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Abstract Purpose The primary aim was to determine the effect of a physical activity (PA) program with education sessions on walking capacity and fatigue in people with cancer. The secondary objective was to assess the factors that moderated the program’s effect on walking capacity and fatigue among sociodemographic, physical capacity and symptom-related factors. Satisfaction with the program was also evaluated. Method A retrospective, observational study of data from a 12-week program of twice-weekly group PA sessions combined with education sessions was conducted. The 6-min walk test (6MWT), the Multidimensional Fatigue Inventory (MFI-20) and program satisfaction were assessed. Paired t-tests were applied to assess changes in 6MWT and MFI-20. Multiple linear regressions were applied to determine the influence of age, gender, initial walking capacity and fatigue on the effects of the program. Results Among the 264 participants (age 57.36 ± 12.43 years; 189 women; 134 with breast cancer), 125 (47%) completed the program. Walking capacity (+ 41.63 ± 91.00 m) and fatigue (-2.01 ± 3.77) were improved after the program (p

Abstract Background Young musicians starting their professional education are particularly vulnerable to playing-related musculoskeletal disorders (PRMDs). In the context of research on PRMDs, physical and psychological associated factors are frequently highlighted without investigating their complex interrelationships. The objective of this exploratory study was to examine the associations between lifestyle, music practice habits, physical and psychological variables, and PRMDs in student musicians. Methods Students of the Geneva University of Music participated in the survey. The primary outcome was students’ PRMDs, measured with the validated Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM). Additionally, to investigate potential associated factors, participants completed free-form questions about lifestyle and practice habits and seven validated questionnaires: physical activity, self-rated health, psychological distress, musical performance anxiety (MPA), perfectionism, fatigue, and personality traits. After performing standard descriptive statistics, network analyses were applied to investigate the links between students' PRMDs experience and all factors. Results Two hundred thirty-five student musicians completed the survey. 86 (37%) participants experienced PRMDs over the last 12 months. When considering all participating students, the network analysis showed the strongest association between the presence of PRMDs and the psychological distress factor. In the subgroup with students with PRMDs, the degree of pain interference with musical practice was correlated with psychological distress, MPA, self-rated health, and fatigue. Conclusion Psychological distress is the primary factor associated with PRMDs, whereas physical factors like posture and activity show no direct link. Therefore, addressing psychological aspects is crucial for student musicians with physical disorders to provide proper prevention care.

The 2021 discovery of the unmarked graves of Indigenous children by the Tk’emlúps te Secwépemc First Nation on the grounds of the former Kamloops Indian Residential School in British Columbia revealed the brutal genocide at the heart of Canadian colonial rule. Canadian governments and the Catholic Church had sought to leave this issue buried, literally and figuratively, by asserting a modern form of terra nullius in positing that these and other residential schools were ‘empty lands’ in the sense that they did not contain the remains of Indigenous children, even as Indigenous nations knew the truth. This essay argues that these gruesome discoveries are evidence of the after-lives of terra nullius of modern settler colonialism, where Indigenous peoples’ deaths are a colonial after-thought in settler society, which leads to settler denials and avoidance of responsibility for the damage done. This colonial after-thought can be traced right on up to Pope Francis’ apology for the Church’s role in the schools. In resistance to the settler effort to produce Indigenous peoples as ontological absences, as colonial after-thoughts, nations such as the Tk’emlúps te Secwépemc demonstrate the power of Indigenous resurgence through their persistence in nation and movement building.

Background: Metastases to the internal auditory canal (IAC) are exceedingly rare. This case report details the case of a patient with a history of locally advanced non-small cell lung carcinoma (NSCLC) who developed a solitary IAC metastasis. Case presentation: A 59-year-old active smoker was initially diagnosed with a locally advanced, unresectable stage IIIA Pancoast tumor (NSCLC, cT4N1M0) and treated with concurrent chemoradiation (cisplatin-pemetrexed) followed by immunotherapy (durvalumab). A subsequent PET CT scan indicated a complete metabolic response. Eighteen months later, the patient presented with rapidly progressing vertigo, left-sided facial palsy, and hearing loss. MRI revealed enhancement on nerves VII and VIII, with no intracranial metastasis or leptomeningeal enhancement. A biopsy via an endoscope-assisted retrosigmoid approach confirmed that it was an NSCLC metastasis. Gamma knife radiosurgery was initiated, resulting in a favorable clinical and radiological response. Discussion: IAC metastases are rare, representing only 0.3%–0.7 % of all lesions in this anatomical space. Lung cancer is a common primary source. Clinically, IAC metastases manifest with acute onset and rapid symptom progression, often mimicking benign conditions. MRI with gadolinium contrast is the imaging modality of choice. Biopsy, though challenging, is sometimes crucial for definitive diagnosis. Gamma knife radiosurgery is a promising treatment, offering potential preservation of hearing and tumor control. Conclusion: This rare case underscores the importance of considering metastatic IAC lesions in patients with a history of malignancy, highlights the feasibility of a biopsy via retrosigmoid approach for diagnosis, and demonstrates the effectiveness of gamma knife radiosurgery.

