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Eierstokkanker : diagnose, behandeling en follow-up – Samenvatting
No full text13 p.ill.,Eierstokkanker wordt jaarlijks bij bijna 900 vrouwen in België vastgesteld. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) ontwikkelde samen met een groep van clinici en het College voor Oncologie een klinische richtlijn voor de diagnose, behandeling en follow-up van eierstokkanker op basis van de meest recente wetenschappelijke bevindingen. In een volgende fase zullen kwaliteitsindicatoren voor alle aspecten van de behandeling worden ontwikkeld, en zullen de zorgverleners feedback ontvangen over hun resultaten. De uiteindelijke bedoeling is om gerichte acties te ondernemen om de kwaliteit, waar nodig, te verbeteren
De performantie van het Belgische gezondheidssysteem : Rapport 2015
No full text78 p.ill.,Om de drie jaar publiceert het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) een check-up van ons gezondheidssysteem, samen met het RIZIV en het Wetenschappelijk Instituut Volksgezondheid (WIV). Het huidige rapport geeft een overzicht van de sterke en zwakke punten van het systeem over de periode 2008-2013 op basis van 106 indicatoren. Het helpt de beleidsmakers en de verantwoordelijken van het systeem bij het stellen van prioriteiten om het systeem performant te houden of zelfs te verbeteren. De oefening wordt uitgevoerd in vele Europese landen, die daardoor met elkaar kunnen worden vergeleken en doelstellingen kunnen bepalen om het niveau van de best scorenden te bereiken.
In het algemeen zijn de Belgen best tevreden met hun gezondheidszorg, en 78% vindt dat hij/zij in goede gezondheid verkeert. De zorgkwaliteit van ons land bevindt zich op het Europese gemiddelde. Wanneer we de criteria echter van naderbij bekijken, komt er een meer genuanceerd beeld tevoorschijn, en gaan er 34 alarmsignalen af.VOORWOORD 1 -- AFKORTINGENLIJST 3 -- KERNBOODSCHAPPEN 6 -- INHOUDSTAFEL 8 -- DEEL 1 – CONTEXT EN METHODES.10 -- 1. CONTEXT EN DOELSTELLINGEN 10 -- 1.1. INLEIDING.10 -- 1.2. INTERNATIONALE INITIATIEVEN 11 -- 1.3. CONCEPTUEEL KADER 12 -- 1.4. DOELSTELLINGEN VAN HET RAPPORT 2015 12 -- 2. METHODES EN DATA 14 -- 2.1. SELECTIE VAN INDICATOREN EN GEGEVENSBRONNEN 14 -- 2.2. WAT IS ER NIEUW IN DIT RAPPORT IN VERGELIJKING MET DE VORIGE VERSIE? 15 -- 2.3. HOE VOERDEN WE DE EVALUATIE UIT? 15 -- DEEL 2 – RESULTATEN 17 -- 3. PREVENTIEVE ZORG 17 -- 4. CURATIEVE ZORG 20 -- 4.1. TOEGANKELIJKHEID VAN DE ZORG 20 -- 4.2. ZORGKWALITEIT 23 -- 4.2.1. Doeltreffendheid van de zorg 23 -- 4.2.2. Aangepastheid van zorg 26 -- 4.2.3. Veiligheid van zorg 29 -- 4.2.4. Continuïteit van zorg 31 -- 4.2.5. Patiëntgerichtheid 34 -- 5. GEESTELIJKE GEZONDHEIDSZORG 36 -- 6. LANGETERMIJNZORG VOOR OUDEREN 39 -- 7. ZORG RONDOM HET LEVENSEINDE 42 -- 8. EFFICIËNTIE VAN HET GEZONDHEIDSSYSTEEM 44 -- 9. DUURZAAMHEID 46 -- 10. GEZONDHEIDSTOESTAND 49 -- 11. GEZONDHEIDSPROMOTIE EN LEVENSSTIJL 52 -- 12. BILLIJKHEID EN ONGELIJKHEID 55 -- 12.1. SOCIO-ECONOMISCHE ONGELIJKHEDEN IN GEZONDHEID EN GEBRUIK VAN GEZONDHEIDSDIENSTEN 55 -- 12.2. CONTEXTUELE INDICATOREN VAN BILLIJKHEID 58 -- 13. CONCLUSIES OVER DE STERKE EN ZWAKKE PUNTEN VAN HET BELGISCHE GEZONDHEIDSSYSTEEM.60 -- DEEL 3 – DISCUSSIE 62 -- 14. BELGISCHE HSPA EN BELEIDVORMINGSPROCES 62 -- 14.1. DE BELGISCHE HSPA IN HET BELEIDVORMINGSPROCES 62 -- 14.2. STREEFDOELEN VOOR HET GEZONDHEIDSSYSTEEM 64 -- 15. CONCLUSIE 65 -- AANBEVELINGEN 68 -- BIJLAGE 70 -- REFERENTIES 7
