Digital toolbox with methods of ethical case deliberation in care This era is characterized by pluralism of values. Therefore, caregivers cannot find the answer to the question “How do I have to act to be a good caregiver?” any longer in old certainties, but in dialogue between everybody involved in a given care situation. It is necessary to hold this dialogue systematically. Especially in complex situations, moral case deliberation is, therefore, the most proper method. The essential point in each ethical deliberation is posing the accurate moral question, which doesn’t probe only into theoretical or practical knowhow, but interrogates what the persons involved in the given situation are permitted to do, must do or have to refrain from. There are a lot of different methods of ethical deliberation, but in principle, they all have the same basic structure consisting of 7 parts. Moral deliberation must always start from the facts that occur in a specific situation, but one must look beyond the bare facts. Humans essentially give meaning to the facts that happen in their lives. Ethical deliberation should especially give attention to this sense-making. In practice, moral deliberation is not always practicable due to the lack of time. Therefore, more compact methods of ethical deliberation were developed. In order to place all these methods at everyone’s disposal, 2 websites with a digital toolbox were created: one in Dutch and one in French.
{"title":"Digitale werktuigkist met ethische overlegmethoden in de zorg","authors":"J. Crikemans, J. Libbrecht, I. Beckers, G. Froyen","doi":"10.47671/tvg.80.24.016","DOIUrl":"https://doi.org/10.47671/tvg.80.24.016","url":null,"abstract":"Digital toolbox with methods of ethical case deliberation in care\u0000\u0000 \u0000\u0000This era is characterized by pluralism of values. Therefore, caregivers cannot find the answer to the question “How do I have to act to be a good caregiver?” any longer in old certainties, but in dialogue between everybody involved in a given care situation. It is necessary to hold this dialogue systematically. Especially in complex situations, moral case deliberation is, therefore, the most proper method. The essential point in each ethical deliberation is posing the accurate moral question, which doesn’t probe only into theoretical or practical knowhow, but interrogates what the persons involved in the given situation are permitted to do, must do or have to refrain from. There are a lot of different methods of ethical deliberation, but in principle, they all have the same basic structure consisting of 7 parts. Moral deliberation must always start from the facts that occur in a specific situation, but one must look beyond the bare facts. Humans essentially give meaning to the facts that happen in their lives. Ethical deliberation should especially give attention to this sense-making. In practice, moral deliberation is not always practicable due to the lack of time. Therefore, more compact methods of ethical deliberation were developed. In order to place all these methods at everyone’s disposal, 2 websites with a digital toolbox were created: one in Dutch and one in French.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140722164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J.-H. Keijzer, S. Mokrane, N. Dekker, M. Goossens, O. Vanderveken, A. De Sutter, R. Mehta, C. Ducène, A. Sousa, M. Boulad, P. Van Royen
New recommendations for the management of acute otitis media in primary care This article is a summary of the recent clinical guideline update of acute otitis media with recommendations for its diagnosis, treatment and prevention, including complicated acute otitis media or acute otitis media at risk of complications in children and adults in general practice. The clinical practice guideline came about 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. Moreover, symptoms alone are not enough to make the diagnosis of acute otitis media. 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). 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 therapy. Effective pain or fever treatment (with paracetamol or ibuprofen) has become the cornerstone of acute otitis media management. More targeted antibiotic therapy is reserved for specific indications.
