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The emergency department (ED) is a high-risk setting for the occurrence of medication discrepancies (MDs) due to inconsistencies between real and documented chronic medication therapies. A clinical pharmacist (CP) improves medication safety by performing a structured medication reconciliation on ED admission. The main objective was to identify the frequency and type of MDs in the chronic medication therapy by comparing the medication displayed in the home medication module of the electronic medical record and in the genereal practitioner's (GP) referral letter with the best possible medication history by performing a structured medication reconciliation on ED admission. This prospective, monocentric, interventional study was carried out in the ED of a tertiary care university hospital in Brussels, Belgium. Inclusion criteria were patients of at least 65 years, polypharmacy, ED admission between 8 a.m. and 4 p.m. on weekdays, hospitalization and signed informed consent. During 24 days, a CP performed a structured medication reconciliation in order to obtain the best possible medication history and registered all MDs. The CP compared the best possible medication history with the home medication module and the GP's referral letter and registered the different types of MDs. Eighty-three patients were included. The median number of medications in the home medication module and the best possible medication history was significantly different {7.0 [interquartile range (IQR), 5.0-11.0] vs. 8.0 (IQR, 6.0-11.0)/patient; P < 0.0001} with a median of 5.0 (IQR, 3.0-8.0) MDs per patient. Main MDs were omission (38.8%), addition (18.4%) and a deviant administration time (15.2%). Only 22.9% of patients ( N = 19) had a GP's referral letter containing their chronic medication therapy. The median number of medications in the GP's referral letter and the best possible medication history were significantly different [6.0 (IQR, 4.0-9.0) vs. 8.0 (IQR, 7.0-11.0)/patient; P < 0.0001] with a median of 6.0 (IQR, 5.0-11.0) MDs per patient. Main MDs were omissions (39.9%), deviant frequencies (35.3%) and doses (16.7%). A CP, integrated in a multidisciplinary ED team, enhances medication safety by intercepting MDs on ED admission. Few patients possess a GP's referral letter containing their chronic medication therapy and when they do, the accuracy and completeness are poor.

Aims Many clinical decision support systems trigger warning alerts for drug-drug interactions potentially leading to QT prolongation and torsades de pointes (QT-DDIs). Unfortunately, there is overalerting and underalerting because stratification is only based on a fixed QT-DDI severity level. We aimed to improve QT-DDI alerting by developing and validating a risk prediction model considering patient- and drug-related factors. Methods We fitted 31 predictor candidates to a stepwise linear regression for 1000 bootstrap samples and selected the predictors present in 95% of the 1000 models. A final linear regression model with those variables was fitted on the original development sample (350 QT-DDIs). This model was validated on an external dataset (143 QT-DDIs). Both true QTc and predicted QTc were stratified into three risk levels (low, moderate and high). Stratification of QT-DDIs could be appropriate (predicted risk = true risk), acceptable (one risk level difference) or inappropriate (two risk levels difference). Results The final model included 11 predictors with the three most important being use of antiarrhythmics, age and baseline QTc. Comparing current practice to the prediction model, appropriate stratification increased significantly from 37% to 54% appropriate QT-DDIs (increase of 17.5% on average [95% CI +5.4% to +29.6%], padj = 0.006) and inappropriate stratification decreased significantly from 13% to 1% inappropriate QT-DDIs (decrease of 11.2% on average [95% CI −17.7% to −4.7%], padj ≤ 0.001). Conclusion The prediction model including patient- and drug-related factors outperformed QT alerting based on QT-DDI severity alone and therefore is a promising strategy to improve DDI alerting.

Although research on sociodemographic correlates of internet use in older adults without and with pronounced cognitive impairment is already quite extensive, much less is known about the relationship between cognitive frailty (CF) and this behaviour. As CF is associated to multidimensional frailty aspects, this study explored the relationship between internet use and CF, operationalised as Subjective Cognitive Impairment, in older adults by means of a comprehensive explanatory model including sociodemographic factors and multiple frailty measures. The dataset included a sample of community-dwelling 60 + older adults that were included in the Belgian Ageing Studies (BAS) and that completed survey questions on (i) internet use frequency and (ii) internet activities. Multidimensional frailty was measured with the CFAI-Plus. The analysis comprised a structural equation modelling (SEM) procedure. Internet use was frequent; however, it became less frequent with higher CF. Moreover, the latter used less tablets as compared to the no-low CF group. Navigating the web, sharing email and online banking were the most frequently reported activities. Tele-communicating with Skype, online shopping and using e-government services were the least frequent. Age, female gender, lower income and living with a partner were also negatively associated with internet use. To conclude, CF, along with other frailty and sociodemographic factors, was negatively related to internet use in older adults. Future research should focus, amongst others, on the dynamic processes underlying internet use in the population of older adults affected by CF.The online version contains supplementary material available at 10.1007/s10433-022-00686-2.

