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Nguyen MH, Fornes R, Kamau N, Danielsson H, Callens S, Fransson E, Engstrand L, Bruyndonckx R, Brusselaers N. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1461-1467. [PMID: 35233608 PMCID: PMC9047673 DOI: 10.1093/jac/dkac053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- M H Nguyen
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Translational Microbiome Research, Department of Microbiology Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - R Fornes
- Centre for Translational Microbiome Research, Department of Microbiology Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - N Kamau
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Translational Microbiome Research, Department of Microbiology Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - H Danielsson
- Centre for Translational Microbiome Research, Department of Microbiology Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Sach’s Children’s and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - S Callens
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - E Fransson
- Centre for Translational Microbiome Research, Department of Microbiology Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - L Engstrand
- Centre for Translational Microbiome Research, Department of Microbiology Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - R Bruyndonckx
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - N. Brusselaers
- Centre for Translational Microbiome Research, Department of Microbiology Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Corresponding author. E-mail:
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Affiliation(s)
- S. Callens
- Lawyer of the Brussels bar. Professor of health law (University of Leuven)
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Baboo J, Kilbride P, Delahaye M, Gaddum N, Blanco M, Morris J, Milne S, Callens S, Ward S. The important relationship between cooling and thawing rates on human t cell quality. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Morris J, Baboo J, Milne S, Lamb S, Nancekievill A, Creasy C, Kilbride P, Delahaye M, Gaddum N, Blanco M, Callens S, Ward S. Completing the cold chain: The development of GMP compliant dry thawers. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Delahaye M, Fraser H, Partington L, Popova D, Gaddum N, Callens S, Ward S, Thomas D. Characterisation of a dynamic modular automated system for the scale-up of allogeneic and autologous cell therapy products. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Popova D, Dhadda P, Bell M, Amable P, Murrell J, McCoy R, Callens S, Kerby J, Ward S. Developing integrated single-use upstream and downstream platform processing options for allogeneic cell therapy applications: Linking the stirred tank bioreactor to the TFF. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ravelingien T, Buyle F, Deryckere S, Huis In 't Veld D, Debrauwere M, Verplancke K, Callens S, Commeyne S, Pattyn C, Somers A, Vogelaers D. [A practical program for outpatient parenteral antimicrobial therapy]. J Pharm Belg 2016:22-31. [PMID: 30281241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Some infections require prolonged parenteral antimicrobial therapy, which can be continued in an outpatient setting. The Ghent University Hospital has fifteen years of experience with Outpatient Parenteral Antimicrobial Therapy [OPAT) in the patient own home setting. As a quality improvement initiative, this process was critically reviewed in a multidisciplinary approach. Several challenges and barriers were identified, including regulatory obstacles for OPAT in Belgium, such as Lack of uniformity in ambulatory reimbursement of parenteral antimicrobials. There is no financial incentive for the patient with OPAT, as costs for the patient of outpatient therapy can be higher as compared with hospitalization. Other barriers include delayed approval of the certificate for reimbursement, low availability of medicines in the community pharmacies and limited knowledge of the medical devices for administration in ambulatory setting. All critical steps in the revised OPAT program are summarized in a flowchart with a checklist for all stakeholders. Firstly, a list with specific criteria to include patients in an OPAT program is provided. Secondly, the Multidisciplinary Infection Team received a formal mandate to review all eligible OPAT patients. In order to select the most appropriate catheter a decision tree was developed and standardized packages with medical devices were developed. Thirdly, patients receive oral and written information about the treatment with practical and financial implications. Fourthly, information is provided towards the general practitioners, community pharmacists and home care nurses. Standardization of the OPAT-program aims at improving quality and safety of intravenous antimicrobial therapy in the home setting.
