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Abstract Faculty development in medical simulation is a growing need, given the increased use of simulation-based learning in healthcare. Training of trainers is demanding and resource-consuming; therefore, there is a need for accessible, practical, and resource-saving solutions enabling efficient faculty development. For that purpose, we investigated whether a massive open online course (MOOC) could meet these challenges. This manuscript presents a MOOC, its pedagogical strategies, and its impacts on faculty development. The University of Liège Medical Simulation Center developed a MOOC with five learning units focused on the foundations of simulation training. Each unit ends with a set of theoretical and practical exercises. Our results showed knowledge and skills acquisition (objective exercise score data) among participants with a success rate of 67%, as well as high levels of engagement and confidence in learning (self-reported data). We demonstrate that a MOOC for faculty development in healthcare simulation is effective, has the potential to be an accessibility enabler, and offers an additional tool for trainer training. We recommend designing it with various asynchronous online modalities and multiplying social interactions with peers and trainers to favor trainees’ engagement and subsequent learning. Further perspectives should study blended learning strategies in faculty development and define the optimum ratio between face to face and online synchronous and asynchronous modalities. Graphical Abstract Characteristics and advantages of MOOCs as an asynchronous online teaching tool for faculty development in healthcare simulation.

Abstract Background Convalescent plasma (CP) reduced the mortality in COVID-19 induced ARDS (C-ARDS) patients treated in the CONFIDENT trial. As patients are immunologically heterogeneous, we hypothesized that clusters may differ in their treatment responses to CP. Methods We measured 20 cytokines, chemokines and cell adhesion markers using a multiplex technique at the time of inclusion in the CONFIDENT trial in patients of centers having accepted to participate in this secondary study. We performed descriptive statistics, unsupervised hierarchical cluster analysis, and examined the association between the clusters and CP effect on day-28 mortality. Results Of the 475 patients included in CONFIDENT, 391 (82%) were sampled, and 196/391 (50.1%) had been assigned to CP. We identified four sub-phenotypes representing 89 (22.8%), 178 (45.5%), 38 (9.7%), and 86 (22.0%) patients. The most contributing biomarkers in the principal component analysis were IL-1β, IL-12p70, IL-6, IFN-α, IL-17A, IFN-γ, IL-13, TFN-α, total IgG, and CXCL10. Sub-phenotype-1 displayed a lower immune response, sub-phenotype-2 a higher adaptive response, sub-phenotype-3 the highest innate antiviral, pro and anti-inflammatory response, and adhesion molecule activation, and sub-phenotype-4 a higher pro and anti-inflammatory response, migration protein and adhesion molecule activation. Sub-phenotype-2 and sub-phenotype-4 had higher severity at the time of inclusion. The effect of CP treatment on mortality appeared higher than standard care in each sub-phenotype, without heterogeneity between sub-phenotypes (p = 0.97). Conclusion In patients with C-ARDS, we identified 4 sub-phenotypes based on their immune response. These sub-phenotypes were associated with different clinical profiles. The response to CP was similar across the 4 sub-phenotypes. Trial registration: Ethics Committee of the University Hospital of Liège CE 2020/239. Clinicaltrials.gov NCT04558476. Registered 2020-09-11, https://www.clinicaltrials.gov/study/NCT04558476 .

Abstract Background 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography combined with low-dose computed tomography (PET/CT) can be used at diagnosis to identify myeloma-defining events and also provides prognostic factors. The aim of this study was to assess the prognostic significance of baseline [18F]FDG PET/CT visual IMPeTUs (Italian myeloma criteria for PET Use)-based parameters and/or total metabolic tumor volume (TMTV) in a single-center population of patients with newly diagnosed multiple myeloma (NDMM) eligible for transplantation. Methods Patients with MM who underwent a baseline [18F]FDG PET/CT were retrospectively selected from a large internal database of the University Hospital of Liege (Liege, Belgium). Initially, all PET/CT images were visually analyzed using IMPeTUs criteria, followed by delineation of TMTV using a semi-automatic lesion delineation workflow, including [18F]FDG-positive MM focal lesions (FL) with an absolute SUV threshold set at 4.0. In a first step, to ensure PET/CT scans accurate reporting, the agreement between two nuclear medicine physicians with distinct experience was assessed. In the second step, univariable and multivariable analyses were conducted to determine the prognostic significance of [18F]FDG PET/CT parameters on progression free survival (PFS) and overall survival (OS), respectively. Results A total of 40 patients with NDMM were included in the study. The observers agreement in the analysis [18F]FDG PET/CT images was substantial for the presence of spine FL, extra spine FL, at least one fracture and paramedullary disease (Cohen’s kappa 0.79, 0.87, 0.75 and 0.64, respectively). For the presence of skull FL and extramedullary disease the agreement was moderate (Cohen’s kappa 0.56 and 0.53, respectively). Among [18F]FDG PET/CT parameters, a high number of delineated volumes of interest (VOI) using the SUV4.0 threshold was the only independent prognostic factor associated with PFS [HR (95% CI): 1.03 (1.004–1.05), P = 0.019] while a high number of FL (n > 10; F group 4) was the only independent prognostic factor associated with OS [HR (95% CI): 19.10 (1.90–191.95), P = 0.01]. Conclusion Our work confirms the reproducibility IMPeTUs criteria. Furthermore, it demonstrates that a high number of FL (n > 10; IMPeTUs F group 4), reflecting a high [18F]FDG-avid tumor burden, is an independent prognostic factor for OS. The prognostic value of the TMTV delineated using a SUV4.0 threshold was not significant. Nevertheless, the count of delineated [18F]FDG-avid lesions VOI using a SUV4.0 threshold was an independent prognostic factor for PFS.

