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De Hosson M, Goossens E, De Groote K, Muino Mosquera L, Wynendaele H, De Backer J. Preferences for disease-related information and transitional skills among adolescents with congenital heart disease in the early transitional stage. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction and aims
The transition towards adult-focused healthcare comprises a complex process through which adolescents with congenital heart disease (CHD) should be carefully guided. Various task forces encourage implementing person-tailored transition programs, but detailed data on adolescents' preferences regarding disease-related information and acquirable transitional skills are mostly lacking. This study examined these preferences towards adolescents with moderately and severely complex CHD.
Material and methods
A cross-sectional descriptive study including logistic regression analysis was performed in a Belgian tertiary CHD center with adolescents recruited from “Transition With a Heart” (TWAH). For this 4-year transition program, adolescents were invited to complete a communication paper (focused on the need for information) and an individualized transition plan (focused on the evaluation of transitional skills) prior to an outpatient visit. Only questionnaires completed in the early transition stage, from January 2016 to August 2021, were used for data analysis.
Results
Forty-nine adolescents completed both questionnaires at an average age of 15.9±1.2 years. Of all adolescents, 59% indicated the need for information about the heart defect and surgical treatment, followed by 45% that expressed the need for information about sports and medication; and ≤27% regarding psychosocially-related topics. The proportion of girls needing information was larger than boys. Significantly more girls than boys requested information about surgeries (76% versus 46%; p=0.04). Younger adolescents were more likely to express a need for information about most topics and significantly more likely regarding surgeries (odds ratio=0.53; 95% CI [0.26 to 0.88]; p=0.03).
A maximum of 14% of adolescents were interested in acquiring transitional skills. Larger proportions of adolescents perceived the relevant transitional skills as insufficient, from 21% to 83%.
Conclusion
The preferences for disease-related information of adolescents with CHD are mainly related to medical topics and tend to decrease with increasing age. This motivates timely gauging of individual information needs and delivering disease-related information, ideally in the early teens. Furthermore, preferences varied according to gender, with more information requested by girls.
Adolescents expressed minimal needs to acquire transitional skills despite the low self-perceived skills levels. This paradox requires further research to enable the adaptation of transition interventions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M De Hosson
- University Hospital Ghent, Adult Congenital Heart Disease , Gent , Belgium
| | - E Goossens
- University of Antwerp, Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences , Antwerp , Belgium
| | - K De Groote
- University Hospital Ghent, Pediatric cardiology , Gent , Belgium
| | - L Muino Mosquera
- University Hospital Ghent, Pediatric cardiology , Gent , Belgium
| | - H Wynendaele
- Ghent University, Department of Public Health and Primary Care & Health Economics , Ghent , Belgium
| | - J De Backer
- University Hospital Ghent, Adult Congenital Heart Disease , Gent , Belgium
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Van Bulck L, Goossens E, Morin L, Luyckx K, Ombelet F, Willems R, Budts W, De Groote K, De Backer J, Annemans L, Moniotte S, De Hosson M, Marelli A, Ecarnot F, Moons P. End-of-life and palliative care provision to adults with congenital heart disease: mortality follow-back study using administrative data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although many adults with congenital heart disease (CHD) still die prematurely, end-of-life care for these patients receives limited attention. There are indications that current care provision at the end of life is burdensome, expensive, and not in line with patients' needs and preferences. We sought to analyse end-of-life care in adult CHD patients to determine whether health services need to be optimized.
Purpose
This study aimed to describe patterns of healthcare consumption of adults with CHD who died in the last year of life.
Methods
This retrospective mortality follow-back study used data of the BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC), including individually linked healthcare claims, death certificates and clinical data from adults with CHD in Flanders (Belgium). For this study, adults with CHD who died between 2007 and 2016 from any cause except sudden death, accident or violence, were selected for inclusion. Accidental, violent, and sudden deaths were identified based on causes of death and healthcare use in the last 3 months of life. Healthcare consumption was based on nomenclature codes derived from healthcare claims data.