Objectives To study between-hospital variation in mortality, readmissions and prolonged length of stay across Belgian hospitals.Design A retrospective nationwide observational study.Setting Secondary and tertiary acute-care hospitals in Belgium.Participants We studied 4 560 993 hospital stays in 99 (98%) Belgian acute-care hospitals between 2016 and 2018.Primary outcome measures Using generalised linear mixed models, we calculated hospital-specific and Major Diagnostic Category (MDC)-specific risk-adjusted in-hospital mortality, readmissions within 30 days and length of stay above the MDC-specific 90th percentile and assessed between-hospital variation through estimated variance components.Results There was strong evidence of between-hospital variation in mortality, readmissions and prolonged length of stay across the vast majority of patient service lines. Overall, should hospitals with upper-quartile risk-standardised rates succeed in improving to the median level, a yearly 4076 hospital deaths, 3671 readmissions and 15 787 long patient stays could potentially be avoided in those hospitals. Our analysis revealed a select set of ‘high-impact-opportunity hospitals’ characterised by poor performance across outcomes and across a large number of MDCs.Conclusions Analysis of between-hospital variation highlights important differences in patient outcomes that are not explained by known patient or hospital characteristics. Identifying ‘high-impact-opportunity hospitals’ can help government inspection bodies and hospital managers to establish targeted audits and inspections to generate effective quality improvement initiatives.

IntroductionThe literature establishes a clear social gradient in health for transmissible respiratory diseases. However, this gradient’s extent remains largely unexplored in the context of COVID-19, and it is uncertain whether the pandemic has exacerbated this gradient. The study aims to compare the socio-economic profiles and comorbidities during the COVID-19 pandemic with a control population affected by viral pneumonia/respiratory disease in 2019.MethodsThis case-control study analyzed linked data from all patients hospitalized for COVID-19 in 2020 (n = 22,087) and for respiratory diseases in 2019 (n = 7,586). Socio-economic data from the social security database were linked to clinical data from the hospital registry. We analyzed the socio-demographic and clinical factors associated with COVID-19 hospitalization (control group, wave 1, and wave 2) using multinomial regressions and logistic regression models and the length of stay during hospitalization using binomial negative regressions.ResultsA social health gradient was observed in both the COVID-19 and control groups, with a significant increase across waves for COVID-19 (p-trend < 0.0001). Men, people over the age of 45, those with comorbidities, high population density, lower income, lower socio-economic status, and people living in Brussels capital were at higher risk of COVID-19 hospitalization and longer length of stay compared to the control group. Except for sub-Saharan Africans, all patients of foreign nationality had a significantly increased risk of hospitalization (p

Nathalie Demaeyer,1 Marie Bruyneel1,2 1Department of Pneumology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; 2Department of Pneumology, CHU Brugmann, Université Libre de Bruxelles, Brussels, BelgiumCorrespondence: Marie Bruyneel, Department of Pneumology, CHU Saint-Pierre, 322 rue haute, Brussels, 1000, Belgium, Tel +3225354219, Fax +3225353362, Email marie.bruyneel@stpierre-bru.beAbstract: The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45– 70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m2, age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11– 12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients.Keywords: bariatric surgery, gastric sleeve, gastric bypass, obstructive sleep apnea, polygraphy, polysomnography

Abstract Chronic insomnia is reported by up to 50% of chronic obstructive pulmonary disease (COPD) patients. This may be attributable to several factors including nocturnal dyspnea, reduced physical activity, and less time outside. Pulmonary rehabilitation (PR) is recommended in COPD to improve both physical and psychological conditioning. The aim of this study was to assess the effect of PR on sleep efficiency (SE, measured by actigraphy) in COPD patients. COPD eligible for PR were prospectively included. Baseline and post PR (30 sessions) assessments included incremental and maximal exercise testing, 6-min walking distance test (6MWT), actigraphy, and questionnaires [Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety Depression scale, St George Respiratory, and modified Medical Research Council dyspnea scale]. Sixty-one patients were included, and 31 patients completed the study protocol (68% of males, age 63 ± 9 y, FEV1 44.2 ± 12.3%). After PR, SE remained unchanged, p = 0.07, as well as PSQI score (p = 0.22), despite improvements in exercise capacity (incremental exercise test, 6MWT) and dyspnea. However, SE improved significantly in the poor sleeper subgroup (SE

