Jan Bernheim | Universiteit Gent and Vrije Universiteit Brussel (original) (raw)
Papers by Jan Bernheim
Quality of Life Research, 2019
ABSTRACT To identify preferences of advanced lung cancer patients for receiving information and p... more ABSTRACT To identify preferences of advanced lung cancer patients for receiving information and participating in decision-making concerning treatment options, health-care-setting transfers and end-of-life decision-making. Over the course of 1 year, pulmonologists and oncologists in 13 hospitals in Flanders, Belgium, invited patients with an initial diagnosis of non-small-cell lung cancer IIIb/IV to participate in the study. Shortly after inclusion, the patients were interviewed with a structured questionnaire. One-hundred and twenty-eight patients with a median estimated survival time of 10 months participated. Almost all wanted information on diagnosis, treatment and cure rate and slightly fewer on life expectancy (88.2%). Information about palliative care was desired by 63.5% of patients and information about end-of-life decisions by 56.8%. The percentage of patients who preferred personal control over medical decision-making increased to 14.8% for treatment, 25.0% for transfer and 49.2% for end-of-life decisions, all of which were higher than for medical decisions in general (9.3%). Information and participation preferences of advanced lung cancer patients differ depending on the type of information or decision. As part of a patient-centred approach, physicians should not only check the general but also the specific information and participation preferences of their patients.
Nederlands Tijdschrift voor Geneeskunde, 1998
Revue médicale de Liège, 2001
Introduction: Cette etude est une premiere replication de l'etude nationale sur les decisions... more Introduction: Cette etude est une premiere replication de l'etude nationale sur les decisions medicales concernant la fin de la vie aux Pays-Bas. Son objectif principal est l'evaluation des frequences d'euthauasie, d'aide au suicide et d'autres decisions concernant la fin de la vie en pratique medicale en Flandre, Methode, Un echantillon de 3.999 personnes decedees a ete selectionne parmi les attestations de deces etablies du premier janvier 1998 au 30 avril 1998. Pour chaque attestation de deces, le medecin signataire a recu un questionnaire a remplir anonymement, Resultats, Le taux de reponse a ete de 52 %, Les estimations pour l'ensemble de 1998 ont ete sjustees en fonction des blais de non reponse et des influences saisonnieres, En 1998, 1,1 % de tous les deces etaletit la consequence d'euthanasie (l'administration de moyens letaux a la demande expresse du patient), et 0,1 % a la suite d'aide au suicide. Dans 3,2 % des deces, des moyens letaux ont ete administres sans la demande expresse du patient, Le deces a ete la consequence du soulagement de la souffrance et des symptomes par des doses d'opiaces susceptibles d'abreger la survie dans 18,4 % de ne pas initier ou d'arreter un traitement susceptible de prolonger la survie a ete prise dans 16,4 % des cas. Conclusions. Les decisions medicales influant la duree de la survie sont frequentes en pratique medicale en Flandre, L'incidence de l'euthanasie est moindre qu'aux Pays-Bas, mais l'administration de medicaments letaux sans demande formelle du patient est plus frequente. En Flandre, les decisions concernant la fin de la vie sont moins souvent discutees avec les patients et sont appliquees avec moins de precautions qu'aux Pays-Bas.
The British journal of general practice : the journal of the Royal College of General Practitioners, 2006
BACKGROUND Communication with patients on end-of-life decisions is a delicate topic for which the... more BACKGROUND Communication with patients on end-of-life decisions is a delicate topic for which there is little guidance. AIM To describe the development of a guideline for GPs on end-of-life communication with patients who wish to die at home, in a context where patient autonomy and euthanasia are legally regulated. DESIGN OF STUDY A three-phase process (generation, elaboration and validation). In the generation phase, literature findings were structured and then prioritised in a focus group with GPs of a palliative care consultation network. In the elaboration phase, qualitative data on patients' and caregivers' perspectives were gathered through a focus group with next-of-kin, in-depth interviews with terminal patients, and four quality circle sessions with representatives of all constituencies. In the validation phase, the acceptability of the draft guideline was reviewed in bipolar focus groups (GPs-nurses and GPs-specialists). Finally, comments were solicited from expert...
