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Electronic Health Records contain a lot of information in natural language that is not expressed in the structured clinical data. Especially in the case of new diseases such as COVID-19, this information is crucial to get a better understanding of patient recovery patterns and factors that may play a role in it. However, the language in these records is very different from standard language and generic natural language processing tools cannot easily be applied out-of-the-box. In this paper, we present a fine-tuned Dutch language model specifically developed for the language in these health records that can determine the functional level of patients according to a standard coding framework from the World Health Organization. We provide evidence that our classification performs at a sufficient level (F1-score above 80% for the main categories and error rates of less than 1 level on a 5-point Likert scale for levels) to generate patient recovery patterns that can be used to analyse factors that contribute to the rehabilitation of COVID-19 patients and to predict individual patient recovery of functioning.

BACKGROUND: Coercion is much discussed topic in psychiatry.AIM: Presentation of an ethics of care perspective on coercion, focusing on the moral aspects of the relationship between care recipient and caregiver, and the prevention and reduction of coercion.METHOD: Clarification of the care-ethical aspects of the high and intensive care (HIC) model and discussion of the Compulsory Mental Health Care Act (Wvggz).RESULTS: In the HIC model, ethics of care underlies three cultural changes: from control to contact, from reactive to proactive, from individuality to solidarity. More than the older Bopz Act, the Wvggz pays attention to relational aspects of coercion, but the procedures endanger care contact.CONCLUSION: Ethics of care - in which the care relationship is the starting point - offers a perspective that is of great value to psychiatry. The development of HIC is a concrete example of this. The Wvggz emphasizes collaboration in care, but care contact is hindered in practice by a multitude of procedures.

BACKGROUND: Coercion is much discussed topic in psychiatry. AIM: Presentation of an ethics of care perspective on coercion, focusing on the moral aspects of the relationship between care recipient and caregiver, and the prevention and reduction of coercion. METHOD: Clarification of the care-ethical aspects of the high and intensive care (HIC) model and discussion of the Compulsory Mental Health Care Act (Wvggz). RESULTS: In the HIC model, ethics of care underlies three cultural changes: from control to contact, from reactive to proactive, from individuality to solidarity. More than the older Bopz Act, the Wvggz pays attention to relational aspects of coercion, but the procedures endanger care contact. CONCLUSION: Ethics of care - in which the care relationship is the starting point - offers a perspective that is of great value to psychiatry. The development of HIC is a concrete example of this. The Wvggz emphasizes collaboration in care, but care contact is hindered in practice by a multitude of procedures.

BACKGROUND: The waiting list of the expertise center euthanasia (EE) in the Netherlands for patients requesting euthanasia on the basis of psychiatric suffering has increased to two years in a short space of time. AIM: Clarity about the causes and direct consequences of the EE waiting list and an answer to the question: what now? METHOD: We analyzed the EE waiting list based on various media reports, annual reports from the EE and scientific studies. RESULTS: The EE waiting list arose because, on the one hand, the demand for euthanasia among patients with a mental illness has increased, while on the other hand, the willingness to perform euthanasia among psychiatrists appears to be declining. The reasons for both trends seem multifactorial. The direct consequence of the waiting list is that patients with a mental illness have less access to euthanasia, which in itself can also have harmful and protective consequences. CONCLUSION: The EE waiting list is the result of an increasing number of requests and an apparent decrease in psychiatrists' willingness to perform euthanasia. In response to this situation, roughly three ways forward are conceivable: first the mental health care sector can assign itself a more active role in the field of euthanasia, second a further demedicalisation of the end of life is possible, or third a choice can be an amendment to EE's referral procedure. All of these options have potential pros and cons.

Whole-bodies, or human cadavers, are of great value for medical education and science. The process of body donation and its regulation is, however, questionable. The Dutch legal framework is not sufficient. For example, the collaboration of anatomy departments with industry is not covered by existing regulations. Also, it is unclear what should be done in case of unexpected findings. Moreover, consent in whole-body donation does not meet specific conditions for informed consent. It takes the form of 'broad consent', allowing for unspecified use of the bodies. A monitoring system concerning the use for a specific educational program or research falls is absent. Therefore, we propose to develop a Code of Conduct and an adequate system of monitoring.

BACKGROUND: In the Netherlands, increasing attention is being paid to psychiatric patients with a request for termination of life. One discussion related to this is the role of the family. However, the experiences and wishes of the family regarding their involvement in dealing with a psychiatric patient's request for termination of life, are not yet well documented. AIM: To investigate the experiences and wishes of families regarding their role in dealing with the psychiatric patient's request for termination of life, and to develop a checklist for physicians to adequately involve the family in the process of dealing with such a request. METHOD: The experiences and wishes of families regarding their role in dealing with a psychiatric patient's request for termination of life were investigated in a focus group meeting with family members. Based on the results, recommendations were formulated for physicians and their feasibility was tested in a dialogue group of family members and caregivers. Finally, the results were discussed in a focus group of family members to develop a checklist for physicians to involve the family in dealing with a psychiatric patient's request for termination of life. RESULTS: Family members prefer that physicians: 1. involve the family in the process and understand the impact of the situation on family members; 2. discuss expectations and explore the wishes of the family; 3. make use of the knowledge and expertise of the family in order to understand the patient in the context of his/her life; 4. support the family and provide after care, and jointly evaluate the process. The recommendations were consolidated in a checklist for physicians about involving the family in dealing with a psychiatric patient's request for termination of life. CONCLUSION: It is expected that application of the recommendations and the checklist will promote adequate involvement of the family in dealing with a psychiatric patient's request for termination of life.