Results
A total of 327 eligible patients (median age: 58 y; 54% women; 43% mild CHD; 45% moderate CHD; 11% complex CHD; 49% cardiovascular cause of death) were identified. During the last year of life, healthcare use increased substantially (Fig. 1). During the last month of life, 54% of patients were hospitalised, 55% visited the emergency department, and 15% were admitted to an intensive care unit at least once (Fig. 2). A total of 8% and 5% of patients underwent heart surgery or catherization in the last month of life, respectively. Furthermore, 70% of patients had at least one encounter with a general practitioner and 11% with a CHD specialist in the last month of life. Specialist palliative care was provided to 13% of patients in the last month of life.
When looking at the subgroup of patients with CHD that died due to a cardiovascular cause, proportions of patients that were hospitalised or had visits at the emergency department or intensive care unit in the last month of life were similar (Fig. 2). However, these patients underwent more heart surgeries (11%) and catherizations (8%), had more encounters with CHD specialists (15%), and received remarkably less specialized palliative care (4%) in the last month of life.
Conclusion
Resource utilization increased substantially during the last year of life, resulting in high acute healthcare consumption in the last month of life. It is remarkable that only a minority of patients received palliative care, especially when looking at patients who died due to a cardiovascular cause. Our findings motivate the need to assess if and how end-of-life is planned for adults with CHD. Future studies using qualitative analyses and survey methodology are needed to optimize the management of end-of-life care.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Research Foundation Flanders, European Society of Cardiology, Koning Boudewijnstichting, National Foundation on Research in Pediatric Cardiology, Swedish Research Council for Health, Working Life and Welfare-FORTE
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Affiliation(s)
- L Van Bulck
- University of Leuven, Department of Public Health and Primary Care , Leuven , Belgium
| | - E Goossens
- University of Antwerp, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care , Antwerp , Belgium
| | - L Morin
- Regional University Hospital Jean Minjoz, Inserm Centre d'investigation clinique 1431 , Besancon , France
| | - K Luyckx
- University of Leuven, Department of Psychology and Educational Sciences , Leuven , Belgium
| | - F Ombelet
- University Hospitals (UZ) Leuven, Division of Neurology , Leuven , Belgium
| | - R Willems
- Ghent University, Department of Public Health and Primary Care , Ghent , Belgium
| | - W Budts
- University Hospitals (UZ) Leuven, Division of Congenital and Structural Cardiology , Leuven , Belgium
| | - K De Groote
- University Hospital Ghent, Department of Pediatric Cardiology , Gent , Belgium
| | - J De Backer
- University Hospital Ghent, Department of Adult Congenital Cardiology , Gent , Belgium
| | - L Annemans
- Ghent University, Department of Public Health and Primary Care , Ghent , Belgium
| | - S Moniotte
- University Hospitals St Luc Brussels, Pediatric and Congenital Cardiology Department , Brussels , Belgium
| | - M De Hosson
- University Hospital Ghent, Department of Adult Congenital Cardiology , Gent , Belgium
| | - A Marelli
- McGill University Health Centre, McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) , Montreal , Canada
| | - F Ecarnot
- Regional University Hospital Jean Minjoz, Department of Cardiology , Besancon , France
| | - P Moons
- University of Leuven, Department of Public Health and Primary Care , Leuven , Belgium
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Van Bulck L, Goossens E, Morin L, Luyckx K, Ombelet F, Willems R, Budts W, De Groote K, De Backer J, Moniotte S, De Hosson M, Marelli A, Moons P. Healthcare use at the end of life of patients with congenital heart disease: does heart failure matter? Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Research Foundation Flanders (to PM, EG, and LVB)
European Society of Cardiology (Nursing Training Grant to LVB)
Background
Heart failure (HF) is a common cause of morbidity and mortality in patients with congenital heart disease (CHD). Although limited in scope, previous studies suggest that patients with heart failure follow a specific end-of-life trajectory with episodes of serious complications, which may impact the patterns of care as death approaches.
