Search

BACKGROUND: Sleep disorders, including insomnia, are widespread problems, which have increased during the COVID-19 pandemic. Guidelines for the treatment of insomnia prioritize non-pharmacological interventions. Nevertheless, primary care professionals lack well-developed material for patient education, that could help implement the treatment guidelines in Flanders, Belgium. OBJECTIVE: This project's purpose is to develop complementary, written educational material, grounded in the principles of evidence-based practice, for primary care. PATIENT INVOLVEMENT: This co-design project involved patients and health professionals. Special attention was given to including patients with low health literacy, and empowering patients when designing in mixed groups. METHODS: Based on the framework of Sanders and Stappers (2014), data were collected and analyzed in four phases. Pre-design, needs were explored using think-aloud studies and focus groups. Next, for generative purposes, the design studio method was used. Then, evaluation of the prototype happened with another series of think-aloud studies. Finally, post-design, implementation of the product was evaluated with a short survey. RESULTS: Twenty-five participants (10 patients and 15 healthcare professionals) contributed to the development of an educational patient leaflet called Sssssst. How do you sleep (at night)? Out of 30 professionals who received the printed leaflet for use in practice, 17 provided feedback after six months. Generally, the leaflet was well received. Visual design aspects stimulated use in practice. DISCUSSION: Written and visual materials aid primary care professionals to educate patients on sleep and insomnia. This supporting tool also stimulates self-management in patients. Although inspiring and educational for all stakeholders, a co-design approach is no guarantee for the product to "fit all". ispartof: PATIENT EDUCATION AND COUNSELING vol:105 issue:12 pages:3558-3565 ispartof: location:Ireland status: published

Background: To support self-management of chronically ill persons, innovative approaches of care practice are being developed. Unfortunately, many self-management supporting interventions struggle to achieve reliable and consistent improvements at various levels (patient, provider and healthcare system level). One possible strategy to facilitate translating theory into practice, is to consider the healthcare professionals’ perspective prior to the development of new interventions. An exploration of their knowledge and opinion about barriers and facilitators is necessary before employing any self-management support (SMS) intervention. Therefore, our study aims to explore care professionals’ perspectives about SMS within the Flemish primary care setting. Methods: This study used a qualitative study design to examine SMS in primary care setting. Five focus groups were conducted, grouped into three waves. Participants were healthcare professionals in Flanders representing different disciplines and settings. A maximum variation purposive sampling was used to recruit participants. For the data analysis, the framework of thematic networks by Attride-Stirling was applied. Results: A total of 34 healthcare professionals participated. Three global themes related to SMS were derived from the thematic analysis: (1) Characteristics, (2) Support strategies, (3) Barriers and facilitators. SMS was characterised as a collaboration-based and person-centred approach. A variety of supporting strategies were mentioned by the focus group participants. Most strategies consisted of informing and educating patients. Complementary to individual strategies, collaborative strategies were deemed necessary to support self-management. Regarding barriers and facilitators, different patient-related factors were identified. Additionally, competencies of healthcare providers and external factors seem to hinder the implementation of SMS in practice. Conclusions: This focus group study highlights the importance of a collaborative, person-centred approach to SMS in the context of chronic diseases. Our findings point to the need for interventions that raise awareness and address barriers associated with SMS. Since generic SMS does not exist, the road to success is a growth process in which support must be adapted to the individual patient.

Background Belongingness has been proposed as a potential proxy for legitimate peripheral participation in medical education. Previous studies have shown good internal and external validity for tools designed to measure this variable, with potential use measuring the effectiveness of clinical teaching environments. This study examined changes in belongingness in medical students between 2019 and 2021 during covid related restrictions, and compared levels of belongingness in medical students in Belgium and the United Kingdom. Methods This study used a validated assessment tool that was self-administered via an online survey platform. Anonymised data was collected from undergraduate medical students from all years of training and results compared with previous data collected in 2019. Results The belongingness assessment tool described here good internal and external validity in undergraduate medical students in United Kingdom and Belgium, identified statistically significant changes in Belongingness (as measured with this tool) in undergraduate medical students during Covid restrictions and identified statistically significant differences between medical students in Belgium and the United Kingdom. Conclusions These results suggest that belongingness in in undergraduate medical students fluctuates and varies both between different demographic groups and under different conditions. The ability to measure this key facet of educational development has potential to monitor teaching environments to ensure optimal learning conditions for all students.

Background In view of the exponential use of the CanMEDS framework along with the lack of rigorous evidence about its applicability in workplace-based medical trainings, further exploring is necessary before accepting the framework as accurate and reliable competency outcomes for postgraduate medical trainings. Therefore, this study investigated whether the CanMEDS key competencies could be used, first, as outcome measures for assessing trainees’ competence in the workplace, and second, as consistent outcome measures across different training settings and phases in a postgraduate General Practitioner’s (GP) Training. Methods In a three-round web-based Delphi study, a panel of experts (n = 25–43) was asked to rate on a 5-point Likert scale whether the CanMEDS key competencies were feasible for workplace-based assessment, and whether they could be consistently assessed across different training settings and phases. Comments on each CanMEDS key competency were encouraged. Descriptive statistics of the ratings were calculated, while content analysis was used to analyse panellists’ comments. Results Out of twenty-seven CanMEDS key competencies, consensus was not reached on six competencies for feasibility of assessment in the workplace, and on eleven for consistency of assessment across training settings and phases. Regarding feasibility, three out of four key competencies under the role “Leader”, one out of two competencies under the role “Health Advocate”, one out of four competencies under the role “Scholar”, and one out of four competencies under the role “Professional” were deemed as not feasible for assessment in a workplace setting. Regarding consistency, consensus was not achieved for one out of five competencies under “Medical Expert”, two out of five competencies under “Communicator”,one out of three competencies under “Collaborator”, one out of two under “Health Advocate”, one out of four competencies under “Scholar”, one out of four competencies under “Professional”. No competency under the role “Leader” was deemed to be consistently assessed across training settings and phases. Conclusions The findings indicate a mismatch between the initial intent of the CanMEDS framework and its applicability in the context of workplace-based assessment. Although the CanMEDS framework could offer starting points, further contextualization of the framework is required before implementing in workplace-based postgraduate medical trainings.

Introduction Since 2000, an increasing misuse of emergency services in Belgium was noticed. In 2015, a multidisciplinary task-force designed a triage system. Trained operators and integrated triage protocols were installed in a call center for life-threatening and non-life-threatening care needs. Teleconsultations by telephone find their way to planned care and are well studied in this context. Also unplanned care might benefit from telephone-consultations. Method This intervention study investigated the feasibility of teleconsultations in unplanned care according to medical doctors. They were present at the call center during the weekend and on public holidays in the period of April 17, 2021 to November 21, 2021. Their task was to call patients who had contacted the call center to perform a teleconsultation, without interfering with regular care. Results 21 triage doctors participated in the study, they completed 59 surveys and conducted 551 teleconsultations. They perceived the quality of the consultations as good with an average score of 82.85 out of 100 on the sliding scale. The doctors gave an average score of 72.40 for the level of certainty for diagnosis and treatment. For 415 consultations, triage doctors judged that the consultation would gain certainty if followed by a physical examination. Video was mainly considered to be valuable in psychiatric problems, allergic reactions and skin problems. Discussion This study showed that teleconsultations are feasible in unplanned care. Videos add value in particular cases. Only few barriers are reported in terms of communication, technology and equipment. Conclusion Teleconsultations in unplanned primary care could be performed with a high quality and a sufficient level of certainty. The willingness to conduct teleconsultations in unplanned care is high. It would be useful in a future study to investigate the feasibility, obstacles and needs for implementation of video consultations as they may differ from teleconsultations.

