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Christiaens A, Boland B, Henrard S. 530 INTERPRETATION OF HBA1C VALUES IN GERIATRIC PATIENTS WITH TYPE 2 DIABETES: LARGE DIVERGENCE BETWEEN CLINICAL PRACTICE GUIDELINES. Age Ageing 2021. [DOI: 10.1093/ageing/afab117.11] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
An individualised glycated haemoglobin (HbA1c) target according to the patients’ health status is central in the glycaemic management of geriatric people with type 2 diabetes (T2D) in order to avoid hypoglycaemic events through an appropriate management of the glucose-lowering therapy (GLT). Current clinical practice guidelines (CPGs) provide different recommendations for patients’ HbA1c targets. Using real-life data from geriatric patients, this study aimed at assessing the concordance in interpretation of HbA1c values according to three current major CPGs from the Diabetes Canada-2018 (DC18), the Endocrine Society-2019 (ES19) and the American Diabetes Association-2020 (ADA20).
Introduction
Retrospective study in consecutive older patients (≥75 years) with T2D admitted to a Belgian geriatric ward, with GLT before admission and HbA1c measurement during the hospital stay. Patients were classified into three categories of HbA1c values according to the CPGs recommendations: in-target HbA1c (appropriate-GLT), too-low HbA1c (GLT-overtreatment) and too-high HbA1c (GLT-undertreatment). Concordance of health status classifications and GLT categories between the three CPGs was assessed using Cohen’s and Fleiss’ κ, respectively.
Results
Of the 318 patients (median age 84 years, 54% women), one-third were in intermediate health and two-thirds in poor health (κ = 0.86; excellent concordance). According to the DC18, ES19 and ADA20 CPGs, HbA1c was in-target for respectively 46%, 25% and 82% of the patients, and too-low HbA1c (GLT-overtreatment) was present in 28%, 57% and 0% (κ = 0.36; low concordance).
Results
Patients’ HbA1c values are interpreted differently according to these major CPGs, mainly because of differences in their recommendations about HbA1c target individualisation and specifically the definition of a too-low HbA1c value. In clinical practice, these diverging interpretations regarding overtreatment may lead to unsafe GLT prescribing and thereby to hypoglycaemic events in this high-risk population.
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Affiliation(s)
- A Christiaens
- Fund for Scientific Research – FNRS (Brussels, Belgium)
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain (Brussels, Belgium)
- Institute of Health and Society (IRSS), Université catholique de Louvain Brussels, Belgium)
| | - B Boland
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain (Brussels, Belgium)
- Institute of Health and Society (IRSS), Université catholique de Louvain Brussels, Belgium)
- Geriatric medicine unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (Brussels, Belgium)
| | - S Henrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain (Brussels, Belgium)
- Institute of Health and Society (IRSS), Université catholique de Louvain Brussels, Belgium)
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Abstract
Due to the global coronavirus disease 2019 pandemic, the high risk of cross-contamination and the overload of hospital facilities have resulted in a real urgency for restricting dental emergency patient flow. In this context, the objectives of the current work were to 1) measure the ability of a triage-based management strategy to limit patient admission and 2) evaluate the success rate of both on-site and remote emergency management regarding symptom relief and pain control over a 1-mo period. We included all patients contacting the dental medicine department for an emergency consultation during the lockdown, between April 1 and April 30, 2020 (N = 570). Following a telephone consultation and based on preestablished admission guidelines, a decision was made at baseline (T0) to either admit the patient for treatment or perform remote management by providing advice and/or drug prescription. Patients were then followed up systematically at 1 wk and 1 mo. Management failure was defined as the need for emergency admission for patients managed remotely since T0 and for new emergency admission for those admitted at T0. The global follow-up rate of patients with a complete data set was 91.4% (N = 521). Of included patients, 49.3% could be managed without admission for emergency reasons for 1 mo. The proportion of successful management was 71.8% and 90.2% at 1 mo for remote and on-site management, respectively. To conclude, the proposed triage-based emergency management strategy with systematic follow-up was a good compromise between limiting patient admission and ensuring effective symptom relief and pain control. The strategy can be useful in situations where regulation of the emergency patient flow is required.