Abstract Background The use of virtual reality (VR) in healthcare education is on the increase. In disaster medicine, it could be a solution to the cost and logistic constraints for a “full-scale” scenarios. However, VR is mainly designed for single players, which is not appropriate for the objectives pursued in disaster medicine. We decided to evaluate the educational value of using individual VR simulation in disaster medicine on a group of learners. Methods The VR scenario used was a reproduction of a major train crash, with 21 victims and whose objectives were START triage and first aid techniques. The sessions were carried out in multi-participant groups with different roles (active and immersed with headset, paper triage without headset, and active for communications not immersed in the headset). Their perceived self-efficacy was assessed before (T0), after (T1) and 2 months (T2) after the training. Satisfaction and confidence in learning were also measured. Results The median levels of satisfaction and confidence in learning were of 21/25 and 32/40 respectively. Their perceived self-efficacy increased significantly between T0 and T1 (p

Abstract Background In response to the COVID-19 pandemic, the World Health Organization established a number of key recommendations such as educational activities especially within primary care practices (PCPs) which are a key component of this strategy. This paper aims to examine the educational activities of PCPs during COVID-19 pandemic and to identify the factors associated with these practices across 38 countries. Methods A "Patient Education (PE)" score was created based on responses to six items from the self-reported questionnaire among PCPs (n = 3638) compiled by the PRICOV-19 study. Statistical analyses were performed on 3638 cases, with PCPs with missing PE score values were excluded. Results The PE score features a mean of 2.55 (SD = 0.68) and a median of 2.50 (2.16 – 3.00), with a maximum of 4.00, and varies quite widely between countries. Among all PCPs characteristics, these factors significantly increase the PE score: the payment system type (with a capitation payment system or another system compared to the fee for service), the perception of average PCP with patients with chronic conditions and the perception of adequate governmental support. Conclusion The model presented in this article is still incomplete and requires further investigation to identify other configuration elements favorable to educational activities. However, the results already highlight certain levers that will enable the development of this educational approach appropriate to primary care.

Abstract Background The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries. Methods The data collected from 479 Belgian practices during 2020–2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed. Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system. Results Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries. Conclusions Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care.

Abstract Background Aging is frequently associated with impairments of the musculoskeletal system and many elderly people experience joint discomfort or pain which might reduce their ability to move and consequently alter their quality of life. A beneficial effect of fish cartilage hydrolysate (FCH) on pain and joint function has recently been shown in an ACLT/pMMx osteoarthritis rat model. Methods We therefore performed an exploratory, non-comparative, multi-centric clinical trial including 33 subjects with moderate knee joint discomfort and loss of functionality to investigate the efficacy of FCH on their algo-functional status. We further determined the potential health benefit of FCH in an original clinical ex vivo study investigating the role of FCH human metabolites on primary human chondrocytes. Results FCH significantly improved knee pain and function, as assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS). Moreover, FCH significantly reduced pain at rest and while walking, and patient global assessment (PGA), as assessed by the Visual Analogue Scale (VAS), and improved patients’ quality of life (SF-36). FCH metabolites decreased the synthesis of catabolic factors (MMP-13) and pro-inflammatory mediators (NO, PGE2) and limited the inhibitory effect of IL-1β on the synthesis of cartilage matrix components (GAG and collagen). Conclusions Thus, these data provide insights on the mode of action of FCH in humans and contribute to explain how FCH may relieve pain and improve joint function in subjects with knee discomfort. Although these preliminary data need to be confirmed in a randomized controlled trial, they strongly support the potential health benefit of such an active ingredient. Trial registration: The study was registered on clinicaltrials.gov with the identifier NCT04420091 (09/06/2020).

Even before the COVID-19 pandemic, vaccine hesitancy was one of the main global public health threats. Unfortunately, the COVID-19 crisis and its associated risks only reinforced this hesitancy. This study aimed to identify to what extent the COVID-19 vaccination affected confusion around vaccination in general, its change and any associated factors. A questionnaire was distributed to the university population of Liège between April-June 2021 (Time 1) and July-September 2022 (Time 2). The impact of the COVID-19 vaccination on confusion around vaccination in general (score 0 to 100) was divided into three groups based on the tertiles of the study sample at different times and whether or not any change had been observed. Ordinal and multinomial regression analyses were performed to assess the relationship between the confusion and various determinants. The sample consisted of 491 participants. Time 1 vs Time 2, 41.3% vs 35.4% seemed to be less confused, 24.2% vs 28.7% were moderately confused and 34.4% vs 35.8% more confused, respectively. In terms of change, 19.4% of participants were less confused, 55.2% had not changed their opinion and 25.5% were more confused. The determinants causing confusion at both times and regarding change were self-perception, health literacy, past vaccination experiences and COVID-19 related factors (COVID-19 vaccination intention and trust in source of information at Time 1; preferred source of information, trust in vaccine producers and conspiratorial beliefs at Time 2; trust in vaccine producers for change). The results demonstrated that the COVID-19 vaccination impacted confusion around vaccination in general. Both unrelated and related COVID-19 factors, particularly regarding the progression of the pandemic, seem to have contributed to this confusion. Contributing factors require a personalised approach, evidence-based information being communicated with messages adapted to the situation and its evolution designed to allay individuals' fears about vaccination.