Gastro-oesophageal reflux disease (GORD) and obesity are associated with frequent exacerbations and poor quality of life in asthmatics. Multiple mechanisms have been proposed for the effect of obesity, including modification of inflammation affecting epithelial cell proliferation and wound repair, while the role of GORD is poorly understood and proton pump inhibitor (PPI) are of variable efficacy. GORD might exert a deleterious effect by inducing vagal reflex, neuroinflammation and directly ( via microaspiration) triggering airway inflammation. Studies of reflux in animal models and human bronchial epithelial cell culture show varying impact on inflammation and airway remodelling. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr PEROTIN has nothing to disclose. Conflict of interest: Dr Schofield has nothing to disclose. Conflict of interest: Dr Wilson has nothing to disclose. Conflict of interest: Dr Ward has nothing to disclose. Conflict of interest: Dr Brandsma has nothing to disclose. Conflict of interest: Dr Strazzeri has nothing to disclose. Conflict of interest: Dr Bansal has nothing to disclose. Conflict of interest: Dr Yang has nothing to disclose. Conflict of interest: Dr Rowe reports and a full time employee and shareholder of Janssen Pharmaceutical Companies of Johnson and Johnson. Conflict of interest: Miss Corfield has nothing to disclose. Conflict of interest: Dr Lutter has nothing to disclose. Conflict of interest: Prof. Shaw reports personal fees and non-financial support from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Teva, personal fees from Circassia, and a grant from GSK, outside the submitted work. Conflict of interest: Dr Bakke reports personal fees from GSK, AZ, Novartis andTeva, outside the submitted work. Conflict of interest: MC have no conflict of interest to disclose. Conflict of interest: Dr Dahlen has nothing to disclose. Conflict of interest: Dr Fowler reports personal fees and non-financial support from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Teva, outside the submitted work. Conflict of interest: Dr Horvath reports personal fees from Astra Zeneca, Boehringer Ingelheim, Novartis, CSL, Chiesi, Roche, GSK, Berlin-Chemie and Sandoz, outside the submitted work. Conflict of interest: Dr Howarth reports personal fees from GSK, outside the submitted work. Conflict of interest: Dr Krug has nothing to disclose. Conflict of interest: Dr Montuschi has nothing to disclose. Conflict of interest: Dr Sanak has nothing to disclose. Conflict of interest: Dr Sandstrom reports other monetary support from Boehringer Ingelheim, outside the submitted work. Conflict of interest: Dr Sun has nothing to disclose. Conflict of interest: Dr Pandis has nothing to disclose. Conflict of interest: Dr Auffray reports grants from Innovative Medicine Initiative, during the conduct of the study. Conflict of interest: Dr De Meulder reports grants from Innovative Medicine Initiative, during the conduct of the study. Conflict of interest: Ms. Lefaudeux reports grants from Innovative Medicine Initiative, grants from Innovative Medicine Initiative, during the conduct of the study. Conflict of interest: Dr Riley reports and I have shares in and I am employed by GSK. Conflict of interest: Dr Sousa has nothing to disclose. Conflict of interest: Dr Dahlen has nothing to disclose. Conflict of interest: Dr Adcock reports grants from EU-IMI, during the conduct of the study. Conflict of interest: KFC has received honoraria for participating in Advisory Board meetings of GSK, AZ, BI, Teva, Novartis and Merck regarding treatments for asthma and chronic obstructive pulmonary disease and has also been renumerated for speaking engagements. Conflict of interest: Dr Sterk reports grants from Innovative Medicines Initiative, during the conduct of the study. Conflict of interest: Dr Skipp has nothing to disclose. Conflict of interest: Dr Collins reports a patent application for use of a genetically modified Drosophila line carrying one or more mammalian genes associated with a chronic respiratory disease and uses to screen the impact of such genes. Conflict of interest: Dr Davies has nothing to disclose. Conflict of interest: Dr Djukanovic reports receiving fees for lectures at symposia organised by Novartis, AstraZeneca and TEVA, consultation for TEVA and Novartis as member of advisory boards, and participation in a scientific discussion about asthma organised by GlaxoSmithKline. He is a co-founder and current consultant, and has shares in Synairgen, a University of Southampton spin out company.

Background: Euthanasia and Physician-Assisted Suicide (PAS) have been a component of common patient care in the Netherlands since legalization in 2002. Although seen as an exception, about 6000 cases of euthanasia/PAS were performed last year, 90% in general practice. In Germany both euthanasia/PAS[for full text, please go to the a.m. URL], 51. Kongress für Allgemeinmedizin und Familienmedizin

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This chapter draws on examples taken from the area of nursing to illustrate some of the normative problems that medical staff currently experience in German hospitals. Clinical ethics consultation could provide the appropriate institutional setting for medical staff to reflect on their professional norms and duties in the hospital environment. This reflection is a crucial task because the fulfillment of traditional professional norms is challenged by current developments within the health system such as rationalization, rationing and an increased emphasis on economic incentives. The professional ethics of nurses and physicians respectively comprise some kind of traditional knowledge of what it means to be a good nurse or a good doctor. A lot of this knowledge has been transmitted by example and has been part of the daily practice of medicine. Clinical ethics consultation can help medical staff to express their conflicts and problems more clearly.