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Globale geriatrische benadering : rol van de interne geriatrische liaison teams – Synthese
No full text24 p.Ill.,Door de vergrijzing worden hoe langer hoe meer oudere patiënten in het ziekenhuis opgenomen. Een aantal van hen heeft een erg kwetsbare gezondheidstoestand. Deze kwetsbaarheid wordt een « geriatrisch profiel » genoemd, en het wordt vastgesteld met behulp van aangepaste testen. Waneer deze patiënten in het ziekenhuis worden opgenomen moeten zij een « globale geriatrische benadering » krijgen, speciale zorg met bijzondere aandacht voor hun cognitieve, lichamelijke en psychosociale capaciteiten. Om die reden werden geriatrische afdelingen (de G-bedden) opgericht. Probleem is dat deze afdelingen vandaag al niet meer voldoen aan de toenemende behoeften, en dat geriatrische patiënten vaak ook verzorgd worden in andere, niet-geriatrische afdelingen, bijvoorbeeld voor het plaatsen van een heupprothese, terwijl ze ook geriatrische zorg nodig hebben. Daarom werden bijna tien jaar geleden de “interne geriatrische liaisonteams” in het leven geroepen. Deze gespecialiseerde, mobiele teams bezoeken de patiënten met hoog geriatrisch risico in andere afdelingen om hun situatie te evalueren en om aanbevelingen te formuleren over de te verlenen zorg. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) bekeek hun organisatie en werking. Ze blijken op heel uiteenlopende manieren te functioneren, en alle voorwaarden om doeltreffend te werken zijn niet altijd aanwezig. Zo zouden ze meer actief betrokken moeten worden bij de door hen aanbevolen zorgverlening. Daarnaast zijn er dringend maatregelen nodig om het aantal geriaters en verpleegkundigen met geriatrische expertise te doen stijgen, en om alle zorgverleners te sensibiliseren voor de geriatrische benaderingVOORWOORD 1 -- SAMENVATTING 2 -- SYNTHESE 4 -- 1. CONTEXT 6 -- 1.1. EEN VEROUDERENDE (ZIEKENHUIS)POPULATIE 6 -- 1.2. HET GERIATRISCH PROFIEL 6 -- 1.3. GLOBALE GERIATRISCHE BENADERING VERGT EEN MULTIDISCIPLINAIRE AANPAK 7 -- 1.4. EEN ‘GOUDEN STANDAARD’ DIE NIET MEER VOLSTAAT 7 -- 1.5. DE INTERNE GERIATRISCHE LIAISON 7 -- 2. DE ORGANISATIE VAN DE ZIEKENHUISZORG VOOR GERIATRISCHE PATIËNTEN IN BELGIË 8 -- 2.1. HET ZORGPROGRAMMA VOOR DE GERIATRISCHE PATIËNT: VIJF MANIEREN OM DE ZORG VOOR OUDERE PATIËNTEN TE VERBETEREN 8 -- 2.1.1. De acute geriatriedienst 9 -- 2.1.2. De interne geriatrische liaison functie 9 -- 2.1.3. De externe geriatrische liaison functie 10 -- 2.1.4. De ambulante geriatrische consultaties 10 -- 2.1.5. De geriatrische dagziekenhuizen 10 -- 2.2. GERIATERS: DE VRAAG OVERSCHRIJDT HET AANBOD RUIMSCHOOTS 10 -- 2.3. TE WEINIG VERPLEEGKUNDIGEN GESPECIALISEERD IN DE GERIATRIE.10 -- 3. UITDAGINGEN VOOR DE INTERNE GERIATRISCHE LIAISONTEAMS.11 -- 3.1. DOELTREFFENDHEID INTERNE GERIATRISCHE LIAISONTEAMS: WETENSCHAPPELIJKE EVIDENTIE