Background Randomised controlled trials have shown that benralizumab, an anti-interleukin-5 receptor monoclonal antibody, reduces exacerbations and oral corticosteroid dose and improves asthma control and lung function in severe eosinophilic asthma. The aim of this study was to confirm results of randomised controlled trials in real life in a population of 73 patients with severe eosinophilic asthma treated with benralizumab for at least 12 months. Methods Patients underwent careful monitoring of asthma exacerbations, exhaled nitric oxide fraction, lung function, asthma control and quality of life questionnaire responses and sputum induction, and gave a blood sample at baseline, after 6 months and then every year. Results We found significant reductions in exacerbations (by 92%, p

Abstract Background Management of unscheduled urgent care is a complex concern for many healthcare providers. Facing the challenge of appropriately dispatching unscheduled care, primary and emergency physicians have collaboratively implemented innovative strategies such as telephone triage. Currently, new original solutions tend to emerge with the development of new technologies. We created an interactive patient self-triage platform, ODISSEE, and aimed to explore its accuracy and potential factors affecting its performance using clinical case scenarios. Methods The ODISSEE platform was developed based on previously validated triage protocols for out-of-hours primary care. ODISSEE is composed of 18 icons leading to algorithmic questions that finally provide an advised orientation (emergency or primary care services). To investigate ODISSEE performance, we used 100 clinical case scenarios, each associated with a preestablished orientation determined by a group of experts. Fifteen volunteers were asked to self-triage with 50 randomly selected scenarios using ODISSEE on a digital tablet. Their triage results were compared with the experts’ references. Results The 15 participants performed a total of 750 self-triages, which matched the experts references regarding the level of care in 85.6% of the cases. The orientation was incorrect in 14.4%, with an undertriage rate of 1.9% and an overtriage rate of 12.5%. The tool’s specificity and sensitivity to advise participants on the appropriate level of care were 69% (95% CI: 64—74) and 97% (95% CI: 95—98) respectively. When combined with advice on the level of urgency, the tool only found the correct orientation in 68.4% with 9.2% of undertriages and 22.4% of overtriages. Some participant characteristics and the types of medical conditions demonstrated a significant association with the tool performance. Conclusion Self-triage apps, such as the ODISSEE platform, could represent an innovative method to allow patients to self-triage to the most appropriate level of care. This study based on clinical vignettes highlights some positive arguments regarding ODISSEE safety, but further research is needed to assess the generalizability of such tools to the population without equity issues.

ObjectivesThe effect and safety of Nasafytol®, a food supplement combining curcumin, quercetin, and Vitamin D, on hospitalized COVID-19-positive patients as support to standard of care were to be assessed.MethodsThis exploratory, open-label, randomized, controlled trial was carried out among hospitalized adults with COVID-19 infection. Participants were randomly assigned to receive Nasafytol® or Fultium® control. The improvement of the clinical condition and occurrence of (serious) adverse events were evaluated. The study was registered on clincaltrials.gov with the identifier NCT04844658.ResultsTwenty-five patients received Nasafytol®, and 24 received Fultium®. Demographic characteristics were well balanced between the groups. On day 14 (or at hospital leave if

Abstract Background The initial training of Radiation Oncology professionals can vary widely across Europe. The aim of this study was to assess the status and content of the initial training programs currently implemented in the Greater Region: Lorraine (Nancy, France), Saarland (Homburg, Germany), Luxembourg, and Liège (Wallonia, Belgium). Methods A survey was developed to investigate (1) the overall satisfaction, learning objectives, and teaching methods used during initial training programs and (2) the perceptions of the importance of key professional competencies as described by the CanMEDS (a framework that identifies and describes the abilities physicians require to effectively meet the health care needs of the people they serve). In addition, open-ended questions were used to elicit opinions on room for improvement. Participants (N = 38) were physicians (radiation oncologists (RO) seniors and residents) and radiation therapists (RTTs). Results Only 21.1% of the respondents declared having acquired all the competencies required for their professional practice during their initial training. Heterogeneity in teaching methods was noted within professional programs but there is no difference between those from RO and RTT in the teaching of technical and relational skills. Relational skills were not addressed in a range of 39.5–57.9% of respondent’s curricula. More practical lessons were deemed necessary to improve radiotherapy (RT) training programs. Conclusions Radiation oncology professionals expressed the need for more practical teaching, especially in the training of non-technical skills. Regarding the perceived importance of professional aptitudes, radiation oncology professionals highlighted medical and relational skills as the most important competencies.

Abstract Background Since the beginning of the pandemic, hospitals have been constantly overcrowded, with several observed waves of infected cases and hospitalisations. To avoid as much as possible this situation, efficient tools to facilitate the diagnosis of COVID-19 are needed. Objective To evaluate and compare prediction models to diagnose COVID-19 identified in a systematic review published recently using performance indicators such as discrimination and calibration measures. Methods A total of 1618 adult patients present at two Emergency Department triage centers and for whom qRT-PCR tests had been performed were included in this study. Six previously published models were reconstructed and assessed using diagnostic tests as sensitivity (Se) and negative predictive value (NPV), discrimination (Area Under the Roc Curve (AUROC)) and calibration measures. Agreement was also measured between them using Kappa’s coefficient and IntraClass Correlation Coefficient (ICC). A sensitivity analysis has been conducted by waves of patients. Results Among the 6 selected models, those based only on symptoms and/or risk exposure were found to be less efficient than those based on biological parameters and/or radiological examination with smallest AUROC values ( 0.75 for Se and NPV but poor agreement (Kappa and ICC

Abstract Background The role played by large-scale repetitive SARS-CoV-2 screening programs within university populations interacting continuously with an urban environment, is unknown. Our objective was to develop a model capable of predicting the dispersion of viral contamination among university populations dividing their time between social and academic environments. Methods Data was collected through real, large-scale testing developed at the University of Liège, Belgium, during the period Sept. 28th-Oct. 29th 2020. The screening, offered to students and staff (n = 30,000), began 2 weeks after the re-opening of the campus but had to be halted after 5 weeks due to an imposed general lockdown. The data was then used to feed a two-population model (University + surrounding environment) implementing a generalized susceptible-exposed-infected-removed compartmental modeling framework. Results The considered two-population model was sufficiently versatile to capture the known dynamics of the pandemic. The reproduction number was estimated to be significantly larger on campus than in the urban population, with a net difference of 0.5 in the most severe conditions. The low adhesion rate for screening (22.6% on average) and the large reproduction number meant the pandemic could not be contained. However, the weekly screening could have prevented 1393 cases (i.e. 4.6% of the university population; 95% CI: 4.4–4.8%) compared to a modeled situation without testing. Conclusion In a real life setting in a University campus, periodic screening could contribute to limiting the SARS-CoV-2 pandemic cycle but is highly dependent on its environment.