Aims
The study aims to identify differences in characteristics and patterns of care in the last year of life in deceased CHD patients with and without HF.
Methods
This retrospective study used data of deceased adult patients included in the BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC). To describe patterns of care in the last year of life, we captured information about hospitalisations, emergency department visits, and visits to the general practitioner using nomenclature codes. Heart failure was identified as having HF as cause of death and/or at least one prescription of a loop diuretic in the last year of life. Sensitivity analyses with a stricter definition for HF (HF as cause of death or ≥ 1 prescription of a loop diuretic combined with a prescription of digoxin, dopamine, dobutamine, other non-glycoside stimulants, metoprolol, bisoprolol, carvedilol, aldosterone antagonists, ACE inhibitors or ARBs) were performed as well.
Results
During the period 2007–2016, 390 adults with CHD died, of which 170 patients with HF (44%). Patients with HF were older, died more often due to a cardiovascular cause of death, and had more complex heart lesions, compared to patients without HF (Table 1). While the number of emergency department visits and hospitalisations in the last year was similar, patients with HF had almost twice as much monthly visits at the general practitioner in their last year of life (Table 1). As shown in Figure 1, the mean number of hospitalisations and emergency department visits increased in a similar fashion throughout the last year of life, but the pattern of general practitioner visits was substantially different for patients with and without HF. The sensitivity analyses, in which a stricter definition for HF was used, yield very similar results. In these analyses, the difference in mean monthly hospitalisations was also significant between the two groups.
Conclusions
This study shows clinically important differences in characteristics and patterns of care of deceased patients with CHD with and without heart failure. Patients with HFhave different needs and should receive a tailored approach at the end of life. Future research is needed to understand these differences and investigate these patients' end-of-life care needs in more detail.
Funding acknowledgments: This work was supported by Research Foundation Flanders; European Society of Cardiology; the King Baudouin Foundation; the National Foundation on Research in Pediatric Cardiology; and the Swedish Research Council for Health, Working Life and Welfare-FORTE.
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Affiliation(s)
- L Van Bulck
- University of Leuven, Department of Public Health and Primary Care , Leuven , Belgium
| | - E Goossens
- University of Antwerp, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care , Antwerp , Belgium
| | - L Morin
- Regional University Hospital Jean Minjoz, Inserm Centre d'investigation clinique 1431 , Besancon , France
| | - K Luyckx
- University of Leuven, Department of Psychology and Educational Sciences , Leuven , Belgium
| | - F Ombelet
- University Hospitals (UZ) Leuven, Division of Neurology , Leuven , Belgium
| | - R Willems
- Ghent University, Department of Public Health and Primary Care , Ghent , Belgium
| | - W Budts
- University Hospitals (UZ) Leuven, Division of Congenital and Structural Cardiology , Leuven , Belgium
| | - K De Groote
- University Hospital Ghent, Department of Pediatric Cardiology , Gent , Belgium
| | - J De Backer
- University Hospital Ghent, Department of Adult Congenital Cardiology , Gent , Belgium
| | - S Moniotte
- Cliniques Saint-Luc UCL, Pediatric and Congenital Cardiology Department , Brussels , Belgium
| | - M De Hosson
- University Hospital Ghent, Department of Adult Congenital Cardiology , Gent , Belgium
| | - A Marelli
- McGill University Health Centre, McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) , Montreal , Canada
| | - P Moons
- University of Leuven, Department of Public Health and Primary Care , Leuven , Belgium
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Van Bulck L, Goossens E, Luyckx K, Ombelet F, Willems R, De Hosson M, Annemans L, Budts W, De Backer J, Moniotte S, Marelli A, De Groote K, Moons P. Provision of palliative care to adults with congenital heart disease at the end of life. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by Research Foundation Flanders [grant numbers G097516N to PM, 12E9816N to EG and 1154719N to LVB]; the King Baudouin Foundation (Fund Joseph Oscar Waldmann-Berteau & Fund Walckiers Van Dessel); the National Foundation on Research in Pediatric Cardiology; and the Swedish Research Council for Health, Working Life and Welfare -FORTE (grant number STYA-2018/0004).
