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For the growing group of adult migrants, flexible solutions for second language (L2) acquisition are increasingly important, while concerns about the efficacy of online language learning abound. This study on the L2 situation in Flanders has 4 key aims: analyzing adult learner profiles in fully online Dutch beginners' courses; comparing learner achievements in fully online and face-to-face (F2F) courses; reporting on differences in learner achievement considering learner profile variables and comparing time investment in F2F and online courses. A quantitative design was adopted, including a survey among the online students; assessment scores and data on learner profiles of online and F2F learners. The survey dealt with biographical variables and variables related to online learning. Results show that i) the online Dutch L2 learner is typically highly educated and employed; ii) online learners spend less time on the course than F2F learners, but perform significantly better in reading, listening and speaking skills; iii) writing skills are better achieved in F2F learning and iv) prior educational level and the language spoken by the host community have no significant impact on learner achievement. The findings indicate that online L2 learning can be as effective as F2F learning, even for learners with a lower educational level, or lacking contact with native speakers.

Due to immigration, globalization and a changing labor market, there is a recognized need for flexible learning. In Europe, second language (L2) acquisition specifically has become of vital importance. Research on less commonly taught languages (LCTL), however, is scarce and focuses mainly on foreign language acquisition, compulsory education and on face-to-face (F2F) and blended learning. However, the effectiveness of learning a LCTL -- such as Dutch -- as a second language fully online in adult education has yet to be uncovered. The principal objective of this paper was to investigate whether learning Dutch L2 fully online can be as effective as learning it fully F2F. A quantitative methodological approach was adopted. Independent samples t-tests were carried out to compare online and F2F adult learners' performance in a Waystage-level Dutch L2 course in Flanders, Belgium. The key variables 'previous knowledge', 'course level', 'content', 'teacher', 'assessment' and 'learning outcomes' are controlled. Main findings indicated that online Dutch L2 learning in adult education can be at least as effective as F2F learning. This study should, therefore, be of value to language course providers wishing to implement flexible L2 learning, and to LCTL and computer-assisted language learning (CALL) researchers.

This study examines educators' and providers' perceptions of constraints and critical success factors of the development and implementation of online L2 learning. The focus is on Dutch L2 learning in adult education in Flanders. Semi-structured interviews with seven educators (shaping pedagogies/curricula) and six providers (organizing/offering language programmes) were conducted. Consequently, a focus group consisting of 12 teachers of Dutch (L2) and teacher trainers was run. The findings show that the main perceived constraints of the design and implementation of an online curriculum are negative beliefs about the effectiveness of online language learning, costs, a lack of technical and pedagogical support and insufficient teacher ICT-skills. The perceived major critical success factors are course design, technological facilities, (technical, financial and pedagogical) support, learner skills and attitudes, and competencies of instructional designers. Although many literature references were found concerning the importance of assessment, teacher skills and the role of the faculties, these were hardly mentioned during the interviews. The findings of this study call for a better financial framework, more collaboration among different stakeholders in the field, a focus on online teacher skills, adequate pedagogical and technical support and for a framework for quality assurance in online language learning.

Understanding reasons for drop-out, factors contributing to student satisfaction and strategies for enhancing student retention is fundamental to the success of online (language) courses. This study examines drop-out rates, student satisfaction, retention rates and attainment in fully online elementary-level courses for Dutch as a second language (L2) in Flanders. Results show that drop-out rates are highly "front-loaded" and that success in the A1 level course is a good predictor for success in the subsequent level. Retention strongly increases after the first module. Student-tutor interaction is a key element in student satisfaction that deserves attention from instructional designers, policy makers and educators.

To date, teacher perceptions of online language teaching have attracted very little attention. However, these perceptions may influence decisions regarding instructional design, teaching practices and eventually the learning experience. Furthermore, teacher perceptions can contribute to the design of teacher training programs. This study provides teacher perceptions regarding i) effective communication tools for teaching online second language classes; ii) required teacher & instructional designer skills and iii) challenges of online teaching. Results include that student engagement and the facilitation of collaboration among students is perceived difficult, unlike the availability of user-friendly tools; that professional development is perceived necessary to acquire the indispensable technical and pedagogical skills; and that online teachers need to make a shift towards an individualized, learner-centred teaching model.