Background Experience and research show that screening for malnutrition in primary care mainly takes place by monitoring the weight parameter and that validated screening instruments are hardly used. In this study we examined the effectiveness and predictive value of weight evolution in screening for (risk of) malnutrition in older people living at home, in comparison with a validated screening tool, namely the Mini Nutritional Assessment Short Form (MNA-SF). Methods This project was a prospective, longitudinal study with quantitative data that took place in the province of Antwerp (Belgium) from December 2020 until June 2021. The target group of this study consisted of people over 70 living at home who were visited by a home nurse on a regular basis (at least once a month). The outcome measure was the weight evolution over six months compared with the score on the MNA-SF at month six. Weight was measured and recorded once a month during 6 months. At the last weight measurement, the MNA-SF was administered. In order to assess their own nutritional state, three additional questions were asked after taking the MNA-SF. Results A total of 143 patients gave consent to participate, of which 89 were women and 54 men. The mean age was 83.7 years (SD6.62) with a range of 70 to 100 years. Based on the MNA-SF score measured after six months, 53.1% (76/143) of participants had a normal nutritional status, 37.8% (54/143) scored risk of malnutrition and 4.9% (7/ 143) was malnourished. In order to detect people with (risk of) malnutrition, a PPV of 78.6%, a NPV of 60.7%, a sensitivity of 19.3% and a specificity of 96.0% were established with a weight evolution of ≥ 5% weight loss at six months. To detect malnutrition, our results showed respectively 33.3%, 98.4%, 71.4% and 92.3%. Conclusion In this study, weight evolution has a low sensitivity in screening for (risk of) malnutrition in people over 70 living at home compared to the MNA-SF. However, in order to detect people with malnutrition, this study demonstrated a sensitivity of 71.4% and a specificity of 92.3% for a weight loss of ≥ 5% at six months.

Study Objectives International guidelines recommend using benzodiazepine receptor agonists (BZRA) for maximally four weeks. Nevertheless, long-term use for chronic insomnia disorder remains a common practice. This study aimed to test the effectiveness of blended care for discontinuing long-term BZRA use in general practice. Methods A pragmatic cluster randomized controlled superiority trial compared blended care to usual care through urine toxicology screening. In the intervention, care by the general practitioner (GP) was complemented by an interactive e-learning program, based on cognitive behavioral therapy for insomnia. Adults using BZRA daily for minimally 6 months were eligible. Participants were clustered at the level of the GP surgery for allocation (1:1). Effectiveness was measured as the proportion of patients who had discontinued at one-year follow-up. Data analysis followed intention-to-treat principles. Results In total, 916 patients in 86 clusters, represented by 99 GPs, were randomized. Primary outcome data was obtained from 727 patients (79%). At one-year follow-up, 82 patients (18%) in blended care, compared to 91 patients (20%) in usual care, had discontinued. There was no statistically significant effect for the intervention (OR: 0.924; 95% CI: 0.60; 1.43). No adverse events were reported to the research team. Conclusions The findings did not support the superiority of blended care over usual care. Both strategies showed clinical effectiveness, with an average of 19% of patients having discontinued at one-year follow-up. Further research is important to study the effect of structurally implementing digital interventions in general practice. Clinical trial Big Bird trial; KCE-17016. This trial is registered at clinicaltrials.gov (NCT03937180).

Background Malnutrition is a heavily underestimated but frequently occurring pathology. Due to aging of the population and the increasing survival rate for a number of pathologies, the prevalence of malnutrition is increasing. Malnutrition in the home situation will increase due to the decrease in the hospitalization length and the shift of care to primary care. Screening for malnutrition is indispensable, as only half of malnourished patients are recognized by health care providers. Experience and research show that screening in primary care mainly takes place by monitoring the weight parameter and that validated screening instruments are hardly used. With this study we want to investigate how effective and predictive weight evolution is in screening for (risk of) malnutrition in older people living at home, in comparison with the gold standard, namely the MNA-SF. Methods This project is a prospective, longitudinal study with quantitative data. The outcome measure is the weight evolution over six months compared with the score on the MNA-SF at month six. The target group of this study consists of people over 70 living at home and receiving help from a nurse on a regular basis (at least once a month). Weight is measured and recorded once a month during 6 months. At the last weight measurement, the MNA-SF is administered. In order to assess their own nutritional state, three additional questions are asked after taking the MNA-SF Results A total of 143 patients consented to participate. Based on the MNA-SF score measured after six months, 37.8% (54/143) was at risk of malnutrition and 4.9% (7/ 143) was malnourished. In order to detect people with (risk of) malnutrition, a sensitivity of 19.3% and a specificity of 96.0% were established with a weight evolution of ≥5% weight loss at six months. To detect malnutrition, this was 71.4% and 92.3%, respectively. Conclusion Weight evolution has a low sensitivity in screening for malnutrition in people over 70 living at home compared to the MNA-SF as the gold standard. In order to detect people with malnutrition, weight loss seems to have a considerable predictive value in this study.

ObjectiveThe aim of the present study is to describe a stepwise approach to study which contextual factors might moderate the effect of healthcare interventions and to test feasibility of this approach within the D-SCOPE project.DesignExploratory case study.SettingIn the D-SCOPE project, a complex intervention by means of home visits was set up to improve access to tailored care in three municipalities (Ghent, Knokke-Heist and Tienen).MethodsOne designed and tested an approach including five steps: (1) a theoretical/conceptual discussion of relevant contextual factor domains was held; (2) a search was done to find appropriate web-based public datasets which covered these topics with standardised information; (3) a list of all identified contextual factors was made (inventory); (4) to reduce the long list of contextual factors, a concise list of most relevant contextual factors was developed based on the opinion of two independent reviewers and (5) a nominal grouping technique (NGT) was applied.ResultsThree public web-based datasets were found resulting in an inventory of 157 contextual factors. After the selection by two independent reviewers, 41 contextual factors were left over and presented in a NGT which selected 10 contextual factors. The NGT included seven researchers, all familiar with the D-SCOPE intervention, with various educational backgrounds and expertise and lasted approximately 1 hour.ConclusionThe present study shows that a five-step approach is feasible to determine relevant contextual factors that might affect the results of an intervention study. Such information may be used to correct for in the statistical analyses and for interpretation of the outcomes of intervention studies.NCT03168204

BackgroundContrary to most European guidelines, benzodiazepine receptor agonists (BZRA) are often used continuously at a low dosage, being the most common form of long-term use. In Belgium, BZRA use is monitored by analyzing self-report data about medication use in the last 24 h. This method provides insufficient insight into the terms of use of these psychoactive drugs.AimTo describe trends in BZRA prescribing in Flanders, Belgium, between 2000 and 2019.Design and settingPopulation-based trend analysis and a case-control study for the year 2019 were done with data from a morbidity registry in general practice.MethodsRepeated cross-sectional and joinpoint regression analyses revealed trends in sex- and age-standardized prescription rates among adult patients (18+).ResultsOverall, BZRA prescriptions increased. The highest overall increase was found among male patients 18–44 years old, with an average annual percentage change of 2.5 (95% CI: 0.9, 4.3). Among 65+ female patients, a decrease was found since 2006, with an annual percentage change of −0.7 (95% CI: −1.3, −0.1). In 2019, 12% of registered patients received minimally one prescription, long-term use was observed in 5%, back pain was the most common morbidity significantly associated with a rise in BZRA prescriptions, and zolpidem was the most prescribed BZRA (22%).ConclusionDespite some statistically significant decreasing trends, an overall increase in BZRA prescriptions was observed throughout the 19-year study period, especially among long-term users of 18–44 years and 65-plus. Zolpidem became the most prescribed BZRA and warrants more attention.

