Diagnosis is an incredibly dynamic and complex process, which is prone to errors. We all make many diagnostic errors and this, in every healthcare setting, but particularly so in the emergency department. However, these errors are preventable. It is thus essential to better understand how and why these errors occur; then, some simple steps must be taken to avoid their repetition. Many of these errors pertain to the clinical reasoning process and are due to cognitive errors, although other system-related factors are likely present in most cases.
Keeping vaccines requires maintaining the cold chain, which commonly exhibits weaknesses, even in more developed countries. However, the exposure of most vaccines to high temperatures results in some degree of degradation. Moreover, the freezing itself can cause an immediate vaccine degradation. In this context, the conservation of vaccines in the refrigerator at a constant temperature between 2 and 8 °C is a required framework for the general practitioner, which is designed to preserve the vaccines’ properties. The main characteristics of suitable refrigerators must combine the maintenance of temperature (between 2 and 8 °C), an equal temperature distribution, the availability of an evaporator that prevents freezing, a very rapid temperature recovery device, as well as forced air circulation. Domestic refrigerators may suffice for storing small volumes of vaccines. They must display the minimum characteristics required for good storage conditions and undergo the adaptations necessary to their proper use. Additionally, regular temperature monitoring and reporting must be performed using an outdoor thermometer with a probe. These easily manageable elements enable vaccines to be stored in good conditions, with the eventual outcome of optimizing vaccine coverage of the population.
Artificial intelligence (AI) refers to the simulation of human intelligence by machines with integrated computer programs. AI analyzes data and contributes to decision making. The computer performs human-like tasks based on algorithms. Moore's law says that computer performance increases exponentially and doubles every 18 months. On this basis, AI would surpass human intelligence by 2050. Machine learning mimics the human brain. It is fed by big data, which is a mass of heterogeneous data that are processed at a rate far beyond human capacity and in which exploitable data can be gathered. In addition to this virtual branch of AI, there is also the physical branch of robots. It has been shown that physicians surpass current diagnostic programs with respect to medical diagnosis. However, in the case of mammography, while no single AI algorithm outperformed radiologists, overall diagnostic accuracy was improved when using a set of AI algorithms combined with radiologist assessment in a single-reader screening. Only the physicians who have empathy, unlike the machines that lack this skill, may diagnose the disease. Patients’ confidence must come at the top of researchers’ priority list. Nat Med 26, 301 (2020).
Laura Orioli, Bernard Vandeleene, Dan Putineanu, Caroline Briquet, Hector Rodriguez-Villalobos, Jean-Cyr YombiPublished in the journal : September 2020Category : Endocrinologie et Nutrition
Infections are a common complication of the diabetic foot ulcer. They are recognized as a factor of poor prognosis for both the foot and the patient. Their management is complex, requiring multidisciplinary collaboration. Our article summarizes the general principles of the management of diabetic foot infections, mainly based on the new recommendations of the International Working Group for the Diabetic Foot (IWGDF). It also presents the recommendations on the use of antibiotics, based on the PEDIS classification, as applied in the Saint-Luc University Hospital.
This article presents the different pharmacological classes and therapeutic strategies employed at the different stages of Parkinson's disease. To date, only symptomatic treatments exist. Levodopa remains the most effective treatment with the best benefit-risk ratio. It is the initial treatment of choice for most patients. In order to delay the onset of motor complications, such as dyskinesia or end-of-dose akinesia, dopamine agonists or monoamine oxidase B inhibitors may be proposed as first-line treatment to young patients with mild disability. Motor fluctuations can be improved by adjusting the levodopa dosing frequency or by adding a dopamine agonist, monoamine oxidase inhibitor, or catechol-O-methyltransferase inhibitor. Disabling dyskinesias can be improved by reducing the levodopa dose or using amantadine. Patients with severe motor complications may benefit from a treatment with Duodopa® or subcutaneous apomorphine.
