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Severe rhabdomyolysis due to idiopathic inflammatory myopathies, a wary manifestation of a heterogenous pathology. 严重的横纹肌溶解由于特发性炎性肌病,一个谨慎的表现异质病理。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17843286.2022.2070974
Niels Schepens, Pauline H Herroelen, An-Sofie Decavele, An Vanacker

Idiopathic inflammatory myopathies (IIM) are historically classified by The Bohan and Peter criteria. The presentation of IIM is versatile and clinical-serological findings can aid in diagnosing the underlying form of IIM. Over the past years, the discovery and the use of myositis-specific autoantibodies (MSA) and myositis-associated autoantibodies (MAA) have led to a more heterogeneous classification by the European League Against Rheumatism and American College of Rheumatology (EULAR/ACR).This paper describes a case of dermatomyositis sine dermatitis. A 70-year -old woman presented with complaints of muscle weakness and was admitted because of severe oliguric renal failure due to rhabdomyolysis. Despite treatment with hemodialysis and initial recovery, her clinic worsened again. The disease course in combination with electromyography findings, PET-scan results, and positive myositis-specific autoantibodies, that is, anti-NXP-2 antibodies, ultimately led to the diagnosis.Today, commercial kits based on line immunoassay and dot blot have mostly replaced the labor-intensive immunoprecipitation of RNA and/or proteins for detecting MSA. Though it makes routine testing of multiple MSA easy to implement in clinical practice, more validation studies are required and clinicians should be aware of its limitations, including false-positive results. When clinical suspicion for IIM is high, a negative screening for antinuclear antibodies (ANA) result does not exclude IIM and the first test of choice remains a multi-specific immunoassay for the whole spectrum of MSA.In this paper, we want to underline that there is no shortcut in diagnosing IIM. Caution is required in interpreting different EMG, PET-scan, histological, and laboratory findings. Especially in the case of rhabdomyolysis, as this is a severe and wary manifestation of myositis.

特发性炎症性肌病(IIM)历来被Bohan和Peter标准分类。IIM的表现是多种多样的,临床血清学结果可以帮助诊断IIM的潜在形式。在过去的几年里,肌炎特异性自身抗体(MSA)和肌炎相关自身抗体(MAA)的发现和使用导致了欧洲抗风湿病联盟和美国风湿病学会(EULAR/ACR)更加异质的分类。本文报告一例皮肌炎合并皮炎。一名70岁妇女,因横纹肌溶解引起的严重少尿肾功能衰竭,以肌肉无力为主诉入院。尽管进行了血液透析治疗并初步恢复,但她的病情再次恶化。疾病病程结合肌电图、pet扫描结果和肌炎特异性自身抗体阳性,即抗nxp -2抗体,最终导致诊断。今天,基于在线免疫分析和点印迹的商业试剂盒已经基本上取代了RNA和/或蛋白质的劳动密集型免疫沉淀来检测MSA。虽然它使临床实践中对多种MSA的常规检测变得容易,但需要更多的验证研究,临床医生应该意识到它的局限性,包括假阳性结果。当临床对IIM的怀疑很高时,抗核抗体(ANA)的阴性筛查结果不能排除IIM,首选的检测方法仍然是针对MSA全谱的多特异性免疫测定。在本文中,我们想强调的是,诊断IIM没有捷径。在解释不同的肌电图、pet扫描、组织学和实验室结果时需要谨慎。特别是横纹肌溶解,因为这是肌炎的一种严重而谨慎的表现。
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引用次数: 1
Changes in the use and uptake of a national out-of-hours telephone triage service by younger and older patients seeking non-urgent unplanned care surrounding the COVID-19 pandemic in Flanders (Belgium). 法兰德斯(比利时)在COVID-19大流行期间寻求非紧急计划外护理的年轻和老年患者使用和接受国家非工作时间电话分诊服务的变化。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17843286.2022.2068296
Farah Islam, Koen Milisen, Marc Gellens, Joël Enckels, Ewa Kocot, Christoph Sowada, Marc Sabbe

Background: This study seeks to examine if and how the COVID-19 pandemic has prompted changes in the use and uptake of a national out-of-hours (OOH) telephone triage service by younger and older patients seeking non-urgent unplanned care in Flanders (Belgium).

Methods: A descriptive study was conducted using registry data obtained from the 1733 OOH telephone triage service in a Flemish region of Belgium. All calls received between 1 January 2019 and 31 December 2020 were analyzed.

Results: A significant association was found between patient age and period of call (χ2 = 594.54, p < .001). Calls made to the 1733 OOH telephone triage service were significantly less likely to be dispatched to a higher level of urgency by operators compared to calls made before the COVID-19 period (OR = 0.80, 95% CI [0.74-0.85]). While calls concerning older adults were significantly more likely to be dispatched to a higher level of urgency by operators compared to younger adults (regardless of period of call) (65 to 74 yrs: OR = 5.75, 95% CI [4.86-6.80]; 75 to 84 yrs: OR = 15.21, 95% CI [13.18-17.56]; ≥ 85 yrs: OR = 28.77, 95% CI [25.01-33.09]), only 6.7% of all COVID-19 related calls involved older adults over 65 years of age.