International guidelines recommend using benzodiazepine receptor agonists (BZRA) for maximally four weeks. Nevertheless, long-term use for chronic insomnia disorder remains a common practice. This study aimed to test the effectiveness of blended care for discontinuing long-term BZRA use in general practice.A pragmatic cluster randomized controlled superiority trial compared blended care to usual care through urine toxicology screening. In the intervention, care by the general practitioner (GP) was complemented by an interactive e-learning program, based on cognitive behavioral therapy for insomnia. Adults using BZRA daily for minimally six months were eligible. Participants were clustered at the level of the GP surgery for allocation (1:1). Effectiveness was measured as the proportion of patients who had discontinued at one-year follow-up. Data analysis followed intention-to-treat principles.In total, 916 patients in 86 clusters, represented by 99 GPs, were randomized. Primary outcome data was obtained from 727 patients (79%). At one-year follow-up, 82 patients (18%) in blended care, compared to 91 patients (20%) in usual care, had discontinued. There was no statistically significant effect for the intervention (OR: 0·924; 95% CI: 0·60, 1·43). No adverse events were reported to the research team.The findings did not support the superiority of blended care over usual care. Both strategies showed clinical effectiveness, with an average of 19% of patients having discontinued at one-year follow-up. Further research is important to study the effect of structurally implementing digital interventions in general practice.

IntroductionSince 2000, an increasing misuse of emergency services in Belgium was noticed. In 2015, a multidisciplinary task-force designed a triage system. Trained operators and integrated triage protocols were installed in a call center for life-threatening and non-life-threatening care needs. MethodThis cross-sectional survey with intervention studied the feasibility of teleconsultations in unplanned care in a primary care setting. Medical doctors were present at the call center during the weekend and on public holidays in the period of 17 April 2021 to 21 November 2021. Their task was to call They called patients who had contacted the call center to perform a teleconsultation, without interfering with regular care. Results21 triage doctors participated in the study, they completed 59 surveys and conducted 551 teleconsultations. They perceived the quality of the consultations as good with an average score of 82.85 out of 100 on the sliding scale. The doctors gave an average score of 72.40 for the level of certainty for diagnosis and treatment. For 415 consultations, triage doctors judged that the consultation would gain certainty if followed by a physical examination. Video was mainly considered to be valuable in psychiatric problems, allergic reactions and skin problems. DiscussionThis study showed that teleconsultations are feasible in unplanned care. Videos add value in particular cases. Only few barriers are reported in terms of communication, technology and equipment.ConclusionTeleconsultations in unplanned primary care could be performed with a high quality and a sufficient level of certainty. The willingness to conduct teleconsultations in unplanned care is high. It would be useful in a future study to investigate the feasibility, obstacles and needs for implementation of video consultations as they may differ from teleconsultations.

We wanted to investigate the relationship of medical and non-medical factors with the clinical decision-making of pediatricians. We hypothesize that the addition of relevant medical information (either alarming or reassuring) will influence the physician's decision-making, but that the addition of non-medical information will also play a role. To investigate this, we designed an online questionnaire containing ten clinical case-based scenarios, of which five focused on medical factors and five on non-medical/context factors, each scored on a five-point Likert scale. In total, 113 pediatricians completed the online questionnaire. Both medical and non-medical/context factors were considered relevant to change the initial decision in most cases. Additional information of an alarming nature induces the physician to become more worried, whereas reassuring information decreases this worry. In some cases, with the medical factors, the gender and the age of the pediatrician does have some effect on the clinical decision-making. We conclude that medical decision-making is affected by multiple intrinsic and extrinsic factors that differ between physicians. Our data indicate that these non-medical factors must be considered when making a medical decision, as it is crucial to be aware that they have a substantial influence on that decision-making. ispartof: Children vol:9 issue:3 pages:1-12 ispartof: location:Switzerland status: published

BACKGROUND: Motivating patients to discontinue long-term benzodiazepine receptor agonist (BZRA) use for insomnia remains an important challenge in primary care because of the medication's unfavourable risk-benefit profile. Previous studies have shown that understanding the complexity of patients' motivation is crucial to the primary care physician for providing effective interventions efficiently. Theoretical frameworks about behaviour change show that motivation is a multi-layered concept that interacts with other concepts, which aligns with a holistic perspective or implementation of the biopsychosocial model. AIM: Exploring primary care patients' views and ideas on what factors helped or hindered them in discontinuing long-term BZRA use, in relation to motivation as conceptualised in the Behaviour Change Wheel, and associated domains of the Theoretical Domains Framework. DESIGN AND SETTING: A qualitative study with semi-structured interviews in primary care in Belgium between September 2020 and March 2021. METHOD: Eighteen interviews with long-term hypnotic users were audio recorded, transcribed and thematically analyzed, using the Framework Method. RESULTS: The success of discontinuation interventions does not solely rely on patients' spontaneous sense of striving for improvement. Reinforcement and identity were found to be important domains for motivation. Beliefs about personal capabilities, and about consequences of both BZRA intake and discontinuation, differed between previous and current users. CONCLUSION: Motivation is a multi-layered concept which is not fixed in time. Patient empowerment and goal setting could help long-term BZRA users to lower their intake. As well as public health interventions that might change social attitudes towards the use of hypnotic medication. ispartof: Heliyon vol:9 issue:5 pages:e16215- ispartof: location:England status: Published online

BackgroundCoping with a chronic disease can be really challenging. Self-management represents a promising strategy to improve daily life experiences. The role of primary healthcare professionals cannot be underestimated in supporting self-management. Due to a shortage of theory, implementation of self-management support is hindered in primary care practice. The aim of this study is to create a conceptual model for self-management support by analysing patients’ care experiences towards self-management support. MethodsAn explorative-descriptive qualitative study was conducted in Flanders, Belgium. Semi-structured interviews were performed with 16 patients and their informal caregiver (dyads) using a purposive sampling strategy and processed by an inductive content analysis. ResultsInterviews revealed in-depth insights into patients’ care experiences. A conceptual model was developed for primary care practice, including five fundamental tasks for healthcare professionals - Supporting, Involving, Listening, Coordinating and Questioning (SILCQ) – contributing to the support of self-management of chronic patients.ConclusionThis qualitative paper emphasises the use of the SILCQ-model to develop optimal roadmaps and hands-on toolkits for healthcare professionals to support self-management. The model needs to be further explored by all stakeholders to support the development of self-management interventions in primary care practice.