BEPERKT 11 -- 3.1.1. Een positieve perceptie 12 -- 3.1.2. Internationaal geen wijdverspreid concept 12 -- 3.2. ZORGMODEL EN IMPLEMENTATIE ZIJN HETEROGEEN 12 -- 3.2.1. Heterogeniteit bij de implementatie van de principes van de globale geriatrische benadering 3.2.2. Heterogeniteit van de organisatorische aspecten 14 -- 3.3. ONTSTAAN VAN ALTERNATIEVE ZORGMODELLEN 16 -- 3.4. DE EVALUATIE VAN DE KWALITEIT VAN DE GERIATRISCHE ZORG LAAT NOG TE WENSEN OVER 17 -- 4. CONCLUSIE 17 -- AANBEVELINGEN 19 -- REFERENTIES 2
Implementation of hospital at home : Orientations for Belgium - Appendix
No full text111 p.ill.,TABLE OF CONTENTS 1 -- LIST OF FIGURES 3 -- LIST OF TABLES 3 -- 1. SEARCH STRATEGY OF THE LITERATURE REVIEW 5 -- 1.1. MEDLINE @ OVID 5 -- 1.2. CINAHL 6 -- 1.3. EMBASE @ EMBASE.COM 7 -- 1.4. COCHRANE DATABASE OF SYSTEMATIC REVIEWS 8 -- 2. BELGIAN SITUATION 10 -- 2.1. HOME DIALYSIS 10 -- 2.2. HOME OXYGEN THERAPY 11 -- 2.3. PALLIATIVE CARE SERVICES AT HOME 12 -- 2.4. MENTAL HEALTH CARE SERVICES AND THE ARTICLE 107 13 -- 2.5. PROTOCOL 3 14 -- 2.6. CARE PATHWAYS, CLINICAL PATHWAYS, CARE PROGRAMS AND NETWORKS 14 -- 3. INTERNATIONAL COMPARISON 15 -- 3.1. METHODS FOR THE INTERNATIONAL COMPARISON 15 -- 3.1.1. Questionnaire: 15 -- 3.1.2. Belgian Chronic Care Model 16 -- 3.1.3. Experts contacted for validation of the countries 16 -- 3.2. VICTORIA (AUSTRALIA) 17 -- 3.2.1. Historic perspective and implementation stages 19 -- 3.2.2. What requirements must be met by HAH suppliers? 21 -- 3.2.3. How are routine hospital at home interventions planned, provided and coordinated? 27 -- 3.2.4. In case of emergency, how is acute response provided? 28 -- 3.2.5. How are patients and families supported? 28 -- 3.2.6. Are there specific conditions for early identification or screening of patients? 29 -- 3.2.7. How are HAH activities integrated within the health system? 29 -- 3.2.8. Follow-up of HAH activities - How are HAH’s activities evaluated? 30 -- 3.3. THE AUTONOMOUS COMMUNITIES OF VALENCIA AND THE BASQUE COUNTRY (SPAIN) 33 -- 3.3.1. Historic perspective and implementation stages 34 -- 3.3.2. What requirements must be met by HAH suppliers? 37 -- 3.3.3. How are routine hospital at home interventions planned, provided and coordinated? 44 -- 3.3.4. In case of emergency, how is acute response provided? 45 -- 3.3.5. How are patients and families supported? 46 -- 3.3.6. Are there specific conditions for early identification or screening of patients? 46 -- 3.3.7. How are HAH activities integrated within the health system? 47 -- 3.3.8. Follow-up of HAH activities – How are HAH’s activities evaluated? 48 -- 3.4. NETHERLANDS 50 -- 3.4.1. Historic perspective and implementation stages 52 -- 3.4.2. What requirements must be met by HAH suppliers? 55 -- 3.4.3. How are routine hospital at home interventions planned, provided and coordinated? 