Steven Vanderschueren
Publications
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2.40Impact points
Adult-onset Still's disease: still a diagnosis of exclusion.A nested case-control study in patients with fever of unknown origin.
Clinical and experimental rheumatology. 03/2012;
OBJECTIVES: Several sets of criteria have been proposed to classify adult-onset Still's disease (AOSD), those of Yamaguchi being the most commonly used. The Yamaguchi criteria demand the exclusion of other conditions. A clinical scale, recently proposed by Crispin et al., but not yet validated, ... [more] OBJECTIVES: Several sets of criteria have been proposed to classify adult-onset Still's disease (AOSD), those of Yamaguchi being the most commonly used. The Yamaguchi criteria demand the exclusion of other conditions. A clinical scale, recently proposed by Crispin et al., but not yet validated, would allow a positive diagnosis of AOSD in a majority of patients, without the need of thorough diagnostic procedures. METHODS: From a database of 447 patients with classical fever of unknown origin (FUO), collected over a 10-year period (2000-2009) at a general internal medicine department of a university hospital, 22 patients with AOSD according to the Yamaguchi criteria were extracted and compared with 44 controls, matched to index year. Clinical and laboratory parameters were recorded. Sensitivity, specificity and accuracy of the Yamaguchi criteria and of the clinical score were assessed. RESULTS: Lower age, joint symptoms, rash, throat ache, neutrophilic leukocytosis, and elevated erythrocyte sedimentation rate were the principal characteristics supporting a diagnosis of AOSD in patients with FUO. Sensitivity, specificity, and accuracy of the Yamaguchi criteria were 95% or more. The clinical scale, while being specific (98%), lacked sensitivity (55%) and had lower accuracy (83%). CONCLUSIONS: In patients with FUO, the Yamaguchi criteria are a time honored and reliable guide to a diagnosis of AOSD. The clinical scale may serve to rule in, rather than to rule out, AOSD. In many patients, Still's disease is still a diagnosis of exclusion.
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Concerns about medication and medication adherence in patients with chronic pain recruited from general practice.
Evidence-based nursing. 11/2011;
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1.39Impact points
Perioperative beta-blocker therapy: how to see the forest for the trees?
European journal of internal medicine. 06/2011; 22(3):e20-1.
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Fibromyalgia: do not give up the tender point count too easily: comment on the article by Wolfe et al.
Arthritis care & research. 11/2010; 62(11):1675; author reply 1676-8.
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1.91Impact points
Determinants of medication underuse and medication overuse in patients with chronic non-malignant pain: a multicenter study.
International journal of nursing studies. 11/2010; 47(11):1408-17.
In chronic non-malignant pain, medication is often used as an important cornerstone of the treatment. Medication non-adherence is a frequent problem in chronic conditions. In patients with chronic non-malignant pain, medication non-adherence ranges between 8% and 53%. Two types of non-adherence can ... [more] In chronic non-malignant pain, medication is often used as an important cornerstone of the treatment. Medication non-adherence is a frequent problem in chronic conditions. In patients with chronic non-malignant pain, medication non-adherence ranges between 8% and 53%. Two types of non-adherence can be identified: underuse and overuse of pain medication. To examine determinants of both medication underuse and overuse non-adherence in patients with chronic non-malignant pain, with a focus on factors related to all five categories of determinants of medication non-adherence simultaneously, as proposed by the WHO. A multicenter cross-sectional study. Three multidisciplinary outpatient pain centers in Flanders, Belgium. A total of 265 patients with chronic non-malignant pain participated in the study. Medication non-adherence was assessed by a self-report interview. Associations of socio-economic, treatment related, condition related, patient related and health care system related factors with medication underuse or overuse were determined by building two separate multivariable binary logistic regression models. Thirty eight percent of the patients were fully adherent. Based on multivariable analyses, underuse was significantly associated with more prescribed analgesics (OR=2.303), self-medication (OR=4.679), lower pain intensity (OR=0.821), active coping strategies (OR=1.132) and lack of information (OR=0.268). Overuse of medication was associated with more prescribed analgesics (OR=1.645) and current smoking (OR=2.744). Patients underusing or overusing their medication do have a different risk profile. The set of determinants of non-adherence, proposed by WHO, is suitable to study determinants of underuse, but the framework is less suitable to study determinants of medication overuse.
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6.26Impact points
A 67-year-old woman with a systemic inflammatory syndrome and sicca.
Clinical chemistry. 09/2010; 56(9):1508-9.
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3.60Impact points
Lysosomal lipid vacuoles in macrophages located in the colon.
