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The way in which retirement is conceptualized and measured is likely to influence the research findings. The previous literature has addressed a wide range of elements related to the complex work-to-retirement process, such as early, late and partial retirement, statutory retirement, work disability and unemployment paths to retirement, or different types of bridge employment. However, conceptual clarity in terms of connections between the different elements is called for. We introduce a conceptual framework of the work-to-retirement process to guide its future measurement. Together with information on the statutory retirement age, the main elements of the framework are based on employment and pension receipt, acknowledging that these may overlap. The framework is flexible to the user, providing the possibility to add various specifications—e.g. of types of employment, types of pension receipt, unemployment, and being outside the labour force—depending on the study context and aims. The framework highlights the complexity of the work-to-retirement process, bringing forth its multifaceted, multiphased and multidirectional features. Accounting for such complexity in later-life labour market dynamics helps to elaborate what is actually addressed when investigating “retirement”. Our conceptual framework can be utilized to enhance well-defined, precise and comparable measurement of the work-to-retirement process in studies. ispartof: European Journal Of Ageing vol:19 issue:4 ispartof: location:Germany status: Published online

Purpose: To reduce long-term absenteeism, several countries take legislative initiatives. In this study, we evaluate the impact of a legally defined return-to-work (RTW) trajectory on the RTW of sick-listed employees.Methods: We conducted a retrospective registered-based cohort study on Belgian employees (N = 1416) who followed a RTW-trajectory in 2017. We linked workers’ data from a Service for Prevention and Protection at Work with data from the Crossroads Bank for Social Security. We analysed how many employees RTW with the same employer, with another employer or not at all. By multinomial logistic regression, we analysed which characteristics are predictive for RTW.Results: One year after their trajectory, 69.2% of employees did not RTW, 10.7% did RTW with the same employer, 20.1% did RTW with a new employer. Duration of sickness absence (SA) was an important predictor for both RTW with the same as with another employer. When duration of SA exceeded six months, odds of RTW were lower than when the duration of SA was < six months. Marital status, organization-size, and decision of occupational physician had significant impact on RTW with the same employer, while age and who initiated the trajectory were key factors for RTW with another employer. Conclusions: 30.8% of employees succeeded to RTW after their trajectory. Results show that a one-size-fits-all-approach is not recommended. A stepped approach with an early, informal start of the RTW-process should be implemented. When employees or employers fail to initiate RTW on their own, a legally defined RTW-trajectory could be useful.

BackgroundIncreasing rates of long-term sickness absence are a worldwide problem. Belgium is the first country in Europe that aims to screen its entire population of sick leavers (sick leave > 6 weeks) for the risk of long-term sickness absence in order to focus resources on the high-risk group and to provide adequate return-to-work support. Our aim was to investigate content and face validity of a newly designed questionnaire (Quickscan) using item prioritization of patients and professionals in the field of long-term sickness absence. This questionnaire was developed based on a review of the literature and existing instruments (Goorts et al, J Public Health Res 7:1419, 2018).MethodsQualitative data were collected using the nominal group technique. The data were gathered exploring factors that influence return-to work restrictions or opportunities.ResultsParticipants indicated 20 out of 21 of the questionnaire factors as important reasons that might influence the return-to-work process. Additionally, 16 factors were discussed that were not yet included in the Quickscan but that might provide useful information on return-to-work issues, according to the participants. In the prioritization of items, we found considerable diversity among participants.ConclusionsOur findings demonstrate the validity of the Quickscan items to ask patients about important return-to-work barriers or opportunities. However, additional factors were identified that may improve the assessment of risk for long-term sickness absence.

Langdurig verzuim blijft toenemen en zieke werknemers worden onvoldoende ondersteund bij hun terugkeer! In dit artikel geven we een overzicht van de voorspellende factoren voor een succesvolle terugkeer naar het werk en een overzicht van vragenlijsten die in dit verband kunnen gebruikt worden.