Conclusion: Findings showed that there was a general decline in the number of calls dispatched to a higher level of urgency by operators during the COVID-19 period but that there were differences in the use and uptake of these services by younger and older age segments.

背景:本研究旨在研究COVID-19大流行是否以及如何促使比利时法兰德斯(Flanders)寻求非紧急计划外护理的年轻和老年患者使用和接受全国非工作时间(OOH)电话分诊服务的情况发生变化。方法:一项描述性研究使用登记数据从1733户外电话分诊服务在比利时佛兰德地区进行。分析了2019年1月1日至2020年12月31日期间收到的所有电话。结果:发现患者年龄与呼叫时间之间存在显著关联(χ2 = 594.54, p)。结论:研究结果显示,在COVID-19期间,接线员向更高紧急级别发送的呼叫数量普遍下降,但年轻人和老年人对这些服务的使用和接受程度存在差异。
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引用次数: 1
A Belgian student with black eschars. 一个比利时学生,身上有黑色疤痕。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17843286.2022.2090181
Astrid Van Reempts, Liesbet De Meester, Koen Blot, Ann-Sophie Candaele, Hilde Beele, Jo Van Dorpe, Diana Huis In 't Veld

Background: Human cowpox virus infection is a rare zoonotic disease. Cowpox virus is a member of the Orthopoxvirus genus, like smallpox. Over the last years records of cowpox virus transmission from pet cats and pet rats to humans in Europe have increased. This observation may result from the loss of cross-immunity against orthopoxviruses after discontinuation of routine smallpox vaccination in the 1980s.

Case presentation: We report the first case of a human cowpox infection in an unvaccinated Belgian citizen. This 19-year-old student presented with multiple necrotic skin lesions on the chin, the scalp and the pubic region, and with cervical lymphadenopathy and flu-like symptoms. The diagnosis of human cowpox was based on electron microscopic findings and PCR examination performed on a skin biopsy of the pubic lesion. Close contact with cats (her domestic cats or cats from a local shelter) was probably the source of transmission. Spreading of the lesions was likely the result of autoinoculation. After six months all lesions spontaneously healed with atrophic scars.

Discussion: To enhance awareness of this rare viral zoonosis and to verify the suspected increase in incidence and symptom severity after cessation of smallpox vaccination, one could argue whether human cowpox should become a notifiable disease.

背景:人牛痘病毒感染是一种罕见的人畜共患疾病。牛痘病毒和天花一样,是正痘病毒属的一员。在过去几年中,欧洲从宠物猫和宠物鼠向人类传播牛痘病毒的记录有所增加。这一观察结果可能是由于20世纪80年代停止常规天花疫苗接种后丧失了对正痘病毒的交叉免疫。病例介绍:我们报告第一例人类牛痘感染在未接种疫苗的比利时公民。这名19岁的学生表现为下巴、头皮和阴部多发皮肤坏死,并伴有颈部淋巴结病和流感样症状。人类牛痘的诊断是基于对耻骨病变的皮肤活检进行的电子显微镜检查和PCR检查。与猫(她的家猫或当地收容所的猫)的密切接触可能是传播源。病变的扩散可能是自体接种的结果。六个月后,所有病变自发愈合,并留下萎缩性疤痕。讨论:为了提高对这一罕见病毒性人畜共患病的认识,并验证停止天花疫苗接种后疑似发病率和症状严重程度的增加,人们可能会争论人类牛痘是否应成为一种法定通报疾病。
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引用次数: 0
Associations between obesity, self-reported weakness and their combinations with mortality in nursing home residents. 养老院居民肥胖、自述虚弱及其与死亡率的关系。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17843286.2022.2075180
Gulistan Bahat, Birkan Ilhan, Nezahat Muge Catikkas, Asli Tufan, Savaş Ozturk, Hafize Dogan, Mehmet Akif Karan

Objectives: There are studies on associations between obesity and mortality in nursing home (NH) residents, but the presence of concomitant muscle weakness has not been examined. We considered that self-reported weakness might be a low muscle strength proxy marker. We aimed to examine associations of obesity alone, self-reported muscle weakness alone, and their combination with mortality in NH residents.

Methods: This is a retrospective longitudinal follow-up study. We noted age, sex, nutritional status, functionality, number of chronic diseases, and regular medication. Obesity was assessed by the body fat-percentage method estimated by bioimpedance analysis. Weakness was identified by self-reported muscle weakness. Survival was evaluated with a univariate log-rank test and multivariate Cox regression analyses.