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Affiliation(s)
- J Beauquis
- Conservative Dentistry and Endodontics Department, Cliniques Universitaires St-Luc, UCLouvain, Brussels, Belgium.,DRIM Research Group, Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
| | - A E Petit
- Pharmacy Department, Cliniques Universitaires St-Luc, UCLouvain, Brussels, Belgium.,Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
| | - V Michaux
- Conservative Dentistry and Endodontics Department, Cliniques Universitaires St-Luc, UCLouvain, Brussels, Belgium.,DRIM Research Group, Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
| | - V Sagué
- DRIM Research Group, Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium.,Prosthetic Dentistry Department, Cliniques Universitaires St-Luc, UCLouvain, Brussels, Belgium
| | - S Henrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium.,Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
| | - J G Leprince
- Conservative Dentistry and Endodontics Department, Cliniques Universitaires St-Luc, UCLouvain, Brussels, Belgium.,DRIM Research Group, Advanced Drug Delivery and Biomaterials, Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
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Paul J, Vaillant F, Vanden Bossche O, Pepersack T, Henrard S, Boland B. Orthostatic blood pressure drop and cardiovascular and psychotropic medication dosages in acutely ill geriatric inpatients. Acta Clin Belg 2020; 75:313-320. [PMID: 31141464 DOI: 10.1080/17843286.2019.1623516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES . To investigate the dose-response relationship between cardiovascular or psychotropic medication dosages and falling orthostatic blood pressure in geriatric inpatients. METHODS . This cross-sectional study included 100 consecutive geriatric inpatients of a Belgian hospital. The end points were the maximum changes of systolic (sBP) and diastolic (dBP) blood pressure in a standing up position at one or three minutes. The dosages of six classes of vascular and five classes of psychotropic medications were expressed in terms of a proportion of defined daily doses (DDD). Bivariate and multivariate linear regression models were used. RESULTS . The 100 geriatric patients (85 ± 5 years, 58 % women) received 7.7 ± 4 medications (mean DDD: vascular = 1.0, psychotropic = 0.74) on the day of an orthostatic test (lying sBP: 136 ± 21; dBP: 72 ± 14 mm Hg). In a standing position, sBP and dBP fell by 12 ± 17 and 11 ± 5 mmHg, respectively. At the individual level, BP change was not correlated with vascular DDD (sBP: p = 0.07, r2 = 0.04; dBP: p = 0.59; r2 = 0.004) nor with psychotropic DDD (sBP: p = 0.14, r2 = 0.02; dBP: p = 0.82; r2 = 0.0). In multivariate analysis, sBP drop was positively associated with age, diabetes, falls history, and number of medications, but not with the DDD of any of the medication classes, while dBP drop was positively associated with age, diabetes, stroke and anaemia, but again with the DDD of any of the medication classes. CONCLUSION . No correlation was found between vascular and psychotropic medication dosages and the orthostatic blood pressure drop expressed as a continuous variable.
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Affiliation(s)
- J. Paul
- Geriatric Medecine, Brussels, Belgium
| | - F. Vaillant
- Geriatric Medecine, Brussels, Belgium
- Pharmacy, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - T. Pepersack
- Institut Jules Bordet, Oncogeriatric Unit, Université Libre de Bruxelles, Belgium
| | - S. Henrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - B. Boland
- Geriatric Medecine, Brussels, Belgium
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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Potier F, Degryse JM, Aubouy G, Henrard S, Bihin B, Debacq-Chainiaux F, Martens H, de Saint-Hubert M. Spousal Caregiving Is Associated with an Increased Risk of Frailty: A Case-Control Study. J Frailty Aging 2019; 7:170-175. [PMID: 30095147 DOI: 10.14283/jfa.2018.11] [Citation(s) in RCA: 6] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND Evidence suggests that providing care for a disabled elderly person may have implications for the caregiver's own health (decreased immunity, hypertension, and depression). OBJECTIVE Explore if older spousal caregivers are at greater risks of frailty compared to older people without a load of care. DESIGN Case-control study. SETTING Participants were assessed at home in Wallonia, Belgium. PARTICIPANTS Cases: community-dwelling spousal caregivers of older patients, recruited mainly by the geriatric outpatient clinic. CONTROLS people living at home with an independent spouse at the functional and cognitive level matched for age, gender and comorbidities. MEASUREMENTS Mini nutritional assessment-short form (MNA-SF), short physical performance battery (SPPB), frailty phenotype (Fried), geriatric depression scale (GDS-15), clock drawing test, sleep quality, and medications. The multivariable analysis used a conditional logistic regression. RESULTS Among 79 caregivers, 42 were women; mean age and Charlson comorbidity index were 79.4±5.3 and 4.0±1.2, respectively. Among care-receivers (mean age 81.4±5.2), 82% had cognitive impairment. Caregiving was associated with a risk of frailty (Odd Ratio (OR) 6.66; 95% confidence interval (CI) 2.20-20.16), the consumption of antidepressants (OR 4.74; 95% CI 1.32 -17.01), shorter nights of sleep (OR 3.53; 95% CI 1.37-9.13) and more difficulties maintaining a social network (OR 5.25; 95% CI 1.68-16.40). CONCLUSIONS Spousal caregivers were at an increased risk of being frail, having shorter nights of sleep, taking antidepressants and having difficulties maintaining their social network, compared to non-caregiver controls. Older spousal caregivers deserve the full attention of professionals to prevent functional decline and anticipate a care breakdown.