56 -- 3.4.4. In case of emergency, how is acute response provided? 57 -- 3.4.5. How are patients and families supported? 57 -- 3.4.6. Are there specific conditions for early identification or screening of patients? 57 -- 3.4.7. How are HAH activities integrated within the health system? 57 -- 3.4.8. Follow-up of HAH activities - How are HAH”s activities evaluated? 58 -- 3.5. FRANCE 58 -- 3.5.1. Historic perspective and implementation stages 59 -- 3.5.2. What requirements must be met by HAH suppliers? 60 -- 3.5.3. How are routine hospital at home interventions planned, provided and coordinated? 68 -- 3.5.4. In case of emergency, how is acute response provided? 69 -- 3.5.5. How are patients and families supported? 70 -- 3.5.6. Are there specific conditions for early identification or screening of patients? 71 -- 3.5.7. How are HAH activities integrated within the health system? 71 -- 3.5.8. Follow-up of HAH activities - How are HAH’s activities evaluated? 73 -- 4. DISCUSSION OF POSSIBILITIES FOR THE IMPLEMENTATION OF HAH IN BELGIUM 79 -- 4.1. SEMI-STRUCTURED QUESTIONNAIRE 79 -- 4.1.1. In French 79 -- 4.1.2. In Dutch 81 -- 4.2. BACKGROUND NOTE GIVEN BEFORE INTERVIEWS 83 -- 4.2.1. Une définition commune 83 -- 4.2.2. Trois scénarios alternatifs d’organisation 84 -- 4.3. SUMMARY OF THE RESULTS OF THE WORKSHOP 86 -- 5. STAKEHOLDER CONSULTATION: PRESENTATION OF RECOMMENDATIONS 92 -- 5.1. RECOMMENDATIONS TO LAUNCH PILOT-PROJECT 92 -- 5.2. RECOMMENDATIONS FOR ACTORS IMPLIED IN HAH 93 -- 5.3. RECOMMENDATIONS FOR THE SYSTEM 93 -- APPENDIX 1. SPAIN 94 -- APPENDIX 2. THE NETHERLANDS 96 -- APPENDIX 3. FRANCE 99 -- APPENDIX 3.1. MODES OF CARE IN FRANCE (FULL REPRODUCTION IN FRENCH) 99 -- APPENDIX 3.2. PRINICIPAL DIAGNOSIS OF PATIENTS IN HAH IN 2013 101 -- REFERENCES 10
Next generation sequencing gene panels for targeted therapy in oncology and haemato-oncology : Synthesis
No full text13 p.ill.FOREWORD 1 -- SUMMARY 2 -- 1. INTRODUCTION 3 -- 1.1. BACKGROUND 3 -- 1.2. RESEARCH QUESTIONS 3 -- 1.3. GENERAL APPROACH 3 -- 2. NEXT GENERATION SEQUENCING PANEL TESTS 4 -- 2.1. STEPS OF NGS PANEL TESTS 4 -- 2.2. AVAILABILITY OF NGS PANELS 5 -- 2.3. ADVANTAGES OF NGS PANEL TESTS FOR THE LABORATORY 6 -- 2.4. POINTS OF ATTENTION 6 -- 2.5. REGULATIONS, QUALITY ASSURANCE AND EDUCATION 7 -- 3. ECONOMIC ASPECTS 8 -- 3.1. IMPACT OF TEST ACCURACY ON COST-EFFECTIVENESS 8 -- 3.2. BILLING CODES AND NGS NEEDS FOR BELGIUM 10 -- 4. INTRODUCING NGS PANEL TESTS 11 -- RECOMMENDATIONS 1
Cervical and lumbar total disc replacements
