Contribuição da hipnose na gestão da dor e ansiedade em clínica de medicina dentária: revisão narrativa

Objetivo: As condições e práticas dentárias são uma fonte de ansiedade, medo e dor para os pacientes. O objetivo desta revisão foi avaliar a eficácia, segurança e aplicação da hipnose em clínicas dentárias. Metodologia: Foi efectuada uma pesquisa bibliográfica nas bases de dados electónicos PubMed, Google Scholar, PMC, Cochrane e Elviser para selecionar artigos científicos que avaliassem o efeito da hipnose na dor, medo e ansiedade. Os termos pesquisados foram o termo “Hipnosis” e o operador boleano AND com os termos: “Dentistry”, “Dental care”, “Dental Anxiety”, e“Dental Pain”. A pesquisa foi limitada a artigos científicos e revisões publicadas entre 2005 e 2021. Foram selecionadas 54 referências bibliográficas. Resultados: Os resultados mostraram que o uso de hipnose durante o tratamento dentário teve benefícios significativos em termos de bioquímica, comportamento, ansiedade e dor em comparação com o grupo controle. Conclusão: Esta revisão mostra a eficácia da hipnose sobre a dor e ansiedade na clínica de medicina dentária. Demonstrou-se ser um meio vantajoso de aliviar as experiências dos pacientes em cuidados dentários.Objective: Dental conditions and practices are a source of anxiety, fear and pain for patients. The aim of this review was to assess the effectiveness, safety and application of hypnosis in dental clinics. Methodology: A literature search was conducted in the PubMed, Google Scholar, PMC, Cochrane and Elviser electonic databases to select scientific articles assessing the effect of hypnosis on pain, fear and anxiety. The terms searched were the term "Hypnosis" and the Boolean operator AND with the terms: "Dentistry", "Dental care", "Dental Anxiety", and "Dental Pain". The search was limited to scientific articles and reviews published between 2005 and 2021. Fifty-four bibliographical references were selected. Results: The results showed that the use of hypnosis during dental treatment had significant benefits in terms of biochemistry, behaviour, anxiety and pain compared to the control group. Conclusion: This review shows the effectiveness of hypnosis on pain and anxiety in dentistry. It has been shown to be an advantageous means of relieving patients' experiences in dental care

Antimicrobial Stewardship Programs in 13 Belgian hospitals: a survey from the french association of belgian hospital pharmacists

Background: Since 2002, the Belgian Antibiotic Policy Coordibnation Committee (BAPCOC) has supported the development of antimicrobial stewardship (AMS) teams in Belgian hospitals with policy guidance and federal funding. A Royal Decree of 12 February 2008 has consolidated the minimum composition, mandate and tasks of AMS teams. However, between 2017 and 2019, the European Centre for Disease Prevention and Control (ECDC) and the Belgian Health Care Knowledge Centre (KCE) emphasized flaws in our national strategies and policies on antimicrobial resistance. This survey evaluated if the essential and the minimum standards for AMS programs in Belgian hospitals were fulfilled after more than 10 years of activities. Materials/methods: A questionnaire survey was performed based on the international consensus approach developed by Pulcini et al. in 2019. Seven core elements and their related 29 checklist items for global hospital AMS programs were assessed. All the items are weighted identically: 1 point per hospital regardless of the type of hospital or the number of beds. The results are expressed in percentages. Results: Completed questionnaires were provided by 13 hospitals (8 primary, 3 secondary and 2 tertiary hospitals). Figure 1 showed the results of the seven core elements. The core elements number 3 (Available expertise on infection management) and 6 (Monitoring and surveillance) gained good scores. The core elements number 1 (Senior hospital management leadership towards antimicrobial stewardship) and number 7 (Reporting and feedback) have to be improved in the future. The sub-analysis of the 29 items emphasized within the core elements which questions can still be improved. Conclusions: This survey confirmed on the ground what is reflected in the ECDC and KCE reports: the effectiveness of the belgian AMS teams could be improved. This survey could help BAPCOC to easily underline which core elements need improvement

Comparison of Mesenchymal Stromal Cells From Different Origins for the Treatment of Graft-vs.-Host-Disease in a Humanized Mouse Model

