Expectations of general practitioners and pharmacists regarding health data communication: a cross-sectional survey in the Wallonia-Brussels Federation

 Florent Guyaux (1), Annick Nonneman (2) Published in the journal : December 2023 Category : Médecine Générale

Objective

This study aims to explore the expectations of pharmacists and general practitioners (GPs) regarding the exchange of medi­cal data via health networks.

Methodology

A quantitative questionnaire study was conducted among pharmacists and general practitioners in the Wallonia-Brussels Federation (FWB). Data were analyzed using descriptive statistics.

Results

The questionnaire yielded a sample of 609 people. Overall, 83% of GPs wanted access to the medication dispensing history, 93% of pharmacists wanted to access the full Summarized Electronic Health Record (SUMEHR), and 62% of GPs favored sharing this SUMEHR with the pharmacists believing it would improve their collaboration and treatment control. However, less than 10% of GPs agreed with sharing more sensitive data such as medical reports or biological results, while 64% of doctors believed the indication for treatment should be shared with pharmacists on an optional basis. More than 70% of GPs and pharmacists preferred to use specific communication tools between themselves.

Conclusion

GPs and pharmacists are looking for health networks to facilitate communication, health data exchange, and access to medication history and patterns. Their underuse can be partially explained by insufficient knowledge of the tools, difficulty of access, bugs, respect for privacy, non-implementation of the tools in business software, time-consuming encoding and fear of judgment of drug prescriptions, or the transfer of the GP’s role to the pharmacist.

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Pediatric palliative care: for whom? Current situation in Belgium

 Manon Le Roux (1,2), Dominique Bellis (3), Brigitte de Terwangne (3), Bénédicte Brichard (1,2) Published in the journal : October 2023 Category : Pediatric Hematology/ Oncology

Palliative care is intended for children with life-limiting or life-threatening illnesses, regardless of age and pathology, and their families.

It is not limited to children at the end of life. Palliative care begins as soon as an illness is diagnosed and includes, in varying proportions over time, treatments that are still directed against the illness, as well as comfort care.

Palliative care requires an interdisciplinary approach and is tailored to the physical, psychological, social, and spiritual needs of children and their families, with the aim of improving their quality of life. Palliative care continues after the child’s death by supporting the family.

Many children are concerned by palliative care, but only a minority will benefit from structured care. In Belgium, there are pediatric liaison teams whose role is to provide palliative care for children and adolescents in hospitals and at home.

There is a real need for communication and information regarding this subject, and to broaden the range of training courses available.

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Vasculitis: from clinical and pathological descriptions to successful treatments

 Loïc Guillevin Published in the journal : October 2023 Category : Docteur Honoris Causa

Systemic vasculitis is a group of inflammatory diseases of vessels of various sizes, with variable pathogenic mechanisms. Their causes are often unknown. This disease group is historically dominated by polyarteritis nodosa but also includes granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and giant cell arteritis. Immunologically, anti-neutrophil cytoplasmic antibodies (ANCA) are present in a group of small-sized vessel necrotizing vasculitis. The extremely severe prognosis of vasculitis has been modified by corticosteroids and immunosuppressive treatments. More recently, biotherapies, including rituximab in ANCA-associated vasculitis, mepolizumab in eosinophilic granulomatosis with polyangiitis, and tocilizumab in giant cell arteritis, have achieved remissions in more than 90% of patients and prevented relapses. They have also made possible to considerably reduce corticosteroid treatment and, consequently, its side effects. Vasculitis is now curable with a favorable prognosis.

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New recommendations for the management of acute otitis media in primary care

 Jan-Harm Keijzer (1), Saphia Mokrane (1,2), Paul Van Royen (3), Nicole Dekker (1), Martine Goossens (1), Olivier Vanderveken (4), An De Sutter (5), Rupal Mehta (6), Cécile Ducène (7), Alexandra Sousa (8), Monique Boulad (9) Published in the journal : October 2023 Category : Médecine Générale

This article is a summary of the recent update of the clinical practice guideline (CPG) on the management of acute otitis media (AOM) in general practice.

The CPG was developed with the participation of all relevant disciplines and according to an internationally recognized methodology for guideline development (Adapte procedure).

The elements of the medical history and clinical examination have limited diagnostic value and symptoms alone are not enough to make a diagnosis of AOM. The diagnostic hypothesis is based on the combination of these elements.

The doctor pays attention to the patient's experience and provides the necessary information to enable the patient to manage his/her disease properly (e.g., pain management, etc.). Shared decision making is a key point.

Antibiotics are justified in case of an unfavorable disease course and in the presence of major risk factors for complications. However, certain subgroups may benefit from antibiotic treatment.

Effective treatment (paracetamol or ibuprofen) of pain or fever has become the cornerstone of AOM management. More targeted antibiotic treatment is reserved for specific indications.

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High-flow priapism after pelvic fracture

 Romain Carlat (1), Renaud Destraix (4), Nicolas Jacquemart (2), François Melebeck (3), Michaël Twahirwa (4), Michaël De Foy (3) Published in the journal : October 2023 Category : Chirurgie orthopédique

Priapism is an erectile dysfunction characterized by partial or complete penile erection lasting more than four hours without any sexual stimulation. Its incidence is estimated at 0.5-0.9 cases per 100,000 people per year. Ischemic priapism, which is more frequent and painful, is induced by the paralysis of the cavernous smooth muscle, which can no longer contract, allowing hypoxic blood to stagnate within the sinusoidal spaces. Arterial priapism, rare (5% of priapism) and typically painless, generally results from direct perineal trauma responsible for an arterio-cavernous fistula. In this case report, we discuss the multidisciplinary management of a 31-year-old patient, polytraumatized after a high-velocity motorcycle accident. He presented with a pelvic fracture osteosynthesized with a plate and screws. Following surgery, the patient developed post-traumatic high-flow priapism, which was managed by interventional radiology.