Organisation and payment of emergency care services in Belgium : current situation and options for reform
No full text245 p.ill.,1 INTRODUCTION AND SCOPE 13 -- 1.1 WHAT ARE EMERGENCY CARE SERVICES? 13 -- 1.2 WHY THIS REPORT? 15 -- 1.2.1 Objective of the study .15 -- 1.2.2 Scope of the study 15 -- 1.3 ORGANISATION OF THE REPORT16 -- 2 SCOPE AND METHODS 17 -- 2.1 INTRODUCTION17 -- 2.2 METHODS17 -- 2.2.1 Legal documents and text books .17 -- 2.2.2 Belgian data 17 -- 2.2.3 Literature 18 -- 2.2.4 Review of the literature and Belgian reports .18 -- 2.2.5 Qualitative study design18 -- 3 BELGIAN EMERGENCY DEPARTMENTS: ORGANISATION AND ACTIVITY 20 -- 3.1 EMERGENCY DEPARTMENTS IN BELGIUM: PROFILE AND ACTIVITY.20 -- 3.1.1 Specialised and non-specialised emergency departments 20 -- 3.1.2 Geographical distribution 21 -- 3.1.3 Activity profile .22 -- 3.2 CRITICAL APPRAISAL: A RELATIVELY HIGH NUMBER OF EMERGENCY DEPARTMENTS WITH LARGE DIFFERENCES BETWEEN URBAN AND RURAL AREAS.37 -- 3.2.1 Current capacity is a consequence of (not always harmonized) policy measures: programming, recognition, financing .37 -- 3.2.2 Advantages and disadvantages of the current ED capacity 38 -- 3.3 CRITICAL APPRAISAL: ARE EMERGENCY DEPARTMENTS THE MOST APPROPRIATE ORGANISATIONAL LEVEL FOR ALL CURRENT ACTIVITY? .39 -- 3.3.1 Not all emergency department visits are urgent, but are they inappropriate? A uniform definition is lacking 39 -- 3.3.2 Throughput and outflow problems are also burdening emergency departments 44 -- 3.4 SOLUTION ELEMENTS .45 -- 3.4.1 Planning of the required number of emergency departments in the larger spectrum of acute care services 45 -- 3.4.2 Reduction of emergency department capacity 47 -- 3.4.3 Concentration of highly-specialised services in reference centres51 -- 4 EMERGENCY DEPARTMENT WORKFORCE 55 -- 4.1 PHYSICIANS AND NURSES SPECIALISED IN EMERGENCY CARE .55 -- 4.1.1 Physicians working in Belgian emergency departments.55 -- 4.1.2 Nurses with a special title in intensive and emergency care .59 -- 4.2 CRITICAL APPRAISAL: THE ED IS A DEMANDING WORKPLACE AND STAFFING SHORTAGES ARE REPORTED .60 -- 4.2.1 Emergency physician shortage: need for evaluation in larger policy context .60 -- 4.2.2 A stressful work environment with high levels of burnout for physicians and nurses 61 -- 4.2.3 Are the current policy measures sufficient to tackle the shortage? .63 -- 4.3 SOLUTION ELEMENTS .66 -- 4.3.1 Focus on emergency care .66 -- 4.3.2 Adequate remuneration 66 -- 4.3.3 New roles and workforce innovations in the emergency department.66 -- 5 OUT-OF-HOURS SERVICES FOR ACUTE CARE: THE ROLE OF PRIMARY CARE SERVICES 69 -- 5.1 OUT-OF-HOURS PRIMARY CARE SERVICES 69 -- 5.1.1 The context of primary care and out-of-hours services in Belgium .69 -- 5.1.2 Payment system for general practitioners 74 -- 5.2 CRITICAL APPRAISAL OF ORGANISED DUTY CENTRES 78 -- 5.2.1 Rationale for ODC implementation: isolated focus on better working conditions for GPs or part of a larger vision?78 -- 5.2.2 Implementation of ODCs: increased use of out-of-hours GP services did not result in a decreased use of ED attendances .80 -- 5.2.3 ODCs are geographically well dispersed but is their location well chosen?.91 -- 5.2.4 Paying for ODCs: are the budgets covering investments and operational costs and the fee-forservice payments for GPs well-balanced? 