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Whole-Body Magnetic Resonance Imaging (WB-MRI) is increasingly used for metastatic screening in oncology. This prospective single center study assesses the diagnostic value of WB-MRI including diffusion weighted imaging (DWI) and identifies the sufficient protocol for metastatic lymph node detection in patients with testicular germ cell cancer (TGCC). Forty-three patients underwent contrast enhanced thoraco-abdominopelvic CT (TAP-CT) and WB-MRI with DWI for metastatic lymph node screening. Two independent readers reviewed CTs and WB-MRIs. The diagnostic performance of different imaging protocols (CT, complete WB-MRI, T1W + DWI, T2W + DWI), the agreement between these protocols and the reference standard, the reproducibility of findings and the image quality (Signal and contrast to Noise Ratios, Likert scale) were studied. Reproducibility was very good regardless of both lesion locations (retroperitoneal vs distant lymph nodes, other lesions) and the reader. Diagnostic accuracy of MRI was ≥95% (regardless of the locations and imaging protocol); accuracy of CT was ≥93%. There was a strict overlap of 95% CIs associated with this accuracy between complete WB-MRI, T1W + DWI and T2W + DWI, regardless of the reader. Higher Likert score and SNR were observed for DWI, followed by T2W and T1W sequences. In conclusion, a fast WB-MRI protocol including T2W and DWI is a sufficient, accurate, non-irradiating alternative to TAP-CT for metastatic lymph node screening in TGCC.

No abstract available

Considering the limited information available, the aim of the study was to examine the prevalence and characteristics of inpatients with dementia in Belgian general hospitals. All admissions of inpatients aged at least 40 years with or without dementia were retrieved from the nationwide administrative hospital discharges database for the period 2010-2014. Admissions of inpatients aged 40 years or more with dementia have increased to reach 83,017 out of 1,285,593 admissions (6.46%) in general hospitals in 2014, mostly admitted through the emergency department (79.7%) and for another reason than dementia (85.9%). These patients stayed longer [19.2 days, standard deviation (sd) = 23.6, median = 13] than the average length of stay of patients of the same age (7.9 days, sd = 14.1, median = 17). Considering patients aged 75 years or more falling into the 20 most common pathology groups (of patients with dementia), the group with dementia spent 5 days more than the group without dementia. Patients admitted from home spent more time in hospital when they were discharged to a residential care facility than when they returned home (27.2 days versus 15.8 days). The in-hospital mortality was high in the first days of admission. The growing prevalence of patients with dementia in inpatient setting puts a high pressure on the hospital capacity planning and geriatric expertise. Moreover, as patients with dementia should be kept outside hospitals when possible for safety and quality matters, long-term organizational investments are required inside hospital and residential care settings as well as in community care.

In the context of the flat-rate reimbursements in healthcare, we reviewed physicians' behavior towards laboratory test ordering. We demonstrated how it could be improved when a specific stage of the patient management is considered. We took a multi-step approach to analyze the laboratory test orders in the context of planned laparoscopic cholecystectomy in a general teaching hospital. A reference order set was defined through a collaborative analysis between clinicians and laboratory physicians. The clinical and financial impacts were then evaluated over a period of 24 months. After the introduction of the reference order set, the number of laboratory tests per order decreased significantly for patients with cholecystitis of low severity. Above the monitoring of repeated orderings during a single stay, the major impacts were achieved by a drastic reduction of inappropriate orders, particularly in the field of bacteriology. The main effects of the order set were maintained throughout a follow-up period of 24 months. Our study demonstrated that, when considering laboratory test ordering optimization, reference order sets could achieve high levels of efficiency. To ensure high compliance to reference order sets, extensive collaboration between clinicians and laboratory physician is mandatory even if very sophisticated information systems are available.

Our objectives were to (1) describe the evolution of the underuse of anticoagulants in older people with atrial fibrillation (AF) and a CHADS2 score ≥ 2 since direct oral anticoagulants (DOACs) were introduced to the market and (2) describe factors associated with this underuse. We conducted a retrospective cross-sectional study including geriatric patients admitted during the pre-DOAC (2008-2011) and post-DOAC (2013-2015) periods in an academic hospital in Belgium. Five inclusion criteria were met: age ≥ 75 years, diagnosis of AF, indication for anticoagulation (CHADS2 score ≥ 2), risk of functional decline (Identification of Seniors At Risk [ISAR] score ≥ 2), and comprehensive geriatric assessment. The use of anticoagulants and antiplatelets at home before admission was recorded. Risks of stroke and bleeding were calculated using CHADS2 and HEMORR2HAGES scores, respectively. Three different logistic regression models were performed to describe the evolution of and factors associated with the underuse of anticoagulants after DOAC marketing. Anticoagulant underuse, present in 209 of 614 (34%) geriatric patients with AF, was lower in patients with a history of stroke (28.5%) or congestive heart failure (26.9%) but higher in those receiving antiplatelets (56.2%) and in older individuals. Anticoagulant underuse decreased significantly from the pre-DOAC (37.3%) to the post-DOAC (29.7%) era, as shown by two analyses using propensity scores. In older patients with AF, anticoagulant underuse was mainly associated with antiplatelet use. Anticoagulant underuse and antiplatelet use have both decreased since DOAC marketing. Underuse of anticoagulants was still a concern for three in ten geriatric patients with AF at high risk of stroke (CHADS2 score ≥ 2).

