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The Belgian EBP Network : operationalisation of processes and governance structures for the Federal EBP Programme
No full text144 p.ill.,1. INTRODUCTION 10 -- 1.1 THE CONCEPT OF EVIDENCE-BASED PRACTICE (EBP) 10 -- 1.2 FEDERAL INITIATIVES THAT PRECEDED THIS REPORT 10 -- 1.2.1 From a ministerial note to a governance plan 10 -- 1.2.2 A network structure, three lines of power 11 -- 2. METHODOLOGY 14 -- 2.1 DESIGN 14 -- 2.2 FEEDBACK AND VALIDATION 14 -- 2.3 IMPLEMENTATION 16 -- 2.4 OPERATIONALISATION TIMELINE 16 -- 2.5 WORKSHOP OVERVIEW 17 -- 2.6 ORGANISATIONS INVOLVED IN DEVELOPMENT AND FEEDBACK PROCESSES OF THE EBP CHARTER OF GOOD GOVERNANCE 18 -- 3. CHARTER OF GOOD GOVERNANCE 20 -- 3.1 DEVELOPMENT OF THIS CHARTER 20 -- 3.2 THE EBP NETWORK STRATEGIC FRAMEWORK 22 -- 3.2.1 Stakeholders 24 -- 3.2.2 Mission 27 -- 3.2.3 Vision 30 -- 3.2.4 Strategic Goals 31 -- 3.3 PROCESSES OF THE EBP NETWORK: GENERAL OUTLINE 32 -- 3.3.1 The EBP Scientific Processes - The EBP Life Cycle 34 -- 3.3.2 The EBP Network processes 49 -- 3.3.3 Coordination and decision making processes 51 -- 3.4 COORDINATION AND DECISION MAKING ENTITIES IN THE EBP NETWORK 52 -- 3.4.1 Federal Steering Board 52 -- 3.4.2 Core Partner Meeting 54 -- 3.4.3 Advisory Board 54 -- 3.4.4 EBP Network Coordinator 57 -- 3.5 DECISION MAKING AND INTERACTION PROCESS IN THE EBP NETWORK 58 -- 3.5.1 Formal interaction procedure 59 -- 3.5.2 Interaction between the Federal Steering Board, the Advisory Board and the Core Partners 61 -- 3.6 PERFORMANCE MANAGEMENT 61 -- 3.6.1 The role of feedback in organisational performance management 61 -- 3.6.2 Performance management of Core Partners 63 -- 3.7 HOW THIS DOCUMENT WILL BE UPDATED 6
Cost-effectiveness analysis of HPV vaccination of boys in Belgium
No full text107 p.ill.,LIST OF FIGURES 4 -- LIST OF TABLES .5 -- LIST OF ABBREVIATIONS 7 -- SCIENTIFIC REPORT .9 -- 1 BACKGROUND .9 -- 1.1 HPV INFECTION AND DISEASE .9 -- 1.2 THE HPV VACCINES 10 -- 1.2.1 Cervarix .11 -- 1.2.2 Gardasil .11 -- 1.2.3 Gardasil 9 .12 -- 2 HPV VACCINATION IN BELGIUM 12 -- 2.1 RECOMMENDATIONS OF HPV VACCINATION 12 -- 2.2 ORGANISATION AND FUNDING 13 -- 2.2.1 NIHDI reimbursement 13 -- 2.2.2 Vaccination programmes .14 -- 2.3 VACCINE UPTAKE 14 -- 3 RESEARCH QUESTIONS .15 -- 4 BURDEN OF HPV DISEASES IN BELGIUM 17 -- 4.1 METHODS 17 -- 4.2 HPV PREVALENCE IN BELGIUM OR IN SIMILAR SETTINGS 17 -- 4.3 BURDEN OF HPV-RELATED CANCERS .18 -- 4.3.1 Cervical cancer .22 -- 4.3.2 Anal cancers 22 -- 4.3.3 Vulvar cancer .22 -- 4.3.4 Vaginal cancer 23 -- 4.3.5 Penile cancer .23 -- 4.3.6 Oropharyngeal cancers .24 -- 4.4 BURDEN OF ANOGENITAL WARTS 25 -- 4.5 OTHER COMPLICATIONS OF HPV INFECTION .26 -- 4.6 GENDER DIFFERENCES IN HPV-RELATED DISEASES 26 -- 5 VACCINE EFFICACY AND SAFETY 27 -- 5.1 METHODS 27 -- 5.2 VACCINE EFFICACY 27 -- 5.2.1 Cervical cancers 29 -- 5.2.2 Anal cancer .31 -- 5.2.3 Vulvar and vaginal cancers .32 -- 5.2.4 Penile cancer .33 -- 5.2.5 Oropharyngeal cancer 34 -- 5.2.6 Anogenital warts 35 -- 5.2.7 Additional results for HPV9 .36 -- 5.3 BRIDGING STUDIES 36 -- 5.4 CROSS-PROTECTION 36 -- 5.5 DURATION OF PROTECTION 37 -- 5.6 EFFICACY OF SHORTER SCHEDULE .37 -- 5.7 COMPARISON ACROSS VACCINES .38 -- 5.8 VACCINE SAFETY .38 -- 6 HERD EFFECTS OF HPV VACCINATION 39 -- 6.1 METHODS 39 -- 6.2 SYSTEMATIC REVIEWS 39 -- 6.3 AUSTRALIA 40 -- 7 HPV VACCINATION OF MALES IN OTHER INDUSTRIALISED COUNTRIES 41 -- 7.1 BOYS .41 -- 7.2 MEN HAVING SEX WITH MEN 44 -- 8.1 METHODS 45 -- 8.2. Technical characteristics, vaccine costs and diseases modelled 46 -- 8.2.2 Vaccine efficacy and duration of protection 48 -- 8.2.3 Outcomes considered 50 -- 8.2.4 Disease burden and HPV attribution fraction .50 -- 8.3.1 Criteria 55 -- 8.3.2 Results 55 -- 8.4.1 What is the cost-effectiveness universal (girls and boys) versus girl-only HPV vaccination for the EMA+ indications? 59 -- 8.4.2 What is the cost-effectiveness of universal (girls and boys) versus girl-only HPV vaccination for all HPV-related diseases? 63 -- 8.4.3 Is extending HPV vaccination to boys more cost-effective than increasing the vaccine uptake in girls? 66 -- 8.4.4 If universal (girls and boys) vaccination is opted for, which vaccine is cost-effective? 68 -- 8.4.5 What is the cost-effectiveness of universal (girls and boys) versus girl-only vaccination using low vaccine prices? 69 -- 8.4.6 What is the impact of the vaccine duration of protection on the incremental costeffectiveness ratio? .70 -- 9 DISCUSSION 72 -- 9.1 CLINICAL ASPECTS .72 -- 9.2 ECONOMIC ASPECTS 73 -- 9.3 OTHER ASPECTS 74 -- 9.4 LIMITATIONS 75 -- 9.5 CONCLUSIONS 76 -- APPENDICES 77 -- REFERENCES .9