Introduction Although asthma is a common disease, its diagnosis remains a challenge in clinical practice with both over- and underdiagnosis. Here, we performed a prospective observational study investigating the value of symptom intensity scales alone or combined with spirometry and exhaled nitric oxide fraction (FENO) to aid in asthma diagnosis. Methods Over a 38-month period we recruited 303 untreated patients complaining of symptoms suggestive of asthma (wheezing, dyspnoea, cough, sputum production and chest tightness). The whole cohort was split into a training cohort (n=166) for patients recruited during odd months and a validation cohort (n=137) for patients recruited during even months. Asthma was diagnosed either by a positive reversibility test (≥12% and ≥200 mL in forced expiratory volume in 1 s (FEV1)) and/or a positive bronchial challenge test (provocative concentration of methacholine causing a 20% fall in FEV1 ≤8 mg·mL−1). In order to assess the diagnostic performance of symptoms, spirometric indices and FENO, we performed receiver operating characteristic curve analysis and multivariable logistic regression to identify the independent factors associated with asthma in the training cohort. Then, the derived predictive models were applied to the validation cohort. Results 63% of patients in the derivation cohort and 58% of patients in the validation cohort were diagnosed as being asthmatic. After logistic regression, wheezing was the only symptom to be significantly associated with asthma. Similarly, FEV1 (% pred), FEV1/forced vital capacity (%) and FENO were significantly associated with asthma. A predictive model combining these four parameters yielded an area under the curve of 0.76 (95% CI 0.66–0.84) in the training cohort and 0.73 (95% CI 0.65–0.82) when applied to the validation cohort. Conclusion Combining a wheezing intensity scale with spirometry and FENO may help in improving asthma diagnosis accuracy in clinical practice.

Abstract Background Ventilator-associated pneumonia (VAP) causes increased mortality, prolonged hospital stay and increased healthcare costs. Prevention of VAP in intensive care units (ICUs) is currently based on several measures, and application of noble metal coating on medical devices has been shown to inhibit the bacterial adherence of microorganisms to the surface. The objective of this study was to evaluate the potential benefit of noble metal coating of endotracheal tubes for the prevention of VAP. Methods This was a multi-center, randomized, controlled, double-blind, prospective study including ventilated patients from nine ICUs from four hospital sites in Belgium. Patients were randomly intubated with identical appearing noble metal alloy (NMA) coated (NMA-coated group) or non-coated (control group) endotracheal tubes (ETT). Primary endpoint was the incidence of VAP. Secondary endpoints were the proportion of antibiotic days during ICU stay and tracheal colonization by pathogenic bacteria. Results In total, 323 patients were enrolled, 168 in the NMA-coated group and 155 in the control group. During ventilation, VAP occurred in 11 patients (6.5%) in the NMA-coated group and in 18 patients (11.6%) in the control group (p = 0.11). A higher delay in VAP occurrence was observed in the NMA-coated group compared with the control group by Cox proportional hazards regression analysis (HR 0.41, 95% CI 0.19–0.88, p = 0.02). The number of antibiotic days was 58.8% of the 1,928 ICU days in the NMA-coated group and 65.4% of the 1774 ICU days in the control group (p = 0.06). Regarding tracheal colonization, bacteria occurred in 38 of 126 patients in the NMA-coated group (30.2%) and in 37 of 109 patients in the control group (33.9%) (p = 0.57). Conclusions This study provides preliminary evidence to support the benefit of noble metal coating in the prevention of VAP. A confirmatory study in a larger population would be valuable. Trial registration: Clinical trial number: NCT04242706 ( http://www.clinicaltrials.gov )

Saegerman et al. perform saliva SARS-CoV-2 testing in a cohort of nursing home workers in Belgium who are either unvaccinated or have received one or two doses of the BNT162b2 mRNA vaccine. The authors show that vaccination protects against shedding of SARS-CoV-2 into saliva and observe greater variability in viral load in the unvaccinated group.

Abstract Background Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). Methods In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.

Communication skills training is essential in nurse education. Miscommunication may lead to adverse events and unsafe healthcare. To date, valid and reliable instruments to serve both communication training and assessment purposes across different cultural contexts are scarce. The present study empirically tested a French-language version of the Health Communication Assessment Tool© (HCAT-f) across different levels of communication skills performance to establish its reliability and validity through a cognitive fluency framework. Ten experts in communication and 52 nurse educators rated three videos simulating conversations between a nurse and a patient scheduled for lumpectomy. Each video captured a different level of communication skills performed by the nurse: High, medium, and low. Three distinct constructs were identified, i.e., professional presentation, empathy, and trust building. At absolute single-measure, an ICC = .43 suggested adequate interrater reliability of the whole scale for the medium-performed scenario, which decreased in low-performed (ICC = .35) and high-performed (ICC = .18) scenarios. The HCAT-f fulfils the criteria of linguistic equivalence, contextual relevance, and demonstrates acceptable construct validity. It can be used as a summative assessment tool after prior training on scale calibration is in place because interrater agreement was difficult to be established in high and low performance scenarios.