Mesenchymal stromal cells (MSCs) have potent immunomodulatory properties that make them an attractive tool against graft- vs.-host disease (GVHD). However, despite promising results in phase I/II studies, bone marrow (BM-) derived MSCs failed to demonstrate their superiority over placebo in the sole phase III trial reported thus far. MSCs from different tissue origins display different characteristics, but their therapeutic benefits have never been directly compared in GVHD. Here, we compared the impact of BM-, umbilical cord (UC-), and adipose-tissue (AT-) derived MSCs on T-cell function in vitro and assessed their efficacy for the treatment of GVHD induced by injection of human peripheral blood mononuclear cells in NOD-scid IL-2Rγnull HLA-A2/HHD mice. In vitro, resting BM- and AT-MSCs were more potent than UC-MSCs to inhibit lymphocyte proliferation, whereas UC- and AT-MSCs induced a higher regulatory T-cell (CD4+CD25+FoxP3+)/T helper 17 ratio. Interestingly, AT-MSCs and UC-MSCs activated the coagulation pathway at a higher level than BM-MSCs. In vivo, AT-MSC infusions were complicated by sudden death in 4 of 16 animals, precluding an analysis of their efficacy. Intravenous MSC infusions (UC- or BM- combined) failed to significantly increase overall survival (OS) in an analysis combining data from 80 mice (hazard ratio [HR] = 0.59, 95% confidence interval [CI] 0.32–1.08, P = 0.087). In a sensitivity analysis we also compared OS in control vs. each MSC group separately. The results for the BM-MSC vs. control comparison was HR = 0.63 (95% CI 0.30–1.34, P = 0.24) while the figures for the UC-MSC vs. control comparison was HR = 0.56 (95% CI 0.28–1.10, P = 0.09). Altogether, these results suggest that MSCs from various origins have different effects on immune cells in vitro and in vivo. However, none significantly prevented death from GVHD. Finally, our data suggest that the safety profile of AT-MSC and UC-MSC need to be closely monitored given their pro-coagulant activities in vitro

Towards a better detection of patients at-risk of linezolid toxicity in clinical practice: a prospective study in three Belgian hospital centers

Introduction: Linezolid is a last-resort antibiotic for infections caused by multidrug-resistant microorganisms. It is widely used for off-label indications and for longer than recommended treatment durations, exposing patients at higher risk of adverse drug reactions (ADRs), notably thrombocytopenia. This study aimed to investigate ADR incidence and risk factors, identify thrombocytopenia-related trough levels based on treatment duration, and evaluate the performance of predictive scores for ADR development.Methods: Adult in- and outpatients undergoing linezolid therapy were enrolled in three hospitals and ADRs and linezolid trough levels prospectively monitored over time. A population pharmacokinetic (pop-PK model) was used to estimate trough levels for blood samples collected at varying times.Results: A multivariate analysis based on 63 treatments identified treatment duration ≥10 days and trough levels >8 mg/L as independent risk factors of developing thrombocytopenia, with high trough values correlated with impaired renal function. Five patients treated for >28 days did not develop thrombocytopenia but maintained trough values in the target range (<8 mg/L). The Buzelé predictive score, which combines an age-adjusted Charlson comorbidity index with treatment duration, demonstrated 77% specificity and 67% sensitivity to predict the risk of ADR.Conclusion: Our work supports the necessity of establishing guidelines for dose adjustment in patients with renal insufficiency and the systematic use of TDM in patients at-risk in order to keep trough values ≤8 mg/L. The Buzelé predictive score (if ≥7) may help to detect these at-risk patients, and pop-PK models can estimate trough levels based on plasma samples collected at varying times, reducing the logistical burden of TDM in clinical practice

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Perceptions, attitudes, and practices of a Belgian teaching hospital's physicians, pharmacists, and nurses regarding antibiotic use and resistance: survey towards targeted actions for Antimicrobial Stewardship.