97 -- 5.3 SOLUTION ELEMENTS .99 -- 5.3.1 Integration of EDs and ODCs .99 -- 5.3.2 Payment and organisation of acute care requires one general approach 102 -- 5.3.3 The role of primary care services during office hours in acute care .103 -- 6 TELEPHONE TRIAGE FOR PATIENTS WITH NON-EMERGENCY MEDICAL CONDITIONS .106 -- 6.1 ACCESS TO THE EMERGENCY CARE SYSTEM: REFERRALS, SELF-REFERRALS OR CONTACTING THE EMERGENCY CALL CENTRE 106 -- 6.2 CRITICAL ANALYSIS.107 -- 6.3 SOLUTION ELEMENTS 109 -- 7 THE ROLE OF PATIENT COST SHARING IN PROVIDER CHOICE .115 -- 7.1 PATIENT COST SHARING FOR GP AND EMERGENCY DEPARTMENT SERVICES .116 -- 7.1.1 Patient cost sharing for emergency department services 116 -- 7.1.2 Patient cost sharing for GP services .117 -- 7.1.3 Direct payment versus third-party payer system 119 -- 7.2 CRITICAL APPRAISAL OF THE ROLE OF PATIENT COST SHARING IN THE CHOICE BETWEEN GP AND EMERGENCY DEPARTMENT SERVICES 120 -- 7.3 SOLUTION ELEMENTS 121 -- 8 PAYMENT MODELS FOR THE EMERGENCY DEPARTMENT AND ITS WORKFORCE 123 -- 8.1 THE BUDGET OF FINANCIAL MEANS 123 -- 8.1.1 Components of the closed-end hospital budget .123 -- 8.1.2 Calculation of the B2-budget for clinical costs .124 -- 8.1.3 The B2-budget for the emergency department 127 -- 8.2 THE REMUNERATION SYSTEM OF MEDICAL SPECIALISTS PROVIDING SERVICES IN AN EMERGENCY DEPARTMENT .139 -- 8.2.1 How are physician fees determined? 139 -- 8.2.2 The fee schedule for emergency physicians and other medical specialists providing services at the emergency department 140 -- 8.2.3 Fees for physicians providing services in the ED: evolution of reimbursements and cases142 -- 8.2.4 Combination of one A-fee and one or more C-fees per emergency department visit .142 -- 8.2.5 A-fees by type of emergency physician .142 -- 8.3 PERFORMANCE MEASUREMENT AND PAY FOR PERFORMANCE .147 -- 8.3.1 Quality of care in emergency departments traditionally relies on a policy of recognition norms .147 -- 8.4 CRITICAL APPRAISAL OF THE OLD CALCULATION METHOD OF THE B2 BUDGET FOR THE EMERGENCY DEPARTMENT .147 -- 8.4.1 The B2 budget is not sufficient to guarantee minimum staffing ratios 147 -- 8.4.2 Distribution of the budget among hospitals: parameters are insufficiently related to ED activity and favour large hospitals148 -- 8.4.3 The old emergency department payment system better reflected the case-mix of the hospital .149 -- 8.4.4 Hospital responses.149 -- 8.5 CRITICAL APPRAISAL OF THE NEW CALCULATION METHOD OF THE B2 BUDGET FOR THE EMERGENCY DEPARTMENT .150 -- 8.5.1 New rules did not solve the structural underpayment but only changed the distribution of the closed-end budget 150 -- 8.5.2 Emergency department caseload and workload is better reflected 150 -- 8.5.3 The pros and cons of a patient classification system for emergency department payments150 -- 8.5.4 Hospital responses.151 -- 8.6 CRITICAL APPRAISAL OF THE REMUNERATION SYSTEM OF MEDICAL SPECIALISTS PROVIDING SERVICES AT THE EMERGENCY DEPARTMENT 151 -- 8.6.1 A fee-for-service payment system contributes to a productive workforce but incentivizes the quantity of services a physician provides .151 -- 8.6.2 The fee schedule helps us to keep track of what happens within the system.152 -- 8.6.3 The fee schedule for physians working in the ED: amount of the fee 153 -- 8.6.4 Large differences between hospitals in the share of ED visits for which a C-fee is charged 155 -- 8.6.5 A system of salaried emergency physicians: less appropriate for a flexible