Proposals for a more effective antibiotic policy in Belgium
No full text378 p.ill.,SCIENTIFIC REPORT 23 -- 1 INTRODUCTION 23 -- 1.1 SHORT DESCRIPTION OF THE PROBLEM 23 -- 1.1.1 Antibiotic resistance 23 -- 1.1.2 Antibiotic use in Belgium 24 -- 1.1.3 The concept of prudent antimicrobial/antibiotic use 24 -- 1.1.4 One Health approach 24 -- 1.1.5 Belgian Antibiotic Policy Coordination Committee (BAPCOC) 24 -- 1.1.6 Difficult to obtain significant improvements 24 -- 1.2 RESEARCH QUESTIONS & SCOPE 25 -- 1.3 TERMINOLOGY 25 -- 1.4 METHODOLOGY 26 -- 1.5 STRUCTURE OF THE REPORT 26 -- 2 ANTIBIOTIC USE AND ITS LINK WITH ANTIBACTERIAL RESISTANCE 27 -- 2.1 WHAT IS ANTIMICROBIAL RESISTANCE? 27 -- 2.1.1 Antibacterial resistance, a natural phenomenon .27 -- 2.1.2 How do bacteria become resistant? 27 -- 2.1.3 How does antibiotic resistance spread? 28 -- 2.1.4 Multidrug resistant organisms 28 -- 2.1.1 Resistance in community and healthcare acquired infections 29 -- 2.2 WHAT IS PRUDENT ANTIBIOTIC USE? 29 -- 2.3 USE AND MISUSE OF ANTIBIOTICS .30 -- 2.4 THE BURDEN OF ANTIBACTERIAL RESISTANCE 30 -- 2.5 TIME FOR ACTION 32 -- 3 ANTIBIOTICS IN BELGIUM 33 -- 3.1 WHO CAN PRESCRIBE ANTIBIOTICS IN BELGIUM? 33 -- 3.1.1 Human sector 33 -- 3.1.2 Veterinary sector 34 -- 3.2 WHO CAN OBTAIN ANTIBIOTICS IN BELGIUM AND HOW? 34 -- 3.2.1 Human sector 34 -- 3.2.2 Who can administer antibiotics to animals and who is allowed to keep stocks of medicines at farms? 35 -- 3.3 FINANCIAL ASPECTS 36 -- 3.3.1 Human sector 36 -- 3.3.2 Veterinary sector 42 -- 3.4 ACTORS INVOLVED, INSPIRED BY THE VIABLE SYSTEMS MODEL 43 -- 3.4.1 Introduction 43 -- 3.4.2 Human sector 43 -- 3.4.3 Veterinary sector 50 -- 4 ANTIBIOTIC USE AND ANTIMICROBIAL RESISTANCE 54 -- 4.1 HOW TO MEASURE ANTIBIOTIC USE 54 -- 4.1.1 Human sector 54 -- 4.1.2 Veterinary sector 59 -- 4.2 HOW IS ANTIBIOTIC USE MONITORED? 61 -- 4.2.1 Human sector 61 -- 4.2.2 Veterinary sector 65 -- 4.3 DATA ON ANTIBIOTIC USE IN BELGIUM, IN A EUROPEAN CONTEXT 68 -- 4.3.1 Human sector 68 -- 4.3.2 Veterinary sector 83 -- 4.4 ANTIBIOTIC USE IN THE BELGIAN AMBULATORY AND HOSPITAL SECTOR FURTHER EXPLORED 90 -- 4.4.1 Methods 90 -- 4.4.2 Results 92 -- 5 DETERMINANTS OF ANTIBIOTIC PRESCRIPTION AND USE 104 -- 5.1 DETERMINANTS OF ANTIBIOTIC PRESCRIBING IN HUMAN MEDICINE 104 -- 5.1.1 Determinants of antibiotic prescription in Belgium 105 -- 5.1.2 Determinants of antibiotic prescription in other regions 110 -- 5.1.3 Determinants of antibiotic use by patients 116 -- 5.1.4 Limitations 119 -- 5.2 DETERMINANTS OF ANTIBIOTIC PRESCRIPTION AND CHOICE IN VETERINARY MEDICINE 120 -- 5.2.1 Methods 120 -- 5.2.2 Determinants of antibiotic prescription 121 -- 5.2.3 Determinants of antibiotic choice 126 -- 5.2.4 Limitations 127 -- 6 INTERVENTIONS TO PROMOTE THE PRUDENT USE OF ANTIBIOTICS 128 -- 6.1 INTERVENTIONS TO PROMOTE THE PRUDENT USE OF ANTIBIOTICS IN THE HUMAN SECTOR 128 -- 6.1.1 Belgian interventions to promote the prudent use of antibiotics 128 -- 6.1.2 Interventions that have been implemented and evaluated elsewhere 153 -- 6.2 INTERVENTIONS TO PROMOTE THE PRUDENT USE OF ANTIBIOTICS IN THE VETERINARY SECTOR 167 -- 6.2.1 Introduction 167 -- 6.2.2 Nation-wide interventions to promote prudent antibiotic use 169 -- 6.2.3 European initiatives 173 -- 6.2.4 Concluding remarks 173 -- 6.2.5 Examples from abroad 173 -- 6.3 OTHER ASPECTS TO CONSIDER IN DEVELOPING INTERVENTIONS AIMING TO CHANGE PRESCRIPTION BEHAVIOUR 177 -- 7 STAKEHOLDER CONSULTATION AND SYSTEMS MAPPING 178 -- 7.1 INTRODUCTION 178 -- 7.2 APPROACH 178 -- 7.3 SYSTEMS MAP 179 -- 7.3.1 Concept and syntax of the systems map developed in this research 180 -- 7.3.2 The status of the systems map 181 -- 7.3.3 Use of systems maps 182 -- 7.4 METHODS 184 -- 7.4.1 Selection of stakeholders 184 -- 7.4.2 Interview guide 184 -- 7.4.3 Coding of interviews .185 -- 7.4.4 Internal review of the systems map 185 -- 7.4.5 Stakeholder review of the systems map 187 -- 7.4.6 Stakeholder deliberation on suggested improvements of antibiotics policy 187 -- 7.5 FINDINGS 187 -- 7.5.1 Main features