OBJECTIVES: This study aimed to identify barriers to the proper use of antibiotics by healthcare professionals and to help the hospital Antimicrobial Stewardship develop suitable actions for the staff. METHODS: In a Belgian teaching hospital, a survey was conducted among physicians, pharmacists, and nurses involved in antibiotherapy. Questions from the 2019 European Center for Disease Prevention and Control (ECDC) survey were analyzed based on components of the COM-B model (capabilities, opportunities, and motivations). First, collected data were reviewed with the Ethnos software to analyze the different COM-B model components. For statistical analyses, responses were grouped into three clear-cut answers in a Fisher's exact test. RESULTS: Overall, 400 staff members were included. We found that our professions, combined, have a good perception of antibiotic resistance (97.8%). For capabilities, however, only 77.2% state that they have sufficient knowledge, with 91.3%, 71.5%, and 63.0% for physicians, nurses, and pharmacists, respectively. For opportunities (access to resources, information, and training), it is observed that 72.2% report having easy access to the guidelines they need to manage infections. In comparison, for 64.2% of the respondents, this information changed their opinion on the useless or inappropriate prescription, administration, and delivery of antibiotics. For 55.0%, this information has enabled them to change their practices. Finally, for motivations, 92.8% of respondents state that they know about the link between their practices and the emergence and spread of antibiotic resistance. However, only 65.0% of participants say they have a role in managing antibiotic resistance. We found that 5 out of 8 questions are significantly dependent on the profession: 2 inquiries related to capability, 1 to opportunity, and 2 to motivation. CONCLUSION: We found that responses to the ECDC questionnaire are related to the profession. While some topics are universal/cross-functional, others must be explicitly tailored to each professional category. Information is useless if not accessible. Communication and provision of documents are thus paramount

Different patterns of inappropriate antifungals use in daily practice: a single center experience

The use and cost of antifungal are increasing. There is an urgent need to change prescribing practice. Objective: Our aim was to identify different patterns of inappropriate antifungal use in daily practice in our center (Cliniques Universitaires St Luc, Brussels). Setting: A 989 bed teaching hospital in Belgium. Method: Four point prevalence surveys (PPS) were undertaken prospectively during February, March, August 2014 and March 2015. One infectious disease specialist and two pharmacists assessed the quality of antifungal treatments according to standard guidelines. Antifungal use was evaluated by a modified algorithm used for antimicrobial use evaluation considering indication, dosage and duration of treatment. Main outcome measure: To assess the quality of use of antifungal agents in terms of indication, choice of molecule, dosage and duration of treatment. Toxicity and potential drug-drug interactions were also evaluated. Results: 108 antifungal therapies were prescribed to 104 patients during the four PPS. Fifty eight therapies were prophylactic indications (54%). 51.3% of the therapeutic indications were empirical and 21.3% targeted therapies. Fluconazole was the most frequently used drug (61.1%), followed by voriconazole (13%). According to Gyssens algorithm, only 61 prescriptions (56.5%) were judged definitely appropriate. Indications were considered correct in 93.5% (101). In 11.9% of cases the antifungal drug was not chosen correctly. The correct dose of antifungal drugs was prescribed in 75.9%. Conclusion: These four PPS days identified different patterns of inappropriate antifungal use that should be improved by education and feedback of these results of prescribing habits. This kind of interventions is one of the most successful means of influencing physicians' performanc

PMMA-cement anterior column reconstruction in surgical treatment of spondylodiscitis.

INTRODUCTION AND RESEARCH QUESTION: This paper explains how antibiotic loaded cement can be used in surgical treatment of spondylodiscitis to reconstruct the anterior column of the spine. MATERIAL AND METHODS: 35 consecutive surgical procedures performed for spondylodiscitis were collected over a 11-year period and charts were reviewed. Most infections were caused mainly by staphylococcus spp (n = 16), streptococcus spp (n = 8) and pseudomonas spp (n = 4). Most patients had long standing but unsuccessful antibiotic therapy (median 42 days). Other indications included instability, neurologic deficit, abscess, and patients were generally in very poor medical condition. RESULTS: Anterior debridement was followed by a partial cavity filling with surgical high viscosity PMMA cement in all cases. Cement was a high viscosity gentamycin loaded cement, that was placed in the cavity created by debridement under the direct eye control. In 25 cases, a part of the cavity was filled with freeze dried cancellous bone allograft rehydrated in rifampicin. Spine was further stabilized with an anterior plate in 15 cases, with short (+1/+1) posterior instrumentation in 5 cases, and a long (≥ +2/+2) posterior instrumentation in 11 cases. In four patients, spine was left un-instrumented. Immediate, unrestricted mobilization was always authorized after surgery. None of the patients were reoperated neither for mechanical failure nor for infection relapse. CONCLUSION: This report supports the idea that surgical bone cement is an efficient gap filler when used through anterior approach. For small as well as for large defects, it can help to reconstruct the anterior column and locally control the infection in combination with additional stabilization and optimal intravenous and oral antibiotic treatment