Le syndrome hépato-rénal: revue Le syndrome hépato-rénal (SHR) est défini comme une insuffisance rénale fonctionnelle chez les patients atteints d'une maladie hépatique présentant des reins morphologiquement intacts, où les mécanismes de régulation ont minimisé la filtration glomérulaire et maximisé la résorption tubulaire et la concentration urinaire. Le syndrome survient presque exclusivement chez les patients atteints d'ascite. Le type 1 du SHR se développe à la suite d'une réduction sévère du volume circulant efficace en raison d'une vasodilatation artérielle splanchnique extrême et une réduction du débit cardiaque. Le type 2 du SHR est caractérisé par une insuffisance rénale stable ou lentement progressive, de sorte que sa principale conséquence clinique n'est pas une insuffisance rénale aiguë, mais une ascite réfractaire, et son impact sur le pronostic est moins négatif. La transplantation hépatique est la méthode thérapeutique

Introduction Telemedicine has emerged as a critical technology to mitigate SARS-CoV-2 infection. We aim in this work to explore how general practitioners (GPs) perceived the use of telemedicine, recently recognized and reimbursed by the Public Health Insurance House (PHIH) for primary care (PC) provision. Methods A cross-sectional study was performed in 2020 in one county of Romania using an anonymous questionnaire that assessed physicians’ perceptions regarding teleconsultation, reliability in tele-decision, remote pathology management, pregnant women’s surveillance, patients’ satisfaction with telemedicine, the need for its further reimbursement. Bivariate correlation was used to measure associations between the investigated issues. Results More than a quarter of GPs (28.6%) found it easier to address patients’ healthcare needs remotely, while 60.7% considered time-consuming teleconsultations compared to face-to-face visits. Tele-diagnostic uncertainty was expressed by 64.3% of physicians, and a quarter were confident in tele-decisions. Almost half of GPs (43%) observed patients’ satisfaction with tele-visits, while half said patients encountered difficulties using technology. A large percentage of doctors (62.5%) perceived that patients felt as well treated by virtual as in-person visit and 91.1% suggested post-pandemic reimbursement. The results of the bivariate correlation showed that physicians who perceived positive patient feedback on telemedicine were more supportive of subsequent reimbursement. Conclusion This study showed the GPs’ positive perception of the use of telemedicine. Its adoption in PC has shed light on the shadows of the pandemic. The time-consuming nature of teleconsultations, uncertainty in tele-decisions, patients’ difficulties in using technology were seen as shadows of telecare. However, most of the GPs surveyed agreed with the need for further reimbursement. Future work should focus on innovative solutions for integrating telemedicine as complementary form of PC, the need for telemedicine-based training for GPs to improve capacity building, and patients’ perceptions of virtual care, helping to build trust and satisfaction.

Prediction problems in biomedical sciences are generally quite difficult, partially due to incomplete knowledge of how the phenomenon of interest is influenced by the variables and measurements used for prediction, as well as a lack of consensus regarding the ideal predictor(s) for specific problems. In these situations, a powerful approach to improving prediction performance is to construct ensembles that combine the outputs of many individual base predictors, which have been successful for many biomedical prediction tasks. Moreover, selecting a parsimonious ensemble can be of even greater value for biomedical sciences, where it is not only important to learn an accurate predictor, but also to interpret what novel knowledge it can provide about the target problem. Ensemble selection is a promising approach for this task because of its ability to select a collectively predictive subset, often a relatively small one, of all input base predictors. One of the most well-known algorithms for ensemble selection, CES (Caruana et al.’s Ensemble Selection), generally performs well in practice, but faces several challenges due to the difficulty of choosing the right values of its various parameters. Since the choices made for these parameters are usually ad-hoc, good performance of CES is difficult to guarantee for a variety of problems or datasets. To address these challenges with CES and other such algorithms, we propose a novel heterogeneous ensemble selection approach based on the paradigm of reinforcement learning (RL), which offers a more systematic and mathematically sound methodology for exploring the many possible combinations of base predictors that can be selected into an ensemble. We develop three RL-based strategies for constructing ensembles and analyze their results on two unbalanced computational genomics problems, namely the prediction of protein function and splice sites in eukaryotic genomes. We show that the resultant ensembles are indeed substantially more parsimonious as compared to the full set of base predictors, yet still offer almost the same classification power, especially for larger datasets. The RL ensembles also yield a better combination of parsimony and predictive performance as compared to CES.

Dyslipidemia is a significant threat to public health worldwide and the identification of its pathogenic mechanisms, as well as novel lipid-lowering agents, are warranted. Magnesium (Mg) is a key element to human health and its deficiency has been linked to the development of lipid abnormalities and related disorders, such as the metabolic syndrome, type 2 diabetes mellitus, or cardiovascular disease. In this review, we explored the associations of Mg (dietary intake, Mg concentrations in the body) and the lipid profile, as well as the impact of Mg supplementation on serum lipids. A systematic search was computed in PubMed/MEDLINE and the Cochrane Library and 3649 potentially relevant papers were detected and screened (n = 3364 following the removal of duplicates). After the removal of irrelevant manuscripts based on the screening of their titles and abstracts (n = 3037), we examined the full-texts of 327 original papers. Finally, after we applied the exclusion and inclusion criteria, a number of 124 original articles were included in this review. Overall, the data analyzed in this review point out an association of Mg concentrations in the body with serum lipids in dyslipidemia and related disorders. However, further research is warranted to clarify whether a higher intake of Mg from the diet or via supplements can influence the lipid profile and exert lipid-lowering actions.

ObjectiveTo describe the activities performed by people involved in clinical decision support (CDS) at leading sites.Materials and methodsWe conducted ethnographic observations at seven diverse sites with a history of excellence in CDS using the Rapid Assessment Process and analyzed the data using a series of card sorts, informed by Linstone's Multiple Perspectives Model.ResultsWe identified 18 activities and grouped them into four areas. Area 1: Fostering relationships across the organization, with activities (a) training and support, (b) visibility/presence on the floor, (c) liaising between people, (d) administration and leadership, (e) project management, (f) cheerleading/buy-in/sponsorship, (g) preparing for CDS implementation. Area 2: Assembling the system with activities (a) providing technical support, (b) CDS content development, (c) purchasing products from vendors (d) knowledge management, (e) system integration. Area 3: Using CDS to achieve the organization's goals with activities (a) reporting, (b) requirements-gathering/specifications, (c) monitoring CDS, (d) linking CDS to goals, (e) managing data. Area 4: Participation in external policy and standards activities (this area consists of only a single activity). We also identified a set of recommendations associated with these 18 activities.DiscussionAll 18 activities we identified were performed at all sites, although the way they were organized into roles differed substantially. We consider these activities critical to the success of a CDS program.ConclusionsA series of activities are performed by sites strong in CDS, and sites adopting CDS should ensure they incorporate these activities into their efforts.