The threshold model revisited.

Background: The threshold model represents one of the most significant advances in the field of medical decision-making, yet it often does not apply to the most common class of clinical problems, which include health outcomes as a part of definition of disease. In addition, the original threshold model did not take a decision-maker's values and preferences explicitly into account.

Methods: We reformulated the threshold model by (1) applying it to those clinical scenarios, which define disease according to outcomes that treatment is designed to affect, (2) taking into account a decision-maker's values.

Clinical and microscopic predictors of Entamoeba histolytica intestinal infection in travelers and migrants diagnosed with Entamoeba histolytica/dispar infection.

Background: Amebiasis is a protozoal infection caused by Entamoeba histolytica, while the morphologically indistinguishable E. dispar is considered as non-pathogenic. Polymerase chain reaction (PCR) assays are necessary to differentiate both species.

Do travel clinic visitors read information on sexual risk abroad in travel health brochures?

Background: A substantial proportion of travel clinic visitors have sexual encounters while abroad. Hence, guidelines on travel health recommend discussing sexual risk in a pre-travel consultation. However, previous studies showed that it often is not discussed.

Rationality, practice variation and person-centred health policy: a threshold hypothesis.

Variation in practice of medicine is one of the major health policy issues of today. Ultimately, it is related to physicians' decision making. Similar patients with similar likelihood of having disease are often managed by different doctors differently: some doctors may elect to observe the patient, others decide to act based on diagnostic testing and yet others may elect to treat without testing.

A 68-year old male presenting with rhabdomyolysis-associated acute kidney injury following concomitant use of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate and pravastatin/fenofibrate: a case report.

Introduction: We present what we believe to be the first case in the literature of rhabdomyolysis-induced renal failure caused by a probable drug interaction between elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/COBI/FTC/TDF) and pravastatin/fenofibrate.

Case Presentation: A 68-year old Caucasian man presented with progressive pain in both legs two weeks after commencing treatment with EVG/COBI/FTC/TDF. He was found to have biochemical evidence of rhabdomyolysis and acute renal failure.

Toxocariasis diagnosed in international travelers at the Institute of Tropical Medicine, Antwerp, Belgium, from 2000 to 2013.

Although infection with Toxocara canis or T. catis (commonly referred as toxocariasis) appears to be highly prevalent in (sub)tropical countries, information on its frequency and presentation in returning travelers and migrants is scarce. In this study, we reviewed all cases of asymptomatic and symptomatic toxocariasis diagnosed during post-travel consultations at the reference travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium.

When is rational to order a diagnostic test, or prescribe treatment: the threshold model as an explanation of practice variation.

Background: The threshold model represents an important advance in the field of medical decision-making. It is a linchpin between evidence (which exists on the continuum of credibility) and decision-making (which is a categorical exercise - we decide to act or not act). The threshold concept is closely related to the question of rational decision-making.

Serious altitude illness in travelers who visited a pre-travel clinic.

Background: Few data are available on the incidence and predictors of serious altitude illness in travelers who visit pre-travel clinics. Travel health consultants advise on measures to be taken in case of serious altitude illness but it is not clear if travelers adhere to these recommendations.

Methods: Visitors to six travel clinics who planned to travel to an altitude of ≥3,000 m were asked to complete a diary from the first day at 2,000 m until 3 days after reaching the maximum sleeping altitude.

Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis: an interview study of physicians in India, Pakistan and Bangladesh.

Background: To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis.

Methods: An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis.

Autochthonous cases of mycetoma in Europe: report of two cases and review of literature.

Background: Mycetoma is a chronic granulomatous infection involving cutaneous and subcutaneous tissues. It is endemic in tropical and subtropical areas, but sporadic cases have been reported also in countries of temperate climate. The purpose of this paper is to review the cases of mycetoma in European subjects (and presumably acquired in Europe), to give an insight in the main factors associated with this condition, and to describe two previously unpublished cases observed at our Centre.

Three cases of imported dengue virus infection from Madeira to Belgium, 2012.

We report three laboratory-confirmed dengue virus (DENV) infections imported to Belgium by travelers returning from Madeira (Portugal). Despite the use of a mosquito-repellent spray as reported by two patients, the infection could not be prevented. Diagnosis was made by antigen detection and real-time reverse transcriptase polymerase chain reaction (RT-PCR) in two cases and by serology 1 month after onset of symptoms in a third one.

Factors for viral infection in blood donors of South Kivu in the Democratic Republic of Congo.

Introduction: Assessing the knowledge, attitudes, practices and behaviors among blood donors in South Kivu and identify risk factors for viral markers.

Methods: A descriptive and analytical cross-sectional study involved 595 blood donors in the city of Bukavu (Head city of the province of South Kivu) in the eastern Democratic Republic of Congo.

Results: Our sample consisted of 70.

A systematic review and meta-analysis of the performance of two point of care typhoid fever tests, Tubex TF and Typhidot, in endemic countries.

Background: In the absence of well-equipped laboratory infrastructure in many developing countries the accurate diagnosis of typhoid fever is challenging. Rapid diagnostic tests (RDT) with good performance indicators would be helpful to improve clinical management of suspected cases. We performed a systematic literature review and meta- analysis to determine the performance of TUBEX TF and Typhidot for the diagnosis of typhoid fever using PRISMA guidelines.

The effect of pre-travel advice on sexual risk behavior abroad: a systematic review.

Background: Travelers often have casual sex abroad and the risk of acquiring a sexually transmitted infection (STI) associated with casual travel sex is considered to be threefold higher compared to the risk of casual sex in the home country. Consequently, international guidelines recommend including STI advice in the pre-travel consultation. We performed a systematic review on the effect of a pre-travel STI intervention on sexual risk behavior abroad.

Tuberculous meningitis: do modern diagnostic tools offer better prognosis prediction?

Background: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease severity and establish the approximate prognosis of tuberculous meningitis.

Aims: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical features, laboratory tests and imaging.

Methods: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the prognosis of patients with Central Nervous System Tuberculosis.

Should malaria treatment be guided by a point of care rapid test? A threshold approach to malaria management in rural Burkina Faso.

Background: In Burkina Faso, rapid diagnostic tests for malaria have been made recently available. Previously, malaria was managed clinically. This study aims at assessing which is the best management option of a febrile patient in a hyperendemic setting.

Severe strongyloidiasis: a systematic review of case reports.

Background: Strongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. We carried out a review of literature on hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), in order to describe the most challenging aspects of severe strongyloidiasis.

Methods: We conducted a structured search using PubMed to collect case reports and short case series on HS/DS published from 1991 to 2011.

Does introduction of thresholds in decision aids benefit the patient?: Comparison between findings-based and threshold-based diagnostic decision aids.

Purpose: To assess how different diagnostic decision aids perform in terms of sensitivity, specificity, and harm.

Methods: Four diagnostic decision aids were compared, as applied to a simulated patient population: a findings-based algorithm following a linear or branched pathway, a serial threshold-based strategy, and a parallel threshold-based strategy. Headache in immune-compromised HIV patients in a developing country was used as an example.

Diagnosis of Malaria Infection with or without Disease.

The revised W.H.O.