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Gudmundsson A, Stevenson J, Petrovic M, Somers A, Onder G, Callens S, van der Cammen T. Challenges and risks for older travellers with multimorbidity: Focus on pharmacotherapy. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kosgei RJ, Sitienei JK, Kipruto H, Kimenye K, Gathara D, Odawa FX, Gichangi P, Callens S, Temmerman M, Sitienei JC, Kihara AB, Carter EJ. Gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis in Kenya. Int J Tuberc Lung Dis 2016; 19:1176-81. [PMID: 26459529 DOI: 10.5588/ijtld.15.0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis (PTB) and factors associated with poor outcomes in Kenya. DESIGN Retrospective descriptive cohort. RESULTS Of 16 056 subjects analysed, 38% were female and 62% male. Females had a higher risk of poor treatment outcome than males (12% vs. 10%, P < 0.001; adjusted OR 1.29, 95%CI 1.16-1.44, P < 0.001). In the first multivariate model, restricting the analysis to human immunodeficiency virus (HIV) positive patients and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor outcome (OR 0.99, 95%CI 0.86-1.13, P = 0.844). In the model restricted to HIV-negative patients, a non-significantly lower risk was found (OR 0.89, 95%CI 0.73-1.09, P = 0.267). In the second model, restricting analysis to patients on antiretroviral therapy (ART) and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor PTB treatment outcomes (OR 0.98, 95%CI 0.84-1.14, P = 0.792). In the model restricted to HIV-positive patients not on ART, a non-significantly higher risk was found (OR 1.15, 95%CI 0.79-1.67, P = 0.461). CONCLUSION Females of reproductive age are likely to have poorer treatment outcomes than males. Among females, not commencing ART during anti-tuberculosis treatment seemed to be associated with poor outcomes.
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Affiliation(s)
- R J Kosgei
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - J K Sitienei
- Ministry of Health, Department of Disease Prevention and Control, Nairobi, Kenya; Moi University Department of Epidemiology, Nairobi Campus, Nairobi, Kenya
| | - H Kipruto
- World Health Organization, Nairobi, Kenya
| | - K Kimenye
- Division of Leprosy Tuberculosis and Lung Disease, Ministry of Health, Nairobi, Kenya
| | - D Gathara
- Ruby Medical Centre, Kiambu West, Kenya
| | - F X Odawa
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - P Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya, Kenya
| | - S Callens
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - M Temmerman
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - J C Sitienei
- Department of Health Management, Moi University, Eldoret, Kenya
| | - A-B Kihara
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - E-J Carter
- Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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Abstract
We present a case of a 52-year-old woman of Ghanaian origin who developed Plasmodium falciparum malaria 4 years after leaving Africa. She had not returned to an endemic area since. We hypothesize several possible scenarios to explain this infection, of which we believe recrudescence of P. falciparum is the most plausible. This occurred most likely as a consequence of waning immunity several years after leaving a high-transmission area. She recovered after a 3-day treatment with atovaquone/proguanil.
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Affiliation(s)
- B Vantomme
- a Department of Internal Medicine , Ghent University Hospital , Belgium
| | - J Van Acker
- b Department of Clinical Biology , St. Lucas General Hospital , Ghent , Belgium
| | - S Rogge
- c Department of Gastroenterology , St. Lucas General Hospital , Ghent , Belgium
| | - D Ommeslag
- d Department of Infectious Diseases , St. Lucas General Hospital , Ghent , Belgium
- e Department of Pneumology , St. Lucas General Hospital , Ghent , Belgium
| | - J Donck
- f Department of Nephrology , St. Lucas General Hospital , Ghent , Belgium
| | - S Callens
- g Department of Infectious Diseases , Ghent University Hospital , Belgium
- h Department of Infectious Diseases , St. Lucas General Hospital , Belgium
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Katchunga PB, Twagirumukiza M, Kluyskens Y, Kaishusha D, Baguma M, Bapolisi A, Cikomola J, Ntabure T, Callens S, M'Buyamba-Kabangu JR, Van Bortel L. Blood pressure in the Congolese adult population of South Kivu, Democratic Republic of Congo: Preliminary results from the Bukavu Observ Cohort Study. Rev Epidemiol Sante Publique 2015; 63:339-45. [PMID: 26586457 DOI: 10.1016/j.respe.2015.07.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/12/2015] [Accepted: 07/09/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Providing factual data about non-communicable diseases (NCDs) is of utmost importance in the sub-Saharan African countries where NCDs and arterial hypertension data remain scattered, scarce, and less representative given the region's heterogeneous population. Within this context, the interuniversity cooperation VLIR-UOS/Catholic University of Bukavu (Democratic Republic of Congo) has established an integrated project for monitoring hypertension and cardiovascular risk factors in the population of South Kivu. The aim of the study was to present the basic results of the determinants of blood pressure in the cohort studied. METHODS In 2013 and 2014, trained interviewers collected the anthropometric parameters, blood pressure, and medical history of 7405 adults (3060 in urban areas and 4345 in rural areas) including 3162 males and 4243 females; the cohort is expected to be followed for 9 years. RESULTS The average age of the entire group was 33.0±16.7 years. Compared to men, women had significantly higher obesity indices (P<0.0001), lower blood pressure between 20 and 39 years of age (P<0.0001) but higher blood pressure at 60 years of age and older (P<0.0001). Blood pressure was positively correlated with body mass index, waist circumference, and paradoxically with consumption of vegetables, but negatively correlated with the consumption of fruit, intense physical activity, and relaxation at home. CONCLUSIONS These results show that a cohort study is feasible in the Democratic Republic of Congo. The factual data analysis can contribute to health policy orientation and setting up of preventive measures. Since most correlated risk factors are preventable, recommendations can already be made in the fight against high blood pressure in this population.
