Search

Abstract Background Measuring quality is essential to drive improvement initiatives in hospitals. An instrument that measures healthcare quality multidimensionally and integrates patients’, kin’s and professionals’ perspectives is lacking. We aimed to develop and validate an instrument to measure healthcare quality multidimensionally from a multistakeholder perspective. Methods A multi-method approach started by establishing content and face validity, followed by a multi-centre study in 17 Flemish (Belgian) hospitals to assess construct validity through confirmatory factor analysis, criterion validity through determining Pearson’s correlations and reliability through Cronbach’s alpha measurement. The instrument FlaQuM-Quickscan measures ‘Healthcare quality for patients and kin’ (part 1) and ‘Healthcare quality for professionals’ (part 2). This bipartite instrument mirrors 15 quality items and 3 general items (the overall quality score, recommendation score and intention-to-stay score). A process evaluation was organised to identify effective strategies in instrument distribution by conducting semi-structured interviews with quality managers. Results By involving experts in the development of quality items and through pilot testing by a multi-stakeholder group, the content and face validity of instrument items was ensured. In total, 13,615 respondents (5,891 Patients/kin and 7,724 Professionals) completed the FlaQuM-Quickscan. Confirmatory factor analyses showed good to very good fit and correlations supported the associations between the quality items and general items for both instrument parts. Cronbach’s alphas supported the internal consistency. The process evaluation revealed that supportive technical structures and approaching respondents individually were effective strategies to distribute the instrument. Conclusions The FlaQuM-Quickscan is a valid instrument to measure healthcare quality experiences multidimensionally from an integrated multistakeholder perspective. This new instrument offers unique and detailed data to design sustainable quality management systems in hospitals. Based on these data, hospital management and policymakers can set quality priorities for patients’, kin’s and professionals’ care. Future research should investigate the transferability to other healthcare systems and examine between-stakeholders and between-hospitals variation.

Background: Previous case studies have provided evidence for chemotherapy-induced leukoencephalopathy in patients with breast cancer. However, prospective research is lacking. Hence, we investigated leukoencephalopathy before and after chemotherapy and its association with a serum neuroaxonal damage marker. Methods: This prospective cohort study included 40 patients receiving chemotherapy for breast cancer, and two age- and education-matched control groups, recruited between 2018 and 2021 (31–64 years of age). The latter control groups consisted of 39 chemotherapy-naïve patients and 40 healthy women. Fluid-attenuated inversion-recovery magnetic resonance imaging was used for lesion volumetry (total, juxtacortical, periventricular, infratentorial, and deep white matter) and blood serum to measure neurofilament light chain (NfL) levels. Acquisition took place pre-chemotherapy and three months and one-year post-chemotherapy, or at corresponding intervals. Within/between group differences were compared using robust mixed-effects modeling, and associations between total lesion volume and serum-NfL with linear regression. Results: Stronger increases in deep white matter lesion volumes were observed shortly post-chemotherapy, compared with healthy women (ßstandardized=0.09, pFDR0.70, p

Vaccine-induced thrombotic thrombocytopenia (VITT) is a rare, newly described syndrome characterised by thrombocytopenia and thrombosis 5–24 days after administration of an adenoviral vector-based COVID-19 vaccine. It resembles heparin-induced thrombocytopenia and, therefore, diagnostics and treatment are similar. Early recognition is essential to avoid potentially fatal outcomes. This article describes a case of VITT with symptomatic cerebral venous-sinus thrombosis and splanchnic vein thrombosis, as well as asymptomatic pulmonary embolism in a 49-year-old male. The authors discuss VITT, focusing on the possibility of pulmonary embolism being under-reported, diagnostic criteria, differential diagnosis, and treatment.