No full text84 p.ill.,LIST OF FIGURES .2 -- LIST OF TABLES .3 -- LIST OF ABBREVIATIONS .4 -- SCIENTIFIC REPORT 7 -- 1 INTRODUCTION 7 -- 1.1 BACKGROUND 7 -- 1.2 SCOPE AND OBJECTIVES .8 -- 2 CERVICAL TOTAL DISC REPLACEMENT 9 -- 2.1 HEALTH PROBLEMS 9 -- 2.1.1 Population and condition 9 -- 2.1.2 Existing treatments .9 -- 2.2 DESCRIPTION AND TECHNICAL CHARACTERISTICS 9 -- 2.3 CURRENT USE 14 -- 2.3.1 Methods 14 -- 2.3.2 Results .15 -- 2.4 CLINICAL EFFECTIVENESS AND SAFETY .19 -- 2.4.1 Methods 19 -- 2.4.2 Results on Clinical Effectiveness .23 -- 2.4.3 Results on Safety .35 -- 2.4.4 Discussion 42 -- 2.5 ECONOMIC EVALUATION 42 -- 2.5.1 Introduction 42 -- 2.5.2 Methods 43 -- 2.5.3 Characteristics of the economic evaluations 44 -- 2.5.4 Results of the economic evaluations .48 -- 2.5.5 Discussion 50 -- 3 LUMBAR TOTAL DISC REPLACEMENT .51 -- 3.1 HEALTH PROBLEMS 51 -- 3.1.1 Population and condition 51 -- 3.1.2 Existing treatments .51 -- 3.2 DESCRIPTION AND TECHNICAL CHARACTERISTICS 51 -- 3.3 CURRENT USE 56 -- 3.3.1 Methods 56 -- 3.3.2 Results .56 -- 3.4 CLINICAL EFFECTIVENESS AND SAFETY .60 -- 3.4.1 Methods 60 -- 3.4.2 Results on Clinical Effectiveness .62 -- 3.4.3 Results on Safety .67 -- 3.4.4 Discussion 69 -- 3.5 ECONOMIC EVALUATION 70 -- 3.5.1 Introduction 70 -- 3.5.2 Methods 70 -- 3.5.3 Characteristics of the economic evaluations 72 -- 3.5.4 Results of the economic evaluations .75 -- 3.5.5 Discussion 77 -- REFERENCES .7
Remplacement total de disque cervical ou lombaire : Synthèse
No full text19 p.ill.,Les maux de dos dans leur ensemble comptent parmi les problèmes de santé les plus fréquents. Quand ils persistent un certain temps, la chirurgie est parfois proposée, avec l’espoir qu’elle apporte la guérison. Le Centre fédéral d’Expertise des Soins de Santé (KCE) a examiné deux types d’interventions portant sur les vertèbres, l’une destinée à traiter les fractures ou « tassements » douloureux, l’autre à remplacer les disques intervertébraux abîmés. Aucune des deux techniques n’est pleinement à la hauteur des espoirs placés en elle
Inconsistent diagnosis of acute malnutrition by weight-for-height and mid-upper arm circumference : contributors in 16 cross-sectional surveys from South Sudan, the Philippines, Chad, and Bangladesh
No full text86BACKGROUND:
The two anthropometric indicators of acute malnutrition in children under 5 years, i.e. a Mid-Upper Arm Circumference < 125 mm (MUAC125) or a Weight-for-Height Z-score<-2 (WHZ-2), correlate poorly. We aimed at assessing the contribution of age, sex, stunting (Height-for-Age HAZ<-2), and low sitting-standing height ratio Z-score (SSRZ in the 1st tertile of the study population, called hereafter 'longer legs') to this diagnosis discrepancy.
METHODS:
Data from 16 cross-sectional nutritional surveys carried out by Action Against Hunger International in South Sudan, the Philippines, Chad, and Bangladesh fed multilevel, multivariate regression models, with either WHZ-2 or MUAC125 as the dependent variable and age, sex, stunting, and 'longer legs' as the independent ones. We also compared how the performance of MUAC125 and WHZ-2 to detect slim children, i.e. children with a low Weight-for-Age (WAZ<-2) but no linear growth retardation (HAZ≥-2), was modified by the contributors.