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Affiliation(s)
- P B Katchunga
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo.
| | - M Twagirumukiza
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Université de Gand, Ghent, Belgium
| | - Y Kluyskens
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Université de Gand, Ghent, Belgium
| | - D Kaishusha
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - M Baguma
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - A Bapolisi
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - J Cikomola
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - T Ntabure
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Institut de technique médicale, hôpital général de référence de Katana, Katana, Sud-Kivu, The Democratic Republic of the Congo
| | - S Callens
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Université de Gand, Ghent, Belgium
| | - J R M'Buyamba-Kabangu
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, université de Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - L Van Bortel
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Université de Gand, Ghent, Belgium
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Van Beckhoven D, Florence E, Ruelle J, Deblonde J, Verhofstede C, Callens S, Vancutsem E, Lacor P, Demeester R, Goffard JC, Sasse A. Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants. BMC Infect Dis 2015; 15:496. [PMID: 26530500 PMCID: PMC4631021 DOI: 10.1186/s12879-015-1230-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/19/2015] [Indexed: 01/06/2023] Open
Abstract
Background The Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors. Methods Data on new HIV diagnoses 2007–2010 and HIV-infected patients in care in 2010–2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied. Results Of all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2 % were linked to HIV care, 90.8 % were retained in care, 83.3 % received antiretroviral therapy and 69.5 % had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression. Conclusions The continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20 % based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1230-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Van Beckhoven
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium.
| | - E Florence
- Department of Clinical Sciences, Instituut Tropische Geneeskunde, Antwerp, Belgium.
| | - J Ruelle
- Institute of Experimental and Clinical Research (IREC), Unit of Medical Microbiology (MBLG), Université Catholique de Louvain, Brussels, Belgium.
| | - J Deblonde
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium.
| | - C Verhofstede
- AIDS Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium.
| | - S Callens
- Department of Internal Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium.
| | - E Vancutsem
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - P Lacor
- Department of Internal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - R Demeester
- Department of Internal Medicine and Infectious Diseases, CHU de Charleroi, Charleroi, Belgium.
| | - J-C Goffard
- Service of Internal Medicine, Hôpital Erasme, Brussels, Belgium.
| | - A Sasse
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health, Rue J. Wytsman 14, 1050, Brussels, Belgium.
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Kosgei RJ, Szkwarko D, Callens S, Gichangi P, Temmerman M, Kihara AB, Sitienei JJ, Cheserem EJ, Ndavi PM, Reid AJ, Carter EJ. Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya. Public Health Action 2015; 3:294-8. [PMID: 26393049 DOI: 10.5588/pha.13.0073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/27/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES 1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ≥2 weeks' duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya. DESIGN Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya. RESULTS Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26-35) and 26 years (IQR 24-31) in HIV-infected and non-infected participants. A positive symptom screen was found in respectively 8% (119/1488) and 5% (67/1461) of the HIV-infected and non-infected women. The median CD4 count at enrolment was 377 cells/μl (IQR 244-530) for HIV-infected women. One non-HIV-infected patient was sputum-positive. For HIV-infected women, TB was presumptively treated in 1% (16/1488) based on clinical symptoms and chest X-ray. Cumulatively, anti-tuberculosis treatment was offered to 0.6% (17/2949) of the participants. CONCLUSION This study does not seem to demonstrate the utility of TB symptom screening questionnaires in a routine setting among pregnant women, either HIV-infected or non-infected, in western Kenya.