Journal of Immunology Research
Purpose. To assess neurocognitive function (NCF), psychosocial outcome, health-related quality of... more Purpose. To assess neurocognitive function (NCF), psychosocial outcome, health-related quality of life (HRQoL), and long-term effects of immune-related adverse events (irAE) on metastatic melanoma survivors treated with ipilimumab (IPI). Methods. Melanoma survivors were identified within two study populations (N=104), at a single-center university hospital, and defined as patients who were disease-free for at least 2 years after initiating IPI. Data were collected using 4 patient-reported outcome measures, computerized NCF testing, and a semistructured interview at the start and 1-year follow-up. Results. Out of 18 eligible survivors, 17 were recruited (5F/12M); median age is 57 years (range 33-86); and median time since initiating IPI was 5.6 years (range 2.1-9.3). The clinical interview revealed that survivors suffered from cancer-related emotional distress such as fear of recurrence (N=8), existential problems (N=2), survivor guilt (N=2), and posttraumatic stress disorder (N=6). ...
Blood
A diagnosis of hairy cell leukemia was made by optic microscopy, phase- contrast microscopy, elec... more A diagnosis of hairy cell leukemia was made by optic microscopy, phase- contrast microscopy, electron microscopy, scanning microscopy, and histochemistry of the abnormal blood cells. In vivo these cells were found to have a half-time in the blood of approximately 150 hr. In vitro they had the capacity to adhere firmly to plastic, making it possible to obtain a pure population of hairy cells. Neither T-rosette formation nor phytohemagglutinin (PHA) transformation could be demonstrated in these cells. On the other hand, the presence of immunoglobulins on the surface of the hairy cells (HC) by immunofluorescence, and the synthesis and secretion by these cells of IgM type lambda-chains shown by radioimmunodiffusion, were in favor of their B-type lymphocyte origin. Similarities to chronic lymphocytic leukemia were apparent.
Palliative medicine, 2016
Journal of medical ethics, Jan 6, 2017
The Belgian model of 'integral' end-of-life care consists of universal access to palliati... more The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects. It is problematic that some critics disregard the empirical evidence as epistemologically irrelevant in a normative ethical debate. Next, rejecting euthanasia because its prevention was a founding principle of PC ignores historical development...
Journal of palliative medicine, Jan 21, 2017
Dear Editor: The International Association for Hospice and Palliative Care’s (IAHPC) recent offic... more Dear Editor: The International Association for Hospice and Palliative Care’s (IAHPC) recent official position statement in this journal aimed to ‘‘describe the position of the IAHPC regarding euthanasia and physician-assisted suicide.’’ A group of board members carried out a literature search to ‘‘identify existing position statements from health professional organizations,’’ and ‘‘statements from seven general medical and nursing associations and statements from seven palliative care organizations were identified.’’ The IAHPC endorsed the European Association for Palliative Care’s (EAPC) majority position on euthanasia and physician-assisted suicide (EAS), which stated that EAS is doctrinally ‘‘incompatible with the very foundations of PC.’’ However, this EAPC white paper (which one of us, P.V.B., coauthored) duly reproduced a dissenting minority position from the Benelux countries and called for more debate and further studies. The IAHPC did neither. One is left wondering why, contradicting its claim to have inventorized all position statements worldwide, the IAHPC completely occulted the dissenting position from Flanders (the northern, Dutch-language half of Belgium). In 2003, the Federation of Palliative Care Flanders (FPCF) officially embraced euthanasia as an option within palliative care (PC) upon legally valid patient request and caregiver agreement. The FPCF’s position stated:
The Journal of Immunology, Mar 1, 1978
Page 1. of December 13, 2010 This information is current as 1978;120;963-970 J Immunol Jan L. Ber... more Page 1. of December 13, 2010 This information is current as 1978;120;963-970 J Immunol Jan L. Bernheim and John Mendelsohn Phytohemagglutinin Stimulation DNA Newly Synthesized After : II. Characterization of the in ...
The Journal of Immunology, Mar 1, 1978
Page 1. of December 13, 2010 This information is current as 1978;120;963-970 J Immunol Jan L. Ber... more Page 1. of December 13, 2010 This information is current as 1978;120;963-970 J Immunol Jan L. Bernheim and John Mendelsohn Phytohemagglutinin Stimulation DNA Newly Synthesized After : II. Characterization of the in ...
Cell Biology and Immunology of Leukocyte Function, 1979
Publisher Summary This chapter presents a study in which it was found that PHA-stimulated culture... more Publisher Summary This chapter presents a study in which it was found that PHA-stimulated cultures contained much fewer cells than expected from the amount of DNA synthesis. By determining the rate of entry into DNA synthesis (S) phase and by assuming every cell entering the S phase gives rise to a new cell, it was calculated that a concentrated (3 × l06 lymphocytes/ml initially) culture would after 6 days have contained 8 × 106 cells. However, only 2 × 106 cells were found. In the much better dilute culture circumstances, the culture expanded to 9.5 × 105 cells, but 13 × 105 were theoretically expected. The rate of entry into the S phase was always in excess of the rate of entry into mitosis. To calculate the cell death rate from the observable number of dead cells, a method to determine the disintegration time of dead lymphocytes was developed. Applying this, it was found that the vast majority of total cell and mitotic deficits were because of cell disintegration and cell death between entry in S and exit from mitosis, respectively. Thus, nearly all cells starting DNA synthesis eventually divide, unless they die underway.