of the systems map 187 -- 7.5.2 Description and presentation of the systems map 190 -- 7.5.3 Assessment of the scope of the systems map 219 -- 7.5.4 Stakeholders’ suggestions to improve antibiotic policy, prescription and use 220 -- 7.6 DISCUSSION 230 -- 7.7 CONCLUSION 232 -- 8 OTHER CHALLENGES WITH REGARD TO ANTIBIOTIC POLICY IN BELGIUM 233 -- 8.1 ACCESS TO THE RIGHT ANTIBACTERIAL PRODUCT NOT STRAIGHTFORWARD 233 -- 8.1.1 Background 233 -- 8.1.2 The availability of antibiotics in Belgium 235 -- 8.2 MISMATCH BETWEEN ANTIBIOTIC PACKAGE SIZE AND GUIDELINES FOR THEIR USE LEADING TO SELF-MEDICATION 238 -- 8.3 ETHICAL CHALLENGE: INDIVIDUAL VS. COLLECTIVE RESPONSIBILITY 241 -- 9 JOINT EC – ECDC ONE HEALTH COUNTRY VISIT TO BELGIUM – KEY ISSUES WITH REGARD TO ANTIBIOTIC USE 242 -- 9.1 HUMAN HEALTH – ECDC 242 -- 9.1.1 Observations made by ECDC 242 -- 9.1.2 Key recommendations made by ECDC 245 -- 9.2 ANIMAL HEALTH - DG HEALTH AND FOOD SAFETY 247 -- 9.2.1 Observations made by DG Health and Food Safety 247 -- 9.2.2 Considerations for possible future actions 250 -- 10 DISCUSSION 251 -- 11 HOW CAN THE SITUATION BE IMPROVED? 253 -- 11.1 DEVELOP A NATIONAL ONE HEALTH AMR ACTION PLAN 253 -- 11.2 STRENGTHEN ANTIBIOTIC STEWARDSHIP IN ACUTE CARE HOSPITALS 254 -- 11.3 ROLL OUT LOCAL ANTIBIOTIC STEWARDSHIP TEAMS IN THE AMBULATORY SECTOR 255 -- 11.4 DEVELOP ANTIBIOTIC STEWARDSHIP IN NURSING HOMES 255 -- 11.5 IMPROVE THE PROFESSIONAL EDUCATION ON PRUDENT ANTIBIOTIC PRESCRIPTION AND USE, AND DEVELOP AND IMPLEMENT INTERVENTIONS TARGETING PSYCHOLOGI CAL, SOCIAL AND INSTITUTIONAL DETERMINANTS OF BEHAVIOURAL CHANGE 256 -- 11.6 RECOGNISE MEDICAL MICROBIOLOGY AND INFECTIOLOGY AS MEDICAL SPECIALTY AND PROVIDE REMUNERATION FOR THEIR ADVICE 257 -- 11.7 IMPROVE THE AVAILABILITY OF OLD/NARROW SPECTRUM ANTIBIOTICS 257 -- 11.8 PUT INTO PRACTICE THE DELIVERY OF THE EXACT NUMBER OF ANTIBIOTIC TABLETS IN PHARMACIES OPEN TO THE PUBLIC 258 -- 11.9 IMPROVE THE COMPLIANCE WITH EVIDENCE-BASED PRESCRIPTION GUIDELINES 258 -- 11.10 MAKE USE OF THE (FUTURE) MANDATORY IMPLEMENTATION OF E-PRESCRIBING TO IMPROVE THE PRUDENT PRESCRIPTION OF ANTIBIOTICS 259 -- 11.11 CONSIDER TAKING STRUCTURAL MEASURES TO IMPROVE THE PRUDENT PRESCRIPTION AND USE OF ANTIBIOTICS 259 -- 11.12 PERFORM A HEALTH TECHNOLOGY ASSESSMENT ON POINT OF CARE TESTING FOR THE DIAGNOSIS OF INFECTIOUS DISEASES IN THE BELGIAN AMBULATORY CARE CONTEXT 259 -- 11.13 STIMULATE BEHAVIOURAL CHANGE AMONG THE GENERAL PUBLIC AS WELL AS THE PRESCRIBERS TOWARDS MORE PRUDENT USE OF ANTIBIOTICS 260 -- 11.14 STRENGTHEN VETERINARIANS’ COUNSELLING ROLE 260 -- 11.15 CHANGE PRESCRIBING BEHAVIOUR OF HIGH ANTIBIOTIC PRESCRIBERS 261 -- 11.16 MONITOR AND STIMULATE RESEARCH ON ANTIBIOTIC USE AND AMR IN THE SECTOR OF COMPANION ANIMALS 261 -- 11.17 STIMULATE BIOSECURITY IMPROVEMENTS AS AN ALTERNATIVE TO ANTIBIOTIC USE 261 -- 11.18 ENFORCE COMPLIANCE WITH THE LEGISLATION ON ANIMAL WELFARE 262 -- 11.19 MAKE THE USE OF ANTIBIOTICS AS MEANS TO INTENSIFY ANIMAL PRODUCTION SUPERFLUOUS 263 -- 11.20 AVOID SELF-MEDICATION BY MINIMIZING STOCKS AT FARMS AND BY ADJUSTING PACKAGE SIZES .263 -- 11.21 DEFINE NEW GOALS REGARDING ANTIBIOTICS IN THE VETERINARY SECTOR 26
Sexually Transmitted Infections in primary care consultations : development of an online tool to guide healthcare practitioners
No full text72 p.ill.,LIST OF TABLES 3 -- LIST OF FIGURES 4 -- LIST OF ABBREVIATIONS 5 -- SCIENTIFIC REPORT 7 -- 1 INTRODUCTION 7 -- 2 DEVELOPMENT OF THE SCIENTIFIC CONTENT 8 -- 2.1 GENERAL APPROACH AND CLINICAL RESEARCH QUESTIONS 8 -- 2.2 SEARCH FOR GUIDELINES, GUIDANCE INSTRUMENTS AND QUALITY APPRAISAL 10 -- 2.2.1 Search strategy 10 -- 2.2.2 Identification and selection of guidance documents 10 -- 2.2.3 Quality appraisal 12 -- 2.3 SCIENTIFIC CONTENT 12 -- 2.3.1 How to start a conversation about sexual health 12 -- 2.3.2 How to assess if the patient is ready for STI testing and if there is a need for testing 16 -- 2.3.3 How to define the patient’s risk or risk group for an STI 17 -- 2.3.4 How to define which STI should be tested for by groups at risk 20 -- 2.3.5 Which is the correct sample for each STI 23 -- 2.3.6 How should the STI be treated 26 -- 2.3.7 The follow-up of a patient with an STI 28 -- 2.3.8 How often should a patient with an STI be re-tested 30 -- 2.3.9 Tracing partners of a patient with an STI 30 -- 2.3.10 How are