Introduction: This study investigates the incidence, clinical characteristics, and treatment response of macular neovascularization (MNV) occurring after retinal pigment epithelium (RPE) and choroid graft translocation surgery (RPE-choroid TS). Methods: Retrospective analysis of 36 eyes of 36 consecutive patients who underwent RPE-choroid TS. Longer term follow-up of graft survival focusing on the occurrence of MNV was performed using multimodal imaging. Results: Indications for RPE-choroid TS included complications of neovascular age-related macular degeneration in 34 patients and drusenoid pigment epithelial detachment in 2 patients. With a mean follow-up of 30 months, 8 patients out of 36 developed signs of MNV. Of these 8 patients, 4 presented with a drop in visual acuity (VA) due to centrally located type 3 MNV. Early diagnosis and treatment prevented significant functional consequences. Four patients developed type 2 MNV at the border of the graft, which did not tend to affect the VA. Conclusion: We report a high incidence of MNV after RPE-choroid TS. Early diagnosis and treatment may preserve function in these patients. The type of MNV and location can be used to guide the management.

Introduction Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19. Methods In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis. Results Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as ‘appropriate’). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis. Conclusion In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19. Trial Registration The study is registered at ClinicalTrials.gov (NCT04544072). Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00535-2.

OBJECTIVE: An exponential implementation of remote mental health care has been observed, but little data is available on experiences and barriers of remote health from a patient's perspective. This study investigated experiences associated with several forms of remote consultations (both telephone and online video) for mental health care during the COVID-19 coronavirus pandemic with a particular focus on patients' experiences. METHODS: This study includes results of an online web-based survey filled in by 512 patients on the use and experiences of remote mental health consultations and circulating between March and October 2021. RESULTS: Psychiatric consultations were initiated by the health care provider in 47.0% of cases, while psychological consultations were most often initiated in shared decision with the patient (54.9%). Only 28.8% of participants mentioned advantages regarding teleconsultations over face-to-face, compared to 39.3% for online video consultations. Moreover, 49.3% saw clear disadvantages for teleconsultations and 32.7% for video consultations. Positive factors associated with remote mental health care included when faced with transportation problems, followed by consultations primarily focusing on medication (for telephone consultations) or on more practical aspects (for video consultations). 25.0% of patients deemed conversations when being angry or sad to be feasible by telephone, and 33.0% considered these feasibly using video consultations. CONCLUSION: Remote consultations were deemed feasible, but the positive factors did not seem to outweigh the face-to-face contacts from a patient's perspective. Remote consultations will probably remain present in the following decades, although care must be taken when providing the possibility of remote mental health care.

In clinical practice, many drug therapies are associated with prolongation of the QT interval. In literature, estimation of the risk of prescribing drug-induced QT prolongation is mainly executed by means of logistic regression; only one paper reported the use of machine learning techniques. In this paper, we compare the performance of both techniques on the same dataset. High risk for QT prolongation was defined as having a corrected QT interval (QTc) ≥ 450 ms or ≥ 470 ms for respectively male and female patients. Both conventional statistical methods (CSM) and machine learning techniques (MLT) were used. All algorithms were validated internally and with a hold-out dataset of respectively 512 and 102 drug-drug interactions with possible drug-induced QTc prolongation. MLT outperformed the best CSM in both internal and hold-out validation. Random forest and Adaboost classification performed best in the hold-out set with an equal harmonic mean of sensitivity and specificity (HMSS) of 81.2% and an equal accuracy of 82.4% in a hold-out dataset. Sensitivity and specificity were both high (respectively 75.6% and 87.7%). The most important features were baseline QTc value, C-reactive protein level, heart rate at baseline, age, calcium level, renal function, serum potassium level and the atrial fibrillation status. All CSM performed similarly with HMSS varying between 60.3% and 66.3%. The overall performance of logistic regression was 62.0%. MLT (bagging and boosting) outperform CSM in predicting drug-induced QTc prolongation. Additionally, 19.2% was gained in terms of performance by random forest and Adaboost classification compared to logistic regression (the most used technique in literature in estimating the risk for QTc prolongation). Future research should focus on testing the classification on fully external data, further exploring potential of other (new) machine and deep learning models and on generating data pipelines to automatically feed the data to the classifier used.

