Clinique Saint-Joseph

Understanding young people’s and professionals’ attitudes towards ways to deal with mental health problems is important to overcome barriers to care. We investigated the short- and long-term perceived helpfulness of a list of coping strategies and help-seeking behaviors in a vignette study. Differences between stakeholder groups were also assessed. Belgian youth (N = 919), aged 16–24 years, and professionals (N = 569) in youth work, social welfare services, and mental health services took part in the study. Young people were either recruited from a random community sample (N = 5000), a school/university setting or via social media. For professionals convenience sampling was used (mailing list, informing relevant services in the sector). Each participant read one out of six vignettes describing a young person with mental health complaints and the help that young person had received. Descriptive statistics were used to assess consensus about perceived helpfulness. Expectations of the impact of mental health interventions were also assessed. Regression analyses were performed to examine differences between stakeholder groups. Young people showed positive attitudes towards the helpfulness of professional resources. For the short term, they slightly preferred some personal coping strategies and informal sources of help over professional resources. Performing a hobby and talking to a confidant were found the most helpful coping strategy and help-seeking behavior, respectively, by young people both for the short and the long term. Professionals’ views were mostly consistent with those of young people. Nevertheless, and somewhat counterintuitive, young people had more positive expectations of the impact of professional help than professionals themselves. Whilst informal strategies still play an important role when dealing with mental health complaints, young people showed generally favorable attitudes towards helpfulness and particularly the impact of professional resources. The list of helpful personal coping strategies identified in this study may provide a focus for implementation in first-line care and for future empirical studies. We highlight the need for educating young people about where to find professional help, and what treatment involves to set realistic expectations.

Despite the preference for transradial access (TRA) in percutaneous coronary interventions (PCI), many operators still use large-bore guiding catheters through the transfemoral approach (TFA), especially in complex cases. This study evaluated the feasibility, safety, and efficacy of the Distal RailTracking (DRT) technique, a sheathless approach via distal radial access (DRA), and investigated its impact on clinical practice. The multicenter SWITCH D-RIL study enrolled patients who required treatment of severely calcified coronary disease by rotational atherectomy, and compared those who underwent PCI before (pre-DRT, n = 97) and after (post-DRT, n = 99) DRT was adopted as the primary approach. Procedural success rates without access site crossover were similar between groups. No significant differences were found in periprocedural complications, in-hospital and 30-day major adverse cardiovascular events, and access- and non-access-related major bleedings. The post-DRT group exhibited a significantly higher use of large-bore guiding catheters (97.1% vs 31.7%). Overall, DRA was used in 90.5% of cases in the post-DRT group, with TFA accounting for 9.5%; the pre-DRT group primarily employed conventional TRA (82.2%), with the remaining cases involving TFA and 1 transbrachial access. The post-DRT group demonstrated increased usage of burrs larger than 1.5 mm (51.4% vs 13.9%) and additional calcium modifying tools (42.9% vs 24.8%). The DRT technique demonstrated feasibility, safety, and efficacy in treating severely calcified coronary disease. This study highlights the reliability of DRA, even when large bore guiding catheters are necessary, emphasizing its potential to provide a safer approach while ensuring radial artery preservation.

BackgroundSkin diseases are symptomatic, visible, and stigmatizing and it is acknowledged that they can be associated with stress. However, large studies comparing disease-specific stress are scarce.ObjectivesTo investigate stress in a large, diverse sample of patients with different skin conditions and identify predictors of stress.MethodsA cross-sectional, multicenter study was conducted in 22 dermatology clinics across 17 European countries (response rate 82.4%). The study included 5487 patients diagnosed with various dermatological conditions and 2808 skin-healthy controls. The Perceived Stress Scale, 10 items was used to measure stress.ResultsPatients reported significantly higher stress levels, more stressful life events during the last 6 months, and more economic difficulties than controls. Patients with psychodermatological conditions, hyperhidrosis, hidradenitis suppurativa, atopic dermatitis, acne, and urticaria experienced the highest stress levels. 44% of the variance of perceived stress in patients with skin conditions could be predicted by sociodemographic data and disease-related and psychological variables (depression, anxiety, stigmatization, and body dysmorphic concerns).LimitationsAs with all cross-sectional studies, causality and directionality cannot be inferred.ConclusionStress poses a significant psychosocial burden to dermatological patients, especially to vulnerable subgroups. Health interventions targeting stress may be essential to improve clinical outcomes.