OnBehalf
BELCODAC consortium
Background
Although recent position papers have discussed and advocated for the integration of palliative care in the treatment course of adults with congenital heart defects (CHD), empirical studies reporting to what extent palliative care is currently provided, are still lacking.
Purpose
(1) To explore the current provision of palliative care to adults with CHD in the last 6 months of their life; and (2) to describe the profile of patients who received palliative care.
Methods
In this retrospective study, data of deceased adult patients included in the BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC) were analysed. Palliative care provision (i.e., admission to palliative care ward, or palliative care at home) was identified using nomenclature codes. The level of anatomical complexity was based on the Bethesda classification. Descriptive analyses were performed.
Results
During the period 2006-2016, 480 adults with CHD died (mean age: 54.4y; 45% simple CHD, 43% moderate CHD, 12% complex CHD). We identified that 75 patients (16%) had at least one nomenclature code linked to palliative care in the last 6 months of their life. More specifically, 16 patients were admitted to an inpatient palliative care service and 67 patients received palliative care at home. Of the patients who received palliative care at home, 40 patients were cared for by a multidisciplinary team specialized in palliative care provision and 59 patients received care from nurses and/or general practitioners while being recognized as a palliative patient. A total of 8 patients received palliative care both at the inpatient palliative care service and at home.
Of the 75 patients receiving palliative care, 44 (59%) had a neoplasm as the primary cause of death and a cardiac cause of death was reported for 10 patients (13%) (see Figure 1). The mean age of patients receiving palliative care was 57.9 years. Most patients receiving palliative care had a simple CHD (n = 40; 53%), 29 patients (39%) had a moderate lesion, and 6 patients (8%) had a complex lesion. That means that, respectively, 19%, 14%, and 11% of all deceased patients with a simple, moderate, and complex heart lesion received palliative care.
Conclusions
This is the first exploratory study on palliative care in adults with CHD. About one in six patients who died received palliative care. Of those who received palliative care, the cause of death was in most cases of a non-cardiac nature. Further research is needed to investigate the care trajectories and care needs of adults with CHD in the last months of life.
Figure 1. Causes of death of adults with CHD who received palliative care in the last 6 months of life (n = 75).
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Affiliation(s)
- L Van Bulck
- KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium
| | - E Goossens
- University of Antwerp, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Antwerp, Belgium
| | - K Luyckx
- KU Leuven, Department of School Psychology and Development in Context, Leuven, Belgium
| | - F Ombelet
- KU Leuven, VIB - KU Leuven Center for Brain & Disease Research, Leuven, Belgium
| | - R Willems
- Ghent University, Department of Public Health and Primary Care, Ghent, Belgium
| | - M De Hosson
- Ghent University Hospital, Department of Adult Congenital Cardiology, Ghent, Belgium
| | - L Annemans
- Ghent University, Department of Public Health and Primary Care, Ghent, Belgium
| | - W Budts
- University Hospitals (UZ) Leuven, Division of Congenital and Structural Cardiology, Leuven, Belgium
| | - J De Backer
- Ghent University Hospital, Department of Adult Congenital Cardiology, Ghent, Belgium
| | - S Moniotte
- Cliniques Saint-Luc UCL, Pediatric and Congenital Cardiology Division, Brussels, Belgium
| | - A Marelli
- McGill University Health Centre, McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), Montreal, Canada
| | - K De Groote
- University Hospital Ghent, Department of Pediatrics, Pediatric Cardiology, Gent, Belgium
| | - P Moons
- KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium
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6
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Claerhout I, Buijsrogge M, Delbeke P, Walraedt S, De Schepper S, De Moerloose B, De Groote K, Decock C. The use of propranolol in the treatment of periocular infantile haemangiomas: a review. Br J Ophthalmol 2010; 95:1199-202. [PMID: 21131380 DOI: 10.1136/bjo.2010.192245] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Infantile haemangiomas (IH) are benign vascular tumours characterised by their very rapid growth. Although usually innocuous, periocular IH can cause serious visual loss through induction of strabismic, deprivational or anisometropic astigmatism. Common treatment modalities for these IH include intralesional and systemic oral steroids; however, both treatments are associated with potentially severe side effects. A report was published recently demonstrating the impressive effect of propranolol in the treatment of IH. This exciting finding has provoked a paradigm shift in the management of this condition. So far little has been reported in the specific ophthalmologic literature, although case reports are emerging. This review gives an overview of the recent findings and includes the authors' experience with 10 patients treated with propranol.