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Affiliation(s)
- F Potier
- Florence Potier M.D., Department of Geriatrics, Centre Hospitalier Universitaire Université Catholique de Louvain Namur, 1, rue Dr G. Therasse, 5530 Mont-Godinne, Belgium. Tel 0032/81422175. Fax: 0032/81423885.
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Henrard S, Vaes B. Initiation of oral anticoagulation in patients with new-onset atrial fibrillation diagnosed between 2002 and 2014: Trends from a registry-based study in Flanders, Belgium. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.547] [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: 11/25/2022] Open
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Clevers E, Vaes B, Henrard S, Goderis G, Tack J, Törnblom H, Simrén M, Van Oudenhove L. Health problems associated with irritable bowel syndrome: analysis of a primary care registry. Aliment Pharmacol Ther 2018; 47:1349-1357. [PMID: 29572885 DOI: 10.1111/apt.14612] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/13/2017] [Accepted: 02/22/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Associations between irritable bowel syndrome and other health problems have been described, but comprehensive reports are missing, especially in primary care. AIMS To investigate which health problems are associated with irritable bowel syndrome, how they cluster together and when they are typically diagnosed relative to irritable bowel syndrome. METHODS We used Intego, a general practice registry in Flanders, Belgium. Patients with an irritable bowel syndrome diagnosis (n = 13 701) were matched with controls without gastrointestinal diagnosis and controls with organic gastrointestinal disease. Long-term prevalences of 680 symptoms and diagnoses were compared between patients and controls. Results were summarised using functional enrichment analysis and visualised in a network and we calculated incidence rate ratios in the 10 years before and after the irritable bowel syndrome diagnosis for the network's key components. RESULTS Various symptoms and infections, but not neoplasms, were enriched in irritable bowel syndrome patients compared to both control groups. We characterised the comorbidities of irritable bowel syndrome as psychosocial health problems, urogenital symptoms and infections, musculoskeletal symptoms and other somatic symptoms. These had a uniform incidence in the years around the irritable bowel syndrome diagnosis, and did not structurally precede or follow irritable bowel syndrome. CONCLUSIONS Irritable bowel syndrome shares long-term associations with psychosocial health problems, urogenital symptoms and infections, musculoskeletal symptoms and other somatic symptoms in primary care. Clinicians are encouraged to take comorbidities into account when diagnosing and managing irritable bowel syndrome, as this may have important treatment implications.