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Affiliation(s)
- R J Kosgei
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - D Szkwarko
- AMPATH, Eldoret, Kenya ; The Memorial Hospital of Rhode Island Brown Family Medicine Residency Program, Pawtucket, Rhode Island, USA
| | - S Callens
- University of Ghent School of Medicine, Ghent, Belgium
| | - P Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - M Temmerman
- University of Ghent School of Medicine, Ghent, Belgium
| | - A-B Kihara
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - J J Sitienei
- AMPATH, Eldoret, Kenya ; Moi University School of Public Health, Eldoret, Kenya
| | - E J Cheserem
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - P M Ndavi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - A J Reid
- Operational Research Unit, Médecins Sans Frontières Operational Centre Brussels, Luxembourg
| | - E J Carter
- AMPATH, Eldoret, Kenya ; Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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Buyle FM, Wallaert M, Beck N, Boelens J, Callens S, Claeys G, Deryckere S, Haegeman E, Leroux-Roels I, Sermijn E, Steel E, Robays H, Vandekerckhove L, Vermis K, Vogelaers D. Implementation of a multidisciplinary infectious diseases team in a tertiary hospital within an Antimicrobial Stewardship Program. Acta Clin Belg 2014; 69:320-6. [PMID: 25027808 DOI: 10.1179/2295333714y.0000000045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In January 2011, as part of an antimicrobial stewardship program the Antimicrobial Management Team (AMT) at the Ghent University Hospital initiated a multidisciplinary Infectious Diseases Team (MIT) consisting of infectious diseases physicians, clinical microbiologists, and clinical pharmacists. The aim of this study is to describe the type and acceptance rate of recommendations provided by the MIT. METHOD Prospective, observational study in a tertiary care, university teaching hospital with 1062 beds in non-consecutive hospitalized adult patients, excluding intensive care units and paediatrics. RESULTS The MIT communicated 432 recommendations in 87 days observed. Of the 293 patients for whom a recommendation was made, the median age was 57 years (range: 16-91 years) and 169 (57·7%) were male. Skin or soft tissue infections (14%), respiratory tract infections (13%), infections without known focus (11%), abdominal infections (11%), and bone infections (8%) were most common. Recommendations were made to perform additional clinical investigation(s) [N = 137 (27%)], to adjust the dose of an antimicrobial drug [N = 42 (8%)], to stop an antimicrobial drug [N = 104 (21%)], to switch from a parenteral to an oral drug [N = 39 (8%)] or to initiate an antimicrobial drug [N = 178 (36%)], with an acceptance rate of 73·0%, 83·3%, 81·7%, 76·9%, and 84·0%, respectively. CONCLUSIONS The MIT formulated about five recommendations a day primarily focusing on pharmacotherapy, but also on clinical investigations. In both fields, a high acceptance rate was observed.
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Dekeyzer S, Moerman F, Callens S, Vandekerckhove L. Cutaneous metastatic tuberculous abcess in a patient with cervico-mediastinal lymphatic tuberculosis. Acta Clin Belg 2013; 68:34-6. [PMID: 23627192 DOI: 10.2143/acb.68.1.2062717] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Metastatic tuberculous abcess or tuberculous gumma is a rare form of cutaneous tuberculosis resulting from haematogenous spread from a non-cutaneous tuberculous focus. A 26-year old patient of Pakistani origin presented at our clinic with an abcess on his right thigh that had slowly grown over a period of two months to a total size of 30 cm. Based on clinical findings, microbiology, CT thigh and CT chest, our patient was diagnosed with a tuberculous abcess and cervico-mediastinal tuberculous lymphadenitis. Antituberculosis drugs were initiated. Cutaneous tuberculosis should be included in the differential diagnosis of chronic cutaneous abcesses, especially in patients from tuberculosis endemic nations.