Feed-back of the optimal nutritional care for all (ONCA) conference in Berlin: examples of Israël and the Nederlands Presentation realised for the creation of the ONCA Belgian Alliance in the SPF-SP

Oral manifestations of severe secondary hyperparathyroidism include maxillary and mandibular deformities, brown tumors, dental abnormalities, and metastatic calcification of soft tissues. We report on a chronic hemodialysis (HD) woman with severe, uncontrolled secondary hyperparathyroidism and a painful, nontender mass in the floor of her mouth. The most likely clinical diagnosis was a bone tumoral lesion of the oral cavity, secondary to renal osteodystrophy. Unexpectedly, pathological examination showed characteristic features of ossifying fibroma (OF) of the jaw, a rare, benign fibroosseous lesion characterized by the replacement of normal bone by collagen and fibroblasts containing varying amounts of mineralized substance. The occurrence of an OF in chronic HD patients is exceptional. Differential diagnosis must be made with bone tumoral lesions secondary to renal osteodystrophy. Surgical removal is the treatment of choice. The pathogenesis of OF in the setting of secondary hyperparathyroidism remains unknown. Parathyroidectomy may not be necessary to avoid OF recurrence after surgical removal.

Objectif : Cet article présente la nouvelle version en anglais des critères STOPP/START ainsi que son adaptation en français. Les critères STOPP/START forment un outil de détection des prescriptions potentiellement inappropriées. Description de la problématique : Les prescriptions médicamenteuses inappropriées entraînent un risque élevé d’effets indésirables, notamment pour les personnes âgées. Leur détection doit être une priorité pour les pharmaciens et les soignants médico-infirmiers. Résolution de la problématique : Plusieurs projets de recherche et de pratique clinique ont présenté l’utilisation de critères explicites pour détecter les prescriptions potentiellement inappropriées, comme la première version des critères STOPP/START, ainsi que les répercussions de l’utilisation de tels critères. La nouvelle version anglaise des critères STOPP/START. v2, publiée en 2015, a pris en considération les dernières recommandations ainsi que l’arrivée sur le marché de nouveaux médicaments. Un panel international d’experts francophones en a réalisé l’adaptation française. L’outil STOPP/START.v2 fera l’objet de futures études. Conclusion : La version 2 de l’outil STOPP/START, logique et d’utilisation facile, peut facilement s’intégrer au processus de révision des prescriptions médicamenteuses dans la pratique quotidienne., Objective: This article presents the new English version of the criteria in STOPP/START, a tool for detecting potentially inappropriate prescriptions, and its French adaptation. Problem description: Inappropriate drug prescriptions pose a significant risk of adverse effects, especially in elderly patients. Detecting them should be a priority for pharmacists, physicians and nurses. Problem resolution: Several clinical research and practice projects, such as the STOPP/START tool, published in 2012, present explicit criteria to be used for detecting potentially inappropriate prescriptions and discuss their impact. A new version of STOPP/START (v2) was published in 2015, in English, taking into consideration the latest guidelines and the arrival of new drugs on the market. A French adaptation was developed by an international panel of French-speaking experts. STOPP/START version 2 will be the subject of future studies. Conclusion: Version 2 of the STOPP/START tool is logical and easy to use and can be easily incorporated into the drug prescription review process in daily practice.

Background There are no prognostic factor publications on stage Ta-T1 non-muscle-invasive bladder cancer (NMIBC) treated with 1-3 yr of maintenance bacillus Calmette-Guérin (BCG). Objective To determine prognostic factors in NMIBC patients treated with 1-3 yr of BCG after transurethral resection of the bladder (TURB), to derive nomograms and risk groups, and to identify high-risk patients who should be considered for early cystectomy. Design, setting, and participants Data for 1812 patients were merged from two European Organization for Research and Treatment of Cancer randomized phase 3 trials in intermediate- and high-risk NMIBC. Intervention Patients received 1-3 yr of maintenance BCG after TURB and induction BCG. Outcome measurements and statistical analysis Prognostic factors for risk of early recurrence and times to late recurrence, progression, and death were identified in a training data set using multivariable models and applied to a validation data set. Results and limitations With a median follow-up of 7.4 yr, 762 patients recurred; 173 progressed; and 520 died, 83 due to bladder cancer (BCa). Statistically significant prognostic factors identified by multivariable analyses were prior recurrence rate and number of tumors for recurrence, and tumor stage and grade for progression and death due to BCa. T1G3 patients do poorly, with 1- and 5-yr disease-progression rates of 11.4% and 19.8%, respectively, and 1- and 5-yr disease-specific death rates of 4.8% and 11.3%. Limitations include lack of repeat transurethral resection in high-risk patients and exclusion of patients with carcinoma in situ. Conclusions NMIBC patients treated with 1-3 yr of maintenance BCG have a heterogeneous prognosis. Patients at high risk of recurrence and/or progression do poorly on currently recommended maintenance schedules. Alternative treatments are urgently required. Patient summary Non-muscle-invasive bladder cancer patients at high risk of recurrence and/or progression do poorl