This study critically addresses the assumptions made by educators and providers in the field of Dutch second language (L2) acquisition about the online learning of Dutch L2. These include assumptions about advantages and disadvantages of online language learning, such as flexibility, learner autonomy, enhanced opportunities for remediation and differentiation versus disadvantages including the solitary learning mode, delayed feedback or high production costs. Even though stakeholders perceive a clear need for online Dutch L2 learning, and are aware of several advantages of online language learning, the current implementation level is still low. The perceived disadvantages might be a factor hindering the transition to online learning. A reorientation of the current provision of Dutch L2 courses is perceived as desirable, with self-directed, needs-oriented and customised learning as the key concepts. The outcomes shed light on perceptions that foster or hinder the development of online language courses for adult migrants, and could resonate with language professionals worldwide.

Background Following a train derailment, several tons of acrylonitrile (ACN) exploded, inflamed and part of the ACN ended up in the sewage system of the village of Wetteren. More than 2000 residents living in the close vicinity of the accident and along the sewage system were evacuated. A human biomonitoring study of the adduct N -2-cyanoethylvaline (CEV) was carried out days 14–21 after the accident. Objectives (1) To describe the short-term health effects that were reported by the evacuated residents following the train accident, and (2) to explore the association between the CEV concentrations, extrapolated at the time of the accident, and the self-reported short-term health effects. Methods Short-term health effects were reported in a questionnaire (n=191). An omnibus test of independence was used to investigate the association between the CEV concentrations and the symptoms. Dose-response relationships were quantified by Generalized Additive Models (GAMs). Results The most frequently reported symptoms were local symptoms of irritation. In non-smokers, dose-dependency was observed between the CEV levels and the self-reporting of irritation (p=0.007) and nausea (p=0.007). Almost all non-smokers with CEV concentrations above 100 pmol/g globin reported irritation symptoms. Both absence and presence of symptoms was reported by non-smokers with CEV concentrations below the reference value and up to 10 times the reference value. Residents who visited the emergency services reported more symptoms. This trend was seen for the whole range of CEV concentrations, and thus independently of the dose. Discussion and conclusion The present study is one of the first to relate exposure levels to a chemical released during a chemical incident to short-term (self-reported) health effects. A dose-response relation was observed between the CEV concentrations and the reporting of short-term health effects in the non-smokers. Overall, the value of self-reported symptoms to assess exposure showed to be limited. The results of this study confirm that a critical view should be taken when considering self-reported health complaints and that ideally biomarkers are monitored to allow an objective assessment of exposure. [ABSTRACT FROM AUTHOR]

Background On Saturday May 4, 2013, a train transporting chemicals derailed in the village of Wetteren (Belgium) and caused a leak of acrylonitrile (ACN). Objectives To assess the human exposure to acrylonitrile in the local population with the highest suspected exposure. Methods Between May 18–25, 242 residents participated in the study. N -2-cyanoethylvaline (CEV), a biomarker that is highly specific for ACN exposure, was measured in the blood. To account for potential influence by smoking, cotinine was determined in the urine. Participants also filled in a short questionnaire. Results In the evacuated zone, 37.3% of the non-smokers and 40.0% of the smokers had CEV concentrations above the reference values of 10 and 200 pmol/g globin, respectively, at the time of the train accident. Spatial mapping of the CEV concentrations depending on the residential address showed a distribution pattern following the sewage system. Discussion and conclusion The train derailment resulted in a highly atypical sequence-of-events. In addition to exposure in the direct vicinity of the site of the train derailment, exposure also occurred via the sewage system, into which acrylonitrile had entered shortly after the accident. [ABSTRACT FROM AUTHOR]