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Sexual assaults on very young children (0-6 years)

 Jean-Yves Hayez (1), Hélène Romano (2) Published in the journal : October 2023 Category : Pédopsychiatrie

Although sexual violence against children seems to be better recognized and managed nowadays, one age category of victims is totally forgotten: babies and very young children. It is extreme abuse, given the vulnerability of the victims.

Nevertheless, it is a real problem and the lack of publications on this subject can only make us worry, as it probably leaves many situations unaddressed.

The main objective of this article is to describe the specificity of sexual assaults on young children and to better identify signs likely to alert healthcare professionals.

This article is based on our clinical experience and qualitative data collected throughout our years of experience.

Our fieldwork has enabled us to propose a summary table of the basic identification elements present in very young children who have been assaulted.

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Cervical cysts in adults: caution!

 Daniel Moens (1), Sébastien Van der Vorst (2) Published in the journal : September 2023 Category : Clinical Report

Any cervical cystic lesion detected after the age of 40 should lead to thorough investigations in the ear-nose-throat (ENT) sphere and in particular in the homolateral palatine tonsil and tongue base.

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Pyroglutamic acidemia in an elderly patient

 Maxime Cuylits (1), Christophe Dumont (2), Blaise Anthonissen (3), Denis Glorieux (4), Ioana Almas (5) Published in the journal : September 2023 Category : Clinical Report

Pyroglutamic acidemia, initially described in the pediatric population due to inborn enzymatic deficiencies, is a relatively unknown cause of high anion gap metabolic acidosis (1). Acquired pyroglutamic acidemia is mostly diagnosed in malnourished women suffering from a chronic illness and with a history of chronic acetaminophen use (2). During the past decade, several cases of flucloxacillin- and paracetamol-induced pyroglutamic acidosis have been reported (3,4). We herein report a case of a patient diagnosed with pyroglutamic acidosis in the context of concomitant paracetamol and flucloxacillin treatment. This case report highlights the need to consider pyroglutamic acidosis in the differential diagnosis of high anion gap metabolic acidosis, given its reversibility under appropriate management.

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Study of the benefits of cryotherapy in postoperative anterior total hip arthroplasty

 Antoine Ledoux, Stéphanie Meirlaen, Julie Manon, André Claude Mbaga Ntjam, Jean-Emile Dubuc, Maité Van Cauter, Olivier Cornu Published in the journal : September 2023 Category : Orthopedics

The aim of this prospective study was to evaluate the influence of a cryotherapy device compared to conventional cold packs in postoperative anterior total hip arthroplasty to assess the benefits in terms of rehabilitation, analgesia, and blood loss.

Existing literature suggests that cryotherapy may be beneficial in reducing postoperative pain (1) and blood loss in joint replacement surgery (2,3). However, no study has comprehensively evaluated these effects on patient rehabilitation and mobilization.

Firstly, our cohort comprised 158 patients, 14 of whom were excluded during hospitalization. The control group, consisting of 72 patients, received cold packs twice a day and, if necessary, on demand. The interventional group, also comprising 72 patients, received the cryotherapy machine three times a day during the first two postoperative days.

Secondly, our results showed a significant improvement in the revalidation score on the third postoperative day in the cryotherapy group. We could not confirm the significant impact on the clinical outcome. Moreover, no difference was noted in pain medication intake or blood loss. Finally, we can consider cryothera- py as a simple, non-invasive approach that does not increase the risk of adverse effects when used in immediate postoperative total hip arthroplasty (2).

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Focus on suspected hemorrhagic diathesis

 Michael Iarossi, MD, Cédric Hermans, MD, PhD, FRCP (Lon, Edin) Published in the journal : September 2023 Category : Hematology/Oncology

Clinical bleeding manifestations are commonly encountered reasons for medical consultations in both general and specialized fields. A comprehensive medical history, encompassing personal and familial contexts, plays a pivotal role in predicting a bleeding disorder. Employing a bleeding clinical score constitutes the primary approach. While routine coagulation tests are useful, they are inadequate for definitively ruling out a potential hemostatic abnormality. If a strong suspicion of hemostasis dysfunction exists, a comprehensive array of biological assessments must be requested. This evaluation should encompass primary hemostasis, coagulation factors, and fibrinolysis. This combined clinical and biological strategy is instrumental in recognizing whether a coagulation disorder is acquired or hereditary, in elucidating its underlying cause, and in gauging its severity. The commonly encountered congenital causes comprise platelet functional disorders, von Willebrand disease, hemophilia A/B, and deficiencies in coagulation factors like Factor VII and Factor XI, as well as hyperfibrinolysis. Nonetheless, a notable subset of patients is unlikely to benefit from this diagnostic approach. This prompts us to an undetermined source of the bleeding tendency, necessitating cautious attention to its potential implications. For hemostatic interventions, it is crucial to exercise vigilance. Indeed, the aim of such procedures is to attain effective management or bleeding prevention, while sidestepping unnecessary treatments with inherent risks, such as allergies, immunization, infections, and even thrombotic complications.

 

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