Journal of inherited metabolic disease. 06/2010; 33(3):303-4.
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3.01Impact points
Pharmacologic pain treatment in a multidisciplinary pain center: do patients adhere to the prescription of the physician?
The Clinical journal of pain. 02/2010; 26(2):81-6.
Medication nonadherence is a frequent problem in chronic conditions. In chronic noncancer pain, medication is often used as an important cornerstone of the treatment. Studies on medication nonadherence in this population, however, are scarce. The aim of this study was to determine the prevalence of ... [more] Medication nonadherence is a frequent problem in chronic conditions. In chronic noncancer pain, medication is often used as an important cornerstone of the treatment. Studies on medication nonadherence in this population, however, are scarce. The aim of this study was to determine the prevalence of medication underuse and overuse nonadherence in a large sample of chronic pain patients treated in a multidisciplinary pain center. Second, an extensive list of demographic, disease-related, treatment-related and health behavior-related factors was included to compare these factors between adherent, overusers, and underusers, respectively. Self-report was used to measure medication adherence. Forty-eight percent of the patients were nonadherent, with 34% of them showing underuse and 14% overuse of the prescribed medication. Multivariable analyses showed a significant association between younger age and medication nonadherence (both underuse and overuse). Furthermore, underuse was significantly associated with self-medication. Overuse was associated with current smoking, opioid prescription, and more medication intake moments. We can conclude that medication nonadherence, especially underuse of medication, occurs frequently among patients with chronic nonmalignant pain. Prospective research is needed to learn about the impact of medication overuse or underuse on clinical outcomes. Future research should examine underuse and overuse as different types of nonadherence as different factors might predict this behavior.
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4.97Impact points
Monoclonal gammopathy of undetermined significance: significant beyond hematology.
Mayo Clinic proceedings. Mayo Clinic. 10/2009; 84(9):842-5.
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1.39Impact points
Inflammation of unknown origin versus fever of unknown origin: two of a kind.
European journal of internal medicine. 08/2009; 20(4):415-8.
OBJECTIVES: A vast literature exists on fever of unknown origin (FUO), characterized by prolonged and perplexing fevers >38.3 degrees C. In contrast, no studies are available to guide the approach to inflammation of unknown origin (IUO), defined as prolonged and perplexing inflammation with tempe... [more] OBJECTIVES: A vast literature exists on fever of unknown origin (FUO), characterized by prolonged and perplexing fevers >38.3 degrees C. In contrast, no studies are available to guide the approach to inflammation of unknown origin (IUO), defined as prolonged and perplexing inflammation with temperatures <38.3 degrees C. We aimed to determine the diagnostic yield, the case-mix, and the outcome of patients with IUO, relative to patients with FUO. METHODS: We matched 57 patients with IUO to 57 patients with FUO of the same gender (54% male) and a similar age (median: 67 years). RESULTS: A diagnosis was established in 35 patients with IUO (61%) and in 33 patients with FUO (58%) (p=.70). The case-mix did not differ significantly (p=.43). Non-infectious inflammatory disorders were the dominant diagnostic category in the IUO group (16 patients), while in the FUO group, similar numbers of malignancies [10], infections [9], and non-infectious inflammatory diseases [9] were diagnosed. (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scan contributed comparably to the diagnosis in both groups (in 18 of 50, 36%, patients with IUO and in 13 of 40, 33%, patients with FUO) (p=.83). In both groups, 7 patients (12%) died during an average follow-up of 1 year. CONCLUSION: Diagnostic yield, case-mix, contribution of FDG-PET scan and vital outcome were similar in patients with IUO and FUO. These data suggest that the 38.3 degrees C boundary may be arbitrary and that the diagnostic approaches used in FUO can be applied to IUO.
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3.37Impact points
Medication adherence in patients with chronic non-malignant pain: Is there a problem?
European journal of pain (London, England). 05/2009;
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2.61Impact points
Clinical and echocardiographic risk factors for embolism and mortality in infective endocarditis.
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 12/2008; 27(12):1159-64.