Background On May 4, 2013, a train transporting chemicals derailed in Wetteren, Belgium. Several tanks loaded with acrylonitrile (ACN) exploded, resulting in a fire and a leakage of ACN. Objectives To determine exposure to ACN and to assess discriminating factors for ACN exposure in the emergency responders involved in the on-site management of the train accident. Methods The study population consisted of 841 emergency responders. Between May 21 and June 28, they gave blood for the determination of N -2-cyanoethylvaline (CEV) hemoglobin adducts and urine for the measurement of cotinine. They also filled in a short questionnaire. Results 163 (26%) non-smokers and 55 (27%) smokers showed CEV concentrations above the reference values of 10 and 200 pmol/g globin, respectively. The 95th percentile in the non-smokers was 73 pmol/g globin and the maximum was 452 pmol/g globin. ACN exposure among the non-smokers was predicted by (1) the distance to the accident, (2) the duration of exposure, and (3) the occupational function. Discussion and conclusion Emergency responders involved in the on-site management of the train accident were clearly exposed to ACN from the accident. However, the extent of exposure remained relatively moderate with CEV concentrations staying within the ranges described in literature as background for a smoking population. Moreover, the exposure was less pronounced in the emergency responders as compared to that in the local population. [ABSTRACT FROM AUTHOR]

Background: Trampoline injuries are a cause for concern and data from different countries indicate that these are increasing. The aim of this study was to collect data in a Belgian University Hospital emergency department., Methods: Medical files of patients admitted with a trampoline-related injury between 1st July 2011 and 30th June 2016 were retrospectively analyzed., Results: One hundred and sixty patients, aged between 2 and 64 years old and predominantly males (57%), were admitted most frequently during the months March until September. An increase was observed during the years 2013-2014. Most injuries (76%) occurred during activity on the trampoline. Fractures occurred in 40% of the patients with the extremities most frequently involved. An X-ray examination and a CT scan was performed in 82 and 3% of the cases, respectively. Surgery was carried out in 12% of the patients. 9% of the patients had to be admitted to hospital., Conclusions: Trampoline injuries are increasingly observed in the emergency department. These injuries are important and further research on the circumstances and causes for the accidents is needed. Preventive measures, as proposed in the literature, should be considered.

Objective: Aims were (1) to assess the characteristics, associated factors and compliance of patients with acute poisoning advised by the Belgian Poison Centre (BPC) to go (conditionally) to the hospital, (2) to assess the compliance and potential health-economic impact., Methods: Three types of referrals to the hospital of patients who called the BPC between 1 January and 30 June 2018 were analysed: referrals in case of deterioration in the patient's condition (Hosp-watchful-wait), referrals (Hosp-referral) or urgent referrals (Hosp-urgent-referral). Factors associated with type of recommendation were registered. A survey was conducted on a second dataset of patients who called the BPC between 1 March and 15 May 2019 and referred (conditionally) to the hospital., Results: 5476 referrals were included: 72.4% accidental poisoning, 25.3% intentional self-harm, 1.2% substance abuse and 1.1% unclear intentionality. There were 2368 (43.2%) Hosp-watchful-wait cases, 2677 (48.9%) Hosp-referrals and 431 (7.9%) Hosp-urgent-referrals. In Hosp-watchful-wait cases, soaps and detergents were represented most (20.5%). In Hosp-referrals and Hosp-urgent-referrals, benzodiazepines (12.7% and 15.1%, respectively) predominated. Factors associated with hospitalisation type were number of symptoms, intentionality, type of agent(s) involved and advising antidotes. The survey showed that 7.8% of Hosp-watchful-wait patients went to the hospital versus 57.3% of Hosp-referrals and 59.6% of Hosp-urgent-referrals. The mean cost for Hosp-watchful-wait patients, Hosp-referrals and Hosp-urgent-referrals was estimated at €127, €767 and €796, respectively., Conclusion: Only a small proportion of patients followed the advice of the BPC to go (conditionally) to the hospital. A systematic follow-up of cases is warranted to examine the appropriateness of referrals and the compliance of patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: There is a paucity of data on the incidence and severity of tram tracks related cycling injuries. The aim of this study is to get insight into the incidence, severity and characteristics of tram tracks related cycling injuries, potentially defining significant 'hotspots' in the Ghent city area., Methods: A one-year, multicenter, prospective, observational study was conducted. Patients presenting to the emergency departments of all 4 Ghent hospitals with tram tracks related cycling injury, were included. Data on patient demographics, circumstances of the accident and type of injury were collected., Results: 149 patients were included, with a median age of 31 years. 42 patients had fractures, 39 patients required wound sutures, 79 and 49 patients suffered from bruising and abrasions respectively. Only 5 patients required admission. No patients died or suffered life-threatening injuries. Women (65.1%) presented more frequently than men (34.9%). Forty-tree percent of all accidents happened in autumn ( p  < 0.001). Accidents happened more frequently in rainy conditions ( p  < 0.001). Mean number of days off work was 2.7 days, significantly increasing to 6.56 days when sustaining a fracture or dislocation ( p  = 0.02)., Conclusion: Tram tracks are potentially dangerous and may lead to clinically important injuries and significant number of days off work.

