Teledermatology in Belgium: a pilot study.

: Teledermatology, the application of telemedicine in the field of dermatology, can be a valuable tool to improve the efficiency of care in general practice.: In this pilot study, we implemented a teledermatology programme in Belgian context to assess the effect on referral rate and to evaluate the acceptability of teledermatology by clinicians and patients.: A store-and-forward teledermatology service between 12 general practitioners (GPs) and 3 academic dermatologists was evaluated for a period of 3-6 months.

Impaired cardiovascular structure and function in adult survivors of severe acute malnutrition.

Malnutrition below 5 years remains a global health issue. Severe acute malnutrition (SAM) presents in childhood as oedematous (kwashiorkor) or nonoedematous (marasmic) forms, with unknown long-term cardiovascular consequences. We hypothesized that cardiovascular structure and function would be poorer in SAM survivors than unexposed controls.

A review on leadership of head nurses and patient safety and quality of care.

Purpose: The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

Design/methodology/approach: We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis).

Objectives: This study sought to assess the relationship between central pressure profiles and cardiovascular events (CVEs) in a large community-based sample.

Background: Experimental and physiologic data mechanistically implicate wave reflections in the pathogenesis of left ventricular failure and cardiovascular disease, but their association with these outcomes in the general population is unclear.

Methods: Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 5,960 participants in the Multiethnic Study of Atherosclerosis.

Reallocation of operating room capacity using the due-time model.

Background: Demand for surgical treatment is rising while operating room (OR) resources are limited. Requests for more resources therefore can only be partly met by repartitioning the existing sparse resources.

Objective: Our goal is to define a method to allocate OR block times among surgical disciplines in such a way that patients can be treated within an acceptable time after the need for surgery is established.

Ambulatory arterial stiffness index does not accurately assess arterial stiffness.

Introduction: The ambulatory arterial stiffness index (AASI), derived from ambulatory blood pressure monitoring (ABPM) recordings, has been proposed as a surrogate marker of arterial stiffness. However, there is controversy to what extent it reflects stiffness or is affected by other parameters. Using a previously validated one-dimensional computer model of the arterial circulation, the relative importance of the different determinants of the AASI was explored.

Hospital quality management: the perspective of a Belgian academic medical center.

In this article, we explain why from our perspective as the largest academic medical center in the country, we consider it to be part of our mission to contribute to the elaboration of a value-based health care organization system. We describe our hospital quality management system and how we think that this can deliver added value by introducing lean principles in the care process. We also reflect on the importance of hospital accreditation and external benchmarking in the continuous quality improvement culture within the hospital.

Current and projected prevalence of arterial hypertension in sub-Saharan Africa by sex, age and habitat: an estimate from population studies.

Introduction: In sub-Saharan Africa (SSA), data on hypertension prevalence in terms of urban or rural and sex difference are lacking, heterogeneous or contradictory. In addition, there are no accurate estimates of hypertension burden.

Objective: To estimate the age-specific and sex-specific prevalence of arterial hypertension in SSA in urban and rural adult populations.

Ethnic differences in arterial wave reflections and normative equations for augmentation index.

Data regarding ethnic differences in wave reflections, which markedly affect the central pressure profile, are very limited. Furthermore, because age, heart rate, and body height are strong determinants of augmentation index, relating single measurements to normative data (in which augmentation index values correspond with average population values of its determinants) is challenging. We studied subject-level data from 10 550 adults enrolled in large population-based studies.

Comparison of central pressure estimates obtained from SphygmoCor, Omron HEM-9000AI and carotid applanation tonometry.

Background: The Omron HEM-9000AI is the first automated tonometer to provide an estimate of central SBP (cSBP), which is considered to be more predictive of cardiovascular events than brachial pressure. However, considerable differences between the cSBP estimate of Omron and that of SphygmoCor have been reported, but not explained. This study assesses the sources of differences between both cSBP estimates and provides a handle on which estimate is closest to reality.

The influence of tocolytic drugs on cardiac function, large arteries, and resistance vessels.

Purpose: Beta-2 adrenoceptor agonistic drugs like ritodrine have been the reference tocolytic drugs, but are associated with cardiovascular side-effects. Atosiban, a newer drug, is a competitive antagonist of oxytocin and has been claimed to have fewer cardiovascular side effects. Until now, there has mainly been a subjective reporting of adverse reactions and few objective cardiovascular data.

Different effects of tocolytic medication on blood pressure and blood pressure amplification.