PurposeTo investigate the short-term cerebral metabolic effects of intravenous chemotherapy and their association with long-term fatigue/cognitive complaints.Experimental designUsing [18F]-FDG-PET/CT whole-body scans, we retrospectively quantified relative cerebral glucose metabolism before and after neoadjuvant chemotherapy in a cohort of patients treated for non-metastatic breast cancer (2009-2019). Self-report of cognitive complaints and fatigue were prospectively assessed 7 ± 3 years after therapy. Metabolic changes were estimated with i) robust mixed-effects modelling in regions-of-interest (frontal, parietal, temporal, occipital, and insular cortex) and ii) general-linear modelling of whole-brain voxel-wise outcomes. iii) The association between metabolic changes and self-reported outcomes was evaluated using linear regression-analysis.ResultsOf the 667 screened patients, 263 underwent PET/CT before and after chemotherapy and 183 (48 ± 9 years) met the inclusion criteria. After chemotherapy, decreased frontal and increased parietal and insular metabolism were observed (|ß|>0.273, pFDR0.244, pFDR≤0.048). Voxel-based analysis (pcluster-FWE

Abstract Background Hypocalcemia has detrimental effects on health and performance of dairy cows. As hypocalcemic cows show reduced feed intake, we hypothesized that cows with reduced combined rumination and eating time (CRET) may benefit from Ca supplementation. The objective was to evaluate the effect of postpartum oral Ca administration on metabolic status (Calcium [Ca], fatty acids [FA], and β-Hydroxybutyrate [BHB] serum concentrations) and incidence of puerperal metritis (PM) in dairy cows with reduced postpartum CRET. Cows in an organic-certified dairy, diagnosed with reduced CRET (

Abstract Background The Positive and Negative Syndrome Scale (PANSS) is widely used in schizophrenia and has been divided into distinct factors (5-factor models) and subfactors. Network analyses are newer in psychiatry and can help to better understand the relationships and interactions between the symptoms of a psychiatric disorder. The aim of this study was threefold: (a) to evaluate connections between schizophrenia symptoms in two populations of patients (patients in the acutely exacerbated phase of schizophrenia and patients with predominant negative symptoms [PNS]), (b) to test whether network analyses support the Mohr 5 factor model of the PANSS and the Kahn 2 factor model of negative symptoms, and finally (c) to identify the most central symptoms in the two populations. Methods Using pooled baseline data from four cariprazine clinical trials in patients with acute exacerbation of schizophrenia (n = 2193) and the cariprazine–risperidone study in patients with PNS (n = 460), separate network analyses were performed. Network structures were estimated for all 30 items of the PANSS. Results While negative symptoms in patients with an acute exacerbation of schizophrenia are correlated with other PANSS symptoms, these negative symptoms are not correlated with other PANSS symptoms in patients with PNS. The Mohr factors were partially reflected in the network analyses. The two most central symptoms (largest node strength) were delusions and uncooperativeness in acute phase patients and hostility and delusions in patients with PNS. Conclusions This network analysis suggests that symptoms of schizophrenia are differently structured in acute and PNS patients. While in the former, negative symptoms are mainly secondary, in patients with PNS, they are mainly primary. Further, primary negative symptoms are better conceptualized as distinct negative symptom dimensions of the PANSS.