Background In times of COVID-19, we are challenged to experiment with alternative platforms or software to connect people. In particular, the struggle that arose in health research was how to interact with patients and care professionals. The latter is additionally faced with an extreme workload to fight the pandemic crisis. Creative strategies have been developed to continue research among patients and care professionals to improve quality of care. This paper addresses the issue of synchronous, online, nominal group sessions, a common consensus method used for group brainstorming. Objective The purpose of this study was to share our experiences with performing online, nominal group sessions using the video conference software Microsoft Teams. In addition, we aimed to create a practical guide with recommendations for researchers. Methods We critically analyzed the procedures for the online nominal group technique, according to the Fishbone methodology. Results Performing synchronous, online, nominal group sessions is challenging but offers opportunities. Although interaction with and among the attendees complicates the process, the major advantage of online sessions is their accessibility and comfort because of reduced barriers to participation (eg, lower time investment). The role of the moderators is of major importance, and good preparation beforehand is required. Recommendations for future online, nominal research were formulated. Conclusions Online, nominal group sessions seem to be a promising alternative for the real-life commonly used technique. Especially during the COVID-19 pandemic, the benefits must be highlighted. More expertise is needed to further refine the practical guide for using digital software in research and to achieve optimal performance.

BACKGROUND In times of COVID-19, we are challenged to experiment with alternative platforms or software to connect people. In particular, the struggle that arose in health research was how to interact with patients and care professionals. The latter is additionally faced with an extreme workload to fight the pandemic crisis. Creative strategies have been developed to continue research among patients and care professionals to improve quality of care. This paper addresses the issue of synchronous, online, nominal group sessions, a common consensus method used for group brainstorming. OBJECTIVE The purpose of this study was to share our experiences with performing online, nominal group sessions using the video conference software Microsoft Teams. In addition, we aimed to create a practical guide with recommendations for researchers. METHODS We critically analyzed the procedures for the online nominal group technique, according to the Fishbone methodology. RESULTS Performing synchronous, online, nominal group sessions is challenging but offers opportunities. Although interaction with and among the attendees complicates the process, the major advantage of online sessions is their accessibility and comfort because of reduced barriers to participation (eg, lower time investment). The role of the moderators is of major importance, and good preparation beforehand is required. Recommendations for future online, nominal research were formulated. CONCLUSIONS Online, nominal group sessions seem to be a promising alternative for the real-life commonly used technique. Especially during the COVID-19 pandemic, the benefits must be highlighted. More expertise is needed to further refine the practical guide for using digital software in research and to achieve optimal performance.

ObjectiveTo determine the impact of the affiliate stigma on mental well-being of relatives caring for a person with dementia.DesignThe study was conducted in a cross sectional design.SettingThe study was conducted in a public setting, addressing relatives caring for a person with dementia.ParticipantsParticipants were relatives of patients with a formal diagnosis of dementia. Relatives were defined as caring or living closely to a patient. Participants were recruited with the help of care and welfare organizations.Outcome MeasuresThe main outcome measure was the impact of the affiliate stigma on mental well-being of caring relatives.Results228 participants fully completed the survey. Women, relatives with a higher education and partners experienced more impact of the affiliate stigma on mental well-being than man, relatives with a lower education and relatives with another relationship to the person with dementia (resp. F-ratio = 15.67; p = 0.0001; F-ratio = 2.5865; p = 0.0381; F-ratio = 3.1131; p = 0.0099). The duration of dementia and the age of the caregiver had a clear significant effect on affiliate stigma (F-ratio = 4.9104; p = 0.0083) (F-ratio = 6.5515, p = 0.0112).ConclusionThis study revealed that caregiver related features are predicting the presence of an affiliate stigma. Interventions to prevent or reduce the impact of this stigma might focus on these groups. Education about dementia and the impact on patients, relatives and the broader social context might alter the affiliate stigma surrounding dementia.

Title: To a better understanding of the concept of “a good death”: How do patients, close relatives and healthcare providers define a good death and which affecting factors are important? Introduction: The goal of palliative care is to improve the quality of life when recovery isn’t possible anymore. The objective is to widen our vision of potential (unspoken) needs at the end of life with patients, close relatives, nurses and general practitioners. This is to aim at a more versatile, but personal care at the end of life. The research question is: “How important do patients, close relatives and healthcare providers consider the 11 core themes in defining a good death as described in the article of Meier ‘Defining a Good Death’ in 2016?” Method: Specific questionnaires for general practitioners, nurses, patients and family members were distributed in the working area of the Palliative Care Network in the region Aalst-Dendermonde-Ninove with the cooperation of 5 Local Quality Groups (LOK’s), 2 nursing homes and 2 groups of homecare nurses. The data was analyzed with Microsoft Excel 2016 and the statistical program SAS. Results: The questionnaire was completed by 67 nurses, 57 general practitioners, 16 patients and 8 family members. Although, the 34 subthemes were generally considered important to be able to speak of a good death, there were still significant differences determined with healthcare providers, between general practitioners and nurses, men and women, and depending on their age. Nurses found the following themes significantly more important than general practitioners: dying during sleep, the patient isn’t a burden to their close relatives, life well lived, faith, all available treatments were used, the patient’s last phase of life can be lived in a usual and meaningful manner, he/she can talk to their healthcare provider about spiritual beliefs or fears in relation to dying, the presence of pets and the cost of healthcare. All groups considered unanimously that a pain-free death was the most important. General practitioners, nurses, patients and close relatives found the following themes as important: support of family, respect for the patient as an individual, being able to say goodbye and euthanasia in case of unbearable suffering. Discussion and conclusion: In agreement with the patient, medical care should focus on a pain-free situation during the last phase of life and not on the exhaustion of possible treatments which prolongs life unnecessarily. Appropriate care at the end of life can be broader and all 34 subtheme’s can be important in early healthcare planning. Significant differences between general practitioners and nurses deserve attention, because patients and family members expect that healthcare providers will work together as a team. ispartof: AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY vol:27 issue:5 pages:463-471 ispartof: location:England status: Published online

BACKGROUND: Increasingly, informal caregivers in Belgium care in group for an older patient. This study aimed to decrease the caregiver burden and to increase the well-being of caregivers and patients by supporting the needs of informal care groups of older patients (≥70 years). METHOD: Through an online self-management tool, the groups were supported to make informed choices concerning the care for the older patient, taking into account the standards, values, concerns and needs of every caregiver and patient. A pre-post study was performed. RESULTS: Although patients and caregivers considered the self-management tool as useful and supportive, no clear evidence for decreased caregiver burden was found. There was a positive trend in group characteristics such as the distribution of tasks, communication and prevalence of conflicts. Caregivers also stated that they took more time for themselves, had less feelings of guilt and experienced less barriers to ask help. CONCLUSION: Tailor-made support of informal care groups starts with facilitating and guiding a process to achieve consent within the group to optimise the care for the patient and also for the caregivers. With a shared vision and supported decisions, caregivers can enter into conversations with the professional caregiver to coordinate adjusted support regarding the care needs. ispartof: HEALTH & SOCIAL CARE IN THE COMMUNITY vol:30 issue:4 pages:1514-1529 ispartof: location:England status: published