{"title":"Nieuwe aanbevelingen voor de behandeling van acute otitis media in de eerste lijn","authors":"J.-H. Keijzer, S. Mokrane, N. Dekker, M. Goossens, O. Vanderveken, A. De Sutter, R. Mehta, C. Ducène, A. Sousa, M. Boulad, P. Van Royen","doi":"10.47671/tvg.80.24.017","DOIUrl":"https://doi.org/10.47671/tvg.80.24.017","url":null,"abstract":"New recommendations for the management of acute otitis media in primary care\u0000\u0000 \u0000\u0000This article is a summary of the recent clinical guideline update of acute otitis media with recommendations for its diagnosis, treatment and prevention, including complicated acute otitis media or acute otitis media at risk of complications in children and adults in general practice.\u0000\u0000 \u0000\u0000The clinical practice guideline came about with the participation of all relevant disciplines and according to an internationally recognized methodology for guideline development (Adapte procedure).\u0000\u0000 \u0000\u0000The elements of the medical history and clinical examination have limited diagnostic value. Moreover, symptoms alone are not enough to make the diagnosis of acute otitis media. 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).\u0000\u0000 \u0000\u0000Shared decision-making is a key point.\u0000\u0000 \u0000\u0000Antibiotics 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 therapy. Effective pain or fever treatment (with paracetamol or ibuprofen) has become the cornerstone of acute otitis media management. More targeted antibiotic therapy is reserved for specific indications.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140745021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ethics support in care facilities Two interrelated paths for supporting ethics in care facilities are proposed. The first path concerns the committees or working groups on ethics. The legal provisions for official medical ethics committees are discussed, as well as the search for concrete ways of operating in the practice of care facilities. Ethics committees or working groups have, in the opinion of the author, 4 tasks: advising on research projects, formulating general care opinions, giving individual advice on cases and finally organizing ethical education and awareness for care providers. The second path involves moral deliberation in the workplace. It is described how care providers can be supported to reflect themselves on ethical questions in their work situation, using an ethical method. Exploratory and analytical methods for moral deliberation are distinguished and the method ‘values in dialogue’ is elaborated. This method has strong ethical foundations and involves a value test. An important condition for these 2 paths of ethics support is the appointment of ethics reference persons who have ethics expertise, help realize the tasks of the ethics committee or working group and accompany moral deliberation in the care facility.
{"title":"Ethiekondersteuning in zorgvoorzieningen","authors":"A. Liégeois","doi":"10.47671/tvg.80.24.013","DOIUrl":"https://doi.org/10.47671/tvg.80.24.013","url":null,"abstract":"Ethics support in care facilities\u0000\u0000 \u0000\u0000Two interrelated paths for supporting ethics in care facilities are proposed. The first path concerns the committees or working groups on ethics. The legal provisions for official medical ethics committees are discussed, as well as the search for concrete ways of operating in the practice of care facilities. Ethics committees or working groups have, in the opinion of the author, 4 tasks: advising on research projects, formulating general care opinions, giving individual advice on cases and finally organizing ethical education and awareness for care providers.\u0000\u0000 \u0000\u0000The second path involves moral deliberation in the workplace. It is described how care providers can be supported to reflect themselves on ethical questions in their work situation, using an ethical method. Exploratory and analytical methods for moral deliberation are distinguished and the method ‘values in dialogue’ is elaborated. This method has strong ethical foundations and involves a value test.\u0000\u0000 \u0000\u0000An important condition for these 2 paths of ethics support is the appointment of ethics reference persons who have ethics expertise, help realize the tasks of the ethics committee or working group and accompany moral deliberation in the care facility.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Dekock, T. Taelman, G. Vanhaverbeke, S. Derijcke, K. Ghysen
Immunotherapy-induced diabetes mellitus: a case-report A 73-year-old man presented with diabetic ketoacidosis (DKA) after the recent initiation of immunochemotherapy to treat a lung adenocarcinoma. Pembrolizumab is an IgG4 monoclonal antibody targeting an immune checkpoint protein called ‘programmed cell death protein 1’ (PD-1), which results in antitumoral immunity. Immune checkpoint inhibitors (ICI), such as pembrolizumab, are known for their ability to cause immune-related adverse events (irAEs). Immunotherapy-induced diabetes mellitus (DM) occurs predominantly with the inhibition of PD-1 or its ligand (‘programmed cell death protein 1 ligand’ (PD-L1)). The onset is typically acute with a rapidly progressive deficiency of the endogenous insulin production, resulting in hyperglycaemia and a low or absent serum level of C-peptide with a relatively low to normal HbA1c in the acute phase. The significant loss of endogenous insulin production makes DKA a frequent first presentation. This rapid pathophysiological evolution was present in the discussed patient, who developed DM in less than 6 weeks and needed insulin therapy to establish an adequate glycaemic control. Given the increasingly widespread use of ICI in the treatment of various tumours, caution has to be taken to identify these potentially life-threatening irAEs. Awareness and alertness to glycemia on blood sampling, as well as patient education regarding red flags are fundamental, in addition to adequate recognition and treatment of (potential) ketoacidosis.