Regulatory Mechanisms in Lymphocyte Activation, 1977
Publisher Summary This chapter presents a summary of the workshop organized successively at the T... more Publisher Summary This chapter presents a summary of the workshop organized successively at the Third European Immunology Meeting (Copenhagen, August 23–26, 1976) and at the Eleventh Leukocyte Culture Conference . The workshop addressed the following topics: (1) culture circumstances that best promote lymphocyte transformation and proliferation, (2) kinetics of proliferation in response to antigens and mitogens, (3) the reliable quantitative assay methods for in vitro lymphocyte proliferation, and (4) solid information that exists on three categories of lymphocyte DNA with unusual or apparently specific characteristics. This chapter reviews various studies on this subject into context. The workshop focused on two highly relevant aspects of the lymphocyte response to stimulation, namely, initiation and termination of proliferation.
Environmental Science and Technology Library, 2001
Diethylstilboestrol (DES), the first synthetic hormone, when antenatally prescribed to prevent sp... more Diethylstilboestrol (DES), the first synthetic hormone, when antenatally prescribed to prevent spontaneous abortion, has been described in the offspring to cause a variety of congenital abnormalities of the female genital tract. In addition, with an estimated absolute risk of 1:1000, it also causes clear cell adenocarcinoma (CCA) of the vagina and cervix in young `DES-daughters’. Also neuroteratogenic effects have been attributed to DES, but the psychopathology in DES-exposed persons is shown here to be largely iathrogenic, i.e., as a consequence of having been disproportionately alarmed by its potential toxicity. With over 20,000 publications, DES is one of the most studied compounds ever. Yet, many doubts persist on its mechanisms of action, on whether or not it may have prevented some abortions, on the epidemiology and causation of CCA, and in how far it may have affected humans through the food-chain. Since no dose-effect relationship has been found in humans, it cannot be excluded that DES could have been toxic at low doses, and that other less potent xenoestrogens would have similar effects.
Science, Technology, and Social Change, 1999
Quality of Life Research, 2019
ABSTRACT To identify preferences of advanced lung cancer patients for receiving information and p... more ABSTRACT To identify preferences of advanced lung cancer patients for receiving information and participating in decision-making concerning treatment options, health-care-setting transfers and end-of-life decision-making. Over the course of 1 year, pulmonologists and oncologists in 13 hospitals in Flanders, Belgium, invited patients with an initial diagnosis of non-small-cell lung cancer IIIb/IV to participate in the study. Shortly after inclusion, the patients were interviewed with a structured questionnaire. One-hundred and twenty-eight patients with a median estimated survival time of 10 months participated. Almost all wanted information on diagnosis, treatment and cure rate and slightly fewer on life expectancy (88.2%). Information about palliative care was desired by 63.5% of patients and information about end-of-life decisions by 56.8%. The percentage of patients who preferred personal control over medical decision-making increased to 14.8% for treatment, 25.0% for transfer and 49.2% for end-of-life decisions, all of which were higher than for medical decisions in general (9.3%). Information and participation preferences of advanced lung cancer patients differ depending on the type of information or decision. As part of a patient-centred approach, physicians should not only check the general but also the specific information and participation preferences of their patients.
Nederlands Tijdschrift voor Geneeskunde, 1998
Revue médicale de Liège, 2001
Introduction: Cette etude est une premiere replication de l'etude nationale sur les decisions... more Introduction: Cette etude est une premiere replication de l'etude nationale sur les decisions medicales concernant la fin de la vie aux Pays-Bas. Son objectif principal est l'evaluation des frequences d'euthauasie, d'aide au suicide et d'autres decisions concernant la fin de la vie en pratique medicale en Flandre, Methode, Un echantillon de 3.999 personnes decedees a ete selectionne parmi les attestations de deces etablies du premier janvier 1998 au 30 avril 1998. Pour chaque attestation de deces, le medecin signataire a recu un questionnaire a remplir anonymement, Resultats, Le taux de reponse a ete de 52 %, Les estimations pour l'ensemble de 1998 ont ete sjustees en fonction des blais de non reponse et des influences saisonnieres, En 1998, 1,1 % de tous les deces etaletit la consequence d'euthanasie (l'administration de moyens letaux a la demande expresse du patient), et 0,1 % a la suite d'aide au suicide. Dans 3,2 % des deces, des moyens letaux ont ete administres sans la demande expresse du patient, Le deces a ete la consequence du soulagement de la souffrance et des symptomes par des doses d'opiaces susceptibles d'abreger la survie dans 18,4 % de ne pas initier ou d'arreter un traitement susceptible de prolonger la survie a ete prise dans 16,4 % des cas. Conclusions. Les decisions medicales influant la duree de la survie sont frequentes en pratique medicale en Flandre, L'incidence de l'euthanasie est moindre qu'aux Pays-Bas, mais l'administration de medicaments letaux sans demande formelle du patient est plus frequente. En Flandre, les decisions concernant la fin de la vie sont moins souvent discutees avec les patients et sont appliquees avec moins de precautions qu'aux Pays-Bas.