Primary ciliary dyskinesia is a heterogeneous, inherited motile ciliopathy in which respiratory cilia beat abnormally, and some ultrastructural ciliary defects and specific genetic mutations have been associated with particular ciliary beating alterations. Ciliary beating can be evaluated using digital high-speed videomicroscopy (DHSV). However, normal reference values, essential to assess ciliary beating in patients referred for a PCD diagnostic, vary between centres, as minor variations in protocols might influence ciliary beating. Consequently, establishment of normal values is essential for each PCD diagnostic centre. We aimed to evaluate whether delay after sampling, and temperature for conservation of respiratory ciliated samples, might modify assessments of ciliary beating. In total, 37 healthy nasal brushing samples of respiratory ciliated epithelia were collected. Video sequences were recorded at 37 °C immediately using DHSV. Then, the samples were divided and conserved at 4 °C or at room temperature (RT). Ciliated beating edges were then recorded at 37 °C, at 3 h and at 9 h post sampling. In six samples, recordings were continued up to 72 h after sampling. Ciliary beating was assessed manually by ciliary beat frequency (CBFM) and ciliary beat pattern (CBP). A semi-automatic software was used for quantitative analysis. Both CBF and CBP evaluated manually and by a semi-automated method were stable 9 h after sampling. CBFM was higher when evaluated using samples stored at RT than at 4 °C. CBP and the semi-automated evaluation of ciliary beating were not affected by storage temperature. When establishing normal references values, ciliary beating can be evaluated at 37 °C up to 9 h after nasal brushing, but the storage temperature modifies ciliary beating and needs to be controlled.

The immediate shift to remote teaching or distance learning, due to COVID-19 management strategies, most notably limited in-person contact, was abruptly implemented in universities worldwide. This process was demanding for both the instructors and the students, notwithstanding. The present study examined the challenges in a course attributed as the most challenging during the COVID-19 pandemic by health sciences students of different socio-demographic backgrounds, life circumstances, educational background and academic achievement (N = 743). A questionnaire was designed and translated to French employing the forward-backward translation method. The factor structure and reliability were examined by Categorical Principal Component Analysis (CATPCA) and Cronbach's alpha, respectively. Chi-square tests with post-hoc examinations using adjusted standardized residuals and z-tests of independent proportions were performed to investigate the group differences. Participants were bachelor and master students of Medicine, Pharmacy, Biomedicine, Physiotherapy, Public Health, Motor Sciences (Physical Education) and Dentistry from the University of Liege, Belgium. Results revealed that the most three reported challenges were difficult learning content, course intensity, feeling of stress and worry. Additionally, online learning implementation due to Covid-19 measures, feeling of failure (not having learnt what was supposed to be learnt) and lack of instructors' interaction and support were mentioned as the prominent challenges encountered. Furthermore, more bachelor, full-time and female students, students who were in early stages of the learning trajectory and low and averaged achievers reported experiencing challenges with difficult learning content, course intensity, stress and online learning. The findings, thus, emphasized the role of faculty-led and instructors' support in the early stages of students' learning trajectory and adequate attention to their well-being if online learning is to be institutionalized.

Abstract Background The COVID-19 pandemic is putting significant pressure on the hospital system. To help clinicians in the rapid triage of patients at high risk of COVID-19 while waiting for RT-PCR results, different diagnostic prediction models have been developed. Our objective is to identify, compare, and evaluate performances of prediction models for the diagnosis of COVID-19 in adult patients in a health care setting. Methods A search for relevant references has been conducted on the MEDLINE and Scopus databases. Rigorous eligibility criteria have been established (e.g., adult participants, suspicion of COVID-19, medical setting) and applied by two independent investigators to identify suitable studies at 2 different stages: (1) titles and abstracts screening and (2) full-texts screening. Risk of bias (RoB) has been assessed using the Prediction model study Risk of Bias Assessment Tool (PROBAST). Data synthesis has been presented according to a narrative report of findings. Results Out of the 2334 references identified by the literature search, 13 articles have been included in our systematic review. The studies, carried out all over the world, were performed in 2020. The included articles proposed a model developed using different methods, namely, logistic regression, score, machine learning, XGBoost. All the included models performed well to discriminate adults at high risks of presenting COVID-19 (all area under the ROC curve (AUROC) > 0.500). The best AUROC was observed for the model of Kurstjens et al (AUROC = 0.940 (0.910–0.960), which was also the model that achieved the highest sensitivity (98%). RoB was evaluated as low in general. Conclusion Thirteen models have been developed since the start of the pandemic in order to diagnose COVID-19 in suspected patients from health care centers. All these models are effective, to varying degrees, in identifying whether patients were at high risk of having COVID-19.

Abstract Background The COVID-19 pandemic reached Europe in early 2020. Convalescent plasma is used without a consistent evidence of efficacy. Our hypothesis is that passive immunization with plasma collected from patients having contracted COVID-19 and developed specific neutralizing antibodies may alleviate symptoms and reduce mortality in patients treated with mechanical ventilation for severe respiratory failure during the evolution of SARS-CoV-2 pneumonia. Methods We plan to include 500 adult patients, hospitalized in 16 Belgian intensive care units between September 2020 and 2022, diagnosed with SARS-CoV-2 pneumonia, under mechanical ventilation for less than 5 days and a clinical frailty scale less than 6. The study treatment will be compared to standard of care and allocated by randomization in a 1 to 1 ratio without blinding. The main endpoint will be mortality at day 28. We will perform an intention to treat analysis. The number of patients to include is based on an expected mortality rate at day 28 of 40 percent and an expected relative reduction with study intervention of 30 percent with α risk of 5 percent and β risk of 20 percent. Discussion This study will assess the efficacy of plasma in the population of mechanically ventilated patients. A stratification on the delay from mechanical ventilation and inclusion will allow to approach the optimal time use. Selecting convalescent plasmas with a high titer of neutralizing antibodies against SARS-CoV-2 will allow a homogeneous study treatment. The inclusion in the study is based on the consent of the patient or his/her legal representative, and the approval of the Investigational Review Board of the University hospital of Liège, Belgium. A data safety monitoring board (DSMB) has been implemented. Interim analyses have been planned at 100, 2002, 300 and 400 inclusions in order to decide whether the trail should be discontinued prematurely for ethical issues. We plan to publish our results in a peer-reviewed journal and to present them at national and international conferences. Funding and registration The trial is funded by the Belgian Health Care Knowledge Center KCE # COV201004 Trial registration Clinicaltrials.gov registration number NCT04558476. Registered 14 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04558476

