium. This research study conducted an empirical-qualitative study to discover if these media allegations were true or false, by interviewing heads of ICUs in five major hospitals in the Wallonia region in Belgium. The research discovered that the media allegations are true, but they are also false. The media allegations are true because shortening life or hastening the death is sometimes practiced in the ICUs without the patient’s non-explicit consent. The media allegations are false because consent is not available due to the patient’s critical condition, and not because it was not asked for. In other words, what is practiced in the ICUs is non-voluntary euthanasia or where patient is unable to request or consent to euthanasia.

The Case for Contraception

Informed by personalist ideas, a sizeable contingent of Catholic moralists and physicians pushed for the loosening of church doctrine on issues of sexuality and reproduction during the 1950s and 1960s. Now often overlooked because of their ultimate failure, these cautious reformers looked towards science in search of compelling arguments in favor of limited forms of birth control that could make such practices compatible with church teachings. This article will zoom in on the lines of reasoning developed by several internationally influential Belgian doctors and theologians who found themselves at the forefront of a wider effort to modernize the Catholic church as they championed a more permissive attitude towards marital sex and/or assisted in the perfection of periodical abstinence and ‘the pill’ as acceptable tools of menstrual regulation. Directly or indirectly, they all had ties to the Catholic University of Leuven, the church’s intellectual headquarters in Belgium.

Exploring Entertainment Medicine and Professionalization of Self-Care: Interview Study Among Doctors on the Potential Effects of Digital Self-Tracking.

BackgroundNowadays, digital self-tracking devices offer a plethora of possibilities to both healthy and chronically ill users who want to closely examine their body. This study suggests that self-tracking in a private setting will lead to shifting understandings in professional care. To provide more insight into these shifts, this paper seeks to lay bare the promises and challenges of self-tracking while staying close to the everyday professional experience of the physician.ObjectiveThe aim of this study was to (1) offer an analysis of how medical doctors evaluate self-tracking methods in their practice and (2) explore the anticipated shifts that digital self-care will bring about in relation to our findings and those of other studies.MethodsA total of 12 in-depth semistructured interviews with general practitioners (GPs) and cardiologists were conducted in Flanders, Belgium, from November 2015 to November 2016. Thematic analysis was applied to examine the transcripts in an iterative process.ResultsFour major themes arose in our body of data: (1) the patient as health manager, (2) health obsession and medicalization, (3) information management, and (4) shifting roles of the doctors and impact on the health care organization. Our research findings show a nuanced understanding of the potentials and pitfalls of different forms of self-tracking. The necessity of contextualization of self-tracking data and a professionalization of self-care through digital devices come to the fore as important overarching concepts.ConclusionsThis interview study with Belgian doctors examines the potentials and challenges of self-monitoring while focusing on the everyday professional experience of the physician. The dialogue between our dataset and the existing literature affords a fine-grained image of digital self-care and its current meaning in a medical-professional landscape.

Kongo: Power and Majesty

Kongo: Power and Majesty

La modernización de los contenidos y métodos de enseñanza: reflexiones sobre la Escuela Nueva en Colombia

La Escuela Nueva en Colombia significó la apertura hacia un proceso de modernización de loscontenidos y de reforma de los métodos de enseñanza. Desde una perspectiva histórica, el artículodescribe este proceso por medio de los métodos que mayores transformaciones operaron en los sistemas y métodos de enseñanza en el saber pedagógico colombiano durante la primera mitad del siglo XX, a saber: los Centros de Interés, del médico belga Ovidio Decroly y el Método de Proyectos derivado de la pedagogía activa del norteamericano John Dewey. Los maestros en formación y egresados de las escuelas normales hicieron uso de estos dos sistemas de enseñanza para globalizar la enseñanza y para romper con el antiguo aislamiento de las diferentes asignaturas. Sus tesis o monografías de grado constituyen un campo documental invaluable para comprender la complejidad de las prácticas de apropiación de este acontecimiento pedagógico en Colombia.