We zullen langer moeten werken als gevolg van een verhoogde wettelijke pensioenleeftijd. Of dit zal lukken zal afhangen van de bereidheid en het vermogen van werknemers om aan het werk te blijven. Werkvermogen, de balans tussen individuele kenmerken en werkeisen en ruggengraat van duurzame inzetbaarheid, dient continu te worden opgevolgd. Daarom werd de online tool ‘Wellfie’ ontwikkeld, geinspireerd door het ‘huis van werkvermogen’. Eerst werd een literatuurstudie uitgevoerd voor een selectie van gevalideerde schalen die werkvermogen en beinvloedende factoren meten op werkgevers- en werknemersniveau. Vervolgens werd feedback, gericht op het verbeteren en handhaven van werkvermogen, ontwikkeld. Tenslotte werd Wellfie getest in vier pilootbedrijven uit drie sectoren. Wellfie voorziet een rapport voor zowel werkgever als werknemers. Werkgeversfeedback richt zich op organisatiebeleid en een vergelijking tussen werkgevers-en werknemersresultaten, terwijl werknemersfeedback persoonlijk georienteerd is. Wellfie ondersteunt organisaties in het behouden en verbeteren van werkvermogen, de sleutelfactor voor een lange en gezonde carriere.

OBJECTIVE: Increasing long-term sickness absence in many countries asks for specific measures regarding return-to work. METHODS: The risk of long-term sickness absence was assessed using a questionnaire containing work-related, function-related, stressful life-events-related, and person-related factors. Additionally, workers' occupational health physician estimated the worker's chances for work resumption. Reliability, construct, and criterion validity of the questionnaire were measured. RESULTS: Two hundred seventy-six patients and 35 physicians participated in the study. The reliability was satisfying (α > 0.70) for all scales, except for perfectionism (α = 0.62). The results of the CFAs showed that the hypothesized factor models fitted the data well. Criterion validity tests showed that eight predictors significantly related to the estimation of the occupational physicians (ρ

Background: Long-term sickness absence is a growing concern in Belgium and other European countries. Since 2017, Belgian physicians of the sickness funding organisations are required to assess the re-integration possibilities within the first two months of sickness absence. Given the shortage of physicians in the assessment of work disability and the growing number of people in sickness absence, there is a need for a triage tool, allowing to assign return-to work support to patients having a high-risk profile not to resume work. Methods/design: The current study comprises a comprehensive validation process of a screening tool that supports Belgian physicians in guiding people back to work. The study consists of a theoretical construct validation (face validity and content validity), and an empirical construct validation (concurrence validity, factorial validity, predictive validity, hypothesis testing validity and known- group validity). Expected impact of the study for Public Health: The screening instrument assessing the risk for long-term sickness absence is a tool developed to support physicians who work for sickness funds and for occupational health and safety organisations. Both professionals play an important role in the return to work process and the prevention of long-term sickness absence. The screening tool aims at making a distinction between people who will resume their work independently and people who will need support to do so. Generation of this prediction model will help physicians to focus effort and resources in the high-risk group. Results may also help understand the relationship between the biopsychosocial model and long-term sick-leave. Significance for public health In this research, we tested a generic instrument to screen for long-term sickness absence, regardless the cause of the sickness absence or the political context. Both biomedical factors and psychosocial factors (such as the patients’ own prediction) are questioned in the prediction model, which is thus adapted to the modern view on sick leave. A screening method to detect high risk of long-term sickness absence among the large group of sick employees might help to use resources (e.g. money, services) in a more efficient way. Physicians will be able to focus on patients with a high risk on long-term sick leave, and the return to work process of employees at high risk can start much earlier. The instrument will, next to the physicians’ prognosis, offer support in prioritizing patients’ files. Hence, a lot of patients will resume their work spontaneously. Patients who need support will experience shorter follow-up periods, and better quality of care. In addition, the relationship between predicting factors of the biopsychosocial model and long-term sickness absence will be examined.