Data about predictors of embolism in patients with infective endocarditis (IE) are conflicting. This study aimed to investigate clinical and transoesophageal echocardiography (TEE) characteristics in predicting embolism and six-month mortality. In this observational cohort study, 216 patients with d... [more] Data about predictors of embolism in patients with infective endocarditis (IE) are conflicting. This study aimed to investigate clinical and transoesophageal echocardiography (TEE) characteristics in predicting embolism and six-month mortality. In this observational cohort study, 216 patients with definite left-sided IE, according to the modified Duke criteria, were prospectively recruited. All patients underwent TEE. 'Any embolism' was defined as embolism before or after initiation of antimicrobial therapy; 'new embolism' included embolism after initiation of antimicrobial therapy. Sixty-two of 216 patients (29%) experienced any embolism. New embolism occurred in 12 patients (6%), 7 of which were postoperative. Factors significantly associated with any embolism were community origin of IE and the etiologic microorganism, in particular staphylococci and nonviridans streptococci. Vegetation length >10 mm showed a trend towards association with new embolism and a mobile vegetation was predictive for new embolism. Six-month mortality was 24% (52/216). In multivariable analysis, age, vegetation length >10 mm, Staphylococcus aureus, and the type of treatment predicted mortality. Multiple emboli showed a trend towards association with death. In conclusion, any embolism occurred in over a fourth of patients. A mobile vegetation was significantly associated with new embolism, and vegetation length >10 mm tended to be associated with new embolism. Vegetation length >10 mm predicted six-month mortality, and multiple emboli showed a trend towards association with death.
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1.39Impact points
Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance?
European journal of internal medicine. 08/2008; 19(5):345-9.
BACKGROUND: Involuntary weight loss frequently poses a diagnostic challenge. Patient and physician alike want to exclude malignant and other major organic illness. The present study aimed to evaluate whether a negative baseline evaluation (consisting of clinical examination, standard laboratory exam... [more] BACKGROUND: Involuntary weight loss frequently poses a diagnostic challenge. Patient and physician alike want to exclude malignant and other major organic illness. The present study aimed to evaluate whether a negative baseline evaluation (consisting of clinical examination, standard laboratory examination, chest X-ray, and abdominal ultrasound) lowers the probability of evolving organic illness in patients with significant unexplained weight loss. METHODS: Prospective observational study of 101 consecutive patients presenting to a general internal medicine department of a university hospital with an unexplained unintentional weight loss of at least 5% within 6-12 months. Laboratory tests of interest included C-reactive protein, albumin, haemoglobin, and liver function tests. RESULTS: Weight loss of the 101 patients [age (mean, interquartile range): 64 (51-71) years, 46% male] averaged 10 (7-15) kg. Organic causes were found in 57 patients (56%), including malignancy in 22 (22%). In 44 patients without obvious organic cause for the weight loss (44%), a psychiatric disorder was implicated in 16 (16%) and no cause was established in 28 (28%), despite vigorous effort and follow-up of at least 6 months. Baseline evaluation was entirely normal in none of the 22 patients (0%) with malignancy, in 2 of the 35 (5.7%) with non-malignant organic disease, and in 23 of the 44 (52%) without physical diagnosis. Additional testing, oftentimes extensive, after a normal baseline evaluation led to one additional physical diagnosis (lactose intolerance). CONCLUSION: In patients presenting with substantial unintentional weight loss, major organic and especially malignant diseases seem highly unlikely when a baseline evaluation is completely normal. In this setting, a watchful waiting approach may be preferable to undirected and invasive testing.
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1.39Impact points
An elderly lady with a painful swollen face.
European journal of internal medicine. 08/2008; 19(5):379-80.
Giant cell arteritis (GCA) is the most common vasculitis in the elderly. Common presenting symptoms include cranial ischemic complications, constitutional manifestations and polymyalgia rheumatica. Facial and cervical edema is increasingly recognized as an inaugural sign of GCA. We present a case wi... [more] Giant cell arteritis (GCA) is the most common vasculitis in the elderly. Common presenting symptoms include cranial ischemic complications, constitutional manifestations and polymyalgia rheumatica. Facial and cervical edema is increasingly recognized as an inaugural sign of GCA. We present a case with tender facial and cervical edema as the dominating symptom.
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3.64Impact points
Outcome of patients requiring valve surgery during active infective endocarditis.
The Annals of thoracic surgery. 06/2008; 85(5):1564-9.