373 Burnout, a substantial problem in hospital physicians. A multicentre study on its prevalence, determinants and consequences in 37 Belgian Hospitals

ObjectivesPrevious research revealed burnout in one third of the Belgian critical care physicians. Burnout leads to absenteeism, affects quality and safety of care, while work-engagement positively affects personal performance and...

A Congolese Virus and Belgian Doctors? Postcolonial Perspectives on Migration and HIV1

Abstract Based on collaborative research between a Congolese activist in HIV prevention in Belgium and a French anthropologist, this paper hopes to initiate a debate about the issue of HIV /AIDS in light of the postcolonial links between Belgium and its former colony Congo/Zaire. By exploring the social representations that HIV has generated in Francophone Belgium and the changing political management of the epidemic since the 1980s, the paper focuses on how Congolese HIV-­positive migrants have been viewed, treated and allowed (or not) to settle in Belgium. It analyzes how the HIV/AIDS epidemic was seen as an ‘African disease,’ and more precisely a ‘Congolese virus.’ It concludes that Achille Mbembe’s ‘postcolonial scoriae’ must be taken into account (without necessarily implying a linear passage from colonial to postcolonial relations) in order to understand European and international policies in Africa or policies concerning African migrants.

Characteristics of Chiropractors and their Patients in Belgium

Objective The purpose of this study is to describe the characteristics, practice characteristics, and opinions of chiropractors and the sociodemographic characteristics and the type of complaint of patients presenting to chiropractors in Belgium. Methods In 2008, all doctors of chiropractic in Belgium (N = 101) were asked to provide personal sociodemographic and practice-specific information via postal questionnaires. The participating practitioners presented written questionnaires to a maximum of 10 consecutive patients to collect sociodemographic and clinical data on the patients. Descriptive analyses were used. Results In total, 80 doctors of chiropractic (79.2%, n = 80/101) participated, providing information on 517 patients. Belgian doctors of chiropractic are predominantly male (75%), have a mean age of 44 (SD = 14) years, and have been in practice for 18 years on average. They typically treat neck and/or low back pain with or without radiating pain (85% of all complaints). Patients have a mean age of 43 (SD = 16.4) years, 54% are female, and most patients are employed (70%). Patients present with musculoskeletal complaints of moderate intensity, averaging 5 on a 0 to 10 numeric rating scale. Chiropractors spend, on average, 36 minutes on a new patient and 15 minutes on follow-up consultations. Diversified technique (93%) is the most often used technique, followed by mechanical-assisted (Activator) spinal manipulative therapy (41%). Ergonomic advice and instruction in exercise therapy are most often used in conjunction with spinal manipulative therapy. Most chiropractors would like to have the legal authority to request diagnostic imaging (87%). Conclusions This is the first study describing doctors of chiropractic and their patients in Belgium. Chiropractors in Belgium primarily focus on the treatment of neuromusculoskeletal complaints in adults, with emphasis on the spine. Patients presenting to the chiropractor consult with musculoskeletal complaints of moderate intensity that moderately affect their activities of daily living.

Medical communication in L1 and L2 contexts: Comparative modification analysis

Good communicative skills are key to medical professionals; they may even be life saving. Because of a lack of research on migrant doctors (rather than migrant patients) and on pragmatic aspects of doctors' communication with patients (rather than on strictly linguistic aspects), the present study investigated the pragmatic competence of doctors using an L2 in their clinical setting. By means of discourse completion tasks, L1 and L2 doctors in Belgium and Sweden were studied in terms of how they modify their interactions with patients. Discrepancies were found between the different groups of doctors. The Belgian L1 doctors used more internal modification than their L2 colleagues (syntactic and lexical modification of their main message). The Belgian L2 doctors' underrepresentation of syntactic and lexical modification is counterbalanced by a native-like pattern for external modification, whereby these doctors seem to pay particular attention to consolidation. The Swedish L1 doctors used more external modification (adding an utterance after their main message) than their L2 colleagues, but the Swedish L2 doctors used more internal, syntactic modification which can be understood as an expression of an overcompensation strategy to ensure adequate mitigation and consolidation. Pragmatically, one type of Swedish L2 underrepresentation, i.e., external modification, is counterbalanced by another type of modification, i.e., internal modification.