Background: Professional knowledge aims at improving practice. It reduces uncertainty in decision-making, improves effectiveness in action and relevance in evaluation, stimulates reflexivity, and subjects practice to ethical standards. Heuristics is an approach to problem-solving, learning, and discovery employing a practical methodology that, although not optimal, is sufficient for achieving immediate goals. This article identifies the desirable, heuristic particularities of research in professional, medical practice; and it identifies what distinguishes this research from scientific research., Main Text: We examine the limits of biomedical and sociological research to produce professional knowledge. Then, we derive the heuristic characteristics of professional research from a meta-analysis of two action-research projects aimed at securing access to essential generic drugs in Senegal and improving physicians' self-assessment and healthcare coordination in Belgium. To study healthcare, biomedical sciences ignore how clinical decisions are implemented. Decisions are built into an articulated knowledge system, such as (clinical) epidemiology, where those studied are standardisable - while taking care of patients is an idiosyncratic, value-based, person-to-person process that largely eludes probabilistic methodologies. Social sciences also reach their limits here because descriptive, interpretative methods cannot help with gesture and speech quality, while the management of the patient's suffering and risks makes each of them unique. Research into medical professionalism is normative as it is intended to formulate recommendations. Scientific data and descriptions are useful to the practitioner randomly, only from the similarities in the environment of the authors and their readers. Such recommendations can be conceived of as strategies, i.e., multi-resource and multi-stage action models to improve clinical and public health practice. Action learning and action-research are needed to design and implement these strategies, because their complexity implies trial and error. To validate a strategy, repeated experiences are needed. Its reproducibility assumes the description of the context. To participate in medical action-research, the investigator needs professional proficiency - a frequent difficulty in academic settings., Conclusion: Some criteria to assess the relevance of publicly funded clinical and public health research can be derived from the difference between scientific and professional knowledge, i.e. the knowledge gained with real-life experience in the field.

Objectives: This study evaluates the impact of the Belgian Poison Centre (BPC) on national healthcare expenses for calls from the public for unintentional poisonings., Methods: The probability of either calling the BPC, consulting a general practitioner (GP) or consulting an emergency department (ED) was examined in a telephone survey (February-March 2016). Callers were asked what they would have done in case of unavailability of the BPC. The proportion and cost for ED-ambulatory care, ED 24-h observation or hospitalisation were calculated from individual invoices. A cost-benefit analysis was performed., Results: Unintentional cases (n = 485) from 1045 calls to the BPC were included. After having called the BPC, 92.1% did not seek further medical help, 4.2% consulted a GP and 3.7% went to an ED. In the absence of the BPC, 13.8% would not have sought any further help, 49.3% would have consulted a GP and 36.9% would have gone to the hospital. The cost-benefit ratio of the availability of the BPC as versus its absence was estimated at 5.70., Conclusions: Financial savings can be made if people first call the BPC for unintentional poisonings.