免疫疗法诱发的糖尿病：病例报告 一位73岁的男性在最近开始接受免疫化疗治疗肺腺癌后出现了糖尿病酮症酸中毒（DKA）。Pembrolizumab 是一种 IgG4 单克隆抗体，靶向名为 "程序性细胞死亡蛋白 1"（PD-1）的免疫检查点蛋白，该蛋白可产生抗肿瘤免疫。众所周知，免疫检查点抑制剂（ICI），如pembrolizumab，会导致免疫相关不良事件（irAEs）。免疫疗法诱发的糖尿病（DM）主要发生在PD-1或其配体（"程序性细胞死亡蛋白1配体"（PD-L1））受到抑制的情况下。起病通常较急，内源性胰岛素分泌迅速减少，导致高血糖、血清 C 肽水平低或无 C 肽，急性期 HbA1c 相对较低或正常。内源性胰岛素分泌的大量丧失使 DKA 成为一种常见的首发症状。该患者在不到 6 周的时间内就出现了糖尿病，需要通过胰岛素治疗来控制血糖。鉴于 ICI 在各种肿瘤治疗中的应用越来越广泛，必须谨慎识别这些可能危及生命的非器质性病变。除了充分认识和治疗（潜在的）酮症酸中毒外，对采血时的血糖值的认识和警觉以及对患者进行有关警示信号的教育也是至关重要的。
{"title":"Diabetes mellitus geïnduceerd door immuuntherapie: een casus","authors":"T. Dekock, T. Taelman, G. Vanhaverbeke, S. Derijcke, K. Ghysen","doi":"10.47671/tvg.79.23.132","DOIUrl":"https://doi.org/10.47671/tvg.79.23.132","url":null,"abstract":"Immunotherapy-induced diabetes mellitus: a case-report\u0000\u0000 \u0000\u0000A 73-year-old man presented with diabetic ketoacidosis (DKA) after the recent initiation of immunochemotherapy to treat a lung adenocarcinoma.\u0000\u0000 \u0000\u0000Pembrolizumab is an IgG4 monoclonal antibody targeting an immune checkpoint protein called ‘programmed cell death protein 1’ (PD-1), which results in antitumoral immunity. Immune checkpoint inhibitors (ICI), such as pembrolizumab, are known for their ability to cause immune-related adverse events (irAEs). Immunotherapy-induced diabetes mellitus (DM) occurs predominantly with the inhibition of PD-1 or its ligand (‘programmed cell death protein 1 ligand’ (PD-L1)). The onset is typically acute with a rapidly progressive deficiency of the endogenous insulin production, resulting in hyperglycaemia and a low or absent serum level of C-peptide with a relatively low to normal HbA1c in the acute phase. The significant loss of endogenous insulin production makes DKA a frequent first presentation. This rapid pathophysiological evolution was present in the discussed patient, who developed DM in less than 6 weeks and needed insulin therapy to establish an adequate glycaemic control.\u0000\u0000 \u0000\u0000Given the increasingly widespread use of ICI in the treatment of various tumours, caution has to be taken to identify these potentially life-threatening irAEs. Awareness and alertness to glycemia on blood sampling, as well as patient education regarding red flags are fundamental, in addition to adequate recognition and treatment of (potential) ketoacidosis.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139957540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. de Mey, U. Janssens, M. Tosi, B. von Kemp, M. Breugelmans, D. Vanhonacker
Acute postpartum hypoxemia: diagnosis of rheumatic mitral valve disease Among various causes for peri- and postpartum respiratory insufficiency, rheumatic mitral valve disease is a less common, yet potentially dangerous condition. In Europe, the incidence of rheumatic fever is low, making rheumatic heart valve disease rare. However, as a result of modern migration of patients from endemic regions, one must be aware of possible associated underlying valvular disease in young patients. A 42-year-old patient of North African ethnicity undergoing an elective C-section develops acute hypoxemia during the procedure, persisting postpartum despite the administration of oxygen. Initially, more obvious causes, such as a high spinal block and an allergic reaction, are excluded. A CT scan formally excludes a pulmonary embolism, but is suggestive of heart failure. A consecutive transthoracic echocardiography confirms acute decompensated heart failure with pathognomonic characteristics of rheumatic mitral valve disease. The patient is admitted to the cardiac intensive care unit, where the administration of oxygen and an intravenous treatment with diuretics have a favorable result. A low-dose beta blocker is initiated prior to discharge 5 days postpartum. Although rheumatic mitral stenosis is less common in Europe, one should consider this disease entity in the differential diagnosis when confronted with sudden (cardio)respiratory insufficiency in the parturient. Through this case, the authors highlight the implications of rheumatic mitral valve stenosis during pregnancy and the possible triggers for peripartum cardiac decompensation.