Homeopathy and The Lancet.

The Lancet of August 27, 2005 featured a cluster of articles highly critical of homeopathy which attracted considerable media attention. The media reports echoed The Lancet's press release: ‘homeopathy is no better than placebo’. The centerpiece was a meta-analysis of clinical trials of homeopathy compared with clinical trials of allopathy (conventional medicine) (1). The first author is Aijing Shang, but the leader of the research group is Prof. Matthias Egger of the Department of Social and Preventive Medicine, University of Berne, Switzerland. The meta-analysis formed part of the Complementary Medicine Evaluation Programme (Programm Evaluation Komplementarmedizin, PEK) financed by the Swiss Federal government. The international review board of PEK has publicly protested at political interference in the scientific process: ‘There is a consensus among the review board members that the final PEK process deviated from what would have been expected by conventional standards. Especially disconcerting was the fact that the products of the PEK process—health technology assessment (HTA) reports, single description of studies, manuscripts for publication and the condensed final report—were sent to the board members but no discussion, comment, or review was solicited by the responsible agencies’ (2). The meta-analysis was accompanied by a short, anonymous editorial entitled ‘The end of homoeopathy’ calling for ‘doctors to be bold and honest with their patients about homeopathy's lack of benefit, and with themselves about the failings of modern medicine’ (3); and a more thoughtful commentary from the Dutch epidemiologist Jan Vandenbroucke, reflecting on the ‘growth of truth’, including the relationship between bias, background knowledge and the concordance of clinical results with laboratory science findings (4). Vandenbroucke concludes that the proof of the pudding is in the eating: the ultimate proof of the validity of a scientific or medical idea is extent to which it changes reality. The same issue of The Lancet featured a leak of the World Health Organisation's (WHO) draft report on homeopathy. The WHO document was apparently leaked to The Lancet by Dutch and Belgian doctors hostile to homeopathy; their comments and the (hostile) comments of Prof. Edzard Ernst of the University of Exeter were published. Dr Xiaorui Zhang, Traditional Medicine Coordinator of WHO, who is responsible for the report, was also interviewed, but declined to comment on a leaked, confidential draft. This leak came only 2 days after The Times of London published, as its front page lead, a remarkably similar story: a leak of the Smallwood Enquiry on The Role of Complementary and Alternative Medicine in the NHS commissioned by The Prince of Wales' Foundation for Integrated Health. It is ironic that the editor of The Lancet, Dr Richard Horton, wrote to The Times accusing Prof. Ernst of having ‘broken every code of scientific behaviour’ for leaking the draft report of the Smallwood Enquiry (and incidentally describing complementary medicine as ‘a largely pernicious influence… preying on the fears and uncertainties of the sick’), while simultaneously doing the same to the WHO report in his own journal! Dr Horton also wrote an open letter to the UK Secretary of State for Health, Patricia Hewitt and the Chairman of the National Institute for Clinical Excellence (NICE) Prof. Sir Michael Rawlings, calling for the use of homeopathy in the NHS to be reviewed in light of this publication.