Urinary tract infections (UTIs) are among the most common infections encountered in healthcare settings. Current diagnostic practices often require 24-48 h due to the time needed for culture results. Given that 70%-80% of cultures return negative, there is significant interest in rapidly identifying negative samples to reduce unnecessary antibiotic use. This study aimed to develop and evaluate 6 machine learning models to predict UTIs. Urine samples from 22 961 patients, collected between September 28, 2023 and June 29, 2024, were analyzed. Six machine learning models were assessed for their ability to predict UTIs based on 5 definitions incorporating pyuria and culture outcomes. The dataset was randomly divided into a training set (70%, n = 16 072) and an independent test set (30%, n = 6889). Seventeen predictive parameters, including dipstick reflectance results and demographic variables, were evaluated. The CatBoost Classifier emerged as the best-performing model, achieving an area under the ROC curve of 92.0%-94.7% depending on the UTI definition, with a negative predictive value consistently exceeding 95%, and an average precision ranging from 68.2% to 81.6%. In comparison, the predictive performance of nitrite and/or leukocyte esterase was significantly lower. Machine learning models, particularly the CatBoost Classifier, demonstrate high accuracy and offer a promising tool to aid clinicians in UTI diagnosis. Unlike traditional culture methods, these models deliver results within an hour. Further external validation with an independent dataset and prospective studies assessing the impact on antibiotic prescribing practices is recommended.

Abstract Purpose: This study quantifies the reproducibility of soft tissue laxity and gap measurements under manual stress, and implant positioning planning using the imageless ROSA® robotic system, by comparing a senior high-volume surgeon with a low-volume resident. Methods: In this single-center prospective study, 17 patients undergoing robotic-assisted total knee arthroplasty were evaluated. Intra- and inter-operator variability was assessed by recording intraoperative measurements and planning outcomes using a standardized protocol for functional alignment (FA). Results: Good-to-excellent reproducibility in soft tissue and gap assessments is demonstrated by both intra- and inter-operator measurements. Minor differences in planning parameters—including stylus height, femoral implant flexion, and the distal femoral cut—are observed, likely due to subjective high-volume surgeon adjustments. Conclusion: High reproducibility in soft tissue measurements and surgical planning across surgeons with different experience levels is shown by the ROSA® robotic system, while flexibility for individualized surgical strategies is retained.

BACKGROUNDThumb replantation following complete traumatic avulsion requires complex techniques to restore function, especially in cases of avulsion at the level of the metacarpophalangeal joint (MCP I) and avulsion of the flexor pollicis longus (FPL) at the musculotendinous junction. Possible treatments include direct tendon suture or tendon transfer, most commonly from the ring finger. To optimize function and avoid donor finger complications, we performed thumb replantation with flexion restoration using brachioradialis (BR) tendon transfer with palmaris longus (PL) tendon graft.CASE SUMMARYA 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail. The patient presented with skin and bone avulsion at the MCP I, avulsion of the FPL tendon at the musculotendinous junction (zone 5), avulsion of the extensor pollicis longus tendon (zone T3), and avulsion of the thumb’s collateral arteries and nerves. The patient was treated with two stage thumb repair. The first intervention consisted of thumb replantation with MCP I arthrodesis, resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis. The second intervention consisted of PL tendon graft and BR tendon transfer. Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°, grip strength of 45 kg, key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSIONFlexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.

Introduction: The study aimed to assess the feasibility of calculating the European Society of Breast Cancer Specialists (EUSOMA) quality indicators (QIs) using Belgian Cancer Registry data coupled to administrative health data and to provide national results. Methods: Women diagnosed with ductal carcinoma in situ (DCIS) or invasive breast cancer (IBC) in 2014–2018 were selected from the cancer registry. Fourteen EUSOMA QIs were chosen to assess the quality of care. Results: Overall, 46,035 patients with IBC and 3,973 patients with DCIS were included. Most QIs had to be rephrased so that they could be calculated with the available data. None of the selected QIs on systemic treatment could be calculated due to a lack of reliable receptor status information. For some Qis, there is ample room for improvement in Belgian clinical practice: cTNM stage reporting, multidisciplinary team meetings, sentinel lymph node biopsy only in IBC with clinically negative lymph nodes. The result was 1–5% lower than the target for mammography and breast ultrasound, pTNM reporting, start of treatment, single breast surgery in DCIS, and no axillary clearance in DCIS. For histological or cytological assessment, receptor status assessment, start of radiotherapy, and single breast surgery in IBC, the results were at or above the target. Conclusion: Several EUSOMA QIs can be calculated with routinely collected data, while for several important aspects of care additional data collection is indicated so that its quality can be assessed. The validity of the obtained results depends on the reporting accuracy.