The COVID-19 pandemic due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been plaguing the world since late 2019/early 2020 and has changed the way we function as a society, halting both economic and social activities worldwide. Classrooms, offices, restaurants, public transport, and other enclosed spaces that typically gather large groups of people indoors, and are considered focal points for the spread of the virus. For society to be able to go “back to normal”, it is crucial to keep these places open and functioning. An understanding of the transmission modes occurring in these contexts is essential to set up effective infection control strategies. This understanding was made using a systematic review, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA) 2020 guidelines. We analyze the different parameters influencing airborne transmission indoors, the mathematical models proposed to understand it, and discuss how we can act on these parameters. Methods to judge infection risks through the analysis of the indoor air quality are described. Various mitigation measures are listed, and their efficiency, feasibility, and acceptability are ranked by a panel of experts in the field. Thus, effective ventilation procedures controlled by CO2-monitoring, continued mask wearing, and a strategic control of room occupancy, among other measures, are put forth to enable a safe return to these essential places.

Testing strategies are crucial to prevent and control the spread of covid-19 but suffer from a lack of investment in understanding the human factors that influence their implementation. The aim of this study was to understand the factors that encourage participation and the level of engagement of nursing homes staff in a routine saliva testing programme for COVID-19 In December 2020, nursing homes (n = 571) in Wallonia (Belgium) were invited to participate in a saliva testing programme for their staff. The directors were questioned by telephone at the end of a 3-week pilot phase. 445 nursing homes took part in the evaluation questionnaire, of which 36(8%) answered that they chose not to participate in the testing programme. The average participation rate of nursing staff was 49(±25)%. Perception of the justification of the efforts required for testing and perception of practicability of the procedure were significantly associated with the adoption of the system by the nursing homes directors (OR(95%CI): 5.96(1.97-18.0), p = 0.0016); OR(95%CI): 5.64(1.94-16.4), p = 0.0015 respectively). Staff support, incentives and meetings increased the level of engagement in testing (p

Abstract Background In recent decades, asthma‐related quality of life questionnaires have joined objective clinical indicators as important outcome measures. In this study, we sought to investigate the predictors of asthma‐related quality of life in a large cohort of patients recruited from a secondary care center. Methods We conducted a cross‐sectional study on asthmatics (N = 1301) recruited from the Liège University Hospital asthma clinic (Belgium). After performing a descriptive analysis highlighting the distribution of scores from the Mini Asthma Quality of Life Questionnaire (Mini AQLQ) and its four dimensions (symptoms, activity limitation, emotional function, and environmental stimuli), we did multiple regression analysis to identify the independent predictors of AQLQ. Results Multiple regression beta analysis showed that AQLQ and its four dimensions were primarily associated with asthma control (p

While many studies have documented the intentions for the COVID-19 vaccine booster, few have explored the change from intention to final decision. This study explores the COVID-19 booster intentions and the change from intention to decision in a primo-vaccinated university population, with a distinction between staff members and students. It looks at the sociodemographic and medical characteristics, health literacy, personal COVID-19 infection and vaccination history, and attitudes/intentions regarding the booster, among the 1030 participants (64.4% staff members, 61.3% female, median age 36.0 years). Of the 8.7% who were initially hesitant, 72.7% ultimately got a booster and 27.3% did not. Another 84.2% intended to get a booster and 7.1% did not. Among the latter two groups, 88.9% maintained their intention and 11.1% changed their minds. The determinants associated with the intentions were health literacy and previous intentions regarding the COVID-19 primo-vaccination. The determinants associated with the change to non-vaccination were a previous COVID-19 infection, a past COVID-19 primo-vaccination intention, and a neutralizing antibody level. The results point to an opening for the support in decision-making, with a significant percentage of the study population potentially changing their mind between intention and final decision; this process should start early and be tailored to the individual’s COVID-19 history. A personalized approach seems necessary in order to ensure that individuals make an informed choice.