Results: We included 214 participants. In a median follow-up time of 46 months, mortality occurred in 37.4%. In multivariate analysis adjusted by age, sex, undernutrition, number of chronic diseases, and regular medication, functional scores; 'non-weak non-obese' participants or 'weak alone' participants or 'weak+obese' participants had higher mortality risk when compared with the 'obesity alone' participants [hazard ratio (HR) = 2.6, 95% confidence interval (CI) = 1.2-5.5, p = 0.01; HR = 2.6, 95% CI = 1.2-5.9, p = 0.02; HR = 3.0, 95% CI = 1.2-7.7, p = 0.02].

Conclusion: This is the first report showing that obesity was associated with lower mortality risk if the weakness was not present in NH residents. However, obesity with concomitant weakness was associated with mortality risk similar to non-weak non-obese or weak alone participants. Our study suggests a simple consideration of weakness that can easily be integrated into everyday practice.

目的:有关于养老院(NH)居民肥胖与死亡率之间关系的研究,但尚未检查是否存在伴随的肌肉无力。我们认为自我报告的虚弱可能是一个低肌肉力量的代理标记。我们的目的是研究肥胖单独、自我报告的肌肉无力单独以及它们与NH居民死亡率的关联。方法:回顾性纵向随访研究。我们记录了年龄、性别、营养状况、功能、慢性病数量和定期用药。通过生物阻抗分析估算体脂百分比法评估肥胖。虚弱是通过自我报告的肌肉无力来确定的。生存率评估采用单变量log-rank检验和多变量Cox回归分析。结果:我们纳入了214名参与者。中位随访时间为46个月,死亡率为37.4%。在经年龄、性别、营养不良、慢性病数量和常规用药调整的多变量分析中,功能评分;与“单独肥胖”参与者相比,“非虚弱非肥胖”参与者或“单独虚弱”参与者或“虚弱+肥胖”参与者的死亡风险更高[风险比(HR) = 2.6, 95%可信区间(CI) = 1.2-5.5, p = 0.01;HR = 2.6, 95% CI = 1.2 ~ 5.9, p = 0.02;HR = 3.0, 95% CI = 1.2 ~ 7.7, p = 0.02]。结论:这是第一份报告显示,如果在NH居民中不存在虚弱,肥胖与较低的死亡风险相关。然而,肥胖伴虚弱的死亡风险与非虚弱的非肥胖或虚弱的单独参与者相似。我们的研究表明,对弱点的简单考虑可以很容易地融入日常实践。
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引用次数: 3
Glycomics-based serum markers as reliable tool for assessment of viral response after treatment with direct-acting antiviral drugs in hepatitis C virus infection. 基于糖组学的血清标志物是评估丙型肝炎病毒感染直接作用抗病毒药物治疗后病毒反应的可靠工具。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17843286.2022.2072110
Nicky Somers, Elisabeth Vandekerckhove, Anja Geerts, Helena Degroote, Sander Lefere, Lindsey Devisscher, Leander Meuris, Nico Callewaert, Hans Van Vlierberghe, Xavier Verhelst

Objectives: Patients with chronic hepatitis C virus (HCV) infection have a genuine risk of developing liver fibrosis and cirrhosis, potentially resulting in hepatocellular carcinoma (HCC), a risk that remains even after sustained viral response (SVR). Glycomics-based biomarkers are an attractive tool to closely monitor these patients during and after antiviral treatment, as alterations in the abundance of N-glycans reflect an altered state of the liver. This study assessed serum glycomics for the evaluation of inflammation-related fibrosis regression during and after treatment of HCV with DAAs.

Methods: The GlycoFibroTest and GlycoCirrhoTest were analyzed in the sera 36 HCV-infected patients with advanced fibrosis (F3) or established cirrhosis (F4), before (week 0), during (week 12) and after (week 24) a twelve-week oral administration of DAAs therapy - using an optimized glycomic technology on a DNA sequencer.

Results: All patients achieved SVR after treatment and two of them developed HCC in the subsequent five years. A significant decrease of the GlycoFibroTest (p < 0.0001) was seen after 12 weeks, consistent with other measured biomarkers (APRI, FIB-4, FibroTest). Statistical analysis was performed in IBM SPSS Statistics version 28.0, using the non-parametric Friedman's test with a statistical significance α level of 0.05.

Conclusion: This study suggests that the GlycoFibroTest is a serum biomarker for viral response in HCV patients. The rapid decrease of the glycomics-based biomarker probably reflects the amelioration of liver inflammation as underlying process, rather than the improvement of liver fibrosis itself.