partners best contacted 31 -- 2.3.11 Notification of infectious diseases 33 -- 3 DEVELOPMENT OF THE TOOL 33 -- 3.1 THE CHOICE OF TECHNICAL SPECIFICATIONS REQUIRED FOR THE DEVELOPMENT AND FOR THE UPDATE OF THE TOOL 33 -- 3.2 THE DEVELOPMENT OF THE TOOL INTEGRATING THE CONTENT IN ENGLISH, FRENCH AND DUTCH 34 -- 3.2.1 Iterative first phase: alpha version 34 -- 3.2.2 A preliminary assessment of the tool: beta version 34 -- 3.2.3 Feedback from KCE experts and NGC 35 -- 3.3 A TEST OF THE REVISED VERSION OF THE TOOL 35 -- 3.3.1 Testing via an online survey 35 -- 3.3.2 Feedback from HCPs, GDG members and patients’ representatives 35 -- 4 DISSEMINATION OF THE ONLINE TOOL 36 -- 4.1 KCE COMMUNICATION STRATEGY 36 -- 4.1.1 Website 36 -- 4.1.2 Press 37 -- 4.1.3 Social media and newsletters 37 -- 4.2 EBPNET COMMUNICATION 37 -- 5 CONCLUSION 37 -- APPENDICES 38 -- APPENDIX 1. GUIDANCE DOCUMENTS AND CONSULTATION ALGORITHMS 38 -- APPENDIX 2. STARTING A SEXUAL HEALTH CONVERSATION 40 -- APPENDIX 3. SEXUAL HISTORY QUESTIONS 42 -- APPENDIX 4. HIV TESTING 49 -- APPENDIX 5. WHICH STI TEST 51 -- APPENDIX 6. HEPATITIS TESTING 53 -- APPENDIX 7. STI SAMPLES 55 -- APPENDIX 8. HIV REFERENCE CENTRES 56 -- APPENDIX 9. RETESTING AFTER A POSITIVE TEST 57 -- APPENDIX 10. PARTNER TRACING 59 -- APPENDIX 11. CONTACTING PARTNERS 61 -- APPENDIX 12. SURVEY 63 -- REFERENCES 7
Diagnosis and management of gonorrhoea and syphilis : Appendix
No full text305 p.ill.,1. COMPOSITION OF THE GUIDELINE DEVELOPMENT GROUP 12 -- 1.1. COMPOSITION OF THE GUIDELINE DEVELOPMENT GROUP 12 -- 1.2. COMPOSITION OF THE KCE EXPERT TEAM 13 -- 1.3. EXTERNAL RESEARCHERS INVOLVED IN THE GUIDELINE DEVELOPMENT 13 -- 2. SEARCH STRATEGIES 14 -- 2.1. GENERAL LITERATURE SEARCH 14 -- 2.1.1. Ovid MEDLINE 14 -- 2.1.2. Cochrane 15 -- 2.1.3. Embase 17 -- 2.1.4. Study flow for general literature search 21 -- 2.2. ADDITIONAL SEARCH FOR DIAGNOSIS OF GONORRHOEA 22 -- 2.2.1. Medline 22 -- 2.2.2. Central 22 -- 2.2.3. Study flow of selection of primary studies 22 -- 2.2.4. Excluded studies 24 -- 2.3. ADDITIONAL SEARCH FOR TREATMENT OF GONORRHEA 28 -- 2.3.1. Medline 28 -- 2.3.2. Embase 29 -- 2.3.3. Cochrane 30 -- 2.3.4. Study flow of selection of primary studies 31 -- 2.3.5. Excluded studies 33 -- 2.4. ADDITIONAL SEARCH FOR DIAGNOSIS OF SYPHILIS 35 -- 2.4.1. Medline 35 -- 2.4.2. Cochrane 36 -- 2.4.3. Study flow of selection of systematic reviews and primary studies 37 -- 2.4.4. Excluded studies 38 -- 2.5. ADDITIONAL SEARCH FOR TREATMENT OF SYPHILIS 39 -- 2.5.1. Medline 39 -- 2.5.2. Embase 40 -- 2.5.3. Cochrane 40 -- 2.5.4. Pubmed 41 -- 2.5.5. Excluded studies 43 -- 3. GUIDELINES IDENTIFIED 44 -- 3.1. TOPIC: DIAGNOSIS AND/OR MANAGEMENT OF GONORRHOEA 44 -- 3.2. TOPIC: DIAGNOSIS AND/OR MANAGEMENT OF SYPHILIS 45 -- 4. GUIDANCE DOCUMENTS AND CONSULTATION ALGORITHMS FOR THE TOOL 46 -- 5. GUIDANCE DOCUMENTS FOR PARTNER MANAGEMENT 48 -- 6. QUALITY APPRAISAL 50 -- 6.1. QUALITY APPRAISAL TOOLS 50 -- 6.1.1. Guidelines 50 -- 6.1.2. Diagnostic accuracy studies 54 -- 6.1.3. Primary studies for therapeutic interventions 59 -- 7. EVIDENCE TABLES BY CLINICAL QUESTION 73 -- 7.1. DIAGNOSIS OF GONORRHEA 73 -- 7.1.1. Nucleic acid amplification Tests (NAATs) and culture 73 -- 7.2. TREATMENT OF GONORRHOEA 136 -- 7.2.1. Sexually active women and men including adolescents 136 -- 7.2.2. Pregnant women 144 -- 7.2.3. People with an allergy to cephalosporin 150 -- 7.3. DIAGNOSIS OF SYPHILIS 150 -- 7.3.1. Screening strategies 151 -- 7.3.2. Polymerase Chain Reaction (PCR) assay 154 -- 7.3.3. Enzyme Immunoassay (EIA) 157 -- 7.3.4. Rapid point of care (POC) tests for syphilis 161 -- 7.4. TREATMENT OF SYPHILIS 177 -- 7.4.1. Research question 7 – What is the recommended treatment for uncomplicated syphilis in sexually active women and men including young people? 177 -- 7.4.2. Research question 8 – What is the recommended treatment for uncomplicated syphilis in case of allergy to penicillin? 