Objectives: Training children in cardiopulmonary resuscitation (CPR) is one of the strategies to increase bystander CPR in society. Reinforcing knowledge and awareness and increasing willingness to perform bystander CPR contributes to a better outcome after cardiac arrest. We questioned schoolchildren, teachers and principals about their awareness of the importance of CPR and about their willingness to perform CPR., Methods: During a four-month period, Flemish schoolchildren aged 10-18 years, teachers and principals were invited to complete a survey consisting of three parts: (1) demographics, (2) CPR (training) experience and (3) attitude towards CPR teaching and training., Result: In total, 390 schoolchildren, 439 teachers and 100 principals completed the survey. Previous CPR training was reported by 33% of the schoolchildren (in 82% as part of the curriculum) and by 81% teachers and 82% principals. Willingness to participate in CPR training was 77% in schoolchildren, 79% in teachers and 86% in principals with 88% of the principals convinced that schoolchildren should learn how to perform CPR. Willingness to perform CPR in a real-life situation was 68% in schoolchildren, 84% in teachers and 92% in principals., Conclusion: Schoolchildren are well aware of the importance of CPR and are willing to acquire the related knowledge and skills. Noteworthy is the larger awareness among principals and teachers, establishing a strong base for increasing implementation of CPR training in schools. However, a majority of children indicated a lack of training opportunities, highlighting the need for a stronger implementation.

Objective: Alcohol abuse remains a major health concern. This study aimed to describe the characteristics of alcohol-related emergency department (ED) admissions in an elderly population., Methods: Between 1 September 2013 and 31 August 2014, we retrospectively analyzed patient charts of patients admitted with a blood alcohol concentration (BAC) of at least 0.5 g/L to the EDs of all five hospitals in two distinct areas. We focused on the population ≥65 years, divided in three subgroups (65-74, 75-84 and ≥85, respectively) and compared them to the 55-64 year group., Results: Of the 3918 included patients 645 (16.5%) were between 55 and 64, and 406 (10.4%) were ≥65 years (65-74: 267, 6.8%; 75-84: 128, 3.3%; ≥85: 11, 0.3%). The male-to-female ratio ranged between 2.1:1 and 2.7:1. BACs decreased with increasing age. In all age groups the majority of patients (71.0-77.8%) were transported by emergency medical services. The chief presenting complaint was trauma and its relative importance increased with age. Contextual factors consisted mostly of chronic abuse (43.1-57.8%). Most frequently patients could be discharged within 24 h, although hospital admission rates increased with age., Conclusion: Our study shows that alcohol-related ED admissions in the elderly are common, but less frequent than in younger age groups. More (preferentially prospective) studies are needed to give more insight in the living environment, prescription medication, socioeconomic cost, etc. Nonetheless, it is clear that a national action plan should be developed to tackle the alcohol abuse problem in all age groups.

Introduction Medical problems are frequently encountered during electronic dance music (EDM) events. Problem There are uncertainties about the frequencies and severity of intoxications with different types of recreational drugs: ethanol, "classical" illicit party drugs, and new psychoactive substances (NPS)., Methods: Statistical data on the medical problems encountered during two editions of an indoor electronic dance event with around 30,000 attendants were retrieved from the Belgian Red Cross (Mechelen, Belgium) database. Data on drug use were prospectively collected from the patient (or a bystander), the clinical presentation, and/or toxicological screening., Results: In the on-site medical station, 487 patients were treated (265 in 2013 and 222 in 2014). The most frequent reasons were trauma (n=171), headache (n=36), gastro-intestinal problems (n=44), and intoxication (n=160). Sixty-nine patients were transferred to a hospital, including 53 with severe drug-related symptoms. Analysis of blood samples from 106 intoxicated patients detected ethanol in 91.5%, 3,4-methylenedioxymethamphetamine (MDMA) in 34.0%, cannabis in 30.2%, cocaine in 7.5%, amphetamine in 2.8%, and gamma-hydroxybutyric acid (GHB) in 0.9% of patients (alone or in combination). In only six of the MDMA-positive cases, MDMA was the sole substance found. In 2014, the neuroleptic drug clozapine was found in three cases and ketamine in one. Additional analyses for NPS were performed in 20 cases. Only in one agitated patient, the psychedelic phenethylamines 25B-NBOMe and 25C-NBOMe were found., Conclusions: At this particular event, recreational drug abuse necessitated on-site medical treatment in one out of 350 attendants and a hospital transfer in one out of 1,000. Ethanol remains the most frequently abused (legal) drug, yet classical illicit recreational drugs are also frequently (co-) ingested. The most worrying observation was high-risk poly-drug use, especially among MDMA users. Regarding NPS, the number of cases was low and the clinical presentations were rather mild. It should be stressed that these observations only apply to this particular event and cannot be generalized to other EDM events. Calle P , Sundahl N , Maudens K , Wille SMR , Van Sassenbroeck D , De Graeve K , Gogaert S , De Paepe P , Devriese D , Arno G , Blanckaert P . Medical emergencies related to ethanol and illicit drugs at an annual, nocturnal, indoor, electronic dance music event. Prehosp Disaster Med. 2018;33(1):71-76.