workforce and more expensive for society 156 -- 8.6.6 The fee schedule of emergency physicians: redundant or too restricted? .156 -- 8.6.7 The size of the hospital determines the budget available for physicans on duty in the ED.157 -- 8.7 CRITICAL APPRAISAL OF THE DEVELOPMENT AND IMPLEMENTATION OF QUALITY INDICATORS FOR EMERGENCY CARE .158 -- 8.8 SOLUTION ELEMENTS 159 -- 8.8.1 The ED budget should be sufficient to cover minimum staffing levels 159 -- 8.8.2 The new calculation method for the ED budget should be evaluated regularly 159 -- 8.8.3 A mix of fixed and variable payments 160 -- 8.8.4 Variable payments reflecting the ED caseload and patient case-mix .162 -- 8.8.5 Funding for sparsely populated and remote areas 163 -- 8.8.6 A payment system to support the development of an emergency care network 163 -- 9 ORGANISATION AND PAYMENT OF EMERGENCY CARE SERVICES IN SELECTED COUNTRIES .165 -- 9.1 INTRODUCTION 165 -- 9.1.1 Background 165 -- 9.1.2 Methodology.165 -- 9.1.3 Overview of emergency care services across countries .167 -- 9.2 ORGANISATION OF EMERGENCY CARE SERVICES 170 -- 9.2.1 Framework 170 -- 9.2.2 Organisation and planning .172 -- 9.3 PAYMENT OF EMERGENCY CARE SERVICES 185 -- 9.3.1 Framework 185 -- 9.3.2 Payment of Providers 187 -- 9.4 REFORMS AND DEBATES.194 -- 9.4.1 Overview .194 -- 9.4.2 Improved availability of urgent primary care services and better coordination with emergency care .194 -- 9.4.3 Rationalizing and concentrating emergency care .197 -- 9.5 CONCLUSIONS .200 -- 9.5.1 Guiding patients through the system 200 -- 9.5.2 Reconfiguring urgent primary and emergency care.201 -- 9.5.3 Supporting integrated emergency and urgent care structures through payment .201 -- 10 INTERVENTIONS TO REDUCE EMERGENCY DEPARTMENT UTILIZATION204 -- 10.1 OBJECTIVE.204 -- 10.2 METHOD 204 -- 10.3 RESULTS .206 -- 10.3.1 Search and inclusion 206 -- 10.3.2 Methodological assessment 207 -- 10.3.3 Type of target populations included in systematic reviews212 -- 10.3.4 Type of interventions and scope of reviews 212 -- 10.4 DISCUSSION AND CONCLUSION .22
Modèle d’organisation et de financement des soins psychologiques : Synthèse
No full text40 p.ill.,Anxiété, stress, burnout, sentiments dépressifs, soucis relationnels ou familiaux,… nous traversons tous des moments de vie difficiles, qui pourraient souvent être surmontés si nous avions l’aide d’un professionnel formé à cet effet. Mais les soins psychologiques ne sont généralement pas pris en charge par l’assurance maladie, et ils restent donc peu accessibles. Le Centre fédéral d’Expertise des Soins de Santé (KCE) a analysé les modèles d’organisation et de remboursement des soins psychologiques mis en place dans d’autres pays, pour ensuite élaborer un modèle adaptable à la réalité belge. Il propose un système à deux ‘étages’ : un premier niveau généraliste, largement accessible, pour accueillir sans restriction les problèmes courants et modérés, et un second niveau, d’accès plus restreint, mais permettant de délivrer des soins spécialisés à ceux pour qui le premier niveau n’est pas suffisant.PRÉFACE 1 -- MESSAGES CLÉS 2 -- SYNTHÈSE 4 -- 1. POURQUOI CETTE ÉTUDE? 6 -- 1.1. LA DÉTRESSE PSYCHIQUE, UN PROBLÈME MAJEUR 6 -- 1.2. UN IMPACT SOCIÉTAL CONSIDÉRABLE 6 -- 1.3. LES SOINS PSYCHOLOGIQUES DOIVENT ÊTRE RENFORCÉS. 6 -- 1.4. VERS UN NOUVEAU MODÈLE D’ORGANISATION ET DE FINANCEMENT POUR LES SOINS -- PSYCHOLOGIQUES. 