Objective Changes in working conditions give rise to new occupational health risks and work-related diseases (WRDs). Monitoring these new WRDs is essential for their early recognition and prevention and requires a comprehensive approach, using several complementary methods. The aim of this review is to provide an overview and basic typology of different approaches to detect new/emerging WRDs. Methods We conducted an extensive scientific literature search combining terms for the following three concepts: surveillance/reporting systems; occupational/work–related diseases; and new or emerging risks. In addition, a grey literature search was performed of both grey literature databases and relevant EU and research institute websites for additional resources. Results We identified a total of 75 surveillance systems from 26 different countries. We set up a basic typology of these systems dividing them into four main groups. Compensation-based systems (n=22) were designed to gather data for compensation purposes and are insurance-driven. Non-compensation-related systems (n=34) were created with the aim of improving the collection and analysis of data to measure trends in occupational and work-related diseases. Sentinel systems (n=12) were specifically designed to provide a warning signal that will initiate health interventions and preventive actions. Finally, public health surveillance systems (n=7) aim to monitor the health of the general population, but can also be used for work-related surveillance. These four main types further differed in terms of disease coverage, means of data collection, evaluation of work-relatedness, follow-up of new/emerging risks, link with prevention etc. Conclusion Sentinel systems seem to have the most suitable approach to detect and alert to new/emerging WRDs. Nevertheless, systems identified in the other three groups can also contribute to identifying new/emerging WRDs, despite being primarily designed for other purposes.

Introduction Burnout is a work-related mental health problem and may cause long-term sickness absence. Return-to-work interventions for burned out employees on sick leave aim to prevent long-term work disability. This systematic review adresses 2 questions: Which return–to–work interventions for burned out employees on sick leave have been studied? What is the effect of these interventions on return to work? Methods We performed a systematic literature review and searched Medline, CINAHL, EMBASE and Web of Science from Jan 1, 2000 to March 16, 2016. We searched for articles of return-to-work interventions for burned out employees on sick leave. We excluded studies of self-employed people and studies of employees suffering from mental health problems other than burnout. We conducted the review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Outcomes were return to work and overall burnout symptoms. Results We identified 1578 articles after removal of all duplicates. Ten articles met inclusion criteria of which 5 were person-directed interventions, 2 were organisation-directed and 3 were a combination of both intervention types. None of the person-directed interventions caused a significant improvement in return to work. In contrast, the 2 organisation-directed and 2 of the 3 combined interventions did significantly improve return to work. All interventions had a positive effect on overall burnout symptoms. Discussion Although all interventions improved burnout symptoms, only the interventions that were (partly) organisation-directed had a positive effect on return to work. This finding is important in the development of return-to-work interventions for employees with burnout.

Introduction Promoting good health and attendance, instead of penalising absence, has become a growing policy issue, since long-term sickness absence is increasing in 27 European member states and Norway. As most employees will return to work spontaneously, resources for return to work projects should be dedicated to the high-risk group for long-term sickness absence. Methods In this project, a questionnaire was developed to predict the risk of long-term sickness absence. By combining a literature review of the predictive factors for long-term sickness absence, with a review of existing questionnaires that question long-term sickness absence, a new questionnaire was developed. A study has been set up including 10 000 participants, to assess the predictive value of the questionnaire and the model to predict the risk of long-term sickness absence. Results The literature study revealed 16 predictors for long-term sickness absence. The most predictive factor is the patient’s expectancy regarding their return to work. As the other predictive value of the other factors was ambiguously, the pilot study will explore the value of the complete model and each separate parameter. The developed questionnaire is not specific for a certain illness, nor for use in a specific country. Discussion The questionnaire developed in this research aims to support physicians to assess the risk of long-term sickness absence, wherefore an earlier start of return-to work support becomes possible. We aim to guide more employees successfully and sustainably back to work.

Introduction Burnout is a work-related mental health problem and may cause long-term sickness absence. The aim of this study is to develop and assess the effectiveness of a return-to-work intervention that prevents long-term sick leave due to burnout. This intervention will be presented as a multidisciplinary care pathway for burned out employees on sick leave. The study started in January 2016 and will end in December 2019. Methods We use the Medical Research Council framework to guide 4 phases: development, feasibility, evaluation and implementation. Based on a systematic literature review we made a first draft of the care pathway. During focus groups we discussed this first draft with professionals (i.e. general practitioners, psychologists, occupational physicians) to identify possible barriers and facilitators to implementing the care pathway ( development ). Next we will conduct a pilot study ( feasibility ) followed by a cluster randomised trial (CRT) ( evaluation ). Finally we will use the Reach, Effectiveness, Adoption, Implementation and Maintenance (Re-aim) framework to guide the implementation of the pathway. Results We finished the systematic review and the focus groups. The systematic review showed that (partly) organisation-oriented return-to-work interventions have a positive effect on return to work. The focus groups revealed that professionals find it difficult to differentiate between burnout and other mental health problems (e.g. depression). They also have different opinions on burnout treatment and the role different stakeholders play during the return-to-work process isn’t always clear for professionals. We continue working on the next phases. Discussion Several stakeholders (employees, physicians, employers, psychologists) are involved in the care pathway. Therefore, improving communication between these stakeholders during the return-to-work process is an important focus in this study.