211 -- 8. FOREST PLOTS 212 -- 8.1. N. GONORRHOEA AND C. TRACHOMATIS: DIAGNOSIS 212 -- 8.2. N. GONORRHOEA: TREATMENT 219 -- 8.2.1. Sexually active women and men including young people 219 -- 8.2.2. Pregnant women 224 -- 8.2.3. People with severe cephalosporin allergy 228 -- 8.3. SYPHILIS: DIAGNOSIS 228 -- 8.4. SYPHILIS: TREATMENT 230 -- 8.4.1. Treatment of syphilis in women and men including young people 230 -- 8.5. RESEARCH QUESTION 8: TREATMENT OF SYPHILIS IN ADULTS IN CASE OF ALLERGY -- TO PENICILLIN 248 -- 9. SUMMARY OF FINDINGS TABLES AND GRADE PROFILES 249 -- 9.1. NEISSERIA GONORRHEA: DIAGNOSIS 249 -- 9.2. CHLAMYDIA TRACHOMATIS (ONLY FOR TMA APTIMA COMBO TEST): DIAGNOSIS 254 -- 9.3. NEISSERIA GONORRHEA: TREATMENT 256 -- 9.3.1. Treatment of gonorrhea in sexually active women and men 256 -- 9.3.2. Treatment for pregnant women 260 -- 9.3.3. Treatment for people with severe cephalosporin allergy 262 -- 9.4. SYPHILIS: DIAGNOSIS 262 -- 9.5. SYPHILIS: TREATMENT 266 -- 10. NEISSERIA GONORRHOEA RESISTANCE: BELGIAN DATA 278 -- 11. 6 STEPS FOR TESTING STIS IN A SEXUAL HEALTH CONSULTATION 280 -- STEP 1: STARTING A CONVERSATION ABOUT SEXUAL HEALTH TESTING 280 -- STEP 2 : SEXUAL HISTORY QUESTIONS FOR READINESS, NEEDS AND RISK ASSESSMENT 281 -- STEP 3 : STI TESTING OVERVIEW 282 -- STEP 4 : HOW TO TEST 284 -- STEP 5 : TREATMENT OVERVIEW - TEST OF CURE - FOLLOW UP 285 -- STEP 6 : PARTNER MANAGEMENT AND CONTACT 287 -- REFERENCES 28
Quality indicators for the management of head and neck squamous cell carcinoma : Short report
No full text34 p.ill.,KEY MESSAGES. 1 -- SHORT REPORT. 3 -- 1. BACKGROUND 7 -- 1.1. QUALITY IMPROVEMENT INITIATIVES IN ONCOLOGY. 7 -- 1.2. HEAD AND NECK CANCER, A HETEROGENEOUS GROUP OF MALIGNANCIES AFFECTING VARIOUS SITES WITH DIFFERING PROGNOSES. 7 -- 1.3. SCOPE 7 -- 1.4. WHAT THIS STUDY AIMS AT AND DOES NOT AIM AT 7 -- 2. DATA AND METHODS. 8 -- 2.1. THE DATABASE - A LINKAGE BETWEEN THE BELGIAN CANCER REGISTRY AND ADMINISTRATIVE DATABASES. 8 -- 2.2. THE PATIENTS - DIAGNOSED IN 2009-2014, WITH EXCLUSION OF PATIENTS WITH MULTIPLE AND RECURRENT TUMOURS 9 -- 2.3. ASSIGNMENT OF PATIENTS TO A CENTRE OF DIAGNOSIS, A CENTRE OF MAIN TREATMENT AND A CENTRE OF FIRST TREATMENT 9 -- 2.4. CASE-MIX ADJUSTMENT 9 -- 2.5. IDENTIFICATION AND SELECTION OF POSSIBLE QUALITY INDICATORS 9 -- 2.6. VALIDATION STUDY AND SUBSEQUENT DATA CHECKS. 10 -- 2.7. STATISTICAL ANALYSES 10 -- 3. QUALITY OF CARE FOR PATIENTS WITH HEAD AND NECK SQUAMOUS CELL CARCINOMA 11 -- 3.1. A COHORT OF 9 245 HNSCC PATIENTS DIAGNOSED IN 2009-2014 11 -- 3.2. MAIN THERAPEUTIC PROCEDURES: RADIOTHERAPY AND SURGERY 13 -- 3.3. LARGE DISPERSION OF CARE IN BELGIUM. 13 -- 3.4. RESULTS FOR 12 QUALITY INDICATORS 14 -- 3.4.1. Diagnosis and staging 15 -- 3.4.2. Treatment 18 -- 3.4.3. Safety of care – 30-day mortality after treatment with curative intent 20 -- 3.4.4. Survival after the diagnosis of HNSCC 22 -- 3.5. ASSOCIATION BETWEEN HOSPITAL VOLUME AND SURVIVAL 22 -- 4. STRENGTHS AND LIMITATIONS 24 -- 5. CONCLUSIONS AND PERSPECTIVES FOR THE FUTURE 26 -- RECOMMENDATIONS 28 -- REFERENCES 3
Proton beam therapy in adults : a systematic review
No full text37 p.ill.,LIST OF TABLES 3 -- LIST OF ABBREVIATIONS 4 -- SCIENTIFIC REPORT 6 -- 1 INTRODUCTION 6 -- 1.1 BACKGROUND 6 -- 1.2 BELGIAN CONTEXT 6 -- 1.3 PROJECT SCOPE 7 -- 1.4 INCIDENCE AND PROGNOSIS .9 -- 1.5 AIM OF THE STUDY 9 -- 2 METHODOLOGY 10 -- 2.1 CLINICAL RESEARCH QUESTION 10 -- 2.2 LITERATURE SEARCH AND SELECTION .10 -- 2.3 QUALITY APPRAISAL AND DATA EXTRACTION 11 -- 2.3.1 Quality appraisal 11 -- 2.3.2 Data extraction 11 -- 2.4 STATISTICAL ANALYSIS 11 -- 2.5 GRADE .12 -- 3 RESULTS .12 -- 3.1 OVERVIEW OF SELECTED STUDIES .12 -- 3.2 SYSTEMATIC REVIEWS AND HTA REPORTS 18 -- 3.3 EFFECTIVENESS BY INDICATION 19 -- 3.3.1 Low-grade glioma .19 -- 3.3.2 Primary sinonasal tumours and recurrences of head & neck tumours .19 -- 3.3.3 Breast cancer 19 -- 3.3.4 Pancreatic cancer 19 -- 3.3.5 Hepatocellular cancer .20 -- 3.3.6 Locally recurrent rectal cancer 20 -- 3.3.7 Key points 20 -- 3.4 SAFETY 21 -- 3.4.1 Low-grade glioma .21 -- 3.4.2 Primary sinonasal tumours and recurrences of head & neck tumours .22 -- 3.4.3 Breast cancer 23 -- 3.4.4 Pancreatic cancer 24 -- 3.4.5 Hepatocellular cancer .25 -- 3.4.6 Locally recurrent rectal cancer 28 -- 3.4.7 Key points 28 -- 3.5 SECONDARY TUMOURS .29 -- 3.6 ONGOING TRIALS 29 -- 4 DISCUSSION .31 -- 4.1 SCARCE AND FLAWED EVIDENCE ON THE EFFECTIVENESS OF PROTON TREATMENT .31 -- 4.2 UNCERTAINTY ABOUT THE SAFETY OF PROTON TREATMENT .32 -- 4.3 FEW DATA ON SECONDARY TUMOURS .32 -- 4.4 SOME RCTS UNDERWAY, BUTNOT IN THE VERYNEAR FUTURE 33 -- 4.5 LIMITATIONS OF THIS REPORT 33 -- REFERENCES .3
Excess mortality and life expectancy of individuals with type 1 diabetes : a rapid review
No full text70 p.ill.