Cet article décrit les questions posées autour du dispositif de cointerventions psychothérapeutiques utilisé au sein d’une unité de soins pédopsychiatriques pluridisciplinaires tant au niveau du cadrage que de l’intervention et des places occupées lors des entretiens. Un nouveau dispositif est expérimenté et articule l’intervention de trois thérapeutes : « T. psy enfant », « T. éduc enfant/adulte » et « T. médicopsy adulte ». Pour illustrer ce dispositif, nous décrivons une situation clinique qui se déploie en 3 temps et faisons appel à un schéma qui montre le champ d’intervention de ces « 3 Ts » et le « système famille-réseau en thérapie » qui se situe à l’intersection de plusieurs systèmes : réseau primaire, réseau secondaire et unité de soins pédopsychiatriques., [A Psychotherapeutic Co-Intervention Scheme within a Multidisciplinary Paedopsychiatric Care Unit, the Interaction and Experimental Phase] This article describes the questions posed in the context of a multidisciplinary paediatric psychiatry care unit, both within the framework of the intervention itself, as well as the roles assumed. A new therapeutic approach is the object of this research; it elaborates on an intervention plan involving three therapists: “child psy T.,” “child/adult educ T.” and “adult medical psy T.” To illustrate this approach, we describe a clinical situation deployed in three stages and we apply a scheme that elucidates the scope of intervention based on these “3 Ts,” in addition to the “family therapy network system,” which is positioned at the intersection of several systems: primary network, secondary network, and paedopsychiatric care unit.

Analgesics and sedatives are universally administered in intensive care units (ICUs). Ideally, healthcare professionals must minimize sedative use (e.g. through protocolized sedation or daily sedation interruption) and assess pain, agitation, and delirium (PAD) to improve patient outcomes. However, putting knowledge into action is easier said than done. The objectives of this thesis are to describe knowledge use, challenges to its application, and improvement strategies pertaining to PAD management in ICUs. Using semi-structured interviews, the perspectives of physicians, nurses, and physiotherapists were explored. Different challenges to appropriate implementation of PAD recommendations were found with respect to profession, level of experience, and recommendation type, suggesting improvement strategies must be tailored to healthcare professional type. Using a nationwide survey of ICU physicians and nurses, PAD practices in Belgian ICUs were described. The results showed poor use of sedation minimization strategies, with only 31% of healthcare professionals using protocolized sedation, and 75% using DSI in fewer than 25% of their patients. Only 12% of healthcare professionals used validated pain scales for patients unable to self-report. Challenges to the use of sedation minimization strategies included negative attitudes of healthcare professionals caused by common misperceptions, knowledge issues, and staffing considerations. A systematic review identified various types of knowledge translation interventions (KT-Is) designed to enhance the use of ICU PAD recommendations internationally. The majority of these improved outcomes and process measurements. A secondary analysis, of a previous observational study in Canada, identified several PAD management components were associated with the use of physical restraints. The present thesis provides valuable information for key stakeholders, to inform the design of KT-Is aimed at adopting or enhancing the use of PAD recom, (BIFA - Sciences biomédicales et pharmaceutiques) -- UCL, 2015

IgE is synthesized locally, in the bronchial mucosa, in both atopic and non-atopic asthma. The present study of bronchial secretions from asthma patients confirms that part of this IgE is specific to house dust mite (Dermatophagoïdes pteronyssinus) allergens, irrespective of atopy. In addition, it reveals that this IgE response correlates with periostin, but not to eosinophils, in sputum from these patients, probably in relation to their common IL-4/IL-13 triggering pathway.

BACKGROUND: Little is known about the prevalence and clinical importance of potentially inappropriate prescribing instances (PIPs) in the very old (>80 years). The main objective was to describe the prevalence of PIPs according to START (Screening Tool to Alert doctors to Right Treatment; omissions) and,STOPP (Screening Tool of Older Person's Prescriptions; over/misuse) and the Beers list (over/misuse). Secondary objectives were to identify determinants if PIPs and to assess the clinical importance to modify the treatment in case of PIPs. METHODS: Cross-sectional analysis of baseline data of the BELFRAIL cohort, which included 567 Belgian patients aged 80 and older in primary care. Two independent researchers applied the screening tools to the study population to detect PIPs. Next, a multidisciplinary panel of experts rated the clinical importance of the PIPs on a subsample of 50 patients. RESULTS: In this very old population (median age 84 years, 63 % female), the screening detected START-PIPs in 59 % of patients, STOPP-PIPs in 41 % and Beers-PIPs in 32 %. Assessment of the clinical importance revealed that the most frequent PIPs were of moderate or major importance. In 28 % of the subsample, the relevance of the PIP was challenged by the global medical, functional and social background of the patient hence the validity of some criteria was questioned. CONCLUSION: Potentially inappropriate prescribing is highly prevalent in the very old. A good understanding of the patients' medical, functional and social context is crucial to assess the actual appropriateness of drug treatment.