The British journal of general practice : the journal of the Royal College of General Practitioners, 2006
BACKGROUND Communication with patients on end-of-life decisions is a delicate topic for which the... more BACKGROUND Communication with patients on end-of-life decisions is a delicate topic for which there is little guidance. AIM To describe the development of a guideline for GPs on end-of-life communication with patients who wish to die at home, in a context where patient autonomy and euthanasia are legally regulated. DESIGN OF STUDY A three-phase process (generation, elaboration and validation). In the generation phase, literature findings were structured and then prioritised in a focus group with GPs of a palliative care consultation network. In the elaboration phase, qualitative data on patients' and caregivers' perspectives were gathered through a focus group with next-of-kin, in-depth interviews with terminal patients, and four quality circle sessions with representatives of all constituencies. In the validation phase, the acceptability of the draft guideline was reviewed in bipolar focus groups (GPs-nurses and GPs-specialists). Finally, comments were solicited from expert...
Journal of Immunology Research
Purpose. To assess neurocognitive function (NCF), psychosocial outcome, health-related quality of... more Purpose. To assess neurocognitive function (NCF), psychosocial outcome, health-related quality of life (HRQoL), and long-term effects of immune-related adverse events (irAE) on metastatic melanoma survivors treated with ipilimumab (IPI). Methods. Melanoma survivors were identified within two study populations (N=104), at a single-center university hospital, and defined as patients who were disease-free for at least 2 years after initiating IPI. Data were collected using 4 patient-reported outcome measures, computerized NCF testing, and a semistructured interview at the start and 1-year follow-up. Results. Out of 18 eligible survivors, 17 were recruited (5F/12M); median age is 57 years (range 33-86); and median time since initiating IPI was 5.6 years (range 2.1-9.3). The clinical interview revealed that survivors suffered from cancer-related emotional distress such as fear of recurrence (N=8), existential problems (N=2), survivor guilt (N=2), and posttraumatic stress disorder (N=6). ...
Blood
A diagnosis of hairy cell leukemia was made by optic microscopy, phase- contrast microscopy, elec... more A diagnosis of hairy cell leukemia was made by optic microscopy, phase- contrast microscopy, electron microscopy, scanning microscopy, and histochemistry of the abnormal blood cells. In vivo these cells were found to have a half-time in the blood of approximately 150 hr. In vitro they had the capacity to adhere firmly to plastic, making it possible to obtain a pure population of hairy cells. Neither T-rosette formation nor phytohemagglutinin (PHA) transformation could be demonstrated in these cells. On the other hand, the presence of immunoglobulins on the surface of the hairy cells (HC) by immunofluorescence, and the synthesis and secretion by these cells of IgM type lambda-chains shown by radioimmunodiffusion, were in favor of their B-type lymphocyte origin. Similarities to chronic lymphocytic leukemia were apparent.
Palliative medicine, 2016
Journal of medical ethics, Jan 6, 2017
The Belgian model of 'integral' end-of-life care consists of universal access to palliati... more The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects. It is problematic that some critics disregard the empirical evidence as epistemologically irrelevant in a normative ethical debate. Next, rejecting euthanasia because its prevention was a founding principle of PC ignores historical development...
