[Relationship between pre-dialysis period and mortality and morbidity; the importance of timely pre-dialysis care].

Objective: To investigate if the duration of pre-dialysis nephrology care is a predictive factor for mortality and morbidity in the first year of renal replacement therapy (RRT).

Design: Cohort study.

Method: We included all patients with chronic or acute-on-chronic renal failure whose estimated glomerular filtration time (eGFR) was < 30 ml/min/1.

Failure to Reposition After Sliding Down in Bed Increases Pressure at the Sacrum and Heels.

Unlabelled: The head of the bed (HOB) for a patient is often elevated since it improves comfort and facilitates respiratory functions. However, elevating the HOB essentially causes the patient support surface to turn into a ramp, forcing the patient's body to slide down. As the patient slides down, weight pressing on the pelvis, the coccyx, and the ischial tuberosities increases, resulting in associated increases in interface pressures.

Quantification of EEG reactivity in comatose patients.

Objective: EEG reactivity is an important predictor of outcome in comatose patients. However, visual analysis of reactivity is prone to subjectivity and may benefit from quantitative approaches.

Methods: In EEG segments recorded during reactivity testing in 59 comatose patients, 13 quantitative EEG parameters were used to compare the spectral characteristics of 1-minute segments before and after the onset of stimulation (spectral temporal symmetry).

Rasch-ionale for neurologists.

Outcome measures are considered the most important tools to monitor patients' outcome in both clinical and research settings. Measuring the clinical state of patients is a fundamental part of our daily clinical practice and research that sometimes is taken for granted. In peripheral neuropathies, there are many scales available, but most of these are at the ordinal level.

How to transform a metabolic syndrome score into an insulin sensitivity value?

Background: The metabolic syndrome (MetS) predicts cardiovascular risk and incident type 2 diabetes mellitus. The presence of a MetS is defined by the clustering of ≥3 out of 5 cardiometabolic criteria (hyperglycemia; hypertension; enlarged waist; low high-density lipoprotein-cholesterol; and hypertriglyceridemia), each of which is connected with insulin resistance. It is not known whether the severity of MetS, ranked from the sextet of scores range [0/5 to 5/5], is linearly related to reduced insulin sensitivity (IS) and/or lesser hyperbolic product across the glycemic spectrum.

Real-world Experience With a Decellularized Dehydrated Human Amniotic Membrane Allograft.

Unlabelled: While randomized controlled trials (RCTs) are designed to evaluate efficacy and/or safety under controlled conditions, use of strict inclusion/ exclusion criteria are noted to exclude more than 50% of wound populations. Applicability of RCT outcomes to performance expectations in real-world wound populations raises questions about generalizing their results. The primary aim of this decellularized, dehydrated human amniotic membrane (DDHAM) Use Registry Study was to gain experience and observe outcomes with use of a DDHAM in uninfected, full-thickness, or partial-thickness wounds that, in the investigators' opinions, would benefit from such treatment.

Allelic imbalance at the HER2/TOP2A locus in breast cancer.

Background: Breast cancer is a heterogeneous disease with various histological features and molecular markers. These are utilized for the prediction of clinical outcome and therapeutic decision making. In addition to well established markers such as HER2 overexpression and estrogen and progesterone receptor (ER and PR) status, chromosomal instability is evolving as an important hallmark of cancers.

Baseline diabetes as a way to predict CV outcomes in a lipid-modifying trial: a meta-analysis of 330,376 patients from 47 landmark studies.

Background: Diabetes is a major cardiovascular risk factor. However, its influence on the rate of occurrence of cardiovascular (CV) events during a clinical trial that included a diabetes subgroup has not yet been quantified.

Aims: To establish equations relating baseline diabetes prevalence and incident CV events, based on comparator arms data of major lipid-modifying trials.

Dysregulation of serum gamma interferon levels in vascular chronic Q Fever patients provides insights into disease pathogenesis.

A large community outbreak of Q fever occurred in the Netherlands in the period 2007 to 2010. Some of the infected patients developed chronic Q fever, which typically includes pathogen dissemination to predisposed cardiovascular sites, with potentially fatal consequences. To identify the immune mechanisms responsible for ineffective clearance of Coxiella burnetii in patients who developed chronic Q fever, we compared serum concentrations of 47 inflammation-associated markers among patients with acute Q fever, vascular chronic Q fever, and past resolved Q fever.

Bioelectrical impedance outperforms waist circumference for predicting cardiometabolic risk in Congolese hypertensive subjects: a cross-sectional study.

Background: Waist circumference threshold values used in sub-Saharan Africa correspond to those of European populations and are therefore inappropriate. Thus, they may over predict insulin resistance, especially in hypertensive Africans, in whom there is often no association between blood pressure and insulin resistance. Using bioelectrical impedance measurement in sub-Saharan Africa could possibly be advantageous to overcome the shortcomings of waist circumference measurement.

Trainable hardware for dynamical computing using error backpropagation through physical media.

Neural networks are currently implemented on digital Von Neumann machines, which do not fully leverage their intrinsic parallelism. We demonstrate how to use a novel class of reconfigurable dynamical systems for analogue information processing, mitigating this problem. Our generic hardware platform for dynamic, analogue computing consists of a reciprocal linear dynamical system with nonlinear feedback.

Results of a retrospective comparative study: material cost for managing a series of large wounds in subjects with serious morbidity with a hydrokinetic fiber dressing or negative pressure wound therapy.

Unlabelled: This retrospective observational study analyzed lesions with regard to healing trends and cost of materials.

Materials And Methods: The observed lesions were mostly postsurgical or stage IV pressure ulcers in patients with serious morbidity. The wounds were treated with a hydrokinetic fiber dressing (sorbion Sachet S, sorbion Gmbh & Co, a BSN medical company, Senden, Germany) (n = 26) or negative pressure wound therapy (NPWT) (n = 16).

