Advances in pulmonary hypertension diagnosis and risk stratification.

editorial reviewedPulmonary hypertension (PH) is a common clinical condition linked to chronic cardiopulmonary illnesses. It must be distinguished from pulmonary arterial hypertension (PAH), a rare disease characterized by a specific involvement of the pulmonary arterial bed. An early diagnosis and accurate classification by a multidisciplinary team are necessary for a multimodal and individualized therapy approach. This article aims to provide a summary of the most recent ESC/ERS recommendations published in 2022.L’hypertension pulmonaire (HTP) est une entité clinique fréquemment retrouvée chez les patients atteints d’affections cardio-pulmonaires chroniques. Elle est à différentier de l’hypertension artérielle pulmonaire (HTAP) qui est, quant à elle, une maladie rare caractérisée par une atteinte spécifique du lit artériel pulmonaire. Une identification précoce et une classification correcte, en équipe pluridisciplinaire, sont primordiales pour une prise en charge thérapeutique multimodale et personnalisée. Cet article a pour but de résumer, de façon pratique, les dernières recommandations des sociétés européennes de cardiologie (ESC) et de pneumologie (ERS) publiées en 2022

Patient-physician electronic commmmunication

peer reviewedaudience: professional, student, popularizationThere is a patient demand for online services provided by their doctor, but at the present, in Belgium, there are very few physicians offering such services. This article examines the different types of services and the practical, technical, legal and economic aspects of an interface for electronic doctor-patient communication in the ambulatory sector in the Belgian context. The inventory of pilot projects carried out in other countries shows high patient satisfaction rates and a low impact on doctors’ workload. However, the lack of funding hinders the implementation. Given the confidential nature of data exchanged, both high level of security and development of guidelines adapted to the local Belgian context are required. Electronic communication should remain one of the modalities in a therapeutic relationship. At a technical level, using the Belgian electronic identity card and the opportunity to create a digital signature with legal value would provide a solution to most of the security requirements.Il existe de la part des patients une demande pour des services en ligne offerts par leur médecin, mais actuellement en Belgique, très peu de médecins leur en proposent. Cet article étudie les offres de service possibles ainsi que les contraintes pratiques, techniques, juridiques et économiques pour une interface de communication médecin-patient par voie électronique dans le secteur ambulatoire et dans le contexte belge. L’inventaire des projets-pilotes à l’étranger montre que le taux de satisfaction des patients est élevé et que la charge de travail des médecins est peu modifiée. Cependant, l’absence de financement constitue un frein à l’implémentation. Vu le caractère sensible des données échangées, un niveau de sécurité élevé s’impose, ainsi que l’élaboration de lignes directrices adaptées au contexte local belge. La communication électronique doit rester une des modalités de la relation thérapeutique. Au niveau technique, l’utilisation de la carte d’identité électronique belge et la possibilité qu’elle offre de réaliser une signature numérique ayant une valeur juridique permettraient de rencontrer la majorité des contraintes de sécurité

Efficacy and User Experience of a Novel X-Ray Shield on Operator Radiation Exposure During Cardiac Catheterization: A Randomized Controlled Trial.

peer reviewedBACKGROUND: Radiation shielding is mandatory during cardiac catheterization, but there is a need to improve efficacy and ease of use. METHODS: The aim of the study was to assess the shielding effect and user feedback for a novel flexible multiconfiguration x-ray shield (FMX). The 0.5-mm Pb equivalent FMX can be selectively configured to accommodate for variations in patient morphology, access site, and type of procedure with maintained visualization, vascular access, and shielding. To evaluate efficacy, relative operator dose (operator dose indexed for given dose) was measured during 103 consecutive procedures randomized in a 1:1 proportion to the current routine setup or FMX+routine. User feedback was collected on function, relevance, and likelihood of adoption into clinical practice. RESULTS: Median relative operator dose was 3.63 μSv/µGy·m(2)×10(-3) (IQR, 2.62-6.37) with routine setup and 0.57 μSv/µGy·m(2)×10(-3) (IQR, 0.27-1.06) with FMX+routine, which amounts to an 84.4% reduction (P<0.001). For 500 procedures/year, this corresponds to an estimated yearly dose reduction from 3.6 to 0.7 mSv. User feedback regarding size, functionality, ease of use, likely to use, critical issues, shielding, draping, procedure time, vascular access, patient discomfort, and risk was 99% positive. No critical issues were identified. There was no significant difference in patient radiation exposure. CONCLUSIONS: The FMX reduces radiation exposure considerably. The FMX represents an effective and attractive solution for radiation protection that can easily be implemented in existing workflow. FMX has potential for general use with maintained visualization, vascular access, and shielding in routine cardiac catheterization