RESULTS:
Overall 23.1% of the 14,409 children were identified as acutely malnourished by either WHZ-2 or MUAC125, but only 28.5% of those (949/3,328) were identified by both indicators. Being stunted (+17.8%; 95 % CI: 14.8%; 22.8%), being a female (+16.5%; 95 % CI: 13.5%; 19.5%) and being younger than 24 months (+33.6%; 95 % CI: 30.4%; 36.7%) were factors strongly associated with being detected as malnourished by MUAC125 and not by WHZ-2, whereas having 'longer legs' moderately increased the diagnosis by WHZ-2 (+4.2%; 95 % CI: 0.7%; 7.6%). The sensitivity to detect slim children by MUAC125 was 31.0% (95 % CI: 26.8%; 35.2%) whereas it was 70.6% (95 % CI: 65.4%; 75.9%) for WHZ-2. The sensitivity of MUAC125 was particularly affected by age (57.4% vs. 18.1% in children aged < 24 months vs. ≥ 24 months). Specificity was high for both indicators.
CONCLUSIONS:
MUAC125 should not be used as a stand-alone criterion of acute malnutrition given its strong association with age, sex and stunting, and its low sensitivity to detect slim children. Having 'longer legs' moderately increases the diagnosis of acute malnutrition by WHZ-2. Prospective studies are urgently needed to elucidate the clinical and physiological outcomes of the various anthropometric indicators of malnutrition
Estimating dynamic transmission model parameters for seasonal influenza by fitting to age and season-specific influenza-like illness incidence
No full text1-9Dynamic transmission models are essential to design and evaluate control strategies for airborne infections. Our objective was to develop a dynamic transmission model for seasonal influenza allowing to evaluate the impact of vaccinating specific age groups on the incidence of infection, disease and mortality. Projections based on such models heavily rely on assumed ‘input’ parameter values. In previous seasonal influenza models, these parameter values were commonly chosen ad hoc, ignoring between-season variability and without formal model validation or sensitivity analyses. We propose to directly estimate the parameters by fitting the model to age-specific influenza-like illness (ILI) incidence data over multiple influenza seasons. We used a weighted least squares (WLS) criterion to assess model fit and applied our method to Belgian ILI data over six influenza seasons. After exploring parameter importance using symbolic regression, we evaluated a set of candidate models of differing complexity according to the number of season-specific parameters. The transmission parameters (average R0, seasonal amplitude and timing of the seasonal peak), waning rates and the scale factor used for WLS optimization, influenced the fit to the observed ILI incidence the most. Our results demonstrate the importance of between-season variability in influenza transmission and our estimates are in line with the classification of influenza seasons according to intensity and vaccine matching
Reduction of the treatment gap for problematic alcohol use in Belgium : Supplement
No full text61 p.ill.,APPENDIX 1 SEARCH STRATEGIES 2 -- APPENDIX 1.1. SEARCH NAME: MEDLINE 2 -- APPENDIX 1.2. SEARCH NAME: EMBASE 3 -- APPENDIX 1.3. SEARCH NAME: PSYCHINFO 4 -- APPENDIX 1.4. SEARCH NAME: COCHRANE LIBRARY 5 -- APPENDIX 2. QUESTIONNAIRE DELPHI 'TREATMENT GAP' ALCOHOL -1ER TOUR 6 -- APPENDIX 3. QUESTIONNAIRE DELPHI 'TREATMENT GAP' ALCOHOL – RÉSULTATS DU 1ER TOUR 2
Strong Public Health Recommendations from Weak Evidence? : Lessons Learned in Developing Guidance on the Public Health Management of Meningococcal Disease
No full text11 p.The evidence underpinning public health policy is often of low quality, leading to inconsistencies in recommended interventions. One example is the divergence in national policies across Europe for managing contacts of invasive meningococcal disease. Aiming to develop consistent guidance at the European level, a group of experts reviewed the literature and formulated recommendations. The group defined eight priority research questions, searched the literature, and formulated recommendations using GRADE methodology. Five of the research questions are discussed in this paper. After taking into account quality of evidence, benefit, harm, value, preference, burden on patient of the intervention, and resource implications, we made four strong recommendations and five weak recommendations for intervention. Strong recommendations related not only to one question with very low quality of evidence as well as to two questions with moderate to high quality of evidence. The weak recommendations related to two questions with low and very low quality of evidence but also to one question with moderate quality of evidence. GRADE methodology ensures a transparent process and explicit recognition of additional factors that should be considered when making recommendations for policy. This approach can be usefully applied to many areas of public health policy where evidence quality is often low
Financer des essais cliniques axés sur la pratique avec des fonds publics : Synthèse
No full text23 p.ill.,Beaucoup de questions de soins de santé importantes pour la société ne trouvent pas de réponse dans les essais cliniques menés par l’industrie pharmaceutique. Ainsi, il n’y a que peu d’études qui comparent un traitement médicamenteux et une autre approche (par ex. une comparaison entre des antidépresseurs et une psychothérapie).