EPA guidance on how to improve the image of psychiatry and of the psychiatrist.

Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services.

EPA guidance on the role and responsibilities of psychiatrists.

Psychiatry is that branch of the medical profession, which deals with the origin, diagnosis, prevention, and management of mental disorders or mental illness, emotional and behavioural disturbances. Thus, a psychiatrist is a trained doctor who has received further training in the field of diagnosing and managing mental illnesses, mental disorders and emotional and behavioural disturbances. This EPA Guidance document was developed following consultation and literature searches as well as grey literature and was approved by the EPA Guidance Committee.

Clinical inertia in general practice, a matter of debate: a qualitative study with 114 general practitioners in Belgium.

Background: Prescribing that is not concordant with guidelines is increasingly referred to as clinical inertia (CI). However, CI may be only apparent, and the absence of decision may actually reflect appropriate inaction as a result of good clinical reasoning. Our study aimed to: (i) elucidate GPs' beliefs regarding CI and the risk of CI in their own practice, (ii) identify modifiable provider-related factors associated with CI.

Cardiovascular risk factors: Belgian target achievement.

Objective: The objective of this study was to evaluate the level of target achievement for key modifiable cardiovascular disease (CVD) risk factors (dyslipidaemia, arterial hypertension, hyperglycaemia, smoking, and physical inactivity) in Belgium.

Methods And Results: This non-systematic review of Belgian data from four recent studies assessed the control of CVD risk factors in clinical settings: the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA), the Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment Study (OPTIMISE), the European Action on Secondary and Primary Prevention by Intervention to Reduce Events Survey (EUROASPIRE III), and data from a general practice-based morbidity registration network (INTEGO). For each study, target achievement levels were evaluated using the guidelines that were applicable at the time of the study.

Memristor models for machine learning.

In the quest for alternatives to traditional complementary metal-oxide-semiconductor, it is being suggested that digital computing efficiency and power can be improved by matching the precision to the application. Many applications do not need the high precision that is being used today. In particular, large gains in area and power efficiency could be achieved by dedicated analog realizations of approximate computing engines.

A Dutch version of the Overall Anxiety Severity and Impairment Scale (OASIS): Psychometric properties and validation.

Background: The Overall Anxiety Severity and Impairment Scale (OASIS) is a 5-item self-report measure that can be used to assess the impact of any anxiety disorder or multiple anxiety disorders. Prior US investigations have shown the OASIS to be a reliable and valid measure. To date the OASIS has not been validated for use in a Dutch sample of anxiety disordered patients.

Novel determinants preventing achievement of major cardiovascular targets in type 2 diabetes.

Background: T2DM management requires tight control of 3 critical quality indicators to prevent vascular complications: LDL-C, SBP, and HbA1c. This study evaluated the rate of T2DM patients attaining these critical quality indicators, and the pathophysiological or cardiometabolic traits predicting goal achievement.

Patients And Methods: Cross-sectional analysis evaluating combined goal achievement (LDL-C<100 mg/dL; SBP<130 mmHg and HbA1c<7.

Predictive accuracy and feasibility of risk stratification scores for 28-day mortality of patients with sepsis in an emergency department.

Objectives: Sepsis is associated with high mortality. Because early therapy has proven to decrease mortality, a risk stratification tool that quickly and easily quantifies mortality risk of patients will be helpful to guide appropriate treatment. We investigated five scores in terms of (a) predicting 28-day mortality and (b) their feasibility for use in the emergency department (ED).

Optoelectronic Systems Trained With Backpropagation Through Time.

Delay-coupled optoelectronic systems form promising candidates to act as powerful information processing devices. In this brief, we consider such a system that has been studied before in the context of reservoir computing (RC). Instead of viewing the system as a random dynamical system, we see it as a true machine-learning model, which can be fully optimized.

Histological characteristics of the abdominal aortic wall in patients with vascular chronic Q fever.

The aim of this study was to describe specific histological findings of the Coxiella burnetii-infected aneurysmal abdominal aortic wall. Tissue samples of the aneurysmal abdominal aortic wall from seven patients with chronic Q fever and 15 patients without evidence of Q fever infection were analysed and compared. Chronic Q fever was diagnosed using serology and tissue PCR analysis.

[Levels of target achievement for major modifiable cardiovascular risk factors in Belgium].

Cardiovascular disease (CVD) is the main cause of premature mortality in Europe. The burden of CVD could be reduced by controlling the major modifiable CVD risk factors (dyslipidaemia, arterial hypertension, hyperglycaemia, smoking, and physical inactivity) through lifestyle and dietary changes and appropriate drug therapies. The objective of this article is to assess the level of target achievement for key modifiable CVD risk factors in Belgium by referring to the data from four recent studies.

Factors associated with clinical inertia: an integrative review.

Failure to initiate or intensify therapy according to evidence-based guidelines is increasingly being acknowledged as a phenomenon that contributes to inadequate management of chronic conditions, and is referred to as clinical inertia. However, the number and complexity of factors associated with the clinical reasoning that underlies the decision-making processes in medicine calls for a critical examination of the consistency of the concept. Indeed, in the absence of information on and justification of treatment decisions that were made, clinical inertia may be only apparent, and actually reflect good clinical practice.

Two patients with a neuroendocrine tumour of the small intestine and paraneoplastic myasthenia gravis.

Unlabelled: This paper reports on two patients with a long-standing diagnosis of an ENETS stage IV neuroendocrine tumour (NET) of the small intestine who developed neurological symptoms. The first patient only had bulbar symptoms and tested positive for acetylcholine receptor antibodies. The second patient had more classical symptoms of fatigable diplopia and muscle weakness of the legs, but no detectable antibodies.