目的:慢性丙型肝炎病毒(HCV)感染患者有发生肝纤维化和肝硬化的真实风险,可能导致肝细胞癌(HCC),即使在持续病毒反应(SVR)后仍存在这种风险。基于糖组学的生物标志物是一种有吸引力的工具,可以在抗病毒治疗期间和之后密切监测这些患者,因为n -聚糖丰度的改变反映了肝脏的改变状态。本研究评估了血清糖组学,以评估丙型肝炎病毒DAAs治疗期间和之后炎症相关纤维化的消退。方法:对36例晚期纤维化(F3)或肝硬化(F4)的hcv感染患者,在口服DAAs治疗12周之前(第0周)、期间(第12周)和之后(第24周)的血清进行糖纤维试验和肝功能硬化试验分析-使用DNA测序仪上优化的糖糖技术。结果:所有患者治疗后均达到SVR,其中2例在治疗后5年内发生HCC。结论:本研究提示,糖纤维试验是HCV患者病毒反应的血清生物标志物。基于糖组学的生物标志物的快速下降可能反映了肝脏炎症作为潜在过程的改善,而不是肝纤维化本身的改善。
{"title":"Glycomics-based serum markers as reliable tool for assessment of viral response after treatment with direct-acting antiviral drugs in hepatitis C virus infection.","authors":"Nicky Somers,&nbsp;Elisabeth Vandekerckhove,&nbsp;Anja Geerts,&nbsp;Helena Degroote,&nbsp;Sander Lefere,&nbsp;Lindsey Devisscher,&nbsp;Leander Meuris,&nbsp;Nico Callewaert,&nbsp;Hans Van Vlierberghe,&nbsp;Xavier Verhelst","doi":"10.1080/17843286.2022.2072110","DOIUrl":"https://doi.org/10.1080/17843286.2022.2072110","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with chronic hepatitis C virus (HCV) infection have a genuine risk of developing liver fibrosis and cirrhosis, potentially resulting in hepatocellular carcinoma (HCC), a risk that remains even after sustained viral response (SVR). Glycomics-based biomarkers are an attractive tool to closely monitor these patients during and after antiviral treatment, as alterations in the abundance of N-glycans reflect an altered state of the liver. This study assessed serum glycomics for the evaluation of inflammation-related fibrosis regression during and after treatment of HCV with DAAs.</p><p><strong>Methods: </strong>The GlycoFibroTest and GlycoCirrhoTest were analyzed in the sera 36 HCV-infected patients with advanced fibrosis (F3) or established cirrhosis (F4), before (week 0), during (week 12) and after (week 24) a twelve-week oral administration of DAAs therapy - using an optimized glycomic technology on a DNA sequencer.</p><p><strong>Results: </strong>All patients achieved SVR after treatment and two of them developed HCC in the subsequent five years. A significant decrease of the GlycoFibroTest (p < 0.0001) was seen after 12 weeks, consistent with other measured biomarkers (APRI, FIB-4, FibroTest). Statistical analysis was performed in IBM SPSS Statistics version 28.0, using the non-parametric Friedman's test with a statistical significance α level of 0.05.</p><p><strong>Conclusion: </strong>This study suggests that the GlycoFibroTest is a serum biomarker for viral response in HCV patients. The rapid decrease of the glycomics-based biomarker probably reflects the amelioration of liver inflammation as underlying process, rather than the improvement of liver fibrosis itself.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9398693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hepatic arterial infusion chemotherapy versus transarterial chemoembolization for patients with unresectable hepatocellular carcinoma: a systematic review and meta-analysis. 肝动脉输注化疗与经动脉化疗栓塞治疗不可切除肝癌:一项系统回顾和荟萃分析。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17843286.2022.2076791
Shun-Yu Kong, Jiao-Jiao Song, Yao-Qi Jin, Man-Jun Deng, Jing-Xin Yan

Background: We carried out a systematic review and meta-analysis to assess the safety and effectiveness of hepatic arterial infusion chemotherapy (HAIC) compared with transarterial chemoembolization (TACE) for patients with unresectable hepatocellular carcinoma (uHCC).

Methods: Eligible studies were searched by MEDLINE, the Cochrane Library, Embase, and Web of Science from January 1995 to January 2022, investigating eligible literature comparing HAIC and TACE for patients with HCC. The main outcome measures included progression-free survival (PFS), overall survival (OS), adverse events (AEs), objective response rate (ORR), and diseases control rate (DCR).

Results: Eight literature and 1028 patients were enrolled in this meta-analysis. The pooled PFS, OS, ORR, and DCR were HR = 0.89 (95% CI, 0.81-0.98), HR = 0.84 (95% CI, 0.75-0.93), OR = 2.77 (95% CI, 2.01-3.80), and OR = 4.64 (95% CI, 2.40-8.99), respectively. The adverse events of HAIC were lower than TACE.

Conclusion: Our meta-analysis revealed that HAIC can achieve a better effect and survival benefits than TACE in patients with uHCC.