Olivier S. Descamps, Johan De Sutter, Ann Mertens, Caroline Wallemacq, Michel Langlois, Ann Verhaegen, Ernst Rietzschel, Guy De BackerPublished in the journal : September 2020Category : Internal Medicine
Several members of the Belgian Societies of Atherosclerosis and Cardiology have revisited in the form of 10 questions the main points of the new recommendations of the European Atherosclerosis Society (EAS) and European Society of Cardiology (ESC) concerning dyslipidemia management for preventing atherosclerotic cardiovascular disease (AVD). These new guidelines are underpinned by a number of key concepts, including the certainty that LDL cholesterol is the major cause underlying the development of atherosclerosis, that reducing LDL cholesterol helps diminish cardiovascular risk, that this cardiovascular benefit is the same regardless of how this reduction is met (nutrition, statin, ezetimibe, or PCSK9 inhibitor), and that there is neither a lower limit to this effect nor any danger at all of extremely low LDL cholesterol levels. To effectively put this knowledge into practice, a step-by-step approach is recommended; thereby enabling us to weight the intensity of the preventive approach based on individuals’ overall MCVA risk and their baseline (untreated) LDL-C levels.
Due to the rising prevalence of obesity, non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide. NAFLD refers to a disease spectrum that encompasses steatosis and non-alcoholic steatohepatitis (NASH). NASH, which is the inflammatory subtype of NAFLD, has a clear potential of progression to fibrosis and cirrhosis, and can be associated with the need for transplantation. Identification of NAFLD and NASH is important in order to prevent disease worsening and to provide adequate tools for counteracting the causal factors. Risk factors associated with NAFLD and NASH include clinical comorbidities such as the metabolic syndrome, which is more relevant than high body mass index. Further recently identified characteristics, such as dietary composition, intestinal dysbiosis, genetic predisposition, altered brown adipose tissue, muscle alterations, circadian clock disruption or environmental chemicals, are presented in this review.
Humans come from the humus, they are kneaded out of it. In the crisis, the fragility and immensity of each individual’s humanity has been unveiled, even by what was painfully lacking. We must preserve our humanity as an invaluable treasure. We must root our future in it, because without soil, our “DNA” denatures and dies.
C. Collienne, D. Castanares-Zapatero, M. Apraxine, C. Beauloye, A. Capes, T. Castelein, C. Debaille, M. Dechamps, L. Gérard, P. Hantson, L-M. Jacquet , V. Montiel, S Pierard, J. Pinto Peireira, A. Robert, O. Van Caenegem, A. Wiart, P-F. Laterre, X. WittebPublished in the journal : May 2020Category : Intensive Care
During the COVID-19 pandemic, many patients have been admitted to intensive care units, thereby highlighting the work of a medical specialty that is often little or poorly known to the public. In these patients, respiratory failure, falling within the definition of acute respiratory distress syndrome, had to be managed using non-invasive and invasive oxygenation and ventilation techniques, and in the most severe cases, using extracorporeal membrane oxygenation. These heavy treatments, combined with complicated mobilization techniques (prone position) and other usual intensive care treatments, had to be delivered simultaneously to a large number of patients with a guarded prognosis, which has put under significant pressure the bedside care teams.
Emilie Banse1, Alix Bigot1, Christian De Valkeneer2, Vincent Lorant3, Olivier Luminet1,4, Pablo Nicaise3, Pierre Smith3, Sandy Tubeuf3,5, Amélie Wuillaume6Published in the journal : May 2020Category : Société
The implementation of population containment has proven effective to reduce the number of deaths and avoid overrunning hospitals. However, the restrictive measures of containment and distancing have impacted society far beyond health. In this article, we briefly present four research projects in social sciences and humanities that are currently being conducted at the UCLouvain. The first study, focused on health psychology and emotions, has shown the existence of individual barriers to adopting hygiene and distance behaviors. The second research project on mental health explores the consequences of containment on the mental health of Belgians. The third study, in the field of management and organizational sciences, describes the resilience of companies in crisis situations. Finally, the last study deals with law and discusses the importance of collective responsibility and the need for clear rules to enforce freedom-restricting measures.