Alcohol abuse is a major health concern. The aim of this retrospective study was to analyse the alcohol-related emergency department (ED) admissions among adolescents in all hospitals of distinct areas during a 1-year period. In each hospital, all ED patients with a blood alcohol concentration (BAC) of at least 0.5 g/l were surveyed in a standardised way. Of the 3918 included patients, only 146 (3.7%) were < 18  years. The male-to-female ratio was 1.5:1. There was a strong preponderance of weekend and night time admissions. Most of the patients were transported by ambulance (77% of 138 patients with information on this item). The main reason for ED admittance was depressed level of consciousness (64%), trauma (12%), vomiting and/or abdominal pain (12%), agitation or aggression (4%), syncope (4%) and psychological problems (4%). The context of the alcohol intoxication was related to some kind of festivity in 85%, mental problems in 14% and chronic abuse in 1%. Median BAC values (and range) were 2.08 g/l (0.73-3.70 g/l) for boys and 1.51 g/l (0.73-2.90 g/l) for girls. Most patients (87%) could be discharged home within 24  hours. Our study confirms that problematic alcohol use leading to ED admissions starts in adolescence. Although the numbers of cases below 18 years are low when compared to adults, the phenomenon is alarming as it is associated with substantial health problems. Therefore, Belgium urgently needs a global national alcohol plan, with youngsters being one of the target groups.

Objective: To estimate the percentage of drivers involved in a traffic crash in Belgium who have alcohol and drugs in their blood., Methods: Blood samples of the drivers injured in a traffic crash and admitted to the emergency departments of 5 hospitals in Belgium between January 2008 and May 2010 were analyzed for ethanol (with an enzymatic method) and 22 other psychoactive substances (with ultra-performance liquid chromatography with tandem mass spectrometry or gas chromatography-mass spectrometry)., Results: One thousand seventy-eight drivers were included in the study. Alcohol (≥0.1 g/L) was the most common substance (26.2%). A large majority of the drivers (64%) who were positive for alcohol had a blood alcohol concentration (BAC) ≥1.3 g/L (legal limit in Belgium: 0.5 g/L). These high BACs were most frequent among male injured drivers. Cannabis was the most prevalent illicit drug (5.3%) and benzodiazepines (5.3%) were the most prevalent medicinal drugs. Approximately 1 percent of the drivers were positive for cocaine and amphetamines. No drivers tested positive for illicit opioids. Medicinal drugs were more likely to be found among female drivers and drivers older than 35 years, and alcohol and illicit drugs were more likely to be found among male drivers and drivers younger than 35 years., Conclusion: A high percentage of the injured drivers were positive for a psychoactive substance at the time of injury. Alcohol was the most common substance, with 80 percent of the positive drivers having a BAC ≥0.5 g/L. Compared to a roadside survey in the same area, drivers/riders with high BACs and combinations of drugs were overrepresented. Efforts should be made to increase alcohol and drug enforcement. The introduction of a categorization and labeling system might reduce driving under the influence of medicinal drugs by informing health care professionals and patients.