BackgroundThe coronavirus infectious disease 19 (COVID-19) pandemic has resulted in significant morbidities, severe acute respiratory failures and subsequently emergency departments' (EDs) overcrowding in a context of insufficient laboratory testing capacities. The development of decision support tools for real-time clinical diagnosis of COVID-19 is of prime importance to assist patients' triage and allocate resources for patients at risk.Methods and principal findingsFrom March 2 to June 15, 2020, clinical patterns of COVID-19 suspected patients at admission to the EDs of Liège University Hospital, consisting in the recording of eleven symptoms (i.e. dyspnoea, chest pain, rhinorrhoea, sore throat, dry cough, wet cough, diarrhoea, headache, myalgia, fever and anosmia) plus age and gender, were investigated during the first COVID-19 pandemic wave. Indeed, 573 SARS-CoV-2 cases confirmed by qRT-PCR before mid-June 2020, and 1579 suspected cases that were subsequently determined to be qRT-PCR negative for the detection of SARS-CoV-2 were enrolled in this study. Using multivariate binary logistic regression, two most relevant symptoms of COVID-19 were identified in addition of the age of the patient, i.e. fever (odds ratio [OR] = 3.66; 95% CI: 2.97-4.50), dry cough (OR = 1.71; 95% CI: 1.39-2.12), and patients older than 56.5 y (OR = 2.07; 95% CI: 1.67-2.58). Two additional symptoms (chest pain and sore throat) appeared significantly less associated to the confirmed COVID-19 cases with the same OR = 0.73 (95% CI: 0.56-0.94). An overall pondered (by OR) score (OPS) was calculated using all significant predictors. A receiver operating characteristic (ROC) curve was generated and the area under the ROC curve was 0.71 (95% CI: 0.68-0.73) rendering the use of the OPS to discriminate COVID-19 confirmed and unconfirmed patients. The main predictors were confirmed using both sensitivity analysis and classification tree analysis. Interestingly, a significant negative correlation was observed between the OPS and the cycle threshold (Ct values) of the qRT-PCR.Conclusion and main significanceThe proposed approach allows for the use of an interactive and adaptive clinical decision support tool. Using the clinical algorithm developed, a web-based user-interface was created to help nurses and clinicians from EDs with the triage of patients during the second COVID-19 wave.

BackgroundIn chronic pain, it seems that the effect of cognitive-behavioral therapy (CBT) is boosted when it is combined with hypnosis. The aim of this study was to assess the efficacy of self-hypnosis combined with self-care (i.e., a type of CBT) compared to music/self-care, self-care and psychoeducation/CBT and to evaluate their long-term effects.MethodsAn open label randomized clinical trial enrolled patients with chronic pain and was carried out at the University Hospital of Liège (Belgium). Patients were randomized into four groups: self-hypnosis/self-care, music/self-care, self-care, psychoeducation/CBT (7 monthly sessions of 2 hours). Two follow-up sessions were delivered at 6- and 12-month. Levels of pain, fatigue intensity, anxiety, depression, insomnia severity, disability, health locus of control, mental and physical quality of life and attitudes (control, disability, harm, emotion, medical cure, medication, solicitude) towards pain were assessed before and after the treatments, and at follow-up.Results203 patients were randomized: 52 in self-hypnosis/self-care, 59 in music/self-care, 47 in self-care, and 45 in psychoeducation/CBT. No group effect was found. A significant time effect was showed. Directly after the treatment, all groups decreased in pain attitudes and physical quality of life. Perceived control increased. At 6-month, all patients kept their levels of physical quality of life and perceived control, and showed decrease in pain intensity, harm, emotion and medical cure. At 12-month, scores that had change previously remained ameliorated, a decrease in insomnia severity and an increase in internal locus of control were observed.ConclusionsThe present findings are encouraging as they display long-term beneficial effects of complementary biopsychosocial-based treatments in chronic pain. It seems that patients continued to apply the learnt strategies as improvements were observed one year after the treatments had ended.

Background The diet impact on cardiovascular diseases has been investigated widely, but the association between dietary patterns (DPs) and subclinical cardiovascular damage remains unclear. More informative DPs could be provided by considering metabolic syndrome components as intermediate markers. This study aimed to identify DPs according to generation and sex using reduced‐rank regression (RRR) with metabolic syndrome components as intermediate markers and assess their associations with intima‐media thickness, left ventricular mass, and carotid‐femoral pulse‐wave velocity in an initially healthy population‐based family study. Methods and Results This study included 1527 participants from the STANISLAS (Suivi Temporaire Annuel Non‐Invasif de la Santé des Lorrains Assurés Sociaux) cohort fourth examination. DPs were derived using reduced‐rank regression according to generation (G1: age ≥50 years; G2: age

While weight-loss expectations have primarily been studied in people enrolled in weight-loss programs, the present study explores patient expectations about weight-loss and identifies related determinants in a large, non-clinical population.3916 volunteers (age > 18 years) participated in 2012 in a community-based survey in the French-speaking region of Belgium. Participants were asked to define “dream”, “goal”, “happy”, “acceptable”, and “disappointed” weights. Other self-reported measures were used to determine each participant's body mass index (BMI), body image discrepancy (BID), subjective norm (SN), weight loss activity, weight history, quality of life (QoL), and demographic and socioeconomic characteristics. The study focused on the determinants of unrealistic weight-loss “goal” (≥10% of initial weight).Results showed median weight loss targets ranged from 5 kg (“disappointed” weight loss) to 21 kg (“dreamed” weight loss). Respondents considered the recommended weight-loss target (5–10%) disappointing. Severe and morbid obesity categories are at high risk of unrealistic weight loss goal. Unrealistic weight-loss goals was associated with female gender, weight loss activity, overweight history and lower QoL in overweight and moderate obesity respondents.These findings confirm the urgent need to help patients accept more modest weight loss outcomes and the need for personalized care that considers the patient's specific profile and both weight loss expectations and determinants. Keywords: Overweight, Obesity, Population studies, Weight loss expectations

Abstract Background It is unanimously recognized that the maternal nutritional status at the pregnancy onset influence both short-term and long-term health of the mother and offspring. Among several nutrients, LCPUFA, particularly from the omega-3 family, are of utmost importance. This study was carried out to determine fatty acids profile of maternal erythrocyte membranes in early pregnancy and to identify potential determinants impacting on this status. Methods A cohort of 122 healthy women with a singleton pregnancy was included. Fatty acids were analyzed using gas chromatography. Because of the lack of cutoff values, reference ranges were used to determine fatty acids categories. Results Of concern, our data revealed low monounsaturated and long-chain omega-3 fatty acid status in most participants. More than 75% of Belgian pregnant women exhibited Pal, AO and EPA levels as well as IOM3 values below the laboratory reference ranges. Higher DHA concentrations and IOM3 values were found among foreign-nationality participants, non-smokers and physically active women. With regard to dietary factors, omega-3 supplements and diet seem to be complementary since DHA from supplements (but not from diet) and EPA from diet (but not from supplements) were found to be associated with higher concentrations of DHA and EPA, respectively. Conclusions Our study presents evidence demonstrating that the fatty acid status of most early pregnant women is far from being optimal based on the admitted general reference values. Clinicians should be advice to carefully evaluate and improve this status to guarantee the best possible outcome for both the mother and the baby.