Abstract Background Measuring quality is essential to drive improvement initiatives in hospitals. An instrument that measures healthcare quality multidimensionally and integrates patients’, kin’s and professionals’ perspectives is lacking. We aimed to develop and validate an instrument to measure healthcare quality multidimensionally from a multistakeholder perspective. Methods A multi-method approach started by establishing content and face validity, followed by a multi-centre study in 17 Flemish (Belgian) hospitals to assess construct validity through confirmatory factor analysis, criterion validity through determining Pearson’s correlations and reliability through Cronbach’s alpha measurement. The instrument FlaQuM-Quickscan measures ‘Healthcare quality for patients and kin’ (part 1) and ‘Healthcare quality for professionals’ (part 2). This bipartite instrument mirrors 15 quality items and 3 general items (the overall quality score, recommendation score and intention-to-stay score). A process evaluation was organised to identify effective strategies in instrument distribution by conducting semi-structured interviews with quality managers. Results By involving experts in the development of quality items and through pilot testing by a multi-stakeholder group, the content and face validity of instrument items was ensured. In total, 13,615 respondents (5,891 Patients/kin and 7,724 Professionals) completed the FlaQuM-Quickscan. Confirmatory factor analyses showed good to very good fit and correlations supported the associations between the quality items and general items for both instrument parts. Cronbach’s alphas supported the internal consistency. The process evaluation revealed that supportive technical structures and approaching respondents individually were effective strategies to distribute the instrument. Conclusions The FlaQuM-Quickscan is a valid instrument to measure healthcare quality experiences multidimensionally from an integrated multistakeholder perspective. This new instrument offers unique and detailed data to design sustainable quality management systems in hospitals. Based on these data, hospital management and policymakers can set quality priorities for patients’, kin’s and professionals’ care. Future research should investigate the transferability to other healthcare systems and examine between-stakeholders and between-hospitals variation.

The onset of narcolepsy type 1 (NT1) occurs after 50 years of age in less than 2% of the cases. In older adults, the diagnosis is often delayed due to the presence of neurological degenerative and inflammatory comorbidities and overlapping sleep disorders.

Author(s): Floor Moerman [sup.1] , Petra Warreyn [sup.1] , Ellen Demurie [sup.1] , Sofie Boterberg [sup.1] , Julie Vermeirsch [sup.1] , Chloè Bontinck [sup.1] , Eva Bruyneel, Marjolein Muès, Liedewij [...], Play of younger siblings of children with autism spectrum disorder (ASD) (siblings; n = 44), very preterm children (preterms; n = 44), and children at typical likelihood for ASD (n = 36) was observed at 24 months. Children with ASD and atypical development engaged less in spontaneous (pre-)symbolic play than typically developing children. Total duration of spontaneous and elicited (pre-)symbolic play was associated with later ASD traits in siblings. However, no association between most play variables and ASD traits was found in preterms. This suggests possible different ASD-trajectories between siblings and preterms. Thus, spontaneous (pre-)symbolic play may be indicative of developmental challenges across several populations, and results highlight the need to move beyond studying only siblings in order to broaden our understanding of ASD.

Abstract Background Given the variability of intensive care unit (ICU) costs in different countries and the importance of this information for guiding clinicians to effective treatment and to the organisation of ICUs at the national level, it is of value to gather data on this topic for analysis at the national level in Belgium. The objectives of the study were to assess the total cost of ICUs and the factors that influence the cost of ICUs in hospitals in Belgium. Methods This was a retrospective cohort study using data collected from the ICUs of 17 Belgian hospitals from January 01 to December 31, 2018. A total of 18,235 adult ICU stays were included in the study. The data set was a compilation of inpatient information from analytical cost accounting of hospitals, medical discharge summaries, and length of stay data. The costs were evaluated as the expenses related to the management of hospital stays from the hospital’s point of view. The cost from the hospital perspective was calculated using a cost accounting analytical methodology in full costing. We used multivariate linear regression to evaluate factors associated with total ICU cost per stay. The ICU cost was log-transformed before regression and geometric mean ratios (GMRs) were estimated for each factor. Results The proportion of ICU beds to ward beds was a median [p25-p75] of 4.7% [4.4–5.9]. The proportion of indirect costs to total costs in the ICU was 12.1% [11.4–13.3]. The cost of nurses represented 57.2% [55.4–62.2] of direct costs and this was 15.9% [12.0-18.2] of the cost of nurses in the whole hospital. The median cost per stay was €4,267 [2,050–9,658] and was €2,160 [1,545–3,221] per ICU day. The main factors associated with higher cost per stay in ICU were Charlson score, mechanical ventilation, ECMO, continuous hemofiltration, length of stay, readmission, ICU mortality, hospitalisation in an academic hospital, and diagnosis of coma/convulsions or intoxication. Conclusions This study demonstrated that, despite the small proportion of ICU beds in relation to all services, the ICU represented a significant cost to the hospital. In addition, this study confirms that nursing staff represent a significant proportion of the direct costs of the ICU. Finally, the total cost per stay was also important but highly variable depending on the medical factors identified in our results.