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Affiliation(s)
- S Dekeyzer
- Afdeling Radiologie en Medische Beeldvorming, Infectieziekten en Psychosomatiek, Gent, Belgium.
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Abstract
RATIONALE Owing to the growing health care expenditure and the need to improve efficiency, public authorities have since the 1980s changed their policy with respect to health care. Financial pressures encouraged them to investigate methods to control health care costs. One recent method is the enactment of cost containment measures based on clinical practice guidelines (CPGs) that provide financial or administrative sanctions. AIMS AND OBJECTIVES This article describes the legal value of CPGs, the evolution towards cost containment measures based on CPGs, and finally the legal value of these new cost containment measures. It questions whether these measures may have an impact on the medical liability rules and it wants to open the debate on the legal value of these measures based vis-à-vis the professional autonomy of the physician and patients' rights on quality care. METHODS The research for this article is based on a comparative analysis of the legal literature and jurisprudence of a number of legal systems. RESULTS AND CONCLUSIONS The article concludes that, as a result of the rising costs, it becomes increasingly difficult for a physician to balance his duty to take care on the one hand and his duty to control costs on the other. Maintaining a high standard of care towards patients becomes difficult. Consequently, one wonders whether the law should then allow the standard of care to be adjusted according to the available means. Until now, courts in a fault based system have not been willing to accept such an adjustment of the standard of care, but it might well be possible that this attitude will change in case of no-fault compensation systems.
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Affiliation(s)
- S Callens
- Centre for Biomedical Ethics and Law, K.U. Leuven, Kapucijnenvoer, Leuven, Belgium
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De Schacht C, Smets RME, Callens S, Colebunders R. Bilateral blindness after starting highly active antiretroviral treatment in a patient with HIV infection and cryptococcal meningitis. Acta Clin Belg 2005; 60:10-2. [PMID: 15981698 DOI: 10.1179/acb.2005.003] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A 26-year-old HIV-seropositive Caucasian man with cryptococcal meningitis developed permanent bilateral blindness shortly after starting highly active antiretroviral treatment. The blindness may have been a consequence of an immune reactivation inflammatory syndrome caused by this treatment.
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Affiliation(s)
- C De Schacht
- Departement Klinische Wetenschappen, Instituut voor Tropische Geneeskunde, Nationalestraat 155, B-2000 Antwerpen
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Callens S, van Wijngaerden E, Clerinx J, Colebunders R. [Three patients with African sleeping sickness following a visit to Tanzania]. Ned Tijdschr Geneeskd 2003; 147:581; author reply 581. [PMID: 12693091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Callens S. Informed consent. Acta Chir Belg 2000; 100:169-74. [PMID: 11280188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Callens S, Nys H. Recommendations for European health data protection legislation. Stud Health Technol Inform 1995; 27:23-52. [PMID: 10172820] [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] [Indexed: 02/11/2023]
Abstract
In year 1 of the SEISMED project, the Katholieke Universiteit Leuven coordinated the inventory and analysis of medical personal data protection legislation in Europe. A report on legal issues of medical data protection legislation in Europe was written by the Vrije Universiteit Amsterdam, the Centre National pour la Recherche Scientifique (Paris) and the University College Dublin. This report served as a basis for a second important legal deliverable, i.e. the Health Informatics Deontology Code. In this third and final report, we take into account the results of the other two legal reports and we formulate recommendations for the national and European legislator. This report analyses critically the upcoming privacy directive. We propose several recommendations which should be taken into account by the European and national legislator. We focused quite extensively on the use of medical data for research purposes. We had several reasons to do this. One of them is the fact that the use of medical data for research purposes is very popular, in particular now the health care sector is becoming more and more 'standardized' by using computers, networksystems and telematics. Legislation is therefore needed. Moreover, the use of medical data for research purposes involves the transfer of data from one Member State to another. Therefore, a harmonized legislation is really needed. We hope that the recommendations we propose, will be taken into consideration by the European legislator.
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Affiliation(s)
- S Callens
- Katholieke Universiteit Leuven, Faculteit Geneeskunde, Centrum voor BioMedische Ethiek en Recht, Belgium
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