[Flemish guideline for the prevention and use of seclusion and restraint]. / Vlaamse richtlijn voor de preventie en het gebruik van afzondering en fixatie.

BACKGROUND: International consensus states that seclusion and restraint should only be applied as briefly and as little as possible. However, audits by the Care Inspectorate show that this is not always the case in Flemish mental health care (MHC). AIM: To describe the development of a multidisciplinary guideline for the prevention and application of seclusion and restraint in inpatient MHC, underpinned by both clinical-scientific and legal evidence. METHOD: The GRADE method formed the basis for the development of the guideline. To integrate both types of evidence, two research phases were added. This article provides an overview of the challenges involved in implementing this interdisciplinary method. RESULTS: There are gaps in both clinical-scientific and legal evidence. Nevertheless, the study resulted in a comprehensive guideline because we underpinned the recommendations with practice- and experience-based expertise of the Flemish stakeholders, and integrated the clinical-scientific and legal evidence. CONCLUSION: Focus on implementation research and a clear legal framework for Flanders are necessary to safeguard the (human) rights of MHC users, also in the event of aggression and escalation.

Added value of diffusion weighted MR imaging in the diagnosis of postpartum ovarian vein thrombosis.

Postpartum ovarian vein thrombosis (POVT) is a rare cause of right fossa pain but the diagnosis should be considered in the clinical setting of persistent fever and lower quadrant tenderness in the postpartum period. Although ultrasound is the initial step in the diagnostic work-up right fossa pain, it is often limited by overlying bowel gas and an enlarged puerperal uterus. Therefore, most authors recommend Computed Tomography (CT) as the imaging technique of choice to confirm the clinical suspicion of POVT. Because Magnetic Resonance Imaging (MRI) is less readily available, it is rarely performed for this indication. However, MRI allows not only to make the diagnosis as accurate as CT, but moreover it provides 2 important advantages in compared to CT. First, it avoids ionizing radiation. Secondly, the use of diffusion weighted imaging (DWI) may obviate the administration of intravenous contrast.

Testicular sarcoidosis.

We describe a very unusual form of sarcoidosis of the testis, mimicking malignancy at initial presentation. Genitourinary sarcoidosis is rare and this case report emphasizes the importance of meticulous analysis of the patient's clinical history combined with imaging findings and specific pathological criteria to diagnose this granulomatous disorder.

Splenic hamartoma presenting as an occasional asymptomatic finding.

We report a case of splenic hamartoma that was occasionally detected. Ultrasonography performed as a screening examination revealed a hypoechoic splenic lesion. A computed tomography and magnetic resonance examination were performed in order to characterize the lesion but failed to make a final diagnosis. An elective laparoscopic splenectomy with consecutive histologic examination revealed a splenic hamartoma. Splenectomy may be required for definite characterization of this type of splenic lesion.

Laparoscopy. Basic science and future directions.

Although the problem of port-site metastases is mainly related to the surgeon, the technique, manipulation of the tumor-bearing organ, and some other factors related to laparoscopy itself have been shown to influence tumor growth. The different experimental studies about basic research and possible new therapeutic strategies, including instillation of cytotoxic and immune modulating agents in combination with laparoscopy, are presented and discussed.

Influence of erythropoietin on dialyzer reuse, heparin need, and urea kinetics in maintenance hemodialysis patients.

The administration of erythropoietin (EPO) in maintenance hemodialysis may affect urea kinetic parameters by altering dialyzer function during first use and reuse, and dietary protein intake as a consequence of increased appetite. In the present study, the effect of EPO treatment on urea kinetic parameters in case of reuse (n = 14) and first use (n = 10) of dialyzers was assessed in 24 clinically stable hemodialysis patients who were evaluated before and during EPO treatment. In addition, the heparin need and the number of uses before discarding the dialyzer were registered. No significant differences between urea kinetic parameters before compared with during EPO treatment were noted in the overall population or in the subgroups treated with reused or first-use dialyzers. However, in 13 patients with a low baseline protein catabolic rate (pcr(wt)) (pcr(wt) < 1.0 g/kg/24 hr before EPO treatment), pcr(wt) increased from 0.81 +/- 0.04 to 0.93 +/- 0.06 (+ 15%, P < 0.01). The heparin dosage increased from 6,693 +/- 419 IU/session to 7,659 +/- 566 IU/session and from 5,538 +/- 594 IU/session to 6,918 +/- 649 IU/session (P < 0.05) in the subgroups treated with reused or first-use dialyzers, respectively. Nevertheless, when dialyzer reprocessing was performed, the number of achieved uses before discarding the dialyzers was reduced after the introduction of EPO (5.4 +/- 0.4 v 3.4 +/- 0.4, P < 0.01). In conclusion, during EPO treatment urea kinetic parameters were not affected in case of dialyzer first use or in case of reuse. In patients with low pretreatment values, pcr(wt) increased, possibly indicating improved protein intake in malnourished patients.(ABSTRACT TRUNCATED AT 250 WORDS)