Position of KCE on patient involvement in health care policy research
No full text240 p.ill.,SCIENTIFIC REPORT 16 -- 1 BACKGROUND AND SCOPE 16 -- 2 DEFINITIONS 18 -- 2.1 INVOLVEMENT, ENGAGEMENT, PARTICIPATION 18 -- 2.2 PATIENTS, PATIENT REPRESENTATIVES, CAREGIVERS ETC 21 -- 2.3 PATIENT INVOLVEMENT VERSUS QUALITATIVE RESEARCH ABOUT PATIENT-RELATED ISSUES 22 -- 3 RATIONALES FOR PATIENT INVOLVEMENT IN HEALTH POLICY RESEARCH 24 -- 3.1 REASONS FOR INVOLVING PATIENTS IN POLICY RESEARCH 24 -- 3.2 GOALS OF PATIENT INVOLVEMENT IN HEALTH POLICY RESEARCH 26 -- 4 PHILOSOPHICAL AND ANTHROPOLOGICAL REASONS FOR TAKING THE PATIENT VOICE INTO CONSIDERATION IN HEALTHCARE RESEARCH 28 -- 4.1 FREEDOM, RESPONSIBILITY AND MERIT 28 -- 4.2 THE NORMAL AND THE PATHOLOGICAL 31 -- 4.3 RECOVERY AND IMPROVEMENT 33 -- 4.4 CONCLUDING REMARKS 35 -- 5 WHEN TO INVOLVE PATIENTS IN A RESEARCH PROJECT 35 -- 5.1 IDENTIFICATION AND PRIORITIZATION OF RESEARCH TOPICS 36 -- 5.2 DEFINING THE PROBLEM, SCOPE, OBJECTIVES AND DESIGN OF THE STUDY 38 -- 5.3 ASSESSMENT OF SCIENTIFIC LITERATURE AND OTHER SOURCES OF INFORMATION, DATA COLLECTION AND DATA ANALYSIS 39 -- 5.4 REPORTING THE RESULTS OF THE STUDY 40 -- 5.5 FORMULATION OF RECOMMENDATIONS 40 -- 5.6 DISSEMINATION 41 -- 6 HOW TO SELECT PATIENTS TO BE INVOLVED? 43 -- 6.1 IDENTIFICATION 43 -- 6.2 RECRUITMENT 44 -- 7 BENEFITS, RISKS AND CHALLENGES OF PATIENT INVOLVEMENT IN RESEARCH 47 -- 7.1 BENEFITS, RISKS AND CHALLENGES OF PATIENT INVOLVEMENT IN RESEARCH: FINDINGS OF PUBLISHED LITERATURE REVIEWS 48 -- 7.2 IMPACT ON PATIENTS INVOLVED IN RESEARCH 48 -- 7.3 IMPACT ON RESEARCHERS 48 -- 7.4 IMPACT ON RESEARCH PROCESSES AND OUTCOMES 49 -- 7.5 HOW TO ASSESS THE IMPACT OF PATIENT INVOLVEMENT IN RESEARCH? 52 -- 8 STANDARDS FOR PATIENT INVOLVEMENT IN HEALTH POLICY RESEARCH 53 -- 8.1 GENERAL REQUIREMENTS FOR MEANINGFUL PATIENT INVOLVEMENT IN HEALTH POLICY RESEARCH 53 -- 8.1.1 Culture 53 -- 8.1.2 Leadership and coordination 54 -- 8.1.3 Economic resources 54 -- 8.1.4 Information and training 54 -- 8.2 GUIDANCE FROM LITERATURE 55 -- 8.3 INVOLVE’S NATIONAL STANDARDS FOR PUBLIC INVOLVEMENT IN RESEARCH 57 -- 8.4 HTAI’S QUALITY STANDARDS FOR PATIENT INVOLVEMENT IN HEALTH TECHNOLOGY ASSESSMENT 59 -- 8.5 GOOD CLINICAL PRACTICE GUIDELINES 60 -- 8.6 TRIALS 62 -- 8.7 COMMUNITY-BASED PARTICIPATORY RESEARCH 64 -- 9 ORGANISATION AND GOVERNANCE OF PATIENT INVOLVEMENT 65 -- 9.1 LITERATURE 65 -- 9.2 PATIENTS AS STRUCTURAL MEMBERS OF ADVISORY COMMITTEES, BOARDS OR COUNCILS 66 -- 9.2.1 German Federal Joint Committee (G-BA) 66 -- 9.2.2 National Institute for Health and Care Excellence (NICE) 67 -- 9.2.3 Canadian Agency for Drugs and Technologies in Health 68 -- 9.3 PATIENTS AS ADVISORS 69 -- 9.3.1 Examples from the Netherlands 69 -- 9.3.2 National Institute for Health and Care Excellence (NICE) 70 -- 9.3.3 Healthcare Improvement Scotland 71 -- 9.3.4 Canadian Agency for Drugs and Technologies in Health 72 -- 10 PATIENT INVOLVEMENT IN INTERNATIONAL NETWORKS AND ORGANISATIONS 73 -- 10.1 EUNETHTA 73 -- 10.1.1 Patient involvement in early dialogues 73 -- 10.1.2 Patient involvement in joint and collaborative HTAs 74 -- 10.1.3 Eligibility rules for patients and consumers 74 -- 10.1.4 Experience with patient and consumer involvement so far 75 -- 10.2 REDETS 75 -- 10.2.1 Concepts 76 -- 10.2.2 Principles 76 -- 10.2.3 Levels of involvement 78 -- 10.2.4 Design and procedures 78 -- 10.2.5 Patient selection and recruitment 80 -- 10.2.6 Recommendations: short term, medium term, long term 81 -- 10.3 EUROPEAN MEDICINES AGENCY 85 -- 10.3.1 Objectives of patient involvement at EMA 85 -- 10.3.2 Who to involve? 86 -- 10.3.3 Experience with patient involvement 88 -- 10.3.4 Future plans 88 -- 10.4 FOOD AND DRUG ADMINISTRATION 89 -- 10.4.1 Objectives of patient involvement at the FDA 89 -- 10.4.2 Who to involve? 