Screening of orthostatic hypotension (OH) was performed in 285 patients aged 75 years. Current drugs, reasons for admission, geriatric syndromes, and confounding medical conditions were collected. Patients with OH (n = 116, 41%) as compared to those without OH (n = 169) more frequently (P < 0.01) presented falls in the last 6 months (62 vs. 40%, P < 0.001), a fall as the reason for the current admission (49 vs. 26%, P < 0.001), feeling of fainting (20 vs. 6%, P = 0.002), syncope (29 vs. 4%, P < 0.001) or functional decline (71 vs. 47%, P = 0.012). No difference was observed between the two groups in terms of age (85 ± 5 vs. 84 ± 4 years), gender (59 vs. 50% female), common geriatric conditions (e.g. malnutrition 46 vs. 58%, dementia 22 vs. 26%), comorbidity or confounding conditions (dehydration 28 vs. 30%, sepsis 2 vs. 6%). No difference was detected in the use of drugs with psychotropic cardiovascular or diuretic effect, or in their associations. Orthostatic hypotension is frequent upon hospital admission and should be screened, particularly in geriatric fallers. This absence of relation between OH and drugs use suggests that non-pharmacological interventions should be first attempted in older inpatients with OH before deciding to reduce or withdraw useful drugs.

Revue de l’existant au niveau soin nutritionnel belge Campagne de l'ENHA: Optimal nutritional care for all

« Dans le grand hall des CuSL, le stand qui, à côté des informations sur l’accompagnement psychologique et sur l’activité physique, remporte le plus de succès est incontestablement le stand animé par les diététiciens nutritionnistes. Est-ce le cageot de légumes placé sur la table ou le caractère ludique de la présentation qui attire le public, toujours est-il qu’il défile sans interruption… » L Dardenne. La Libre

Définition de critères diagnostiques nutritionnels institutionnels pratiques

Messages grand public: Beaucoup de personnes âgées ne mangent pas assez pour couvrir leurs besoins. La dénutrition touche ainsi quatre patients sur dix qui arrivent à l'hôpital. Un phénomène lourd de conséquences mais qui peut être facilement détecté.

Background and objective: 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. Design: 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. Results: 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. Conclusion: 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.

Background: Ageing people show increasing morbidity, dependence and vulnerability. Objectives: To compare the relationships of different measures of multimorbidity with dependence (operationalized as disability) and vulnerability (operationalized as frailty). Method: A cross-sectional analysis within the BELFRAIL cohort (567 subjects aged ≥ 80). Multimorbidity was measured using a disease count (DC), the Charlson comorbidity index (CCI) and the cumulative illness rating scale (CIRS), respectively. Associations with disability (based on activities of daily living) and frailty (defined by the Fried frailty criteria) were assessed using bivariable and multivariable analyses. Net reclassification improvement (NRI) values were calculated to compare the abilities of the DC, CCI and CIRS to identify patients with disability or frailty. Results: Disability was associated with the DC (crude odds ratio, OR: 2.1; 95% confidence interval, CI: 1.4-3.4), CCI (crude OR: 1.8; 95% CI: 1.2-2.7) and CIRS (crude OR: 4.0; 95% CI: 2.5-6.5); only the association with CIRS was independent of age, sex, chronic inflammation, impaired cognition and frailty (adjusted OR: 3.2; 95% CI: 1.7-5.8). Frailty was associated with CCI (crude OR: 2.4; 95% CI: 1.2-4.6) and CIRS (crude OR: 2.6; 95% CI: 1.3-5.3); adjusted for age, sex, chronic inflammation, impaired cognition and disability. These associations were not statistically significant. The NRIs demonstrated a similar ability of the DC, CCI, and CIRS to identify patients with disability or frailty, respectively. Conclusion: The associations of different measures of multimorbidity with disability and frailty differ but their ability to identify patients with disability or frailty is similar. Generally, multimorbidity scores incompletely reflect dependence and vulnerability in this age group.

Despite intensive studies, the mechanisms of cytokine receptor activation are still not completely understood. Historically two models have been proposed: early studies suggested a mechanism involving ligand-induced dimerization of the receptors which results in the activation of downstream signaling pathways, whereas, in the absence of ligands, the receptors are thought to be in a monomeric inactive state; later studies uncovered evidence for the existence of many receptors as inactive preformed dimers, which upon ligand binding undergo conformational changes and/or relative rotation of the receptor molecules. Here we focus on the dimerization status of the single chain cytokine receptors, which are involved in the regulation of hematopoiesis. © Institute of Molecular Biology and Genetics, NAS of Ukraine, 2014.