7 -- 2. QUELLE EST LA SITUATION ACTUELLE EN BELGIQUE? 9 -- 2.1. ORGANISATION ACTUELLE DE L’OFFRE DE SOINS PSYCHOLOGIQUES 9 -- 2.1.1. Un premier niveau avec accès direct : 9 -- 2.1.2. Un deuxième niveau de soins spécialisés ambulatoires : 10 -- 2.1.3. Un troisième niveau plus hospitalo-centré : 10 -- 2.2. LES PRINCIPAUX PROBLÈMES IDENTIFIÉS 11 -- 2.2.1. Le premier contact est difficile 11 -- 2.2.2. L’offre manque de clarté et de garanties de qualité 11 -- 2.2.3. Les coûts pour le patient sont élevés 12 -- 2.2.4. Les listes d’attente sont longues 12 -- 2.2.5. La continuité des soins n’est pas garantie 12 -- 3. ACCÈS AUX SOINS PSYCHOLOGIQUES À L’ÉTRANGER13 -- 3.1. SOINS PSYCHOLOGIQUES EN ACCÈS DIRECT 13 -- 3.2. CONDITIONS D’ACCÈS AUX SOINS PSYCHOLOGIQUES SPÉCIALISÉS.14 -- 3.2.1. Gatekeeping 14 -- 3.2.2. Indications 14 -- 3.2.3. Modalités thérapeutiques 14 -- 3.2.4. Nombre de séances 14 -- 4. LES PROJETS PILOTES FLAMANDS DE PSYCHOLOGIE DE 1RE LIGNE16 -- 4.1. OBJECTIFS. 16 -- 4.2. ASPECTS ORGANISATIONNELS 16 -- 4.3. PRINCIPAUX RÉSULTATS 16 -- 5. PISTES POUR L’ORGANISATION DES SOINS PSYCHOLOGIQUES17 -- 5.1. UN SYSTÈME À DEUX COMPOSANTES 17 -- 5.2. INTERVENANTS : À CHAQUE NIVEAU SA SPÉCIFICITÉ 19 -- 5.2.1. En 1re ligne : des intervenants aux compétences complémentaires.19 -- 5.2.2. Soins spécialisés : des professionnels reconnus et agréés .21 -- 5.3. OFFRE DE SOINS : STEPPED CARE ET LIBERTÉ THÉRAPEUTIQUE MAIS NOMBRE DE -- SÉANCES LIMITÉ 22 -- 5.3.1. Stepped Care 22 -- 5.3.2. Types d’interventions 22 -- 5.3.3. Pas de listes limitatives d’indications 22 -- 5.3.4. Pas de restriction liée au type de traitements 23 -- 5.3.5. Pas uniquement des consultations en face à face 23 -- 5.3.6. Limitation du nombre de séances remboursées 24 -- 5.4. ACCÈS : LIBRE EN 1RE LIGNE, CONDITIONNÉ POUR LES SOINS SPÉCIALISÉS 25 -- 5.4.1. 1re ligne : des portes d’entrée multiples 25 -- 5.4.2. Soins spécialisés : un gatekeeping pluridisciplinaire 25 -- 5.5. INSERTION ACTIVE DANS LE RÉSEAU EXISTANT 27 -- 5.6. LOCALISATION : UN HÉBERGEMENT TRÈS FLEXIBLE. 27 -- 5.6.1. En ce qui concerne la 1re ligne : 27 -- 5.6.2. En ce qui concerne les soins spécialisés (ambulatoires) : 28 -- 5.7. QUALITÉ DES SOINS. 28 -- 5.8. UN FINANCEMENT MIXTE 29 -- 5.8.1. Modes de financement des intervenants 29 -- 5.8.2. Propositions du KCE pour un modèle mixte 29 -- 5.8.3. Participation financière du patient. 33 -- RECOMMANDATIONS 34 -- RÉFÉRENCES 3
Multi Criteria Decision Analysis to select priority diseases for Newborn blood screening : Synthesis
No full text20 p.ill.,FOREWORD 1 -- SYNTHESIS 2 -- 1. NEWBORN BLOOD SCREENING (NBS) PROGRAMMES 3 -- 2. SCOPE AND METHODOLOGY 5 -- 3. SELECTION AND DEFINITION OF THE CRITERIA 6 -- 4. DEFINING WEIGHTS OF EACH CRITERION 8 -- 5. GATHERING INFORMATION ON EACH DISEASE 12 -- 6. SCORING BY DISEASE 12 -- 7. COMPOSITE SCORES BY DISEASE 16 -- 8. CONCLUSIONS 18 -- 9. KEY MESSAGES AND LESSONS LEARNED FOR THE FUTURE 18 -- RECOMMENDATIONS 2
Multi Criteria Decision Analysis to select priority diseases for Newborn blood screening : Supplement