Background: The importance of tocolysis has been discussed extensively. Beta-2 adrenoceptor agonistic drugs like ritodrine have been the reference tocolytic drugs in most countries. Cardiovascular side-effects are frequent.

Evaluation of medication adherence methods in the treatment of malaria in Rwandan infants.

Objectives: To compare three methods for evaluating treatment adherence in a 7-day controlled treatment period for malaria in children in Rwanda.

Methods: Fifty-six children (< 5 years) with malaria were recruited at the University Hospital of Butare, Rwanda. Patients were treated with quinine sulfate, taste-masked, pellets during seven days: three days in hospital (in-patient) followed by a four-day out-patient period.

The use of diameter distension waveforms as an alternative for tonometric pressure to assess carotid blood pressure.

Proper non-invasive assessment of carotid artery pressure ideally uses waveforms recorded at two anatomical locations: the brachial and the carotid artery. Calibrated diameter distension waveforms could provide a more widely applicable alternative for local arterial pressure assessment than applanation tonometry. This approach might be of particular use at the brachial artery, where the feasibility of a reliable tonometric measurement has been questioned.

Numerical validation of a new method to assess aortic pulse wave velocity from a single recording of a brachial artery waveform with an occluding cuff.

Recently a new method has been proposed as a tool to measure arterial pulse wave velocity (PWV), a measure of the stiffness of the large arteries and an emerging parameter used as indicator of clinical cardiovascular risk. The method is based on measurement of brachial blood pressure during supra-systolic pressure inflation of a simple brachial cuff [the device is known as the Arteriograph (Tensiomed, Budapest, Hungary)]. This occlusion yields pronounced first and secondary peaks in the pressure waveform, the latter ascribed to a reflection from the aortic bifurcation, and PWV is calculated as the ratio of twice the jugulum-symphysis distance and the time difference between the two peaks.

Prices of antihypertensive medicines in sub-Saharan Africa and alignment to WHO's model list of essential medicines.

Objective: To investigate compliance of National Essential Medicines Lists (NEMLs) with the WHO Essential Medicines List (WHO/EML) in 2007 and to compare prices of antihypertensive drugs in and between 13 sub-Saharan African countries.

Methodology: Data on NEMLs and drug prices were collected from 65 public and 65 private pharmacies (five of each per country). Prices were compared with the International Drug Price Indicator Guide (IDPIG).

Noninvasive assessment of central and peripheral arterial pressure (waveforms): implications of calibration methods.

Objectives: Noninvasive estimation of central blood pressure (BP) from radial artery pressure waveforms is increasingly applied. We investigated the impact of radial artery waveform calibration on central BP assessment and calculated pressure amplification, with focus on the one-third rule used to estimate mean arterial BP (MAP).

Methods: Pressure waveforms were noninvasively measured at the radial and carotid arteries in 1873 individuals (age 45.

Amplification of the pressure pulse in the upper limb in healthy, middle-aged men and women.

Central-to-peripheral amplification of the pressure pulse leads to discrepancies between central and brachial blood pressures. This amplification depends on an individual's hemodynamic and (patho)physiological characteristics. The aim of this study was to assess the magnitude and correlates of central-to-peripheral amplification in the upper limb in a healthy, middle-aged population (the Asklepios Study).

Ultrasound simulation of complex flow velocity fields based on computational fluid dynamics.

In this work, a simulation environment for the development of flow-related ultrasound algorithms is presented. Ultrasound simulations of realistic Doppler signals require accurate modeling of blood flow. Instead of using analytically described flow behavior, complex blood movement can be derived from velocity fields obtained with computational fluid dynamics (CFD).

Evaluation of noninvasive methods to assess wave reflection and pulse transit time from the pressure waveform alone.

Accurate quantification of pressure wave reflection requires separation of pressure in forward and backward components to calculate the reflection magnitude as the ratio of the amplitudes backward and forward pressure. To do so, measurement of aortic flow in addition to the pressure wave is mandatory, a limitation that can be overcome by replacing the unknown flow wave by an (uncalibrated) triangular estimate. Another extended application of this principle is the derivation of aortic pulse transit time from a single pulse recording.

Experimental and numerical modelling of the ventriculosinus shunt (El-Shafei shunt).

This study assesses malresorptive hydrocephalus treatment by ventriculosinus shunting with the shunt in the antegrade or retrograde position. First, an experimental model of the cerebral ventricles, the arachnoid villi, the cortical veins, and the superior sagittal sinus was built. For this purpose, the compliance of a human cortical vein was measured and then modelled by means of Penrose tubes.