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Affiliation(s)
- I Claerhout
- Department of Ophthalmology, Ghent University Hospital, De Pintelaan 185, Gent 9000, Belgium.
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7
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Affiliation(s)
- H De Wilde
- Department of Paediatric Cardiology, Universitair Ziekenhuis Gent, Gent, Belgium.
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8
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Abstract
We report the case of a 7-year-old boy with a history of pulmonary atresia and intact septum who developed a fistula between the remnant of the ligated superior caval vein and the left atrium after bidirectional superior cavopulmonary (Glenn) anastomosis. The close proximity to the right pulmonary veins made closure by a standard occluder impossible. An Amplatzer vascular plug without rim enabled us to close the connection percutaneously without obstructing the pulmonary venous flow. The technique appeared to be easy, safe, and effective.
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Affiliation(s)
- K De Groote
- Department of Pediatric Cardiology, University Hospital Ghent, De Pintelaan 185, B-9000 Ghent, Belgium.
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9
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Abstract
BACKGROUND The purpose of this study is to assess the current management of atrial septal defect closure in an era of increasing feasibility of transcatheter device occlusion. METHODS Atrial septal defect (ASD) closure was performed surgically through complete sternotomy in 165 patients (group 1) and through partial inferior sternotomy in 53 patients (group 2). Transcatheter device occlusion was achieved in 82 patients with only ASD type II and patent foramen ovale (group 3). RESULTS Overall complications were minor and more frequent in group 1: 26.7% versus 13.2% in group 2 and 14.6% in group 3 (p = 0.04). Compared to complete sternotomy, a partial sternotomy led to less chest tube loss (7.1 +/- 2.9 versus 11.6 +/- 14.5 ml/kg) (p < 0.05) and less postoperative pericardial effusion (11.3% versus 13.5%)(p = 0.55). ASD closure was effective in 99.4% in group 1, 100% in group 2 but only in 86.6% in group 3 (p < 0.05). Two major complications of device implantation required early surgery: 1 femoral arteriovenous fistula and 1 device embolization. Hospital stay was significantly shorter in group 3, as well as in group 2 compared to group 1 (8.3 +/- 4.2 versus 5.9 +/- 1.1 versus 2.1 +/- 7.3 days) (p < 0.05). Midterm results were excellent, with only 1 non-cardiac death and 1 re-operation for residual shunt in group 1, and 1 device removal for thrombosis in group 3. CONCLUSION Transcatheter device occlusion has become an established treatment for ASD closure, achieving optimal results in older children and adults with anatomically suited ASD type II and PFO. However, a partial inferior sternotomy offers a valuable and complementary operative approach for all ASD variants, maintaining the predictable success of surgery, with the obvious advantages of minimal access in terms of morbidity, cosmetics and hospital stay.
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Affiliation(s)
- Th Bové
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium.