Introduction Working life will increase due to a raise of the legal retirement age. Yet, its success will depend on the willingness and ability of workers to remain at work. Work-ability, the backbone of sustainable employability, should therefore continuously be monitored and promoted. Work-ability is determined by health and functional capacities; competences; values, attitudes and motivation; work, work community and leadership. Evidence shows that health, functional capacities and work (community) affect work-ability the most. Work-ability and both latter factors were therefore assessed in a large sample of employees and compared between younger and older workers. Methods A cross-sectional study was performed in 100 Belgian companies. The online questionnaire ‘Wellfie’ was used, which is based on the ‘house of work-ability’. The tool consists of validated scales assessing work-ability using four questions of the work-ability index (Range: 1: very bad to 5: very good), lifestyle (diseases) and physical burden. Descriptive statistics were performed using frequencies and equality of proportions was analysed using Chi-square. Result 3887 participants completed Wellfie (i.e. 67% female, 33% male; 60% age Discussion Ageing goes along with a higher risk for chronic diseases and comorbidities affecting employee’s work-ability. Employers should therefore invest more in a health promotion policy for all workers.

Objective Changes in working conditions give rise to new occupational health risks and work-related diseases (WRDs). Monitoring these new WRDs is essential for their early recognition and prevention and requires a comprehensive approach, using several complementary methods. The aim of this review is to provide an overview and basic typology of different approaches to detect new/emerging WRDs. Methods We conducted an extensive scientific literature search combining terms for the following three concepts: surveillance/reporting systems; occupational/work–related diseases; and new or emerging risks. In addition, a grey literature search was performed of both grey literature databases and relevant EU and research institute websites for additional resources. Results We identified a total of 75 surveillance systems from 26 different countries. We set up a basic typology of these systems dividing them into four main groups. Compensation-based systems (n=22) were designed to gather data for compensation purposes and are insurance-driven. Non-compensation-related systems (n=34) were created with the aim of improving the collection and analysis of data to measure trends in occupational and work-related diseases. Sentinel systems (n=12) were specifically designed to provide a warning signal that will initiate health interventions and preventive actions. Finally, public health surveillance systems (n=7) aim to monitor the health of the general population, but can also be used for work-related surveillance. These four main types further differed in terms of disease coverage, means of data collection, evaluation of work-relatedness, follow-up of new/emerging risks, link with prevention etc. Conclusion Sentinel systems seem to have the most suitable approach to detect and alert to new/emerging WRDs. Nevertheless, systems identified in the other three groups can also contribute to identifying new/emerging WRDs, despite being primarily designed for other purposes.

Background Burnout in healthcare is a worldwide problem. However, most studies focus narrowly on work-related factors and outcomes in one health profession or speciality. Aims To investigate the prevalence of burnout and its association with job demands, job resources, individual well-being, work-related attitudes and behaviour in physicians and nurses across different specialties. Methods Multi-centre cross-sectional study of physicians and nurses working in Belgian hospitals. An electronic questionnaire was used to assess job demands (e.g. workload), job resources (e.g. autonomy) and indicators of well-being, work-related attitudes and behaviours. Structural equation modelling was used to examine interrelationships between explanatory variables and outcomes. Results 1169 physicians and 4531 nurses participated; response rate 26%. High scores (>75th percentile in reference group of Dutch health care workers) were seen in 6% of the sample on three burnout dimensions (i.e. emotional exhaustion, depersonalization and personal competence) and in 13% for at least two dimensions. In contrast to the other dimensions, emotional exhaustion strongly related to almost all variables examined in the model. Positive associations were seen with workload, role conflicts, emotional burden and work-home interference and negative associations with learning and development opportunities and co-worker support. Emotional exhaustion correlated negatively with well-being, turnover intention, being prepared and able to work until retirement age, medication use, absenteeism and presenteeism. Conclusions Work-related factors were critical correlates of emotional exhaustion, which strongly related to poor health and turnover intention. Randomized controlled trials are suggested to underpin the effectiveness of interventions tackling job stressors and promoting job resources.

