Acta Clinica Belgica最新文献

{"title":"Retrospective analysis of a suburban out-of-hours clinic in Belgium.","authors":"J L Belche,&nbsp;M A Berrewaerts,&nbsp;P Burette,&nbsp;A L Lenoir,&nbsp;C Duchesnes,&nbsp;D Giet","doi":"10.1179/2295333714Y.0000000052","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000052","url":null,"abstract":"<p><strong>Introduction: </strong>In many countries, out-of-hours medical care is under scrutiny. The aim of this article is to study the activities recorded by the first out-of-hours clinic that has been opened, as a pilot study, in two Walloon communes.</p><p><strong>Material and method: </strong>A retrospective analysis of anonymized data was conducted for 2009. Coding of diagnoses was conducted using the International Classification of Primary Care (ICPC-2).</p><p><strong>Results: </strong>A total of 3949 contacts were recorded in 2009 with the out-of-hours clinic, 3294 related to inhabitants of the two communes covered, which was equivalent to 13% of the total population in question. Compared to 7·2% of contacts between midnight and 8 a.m., 82·9% of contacts took place between 8 a.m. and 9 p.m., and 91·6% of contacts were handled locally, with only 8·4% resulting in hospitalization. In addition, 52% of contacts were with patients aged between 25 and 65; 29·9% of contacts were with paediatric patients (<15 years). Patients over the age of 65 made up 18% of contacts. The most common pathologies were respiratory (R). Analysis of flu diagnoses identified two epidemic peaks.</p><p><strong>Discussion: </strong>The suburban out-of-hours clinic studied fulfilled an important role in managing the demand for health care. The large majority of health problems were resolved locally, and the inhabitants did not need to go to hospital. Appointments between midnight and 8 a.m. were in the minority, which points towards adjusting the organization of the out-of-hours service during the night. The geriatric population is not highly over-represented contrary to what might be expected considering its largest number of pathologies. The on-call doctor's skills profile should take account of the populations and morbidities encountered. Out-of-hours clinics could possibly play a sentinel role in terms of flu epidemics.</p><p><strong>Conclusion: </strong>This study describes a pilot suburban out-of-hours clinic which met three of recommendations set by the KCE in its report on out-of-hours care in general medicine: the organization of an out-of-hours clinic with logistical support, the use of a single telephone number and merging out-of-hours areas. While debate exists on the management of out-of-hours care, this study provides evidence on the role of the physician during these hours.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"341-7"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32529993","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}

{"title":"Massive pericardial effusion and rhabdomyolysis secondary to untreated severe hypothyroidism: the first report.","authors":"M R Zare-Khormizi,&nbsp;M Rahmanian,&nbsp;F Pourrajab,&nbsp;S Akbarnia","doi":"10.1179/2295333714Y.0000000049","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000049","url":null,"abstract":"<p><p>Hypothyroidism is an endocrine disease with various clinical manifestations. It is a rare cause for rhabdomyolysis and massive pericardial effusion. We describe a case of severe hypothyroidism secondary to autoimmune hashimoto thyroiditis with massive pericardial effusion and rhabdomyolysis. Improvement of mentioned complications after hypothyroidism treatment and rule out of other possible causes are supportive clues that hypothyroidism is the main cause of patient's rare presentation. With the best of our knowledge, it is the first report of rhabdomyolysis and massive pericardial effusion coincidence in a patient of adult population with primary uncontrolled hypothyroidism for years. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"375-8"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32532630","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}

{"title":"Views of general practitioners on the use of STOPP&START in primary care: a qualitative study.","authors":"O Dalleur,&nbsp;J-M Feron,&nbsp;A Spinewine","doi":"10.1179/2295333714Y.0000000036","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000036","url":null,"abstract":"<p><strong>Background and objective: </strong>STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria aim at detecting potentially inappropriate prescribing in older people. The objective was to explore general practitioners' (GPs) perceptions regarding the use of the STOPP&START tool in their practice.</p><p><strong>Design: </strong>We conducted three focus groups which were conveniently sampled. Vignettes with clinical cases were provided for discussion as well as a full version of the STOPP&START tool. Knowledge, strengths and weaknesses of the tool and its implementation were discussed. Two researchers independently performed content analysis, classifying quotes and creating new categories for emerging themes.</p><p><strong>Results: </strong>Discussions highlighted incentives (e.g. systematic procedure for medication review) and barriers (e.g. time-consuming application) influencing the use of STOPP&START in primary care. Usefulness, comprehensiveness, and relevance of the tool were also questioned. Another important category emerging from the content analysis was the projected use of the tool. The GPs imagined key elements for the implementation in daily practice: computerized clinical decision support system, education, and multidisciplinary collaborations, especially at care transitions and in nursing homes.</p><p><strong>Conclusion: </strong>Despite variables views on the usefulness, comprehensiveness, and relevance of STOPP&START, GPs suggest the implementation of this tool in primary care within computerized clinical decision support systems, through education, and used as part of multidisciplinary collaborations.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"251-61"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32374747","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}