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Affiliation(s)
- E Clevers
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium.,Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - B Vaes
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Leuven, Belgium.,Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium
| | - S Henrard
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Leuven, Belgium.,Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium
| | - G Goderis
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Leuven, Belgium
| | - J Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - H Törnblom
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Simrén
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
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Bernard W, Lambert C, Henrard S, Hermans C. Screening of haemophilia carriers in moderate and severe haemophilia A and B: Prevalence and determinants. Haemophilia 2018; 24:e142-e144. [DOI: 10.1111/hae.13468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- W. Bernard
- Hemostasis and Thrombosis Unit; Division of Hematology; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - C. Lambert
- Hemostasis and Thrombosis Unit; Division of Hematology; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - S. Henrard
- Louvain Drug Research Institute (LDRI)/Clinical Pharmacy (CLIP); Institute of Health and Society (IRSS); Université catholique de Louvain; Brussels Belgium
| | - C. Hermans
- Hemostasis and Thrombosis Unit; Division of Hematology; Cliniques Universitaires Saint-Luc; Brussels Belgium
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Desuter G, Zapater E, Van der Vorst S, Henrard S, van Lith-Bijl JT, van Benthem PP, Sjögren EV. Very long-term Voice Handicap Index Voice Outcomes after Montgomery Thyroplasty: A cross-sectional study. Clin Otolaryngol 2018; 43:1097-1103. [PMID: 29624876 DOI: 10.1111/coa.13113] [Citation(s) in RCA: 7] [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] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this multicentric cross-sectional study was to examine the permanency of Montgomery thyroplasty (MTIS) results from a patient's perspective. DESIGN The study consisted of collecting Voice Handicap Index (VHI-30) questionnaires from patients who had previously been operated with MTIS between 2 and 12 years before. Very long-term (>2 years) postoperative data were compared with the previously acquired preoperative and early postoperative VHI results. Influence of factors such as age, gender, size/side of the prosthesis and length of the follow-up were also analysed. SETTING Multicentric study involving three tertiary European voice centres. PARTICIPANTS Forty-nine unilateral vocal fold paralysis (UVFP) patients, treated by MTIS, were included in the study. MAIN OUTCOME MEASURES The Voice Handicap Index-30 score. RESULTS & CONCLUSIONS The median VHI was significantly different over time-points (Friedman's test P < .001), with a significant difference between preoperative and early postoperative time-points (median VHI: 70 vs 21, respectively; P < .001) and between preoperative and very long-term postoperative time-points (median VHI: 70 vs 16, respectively; P < .001). The median VHI did not differ for the early and very long-term postoperative time-points (median VHI: 21 vs 16; P = .470). Age differences, gender differences and size/side differences of the prostheses, centres where surgery took place and length of the follow-up showed no significant influence. Medialisation thyroplasty (MT) overall and MTIS, in particular, should be considered as a possible standard of care for UVFP when permanency of voice results is sought.
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Affiliation(s)
- G Desuter
- Otolaryngology, Head & Neck Surgery Department, Voice & Swallowing Clinic, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, The Netherlands
| | - E Zapater
- Otolaryngology, Head & Neck Surgery Department, Valencia Medical School, University General Hospital, Valencia, Spain
| | - S Van der Vorst
- Otolaryngology, Head & Neck Surgery Department, Hôpital universitaire UCL Namur, Mont-Godinne, Université catholique de Louvain, Yvoir, Belgium
| | - S Henrard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - J T van Lith-Bijl
- Otolaryngology, Head & Neck Surgery Department, Voice & Swallowing Clinic, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Otolaryngology Department, Flevoziekenhuis, Almere, The Netherlands
| | - P P van Benthem
- Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, The Netherlands
| | - E V Sjögren
- Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, The Netherlands
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Lobet S, Cartiaux O, Peerlinck K, Henrard S, Hermans C, Detrembleur C, Deschamps K. Assessment of passive musculoarticular ankle stiffness in children, adolescents and young adults with haemophilic ankle arthropathy. Haemophilia 2018; 24:e103-e112. [PMID: 29600577 DOI: 10.1111/hae.13467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To measure passive musculoarticular ankle stiffness (PMAAS) and its intra- and interday reliability in adult control subjects without ankle disorders. We also sought to quantify PMAAS in children, adolescents and young adults with haemophilia (CAAwH) taking into account the accurate tibiotalar and subtalar joints structural status obtained by magnetic resonance imaging (MRI). METHODS We included 23 CAAwH and 23 typically developing boys (TDB) matched by age, weight and height, along with 25 healthy volunteers for reliability assessment. All CAAwH underwent bilateral ankle MRI, with anatomical status assessed using the International Prophylaxis Study Group MRI scale. All CAAwH underwent PMAAS testing for both sides randomly vs the dominant side (DS) in TDBs. For assessing viscous stiffness (VS) and elastic stiffness (ES), eight different oscillation frequencies were randomly repeated three times for each subject. RESULTS Good-to-excellent intra- and interday reliability was observed for ES and VS variables. No relevant differences were observed between the ankle viscoelastic properties in CAAwH without joint damage and matched TDBs, whereas the study revealed significantly increased ES in the affected ankles of CAAwH with severe unilateral joint involvement compared to the non-affected joint. CONCLUSION This study confirmed increased ES in the severely affected ankles of CAAwH compared to non-affected sides. No differences in the ankle viscoelastic properties of CAAwH with or without joint damage were observed, however, compared to matched TDB.