Rapid changes in working conditions constantly give rise to new occupational health risks and work-related diseases (WRDs). Monitoring these new WRDs is essential from the aspects of early recognition and prevention. In addition, it requires a comprehensive approach, using several complementary methods. One of these methods are early warning systems designed to collect information on health effects in order to trigger interventions and prevention. These systems differ in characteristics, their ability to capture new WRDs and their link with prevention. Therefore, the aim of this study is to identify sentinel and alert systems for detecting new and emerging WRDs, describe their main characteristics, and set up a basic typology. In the first phase, we conducted an extensive scientific and grey literature review and we identified 75 surveillance systems covering 26 different countries. We set up a basic typology of these systems dividing them into four main groups: compensation-based systems (21), non-compensation related comprehensive systems (38), sentinel systems (12) and public health surveillance systems aimed at workers and non-workers (7). These systems further differed in type of WRDs, coverage, data collection, evaluation of work-relatedness; follow up of new/emerging risks, link with prevention etc. In the second phase, we chose a representative selection of 12 good practise examples to be described in-depth. Through a desk research and interviews with stakeholders, we gained additional insight into drivers and obstacles regarding these systems and usage of collected data for identification of WRDs, prevention and policy recommendations.

Objectives Drawing on a literature review on sentinel and alert systems for identifying new/emerging work-related diseases (WRDs) a basic typology of systems was developed. These systems differ in characteristics, ability to capture new WRDs and link with prevention. The objectives of the subsequent study of a subset of systems were to describe in-depth aims, drivers and obstacles of the systems and use of their data in practice, for prevention and detecting new/emerging WRDs. Methods Twelve systems were chosen reflecting the different types (linked to compensation or not, aimed at all WRDs or a subset of diseases, sentinel systems, workers only or general public). Six systems were described based on desk research and six other systems were studied through interviews with different actors to gather information on the operation of the systems and the use of the gathered data for prevention. Results Several important themes emerged from the comparative tables, related to the design and performance of the system: visibility, reporting methods, exposure assessment, data quality, linkage to other institutions, and related to data use for prevention, alert on hazardous situations, awareness on new/emerging diseases. Conclusions Each system has its strengths and limitations, closely related to its purpose and the country that developed it. Sentinel systems seem to be best equipped for prevention and alert on new/emerging diseases. Enhancing reporting needs to balance required information and perceived reward for reporters. Embedding of systems in governmental or public health organisations is important in terms of financing, expertise and dissemination of results.

Long-term sickness absence is increasing in 27 European member states and Norway. Promoting good health and attendance, instead of penalising absence, has become a growing policy issue (Edwards & Greasley, 2010). As most employees will return to work spontaneously, resources for return to work projects should be focused on the high-risk group for long-term sickness absence. In this project a questionnaire was developed to predict the risk of long-term sickness absence. The development of the questionnaire started with a literature review of the predictive factors for long-term sickness absence, and with a review of existing questionnaires that question long-term sickness absence. The questionnaire will be validated in a pilot study of 10 000 participants. These data will be used to calculate its predictive value and to build a model to predict the risk of long-term sickness absence. The literature study revealed 16 predictors for long-term sickness absence. The most predictive factor is, according to existing research, the patient‘s expectancy regarding their return to work. As the other factors are not unambiguously strong predictors, the pilot study will explore the predictive value of the complete model and each separate parameter. A new questionnaire was developed based on both reviews and the 16 predictors they revealed. The questionnaire is not specific for a certain illness, nor for use in a specific country. The questionnaire developed in this research will support physicians to assess the risk of long-term sickness absence, and to guide more employees successfully and sustainably back to work.