{"title":"Stressful life events and type 2 diabetes.","authors":"J M Maksimovic,&nbsp;H D Vlajinac,&nbsp;B D Pejovic,&nbsp;N M Lalic,&nbsp;I S Vujicic,&nbsp;M Z Maksimovic,&nbsp;N D Vasiljevic,&nbsp;S B Sipetic","doi":"10.1179/2295333714Y.0000000042","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000042","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study is to compare cases with type 2 diabetes and their controls for the frequency of stressful life events and social support before the occurrence of the disease.</p><p><strong>Methods: </strong>The study of cases and their controls was undertaken in Belgrade. A case group comprised 179 subjects in whom type 2 diabetes was for the first time diagnosed in the 'Savski Venac' Medical Center during the period 2005-2007 year. The diagnosis was made by a specialist of internal medicine according to criteria of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. For each case two controls were chosen among patients with trauma (fracture, reposition, internal/external fixation) who were treated at the 'Banjica' Institute for Orthopedic-Surgical Diseases during the same period. Cases and controls were matched by sex, age (±2 years) and place of residence (Belgrade). Data were collected on demographic characteristics, habits, personal history, stressful life events, social support and family medical history.</p><p><strong>Results: </strong>According to multivariate analysis low social support in personal history, such as relatives/friends help and financial assistance in solving problems, and bad management of monthly income were significantly positively related to type 2 diabetes. However, significantly more controls than cases had no financial insurance in case of urgent need</p><p><strong>Conclusion: </strong>Examine psychosocial factors play a role in the development of type 2 diabetes.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"273-6"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32496096","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}

{"title":"Systemic capillary leak syndrome revealing a diffuse large B-cell lymphoma.","authors":"L Pothen,&nbsp;H Rouvière,&nbsp;R Poncin,&nbsp;L Michaux,&nbsp;P Damoiseau,&nbsp;M Lambert","doi":"10.1179/0001551214Z.00000000076","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000076","url":null,"abstract":"<p><p>We report on a 75-year-old woman who presented with recurrent episodes of hypotension, anasarca, renal failure, hypoalbuminaemia without proteinuria, suggestive of systemic capillary leak syndrome (SCLS). Further investigations led to a diagnosis of diffuse large B-cell lymphoma. Secondary SCLS associated with non-Hodgkin lymphoma is reviewed. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"305-8"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32437130","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}

{"title":"Performance of qualitative urinary hCG assays.","authors":"S Nickmans,&nbsp;P Vermeersch,&nbsp;J Van Eldere,&nbsp;J Billen","doi":"10.1179/0001551214Z.00000000069","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000069","url":null,"abstract":"<p><p>Significant differences in the sensitivity of eight frequently used qualitative urine human chorionic gonadotropin (hCG) tests in Belgium were observed in this study. Although most manufacturers claimed to detect hCG levels as low as 25 mIU/ml, only two out of six tests for home use and one out of two tests for professional use only, achieved the claimed detection limit. According to a survey, we performed among 20 acute care hospitals, 80% of the surveyed hospitals claimed to use these types of hCG analysis in a diagnostic setting. Unsatisfactory performance of these point-of-care testing (POC) assays for urinary hCG could have major consequences in a hospital setting, exposing the early pregnant woman to harmful diagnostic and therapeutic procedures. Although qualitative urine hCG tests are rapid and convenient, determination of hCG in blood remains the gold standard for the diagnosis of pregnancy. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"277-9"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32355111","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}

{"title":"Charcot spinal arthropathy in a diabetic patient.","authors":"S van Eeckhoudt,&nbsp;M Minet,&nbsp;F Lecouvet,&nbsp;C Galant,&nbsp;X Banse,&nbsp;M Lambert,&nbsp;C Lefèbvre","doi":"10.1179/2295333714Y.0000000031","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000031","url":null,"abstract":"<p><p>We report a case of Charcot spinal arthropathy in a diabetic patient and emphasize the clinical reasoning leading to the diagnosis, discuss the differential diagnosis, and insist on the crucial role of the radiologist and pathologist which allows the distinction between Charcot spinal arthropathy and infectious or tumoural disorders of the spine. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"296-8"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32496098","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}