No full text43 p.ill.,SUPPLEMENT REPORT. 1 -- 1. FURTHER DETAILS ON NEWBORN BLOOD SCREENING IN BELGIUM 5 -- 1.1. STEERING COMMITTEE IN FWB 5 -- 1.2. STEERING COMMITTEE IN VG 6 -- 2. ORIGINAL CRITERIA AND WEIGHING FROM THE INESSS REPORT (CITATION FROM THE -- ORIGINAL FRENCH LANGUAGE VERSION). 6 -- 3. DISEASE INFORMATION ON BIOTINIDASE DEFICIENCY (LMCD). 7 -- 3.1. SPECIFIC DATA SOURCES FOR BIOTINIDASE DEFICIENCY 7 -- 3.2. BACKGROUND INFORMATION ON THE DISEASE (NOT TO BE SCORED) 7 -- 3.3. FREQUENCY OF THE DISEASE (INCIDENCE AND PREVALENCE) 7 -- 3.4. SEVERITY OF THE DISEASE IN UNTREATED CASES 8 -- 3.5. TIMELY AVAILABILITY OF THE TEST RESULTS. 8 -- 3.6. EFFICACY OF EARLY VS LATE TREATMENT 9 -- 3.7. PROBABILITY AND IMPACT OF FALSE POSITIVE RESULTS. 9 -- 3.8. PROBABILITY AND IMPACT OF FALSE NEGATIVE RESULTS 9 -- 3.9. IMPACT ON THE HEALTH CARE SYSTEM 9 -- 3.10. KEY POINTS FOR BIOTINIDASE DEFICIENCY. 9 -- 4. DISEASE INFORMATION ON CONGENITAL ADRENAL HYPERPLASIA (CAH) 10 -- 4.1. BACKGROUND INFORMATION ON THE DISEASE (NOT TO BE SCORED).10 -- 4.2. FREQUENCY (INCIDENCE AND PREVALENCE) 12 -- 4.3. SEVERITY OF THE DISEASE IN UNTREATED CASES. 13 -- 4.4. TIMELY AVAILABILITY OF THE TEST RESULTS 13 -- 4.5. EFFICACY OF EARLY VS LATE TREATMENT 13 -- 4.6. PROBABILITY AND IMPACT OF FALSE POSITIVE RESULTS 14 -- 4.7. PROBABILITY AND IMPACT OF FALSE NEGATIVE RESULTS14 -- 4.8. IMPACT ON THE HEALTH CARE SYSTEM 15 -- 4.9. KEY POINTS FOR CONGENITAL ADRENAL HYPERPLASIA.15 -- 5. DISEASE INFORMATION ON GALACTOSEMIAS (MAINLY GALT DEFICIENCY) 16 -- 5.1. SPECIFIC DATA SOURCES FOR GALACTOSAEMIA. 16 -- 5.2. BACKGROUND INFORMATION (NOT TO BE SCORED) 16 -- 5.3. FREQUENCY OF THE DISEASE (INCIDENCE AND PREVALENCE).18 -- 5.3.1. Frequency in other countries 18 -- 5.4. SEVERITY OF THE DISEASE IN UNTREATED CASES. 18 -- 5.5. TIMELY AVAILABILITY OF THE TEST RESULTS 19 -- 5.6. EFFICACY OF EARLY VS LATE TREATMENT 19 -- 5.7. PROBABILITY AND IMPACT OF FALSE POSITIVE RESULTS 19 -- 5.8. PROBABILITY AND IMPACT OF FALSE NEGATIVE RESULTS 20 -- 5.9. IMPACT ON THE HEALTH CARE SYSTEM 20 -- 5.10. KEY POINTS FOR GALACTOSAEMIA 20 -- 6. DISEASE INFORMATION ON HOMOCYSTINURIA (HCY) 21 -- 6.1. BACKGROUND INFORMATION (NOT TO BE SCORED) 21 -- 6.2. FREQUENCY OF THE DISEASE (INCIDENCE AND PREVALENCE).22 -- 6.3. SEVERITY OF DISEASE IN UNTREATED CASES 23 -- 6.4. TIMELY AVAILABILITY OF THE TEST RESULTS 23 -- 6.5. EFFICACY OF EARLY VS LATE TREATMENT 23 -- 6.6. PROBABILITY AND IMPACT OF FALSE POSITIVE RESULTS 24 -- 6.7. PROBABILITY AND IMPACT OF FALSE NEGATIVE RESULTS24 -- 6.8. IMPACT ON THE HEALTH CARE SYSTEM 25 -- 6.9. KEY POINTS FOR HOMOCYSTINURIA 25 -- 7. DISEASE INFORMATION ON TYROSINEMIA TYPE I (TYR I) 26 -- 7.1. BACKGROUND INFORMATION (NOT TO BE SCORED) 26 -- 7.2. FREQUENCY OF THE DISEASE (INCIDENCE AND PREVALENCE).27 -- 7.3. SEVERITY OF THE DISEASE IN UNTREATED CASES. 27 -- 7.4. TIMELY AVAILABILITY OF THE TEST RESULTS 27 -- 7.5. EFFICACY OF EARLY VS LATE TREATMENT 28 -- 7.6. PROBABILITY AND IMPACT OF FALSE POSITIVE RESULTS 28 -- 7.7. PROBABILITY AND IMPACT OF FALSE NEGATIVE RESULTS 28 -- 7.8. IMPACT ON THE HEALTH CARE SYSTEM 29 -- 7.9. KEY POINTS FOR TYROSINEMIA TYPE I 29 -- 8. DISEASE INFORMATION ON VERY LONG CHAIN ACYL COA DEHYDROGENASE DEFICIENCY (VLCAD DEFICIENCY) 31 -- 8.1. BACKGROUND INFORMATION ON THE DISEASE (NOT TO BE SCORED).31 -- 8.2. FREQUENCY (INCIDENCE AND PREVALENCE) 33 -- 8.3. SEVERITY OF THE DISEASE IN UNTREATED CASES. 34 -- 8.4. TIMELY AVAILABILITY OF THE TEST RESULTS 34 -- 8.5. EFFICACY OF EARLY VS LATE TREATMENT 35 -- 8.6. PROBABILITY AND IMPACT OF FALSE POSITIVE RESULTS 35 -- 8.7. PROBABILITY AND IMPACT OF FALSE NEGATIVE RESULTS36 -- 8.8. IMPACT ON THE HEALTH CARE SYSTEM OF SCREENING.36 -- 8.9. KEY POINTS FOR VLCAD DEFICIENCY 37 -- REFERENCES 3
How to improve the detection of child abuse in Belgium?