BACKGROUND: The optimal timing of cardiac operations in patients with infective endocarditis continues to be debated. This observational study analyzed the profile and outcome of patients with active infective endocarditis undergoing operations. METHODS: Between June 2000 and June 2006, 95 surgicall... [more] BACKGROUND: The optimal timing of cardiac operations in patients with infective endocarditis continues to be debated. This observational study analyzed the profile and outcome of patients with active infective endocarditis undergoing operations. METHODS: Between June 2000 and June 2006, 95 surgically treated patients with definite infective endocarditis by the modified Duke criteria were included. RESULTS: Fifty-eight patients were operated on within the first 7 days after diagnosis of infective endocarditis and 37 at more than 7 days after diagnosis up to immediately after completion of antibiotic treatment. Staphylococci predominated and were significantly associated with embolism, abscess, and septic shock. The most frequent indication for operation was severe regurgitation with heart failure. The 6-month mortality was 15%. Early operation showed a trend towards increased mortality vs late operation. In univariable analysis, factors associated with 6-month mortality included staphylococci and septic shock. Multivariable analysis revealed that septic shock predicted 6-month mortality. Despite early operation in patients experiencing septic shock, 57% died. No patients without heart failure died after undergoing (early or late) procedures for severe regurgitation. CONCLUSIONS: The prognosis in surgically treated patients was determined by the occurrence of septic shock. The outcome in patients who underwent late operations was favorable compared with the early group. This difference was probably not due to the timing of the surgical intervention but to the severity of infective endocarditis. In patients with severe regurgitation without heart failure, early operation may offer benefit in length of hospitalization and prevention of development of new heart failure.
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3.58Impact points
Management of prosthetic valve infective endocarditis.
The American journal of cardiology. 04/2008; 101(8):1174-8.
This study analyzed the profile and outcome of surgically versus medically treated patients with prosthetic valve infective endocarditis (PVE). From 2000 to 2006, 80 patients >16 years of age (median 71) with definite PVE according to modified Duke criteria were included. The medically treated gr... [more] This study analyzed the profile and outcome of surgically versus medically treated patients with prosthetic valve infective endocarditis (PVE). From 2000 to 2006, 80 patients >16 years of age (median 71) with definite PVE according to modified Duke criteria were included. The medically treated group was separated into deliberately conservative and perforce conservative treatments, the latter group including patients with contraindications to a cardiosurgical intervention. The most frequent causative micro-organisms were staphylococci. Forty-six percent of patients were surgically treated, 34% had deliberately conservative treatment, and 20% had perforce conservative treatment. Six-month mortality was 29%; 27% of surgically treated patients died, 4% deliberately conservatively patients died, and 75% perforce conservatively treated patients died. Septic shock, multiorgan failure, and type of treatment were significantly associated with death in univariable analysis. Multivariable analysis revealed that type of treatment (perforce conservative) and septic shock predicted death in patients with PVE. Survival was most favorable in deliberately conservatively treated patients, including PVE due to Staphylococcus aureus. In conclusion, there remains a role for watchful waiting in patients with PVE without evidence of major complications. Moreover, patients with uncomplicated S. aureus PVE can be treated successfully without cardiac surgery. Conversely, patients with major complicated PVE should preferentially undergo surgery. Predictors of mortality in patients with PVE included septic shock and perforce conservative treatment.
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10.69Impact points
Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients.
American journal of respiratory and critical care medicine. 02/2008; 177(1):27-34.
RATIONALE: Invasive aspergillosis (IA) is an important cause of mortality in patients with hematologic malignancies. However, IA appears to be gaining a foothold in the intensive care unit (ICU) in patients without classical risk factors. A recent study described 89 cases of IA in patients in a medi... [more] RATIONALE: Invasive aspergillosis (IA) is an important cause of mortality in patients with hematologic malignancies. However, IA appears to be gaining a foothold in the intensive care unit (ICU) in patients without classical risk factors. A recent study described 89 cases of IA in patients in a medical ICU without leukemia or cancer. The diagnosis of IA remains difficult and is often established too late. Galactomannan (GM) is an exo-antigen released from Aspergillus hyphae while they invade host tissue. OBJECTIVES: This prospective single-center study was conducted to investigate the role of GM in bronchoalveolar lavage (BAL) fluid as a tool for early diagnosis of IA in the ICU. METHODS: All patients with risk factors identified in our earlier study were evaluated. BAL for culture and GM detection, serum GM levels, and computed tomography scan were obtained for all included patients with signs of pneumonia. Patients were classified as having proven, probable, or possible IA. MEASUREMENTS AND MAIN RESULTS: A total of 110 patients out of 1,109 admissions were eligible. There were 26 proven IA cases. Using a cutoff index of 0.5, the sensitivity and specificity of GM detection in BAL fluid was 88 and 87%, respectively. The sensitivity of serum GM was only 42%. In 11 of 26 proven cases, BAL culture and serum GM remained negative, whereas GM in BAL was positive. CONCLUSIONS: IA is common in immunocompromised, critically ill patients. GM detection in BAL fluid seems to be useful in establishing or excluding the diagnosis of IA in the ICU.