{"title":"A determination of the current causes of hyperkalaemia and whether they have changed over the past 25 years.","authors":"X Muschart,&nbsp;C Boulouffe,&nbsp;J Jamart,&nbsp;G Nougon,&nbsp;V Gérard,&nbsp;L de Cannière,&nbsp;D Vanpee","doi":"10.1179/0001551214Z.00000000077","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000077","url":null,"abstract":"<p><strong>Objective: </strong>Hyperkalaemia is a potentially lethal electrolyte disorder. The objective of this study was to determine if the causes of hyperkalaemia-related visits to the emergency department (ED) have changed since 25 years.</p><p><strong>Methods: </strong>All patients presenting to the ED with hyperkalaemia between January 2009 and August 2011 were included in this retrospective, single-centre study. Patients were divided into one of these three categories: mild (5·2≤ K(+)<5·8 mEq/l), moderate (5·8≤K(+)<7·0 mEq/l) or severe hyperkalaemia (K(+)≥7·0 mEq/l). The causes of hyperkalaemia were divided into three groups: renal failure (RF), potassium-increasing drugs (PIDs) or others.</p><p><strong>Results: </strong>Overall, 139 patients with hyperkalaemia were included in the study (mean K(+) of 6·2 mEq/l): 35% with mild, 49% with moderate and 16% with severe hyperkalaemia. Eighty-three per cent of patients (n = 115) had RF with creatinine levels ≥1·25 mg/dl or estimated glomerular filtration rate (eGFR) levels ≤60 ml/min/1·73 m(2). Serum potassium levels were significantly related with creatinine and eGFR values (P<0·001). The severity of hyperkalaemia was significantly related with creatinine levels ≥1·25 mg/dl (P = 0·002) and eGFR values ≤60 ml/min/1·73 m(2) (P = 0·005). Seventy-five per cent of patients (n = 105) were taking PIDs. Potassium levels were significantly related with PIDs (P<0·001), in particularly spironolactone (P = 0·001) and angiotensin-converting enzyme inhibitors (P = 0·008). The category 'others' included 7% of patients (n = 10).</p><p><strong>Conclusions: </strong>RF (83%) and PIDs (75%) remain common causes of hyperkalaemia. Hyperkalaemia is significantly related with four variables: creatinine levels, spironolactone, ACEIs and beta-blocker intake. The causes of hyperkalaemia have not changed in recent years.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"280-4"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32437131","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}

{"title":"Hospital doctors behave differently, and only by respecting the fundamentals of professional organizations will managers be able to create common goals with professionals.","authors":"H Van Dijck","doi":"10.1179/0001551214Z.00000000068","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000068","url":null,"abstract":"<p><p>Hospital doctors behave differently from other hospital workers. The general and specific characteristics of the doctors' behavior are described. As professionals, doctors want to make autonomous decisions and more specifically, they negotiate differently. The best description of their negotiation style is one that features multi-actor, multi-issue characteristics. They behave as actors in a network in never-ending rounds of negotiations with variable issues up for discussion: one time you lose, the next you win. A doctor's career starts with a long residency period in which he or she absorbs professional habits. His or her knowledge and way of organizing are implicit. It is hard for him or her to explicitly describe what he or she is doing. This makes it difficult for managers to discuss quality issues with doctors. Dealing with disruptive behavior is not easy either. The difficult tasks of the chief medical officer, who acts as a go-between, are highlighted. Only when managers respect the fundamentals of the professional organization will they be able to create common goals with the professionals. Common goals bring about better care in hospitals. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"309-11"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32355109","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}

{"title":"Frailty indexes, screening instruments and their application in Belgian primary care.","authors":"E Sieliwonczyk,&nbsp;S Perkisas,&nbsp;M Vandewoude","doi":"10.1179/2295333714Y.0000000027","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000027","url":null,"abstract":"<p><strong>Objectives: </strong>The complex and expensive medical care for a rising number of older patients presents a significant challenge to the health care system. Identifying cost-effective preventive interventions and systematically applying them in the elderly population could help address this challenge. Frailty assessments could prove to be valuable tools by identifying at-risk individuals to which these interventions would be offered. This review seeks to provide the reader with an overview of frailty and explain how frailty assessments could contribute to daily practice.</p><p><strong>Methods: </strong>PubMed was searched for articles concerning frailty assessment (July 2013). Articles discussing prominent frailty models and articles primarily focused on comparing frailty assessments in the home-dwelling population were used for this article. Domus Medica was searched for guidelines concerning the use of frailty in Belgian primary care.</p><p><strong>Results: </strong>Several notable models of frailty are summarized and discussed to provide the reader with an overview of available frailty assessments. Frailty screening modalities in primary care are discussed, as well as the current recommendations for the use of frailty assessments in Belgian primary care. The advantages of a systematic frailty assessment in primary care and other settings are highlighted.</p><p><strong>Conclusion: </strong>This article recommends the assessment of frailty status as a screening tool for the evaluation of the older person in primary care. An overview of available frailty models is offered for this purpose. A consensus should be reached on which model is most appropriate. The screening for frailty promotes early intervention and timely involvement of specialists with the purpose of avoiding unfavourable outcomes, such as death or disability.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"233-9"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32297776","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}