No full text106 p.ill.,TABLE OF CONTENTS.1 -- 1 BACKGROUND AND PROBLEM DESCRIPTION .7 -- CHILD ABUSE IS A FREQUENT, BUT MOSTLY HIDDEN PROBLEM… 7 -- … WITH FAR REACHING CONSEQUENCES 7 -- …CALLING FOR PREVENTION, DETECTION AND INTERVENTION 8 -- SCOPE OF THE STUDY 8 -- METHODOLOGY 9 -- REPORT STRUCTURE 10 -- 2 DEFINITIONS AND CONCEPTUAL ISSUES REGARDING CHILD ABUSE.11 -- DEFINITIONS 11 -- 2.1.1 WHO 11 -- 2.1.2 Convention on the Rights of the Child 11 -- 2.1.3 Definitions used in youth care 11 -- 2.1.4 Operational definition for police, magistrates and the staff of the secretariat of the Prosecutors’officices .11 -- 2.1.5 Penal Code .12 -- THEORETICAL PERSPECTIVES IN THE STUDY OF CHILD ABUSE .12 -- 2.2.1 Child abuse as a social problem 12 -- 2.2.2 Child abuse as a medical problem 12 -- 2.2.3 Child abuse as a wicked problem 13 -- 3 PARTICULARITIES RELATED TO THE ORGANISATION OF CHILD ABUSE MANAGEMENT IN THE BELGIAN CONTEXT 14 -- THE ORGANISATION OF SERVICES AND ACTORS INVOLVED IN THE MANAGEMENT OF CHILD ABUSE CASES IS ADDRESSED BY COMMUNITY- AND FEDERAL COMPETENCES. 14 -- PHILOSOPHY OF DEJUDICIARISATION AND SUBSIDIARITY 14 -- NO MANDATORY REPORTING.15 -- 4 NO OVERVIEW OF THE SIZE OF THE PROBLEM 19 -- DATA FROM THE BELGIAN HEALTH QUESTIONNAIRE 19 -- DATA FROM THE SURVEY OF THE FLEMISH OFFICE OF THE CHILDREN'S RIGHTS COMMISSIONER ON THE PREVALENCE OF VIOLENCE AGAINST CHILDREN 20 -- DATA FROM THE DEPARTMENT OF JUSTICE 20 -- DATA FROM POLICE 20 -- DATA OF THE SPECIALIZED SERVICES (VKS AND SOS ENFANTS) 21 -- 4.5.1 Number of reported cases of child abuse to specialized centers (SOS Enfants and VKs) 21 -- 4.5.2 Age classes of children .21 -- 4.5.3 What are the most frequently reported/diagnosed problems? 25 -- 5 THE DETERMINANTS OF PROFESSIONALS’ DECISION-MAKING IN CHILD ABUSE 27 -- INTRODUCTION.27 -- METHODS USED27 -- 5.2.1 Methods used for the narrative literature review 27 -- DETERMINANTS OF HEALTH CARE PROFESSIONALS’ DECISION-MAKING REGARDING CHILD ABUSE IDENTIFIED FROM THE LITERATURE28 -- 5.3.1 Methodological note30 -- 5.3.2 Factors influencing the detection/recognition/becoming suspicious 30 -- 5.3.3 Determinants of the decision to take action31 -- 5.3.4 Empirical models explaining reporting behaviour 36 -- 5.3.5 Conclusion 39 -- 6 KEYS TO IMPROVE THE DETECTION AND REPORTING OF CHILD ABUSE.39 -- SOLUTION STRATEGIES FROM THE LITERATURE 39 -- 6.1.1 Prevention 39 -- 6.1.2 Mandatory reporting?.42 -- 6.1.3 Supportive tools 42 -- 6.1.4 Training to improve knowledge and skills 43 -- 6.1.5 Collaboration, communication and involvement 43 -- 6.1.6 Counselling and feedback44 -- 7 QUALITATIVE PART45 -- RESEARCH DESIGN AND TECHNIQUE 45 -- 7.1.1 Interviews .45 -- 7.1.2 Interview guide 46 -- 7.1.3 Pretesting .48 -- 7.1.4 Realisation of the interview .48 -- SAMPLING AND RECRUITMENT OF THE RESPONDENTS 48 -- 7.2.1 Sampling 48 -- 7.2.2 Recruitment strategy 50 -- 7.2.3 Recruitment.50 -- ETHICAL APPROVAL 50 -- DATA ANALYSIS 50 -- FINDINGS 50 -- 7.5.1 Aversion to see .51 -- 7.5.2 Barriers in assessing the situation 51 -- 7.5.3 Difficulties in the decision to take action 53 -- 7.5.4 Barriers to collaboration in dealing with child abuse 56 -- 7.5.5 Resistance of the target group hampering professionals’ assessment and decision-making 75 -- 7.5.6 Typology of involvement in dealing with child abuse.76 -- 7.5.7 Regional specificities in dealing with child abuse 78 -- 7.5.8 Reported solutions from the qualitative research 90 -- 7.5.9 Conclusion: A system approach 95 -- 8 GENERAL CONCLUSION 100 -- FINDINGS FROM THE INTERNATIONAL LITERATURE AND FROM THE BELGIAN CONTEXT CONVERGE TO A LARGE EXTENT.100 -- RATIONALE FOR SELECTED METHODOLOGIES .101 -- REFERENCES 10
De behandeling van chronische wonden met hyperbare zuurstoftherapie
No full text3 p.ill.,KERNBOODSCHAP
Bij hyperbare zuurstoftherapie (Hyperbaric oxygen therapy - HBOT) dient men zuivere zuurstof (100%) toe onder een druk die hoger ligt dan de atmosferische druk in een compressiekamer. Men is van mening dat HBOT voor de adjuvante behandeling van chronische wonden aan de onderste ledematen kan worden gebruikt, omdat het de gedeeltelijke zuurstofdruk aan het hypoxisch wondweefsel verhoogt.