The impact of COVID-19 infection in pregnant women remained unclear for a long time. Previous research showed that SARS-CoV-2 virus is able to infect the placenta, potentially causing significant lesions leading to placental insufficiency. The impact of maternal vaccination status on the prevalence of SARS-CoV-2 placentitis remains unclear. We characterized placental lesions in SARS-CoV-2 infected pregnant women and studied the impact of vaccination on placental involvement. We retrospectively studied 180 placentas sent to the Department of Pathology in UZ Leuven or AZ Turnhout between January 2020 and August 2022, from non-vaccinated and vaccinated mothers suffering a SARS-CoV-2 proven infection during pregnancy. All reports and hematoxylin-eosin stained sections were revised by two pathologists to determine the presence of histopathological lesions that have been described in SARS-CoV-2 infection. SARS-CoV-2 immunostainings were available for a subgroup of 109 placentas. We gathered clinical data: date of delivery, date of positive serologic test result, vaccination status, SARS-CoV-2 variant and outcome of the pregnancy. Of the 180 placentas, 37,2% showed histopathological lesions and in 12,8% an immunohistochemically proven SARS-CoV-2 placentitis was present. SARS-CoV-2 immunohistochemical positivity was only seen in non-vaccinated mothers. The risk of fetal demise was more than 5 times higher for non-vaccinated mothers and their placentas showed significantly more syncytiotrophoblast necrosis and chronic histiocytic intervillositis compared to vaccinated mothers (both p < 0,001). Maternal vaccination was associated with a reduced risk of SARS-CoV-2 placentitis and stillbirth. This study provides new evidence of the protective effect of vaccination on the placenta. • Maternal vaccination was associated with a reduced risk of SARS-CoV-2 placentitis. • The risk of fetal demise was more than 5 times higher for non-vaccinated pregnant mothers. • SARS-CoV-2 immunohistochemical positivity was only seen in placentas of non-vaccinated mothers. [ABSTRACT FROM AUTHOR]

Introduction Preliminary results indicate that COVID-19 lockdown measures could lead to an increase in eating disorder pathology. However, some patients could be more vulnerable to experience such an increase than others. The reason why some patients are more susceptible to the impact of lockdown measures is still not known. Objectives To analyze the impact of the Belgian COVID-19 lockdown measures on the surroundings, social context, negative affect (NA), positive affect (PA) and binge eating frequency of patients with bulimia nervosa (BN). Methods The data of 15 female patients with BN from an ongoing experience sampling method study were analyzed. Mixed effects models compared surroundings, social context, NA, PA and binge eating before and after the implementation of the lockdown measures. Results After the implementation of the lockdown measures, significant changes in surroundings and social context were found as well as an increase in NA (p < 0.001) and decrease in PA (p = 0.015). Patients who experienced an increase in binge eating frequency also experienced a stronger increase in NA (p = 0.012) and decrease in PA (p = 0.026) after the lockdown measures were implemented. Conclusions Future research should also look at changes in surroundings, social context, affect and how these interact with factors such as personality traits and coping styles when investigating why some patients are more susceptible to the negative effects of lockdown measures than others.

Procarboxypeptidase U (proCPU, TAFI, proCPB2) is a basic carboxypeptidase zymogen that is converted by thrombin(-thrombomodulin) or plasmin into the active carboxypeptidase U (CPU, TAFIa, CPB2), a potent attenuator of fibrinolysis. As CPU forms a molecular link between coagulation and fibrinolysis, the development of CPU inhibitors as profibrinolytic agents constitutes an attractive new concept to improve endogenous fibrinolysis or to increase the efficacy of thrombolytic therapy in thromboembolic diseases. Furthermore, extensive research has been conducted on the in vivo role of CPU in (the acute phase of) thromboembolic disease, as well as on the hypothesis that high proCPU levels and the Thr/Ile325 polymorphism may cause a thrombotic predisposition. In this paper, an overview is given of the methods available for measuring proCPU, CPU, and inactivated CPU (CPUi), together with a summary of the clinical data generated so far, ranging from the current knowledge on proCPU concentrations and polymorphisms as potential thromboembolic risk factors to the positioning of different CPU forms (proCPU, CPU, and CPUi) as diagnostic markers for thromboembolic disease, and the potential benefit of pharmacological inhibition of the CPU pathway.

The period between 1880 and 1900 was a determining moment for urbanism in Brussels as well as for the recognition of photography as an art form. The policy regarding major work sites during the reign of Léopold II was essential in the definition of the Brussels urban identity. At the same time, the status of photographers was redefined. The pioneering photographers from the previous period were followed by a generation of amateurs – in the noble sense of the term – who defended the autonomy of what they considered to be an art form in itself. As part of a fundamental international movement referred to as “Pictorialism” which emerged in the mid 1880s, they modelled their work after painting and favoured timeless subjects. The relationship between the city and its photographic representation was modified, and was seen more as a landscape, including a periurban one. The personal points of view of the urban landscape therefore multiplied, encouraged by the artistic photography circles united within the Belgian Photography Association.