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1.39Impact points
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4.36Impact points
Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study.
American heart journal. 12/2007; 154(5):923-8.
BACKGROUND: In patients with infective endocarditis (IE), detection of abscess remains difficult. We investigated abscess detection by transesophageal echocardiography (TEE) and predictors of abscess and death in patients with IE. METHODS: A 5-year study included 115 patients with definite IE accord... [more] BACKGROUND: In patients with infective endocarditis (IE), detection of abscess remains difficult. We investigated abscess detection by transesophageal echocardiography (TEE) and predictors of abscess and death in patients with IE. METHODS: A 5-year study included 115 patients with definite IE according to the modified Duke criteria who underwent TEE and cardiac surgery. RESULTS: Abscess was found perioperatively in 44 patients (38%). Twenty-one abscesses (48%) were detected by TEE. Sixty-one percent of missed abscesses were localized on the posterior mitral annulus. In 64% of unrecognized mitral valve abscesses, the abscess was localized around calcification in the posterior mitral annulus. Fourteen patients (54%) had prosthetic valve dehiscence, and 8 (57%) had abscess as well. Overall 6-month mortality was 17% and predictable by age (odds ratio 1.1, 95% CI 1-1.001, P = .01), abscess (odds ratio 5.3, 95% CI 1.5-19, P = .01), and the causative microorganism (P = .035), in particular staphylococci. In patients with a missed abscess, surgical delay was significantly longer (P = .04) and mortality was nonsignificantly higher (P = .2) than in patients with a preoperatively detected abscess. CONCLUSIONS: Detection of abscess by TEE seemed to be underestimated. In most cases, abscess was missed in the presence of calcification in the posterior mitral annulus. Age, abscess, and staphylococcal infection predicted 6-month mortality. Early surgery may improve outcome in patients with an abscess.
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4.97Impact points
Risk factors for infective endocarditis and outcome of patients with Staphylococcus aureus bacteremia.
Mayo Clinic proceedings. Mayo Clinic. 11/2007; 82(10):1165-9.
OBJECTIVE: To investigate the risk factors for Staphylococcus aureus infective endocarditis (SAIE) and 6-month mortality in patients with S aureus bacteremia (SAB). PATIENTS AND METHODS: This study consisted of patients who were diagnosed as having nosocomial or community-acquired SAB or SAIE betwee... [more] OBJECTIVE: To investigate the risk factors for Staphylococcus aureus infective endocarditis (SAIE) and 6-month mortality in patients with S aureus bacteremia (SAB). PATIENTS AND METHODS: This study consisted of patients who were diagnosed as having nosocomial or community-acquired SAB or SAIE between June 1, 2000, and December 31, 2005. Clinical characteristics of patients with SAB were compared with those of patients with SAIE, and predictors of mortality in patients with SAB were analyzed. RESULTS: The median age of the 132 randomly selected patients with SAB and the 66 patients with SAIE was 66 and 68 years, respectively. Univariable analysis showed that unknown origin of SAB, a valvular prosthesis, a pacemaker, persistent fever, and persistent bacteremia were significantly associated with SAIE. In multivariable analysis, unknown origin of SAB (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.9-9.3; P=.001), a valvular prosthesis (OR, 9.2; 95% CI, 3.2-26.2; P<.001), persistent fever (OR, 3.1; 95% CI, 1.0-9.0; P=.04), and persistent bacteremia (OR, 6.8; 95% CI, 2.3-20.2- P=.001) were independently associated with SAIE. Six- month mortality was 8% in patients with SAB vs 35% in patients with SAIE (OR, 6.5; 95% CI, 2.9- 14.8; P<.001). In univariable analysis, methicillin- resistant S aureus (OR, 7.2; 95% CI, 1.7 - 29.4; P=.005) was significantly associated with 6-month mortality in patients with SAB. CONCLUSION: Unknown origin of SAB, a valvular prosthesis, persistent fever, and persistent bacteremia were independently associated with SAIE in patients with SAB. In univariable analysis, methicillin-resistant S aureus was associated with 6-month mortality in patients with SAB. S aureus infective endocarditis had a significantly higher mortality than SAB. The optimal management of SAB and SAIE deserves further study.
Following (9)
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Piet Claus
Katholieke Universiteit Leuven -
Katrien Lagrou
Katholieke Universiteit Leuven -
Isabel Spriet
Katholieke Universiteit Leuven -
Luc Mortelmans
Katholieke Universiteit Leuven -
Daniel Blockmans
University Hospital Gasthuisberg, Leuven, Belgium
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