背景:我们进行了一项系统回顾和荟萃分析,以评估肝动脉输注化疗(HAIC)与经动脉化疗栓塞(TACE)对不可切除肝细胞癌(uHCC)患者的安全性和有效性。方法:从1995年1月至2022年1月,通过MEDLINE、Cochrane图书馆、Embase和Web of Science检索符合条件的研究,调查比较HAIC和TACE治疗HCC患者的符合条件的文献。主要结局指标包括无进展生存期(PFS)、总生存期(OS)、不良事件(ae)、客观缓解率(ORR)和疾病控制率(DCR)。结果:8篇文献和1028例患者纳入本荟萃分析。合并PFS、OS、ORR和DCR分别为HR = 0.89 (95% CI, 0.81-0.98)、HR = 0.84 (95% CI, 0.75-0.93)、OR = 2.77 (95% CI, 2.01-3.80)和OR = 4.64 (95% CI, 2.40-8.99)。HAIC组的不良事件低于TACE组。结论:我们的荟萃分析显示,在uHCC患者中,HAIC比TACE可以获得更好的疗效和生存获益。
{"title":"Hepatic arterial infusion chemotherapy versus transarterial chemoembolization for patients with unresectable hepatocellular carcinoma: a systematic review and meta-analysis.","authors":"Shun-Yu Kong,&nbsp;Jiao-Jiao Song,&nbsp;Yao-Qi Jin,&nbsp;Man-Jun Deng,&nbsp;Jing-Xin Yan","doi":"10.1080/17843286.2022.2076791","DOIUrl":"https://doi.org/10.1080/17843286.2022.2076791","url":null,"abstract":"<p><strong>Background: </strong>We carried out a systematic review and meta-analysis to assess the safety and effectiveness of hepatic arterial infusion chemotherapy (HAIC) compared with transarterial chemoembolization (TACE) for patients with unresectable hepatocellular carcinoma (uHCC).</p><p><strong>Methods: </strong>Eligible studies were searched by MEDLINE, the Cochrane Library, Embase, and Web of Science from January 1995 to January 2022, investigating eligible literature comparing HAIC and TACE for patients with HCC. The main outcome measures included progression-free survival (PFS), overall survival (OS), adverse events (AEs), objective response rate (ORR), and diseases control rate (DCR).</p><p><strong>Results: </strong>Eight literature and 1028 patients were enrolled in this meta-analysis. The pooled PFS, OS, ORR, and DCR were HR = 0.89 (95% CI, 0.81-0.98), HR = 0.84 (95% CI, 0.75-0.93), OR = 2.77 (95% CI, 2.01-3.80), and OR = 4.64 (95% CI, 2.40-8.99), respectively. The adverse events of HAIC were lower than TACE.</p><p><strong>Conclusion: </strong>Our meta-analysis revealed that HAIC can achieve a better effect and survival benefits than TACE in patients with uHCC.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10841376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Differences in antibiotic prescribing quality in Belgian out-of-hours primary care services. 比利时非工作时间初级保健服务抗生素处方质量的差异。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17843286.2022.2081772
Jeroen De Man, Roy Remmen, Hilde Philips

Objectives: This study aims to compare trends in antibiotic prescribing behaviour for lower urinary tract infections among different out-of-hours primary care services.

Methods: Cross-sectional study using routine prescription data extracted from electronic health records from six out-of-hours services. The study population included 5888 cases diagnosed with an uncomplicated lower urinary tract infection from 2016 to 2020. Prescriptions were assessed based on the national guidelines.

Results: Considering the total study period, an antibiotic was prescribed in 98.9% of cases. Among these cases, 55.0% was prescribed a guideline recommended antibiotic, 21.0% was prescribed fosfomycin, 17.4% was prescribed a quinolone and 1.8% was prescribed more than one antibiotic. Guideline recommended prescribing improved substantially over time. However, there were significant differences among out-of-hours services in terms of proportion over the total study period (between 49.0% and 66.7%) as well as in terms of time-trend pattern.

Conclusion: Substantial differences among out-of-hours services suggest a potential for further improvement in the quality of antibiotic prescribing. Monitoring prescribing behaviour per out-of-hours primary care service can guide focused interventions.