BACKGROUND: In the migrant population, there is a higher risk of dementia. However, dementia is underdiagnosed in this population due to the underuse of appropriate screening tools. The Rowland Universal Dementia Assessment Scale (RUDAS) is designed for culturally and linguistically diverse populations. OBJECTIVES: To gain insights into the primary care cognitive screening strategy for dementia in migrants and to evaluate the experiences with the RUDAS tool by general practitioners (GPs). METHODS: GPs were questioned about barriers in dementia screening in the migrant population and asked to apply the RUDAS. A mixed-methods study was conducted among Flemish GPs. In an online survey, the currently used methods for screening for dementia in migrants and the barriers were investigated. In a qualitative pilot study, the user experience of the RUDAS scale was explored. RESULTS: A total of 122/322 GPs participated (response rate 38%), 102 (83.6%) of all responding GPs mentioned language problems as the most apparent barrier. Most GPs believed the Mini Mental State Examination was inappropriate for migrants but they were unaware of an alternative. Due to lack of time and target population, only two GPs effectively applied the RUDAS. The tool was found easy to understand and less challenging in case of language problems. The main reason for not using RUDAS was the suspected time consumption. CONCLUSION: GPs find screening for dementia in migrant patients a challenging act, mainly due to language barriers. GPs are not confident enough with the appropriate screening strategies and tools adjusted to the needs of migrant patients. Abbreviations: GP: general practitioner; RUDAS: Rowland Universal Dementia Assessment Scale; MMSE: Mini Mental State Examination. ispartof: EUROPEAN JOURNAL OF GENERAL PRACTICE vol:27 issue:1 pages:45-50 ispartof: location:England status: published

Background: The COVID-19 pandemic has profoundly affected assessment practice in higher education including a complex planning of supervision. To organise safely and reliably a remote proficiency-test for admission to the Advanced Master of General Practice (AMGP), we developed a supervisor app tracking and tracing candidates’ behaviour. Methods: A cross-sectional design was adopted with candidates applying for admission to the AMGP. The supervisor app operated on three levels to register events: recording actions, analysing behaviour, and live supervision. Each suspicious event was given a score. The outcome measures were the number of suspicious events and the exam outcome compared to the past year. To get more insight into candidates’ perceptions about the app, a post-test questionnaire was administered. An exploratory factor analysis was performed to explore quantitative data, while qualitative data were thematically analysed. Results: In total, 472 (79%) candidates used the app in an off campus setting and 121 (20%) were on campus with live supervision. Test results of both groups were comparable. The app detected 22 candidates with a suspicious level >1, mainly due to background noise. All events occurred without fraud purpose. Out of 472 candidates, 304 filled in the post-test questionnaire. Two factors were extracted from the analysis and identified as candidates’ appreciation of the app and as emotional distress because of the app. Four themes were identified in the thematic analysis providing more insight on candidates’ emotional well-being. Conclusions: A supervisor app registering and recording behaviour to prevent fraud during off-campus exams is efficient without influencing the exam outcome. Although candidates’ perceptions were mixed, increased anxiety was due to the lack of clear guidelines about the app. Future research should compare in a controlled design the cost-benefit balance between the supervisor app and candidates’ awareness of being monitored combined with a safe exam browsing plug in.

Background In Belgium, General Practitioner Cooperatives (GPC) aim to improve working conditions for unplanned care and to reduce the number of low acuity emergency visits. Although this system is well organized, the number of low acuity visits does not decrease. Methods We explored the view of patients and physicians on the co-location of a GPC and an emergency service for unplanned care. The study was carried out in a cross section design in primary and emergency care services and included patients and physicians. Main outcome measure was the view of patients and physician on co-location of a GPC and an emergency service. Results 404 patients and 488 physicians participated. 334 (82.7%) of all patients favoured a co-location. The major advantages were fast service (104, 25.7) and adequate referral (54, 13.4%). 237 (74%) of the GPs and 38 (95%) of the emergency physicians were in favour of a co-location. The major advantage was a more adequate referral of patients. 254 (79%) of the GPs and 23 (83%) of the emergency physicians believed that a co-location would lower the workload and waiting time and increase care quality (resp. 251 (78%), 224 (70%) and 37 (93%), 34 (85%). Conclusions To close the expectation gap between GP’s, emergency physicians and to reach for high care quality, information campaigns and development of workflows are indispensable for a successful implementation of a co-location of primary and emergency care.

BACKGROUND The COVID-19 pandemic has affected education and assessment programs and has resulted in complex planning. Therefore, we organized the proficiency test for admission to the Family Medicine program as a proctored exam. To prevent fraud, we developed a web-based supervisor app for tracking and tracing candidates’ behaviors. OBJECTIVE We aimed to assess the efficiency and usability of the proctored exam procedure and to analyze the procedure’s impact on exam scores. METHODS The application operated on the following three levels to register events: the recording of actions, analyses of behavior, and live supervision. Each suspicious event was given a score. To assess efficiency, we logged the technical issues and the interventions. To test usability, we counted the number of suspicious students and behaviors. To analyze the impact that the supervisor app had on students’ exam outcomes, we compared the scores of the proctored group and those of the on-campus group. Candidates were free to register for off-campus participation or on-campus participation. RESULTS Of the 593 candidates who subscribed to the exam, 472 (79.6%) used the supervisor app and 121 (20.4%) were on campus. The test results of both groups were comparable. We registered 15 technical issues that occurred off campus. Further, 2 candidates experienced a negative impact on their exams due to technical issues. The application detected 22 candidates with a suspicion rating of >1. Suspicion ratings mainly increased due to background noise. All events occurred without fraudulent intent. CONCLUSIONS This pilot observational study demonstrated that a supervisor app that records and registers behavior was able to detect suspicious events without having an impact on exams. Background noise was the most critical event. There was no fraud detected. A supervisor app that registers and records behavior to prevent fraud during exams was efficient and did not affect exam outcomes. In future research, a controlled study design should be used to compare the cost-benefit balance between the complex interventions of the supervisor app and candidates’ awareness of being monitored via a safe browser plug-in for exams.

Background Cognitive competencies are widely used to evaluate medical students’ performance in postgraduate education. However, non-cognitive competencies equally play an important role in medical students’ future career. Efficient selection of medical students in GP training plays an important role in improving healthcare quality. The aim of this study was to examine quantitatively and qualitatively the validity of a multicomponent proficiency assessment tool for identifying underperforming students in cognitive and non-cognitive competencies, prior to entering postgraduate GP education. Design Longitudinal cohort study with quantitative and qualitative data. Setting 894 medical GP students from 2016 to 2018 in four Flemish universities in Belgium registered to take a multicomponent proficiency-test before admission to postgraduate education. Method Data on students were obtained from a proficiency-test as a test-score and from traineeship mentors’ reports qualitatively. A thematic analysis was performed to analyze mentors’ reports. The lowest and highest score quartiles were compared. The relationship between test score and whether a student was labelled as underperforming was calculated with chi-square tests, and the effect estimate was calculated with odds ratios. Results In total, 849 students took the multicomponent proficiency-test during 2016-2018. Test scores were normally distributed. Five different descriptive labels were extracted from mentors’ reports considering both cognitive and non-cognitive competences. Conclusion Students that ranked in the lowest score quartile had a higher likelihood of being signaled as underperforming than students ranking in the highest score quartile. Therefore, a low score in the multicomponent proficiency-test could indicate the need for early remediating actions. This present study did not address reliability.