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Affiliation(s)
- S Lobet
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Service d'hématologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - O Cartiaux
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - K Peerlinck
- Centre for molecular and vascular biology, KU Leuven, Leuven, Belgium
| | - S Henrard
- Clinical pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Institute of health and society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - C Hermans
- Service d'hématologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - C Detrembleur
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - K Deschamps
- Department of rehabilitation sciences, Musculoskeletal rehabilitation research group, KU Leuven, Leuven (Heverlee), Belgium.,Department of podiatry, Artevelde University college, Ghent, Belgium.,Department of podiatry, Parnasse-ISEI, Haute École Leonard de Vinci, Brussels, Belgium
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Seyler L, Henrard S, Goffard JC. [HIV-associated haematological complications]. Rev Med Brux 2018; 39:307-311. [PMID: 30320993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite recent advances in combined anti- retroviral therapy that have profoundly changed the prognosis of HIV infection, HIV-associated haematological complications remains frequent whatever the stage of the disease. Some types of lymphoma observed a dramatic reduction in their incidences but others such as diffuse B-cell lymphoma and Hodkin lymphoma remain as frequent as before the CART era. Treatments for lymphoma are nowadays not different for people living with HIV than for others. Other non- neoplastic diseases such as immune thrombo- penic purpura, thrombotic microangiopathies and hemophagocytic lymphohistiocytosis are still associated with HIV infection and will be discussed.
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Affiliation(s)
- L Seyler
- Interne Geneeskunde, UZ Brussels
| | - S Henrard
- Service de Médecine interne, Hôpital Erasme, ULB
| | - J C Goffard
- Service de Médecine interne, Hôpital Erasme, ULB
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Henrard S, Wyndham-Thomas C, Van Vooren JP, Goffard JC. [HIV infection : Reaching a zero risk of transmission]. Rev Med Brux 2016; 37:315-321. [PMID: 28525231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite a global reduction in the prevalence of HIV-infection, the HIV-epidemic is far from over. The prevention of HIV-transmission in all its forms (sexual, mother-to-child etc) must therefore remain a pillar in the fight against AIDS, and both potent and accessible prevention strategies are required. In addition to the classical and wellknown methods such as the condom, ant iretroviral therapy represents a potent prevention tool and the residual risk of transmission of correctly treated HIV-positive persons is virtually nihil. Antiretroviral therapy may and should be used in the prevention of HIV-transmission as Treatment as Prevention (TasP), Pre-Exposure Prophylaxis (PrEP), and Post- Exposure Prophylaxis (PEP). However, because of their exorbitant costs, the accessibility of these prevention strategies is limited, particularly for the most vulnerable populations.
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Affiliation(s)
- S Henrard
- Centre de Référence SIDA, Unité de Traitements des Immunodéficiences, Hôpital Erasme, Route de Lennik 808, Bruxelles, Belgium
| | - C Wyndham-Thomas
- Centre de Référence SIDA, Unité de Traitements des Immunodéficiences, Hôpital Erasme, Route de Lennik 808, Bruxelles, Belgium
| | - J P Van Vooren
- Centre de Référence SIDA, Unité de Traitements des Immunodéficiences, Hôpital Erasme, Route de Lennik 808, Bruxelles, Belgium
| | - J C Goffard
- Centre de Référence SIDA, Unité de Traitements des Immunodéficiences, Hôpital Erasme, Route de Lennik 808, Bruxelles, Belgium
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Henrard S, Hermans C. Impact of being overweight on factor VIII dosing in children with haemophilia A. Haemophilia 2015; 22:361-7. [PMID: 26558443 DOI: 10.1111/hae.12848] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 05/18/2015] [Revised: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Treatment of haemophilia A (HA) requires infusions of factor VIII (FVIII) concentrates. The number of FVIII units infused to obtain a specific circulating FVIII level is calculated with the formula: [body weight (BW) (kg) × desired FVIII increase (%)]/2, with the assumption that each unit of FVIII infused per kg of BW increases the circulating FVIII level by 2%. AIM The aim of this study was to evaluate the impact of several morphometric parameters (BW, body mass index (BMI)-for-age, height), age and type of FVIII concentrate on FVIII recovery in children with HA. METHODS A total of 66 children aged between 10 and 18 with severe HA selected from six pharmacokinetic (PK) clinical trials using two recombinant FVIII concentrates were included in the analysis. Regression tree (RT) was used to identify predictors of FVIII recovery. RESULTS The median age was 14.5 years with a median FVIII recovery of 2.09 for all children. The median FVIII recovery was not significantly different between age groups. Two groups were created by RT: children with a BMI-for-age percentile <P95 (Median FVIII recovery: 1.94) and obese children with a BMI-for-age percentile ≥P95 (Median FVIII recovery: 2.65). The FVIII recovery was significantly different between these two groups (P < 0.001). CONCLUSION These results are consistent with previous studies conducted in adults with HA and confirm that the long-held and current practice of applying an arbitrary and universal recovery of two to the calculations of FVIII dosage should be abolished in both children and adults.