OBJECTIVES: The number of sick-listed employees has increased dramatically worldwide. Therefore, many countries aim to stimulate early and sustainable return to work opportunities to obtain better health outcomes and lower costs for disability pensions. To effectively orientate resources to patients with a high risk of not resuming work spontaneously, it is necessary to screen patients early in their sickness absence process. In this study, we validate "Quickscan", a new instrument to assess return-to-work needs and to predict risks of long-term sick leave. METHODS: As part of the Quickscan validation process, we tested and compared the reliability and construct validity of the questionnaire in two different populations. First, we conducted a cross-sectional study in which the screening instrument was sent to sick-listed individuals in healthcare insurance. In a second cross-sectional study, sick-listed workers who consulted the occupational health physician for return-to-work assessment were asked to fill out the questionnaire. We compared both samples for descriptive statistics: frequencies, means and standard deviations. Reliability of the scales was calculated using Cronbach's alpha. Confirmatory factor analysis was performed to evaluate the construct (factorial) validity of the studied scales using software package AMOS 24. RESULTS: The screening tool was shown to be an instrument with reliable scales (except for the perfectionism and health perception patient scale) in both populations. The construct validity was satisfactory: we found that the hypothesized measurement models with the theoretical factors fitted the data well in both populations. In the first sample, the model improved for scales concerning stressful life events and showed worse fit for person-related factors. Work-related factors and functioning factors both showed similar fit indices across samples. We found small differences in descriptive statistics, which we could explain by the differences in characteristics of both populations. CONCLUSIONS: We can conclude that the instrument has considerable potential to function as a screening tool for disability management and follow-up of sick-leave, provided that some adaptations and validation tests are executed. ispartof: PLoS One vol:14 issue:1 ispartof: location:United States status: published

BACKGROUND: Human errors occur everywhere, including in health care. Not only the patient, but also the involved health professional is affected (ie, the "second victim"). OBJECTIVES: To investigate the prevalence of health care professionals being personally involved in a patient safety incident (PSI), as well as the relationship of involvement and degree of harm with problematic medication use, excessive alcohol consumption, risk of burnout, work-home interference (WHI), and turnover intentions. RESEARCH DESIGN: Multilevel path analyses were conducted to analyze cross-sectional survey data from 37 Belgian hospitals. SUBJECTS: A total of 5788 nurses (79.4%) and physicians (20.6%) in 26 acute and 11 psychiatric hospitals were included. MEASURES: "Involvement in a patient safety incident during the prior 6 months," "degree of harm," and 5 outcomes were measured using self-report scales. RESULTS: Nine percent of the total sample had been involved in a PSI during the prior 6 months. Involvement in a PSI wasrelated to a greater risk of burnout (β=0.40, OR=2.07), to problematic medication use (β=0.33, OR=1.84), to greater WHI (β=0.24), and to more turnover intentions (β=0.22). Harm to the patient was a predictor of problematic medication use (β=0.14, OR=1.56), risk of burnout (β=0.16, OR=1.62), and WHI (β=0.19). CONCLUSIONS: Second victims experience significant negative outcomes in the aftermath of a PSI. An appropriate organizational response should be provided to mitigate the negative effects.

This study aimed to investigate (1) the prevalence of nonadherence with eye drop treatment; (2) selected correlates of nonadherence at the patient and health-care organization level; and (3) the diagnostic value of the ophthalmologists' ratings, using patients' self-reports as standard.This cross-sectional multicenter survey used questionnaires for ophthalmologists and their patients to assess self-reported nonadherence and its correlates. One item, using a 4-point scale [never (ie, adherent) to daily], asked the patients whether they had forgotten to administer eye drops during the past 2 weeks. Ophthalmologists rated their patients as adherent or nonadherent. Nonadherence was also determined by combined methods, whereby either could indicate nonadherence. Given the nested structure of the data, multilevel modeling was used to investigate self-reported nonadherence-correlates. Diagnostic values of ophthalmologists' report were calculated.Of 663 patients (48% female, 44%69 years), nonadherence was indicated in 39.2% (n=260) through self-reporting, 2.1% (n=14) through ophthalmologists' ratings, and 40% (n=266) through combined measures. The multivariable, multilevel model showed following significant nonadherence-correlates: Male sex (P=0.01), younger age (P=0.027), and higher-dose frequency (P=0.001). No significant correlation with treating ophthalmologist (P=0.21) could be seen. Yet, the patients visiting their ophthalmologists at least every 3 months were less nonadherent than patients with fewer consultations (P=0.01). The ophthalmologists' report showed a sensitivity and specificity of 3% and 98.5%, respectively.The prevalence of self-reported nonadherence was congruent with literature. The patients visiting their ophthalmologists at least every 3 months have a lower risk of nonadherence. Ophthalmologist report is an insensitive method for detecting nonadherence.