Dans une nouvelle étude, le Centre fédéral d’Expertise des Soins de Santé (KCE) arrive à la conclusion que le financement de tels essais cliniques par des moyens publics serait un excellent investissement. Il plaide donc pour que nous prenions exemple sur d’autres pays comme le Royaume-Uni ou les Pays-Bas, où cela se fait depuis des années.
Le KCE souligne l’importance de la sélection des questions prioritaires à investiguer et de l’existence d’infrastructures professionnelles et de réseaux d’expertise. Il est également important que les résultats de ces études soient mis en pratique au quotidien sur le terrain. À ces conditions, des programmes de recherche clinique financés par le secteur public pourront contribuer à un système de soins de santé plus efficients et à des soins de meilleure qualité.PRÉFACE 1-- SYNTHÈSE 2-- TABLE DES MATIÈRES. 2-- OBJET DE CE RAPPORT 4-- MESSAGES-CLÉS 4-- 1. CONTEXTE 5-- 1.1. LES ESSAIS CLINIQUES FORMENT LE SOCLE DES DÉCISIONS EN MATIÈRE DE SOINS DE SANTÉ 5-- 1.2. LES DIFFÉRENTS TYPES D’ESSAIS CLINIQUES 5-- 1.3. COMPLEXITÉ DES ESSAIS CLINIQUES 8-- 2. POURQUOI FINANCER DES ESSAIS CLINIQUES AVEC DES FONDS PUBLICS? 9-- 2.1. ESSAIS COMPARATIFS D’EFFICACITÉ CLINIQUE DE MÉDICAMENTS 9-- 2.2. ESSAIS CHEZ LES ENFANTS ET DANS LES MALADIES RARES 10-- 2.3. ESSAIS SUR LES DISPOSITIFS MÉDICAUX 10-- 2.4. ESSAIS SUR LES DIAGNOSTICS 10-- 2.5. ESSAIS DANS DES DOMAINES SANS INTÉRÊT POUR L’INDUSTRIE 10-- 3. IMPACT FINANCIER DES ESSAIS CLINIQUES PUBLICS: UN BON INVESTISSEMENT 11-- 4. QUEL EST LE CADRE NÉCESSAIRE POUR OPTIMALISER L’IMPACT DES ESSAIS PUBLICS? 13-- 4.1. UNE INFRASTRUCTURE ET DES RÉSEAUX EFFICACES 13-- 4.2. DES PROGRAMMES NATIONAUX BIEN STRUCTURÉS 15-- 4.2.1. Le programme d’essais cliniques britannique 15-- 4.2.2. Le programme d’essais cliniques néerlandais 17-- 4.2.3. Le programme d’essais cliniques italien 17-- 4.2.4. Ne pas négliger l’évaluation 17-- 4.3. UN CONTEXTE INTERNATIONAL FAVORABLE 17-- 4.4. UN FINANCEMENT SUFFISANT ET JUDICIEUSEMENT ATTRIBUÉ 18-- 4.4.1. Quel budget pour un programme national ? 18-- 4.4.2. Quel budget pour un essai? 19-- 4.4.3. Vers un système auto-suffisant? 19-- 5. CONCLUSION 20-- RECOMMANDATIONS 2