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Affiliation(s)
- S Henrard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.,Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - C Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Boban A, Henrard S, Lambert C, Hermans C. Continuous infusion of factor VIII concentrates in obese patients with severe haemophilia A: is weight-based dose-adjustment required? Haemophilia 2015; 22:e62-4. [DOI: 10.1111/hae.12837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Boban
- Haemostasis and Thrombosis Unit; Division of Haematology; Saint-Luc University Hospital; Brussels Belgium
- Haemophilia Unit; Division of Haematology; Department of Internal Medicine; University Hospital Centre Zagreb; Zagreb Croatia
| | - S. Henrard
- Haemostasis and Thrombosis Unit; Division of Haematology; Saint-Luc University Hospital; Brussels Belgium
- Institute of Health and Society (IRSS); Université catholique de Louvain; Brussels Belgium
| | - C. Lambert
- Haemostasis and Thrombosis Unit; Division of Haematology; Saint-Luc University Hospital; Brussels Belgium
| | - C. Hermans
- Haemostasis and Thrombosis Unit; Division of Haematology; Saint-Luc University Hospital; Brussels Belgium
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Henrard S, Speybroeck N, Hermans C. Classification and regression tree analysis vs. multivariable linear and logistic regression methods as statistical tools for studying haemophilia. Haemophilia 2015; 21:715-22. [PMID: 26248714 DOI: 10.1111/hae.12778] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Haemophilia is a rare genetic haemorrhagic disease characterized by partial or complete deficiency of coagulation factor VIII, for haemophilia A, or IX, for haemophilia B. As in any other medical research domain, the field of haemophilia research is increasingly concerned with finding factors associated with binary or continuous outcomes through multivariable models. Traditional models include multiple logistic regressions, for binary outcomes, and multiple linear regressions for continuous outcomes. Yet these regression models are at times difficult to implement, especially for non-statisticians, and can be difficult to interpret. AIMS The present paper sought to didactically explain how, why, and when to use classification and regression tree (CART) analysis for haemophilia research. MATERIALS & METHODS The CART method is non-parametric and non-linear, based on the repeated partitioning of a sample into subgroups based on a certain criterion. Breiman developed this method in 1984. Classification trees (CTs) are used to analyse categorical outcomes and regression trees (RTs) to analyse continuous ones. RESULTS The CART methodology has become increasingly popular in the medical field, yet only a few examples of studies using this methodology specifically in haemophilia have to date been published. Two examples using CART analysis and previously published in this field are didactically explained in details. CONCLUSION There is increasing interest in using CART analysis in the health domain, primarily due to its ease of implementation, use, and interpretation, thus facilitating medical decision-making. This method should be promoted for analysing continuous or categorical outcomes in haemophilia, when applicable.