BACKGROUND: Smart infusion pumps have been introduced to prevent medication errors and have been widely adopted nationally in the USA, though they are not always used in Europe or other regions. Despite widespread usage of smart pumps, intravenous medication errors have not been fully eliminated. OBJECTIVE: Through a systematic review of recent studies and reports regarding smart pump implementation and use, we aimed to identify the impact of smart pumps on error reduction and on the complex process of medication administration, and strategies to maximize the benefits of smart pumps. METHODS: The medical literature related to the effects of smart pumps for improving patient safety was searched in PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (2000-2014) and relevant papers were selected by two researchers. RESULTS: After the literature search, 231 papers were identified and the full texts of 138 articles were assessed for eligibility. Of these, 22 were included after removal of papers that did not meet the inclusion criteria. We assessed both the benefits and negative effects of smart pumps from these studies. One of the benefits of using smart pumps was intercepting errors such as the wrong rate, wrong dose, and pump setting errors. Other benefits include reduction of adverse drug event rates, practice improvements, and cost effectiveness. Meanwhile, the current issues or negative effects related to using smart pumps were lower compliance rates of using smart pumps, the overriding of soft alerts, non-intercepted errors, or the possibility of using the wrong drug library. CONCLUSION: The literature suggests that smart pumps reduce but do not eliminate programming errors. Although the hard limits of a drug library play a main role in intercepting medication errors, soft limits were still not as effective as hard limits because of high override rates. Compliance in using smart pumps is key towards effectively preventing errors. Oppor

Environmental contamination, product contamination and technicians exposure were measured following preparation of iv bags with cyclophosphamide using the robotic system CytoCare. Wipe samples were taken inside CytoCare, in the clean room environment, from vials, and prepared iv bags including ports and analysed for contamination with cyclophosphamide. Contamination with cyclophosphamide was also measured in environmental air and on the technicians hands and gloves used for handling the drugs. Exposure of the technicians to cyclophosphamide was measured by analysis of cyclophosphamide in urine. Contamination with cyclophosphamide was mainly observed inside CytoCare, before preparation, after preparation and after daily routine cleaning. Contamination outside CytoCare was incidentally found. All vials with reconstituted cyclophosphamide entering CytoCare were contaminated on the outside but vials with powdered cyclophosphamide were not contaminated on the outside. Contaminated bags entering CytoCare were also contaminated after preparation but non-contaminated bags were not contaminated after preparation. Cyclophosphamide was detected on the ports of all prepared bags. Almost all outer pairs of gloves used for preparation and daily routine cleaning were contaminated with cyclophosphamide. Cyclophosphamide was not found on the inner pairs of gloves and on the hands of the technicians. Cyclophosphamide was not detected in the stationary and personal air samples and in the urine samples of the technicians. CytoCare enables the preparation of cyclophosphamide with low levels of environmental contamination and product contamination and no measurable exposure of the technicians.

Trame du rapport: Données de préambule Reconnaissance, expérience et place au sein de l’institution Développement politique nutritionnelle spécifique Collaboration au sein de l’Institution Actions et outils spécifiques: sensibilisation, prévention, éducation, bonnes pratiques Formation continue Soin diététique réalisé au chevet du patient : enregistrement actes essentiels, càd diagnostic, intervention et suivi nutritionnels

La cachexie cancéreuse est rarement identifiée, évaluée et activement prise en charge. Elle se caractérise par une perte de masse maigre, qui peut être ralentie, voir même contrecarrée par une intervention nutritionnelle, multimodale, adaptée et précoce. Le but de l’étude est de valider la pratique diagnostique nutritionnelle des diététiciens du Centre du Cancer des Cliniques Universitaires St. LUC (UCL). Au vu de la bonne à très bonne concordance avec le diagnostic du PG-SGA, cette étude permet de valider la pratique diagnostique des diététiciens référents du Centre du Cancer, des Cliniques Universitaires St. LUC (UCL) ayant participé à l’étude. Des pratiques diététiques cliniques plus « intuitives », non figées dans un protocole, semblent tout-à-fait pertinentes en nutrition.

Enregistrer les actes essentiels du soin diététique : Evaluation Diagnostic (état nutritionnel) Intervention Notification Suivi Indicateurs proposés au SPF: Le premier indicateur qualité est le nombre de déterminations d’état nutritionnel rapporté au nombre de prises en charge (PEC) initiales. Les indicateurs suivants concernent chaque PEC réalisée, il s’agit du nombre de: • Conseils diététiques personnalisés apportés, • Propositions ou mise en places d’EN, • Propositions de PN. Le dernier indicateur est un indicateur du suivi du patient, il s’agit du nombre de PEC de suivi parmi l’ensemble des PEC.

L’examen des pertes de masse musculaire et de masse grasse sous-cutanée n’est en général pas pris en compte dans le diagnostic de la dénutrition en pédiatrie, alors qu’il permet d’identifier environ 70% des patients dénutris. Cet examen physique est donc prioritaire et doit être complété au minimum par l’analyse de la croissance staturopondérale. Une démarche diagnostique reprenant les critères par ordre de priorité doit être étudiée.

Anticoagulation for the prevention of cardio-embolism is most frequently indicated but largely underused in frail older patients with atrial fibrillation (AF). This study aimed at identifying characteristics associated with anticoagulation underuse.