Journal of palliative medicine, Jan 21, 2017
Dear Editor: The International Association for Hospice and Palliative Care’s (IAHPC) recent offic... more Dear Editor: The International Association for Hospice and Palliative Care’s (IAHPC) recent official position statement in this journal aimed to ‘‘describe the position of the IAHPC regarding euthanasia and physician-assisted suicide.’’ A group of board members carried out a literature search to ‘‘identify existing position statements from health professional organizations,’’ and ‘‘statements from seven general medical and nursing associations and statements from seven palliative care organizations were identified.’’ The IAHPC endorsed the European Association for Palliative Care’s (EAPC) majority position on euthanasia and physician-assisted suicide (EAS), which stated that EAS is doctrinally ‘‘incompatible with the very foundations of PC.’’ However, this EAPC white paper (which one of us, P.V.B., coauthored) duly reproduced a dissenting minority position from the Benelux countries and called for more debate and further studies. The IAHPC did neither. One is left wondering why, contradicting its claim to have inventorized all position statements worldwide, the IAHPC completely occulted the dissenting position from Flanders (the northern, Dutch-language half of Belgium). In 2003, the Federation of Palliative Care Flanders (FPCF) officially embraced euthanasia as an option within palliative care (PC) upon legally valid patient request and caregiver agreement. The FPCF’s position stated:
The Journal of Immunology, Mar 1, 1978
Page 1. of December 13, 2010 This information is current as 1978;120;963-970 J Immunol Jan L. Ber... more Page 1. of December 13, 2010 This information is current as 1978;120;963-970 J Immunol Jan L. Bernheim and John Mendelsohn Phytohemagglutinin Stimulation DNA Newly Synthesized After : II. Characterization of the in ...
The Journal of Immunology, Mar 1, 1978
Page 1. of December 13, 2010 This information is current as 1978;120;963-970 J Immunol Jan L. Ber... more Page 1. of December 13, 2010 This information is current as 1978;120;963-970 J Immunol Jan L. Bernheim and John Mendelsohn Phytohemagglutinin Stimulation DNA Newly Synthesized After : II. Characterization of the in ...
Cell Biology and Immunology of Leukocyte Function, 1979
Publisher Summary This chapter presents a study in which it was found that PHA-stimulated culture... more Publisher Summary This chapter presents a study in which it was found that PHA-stimulated cultures contained much fewer cells than expected from the amount of DNA synthesis. By determining the rate of entry into DNA synthesis (S) phase and by assuming every cell entering the S phase gives rise to a new cell, it was calculated that a concentrated (3 × l06 lymphocytes/ml initially) culture would after 6 days have contained 8 × 106 cells. However, only 2 × 106 cells were found. In the much better dilute culture circumstances, the culture expanded to 9.5 × 105 cells, but 13 × 105 were theoretically expected. The rate of entry into the S phase was always in excess of the rate of entry into mitosis. To calculate the cell death rate from the observable number of dead cells, a method to determine the disintegration time of dead lymphocytes was developed. Applying this, it was found that the vast majority of total cell and mitotic deficits were because of cell disintegration and cell death between entry in S and exit from mitosis, respectively. Thus, nearly all cells starting DNA synthesis eventually divide, unless they die underway.
Regulatory Mechanisms in Lymphocyte Activation, 1977
Publisher Summary This chapter presents a summary of the workshop organized successively at the T... more Publisher Summary This chapter presents a summary of the workshop organized successively at the Third European Immunology Meeting (Copenhagen, August 23–26, 1976) and at the Eleventh Leukocyte Culture Conference . The workshop addressed the following topics: (1) culture circumstances that best promote lymphocyte transformation and proliferation, (2) kinetics of proliferation in response to antigens and mitogens, (3) the reliable quantitative assay methods for in vitro lymphocyte proliferation, and (4) solid information that exists on three categories of lymphocyte DNA with unusual or apparently specific characteristics. This chapter reviews various studies on this subject into context. The workshop focused on two highly relevant aspects of the lymphocyte response to stimulation, namely, initiation and termination of proliferation.
Environmental Science and Technology Library, 2001
Diethylstilboestrol (DES), the first synthetic hormone, when antenatally prescribed to prevent sp... more Diethylstilboestrol (DES), the first synthetic hormone, when antenatally prescribed to prevent spontaneous abortion, has been described in the offspring to cause a variety of congenital abnormalities of the female genital tract. In addition, with an estimated absolute risk of 1:1000, it also causes clear cell adenocarcinoma (CCA) of the vagina and cervix in young `DES-daughters’. Also neuroteratogenic effects have been attributed to DES, but the psychopathology in DES-exposed persons is shown here to be largely iathrogenic, i.e., as a consequence of having been disproportionately alarmed by its potential toxicity. With over 20,000 publications, DES is one of the most studied compounds ever. Yet, many doubts persist on its mechanisms of action, on whether or not it may have prevented some abortions, on the epidemiology and causation of CCA, and in how far it may have affected humans through the food-chain. Since no dose-effect relationship has been found in humans, it cannot be excluded that DES could have been toxic at low doses, and that other less potent xenoestrogens would have similar effects.
Science, Technology, and Social Change, 1999