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Affiliation(s)
- S Henrard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.,Haemostasis-Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - N Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - C Hermans
- Haemostasis-Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Carvalhosa AM, Henrard S, Lambert C, Hermans C. Physical and mental quality of life in adult patients with haemophilia in Belgium: the impact of financial issues. Haemophilia 2013; 20:479-85. [PMID: 24354566 DOI: 10.1111/hae.12341] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 12/15/2022]
Abstract
In Belgium, where haemophilia affects approximately 1:7000 people (2011), data on patients' quality of life (QoL) is scarce. This project aims to assess physical and mental QoL (P-QoL and M-QoL) simultaneously, and to analyse the influence of different variables on these two aspects of QoL. After Ethics Committee approval, we contacted 84 adult haemophilia A (HA) and haemophilia B (HB) patients, without current inhibitors, on replacement therapy (on-demand or secondary prophylaxis), regularly followed up at our comprehensive treatment centre. Seventy-one (n = 59 HA, n = 12 HB) replied to our questionnaire, which included the SF36v2 QoL assessment forms. We analysed two groups of variables: one including variables previously associated with decreased QoL, and another including variables with unclear impact on QoL (e.g., patients' understanding of haemophilia-related issues, economical concerns). In our population (mean ± SD age: 45.2 ± 14.7 years old), P-QoL appeared more reduced than M-QoL. P-QoL was strongly influenced by the number of arthropathies while M-QoL was primarily affected by patients' concern of personal costs due to haemophilia. Among this latter group, having knowledge of insurance coverage had a positive impact on M-QoL. Scores did not depend on haemophilia type. QoL was impaired in our haemophilia patients. A simultaneous assessment of P-QoL and M-QoL confirmed the benefit of primary prophylaxis in P-QoL, while originally pointing out the major burden of patients' concerns and poor understanding of haemophilia-related economical issues on their M-QoL. This might become a particularly challenging issue in times of financial crisis.
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Affiliation(s)
- A M Carvalhosa
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Boland B, Dalleur O, Maes F, Scavée C, Henrard S. Anticoagulation should be started in older patients with atrial fibrillation. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.588] [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: 10/26/2022]
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Dalleur O, Henrard S, Speybroeck N, Spinewine A, Boland B. Hospital admissions related to inappropriate prescribing according to STOPP and START criteria in frail older persons. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.295] [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: 11/16/2022]
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Boland B, Maes F, Henrard S, Scavée C. Anticoagulation is largely underused in elderly patients with atrial fibrillation. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.286] [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: 11/15/2022]
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Abstract
BACKGROUND The treatment of hemophilia A requires infusions of factor VIII (FVIII) concentrates. The number of units to be given in order to obtain the target level is calculated using the formula: [body weight (BW) × desired FVIII increase]/2, which assumes that each unit infused per kg of BW increases the FVIII level by 2%. OBJECTIVES The present observational study evaluated the dependence of FVIII recovery on different morphometrical variables: BW, fat mass index (FMI), body mass index, and the difference between actual and ideal BW. PATIENTS AND METHODS FVIII recovery was measured in 46 non-actively bleeding hemophilia A patients, being treated with a recombinant FVIII concentrate. Regression trees were used to identify morphometrical predictors of recovery. RESULTS The median recovery was 2.08 for all patients, 2.63 for those with a BW ≥ 81.0 kg and 1.87 for others (P < 0.001). The recovery was significantly higher when FMI was ≥ 20% compared with FMI < 15% (median recovery: 2.35 vs. 1.74; P = 0.007). Using regression trees, three groups were created: BW < 80.5 kg and FMI < 22.3%, BW < 80.5 kg and FMI ≥ 22.3% and BW ≥ 80.5 kg. Median recovery in these groups was 1.80, 2.16 and 2.63, respectively (P < 0.001). CONCLUSIONS The dose calculation of FVIII should take into account both BW and FMI, and be adapted to underweight or overweight patients. Comparison of the average recovery after different FVIII concentrates should keep in mind morphometrical patient characteristics.
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Affiliation(s)
- S Henrard
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Jadoul M, Nguyen P, Henrard S, Coche E, Goffin E, Devuyst O. Reply. Nephrol Dial Transplant 2011. [DOI: 10.1093/ndt/gfr210] [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: 11/13/2022] Open
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Henrard S, Robinet S, Piérard LA. [Tachycardia-related cardiomyopathy: a case report]. Rev Med Liege 2010; 65:672-675. [PMID: 21287761] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Tachycardia-mediated cardiomyopathy is a form of dilated cardiomyopathy and heart failure induced by a persistent/chronic supraventricular or ventricular tachyarythmia. The incidence and the patho-physiology remain unspecified. Sometimes related to a previous cardiomyopathy, the diagnosis is always retrospective, but important because of the clinical and the significant haemodynamic improvement following the control of heart rate.
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Henrard S, Maréchal C, Lambert C, Deneys V, Hermans C. EVALUATION OF THROMBOPHILIA SCREENING IN WOMEN WITH OBSTETRICAL COMPLICATIONS: A “REAL WORLD” EXPERIENCE. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb01531.x] [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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