The period between 1880 and 1900 was a determining moment for urbanism in Brussels as well as for the recognition of photography as an art form. The policy regarding major work sites during the reign of Léopold II was essential in the definition of the Brussels urban identity. At the same time, the status of photographers was redefined. The pioneering photographers from the previous period were followed by a generation of amateurs – in the noble sense of the term – who defended the autonomy of what they considered to be an art form in itself. As part of a fundamental international movement referred to as “Pictorialism” which emerged in the mid 1880s, they modelled their work after painting and favoured timeless subjects. The relationship between the city and its photographic representation was modified, and was seen more as a landscape, including a periurban one. The personal points of view of the urban landscape therefore multiplied, encouraged by the artistic photography circles united within the Belgian Photography Association.

The period between 1880 and 1900 was a determining moment for urbanism in Brussels as well as for the recognition of photography as an art form. The policy regarding major work sites during the reign of Léopold II was essential in the definition of the Brussels urban identity. At the same time, the status of photographers was redefined. The pioneering photographers from the previous period were followed by a generation of amateurs – in the noble sense of the term – who defended the autonomy of what they considered to be an art form in itself. As part of a fundamental international movement referred to as “Pictorialism” which emerged in the mid 1880s, they modelled their work after painting and favoured timeless subjects. The relationship between the city and its photographic representation was modified, and was seen more as a landscape, including a periurban one. The personal points of view of the urban landscape therefore multiplied, encouraged by the artistic photography circles united within the Belgian Photography Association.

The acquisition of terminal cell fate and onset of differentiation are instructed by cell type-specific master control genes. Loss of differentiation is frequently observed during cancer progression, but the underlying causes and mechanisms remain poorly understood. We tested the hypothesis that master regulators of differentiation may be key regulators of tumor formation. Using loss- and gain-of-function analyses in Drosophila, we describe a critical anti-oncogenic function for the atonal transcription factor in the fly retina, where atonal instructs tissue differentiation. In the tumor context, atonal acts by regulating cell proliferation and death via the JNK stress response pathway. Combined with evidence that atonal's mammalian homolog, ATOH1, is a tumor suppressor gene, our data support a critical, evolutionarily conserved, function for ato in oncogenesis.

The purpose of the present study was to measure changes in blood flow velocity and volume flow rate (VFR) in the contralateral vertebral artery (VA) during end-range rotation and pre-manipulative hold at C1-C2 and to compare these measurements between participants with and without C1-C2 range of motion (ROM) restriction. This research was approached as an exploratory study and designed as a parallel noninterventional controlled trial with intentionally equal allocation, for studying diagnostic tests. Fifteen women and 13 men (mean age 44) were recruited (volunteer sample) in physiotherapy clinics. No participant had any current neurologic or vertebrobasilar insufficiency symptoms. The measurements of 13 participants with a limited ROM C1-C2 and 15 with no limitation were compared. Blood flow velocity and VFR in the contralateral VA were measured using color duplex Doppler imaging in 3 neck positions: neutral, maximal rotation, and pre-manipulative hold of C1-C2. Pre-manipulative hold significantly (P <.01) decreased all blood flow velocity parameters and VFR, mainly in the left VA. End-range rotation showed a significant (P <.05) decrease in the peak systolic velocity in the left VA. No significant differences were found between participants grouped by the presence or absence of a C1-C2 ROM restriction. A C1-C2 rotational ROM restriction does not appear associated with change in a significantly reduced VA blood flow due to the neck position. [ABSTRACT FROM AUTHOR]