{"title":"Acute postpartale hypoxemie: een diagnose van reumatisch mitraliskleplijden","authors":"J. de Mey, U. Janssens, M. Tosi, B. von Kemp, M. Breugelmans, D. Vanhonacker","doi":"10.47671/tvg.79.23.127","DOIUrl":"https://doi.org/10.47671/tvg.79.23.127","url":null,"abstract":"Acute postpartum hypoxemia: diagnosis of rheumatic mitral valve disease\u0000\u0000 \u0000\u0000Among various causes for peri- and postpartum respiratory insufficiency, rheumatic mitral valve disease is a less common, yet potentially dangerous condition. In Europe, the incidence of rheumatic fever is low, making rheumatic heart valve disease rare. However, as a result of modern migration of patients from endemic regions, one must be aware of possible associated underlying valvular disease in young patients.\u0000\u0000 \u0000\u0000A 42-year-old patient of North African ethnicity undergoing an elective C-section develops acute hypoxemia during the procedure, persisting postpartum despite the administration of oxygen. Initially, more obvious causes, such as a high spinal block and an allergic reaction, are excluded. A CT scan formally excludes a pulmonary embolism, but is suggestive of heart failure. A consecutive transthoracic echocardiography confirms acute decompensated heart failure with pathognomonic characteristics of rheumatic mitral valve disease. The patient is admitted to the cardiac intensive care unit, where the administration of oxygen and an intravenous treatment with diuretics have a favorable result. A low-dose beta blocker is initiated prior to discharge 5 days postpartum.\u0000\u0000 \u0000\u0000Although rheumatic mitral stenosis is less common in Europe, one should consider this disease entity in the differential diagnosis when confronted with sudden (cardio)respiratory insufficiency in the parturient. Through this case, the authors highlight the implications of rheumatic mitral valve stenosis during pregnancy and the possible triggers for peripartum cardiac decompensation.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139834245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. de Mey, U. Janssens, M. Tosi, B. von Kemp, M. Breugelmans, D. Vanhonacker
Acute postpartum hypoxemia: diagnosis of rheumatic mitral valve disease Among various causes for peri- and postpartum respiratory insufficiency, rheumatic mitral valve disease is a less common, yet potentially dangerous condition. In Europe, the incidence of rheumatic fever is low, making rheumatic heart valve disease rare. However, as a result of modern migration of patients from endemic regions, one must be aware of possible associated underlying valvular disease in young patients. A 42-year-old patient of North African ethnicity undergoing an elective C-section develops acute hypoxemia during the procedure, persisting postpartum despite the administration of oxygen. Initially, more obvious causes, such as a high spinal block and an allergic reaction, are excluded. A CT scan formally excludes a pulmonary embolism, but is suggestive of heart failure. A consecutive transthoracic echocardiography confirms acute decompensated heart failure with pathognomonic characteristics of rheumatic mitral valve disease. The patient is admitted to the cardiac intensive care unit, where the administration of oxygen and an intravenous treatment with diuretics have a favorable result. A low-dose beta blocker is initiated prior to discharge 5 days postpartum. Although rheumatic mitral stenosis is less common in Europe, one should consider this disease entity in the differential diagnosis when confronted with sudden (cardio)respiratory insufficiency in the parturient. Through this case, the authors highlight the implications of rheumatic mitral valve stenosis during pregnancy and the possible triggers for peripartum cardiac decompensation.