Background In Belgium there is a problem with improper use of emergency services. The government installed an emergency number 1733 for out of hours care. Through a dry run test we learned that 10% of all calls were allocated to the protocol ‘unclear problem’. In only 10% of all cases, there was indeed an unclear problem.Methods This study aimed to determine whether the adjusted protocol ‘unwell for no clear reason’ led to a safer and more efficient referral and to evaluate the efficiency and safety of the specific primary care protocols. The study was performed in a retrospective and prospective design and involved the community, patients, General Practitioner Cooperatives, emergency departments and telephone operators.Results During 6 months in 2018, 11622 calls to 1733 were registered. 756 of these calls were allocated to ‘unwell for no clear reason’. A random sample of 180 calls was re-listened. The efficiency and safety of the protocol ‘unwell for no clear reason’ improved. The safety levels for under- and over-triage were not exceeded. The GP’s on duty judged that 9/10 of all patient encounters were correctly allocated. In less than 1% of all referrals, there was an under-triage.Conclusion This study demonstrated that the implementation of a 1733-operating system to triage patients to an adequate care level is successful if protocols, flow charts and care levels are well defined and operators well trained.

ispartof: Tijdschrift voor Geneeskunde pages:1-13 status: published

Little is known about the dynamics of a group of people giving informal care together. The aim of this study was to investigate the characteristics of an informal care group, the obstacles the informal care group experiences, the needs and desires they have and how the informal care group can be supported by general practitioners (GPs) and other professionals. Nine informal care groups were interviewed based on a questionnaire that was preapproved by the six Flemish official informal caregiver organisations. The results were analysed using open coding. A survey was conducted among 137 caregivers who were part of a group. Univariate analysis was performed. Informal care group usually consist of close relatives of the patient, with often the partner of the patient as the main caregiver. The size of the informal care group depends on the size of the family. If there are more caregivers in a group, the perceived burden of the individual caregiver decreases. The support of the other caregivers in the group increases capacity. The cooperation and agreements are often spontaneously organised and few problems are reported. There is a large variation in the expectations of support from the general practitioner, ranging from availability in emergencies to information about the possibilities of formal home care. This study depicts a positive image of the informal care group. Being part of a caregiver group both decreases burden and increases capacity. Informal care groups usually function well without a need for formal agreements within the group, and they rarely need a third party to coordinate with them or intervene. ispartof: HEALTH & SOCIAL CARE IN THE COMMUNITY vol:27 issue:2 pages:375-382 ispartof: location:England status: published

BACKGROUND: Policymakers in several European countries, concerned about the sustainability of their pension system, have raised the statutory retirement age. While several studies investigated the effect of retirement on health, the relationship between retirement and frailty is neglected. Notwithstanding, frailty is associated with adverse outcomes. OBJECTIVE: The aim of this study was to examine the relationship between age of retirement and frailty in later life. METHODS: Data of the Belgian Ageing Studies, a cross-sectional research project was used. The present study includes N=12659 participants (>60y) in 83 Flemish municipalities. To address reverse causality, only participants not retired because of health-related reasons were included. The Comprehensive Frailty Assessment Instrument, a multidimensional frailty scale with four domains (physical, psychological, social and environmental) was used to operationalize frailty. Univariate general linear regression analyses (GLM) were performed for scores on the total frailty scale and the four subdomains separately. The analysis was done for men and women separately, since both groups have different labor trajectories. RESULTS: The present study found a negative association between age of retirement and physical frailty for both men and women in later life, and total frailty for men, although the differences were small. No evidence was found for a relation between age of retirement and the other subdomains of frailty. CONCLUSIONS: The results suggest that age of retirement is not a clinically relevant predictor for frailty in later life. Differences within and between subpopulations (e.g., profession) can shed a new light on this relation. ispartof: Archives Of Gerontology And Geriatrics vol:96 ispartof: location:Netherlands status: published

De continuiteit van zorg is wettelijk verplicht in Belgie. In de eerstelijnszorg wordt de continuiteit gegarandeerd door de wachtdienstregelingen binnen een huisartsenkring. De laatste jaren is ook het oprichten van een huisartsenwachtpost zeer in trek. Deze wachtposten garanderen zorg buiten de kantooruren en worden logistiek ondersteund door onthaalmedewerkers en een chauffeur. 1 De huisartsenwachtposten in ons land zijn enkel beschikbaar in het weekend.

In het verlenen van goede zorg en ondersteuning voor ouderen is aandacht nodig voor de preventie van kwetsbaarheid bij ouderen. Een gerichte casefinding van (mogelijk) kwetsbare ouderen is hierbij essentieel om correcte preventieve maatregelen te nemen. Dit onderzoek heeft als doel om risicoprofielen en risicofactoren van kwetsbaarheid bij ouderen in kaart te brengen om zo vroegtijdige detectie mogelijk te maken. Kwetsbaarheid wordt hierbij niet enkel gezien als een fysiek probleem, maar omvat ook psychische, sociale en omgevingscomponenten. Multinomiale logistische regressie analyses op data van de Belgian Ageing Studies (N = 21.664 thuiswonende ouderen) onderzoeken de relatie van socio-demografische en socio-economische factoren op de vier domeinen van kwetsbaarheid (i. e. fysieke, psychische, sociale en omgevingskwetsbaarheid) en totale kwetsbaarheid. De resultaten tonen dat zowel mannen als vrouwen die verhuisd zijn in de afgelopen 10 jaar of een lager inkomen hebben, een groter risico hebben om kwetsbaar te zijn. Voor elk domein afzonderlijk zijn er specifieke risicofactoren gevonden (zoals burgerlijke staat bij psychische kwetsbaarheid). Daarnaast zijn er verschillen tussen risicoprofielen bij mannen en vrouwen. Zo vormt bij mannen het land van herkomst een risicofactor voor kwetsbaarheid, terwijl dit bij vrouwen niet het geval is. Op basis van de resultaten worden praktische aanbevelingen alsook toekomstige onderzoekspistes uitgewerkt voor de detectie en preventie van kwetsbaarheid bij ouderen.

Medicamenteuze therapietrouw wordt door de World Health Organization (WHO) gedefinieerd als een correcte inname van 80-120% van de medicatie gedurende een bepaald tijdsinterval.1 Bij ouderen, mensen van 65 jaar en ouder, stijgt therapieontrouw tot 50% afhankelijk van de context.1

Een groot deel van de vrouwelijke patientenpopulatie gebruikt gedurende een aanzienlijke periode van hun leven een of andere vorm van anticonceptie. De huisarts speelt een belangrijke rol in de keuze en opvolging van het anticonceptiemiddel.

Een plotse hartstilstand is een van de belangrijkste doodsoorzaken in Europa. Jaarlijks worden in Europa 350 000 tot 700 000 personen hierdoor getroffen.1

Continuing medical education (CME) as part of life-long learning in medicine should focus on patient outcomes and appropriate care by increasing knowledge, competence and/or performance of clinicians. In this article, we present the views of the different stakeholders on the future of CME, presented at the ISSECAM colloquium held in December 2018. Within the framework of the colloquium, a survey was done asking health care professionals about their learning practices. We present an integrated summary of the attendees’ views and survey results. Key elements for effective learning in CME and how they can be implemented have been identified. Increased interactivity and focus on real-life practice seem to have the highest likelihood to induce behavioural changes. In addition, online CME activities will steadily gain more weight in the learning curriculum of medical practitioners. CME providers should take these elements (interactivity, real-life practice, online) into consideration when designing their different activities.