Objective: To evaluate the type, acceptance rate, and clinical relevance of clinical pharmacist recommendations at the geriatric ward of the Ghent university hospital., Methods: The clinical pharmacist evaluated drug use during a weekly 2-hour visit for a period of 4 months and, if needed, made recommendations to the prescribing physician. The recommendations were classified according to type, acceptance by the physician, prescribed medication, and underlying drug-related problem. Appropriateness of prescribing was assessed using the Medication Appropriateness Index (MAI) before and after the recommendations were made. Two clinical pharmacologists and two clinical pharmacists independently and retrospectively evaluated the clinical relevance of the recommendations and rated their own acceptance of them., Results: The clinical pharmacist recommended 304 drug therapy changes for 100 patients taking a total of 1137 drugs. The most common underlying drug-related problems concerned incorrect dose, drug-drug interaction, and adverse drug reaction, which appeared most frequently for cardiovascular drugs, drugs for the central nervous system, and drugs for the gastrointestinal tract. The most common type of recommendation concerned adapting the dose, and stopping or changing a drug. In total, 59.7% of the recommendations were accepted by the treating physician. The acceptance rate by the evaluators ranged between 92.4% and 97.0%. The mean clinical relevance of the recommendations was assessed as possibly important (53.4%), possibly low relevance (38.1%), and possibly very important (4.2%). A low interrater agreement concerning clinical relevance between the evaluators was found: kappa values ranged between 0.15 and 0.25. Summated MAI scores significantly improved after the pharmacist recommendations, with mean values decreasing from 9.3 to 6.2 (P < 0.001)., Conclusion: In this study, the clinical pharmacist identified a high number of potential drug-related problems in older patients; however, the acceptance of the pharmacotherapy recommendations by the treating physician was lower than by a panel of evaluators. This panel, however, rated most recommendations as possibly important and as possibly having low relevance, with low interrater reliability. As the appropriateness of prescribing seemed to improve with decreased MAI scores, clinical pharmacy services may contribute to the optimization of drug therapy in older inpatients.

Purpose: The aim of this study was to prospectively evaluate drug interactions and adverse drug reactions (ADRs) in the older patients admitted to the emergency department (ED) and to characterize risk factors., Methods: In 80 patients aged 65 years and older medication history and ED drug administration were analysed. Medical records were analysed for ADRs by an expert panel which also evaluated their avoidability and causality. An interaction program was used to search for potential drug interactions followed by assessment for clinical significance. Data were analysed using a logistic regression model. The significance level was set at alpha=0.05., Results: Eighty seven ADRs were identified in 37 patients; 18 were the result of an interaction (15 patients). Causality was assessed as definite (n=11), probable (n=62) and possible (n=24). The reason for admission was definitely and probably related to an ADR in 6 and 18 patients respectively. Only 17 (20%) of the ADRs were assessed as unavoidable, while 23 (26%) and 47 (54%) were classified as definitely and possibly avoidable, respectively. ADRs were related with female gender (p=0.023) and number of drugs (p=0.004), but not with high age (p=0.151). Clinically relevant interactions were related with older age (p=0.032) and number of drugs (p=0.003), but not with gender (p=0.380). None of the interactions with ED initiated medications were considered unjustified., Conclusions: ADRs frequently occur in the older patients admitted to the ED and are an important cause of hospital admissions with a substantial contribution of adverse drug interactions.

Introduction: Improving pain management in the ED might be attained by adequate teaching of medical students. We assessed the skills in pain treatment of ED physicians who teach the students., Methods: All physicians working in an ED who provide elective training to undergraduate medical students from the Ghent University were asked to complete a questionnaire consisting of vignette patient cases concerning acute pain management of abdominal colic pain, and non-traumatic abdominal pain., Results: Thirty two physicians completed the cases. In the renal colic case 91% of the respondents proposed a NSAID as first line treatment. Butylhyoscine was still suggested by 18%. After initial failure of analgesia 31% administered a strong opioid. In biliary colic pain NSAIDs and butylhyoscine were proposed as first line analgesics by 59% and 31% respectively. In second line, butylhyoscine would be given by 22%. The patient case with right fossa abdominal pain would initially be treated with acetaminophen by 81%. Thirteen % of the respondents would not give further analgesia if the first line treatment was insufficient., Conclusion: Our results indicate that adherence by teachers to evidence based guidelines of acute pain management is insufficient. Therefore improving knowledge and skills in pain management of the teachers should receive more attention.