RAPPORT SPF PLAN CANCER DEPUIS 2014 Trame réalisée à la demande du SPF Données patients pour évaluation des indicateurs qualité proposés

PURPOSE: The present study examined the predictive value of emotional competence and the five-factor model of personality on the quality of life of children with asthma. METHODS: Participants were 90 children (M age = 11.73, SD = 2.60) having controlled and partly controlled asthma, undergoing everyday treatment. Children filled in questionnaires assessing emotional competence and quality of life. Parents completed questionnaires assessing the personality of their child. RESULTS: Results showed that two emotional competences, bodily awareness and verbal sharing of emotions, were related to the quality of life of children with asthma. Moreover, one personality trait, benevolence, was associated with children's quality of life. Regression analyses showed that the predictive value of these three dimensions remained significant over and above asthma control and socio-demographic variables frequently associated with the quality of life of children with asthma (age, gender, and educational level of parents). CONCLUSIONS: These findings emphasize the importance of alerting the clinician who works with children with asthma to observe and assess the child's expression of emotions, attention to bodily sensations, and benevolence.

Obesity and type 2 diabetes are characterized by altered gut microbiota, inflammation, and gut barrier disruption. Microbial composition and the mechanisms of interaction with the host that affect gut barrier function during obesity and type 2 diabetes have not been elucidated. We recently isolated Akkermansia muciniphila, which is a mucin-degrading bacterium that resides in the mucus layer. The presence of this bacterium inversely correlates with body weight in rodents and humans. However, the precise physiological roles played by this bacterium during obesity and metabolic disorders are unknown. This study demonstrated that the abundance of A. muciniphila decreased in obese and type 2 diabetic mice. We also observed that prebiotic feeding normalized A. muciniphila abundance, which correlated with an improved metabolic profile. In addition, we demonstrated that A. muciniphila treatment reversed high-fat diet-induced metabolic disorders, including fat-mass gain, metabolic endotoxemia, adipose tissue inflammation, and insulin resistance. A. muciniphila administration increased the intestinal levels of endocannabinoids that control inflammation, the gut barrier, and gut peptide secretion. Finally, we demonstrated that all these effects required viable A. muciniphila because treatment with heat-killed cells did not improve the metabolic profile or the mucus layer thickness. In summary, this study provides substantial insight into the intricate mechanisms of bacterial (i.e., A. muciniphila) regulation of the cross-talk between the host and gut microbiota. These results also provide a rationale for the development of a treatment that uses this human mucus colonizer for the prevention or treatment of obesity and its associated metabolic disorders.

L’hypothèse de ce travail était que la femme enceinte à Lubumbashi n’avait sans doute pas dans sa diète des apports en iode suffisants pour couvrir les besoins augmentés en hormones thyroïdiennes au cours de la grossesse, et pour couvrir les besoins en iode et en hormones thyroïdiennes indispensables au fœtus pour le développement de son cerveau et la synthèse de ses propres hormones thyroïdiennes. Afin de tester cette hypothèse, nous avons étudié la teneur en iode du sel consommé dans les ménages des femmes enceintes à Lubumbashi. Nous avons ensuite déterminé le statut iodé des femmes enceintes, en le comparant à celui de femmes accouchées et de femmes contrôles non enceintes et en âge de procréer. Nous avons conjointement analysé les apports en fer, étant donné que ces deux types de carence en fer et en iode coexistent souvent. Nous avons analysé la consommation de certains aliments susceptibles d’influencer le statut iodé. Nous avons ensuite étudié la fonction thyroïdienne de la femme enceinte et les aspects morphologiques de la glande thyroïdienne. Enfin, nous avons déterminé la prévalence de nouveau-nés qui présentaient des signes indirects de carence en iode et de dysfonctionnement de la thyroïde. Ceci a conduit à la conclusion que la femme enceinte à Lubumbashi était effectivement modérément déficiente en iode et carencée en fer. Certains aliments qu’elle consomme étaient associés à la carence en iode. La carence en iode chez la femme enceinte se répercutait sur sa fonction thyroïdienne, puisque une femme sur deux présentait le spectre de l’hypothyroïdie durant la grossesse et qu’une femme enceinte sur dix présentait un goitre ou un nodule thyroïdien. Cela se répercutait également sur le nouveau-né puisque plus d’un nouveau-né sur deux présentait des indices de carence en iode. Il est urgent que la lutte contre les troubles dus à la carence en iode soit renforcée à Lubumbashi, et de façon plus générale en République Démocratique du Congo. Des politiques de sa, (MED - Sciences médicales) -- UCL, 2013