目的:本研究旨在比较不同非工作时间初级保健服务中下尿路感染抗生素处方行为的趋势。方法:采用从6个非工作时间服务的电子健康记录中提取的常规处方数据进行横断面研究。研究人群包括2016年至2020年诊断为无并发症下尿路感染的5888例患者。根据国家指南对处方进行评估。结果:考虑到整个研究期间,98.9%的病例开了抗生素。其中55.0%使用指南推荐抗生素,21.0%使用磷霉素,17.4%使用喹诺酮类药物,1.8%使用一种以上抗生素。指南推荐的处方随着时间的推移有了很大的改进。然而,非工作时间服务在整个研究期间所占的比例(介于49.0%至66.7%之间),以及时间趋势模式,均有显著差异。结论:非工作时间服务之间的实质性差异表明抗生素处方质量有进一步改善的潜力。监测每个非工作时间初级保健服务的处方行为可以指导有针对性的干预措施。
{"title":"Differences in antibiotic prescribing quality in Belgian out-of-hours primary care services.","authors":"Jeroen De Man,&nbsp;Roy Remmen,&nbsp;Hilde Philips","doi":"10.1080/17843286.2022.2081772","DOIUrl":"https://doi.org/10.1080/17843286.2022.2081772","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to compare trends in antibiotic prescribing behaviour for lower urinary tract infections among different out-of-hours primary care services.</p><p><strong>Methods: </strong>Cross-sectional study using routine prescription data extracted from electronic health records from six out-of-hours services. The study population included 5888 cases diagnosed with an uncomplicated lower urinary tract infection from 2016 to 2020. Prescriptions were assessed based on the national guidelines.</p><p><strong>Results: </strong>Considering the total study period, an antibiotic was prescribed in 98.9% of cases. Among these cases, 55.0% was prescribed a guideline recommended antibiotic, 21.0% was prescribed fosfomycin, 17.4% was prescribed a quinolone and 1.8% was prescribed more than one antibiotic. Guideline recommended prescribing improved substantially over time. However, there were significant differences among out-of-hours services in terms of proportion over the total study period (between 49.0% and 66.7%) as well as in terms of time-trend pattern.</p><p><strong>Conclusion: </strong>Substantial differences among out-of-hours services suggest a potential for further improvement in the quality of antibiotic prescribing. Monitoring prescribing behaviour per out-of-hours primary care service can guide focused interventions.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9103743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changes in lipid lowering medication and lipid levels over time in patients with stable coronary artery disease. 稳定冠状动脉疾病患者降脂药物和脂质水平随时间的变化
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17843286.2022.2084948
Clara François, A M Willems, L Van Calster, E Germonpré, Johan De Sutter

Background/aim: To provide longitudinal data on the evolution of lipid levels and the intake of lipid-lowering therapies in patients with stable coronary artery disease.

Methods: Single-centre retrospective study with inclusion of 350 patients with a first coronary artery event in 2014 or earlier and outpatient cardiac clinic follow-up in 2015 and 2019. Lipid levels were collected within a time frame of 3 months of their visits.This retrospective study protocol (2020.086) was approved by the ethical committee and by the Data Privacy Officer of AZ Maria Middelares Ghent. For this type of study, formal consent is not required, following local law and regulations.

Results: Average LDL levels were 82 (±26) mg/dl in 2015 and 70 (±24) mg/dl in 2019 (p < 0.001). Most patients included were already on statin treatment before inclusion in the trial (94%), with a significant increase in high-intensity statin use (45% vs. 58%) after a 5-year follow-up. At the same time, we observed a significant increase in ezetimibe use (in combination with statin therapy or in monotherapy) (8% vs. 22%) during follow-up. LDL ≤70 mg/dl was 34% in 2015 and 53% in 2019. LDL ≤55 mg/dl was 13% in 2015 and 28% in 2019.

Conclusion: This study shows significant intensification of lipid-lowering therapy use during follow-up, and a significant lipid level lowering after 5-year follow-up, in an outpatient cardiac clinic follow-up. Further improvement in lipid control is still desirable, especially after the European Society of Cardiology recommend stricter lipid levels in the 2021 Prevention Guidelines.