The current drug allergy documentation module in the electronic health record of our institution is in a free-text format. Two versions of a structured and coded drug allergy documentation module were developed. Twenty-five physicians tested the three interfaces via 3x5 test scenarios. The usability was measured for each interface with a system usability scale questionnaire. Both new versions scored significantly better than the current free-text version. User feedback will be used to further optimize the new module.

The current drug allergy documentation module in the electronic health record of our institution is in a free-text format. Two versions of a structured and coded drug allergy documentation module were developed. Twenty-five physicians tested the three interfaces via 3x5 test scenarios. The usability was measured for each interface with a system usability scale questionnaire. Both new versions scored significantly better than the current free-text version. User feedback will be used to further optimize the new module.

Purpose: To determine whether ocular dominance strength influences success of monovision Design: Single-center, prospective, double blind crossover. Subjects received contact lenses with reading addition added to the left eye in the first trial period and to the right eye in the second period so that the type of monovision was randomized and blinded for the test subject and the investigator. Methods: 17 presbyopic subjects, aged 50-65, received conventional and crossed monovision, each for 2 weeks. Satisfaction, stereopsis (TNO, Titmus) and Snellen visual acuity were measured. Ocular dominance was examined according to Haidinger and +1D test. Results: Pearson correlation coefficient between strength of ocular dominance and subject satisfaction was ρ=0.088 for the conventional and ρ=0.000 for the crossed group. 93% of subjects were most satisfied with the type of monovision that yielded the highest Titmus score. For the TNO test this was only 64%. A statistical significant interaction effect was shown for this relationship (ρ=0.019). Conclusion: A significant correlation between dominance strength, refraction error and satisfaction could not be found. However, we observed that the highest stereopsis score according to the Titmus test was more likely to yield a higher satisfaction when comparing conventional and crossed monovision. When a physician opts for monovision correction, the Titmus test can be performed with test spectacles or contact lenses to decide which eye should be corrected for distance vision. The choice should be in favor of the correction that yields the best Titmus score.

Ensemble modeling is an increasingly popular data science technique that combines the knowledge of multiple base learners to enhance predictive performance. In this paper, the idea was to increase predictive performance by holding out three algorithms when testing multiple classifiers: (a) the best overall performing algorithm (based on the harmonic mean of sensitivity and specificity (HMSS) of that algorithm); (b) the most sensitive model; and (c) the most specific model. This approach boils down to majority voting between the predictions of these three base learners. In this exemplary study, a case of identifying a prolonged QT interval after administering a drug-drug interaction with increased risk of QT prolongation (QT-DDI) is presented. Performance measures included accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Overall performance was measured by calculating the HMSS. Results show an increase in all performance measure characteristics compared to the original best performing algorithm, except for specificity where performance remained stable. The presented approach is fairly simple and shows potential to increase predictive performance, even without adjusting the default cut-offs to differentiate between high and low risk cases. Future research should look at a way of combining all tested algorithms, instead of using only three. Similarly, this approach should be tested on a multiclass prediction problem.

The ghrelin system was previously proposed to mediate an independent branch of the stress response that curbs fear processing. Interestingly, the ghrelin system was also shown to control the activity of midbrain dopamine neurons. Given that dopamine neurons of the ventral tegmental area appear to have a critical role in fear processing, we aimed to investigate their contribution to the effects of ghrelin on fear processing. Our data show that systemic administration of the ghrelin receptor agonist MK0677, in a dose that induces food intake, has no significant effect on auditory fear processing and does not significantly affect dopamine release in the nucleus accumbens of male C57BL/6J mice. Local administration of the ghrelin receptor agonist MK0677 into the ventral tegmental area significantly increases food intake and it also significantly increased dopamine release in the nucleus accumbens, the medial prefrontal cortex and the amygdala. Nevertheless, it did not significantly affect auditory fear extinction. Our data indicate that pharmacological activation of midbrain dopamine neurons using a ghrelin receptor agonist does not affect auditory fear extinction. We also investigated the effect of non-pharmacological manipulation of the ghrelin system on auditory fear processing. However, we found that neither overnight food deprivation nor genetic ablation of the ghrelin receptor had a significant effect on auditory fear extinction. We conclude that the effects of manipulation of the ghrelin system on fear processing are subject to boundary conditions that remain poorly understood.