Introduction : Le microbiote intestinal est impliqué dans le développement de l’obésité, de l’insulino-résistance et du diabète de type 2. Nos travaux précédents ont mis en évidence qu’une bactérie découverte récemment et vivant dans le mucus intestinal, Akkermansia muciniphila, était diminuée (100 à 1000 fois) dans des modèles nutritionnel ou génétique d’obésité et de diabète de type 2. Par contre sa présence dans le contenu caecal est normalisée lors d’un traitement à l’aide de prébiotiques. Cette modulation du microbiote intestinal est associée à une diminution de l’inflammation de bas grade et à une amélioration de la sensibilité à l’insuline et à la leptine. Cependant l’impact direct d’Akkermansia muciniphila sur le métabolisme n’a encore jamais été investigué. Matériel et méthode : Akkermansia muciniphila a été administrée quotidiennement par gavage oral chez des souris nourries avec un régime hyperlipidique pendant 4 semaines. Des marqueurs de l’homéostasie glucidique, du métabolisme lipidique et de la fonction barrière de l’intestin ont été investigués. Résultats : Le traitement avec Akkermansia muciniphila améliore les marqueurs d’insulino-sensibilité et corrige l’hyperglycémie à jeun induite par le régime hyperlipidique. Ces effets bénéfiques sont notamment associés à une diminution de la néoglucogénèse hépatique (diminution de l’expression de l’ARNm de la glucose-6-phosphatase). L’administration d’Akkermansia muciniphila empêche la prise de masse grasse et le développement de l’inflammation du tissu adipeux sous régime hyperlipidique, sans affecter la quantité d’énergie ingérée. Akkermansia muciniphila restaure la fonction barrière de l’intestin (disparition de l’endotoxémie métabolique, restauration de la couche de mucus, modification de la production de peptides antimicrobiens). Conclusions : Ces résultats mettent en évidence de nouveaux mécanismes de régulation du métabolisme par le microbiote intestinal (Akkermansia.muciniphila) et permettent égalemen

Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care. This multicenter, retrospective cohort study enrolled terminal patients from a representative sample of nursing homes. Health care costs included fixed nursing home costs, medical fees, pharmacy charges, other charges, and eventual hospitalization costs. Data sources consisted of accountancy and invoice data. The analysis calculated costs per patient during the final month of life at 2007/2008 prices. Nineteen nursing homes participated in the study, generating a total of 181 patients. Total mean nursing home costs amounted to 3,243 € per patient during the final month of life. Total mean nursing home costs per patient of 3,822 € for patients receiving usual care were higher than costs of 2,456 € for patients receiving palliative care (p = 0.068). Higher costs of usual care were driven by higher hospitalization costs (p < 0.001). This study suggests that palliative care models in nursing homes need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. © 2012 Springer-Verlag.

Management of early mobilisation (including electrostimulation) in adult and pediatric patients in the intensive care unit

Article publié dans l’ActuDieta (revue de l’UPDLF) en janvier 2014 avec l’accord de la cellule Plan Cancer du SPF Santé publique Les objectifs de l’article sont les suivants : • Décrire les indicateurs de qualité de processus du soin nutritionnel en oncologie qui ont été proposés pour le nouveau rapport d’activité des diététiciens financés par le Plan Cancer, • Décrire, étape par étape, le soin nutritionnel du patient adulte atteint de cancer en tenant compte des recommandations théoriques mais aussi des bonnes pratiques cliniques.

Un dépistage ou screening ou détection du risque de dénutrition est un processus de courte durée, réalisé par une personne non qualifiée en nutrition. Plusieurs cas cliniques issus de l'étude MSTC ont été présentés.

Preference measures are widely used in habitat selection studies to test an animal’s choice relative to particular habitat features, but most measures are subject to criticism as they fail to indicate the underlying behavioral motivation. Order of settlement on breeding sites has been proposed as an effective measure in migratory organisms, as it conceptually approaches a choice experiment. We tested the assumption that early red-backed shrikes (Lanius collurio) are more willing to defend their territorial resource than individuals arriving later. We earlier showed that shrikes arriving first settled in forest plantations that resulted in lower reproductive success compared to territories on farmland, suggesting an ecological trap. Therefore, individuals are expected to place higher value on the lower quality sites in forests. Within the context of resource valuation theory in animal contests, we used a simulated territorial intrusion experiment to measure territorial defense and to evaluate the perceived value of the territory during the settlement phase in both habitat types. Males arriving early were much more motivated to defend their territory than late birds. After correction for the disparity in the timing of arrival between habitat types, shrikes also more vigorously defended their territories in the forest habitat associated with the lowest reproductive returns. Although some resource valuation mechanisms remain unclear, our results show that early and late-arriving individuals strongly differ in behavioral motivation to hold their territorial resources. This study also demonstrates for the first time that organisms may exhibit a higher degree of territorial aggressiveness in a lower quality habitat.

Il y a quelques années, la Belgique francophone promulguait un décret démocratisant l'enseignement supérieur (18 juillet 2008). La promotion de la réussite y est rendue obligatoire, ce qui permet aux institutions d'attribuer officiellement des crédits et des charges d’encadrement à des actions d'accompagnement pédagogique devenues maintenant prioritaires. Pourtant, même si les dispositifs se multiplient, la présence et la participation active des étudiants sont souvent en-deçà des attentes des encadrants. Cette problématique a été au coeur des travaux du groupe AdAPTE, qui réunit une quinzaine d’enseignants-chercheurs tous impliqués dans l’aide à la réussite et qui a ciblé les questions de recherche suivantes : Quelles sont les conditions favorables à la présence, la participation et la persévérance des étudiants dans les dispositifs d’aide à la réussite ? Comment les créer ? Au cours de ces deux dernières années, le groupe a dégagé des éléments de réponse à ces questions à partir du partage et de l’analyse d’expériences et de pratiques professionnelles variées en Haute Ecole et à l’Université. Un modèle intégrant l’ensemble des conditions sera présenté lors de la communication.