90 -- 10.4.3 Experience with patient involvement 91 -- 11 EMBEDDED PATIENT INVOLVEMENT PROGRAMMES AND INITIATIVES 92 -- 11.1 JAMES LIND ALLIANCE 92 -- 11.2 INVOLVE 93 -- 11.3 PCORI 94 -- 11.4 SPOR 95 -- 11.5 EUPATI 95 -- 11.6 OTHER INITIATIVES: PFMD, PARTICIPATIEKOMPAS, PARADIGM 95 -- 12 PATIENT INVOLVEMENT EXPERIENCES IN BELGIUM 96 -- 12.1 OVERVIEW OF THE PROCESS AND GENERAL TIMELINES 97 -- 12.2 SELECTION AND RECRUITMENT OF THE PARTICIPANTS 97 -- 12.2.1 Researchers 97 -- 12.2.2 Funding agencies 98 -- 12.2.3 Patient representatives 99 -- 12.2.4 Sickness funds 99 -- 12.3 DATA COLLECTION 99 -- 12.4 DATA ANALYSIS 99 -- 12.5 EXPERIENCES OF THE BELGIAN RESEARCH CENTRES 99 -- 12.5.1 Description of the sample 99 -- 12.5.2 Institute of Tropical Medicine: Community-based participatory research project 100 -- 12.5.3 ULiège: patients involved in different roles 100 -- 12.5.4 UCLouvain & Haute Ecole Léonard de Vinci: Participate Brussels 101 -- 12.5.5 Observatoire du sida et des sexualités : patients as initiators, co-researchers and research leaders 102 -- 12.5.6 Institut Jules Bordet: patients involved in the design of clinical trials 103 -- 12.5.7 Groupe Jolimont: patient partner 104 -- 12.5.8 UGent: longstanding expertise 105 -- 12.5.9 Plateforme pour l’Amélioration de la Qualité et de Sécurité des Soins (PAQS) 105 -- 12.5.10 KU Leuven: first steps of patient involvement 106 -- 12.5.11 LiCalab, Care Living Lab for innovation in health and care 107 -- 12.5.12 ULB: patient as partner 108 -- 12.6 PATIENT REPRESENTATIVES AND PATIENTS INVOLVED IN RESEARCH 109 -- 12.6.1 Ligue des Usagers des Services de Santé (LUSS) 109 -- 12.6.2 Vlaams Patiëntenplatform (VPP) 109 -- 12.6.3 Patienten Rat und Treff (PRT) 110 -- 12.6.4 EUPATI Belgium: patients as experts 111 -- 12.6.5 ULB: patient-partner, the perspective of the patient 112 -- 12.6.6 Plateforme Prévention SIDA: patients as initiators of research 113 -- 12.7 SICKNESS FUNDS 113 -- 12.8 FUNDING AGENCIES 114 -- 12.8.1 Innoviris –Brussels region 114 -- 12.8.2 FWO - Research Foundation-Flanders 114 -- 12.8.3 F.R.S.-FNRS- Research Foundation Fédération Wallonie-Bruxelles 115 -- 12.8.4 King Baudouin Foundation (KBF) 117 -- 12.9 LESSONS LEARNT: CONSENSUS 118 -- 12.9.1 Patient involvement needs to make sense 118 -- 12.9.2 Patient involvement needs to be prepared 119 -- 12.9.3 Patient involvement takes time 120 -- 12.10 DIVERGING ISSUES 120 -- 12.10.1 Who should be included as patients? 120 -- 12.10.2 Which topics should be investigated? 122 -- 12.10.3 Should the patient be paid? 123 -- 12.10.4 In which stages of the research should the patient be involved? 123 -- 12.11 ENABLERS OF PARTICIPATION 124 -- 12.11.1 Supporting organisational and legal context 124 -- 12.11.2 Relational aspects 125 -- 12.11.3 Valorisation of the patients ‘contribution 125 -- 12.11.4 Preparation of researchers 125 -- 12.11.5 Definition of the role of researchers 125 -- 12.11.6 Definition of the roles of patients 126 -- 12.12 BARRIERS TO PARTICIPATION 126 -- 12.13 SUMMARY OF LESSONS LEARNT FROM BELGIAN PATIENT INVOLVEMENT EXPERIENCES 127 -- 13 PATIENT INVOLVEMENT CULTURE AT KCE 128 -- 13.1 METHOD: KCE’S “PATIENTS-ON-BOARD”-GAME 128 -- 13.1.1 Objectives of the game 129 -- 13.1.2 Organization 129 -- 13.1.3 Data analysis 129 -- 13.2 RESULTS 130 -- 13.2.1 Quantitative exploration 130 -- 13.2.2 Qualitative findings 132 -- 13.3 CONCLUSION WITH RESPECT TO THE ACTUAL PATIENT INVOLVEMENT CULTURE AT KCE 139 -- 14 THE CURRENT PLACE OF PATIENT INVOLVEMENT IN KCE PROJECTS 140 -- 14.1 PATIENT INVOLVEMENT IN DEFINING HEALTH POLICY 140 -- 14.2 PATIENT INVOLVEMENT IN THE DEVELOPMENT OF A TOOL FOR SHARED DECISION MAKING 141 -- 14.3 PATIENT INVOLVEMENT IN THE DIFFERENT