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10
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Francois K, Tamim M, Bove T, De Groote K, De Wolf D, Matthys D, Suys B, Verhaaren H, Van Nooten G. Is morbidity influenced by staging in the fontan palliation? A single center review. Pediatr Cardiol 2005; 26:350-5. [PMID: 16374683 DOI: 10.1007/s00246-005-8646-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In a retrospective study of 32 consecutive patients undergoing a total cavopulmonary connection (TCPC), we tried to determine if the trend for decreasing age at Fontan completion and reducing the intervals between the staged procedures during the past decade was associated with a change in morbidity and outcome. In 8 patients the Fontan circulation was completed in one stage and in 24 patients an intermediate step by hemi-Fontan or bidirectional cavopulmonary anastomosis was performed before Fontan completion. Mean age at TCPC and mean interval since the previous palliation have decreased significantly during the past decade. Although major complications were significantly reduced over time the occurrence and duration of postoperative pleural effusions were not. Decreasing age as well as intervals in staged Fontan palliation have beneficial influence on major complications and outcome, without significantly affecting the duration of pleural effusions at Fontan completion.
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Affiliation(s)
- K Francois
- Department of Congenital Cardiac Surgery, University Hospital Gent, Belgium.
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11
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Van Hal G, De Groote K, Van Damme P, Pepermans K, Van Cauwenberghe K, Meheus A. Pros and cons of an illicit drug users' registration system by means of judicial data in Flanders (Belgium). Public Health 2001; 115:70-7. [PMID: 11402355 DOI: 10.1038/sj.ph.1900701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2000] [Indexed: 11/09/2022]
Abstract
The main objective of this study was to evaluate the advantages and shortcomings of a new kind of registration of illicit drug users in Flanders, Belgium. Data about the profile of drug users who have come into contact with the law were collected by examining the records kept by the District Courts. On the one hand, published data on illicit drug users in Flanders are scarce. On the other hand, a lot of unused judicial information is available. All District Courts in Flanders (n=13) and Brussels (n=1) participated in the study. The data show that a simple registration of verbalised drug users with a short questionnaire can provide useful information for prevention campaigns and police investigation and shows the importance of prevention programmes starting at school. Notwithstanding some shortcomings, the illicit drug users' registration system by means of judicial data in Flanders forms a solid basis upon which an integrated registration of illicit drug use can be built.
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Affiliation(s)
- G Van Hal
- Epidemiology and Community Medicine, University of Antwerp, Belgium.
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12
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De Groote K, Van Damme P, Deprettere A, Michielsen P. Prevention of vertical transmission of hepatitis B virus infection. Is there a standard policy in Flanders (Belgium)? Acta Gastroenterol Belg 1997; 60:255-8. [PMID: 9529668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The perinatal transmission of hepatitis B virus (HBV) from mother to child can be effectively prevented by the combined administration of hepatitis B immunoglobulins (HBIg) and hepatitis B vaccine (HB vaccine) immediately after birth. This requires prenatal screening of all pregnant women for HBsAg. In Belgium, a standard prevention policy does not exist. This study evaluated the current prevention policy of paediatricians in Flanders, regarding the prevention of vertical transmission of HBV, and their knowledge regarding the reimbursement of the HB vaccine for neonates of HBsAg-positive mothers. Ninety-one percent out of 134 participants administered both HBIg and HB vaccine. The recommended timing, within 12 hours post-partum, was observed in 60.0% for HBIg and in 50.3% for HB vaccine. Twenty-five percent of the respondents answered not to be well informed regarding the reimbursement of the HB vaccine. A preliminary study in Flanders among gynaecologists showed that 27 out of 29 routinely screened pregnant women for HBV, but the type of serology tested and the timing of this prenatal screening were very heterogeneous. We conclude that a standard policy regarding the prevention of vertical transmission of HBV is currently lacking in Flanders.