Volgens een review van de Cochrane Collaboration gepubliceerd in februari 2015, was de genezing van voetwonden bij diabetische patiënten bij de HBOT groep significant beter op korte (tot 6 maanden), maar niet op lange termijn. Er was geen verschil in het aantal majeure amputaties. HBOT zou wel de grootte van veneuze wonden kunnen verkleinen. De veiligheid van HBOT kon niet worden nagegaan, omdat de meeste studies niet rapporteren over ernstige ongewenste bijwerkingen.
De conclusie van de Cochrane review is dezelfde als die van een vorig KCE-rapport uit 2008 (KCE Reports 74A - 2008)
Use of pneumococcal vaccines in the elderly : an economic evaluation
No full text39 p.ill.,FOREWORD 1 -- SHORT REPORT 2 -- 1 RESEARCH QUESTIONS 4 -- 2 BURDEN OF PNEUMOCOCCAL DISEASE IN THE ELDERLY 5 -- 2.1 INCIDENCE OF PNEUMOCOCCAL DISEASE 5 -- 2.2 MORTALITY OF PNEUMOCOCCAL DISEASE 6 -- 2.3 SEQUELAE 7 -- 2.4 SEROTYPE DISTRIBUTION 7 -- 2.5 COSTS OF PNEUMOCOCCAL DISEASE 8 -- 2.6 QUALITY OF LIFE 9 -- 3 INDIRECT EFFECT OF INFANT PCV VACCINATION 10 -- 4 PNEUMOCOCCAL VACCINES 11 -- 4.1 VACCINE EFFICACY AND EFFECTIVENESS 13 -- 4.1.1 PCV13 efficacy 13 -- 4.1.2 PPV23 efficacy and effectiveness 13 -- 4.1.3 Duration of protection 14 -- 4.1.4 Comparison between PCV13 and PPV23 protection 15 -- 4.2 VACCINE SAFETY 15 -- 4.3 VACCINE UPTAKE 16 -- 4.4 COST OF VACCINE AND VACCINE ADMINISTRATION 16 -- 5 METHODS FOR ECONOMIC EVALUATION 16 -- 5.1 MODEL AND ANALYTICAL APPROACH 16 -- 5.2 ACCOUNTING FOR UNCERTAINTY 17 -- 5.3 VACCINATION STRATEGIES TO COMPARE 17 -- 5.4 SUMMARY OF MODEL PARAMETERS 18 -- 6 RESULTS 22 -- 6.1 CURRENT DISEASE BURDEN 22 -- 6.2 EFFECTIVENESS AND COST-EFFECTIVENESS ANALYSES 23 -- 6.3 BUDGET-IMPACT ANALYSES 27 -- 7 DISCUSSION 28 -- 7.1 BASED ON COST-EFFECTIVENESS, IF WE ARE TO USE PNEUMOCOCCAL VACCINES, HOW SHOULD WE DO THIS? 28 -- 7.2 BASED ON COST-EFFECTIVENESS, SHOULD WE USE PNEUMOCOCCAL VACCINES IN ALL ADULTS ≥50 YEARS AT ALL? 29 -- 7.3 LIMITATIONS 29 -- 7.4 FINDINGS FROM OTHER ECONOMIC EVALUATIONS 29 -- 8 CONCLUSIONS 31 -- RECOMMENDATIONS 32 -- REFERENCES 3
Elective caesarean section in low-risk women at term : consequences for mother and offspring - Synthesis
No full text22 p.ill.,1. INTRODUCTION 4 -- 2. CAESAREAN SECTION RATES IN BELGIUM AND WORLDWIDE 5 -- 3. LITERATURE REVIEW 8 -- 3.1. OBJECTIVES AND METHODS 8 -- 3.2. MORTALITY AND MORBIDITY IN MOTHER 8 -- 3.2.1. Short-term maternal outcomes 8 -- 3.2.2. Maternal mortality 9 -- 3.2.3. Breastfeeding 9 -- 3.2.4. Long-term maternal outcomes 10 -- 3.2.5. Impact on future pregnancies: maternal outcomes 10 -- 3.3. MORTALITY AND MORBIDITY IN OFFSPRING 11 -- 3.3.1. Short-term offspring outcomes 12 -- 3.3.2. Long-term offspring outcomes 13 -- 3.3.3. Impact on future pregnancies: offspring outcomes 16 -- 4. OVERALL CONCLUSION 17 -- 4.1. CAESAREAN SECTION: NATIONAL AND INTERNATIONAL TRENDS 17 -- 4.2. TOWARDS AN IDEAL RATE OF CAESAREAN DELIVERIES? 17 -- 4.3. ASSOCIATION BETWEEN DELIVERY MODES AND OUTCOMES: LEVEL OF EVIDENCE 18 -- 4.4. CAESAREAN SECTION: MATERNAL AND OFFSPRING OUTCOMES 18 -- 4.5. COUNSELLING WOMEN ON THE MODE OF DELIVERY 20 -- 5. EXISTING INITIATIVES 2