Introduction: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills. Methods: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule. Results: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience. Conclusion: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.

BACKGROUND:Frail elderly people experience elevated mortality. However, no consensus exists on the definition of frailty, and many frailty scores have been developed. The main aim of this study was to compare the association between 35 frailty scores and incident cardiovascular disease (CVD), incident cancer, and all-cause mortality. Also, we aimed to assess whether frailty scores added predictive value to basic and adjusted models for these outcomes. METHODS AND FINDINGS:Through a structured literature search, we identified 35 frailty scores that could be calculated at wave 2 of the English Longitudinal Study of Ageing (ELSA), an observational cohort study. We analysed data from 5,294 participants, 44.9% men, aged 60 years and over. We studied the association between each of the scores and the incidence of CVD, cancer, and all-cause mortality during a 7-year follow-up using Cox proportional hazard models at progressive levels of adjustment. We also examined the added predictive performance of each score on top of basic models using Harrell's C statistic. Using age of the participant as a timescale, in sex-adjusted models, hazard ratios (HRs) (95% confidence intervals) for all-cause mortality ranged from 2.4 (95% CI: 1.7-3.3) to 26.2 (95% CI: 15.4-44.5). In further adjusted models including smoking status and alcohol consumption, HR ranged from 2.3 (95% CI: 1.6-3.1) to 20.2 (95% CI: 11.8-34.5). In fully adjusted models including lifestyle and comorbidity, HR ranged from 0.9 (95% CI: 0.5-1.7) to 8.4 (95% CI: 4.9-14.4). HRs for CVD and cancer incidence in sex-adjusted models ranged from 1.2 (95% CI: 0.5-3.2) to 16.5 (95% CI: 7.8-35.0) and from 0.7 (95% CI: 0.4-1.2) to 2.4 (95% CI: 1.0-5.7), respectively. In sex- and age-adjusted models, all frailty scores showed significant added predictive performance for all-cause mortality, increasing the C statistic by up to 3%. None of the scores significantly improved basic prediction models for CVD or cancer. A source of bias could be the differences in mortality follow-up time compared to CVD/cancer, because the existence of informative censoring cannot be excluded. CONCLUSION:There is high variability in the strength of the association between frailty scores and 7-year all-cause mortality, incident CVD, and cancer. With regard to all-cause mortality, some scores give a modest improvement to the predictive ability. Our results show that certain scores clearly outperform others with regard to three important health outcomes in later life. Finally, we think that despite their limitations, the use of frailty scores to identify the elderly population at risk is still a useful measure, and the choice of a frailty score should balance feasibility with performance.

Background: After an occurrence of a Near-Death Experience (NDE), Near-Death Experiencers (NDErs) usually report extremely rich and detailed narratives. Phenomenologically, a NDE can be described as a set of distinguishable features. Some authors have proposed regular patterns of NDEs, however, the actual temporality sequence of NDE core features remains a little explored area.Objectives: The aim of the present study was to investigate the frequency distribution of these features (globally and according to the position of features in narratives) as well as the most frequently reported temporality sequences of features.Methods: We collected 154 French freely expressed written NDE narratives (i.e., Greyson NDE scale total score ≥ 7/32). A text analysis was conducted on all narratives in order to infer temporal ordering and frequency distribution of NDE features.Results: Our analyses highlighted the following most frequently reported sequence of consecutive NDE features: Out-of-Body Experience, Experiencing a tunnel, Seeing a bright light, Feeling of peace. Yet, this sequence was encountered in a very limited number of NDErs.Conclusion: These findings may suggest that NDEs temporality sequences can vary across NDErs. Exploring associations and relationships among features encountered during NDEs may complete the rigorous definition and scientific comprehension of the phenomenon.

INTRODUCTION:Principal component analysis is used to determine dietary behaviors of a population whereas reduced rank regression is used to construct disease-related dietary patterns. This study aimed to compare both types of DP and theirs associations with cardiovascular risk factors (CVRF). MATERIEL AND METHODS:Data were derived from the cross sectional NESCAV (Nutrition, Environment and Cardiovascular Health) study, aiming to describe the cardiovascular health of the Greater region's population (Grand duchy of Luxembourg, Wallonia (Belgium), Lorraine (France)). 2298 individuals were included for this study and dietary intake was assessed using a 134-item food frequency questionnaire. RESULTS:We found that CVRF-related patterns also reflect eating behaviours of the population. Comparing concordant food groups between both dietary pattern methods, a diet high in fruits, oleaginous and dried fruits, vegetables, olive oil, fats rich in omega 6 and tea and low in fried foods, lean and fatty meat, processed meat, ready meal, soft drink and beer was associated with lower prevalence of CVRF. In the opposite, a pattern characterized by high intakes of fried foods, meat, offal, beer, wine and aperitifs and spirits, and low intakes of cereals, sugar and sweets and soft drinks was associated with higher prevalence of CVRF. CONCLUSION:In sum, we found that a "Prudent" and "Animal protein and alcohol" patterns were both associated with CVRF and behaviourally meaningful. Moreover, the relationships of those dietary patterns with lifestyle characteristics support the theory that food choices are part of a larger pattern of healthy lifestyle.

[This corrects the article DOI: 10.1371/journal.pone.0161298.].