ObjectiveTo find out if there is evidence on interventions to prevent aggression against doctors.DesignThis systematic review searched the literature and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesPubmed, Embase, Turning Research into Practice (TRIP), Cochrane and Psycharticle, GoogleScholar andwww.guideline.govwere consulted.Eligibility criteriaAbstracts published in English between January 2000 and January 2018 were screened. Eligible studies focused on prevention and risk factors of type II workplace violence in general healthcare, psychiatric departments, emergency departments, emergency primary care, general practice.Data extraction and synthesisThe selected intervention studies were grouped into quantitative and qualitative studies. Systematic reviews were reported separately. For each study, the design, type of intervention and key findings were analysed. Quality rating was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQUAL).Results44 studies are included. One randomised controlled trial (RCT) provided moderate evidence that a violence prevention programme was effective in decreasing risks of violence. Major risk factors are long waiting times, discrepancy between patients’ expectations and services, substance abuse by the patient and psychiatric conditions. Appropriate workplace design and policies aim to reduce risk factors but there is no hard evidence on the effectiveness. One RCT provided evidence that a patient risk assessment combined with tailored actions decreased severe aggression events in psychiatric wards. Applying de-escalation techniques during an aggressive event is highly recommended. Postincident reporting followed by root cause analysis of the incident provides the basic input for review and optimisation of violence prevention programmes.ConclusionsThis review documented interventions to prevent and de-escalate aggression against doctors. Aggression against physicians is a serious occupational hazard. There is moderate evidence that an integrated violence prevention programme decreases the risks of patient-to-worker violence. The review failed to gather sufficient numerical data to perform a meta-analysis. A large-scale cohort study would add to a better understanding of the effectiveness of interventions.

Background The COVID-19 pandemic has affected education and assessment programs and has resulted in complex planning. Therefore, we organized the proficiency test for admission to the Family Medicine program as a proctored exam. To prevent fraud, we developed a web-based supervisor app for tracking and tracing candidates’ behaviors. Objective We aimed to assess the efficiency and usability of the proctored exam procedure and to analyze the procedure’s impact on exam scores. Methods The application operated on the following three levels to register events: the recording of actions, analyses of behavior, and live supervision. Each suspicious event was given a score. To assess efficiency, we logged the technical issues and the interventions. To test usability, we counted the number of suspicious students and behaviors. To analyze the impact that the supervisor app had on students’ exam outcomes, we compared the scores of the proctored group and those of the on-campus group. Candidates were free to register for off-campus participation or on-campus participation. Results Of the 593 candidates who subscribed to the exam, 472 (79.6%) used the supervisor app and 121 (20.4%) were on campus. The test results of both groups were comparable. We registered 15 technical issues that occurred off campus. Further, 2 candidates experienced a negative impact on their exams due to technical issues. The application detected 22 candidates with a suspicion rating of >1. Suspicion ratings mainly increased due to background noise. All events occurred without fraudulent intent. Conclusions This pilot observational study demonstrated that a supervisor app that records and registers behavior was able to detect suspicious events without having an impact on exams. Background noise was the most critical event. There was no fraud detected. A supervisor app that registers and records behavior to prevent fraud during exams was efficient and did not affect exam outcomes. In future research, a controlled study design should be used to compare the cost-benefit balance between the complex interventions of the supervisor app and candidates’ awareness of being monitored via a safe browser plug-in for exams.

Er is de laatste tijd een groeiende interesse voor architectuur en infrastructuur van een huisartsenpraktijk. Huisartsen in Vlaanderen die hun praktijk willen bouwen of verbouwen, vonden vroeger nogal moeilijk concrete informatie. Architecten hadden vaak wisselende ervaring in de specifieke eisen die gepaard gaan met het bouwen van een huisartsenpraktijk.

Door de sterk evoluerende kennis en technologie in de medische wereld en de vergrijzing van de bevolking groeit de noodzaak tot vroegtijdige zorgplanning (VZP) bij ouderen. In Belgie sterft 9% van de bevolking aan een plotse dood, terwijl 91% sterft aan een ziekte.1 In deze laatste groep sterft 25% aan kanker.1-3

Ruim de helft van de Belgen (56%) gebruikt naast de klassieke bronnen zoals geschreven literatuur ook het internet, alias dokter Google, om gezondheidsgerelateerde informatie op te zoeken.1 Voornamelijk jongeren tussen 15 en 24 jaar, hoger opgeleiden en vrouwen gaan digitaal op zoek naar informatie met betrekking tot ziekte en gezondheid.1-6 Toch vindt twee derde deze informatie niet betrouwbaar en een derde geeft aan verwarder en onzekerder te zijn na de zoektocht.1

Een goede arts-patientrelatie is de hoeksteen van eenkwaliteitsvollezorgverlening.1 Het belang van taal en communicatiein deze zorgverlening is sinds lange tijd gekend.Een Amerikaanse review uit 2002 onderzocht de invloedvan taalbarrieres tussen Engelstalige zorgverleners enSpaanstalige patienten uit de Latino-populatie op de kwaliteitvan zorgverlening. Bij zes op zeven studies bleek ereen significant negatief effect op de kwaliteit van de zorg.Ook de toegang tot de zorg en de uitkomst na opname werdennegatief beinvloed door een taalbarriere.2,3

BackgroundBurnout has been on the rise in recent years. Is this increasing prevalence due to changing working circumstances, or also to a changing societal context?AimThe aim of the study was to explore intergenerational differences in burnout.Design & settingThe study used a mixed quantitative and qualitative design, and tested the theory of the job demands–resources model (JD-RM). The target group of this research was the working population in Belgium, aged between 21–65 years. The study was performed in a public setting with people recruited through social media.MethodA quantitative web survey was distributed among the participants to explore the prevalence of burnout, work ethic, work engagement, and norms and values. The second part of the study used a focus group technique to explore in depth the eight statements that were formulated from the quantitative survey.ResultsA total of 309 people participated in the web survey and 21.5% met the criteria for 'burnout', while 22.6% scored high on the criteria for 'engagement'. It was found that 12.6% of all men and 3.0% of all women could not identify with the portrait of 'equivalence’. The value 'benevolence' was positively rated by 100%. In the youngest generation, 71.3 % identified with the portrait of ‘stimulation', while 70.8% of older men identified with the portrait ‘traditions’. The results also revealed that 43.1% of the younger generation agreed with the statement: 'I often think I would be more successful if I gave up certain pleasures'ConclusionBurnout is more common among young people. In the older generation, a good ability to put things into perspective, a good balance between work and leisure, and a strong sense of tradition appear to be resources to aid against burnout. The younger generation often deals with stressors. This younger generation appears to have a higher work ethic and commitment.