{"title":"Acute postpartale hypoxemie: een diagnose van reumatisch mitraliskleplijden","authors":"J. de Mey, U. Janssens, M. Tosi, B. von Kemp, M. Breugelmans, D. Vanhonacker","doi":"10.47671/tvg.79.23.127","DOIUrl":"https://doi.org/10.47671/tvg.79.23.127","url":null,"abstract":"Acute postpartum hypoxemia: diagnosis of rheumatic mitral valve disease\u0000\u0000 \u0000\u0000Among various causes for peri- and postpartum respiratory insufficiency, rheumatic mitral valve disease is a less common, yet potentially dangerous condition. In Europe, the incidence of rheumatic fever is low, making rheumatic heart valve disease rare. However, as a result of modern migration of patients from endemic regions, one must be aware of possible associated underlying valvular disease in young patients.\u0000\u0000 \u0000\u0000A 42-year-old patient of North African ethnicity undergoing an elective C-section develops acute hypoxemia during the procedure, persisting postpartum despite the administration of oxygen. Initially, more obvious causes, such as a high spinal block and an allergic reaction, are excluded. A CT scan formally excludes a pulmonary embolism, but is suggestive of heart failure. A consecutive transthoracic echocardiography confirms acute decompensated heart failure with pathognomonic characteristics of rheumatic mitral valve disease. The patient is admitted to the cardiac intensive care unit, where the administration of oxygen and an intravenous treatment with diuretics have a favorable result. A low-dose beta blocker is initiated prior to discharge 5 days postpartum.\u0000\u0000 \u0000\u0000Although rheumatic mitral stenosis is less common in Europe, one should consider this disease entity in the differential diagnosis when confronted with sudden (cardio)respiratory insufficiency in the parturient. Through this case, the authors highlight the implications of rheumatic mitral valve stenosis during pregnancy and the possible triggers for peripartum cardiac decompensation.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139774460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Self-sacrifice, subjugation and approval-seeking in women with CFS in comparison to women with rheumatoid arthritis: an observational study CFS is a disorder with a multifactorial pathogenesis in which symptoms arise when precipitating factors combine with predisposing factors. An increasing body of research points to a dysfunction of the stress axis and finds evidence for a high prevalence of early childhood trauma, one of the most important vulnerability factors. Several pathways are conceivable through which early trauma may contribute to the vulnerability to or maintenance of the stress response and the symptoms. In this study, the authors used self-report questionnaires to identify maladaptive patterns that often stand out in clinical practice and may play both a predisposing and a maintaining role. These interpersonal patterns have often been adaptive in an early childhood context, but become harmful when they generalize and remain active in adult life. The authors investigated a group of 49 female CFS patients using 3 subscales of the Young Schema Questionnaire measuring the interpersonal styles of self-sacrifice, approval-seeking and subjugation. They included 45 women with a diagnosis of rheumatoid arthritis as a control group. The authors found significantly higher scores in the CFS group for the 3 variables, with a large effect size for each. The present findings have implications for the further research and treatment. These interpersonal patterns are usually very rigid and serve to protect self-esteem and sense of security. The standard treatment of graded exercise and a limited number of sessions of psychoeducation and cognitive behavioral therapy is often insufficient to allow recovery and prevent relapse. Further research is required to substantiate which is the most optimal treatment strategy to mitigate these patterns.