Healthcare-associated pneumonia (HCAP) is considered to represent a category of disease distinct from community-acquired pneumonia (CAP). We describe the incidence and characteristics of HCAP compared with CAP in patients hospitalised through the emergency department (ED). Pneumonia diagnosed at the ED of Ghent University Hospital from 1 November 2006 to 31 October 2007 was retrospectively categorised as CAP or HCAP according to the definition of the American Thoracic Society/Infectious Diseases Society of America. We categorised 287 episodes of pneumonia, diagnosed in 269 patients, as CAP [159 (55%)] or HCAP [128 (45%)]. Patients with HCAP were older [75 years (range: 64-83) vs 68 (41-78); P < 0.001], had more comorbidity, and had more severe pneumonia [CURB-65: 2 (1-3) vs 1 (0-2); P < 0.001] in comparison to patients with CAP. Patients with HCAP had more frequently an unfavourable clinical course (27% vs 15%; P < 0.01) and a longer hospital stay (12 days vs 9 days; P<0.001) compared with patients with CAP. In multivariate regression analysis, nursing home residence (odds ratio: 2.96; 95% confidence interval: 1.12-7.84; P = 0.03) but not HCAP was an independent predictor for in-hospital mortality. In conclusion, a high percentage (45%) of patients hospitalised with pneumonia through the ED was classified as HCAP. Classification as HCAP was associated with an unfavourable clinical course. Nursing home residence was an independent predictor for increased mortality., (Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.)

Case reports mention a sudden awakening from GHB-associated coma but do not specify its time course. The aim of the present case series was to investigate the time course of the awakening from GHB intoxication and the relationship to plasma concentrations of GHB and the presence of other drugs. Unconscious (GCS or=12 was 30 minutes (range 10 to 50 minutes). A subgroup of five patients had a GCS of 3 upon arrival and remained at 3 for a median time of 60 minutes (range 30 to 110 minutes), while the median time for the transition between the last point with GCS 3 and the first with GCS 15 was 30 minutes (range 20 to 60 minutes). This case series illustrates that patients with GHB intoxications remain in a deep coma for a relatively long period of time, after which they awaken over about 30 minutes. This awakening is accompanied by a small change in GHB concentrations. A confounding factor in these observations is co-ingested illicit drugs.

Alcohol and illicit drug abuse are major health care problems frequently leading to emergency department admission. The aims of this survey were (1) to determine for the Ghent University Hospital how frequently substance abuse contributed to emergency department admissions, (2) to describe the most important clinical features of these patients and (3) to determine how frequently these patients were referred to appropriate psychiatric services. All 1,941 patients attending the emergency department during the month of September 2003 were registered by the attending emergency department personnel. After exclusion of 8 cases, 1,933 patients were included: 198 (10%) with substance abuse leading to the emergency department admission (= INTOX group) and 1,735 (90%) in the NON-INTOX group. Males and the 21-50 years age group were overrepresented in the INTOX group. Patients with substance abuse were also overrepresented during the night, but not during the weekend. Among the patients from the INTOX group the most frequent reason for the emergency department visit was a psychiatric problem (102/198; 51%). Traumatic lesions related to a fight (n= 19), to a traffic accident (n= 17) and to leisure time activities (n=30) were also frequent. In most patients, only alcohol was abused (144/198; 73%), most frequently chronically (102/144; 71%). In 13% (26/198), there was only illicit drug use, and in 14% (28/198) alcohol abuse was combined with illicit drug use. Among the 54 patients with illicit drug use (with or without alcohol abuse) the most frequently reported drugs were cannabis (54%), cocaine (41%), amphetamines (39%) and opiates (39%). With regard to referral to appropriate psychosocial services it was striking that 53% (19/36) of trauma patients with chronic substance abuse were not offered that type of help. We conclude that abuse of alcohol--and to a much lesser degree illicit drugs--is a frequent cause of emergency department admissions. Our data may help to convince and/or reinforce health care policy makers, emergency department medical directors and the public that alcohol consumption (much more than illicit drugs) is responsible for avoidable morbidity and mortality, and that well-co-ordinated strategies against unhealthy alcohol use are urgently needed. In this respect, the importance of detection and referral of emergency department patients with unhealthy alcohol use should be stressed.