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Affiliation(s)
- K De Groote
- Department of Paediatrics, University Hospital Antwerp, Belgium
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13
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De Groote K, Naesens L, Balzarini J, Baes MI, Declercq PE. Effects of 2',3'-dideoxycytidine and 2',3'-dideoxycytidine 5'-triphosphate on phospholipid metabolism in permeabilized rat hepatocytes. Biochem Pharmacol 1997; 54:713-9. [PMID: 9310348 DOI: 10.1016/s0006-2952(97)00244-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Both 2',3'-dideoxycytidine (ddC) and 2',3'-dideoxycytidine 5'-triphosphate (ddCTP) inhibit the synthesis of the major phospholipids phosphatidylcholine (PC) and phosphatidylethanolamine (PE) in permeabilized rat hepatocytes. For PC, this appears to be based on competitive inhibition of cholinephosphotransferase (CDPcholine:1,2-diacylglycerol cholinephosphotransferase; EC 2.7.8.2). The study was based on short-term incubations (6-12 min) of the nucleoside/nucleotide analogs with alpha-toxin permeabilized rat hepatocytes. At a concentration of 1 mM, ddC and ddCTP decreased the incorporation of radiolabelled glycerol-3-phosphate into PC by approximately 50% as compared with control. This was accompanied by a significant increase in diacylglycerol labelling. In the presence of 1 mM CDP-ethanolamine and increasing concentrations of ddC(TP) (0.01-1 mM), the incorporation of radiolabelled glycerol-3-phosphate into PE was decreased to approximately 60% of the control value. When both PC and PE synthesis were operative, the inhibition by ddC(TP) was restricted to PC synthesis. ddC and ddCTP were found to have inhibition constants (K(i)) of 496 microM and 452 microM, respectively, for the inhibition of PC synthesis from CDP-choline. Although the inhibitory concentrations of the nucleoside analog and its triphosphate ester are much higher than the in vivo plasma concentrations, the possibility is raised that the peripheral neuropathy, seen as a dose-dependent adverse effect of ddC treatment in acquired immunodeficiency syndrome therapy is, at least partly, caused by a perturbation of the phospholipid constitution of neuronal membranes.
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Affiliation(s)
- K De Groote
- KU Leuven, Faculty of Pharmaceutical Sciences, Department of Clinical Chemistry, Onderwijs en Navorsing, Belgium
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Van Damme P, Thoelen S, Cramm M, De Groote K, Safary A, Meheus A. Inactivated hepatitis A vaccine: reactogenicity, immunogenicity, and long-term antibody persistence. J Med Virol 1994; 44:446-51. [PMID: 7897379 DOI: 10.1002/jmv.1890440425] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This trial evaluated the reactogenicity, kinetics of antibody induction, and long-term immunogenicity of a 720 enzyme-linked immunosorbent assay units (EL.U.) antigen dose of an inactivated hepatitis A vaccine (Havrix, SmithKline Beecham Biologicals, Rixensart, Belgium). One hundred six healthy adult volunteers were enrolled to receive vaccine intramuscularly according to a 0, 1, and 6-month schedule. The vaccine was well tolerated. The most frequently reported local symptom was soreness, observed following 37.1% of all doses. Headache was the most frequently reported general symptom observed following 12.9% of documented vaccine doses. The administration of one vaccine dose induced seropositivity (anti-hepatitis A virus [HAV] > or = 20 mIU/ml) in 91% of all vaccinees 1 month later. The second vaccine dose resulted in seropositivity of the remaining vaccinees at month 2. All subjects remained seropositive for HAV antibodies at month 6, at which time the booster vaccine dose was given. At month 7, all vaccinees had anti-HAV titres > 200 mIU/ml. Serological results obtained at months 12, 18, 24, and 36 showed that antibodies against HAV induced by the vaccine booster dose persist for at least 30 months following its administration. All 49 subjects followed up until month 36 had antibody titres > or = 20 mIU/ml. The geometric mean titre (GMT) decreased by 60% from month 7 to month 12; between month 12 and 36, the GMT decreased by approximately 14% per period of 12 months. According to the vaccine-induced antibody kinetics and the magnitude of antibody level decrease over time, the predicted duration of antibody persistence is estimated to be at least 20 years.
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Affiliation(s)
- P Van Damme
- Department of Epidemiology and Community Medicine, University of Antwerp, Belgium
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