We investigated whether P300-ERP and cognitive test performance differ for age, sex, and education in two groups of healthy elderly, and verified whether any correlations exist between P300 amplitude and latency and gray matter volume using whole brain voxel-by-voxel-based mapping, controlling for age, education, sex and Total Intracranial Volume (TIV). We used 32 channel electroencephalograms (EEG) to record the P300 responses and 3T Magnetic Resonance Imaging (MRI) to determine gray matter volume. We recruited 36 native-Dutch speaking healthy older subjects, equally divided in two sub-groups of 52-64 and 65-76 years old, administered a battery of cognitive tests and recorded their demographics, EEGs and task performance; additionally, 16 adults from the second sub-group underwent an MRI scan. We found significant differences between age groups in their cognitive tests performance, P300 amplitudes for the frontal and parietal electrodes for the most difficult task, and P300 latencies for frontal, central and parietal electrodes for all three tasks difficulty levels. Interesting, sex and education affected cognitive and P300 results. Higher education was related to higher accuracy, and P300 amplitudes and shorter latencies. Moreover, females exhibited higher P300 amplitudes and shorter latencies, and better cognitive tasks performance compared to males. Additionally, for the 16 adults underwent to MRI scan, we found positive correlations between P300 characteristics in frontal, central and parietal areas and gray matter volume, controlling for demographic variables and TIV, but also showing that age, sex, and education correlate with gray matter volume. These findings provide support that age, sex, and education affect an individual's cognitive, neurophysiological and structural characteristics, and therefore motivate the need to further investigate these in relation to P300 responses and gray matter volume in healthy elderly. ispartof: Frontiers in Aging Neuroscience vol:11 issue:104 pages:1-13 ispartof: location:Switzerland status: published

Background According to some studies, interventions can prevent or delay frailty, but their effect in preventing adverse outcomes in frail community-dwelling older people is unclear. The aim is to investigate the effect of an intervention on adverse outcomes in frail older adults. Methods A systematic review and meta-analysis of Medline, Embase, the Cochrane Library, and Social Sciences Citation Index. Randomized controlled studies that aimed to treat frail community-dwelling older adults, were included. The outcomes were mortality, hospitalization, formal health costs, accidental falls, and institutionalization. Several sub-analyses were performed (duration of intervention, average age, dimension, recruitment). Results Twenty-five articles (16 original studies) were included. Six types of interventions were found. The pooled odds ratios (OR) for mortality when allocated in the experimental group were 0.99 [95% CI: 0.79, 1.25] for case management and 0.78 [95% CI: 0.41, 1.45] for provision information intervention. For institutionalization, the pooled OR with case management was 0.92 [95% CI: 0.63, 1.32], and the pooled OR for information provision intervention was 1.53 [95% CI: 0.64, 3.65]. The pooled OR for hospitalization when allocated in the experimental group was 1.13 [95% CI: 0.95, 1.35] for case management. Further sub-analyses did not yield any significant findings. Conclusion This systematic review and meta-analysis does not provide sufficient scientific evidence that interventions by frail older adults can be protective against the included adverse outcomes. A sub-analysis for some variables yielded no significant effects, although some findings suggested a decrease in adverse outcomes. Trial registration Prospero registration CRD42016035429. Electronic supplementary material The online version of this article (10.1186/s12877-018-0936-7) contains supplementary material, which is available to authorized users.

Aging is often associated with changes in brain structures as well as in cognitive functions. Structural changes can be visualized with Magnetic Resonance Imaging (MRI) using voxel-based grey matter morphometry (VBM) and visual rating scales to assess atrophy level. Several MRI studies have shown that possible neural correlates of cognitive changes can be seen in normal aging. It is still not fully understood how cognitive function as measured by tests and demographic factors are related to brain changes in the MRI. We recruited 55 healthy elderly subjects aged 50–79 years. A battery of cognitive tests was administered to all subjects prior to MRI scanning. Our aim was to assess correlations between age, sex, education, cognitive test performance, and the said two MRI-based measures. Our results show significant differences in VBM grey matter volume for education level (≤ 12 vs. > 12 years), with a smaller amount of grey matter volume in subjects with lower educational levels, and for age in interaction with education, indicating larger grey matter volume for young, higher educated adults. Also, grey matter volume was found to be correlated with working memory function (Digit Span Backward). Furthermore, significant positive correlations were found between visual ratings and both age and education, showing larger atrophy levels with increasing age and decreasing level of education. These findings provide supportive evidence that MRI-VBM detects structural differences for education level, and correlates with educational level and age, and working memory task performance., Highlights • VBM grey matter volume differences were significant for the interaction of age and education level. • Grey matter volume correlated with education level and working memory function (Digit Span Backward). • Significant correlations were found between visual rating scales and both age and education. • VBM is able to detect structural differences for age and education, and correlates with education and working memory.

Theory: In Belgium, there are no family medicine admission requirements. A three‑phase admission program is developed and implemented by the collaboration of four involved universities. Hypotheses: A pilot testing of phase 2, comprising actual proficiency test, is designed as answer to two research questions: What is the validity and reliability of a multicomponent proficiency test? How does a multicomponent proficiency test proportionate to the final grades of family medicine master candidates? Methods: The population consisted of all last master‑phase students applying for family medicine education in Flanders. Students completed a machine‑assisted test on knowledge and situational judgment skills and evidence‑based medicine appraisal. Results: In total, 322 students completed the test. A regression analysis measuring the relationship between the master grades and the test score revealed an odds ratio of 1.1. Analysis of variance showed that the differences were significant between the upper quartile and the lowest quartile of the test results. A qualitative appraisal of the test results showed that the highest and lowest quartiles of the full‑test score included the students who were, respectively, known as “very good” or “very poor.” Conclusion: The test scores were in agreement with the performance and profiling of the participating students. The test succeeded in identifying poor‑performing students and in confirming competences of the average‑ and high‑performing students. In the future, retesting will add to the statements on reliability and will refine the test construction. Follow‑up will address validity. ispartof: Journal of Family Medicine and Primary Care vol:2018;7 issue:1 pages:58-63 ispartof: location:India status: published

BackgroundAggression against GPs has increased in the past decade. Depending on experience, interpretation, and personality, the interpretation of aggressive patient behaviour will differ among doctors.AimTo investigate how often GPs experience aggression in a 1-year time span and what the relationship is between the GP's personality (based on the 'Big Five' personality traits) and the reporting of aggression. Secondly, to investigate how personality is related to feeling safe.Design & settingFlemish (Belgian Federal State) GPs were questioned in a cross-sectional design by online survey. GPs were recruited and questioned in their professional environment.MethodOutcome measures were the 'Big Five' personality traits ('reserved' versus 'outgoing', 'compassionate' versus 'challenging', 'efficient' versus 'careless', 'confident' versus 'nervous', and 'cautious' versus 'innovative', based on Cattel's 'Big Five' model of personality), the type of aggression, the reporting of aggression, and feeling safe.ResultsBoth (n = 247) male and female doctors considered physical contact and verbal intimidation as aggression. Female doctors were more likely to consider sexual harassment as aggression. The majority of GPs were confronted with verbal aggression. More than half considered physical aggression as the most threatening. GPs with 'reserved' and 'careless' personality types were more likely to experience aggression. GPs with 'innovative', 'challenging', or 'confident' personality types were also at increased risk, but to a lesser extent than those with 'reserved' and 'careless' personalities. GPs with 'efficient' and 'innovative' personalities were more likely to report incidents. Male GPs and those with 'efficient' personalities felt safer. GPs with 'confident' and 'cautious' personalities were more likely to feel unsafe.ConclusionThe results of this study might help future interventions and support strategies (designed to prevent aggressive incidents or help GPs cope with them) to target the vulnerable groups. Further research should therefore explore the results of these data in depth and on a larger sample size.

Een van de taken van de huisarts is het voorzien van continuiteit in de eerstelijnszorg. Dit impliceert het organiseren van wachten. Huisartsenwachtposten zijn een eigentijdse manier om dit te verwezenlijken.