背景/目的:为稳定型冠状动脉疾病患者血脂水平的演变和降脂治疗的摄入提供纵向数据。方法:单中心回顾性研究,纳入350例2014年或更早发生首次冠状动脉事件的患者,并于2015年和2019年进行门诊心脏门诊随访。血脂水平是在3个月的时间框架内收集的。本回顾性研究方案(2020.086)经伦理委员会和AZ Maria Middelares Ghent数据隐私官批准。对于此类研究,根据当地法律法规,不需要正式同意。结果:2015年的平均LDL水平为82(±26)mg/dl, 2019年为70(±24)mg/dl (p)。结论:本研究显示,在随访期间,降脂治疗的使用显著加强,在5年的门诊心脏临床随访中,血脂水平显著降低。进一步改善脂质控制仍然是可取的,特别是在欧洲心脏病学会在2021年预防指南中建议更严格的脂质水平之后。
{"title":"Changes in lipid lowering medication and lipid levels over time in patients with stable coronary artery disease.","authors":"Clara François,&nbsp;A M Willems,&nbsp;L Van Calster,&nbsp;E Germonpré,&nbsp;Johan De Sutter","doi":"10.1080/17843286.2022.2084948","DOIUrl":"https://doi.org/10.1080/17843286.2022.2084948","url":null,"abstract":"<p><strong>Background/aim: </strong>To provide longitudinal data on the evolution of lipid levels and the intake of lipid-lowering therapies in patients with stable coronary artery disease.</p><p><strong>Methods: </strong>Single-centre retrospective study with inclusion of 350 patients with a first coronary artery event in 2014 or earlier and outpatient cardiac clinic follow-up in 2015 and 2019. Lipid levels were collected within a time frame of 3 months of their visits.This retrospective study protocol (2020.086) was approved by the ethical committee and by the Data Privacy Officer of AZ Maria Middelares Ghent. For this type of study, formal consent is not required, following local law and regulations.</p><p><strong>Results: </strong>Average LDL levels were 82 (±26) mg/dl in 2015 and 70 (±24) mg/dl in 2019 (<i>p</i> < 0.001). Most patients included were already on statin treatment before inclusion in the trial (94%), with a significant increase in high-intensity statin use (45% vs. 58%) after a 5-year follow-up. At the same time, we observed a significant increase in ezetimibe use (in combination with statin therapy or in monotherapy) (8% vs. 22%) during follow-up. LDL ≤70 mg/dl was 34% in 2015 and 53% in 2019. LDL ≤55 mg/dl was 13% in 2015 and 28% in 2019.</p><p><strong>Conclusion: </strong>This study shows significant intensification of lipid-lowering therapy use during follow-up, and a significant lipid level lowering after 5-year follow-up, in an outpatient cardiac clinic follow-up. Further improvement in lipid control is still desirable, especially after the European Society of Cardiology recommend stricter lipid levels in the 2021 Prevention Guidelines.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9454871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Organization, feasibility and patient appreciation of a follow-up consultation in surgical critically ill patients with favorable baseline quality of life and prolonged ICU-stay: a pilot study. 基线生活质量良好且icu住院时间延长的外科危重患者随访会诊的组织、可行性和患者评价:一项试点研究。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17843286.2022.2050003
Sofie F M Vanderhaeghen, Johan M Decruyenaere, Dominique D Benoit, Sandra G Oeyen

Objectives: Intensive care unit (ICU) survivors are often left with impairments in physical, mental and cognitive functioning (Post-Intensive Care Syndrome (PICS)). We evaluated the organization, the feasibility for caregivers and patients and the patients' appreciation of a post-ICU consultation aiming to detect these PICS-symptoms.

Methods: A single-center prospective observational pilot study was conducted during an 18 month-period in the surgical ICU of a tertiary care hospital. Consecutive adult patients with an ICU-stay of ≥8 days and a favorable baseline quality of life (utility index ≥0.6 on EQ-5D-3 L) were eligible for inclusion. A post-ICU follow-up consultation consisting of a structured interview was scheduled 3 months after hospital discharge. Characteristics of the consultation (CG) and no consultation group (NCG) were compared. P-values <0.05 were considered significant.

Results: Of 133 eligible patients, 85 (64%) consented for the study and 42 (49%) attended the consultation. A total of 148 phone calls were made to schedule the consultations. Consultations took a median of 68 (61-74) minutes. Compared to CG-patients, NCG-patients were more often discharged to a care facility (P = 0.003) and had more problems with mobility (P = 0.014), self-care (P < 0.001) and usual activities (P = 0.005) after 3 months. At least one PICS-related problem was documented in all patients in the CG and NCG. Thirty-four CG-patients (81%) appreciated the initiative.

Conclusion: Organizing an ICU-follow-up consultation was difficult and feasibility was low, but most attending patients appreciated the initiative. Better developed structures for ICU-follow-up are needed in view of the high number of PICS-related problems documented.