Background: The quality of allergy documentation in electronic health records is frequently poor. Objective: To compare the usability of 3 graphical user interfaces (GUIs) for drug allergy documentation. Methods: Physicians tested 3 GUIs by means of 5 fictional drug allergy scenarios: the current GUI (GUI 0), using mainly free-text, and 2 new coded versions (GUI 1 and GUI 2) asking information on allergen category, specific allergen, symptom(s), symptom onset, timing of initial reaction, and diagnosis status with a semiautomatic delabeling feature. Satisfaction was measured by the System Usability Scale questionnaire, efficiency by time to complete the tasks, and effectiveness by a task completion score. Posttest interviews provided more in-depth qualitative feedback. Results: Thirty physicians from 7 different medical specialties and with varying degrees of experience participated. The mean System Usability Scale scores for GUI 1 (77.25, adjective rating “Good”) and GUI 2 (78.42, adjective rating “Good”) were significantly higher than for GUI 0 (56.58, adjective rating “OK”) (Z, 6.27, P adj < .001 and Z, 6.62, P adj < .001, respectively). There was no significant difference in task time between GUIs. Task completion scores of GUI 1 and GUI 2 were higher than for GUI 0 (Z, 9.59, P adj < .001 and Z, 11.87, P adj < .001, respectively). Quantitative and qualitative findings were combined to propose a GUI 3 with high usability. Conclusions: The usability and quality of allergy documentation was higher for the newly developed coded GUIs with a semiautomatic delabeling feature without being more time-consuming.

Background Health-care workers (HCW) are facing the Coronavirus disease 2019 (CoViD-19) epidemic. Consequently, psychological impairments have been reported. However, literature showed controversial results on the relationship between gender, frontline HCW, and psychological impairments. This study aims to investigate CoViD-19 fear and reluctance to work in HCW. Methods Employees who worked between April and October 2020 at the UZ Brussel were included. Data were prospectively collected in two phases through a survey together with serological tests. Sampling strategy was convenience sampling. Results 2336 employees completed the study and response rate was 70%. The prevalence of severe CoViD-19 fear in participants increased from 9% to 15%. Employees showing way less motivation raised from 9% to 14%. The seroprevalence was 7.4% and 7.9%. Multivariable analysis found a relation between reluctance to work, study phase, female gender, shortage of personal protective equipment, and poor education on CoViD-19. Furthermore, CoViD-19 fear was related to the study phase, older age, female gender, being second-line HCW, reported exposure to CoViD-19 during work, and insufficient education on CoViD-19. Discussion Seroprevalence remained rather stable, but fear and reluctance to work significantly increased. Differences in time of data collection together with epidemiological setting might be responsible for conflicting data reported in literature. Conclusion The evolution of the epidemiological setting might influence the results of studies investigating psychological impairments in HCW.

Introduction: Low grip work and high feelings of self-perceived fatigue could be an early characteristic of decline in reserve capacity, which comes to full expression as physical frailty in a later stage. When grip work and self-perceived fatigue can be identified as characteristics differentiating between robustness and pre-frailty it might allow to identify pre-frailty earlier. Therefore, this study aimed to investigate whether the combination of grip work and self-perceived fatigue is related to pre-frailty in well-functioning older adults aged 80 and over. Methods: Four-hundred and five community-dwelling older adults aged 80 and over (214 robust and 191 pre-frail) were assessed for muscle endurance (grip Work corrected for body weight (GW_bw)), self-perceived fatigue (MFI-20) and frailty state (Fried Frailty Index, FFI). A Capacity to Perceived Vitality ratio (CPV) was calculated by dividing GW_bw by the MFI-20 scores. ANCOVA analysis (corrected for age and gender) was used to compare robust and pre-frail older adults, and binary logistic regressions were applied to analyze the relationship between CPV and pre-frailty status. Results: Pre-frail older adults who scored negative on the exhaustion item of the FFI still showed significantly lower GW (p < 0.001), CPV ratios (p < 0.001) and higher self-perceived fatigue (p < 0.05) compared to the robust ones. The likelihood for pre-frailty related significantly to higher age, being men and lower CPV ratios. In women, every unit increase in CPV ratio decreased the likelihood for pre-frailty by 78% (OR 0.22; 95% CI: 0.11–0.44), for men this effect was less strong (34%, OR 0.66; 95% CI: 0.47–0.93). Conclusions: Pre-frail community-dwelling persons aged 80 years and over without clinical signs of exhaustion on the FFI still experience significantly higher fatigue levels (lower Grip Work, higher self-perceived fatigue and lower CPV levels) compared to robust ones. CPV ratio could therefore be a good tool to identify subclinical fatigue in the context of physical (pre-)frailty.