{"title":"Zelfopoffering, onderwerping en pleasing bij vrouwen met CVS in vergelijking met vrouwen met reumatoïde artritis: een observationele studie","authors":"F. Maes, G. Vanaerschot, E. Goossens","doi":"10.47671/tvg.79.23.126","DOIUrl":"https://doi.org/10.47671/tvg.79.23.126","url":null,"abstract":"Self-sacrifice, subjugation and approval-seeking in women with CFS in comparison to women with rheumatoid arthritis: an observational study\u0000\u0000 \u0000\u0000CFS is a disorder with a multifactorial pathogenesis in which symptoms arise when precipitating factors combine with predisposing factors. An increasing body of research points to a dysfunction of the stress axis and finds evidence for a high prevalence of early childhood trauma, one of the most important vulnerability factors. Several pathways are conceivable through which early trauma may contribute to the vulnerability to or maintenance of the stress response and the symptoms. In this study, the authors used self-report questionnaires to identify maladaptive patterns that often stand out in clinical practice and may play both a predisposing and a maintaining role. These interpersonal patterns have often been adaptive in an early childhood context, but become harmful when they generalize and remain active in adult life.\u0000\u0000 \u0000\u0000The authors investigated a group of 49 female CFS patients using 3 subscales of the Young Schema Questionnaire measuring the interpersonal styles of self-sacrifice, approval-seeking and subjugation. They included 45 women with a diagnosis of rheumatoid arthritis as a control group.\u0000\u0000 \u0000\u0000The authors found significantly higher scores in the CFS group for the 3 variables, with a large effect size for each.\u0000\u0000 \u0000\u0000The present findings have implications for the further research and treatment. These interpersonal patterns are usually very rigid and serve to protect self-esteem and sense of security. The standard treatment of graded exercise and a limited number of sessions of psychoeducation and cognitive behavioral therapy is often insufficient to allow recovery and prevent relapse. Further research is required to substantiate which is the most optimal treatment strategy to mitigate these patterns.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139785194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Self-sacrifice, subjugation and approval-seeking in women with CFS in comparison to women with rheumatoid arthritis: an observational study CFS is a disorder with a multifactorial pathogenesis in which symptoms arise when precipitating factors combine with predisposing factors. An increasing body of research points to a dysfunction of the stress axis and finds evidence for a high prevalence of early childhood trauma, one of the most important vulnerability factors. Several pathways are conceivable through which early trauma may contribute to the vulnerability to or maintenance of the stress response and the symptoms. In this study, the authors used self-report questionnaires to identify maladaptive patterns that often stand out in clinical practice and may play both a predisposing and a maintaining role. These interpersonal patterns have often been adaptive in an early childhood context, but become harmful when they generalize and remain active in adult life. The authors investigated a group of 49 female CFS patients using 3 subscales of the Young Schema Questionnaire measuring the interpersonal styles of self-sacrifice, approval-seeking and subjugation. They included 45 women with a diagnosis of rheumatoid arthritis as a control group. The authors found significantly higher scores in the CFS group for the 3 variables, with a large effect size for each. The present findings have implications for the further research and treatment. These interpersonal patterns are usually very rigid and serve to protect self-esteem and sense of security. The standard treatment of graded exercise and a limited number of sessions of psychoeducation and cognitive behavioral therapy is often insufficient to allow recovery and prevent relapse. Further research is required to substantiate which is the most optimal treatment strategy to mitigate these patterns.
{"title":"Zelfopoffering, onderwerping en pleasing bij vrouwen met CVS in vergelijking met vrouwen met reumatoïde artritis: een observationele studie","authors":"F. Maes, G. Vanaerschot, E. Goossens","doi":"10.47671/tvg.79.23.126","DOIUrl":"https://doi.org/10.47671/tvg.79.23.126","url":null,"abstract":"Self-sacrifice, subjugation and approval-seeking in women with CFS in comparison to women with rheumatoid arthritis: an observational study\u0000\u0000 \u0000\u0000CFS is a disorder with a multifactorial pathogenesis in which symptoms arise when precipitating factors combine with predisposing factors. An increasing body of research points to a dysfunction of the stress axis and finds evidence for a high prevalence of early childhood trauma, one of the most important vulnerability factors. Several pathways are conceivable through which early trauma may contribute to the vulnerability to or maintenance of the stress response and the symptoms. In this study, the authors used self-report questionnaires to identify maladaptive patterns that often stand out in clinical practice and may play both a predisposing and a maintaining role. These interpersonal patterns have often been adaptive in an early childhood context, but become harmful when they generalize and remain active in adult life.\u0000\u0000 \u0000\u0000The authors investigated a group of 49 female CFS patients using 3 subscales of the Young Schema Questionnaire measuring the interpersonal styles of self-sacrifice, approval-seeking and subjugation. They included 45 women with a diagnosis of rheumatoid arthritis as a control group.\u0000\u0000 \u0000\u0000The authors found significantly higher scores in the CFS group for the 3 variables, with a large effect size for each.\u0000\u0000 \u0000\u0000The present findings have implications for the further research and treatment. These interpersonal patterns are usually very rigid and serve to protect self-esteem and sense of security. The standard treatment of graded exercise and a limited number of sessions of psychoeducation and cognitive behavioral therapy is often insufficient to allow recovery and prevent relapse. Further research is required to substantiate which is the most optimal treatment strategy to mitigate these patterns.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139844975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Q. Vermeulen, T. Decorte, B. De Coninck, K. Watteyne, L. Vanden Bossche
Hypertrophy of the peroneal tubercle: a rare cause of peroneal tendon synovitis Hypertrophy of the peroneal tubercle is a rare cause of peroneal tendon synovitis. The peroneal tubercle of the calcaneal bone is an anatomical structure with both structural and biomechanical functions. When abnormal in shape and size, it can cause friction or impingement of the peroneal tendons, resulting in tenosynovitis and/or tendon tears. Clinically, the patient presents with tenosynovitis and a prominent peroneal tubercle palpable on the lateral calcaneus. A radiography and an ultrasound are sufficient for the diagnosis. An additional CT scan and MRI are often performed to better visualize the bony structures and soft tissues, respectively. The treatment consists of conservative therapy for at least 6 weeks. If this therapy fails or if the tendon is torn, surgery may be required.