The aim of this review was to summarize literature in view of patient-reported outcome (PRO) instruments for glaucoma and provide guidance on how outcomes are best assessed based on evidence about their content and validity. A systematic literature review was performed on papers describing the developmental process and/or psychometric properties of glaucoma or vision-specific PRO-instruments. Each of them was assessed on their adherence to a framework of quality criteria. Fifty-three articles were identified addressing 27 PRO-instruments. In all, 18 PRO's were developed for glaucoma and 9 for diverse ophthalmologic conditions. Seven instruments addressed functional status, 11 instruments quality of life and 9 instruments disease and treatment-related factors. Most of the instruments demonstrated only partially adherence to predefined quality standards. The tools for assessing functional status were of poor quality, while the Glaucoma Quality of Life Questionnaire and the Vision Quality of Life Index were well-developed QoL measures, yet only validated using classical techniques. The Rasch-scaled QoL-tools, IVI and VCM1 need to improve their item-content for glaucoma patients. The questionnaires to measure adherence should improve their validity and the Treatment Satisfaction Survey for Intra Ocular Pressure pops out as the highest quality tool for measuring topical treatment side effects. This review revealed that most PRO-instruments demonstrated poor developmental quality, more specifically a lack of conceptual framework and item generation strategies not involving the patients' perspective. Psychometric characteristics were mostly tested using classical validation techniques.

The aim of this study was to compare the intra-ocular pressure (IOP) obtained by ocular response analyzer (ORA), dynamic contour tonometer (DCT) and Goldmann applanation tonometer (GAT). In 102 patients (47 with primary open-angle glaucoma and 55 healthy controls) IOP was measured with GAT, ORA and DCT in one eye. The agreement between GAT, DCT and ORA values was assessed using Bland–Altman plots. The discrepancy between the methods was related to central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF) using linear regression models. Significant differences were observed amongst DCT, corneal compensated ORA (ORAcc) and GAT (P < 0.01). Only the ORAcc and DCT were comparable. ORAcc and DCT significantly over-estimated IOP compared to GAT and for ORAcc this difference depended on the height of IOP. A significant correlation was found between CCT and the deviation of DCT and ORAcc from corrected GAT (both P < 0.0001). Our study showed a low degree of agreement between IOP measured by ORA, DCT and GAT. DCT and ORAcc over-estimated the IOP compared to GAT.

In a prospective descriptive laboratory study, 25 Helping Hand(™) (HH) (10 without and 15 with reminder system) and 50 Medication Event Monitoring Systems (MEMS) (25 with 18-month and 25 with 2-year battery life) were manipulated twice daily following a predefined protocol during 3 consecutive weeks. Accuracy was determined using the fixed manipulation scheme as the reference. Perfect functioning (i.e., total absence of missing registrations and/or overregistrations) was observed in 70% of the HH without, 87% of the HH with reminder, 20% MEMS with 18 months, and 100% with 2-year battery life respectively. ispartof: Sensors vol:10 issue:3 pages:1652-1660 ispartof: location:Switzerland status: published

PURPOSE To compare the intraocular pressure (IOP) readings taken by ICare, Pascal dynamic contour tonometer (DCT), and ocular response analyzer (ORA) with those taken by Goldmann applanation tonometer (GAT). We sought to evaluate the influence of central corneal thickness (CCT) on IOP measurements and to compare patients' preferences for the four tonometers. METHODS In this prospective study, 93 eyes from 93 patients were examined. Patients were randomly divided into 4 groups to vary the order in which the tonometers were applied. CCT was measured with an ultrasound pachymeter. RESULTS The average CCT was 558+/-47.4 microm. The mean +/- standard deviation IOP for GAT, ICare, DCT, and ORA (Goldmann-correlated IOP) (ORA(GC)) were 15.1+/-4.8, 15.7+/-5.7, 18.2+/-5.1, and 18.3+/-6.6 mmHg, respectively. There was no significant difference between the mean IOP obtained with GAT and ICare (p=0.14). There was also no difference in IOP levels between the mean IOP obtained with DCT and ORA (p=0.26). There was no correlation between IOP measurements and CCT for the 4 instruments. Bland-Altman graphs showed disagreement between the measurements taken by GAT and the other instruments. There was no significant difference in patients' preference among the 4 instruments (p=0.48). CONCLUSIONS IOP readings from ICare were consistent with those from GAT, whereas DCT readings correspond well to ORA(GC) measurements. DCT and ORA readings both overestimated the GAT readings. There was no correlation between the IOP measurements and the CCT for the 4 instruments. There was no significant difference in patients' preference among the 4 instruments.