et ouvrage présente les expériences professionnelles et les savoir-faire de 35 orthophonistes d'horizons variés (français, belges, canadiens, suisses, tunisien, tahitien), dont plusieurs "noms" reconnus de l'orthophonie. Ces témoignages sont organisés par thématiques (l'orthophonie sciebntifique, réflexions sur l'évaluation, l'orthophonie en Polynésie et en Tunisie...). Chacun fait part de son expérience, en proposant des réflexions accumulées au cours des années (les débuts, expériences positives, négatives, apport des diverses formations...). Puis on aborde la notion d'efficacité, en précisant selon quel critère chacun juge l'efficacité d'une remédiation. Les auteurs discutent de la durée des rééducations, de la notion d'évaluation, du recours aux tests..., en s'appuyant systématiquement sur des exemples concrets. Les points de vue sont variés : un auteur pourra faire état de la prise en charge des patients et du traitement appliqué de manière générale, un autre pourra cibler cette réflexion dans le cadre d'une pathologie déterminée. Chaque témoignage est illustré de petits cas cliniques. En présentant pour de nombreux praticiens le bilan de leur pratique, leur évaluation de l'écart entre la théorie et la pratique, cet ouvrage dresse ainsi un tableau des diverses pratiques francophones. Une réflexion qui enrichit la pratique, en rassemblant les façons de penser, de dire et de faire.

Background. KDOQI guidelines recommend preparation for renal replacement therapy (RRT) once stage 4 chronic kidney disease (CKD) is reached. Recent studies conducted in the general population and in patients referred to nephrologists have shown that CKD patients, especially the elderly, are much more likely to die than to reach RRT. We investigated whether futile preparation for RRT was performed in CKD patients referred to our nephrology department. Methods. We included all patients (n = 386) with stage 4 CKD and without prior RRT, seen at our outpatient clinic between 1 November 2004 and 30 April 2007. Demographics, clinical and laboratory data at inclusion were collected. Follow-up continued until 1 November 2007 or later (last appointment or study outcome). The primary outcome was death without requiring RRT, and secondary outcomes were RRT, going through our pre-dialysis education programme (PDEP) and undergoing the creation of an arterio-venous fistula (AVF). Factors predicting these outcomes were analysed. Results. During complete follow-up (average 23.4 months), 47 patients (12.1%) died without requiring RRT and 59 patients (15.3%) started RRT. The rate of death without requiring RRT in the overall cohort increased from 50 years onwards and exceeded that of RRT in incident patients aged ≥80 years. A structured PDEP was offered to 66.1% of patients starting RRT vs 14.9% of patients dying without requiring RRT and 13.9% of patients surviving without requiring RRT (P < 0.001). In addition, 53.3% of patients starting haemodialysis had a prior AVF creation vs 6.4% of patients dying without requiring RRT and 5.7% of patients surviving without requiring RRT (P < 0.001). Conclusions. The risk of death exceeds that of RRT in stage 4 CKD incident patients aged ≥80 years referred to our clinic. Futile preparation for RRT was relatively uncommon (14.9%). We were able to largely avoid futility at the expense of incomplete exposure of patients who eventually started RRT

Background & Objective. STOPP and START criteria are useful tools to detect inappropriate use of medications in elderly people. Six STOPP and three START criteria concern aspirin use. The aim of this study is to describe aspirin misuse according to STOPP and START criteria in frail older patients and related hospital admission. Methods. Prospective collection upon hospital admission of geriatric, medical and pharmacological information in consecutive older persons (≥ 75 years) with frailty features (ISAR ≥ 2/6) admitted for acute illness. Using the STOPP and START criteria, a pharmacist and a geriatrician independently detected events of inappropriate medication (IM) and of prescribing omission (PO) concerning the pharmacological regimen at home , and determined whether the hospital admission was related to IM or PO. Results. 302 frail older persons (84±5 years; ♀ 63%; ISAR 3.5±1) were included. IM was present in 48 % of them.. Overuse of aspirin concerned 35 of the 210 IM events, i.e "aspirin at dose > 150 mg/day" (n=25; 71%); "aspirin with no history of coronary, cerebral or peripheral vascular symptoms or occlusive event (n=7; 20%) "; "aspirin with a past history of peptic ulcer disease without gastric protection" (n=2); “use of aspirin and warfarin in combination without gastric protection" (n=1); “aspirin to treat dizziness not clearly attributable to cerebrovascular disease (n=1). One patient cumulated 2 STOPP criteria for aspirin. PO was observed in 63 % of the frail older persons. Underuse of aspirin concerned 77 of the 362 PO events (21%), i.e. (non-use of) "aspirin in secondary prevention [i.e. in case of documented history of atherosclerotic coronary, cerebral or peripheral vascular disease in patients with sinus rhythm] (n=41; 53%), in "diabetes mellitus with coexisting major cardiovascular risk factors" (n=33; 43%), or in "chronic atrial fibrillation, where warfarin is contraindicated" (n=3).