{"title":"Hypertroof peroneaal tuberculum met tenosynovitis van de peroneuspezen","authors":"Q. Vermeulen, T. Decorte, B. De Coninck, K. Watteyne, L. Vanden Bossche","doi":"10.47671/tvg.79.23.124","DOIUrl":"https://doi.org/10.47671/tvg.79.23.124","url":null,"abstract":"Hypertrophy of the peroneal tubercle: a rare cause of peroneal tendon synovitis \u0000\u0000 \u0000\u0000Hypertrophy of the peroneal tubercle is a rare cause of peroneal tendon synovitis. The peroneal tubercle of the calcaneal bone is an anatomical structure with both structural and biomechanical functions. When abnormal in shape and size, it can cause friction or impingement of the peroneal tendons, resulting in tenosynovitis and/or tendon tears. Clinically, the patient presents with tenosynovitis and a prominent peroneal tubercle palpable on the lateral calcaneus. A radiography and an ultrasound are sufficient for the diagnosis. An additional CT scan and MRI are often performed to better visualize the bony structures and soft tissues, respectively. The treatment consists of conservative therapy for at least 6 weeks. If this therapy fails or if the tendon is torn, surgery may be required.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139787800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Q. Vermeulen, T. Decorte, B. De Coninck, K. Watteyne, L. Vanden Bossche
Hypertrophy of the peroneal tubercle: a rare cause of peroneal tendon synovitis Hypertrophy of the peroneal tubercle is a rare cause of peroneal tendon synovitis. The peroneal tubercle of the calcaneal bone is an anatomical structure with both structural and biomechanical functions. When abnormal in shape and size, it can cause friction or impingement of the peroneal tendons, resulting in tenosynovitis and/or tendon tears. Clinically, the patient presents with tenosynovitis and a prominent peroneal tubercle palpable on the lateral calcaneus. A radiography and an ultrasound are sufficient for the diagnosis. An additional CT scan and MRI are often performed to better visualize the bony structures and soft tissues, respectively. The treatment consists of conservative therapy for at least 6 weeks. If this therapy fails or if the tendon is torn, surgery may be required.
{"title":"Hypertroof peroneaal tuberculum met tenosynovitis van de peroneuspezen","authors":"Q. Vermeulen, T. Decorte, B. De Coninck, K. Watteyne, L. Vanden Bossche","doi":"10.47671/tvg.79.23.124","DOIUrl":"https://doi.org/10.47671/tvg.79.23.124","url":null,"abstract":"Hypertrophy of the peroneal tubercle: a rare cause of peroneal tendon synovitis \u0000\u0000 \u0000\u0000Hypertrophy of the peroneal tubercle is a rare cause of peroneal tendon synovitis. The peroneal tubercle of the calcaneal bone is an anatomical structure with both structural and biomechanical functions. When abnormal in shape and size, it can cause friction or impingement of the peroneal tendons, resulting in tenosynovitis and/or tendon tears. Clinically, the patient presents with tenosynovitis and a prominent peroneal tubercle palpable on the lateral calcaneus. A radiography and an ultrasound are sufficient for the diagnosis. An additional CT scan and MRI are often performed to better visualize the bony structures and soft tissues, respectively. The treatment consists of conservative therapy for at least 6 weeks. If this therapy fails or if the tendon is torn, surgery may be required.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139847690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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