Purpose: Effectiveness of clinical glaucoma treatment may be dependent on the patient’s adherence (A) with eye drop treatment. The relation between non-adherence (NA) and intraocular pressure (IOP) is not yet well understood, due to methodological weaknesses in the studies performed so far. The goal of this study was to investigate the association between NA with eye drop treatment, IOP and degree of visual field (VF) defects in a large sample of glaucoma patients. Methods: A multi-center cross-sectional survey was performed in 973 patients in 60 ophthalmologic centers in Belgium. NA was assessed by a written self-report question asking patients how many times he/she had forgotten to administer eye drops during the past 2 weeks. Answer options ranged from never, seldom, once a week to daily. The patients indicating they had skipped 1 or more administrations were classified as NA. Current IOP (mmHg) and VF defects were measured with a Goldmann applanation tonometer and perimeter, respectively, at the same time as the NA assessment. Results: 603 out of 937 (64%) questionnaires were available for analysis. 39.5% of the patients reported to be NA. NA patients showed a significant higher current IOP of the left eye than A patients (16.12 +/- 3.15 vs 15.58 +/- 2.83; p=0.030). No significant difference in IOP of the right eye was found between NA and A patients (16.13 +/- 3.53 vs 16.02 +/- 7.61; p=0.843). The degree of visual field defects was not significantly related to NA. Conclusions: Because of the difference in IOP of the left eye between A and NA patients, NA should be carefully monitored as part of glaucoma management. Yet, prospective studies are needed to confirm the relationship between NA and poor outcomes.

Objectives Previous research revealed burnout in one third of the Belgian critical care physicians. Burnout leads to absenteeism, affects quality and safety of care, while work-engagement positively affects personal performance and involvement in the organisation. The aim of this study was to determine the prevalence, determinants and consequences of burnout and work-engagement in a representative sample of Belgian physicians across all medical specialties. Methods A multi-centre survey was conducted using a 2-phased convenience sample: 1) all general and psychiatric hospitals were invited and 2) an electronic questionnaire was send to all doctors from the participating institutions. The 29-item “Utrechtse Burnout Scale” measured 3 dimensions, “emotional exhaustion (EE)”, “depersonalisation (DP)” and “personal accomplishment (PA)”, scored on a likert-scale (0(never)- 6(always/daily)). Doctors with high EE (mean score>2.50) and high DP (mean score>1.80(men)/>1.60(women)) or low PA (mean score 5). Socio-demographics, theory-based determinants and consequences were measured using validated scales. Results Thirty-seven hospitals (20%) joined the study and 1198 doctors (47% female, mean age: 43.66) completed the questionnaire. Almost 89% had at least a master-after-master degree and 62% were medical specialists. The most represented specialties were anesthesia-resuscitation (12%), internal medicine (7.3%) and paediatrics (6.8%). Forty percent, 27.9% and 15.3% suffered from EE, DP and low PA respectively. Burnout was detected in 5.4%, 17.8% were at risk and 63% demonstrated high work-engagement. Important burnout determinants were “workload”, “role conflicts” and “emotional strain”. “Autonomy”, “skill utilisation” and “physician-nurse relation” determined work-engagement. Conclusions A slightly higher number of Belgian doctors suffered from burnout compared to previous studies, yet also showed work-engagement. Further analysis on determinants will be conducted as a base for preventive measures and actions to improve work-engagement.

Results The overall infection, resp. infected patients prevalence was 18.9% and 16.5%. The three most frequent infections were 1) skin or soft tissue (38.7%), 2) lower (22.5%) and 3) upper respiratory tract infections (11.4%). The prevalence of antibiotics’ use was 2,7%. The implementation of a hand hygiene campaign resulted in significant decreased prevalence of infected patients: 17.7% (95% CI: 17.1-18.3) before versus 15.1% (95% CI: 14.415.7) in the 4-years after the implementation. Antibiotics’ use among infected patients diminished from 17.5% to 14.0% (p