目的:重症监护病房(ICU)幸存者往往会留下身体、精神和认知功能的损伤(重症监护后综合征(PICS))。我们评估了组织、护理人员和患者的可行性以及患者对icu后会诊的评价,目的是发现这些pics症状。方法:在某三级医院外科ICU进行为期18个月的单中心前瞻性观察性初步研究。icu住院≥8天且基线生活质量良好(eq - 5d - 3l效用指数≥0.6)的连续成人患者符合纳入条件。出院后3个月进行icu后随访会诊,包括结构化访谈。比较会诊组(CG)和无会诊组(NCG)的特点。p值结果:133例符合条件的患者中,85例(64%)同意研究,42例(49%)参加咨询。共打了148个电话安排咨询时间。咨询时间中位数为68(61-74)分钟。与cg组患者相比,ncg组患者出院率更高(P = 0.003),活动能力问题(P = 0.014)和自我护理问题(P)更多。结论:组织icu随访会诊困难且可行性低,但大多数就诊患者对这一举措表示赞赏。鉴于大量与pics相关的问题记录在案,需要更好地开发icu随访结构。
{"title":"Organization, feasibility and patient appreciation of a follow-up consultation in surgical critically ill patients with favorable baseline quality of life and prolonged ICU-stay: a pilot study.","authors":"Sofie F M Vanderhaeghen,&nbsp;Johan M Decruyenaere,&nbsp;Dominique D Benoit,&nbsp;Sandra G Oeyen","doi":"10.1080/17843286.2022.2050003","DOIUrl":"https://doi.org/10.1080/17843286.2022.2050003","url":null,"abstract":"<p><strong>Objectives: </strong>Intensive care unit (ICU) survivors are often left with impairments in physical, mental and cognitive functioning (Post-Intensive Care Syndrome (PICS)). We evaluated the organization, the feasibility for caregivers and patients and the patients' appreciation of a post-ICU consultation aiming to detect these PICS-symptoms.</p><p><strong>Methods: </strong>A single-center prospective observational pilot study was conducted during an 18 month-period in the surgical ICU of a tertiary care hospital. Consecutive adult patients with an ICU-stay of ≥8 days and a favorable baseline quality of life (utility index ≥0.6 on EQ-5D-3 L) were eligible for inclusion. A post-ICU follow-up consultation consisting of a structured interview was scheduled 3 months after hospital discharge. Characteristics of the consultation (CG) and no consultation group (NCG) were compared. P-values <0.05 were considered significant.</p><p><strong>Results: </strong>Of 133 eligible patients, 85 (64%) consented for the study and 42 (49%) attended the consultation. A total of 148 phone calls were made to schedule the consultations. Consultations took a median of 68 (61-74) minutes. Compared to CG-patients, NCG-patients were more often discharged to a care facility (P = 0.003) and had more problems with mobility (P = 0.014), self-care (P < 0.001) and usual activities (P = 0.005) after 3 months. At least one PICS-related problem was documented in all patients in the CG and NCG. Thirty-four CG-patients (81%) appreciated the initiative.</p><p><strong>Conclusion: </strong>Organizing an ICU-follow-up consultation was difficult and feasibility was low, but most attending patients appreciated the initiative. Better developed structures for ICU-follow-up are needed in view of the high number of PICS-related problems documented.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10529960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Identifying vulnerable older adults at risk for functional decline in cardiac care wards: time to shift the paradigm. 识别易受伤害的老年人在心脏护理病房功能下降的风险:时间转变范式。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17843286.2022.2031374
Anthony Jeuris, Bastiaan Van Grootven, Lisa Geyskens, Koen Milisen, Johan Flamaing, Mieke Deschodt

Objective: To determine whether routine screening with the Flemish version of the Triage Risk Screening Tool (fTRST) is a valid approach to determine which patients on cardiac care wards are at risk for inhospital functional decline and would benefit from geriatric expertise consultation.

Methods: A secondary data-analysis of the G-COACH before-cohort, describing patient profiles and routine care processes, in 189 older adults on two cardiac care wards in the University Hospitals Leuven between September 2016 and June 2017. Inhospital functional decline was defined as an increase of at least one point on the Katz Index of Activities of Daily Living or death between hospital admission and discharge.

Results: Nine in 10 patients had at least one geriatric syndrome and one-third developed functional decline. Based on the fTRST proposed cut-off of ≥2, 156 (82.5%) patients were at risk for functional decline (sensitivity of 95.2%, specificity of 23.8%, negative predictive value of 90.9% and Area Under the Curve of 0.60). Of the 156 'at risk' patients, 43 (27.6%) received a consultation by the geriatric consultation team after a median of four hospitalization days. A positive fTRST was not significantly related to geriatric consultations (x2 = 0.57; p = 0.45).

Conclusion: The fTRST has a low discriminative value in identifying older cardiology patients at risk for functional decline. Given the high prevalence of geriatric syndromes, we propose a new paradigm were all older adults on cardiac care wards undergo a needs assessment upon hospital admission.

目的:确定佛兰德版本的分诊风险筛查工具(fTRST)的常规筛查是否是一种有效的方法,以确定哪些患者在心脏护理病房有住院功能衰退的风险,并从老年专家咨询中获益。方法:对2016年9月至2017年6月期间在鲁汶大学医院两个心脏护理病房的189名老年人的G-COACH前队列进行二次数据分析,描述患者概况和常规护理过程。住院功能下降定义为入院和出院之间的Katz日常生活活动指数或死亡增加至少1点。结果:10名患者中有9名至少有一种老年综合征,三分之一的患者出现功能衰退。根据fTRST建议的临界值≥2,156例(82.5%)患者存在功能衰退风险(敏感性95.2%,特异性23.8%,阴性预测值90.9%,曲线下面积0.60)。在156名“高危”患者中,43名(27.6%)在平均住院4天后接受了老年咨询小组的咨询。fTRST阳性与老年会诊无显著相关(x2 = 0.57;P = 0.45)。结论:fTRST在识别有功能衰退风险的老年心脏病患者方面具有较低的鉴别价值。鉴于老年综合征的高患病率,我们提出了一种新的范式,即所有在心脏护理病房的老年人在入院时接受需求评估。
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Acta Clinica Belgica
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