Objectives To determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety.Design Baseline cross-sectional survey of 2187 physicians and 6643 nurses practicing in 64 hospitals in six European countries participating in the EU-funded Magnet4Europe intervention to improve clinicians’ well-being.Setting Acute general hospitals with 150 or more beds in six European countries: Belgium, England, Germany, Ireland, Sweden and Norway.Participants Physicians and nurses with direct patient contact working in adult medical and surgical inpatient units, including intensive care and emergency departments.Main outcome measures Burnout, job dissatisfaction, physical and mental health, intent to leave job, quality of care and patient safety and interventions clinicians believe would improve their well-being.Results Poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised.Conclusions Burnout, mental health morbidities, job dissatisfaction and concerns about patient safety and care quality are prevalent among European hospital physicians and nurses. Interventions to improve hospital work environments and staffing are more important to clinicians than mental health interventions to improve personal resilience.

Induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) have enormous potential for the study of human cardiac disorders. However, their physiological immaturity severely limits their utility as a model system and their adoption for drug discovery. Here, we describe maturation media designed to provide oxidative substrates adapted to the metabolic needs of human iPSC (hiPSC)-CMs. Compared with conventionally cultured hiPSC-CMs, metabolically matured hiPSC-CMs contract with greater force and show an increased reliance on cardiac sodium (Na+) channels and sarcoplasmic reticulum calcium (Ca2+) cycling. The media enhance the function, long-term survival, and sarcomere structures in engineered heart tissues. Use of the maturation media made it possible to reliably model two genetic cardiac diseases: long QT syndrome type 3 due to a mutation in the cardiac Na+ channel SCN5A and dilated cardiomyopathy due to a mutation in the RNA splicing factor RBM20. The maturation media should increase the fidelity of hiPSC-CMs as disease models.

Abstract Aim The aim of the study was to assess the prevalence of academic burnout (AB) and its associated factors among nursing and midwifery students during the COVID‐19 pandemic. Design A correlational cross‐sectional study. Methods An online survey was distributed from November to December 2020 to nursing and midwifery students in Belgium. The risk of AB was assessed using the MBI‐SS Academic Burnout Inventory scale. Factors associated with AB were related to the personal life and level of education of the student and to the COVID‐19 pandemic. Results The prevalence of overall AB risk was 50.0% (95% CI 48.5–53.1). Factors significantly associated with higher risk of AB were having a child, having a job, the level of academic training, working overtime, insufficient personal protective equipment against viral contamination during the last internship, work overload due to the pandemic, personal proven or possible SARS‐CoV‐2 infection and having a relative who died related to COVID‐19.

Abstract Background Chronic insomnia disorder (CI) is a prevalent sleep disorder that can lead to disturbed daytime functioning and is closely associated with anxiety and depression. First-choice treatment is cognitive behavioral therapy (CBT-I). Other mind–body interventions, such as Tai-chi and Yoga, have demonstrated subjective improvements in sleep quality. The purpose of this study was to assess the efficacy of Yoga for improvement of subjective and objective sleep quality as well as measures of anxiety, depression, sleepiness, and fatigue in patients with CI. Methods Adults with CI were prospectively included in this single group pre-post study. Baseline assessments included home polysomnography (PSG), 7-day actigraphy, and questionnaires (Pittsburgh Sleep Quality Index questionnaire (PSQI), Hospital Anxiety Depression scale (HADS), Epworth Sleepiness Scale (ESS), Pichot fatigue scale (PS)). Patients practiced Viniyoga, an individualised Yoga practice with daily self-administered exercises, for 14 weeks. Assessments were repeated at the end of Yoga practice. Results Twenty-one patients completed the study. Objective sleep measurements revealed no change in PSG parameters after Yoga practice, but a decrease in arousals on actigraphy (p