DOMAINS OF KCE RESEARCH 141 -- 14.4 METHODOLOGICAL REPORTS USEFUL TO INVOLVE PATIENTS 142 -- 14.5 INVOLVEMENT OF PATIENTS IN RECENT KCE RESEARCH 142 -- 14.5.1 Methods 142 -- 14.5.2 Results 143 -- 14.5.3 Conclusions 146 -- 15 FORMULATION OF POSITION STATEMENTS 147 -- 15.1 GENERAL APPROACH 147 -- 15.2 FIRST DRAFT STATEMENTS 147 -- 15.3 ASSESSMENT OF THE SUPPORT FOR THE STATEMENTS BY THE KCE MEMBERS 149 -- 15.3.1 Method 149 -- 15.3.2 Results 150 -- 16 KCE’S POSITION STATEMENTS REGARDING PATIENT INVOLVEMENT IN HEALTH POLICY RESEARCH 162 -- APPENDICES 164 -- APPENDIX 1. LITERATURE SEARCH AND CLASSIFICATION 164 -- APPENDIX 1.1. INTRODUCTION 164 -- APPENDIX 1.2. SOURCES 164 -- APPENDIX 1.2.1. PUBMED 164 -- APPENDIX 1.2.2. GOOGLE 165 -- APPENDIX 1.2.3. WEBSITES 165 -- APPENDIX 1.2.4. CITING SEARCH 166 -- APPENDIX 1.3. INCLUSION CRITERIA 166 -- APPENDIX 1.4. CLASSIFICATION OF RETAINED PAPERS 166 -- APPENDIX 1.4.1. REFERENCES RELATED TO DEFINITIONS AND TERMINOLOGY IN PATIENT INVOLVEMENT 166 -- APPENDIX 1.4.2. REFERENCES RELATED TO RATIONALE FOR PATIENT INVOLVEMENT 169 -- APPENDIX 1.4.3. REFERENCES RELATED TO METHODS FOR PATIENT INVOLVEMENT 173 -- APPENDIX 1.4.4. REFERENCES RELATED TO EFFECTS OF PATIENT INVOLVEMENT 179 -- APPENDIX 1.5. SUMMARY OF FINDINGS FROM REVIEWS ON THE APPLICATION, BENEFITS, RISKS AND CHALLENGES OF PATIENT INVOLVEMENT IN RESEARCH 184 -- APPENDIX 2. EXAMPLES OF PATIENT INVOLVEMENT STRUCTURES IN HTA AGENCIES 192 -- APPENDIX 2.1. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) 192 -- APPENDIX 2.1.1. RATIONALE AND OBJECTIVES FOR PATIENT AND PUBLIC INVOLVEMENT 192 -- APPENDIX 2.1.2. NICE’S PUBLIC INVOLVEMENT POLICY 192 -- APPENDIX 2.1.3. ORGANIZATION AND COORDINATION OF PATIENT INVOLVEMENT ACTIVITIES 193 -- APPENDIX 2.1.4. EXPERIENCE WITH PATIENT INVOLVEMENT AND EVALUATION 193 -- APPENDIX 2.2. HEALTHCARE IMPROVEMENT SCOTLAND 195 -- APPENDIX 2.3. CANADIAN AGENCY FOR DRUGS AND TECHNOLOGIES IN HEALTH 196 -- APPENDIX 3. INTERVIEW GUIDES FOR THE SEMI-STRUCTURED INTERVIEWS ABOUT PROJECTS INVOLVING PATIENTS 197 -- APPENDIX 3.1. INTERVIEW GUIDE FOR RESEARCH CENTRES 197 -- APPENDIX 3.2. INTERVIEW GUIDE FOR SICKNESS FUNDS 198 -- APPENDIX 4. KCE CULTURE DATA ANALYSIS 199 -- APPENDIX 4.1. OVERARCHING THEMES AND CORRESPONDING NODES 199 -- APPENDIX 4.2. FULL LIST OF ARGUMENTS FOR OR AGAINST PATIENT INVOLVEMENT AND CONDITIONS FOR PATIENT INVOLVEMENT IN DIFFERENT PHASES OF THE RESEARCH PROCESS, ACCORDING TO OVERARCHING THEMES 204 -- APPENDIX 5. QUESTIONNAIRE ABOUT PAST AND ONGOING PATIENT INVOLVEMENT ACTIVITIES AT KCE 213 -- APPENDIX 6. SUPPORT OF POSITION STATEMENTS BY KCE EMPLOYEES 224 -- APPENDIX 6.1. RESULTS OF THE FIRST VOTING ROUND OF THE DELPHI PROCESS 224 -- APPENDIX 6.2. RESULTS OF THE SECOND VOTING ROUND OF THE DELPHI PROCESS 226 -- REFERENCES 22
Le rôle des statines dans la prévention primaire des incidents cardiovasculaires : Synthèse
No full text16 p.ill.,PRÉFACE 1 -- MESSAGES CLÉS 2 -- SYNTHÈSE 3 -- 1. OBJECTIFS DE L’ETUDE 4 -- 1.1. QUE SONT LES STATINES ? 4 -- 1.2. QU’AVONS-NOUS ETUDIE ? 5 -- 1.3. COMMENT AVONS-NOUS PROCEDE ? 5 -- 2. UTILISATION DES STATINES EN BELGIQUE 6 -- 2.1. SUR LE MARCHE BELGE DEPUIS LES ANNEES 1990 6 -- 2.2. 13 % DES BELGES PRENNENT DES STATINES… 7 -- 2.3. … MAIS ABANDONNENT GENERALEMENT LE TRAITEMENT AU BOUT D’UN MOMENT 7 -- 2.4. EFFICACES EN PREVENTION PRIMAIRE 9 -- 2.5. … MAIS PAS EXEMPTES D’EFFETS SECONDAIRES 9 -- 3. QUEL EST LE RAPPORT COÛT-EFFICACITÉ DES STATINES EN PRÉVENTION PRIMAIRE ?.10 -- 3.1. LE RAPPORT COUT-EFFICACITE EST INFLUENCE PAR DE NOMBREUX FACTEURS 10 -- 3.2. UN MEILLEUR RAPPORT COUT-EFFICACITE CHEZ LES SUJETS A PLUS HAUT RISQUE .11 -- 4. CONCLUSION : LE PLUS IMPORTANT RESTE L’ADAPTATION DU MODE DE VIE .12 -- RECOMMANDATIONS 14 -- RÉFÉRENCES 1