De grote school van de natie. Legerartsen over drankmisbruik en geslachtsziekten in het Belgisch leger (circa 1850-1950)

The training ground of the nation: Army doctors dealing with alcohol abuse and venereal disease in the Belgian army (circa 1850-1950)In the second half of the nineteenth and the first half of the twentieth century, Belgian army doctors were very concerned about the high incidence of alcoholism and venereal disease in the army. They launched a vigorous campaign to combat these 'diseases'. The underlying motives for this campaign were many and various. In the first place, the army's medical staff wanted to improve the general health and physical fitness of the military. At the same time, they used their campaign to reverse the negative opinion of the army prevalent amongst the general public by trying to reform the moral standards in the barracks. Another important motive for their radical measures against alcoholism and venereal disease was to enhance military and national efficiency. Finally, towards the end of the nineteenth century, more and more army doctors considered alcoholism and venereal disease to be major causes of racial degeneration, and this further legitimised their continued action against these two evils. Ultimately, the army doctors expected the results of their drastic campaign to transcend the confines of the army and have a positive impact on the entire nation as well. In this way, the army would truly become 'la grande école nationale'.

Voluntary health insurance in Bwamanda, Democratic Republic of Congo. An exploration of its meanings to the community.

An insurance scheme covering hospital care in the rural district of Bwamanda in the North-west of the Democratic Republic of Congo, which locally is called the mutuelle, was conceived and developed in 1986 on the initiative of Belgian doctors working in the district under the arrangements for bilateral Belgian aid. After more than 10 years of operation the Bwamanda scheme has achieved a high rate of coverage, contributed to a significant improvement in access to hospital-based in-patient care, and constitutes a stable source of revenue for the operation of the hospital. We present an investigation conducted through focus groups in 1996 of the population's social perceptions of this risk-sharing scheme to identify ways to improve it. The findings pertain to the reasons for people to subscribe to the scheme; to the perception of its redistribution effects; to people's frustrations and questions; and finally to the relationships between the insurance scheme and traditional mutual aid arrangements. The difference between a hospital insurance scheme (a logic of contract) and the traditional systems of mutual aid (a logic of alliance) is highlighted, and the impact of the hospital insurance scheme on social inequalities is discussed. The implications of this study on the management of the Bwamanda health insurance scheme are reviewed, and this study may be useful to health managers working in similar contexts.

Belgian Doctors' Attitudes on the Management of Patients in Persistent Vegetative State (PVS): Ethical and Regulatory Aspects

The best care and management of patients in persistent vegetative state (PVS) has been the subject of sustained moral and legal debate for a number of years. However, the views of specialist doctors in Belgium involved in the care for patients in PVS are largely unknown. A postal questionnaire was sent to 403 members of Belgian Societies of Neurosurgeons, Neurologists and Rehabilitation Doctors. Their views were sought on various aspects of the management and care of PVS, focusing on the issue of the appropriateness of non-treatment and the withdrawal of artificial feeding. Of the 208 doctors who completed the questionnaires (52%), 172 (83%) indicated that they had been involved in the management of a patient in PVS. 88% of the responding doctors thought it was sometimes appropriate not to treat acute infections or other life-threatening conditions in a PVS patient. Fifty-six percent considered it sometimes appropriate to withdraw artificial feeding. About three-quarter of physicians who considered both treatment-limiting decisions appropriate thought that such decisions could be considered within the first year of the patient being in PVS. Forty percent accorded a decisive influence to an advance directive and only a small number of doctors considered the influence of the patient's family in the decision to withdraw artificial feeding as decisive. Over 80% of the clinicians disagreed with the view that each decision about withdrawing artificial nutrition and hydration (ANH) should come before the courts. Doctors in Belgium seem to be more reluctant to withdraw artificial feeding than not to treat acute infections or other life-threatening conditions in PVS. The reason for this difference appeared to be connected with the moral as well as with the clinical content of the decision. The broad variety of answers on the interval when the vegetative state is to be regarded as permanent and when treatment-limiting decisions are appropriate, could be due to the lack of official guidelines in Belgium. There seems however to be no consensus about a future policy in Belgium for making decisions about the withdrawal of ANH.

Belgian doctors face computer monitoring

Doctors in Belgium are to have their prescribing habits monitored by computer after lengthy discussions between the government and unions. The monitoring system, Pharmanet, will rely on bar codes similar to those used in supermarkets to identify doctors and the drugs that they prescribe to generate a …