The 2020 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic introduced unprecedented disruptions in both working conditions and social life. This lead to a variety of additional stressors for academics. The objective of this study was to determine the effect of the SARS-CoV-2 measures on academics, introduced during the first SARS-CoV-2 wave in Belgium, and to verify possible intervening variables in coping with these measures (stress management). The position, family and home situation of the respondents was checked. A cross-sectional study design was used. The study included 1837 respondents from the different Belgian universities. The overall mental and physical well-being amongst academics was lower during the SARS-CoV-2 measures. The results of a hierarchical regression suggest that decline in physical health is associated with an increase in tasks at home, sickness, less options to plan work and breaks, the self-perceived lower quality of teaching and research and the fear that the measures create a backlog at work. Furthermore, having kids had a negative effect on the work/private life balance, which in turn had an effect on physical well-being. A decline in mental well-being was associated with a fading boundary between work and private life, the necessity to take on more house-keeping tasks, sickness, the fear that the disruptions would create a backlog at work, less control over the work planning and less periods of pause during work.

Between 19 May and 12 June 2020, employees of the UZ Brussel were recruited in this study aiming to document the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence, to investigate the potential work-related risk factors for SARS-CoV-2 infection and to estimate the proportion of asymptomatic infections. In total, 2662 participants were included of whom 7.4% had immunoglobulin G antibodies against SARS-CoV-2. Of the participants reporting a positive polymerase chain reaction for SARS-CoV-2, 89% had antibodies at the time of blood sampling. Eleven per cent of the antibody positive participants reported no recent symptoms suggestive of coronavirus disease 2019 (COVID-19). Participants reporting fever, chest pain and/or anosmia/ageusia were significantly more frequently associated with the presence of antibodies against SARS-CoV-2. The presence of antibodies was highest in the group that had had contact with COVID-19-infected individuals outside the hospital with or without using appropriate personnel protective equipment (PPE) (P < 0.001). Inside the hospital, a statistically significant difference was observed for the employees considered as low-risk exposure compared to the intermediate-risk exposure group (P = 0.005) as well as the high-risk exposure group compared to the intermediate exposure risk group (P < 0.001). These findings highlight the importance of using correct PPE.

Traditionally, geriatric patients with musculoskeletal or osteoarticular problems will be admitted to an orthopedic ward and will be treated by sur- geons. However, these patients often suffer from comorbidities requiring geriatric management. In this study, the orthogeriatric co-management (OG- CM) model is compared to traditional orthopedic care model in a retrospective pilot study. In this study, two patients groups were compared during two similar time periods : (1) Group 1 consisted of 119 geriatric patients admitted to an orthopedic (trauma) ward who were treated, with conventional geriatric care on demand (before OG- CM ; October 1-December 31, 2013) and (2) Group 2 consisted of 132 geriatric patients who were admitted after the implementation of the OG-CM model (after OG-CM ; October 1-December 31, 2014). Outcomes measured were : quality of care outcome, mortality and costs. After the introduction of OG-CM, the number of diagnoses increased (P = 0.011) adjusting for sex, age, length of stay (LOS), urgency and getting surgery (yes/ no). However, this did not lead to a significant higher severity of illness (SOI). The number of readmissions within a year were significantly lower after OG-CM (0.31 per patient) compared to before OG-CM (0.89 per patient) (P0.001). No significant difference in in-house and reported mortality after 3 months was observed. Costs increased, but no significant differences were found. The OG-CM model demonstrated an increase in quality of care. This was indicated by an increased number of medical diagnoses resulting in having less readmissions, without affecting the mortality rates and the LOS. Future randomized multi-centered studies are required to enable causal relationships.

Highlights • The combination of heat and TENS significantly improves pain pressure thresholds. • The combination of heat and TENS does not affect maximum and average pain, nor movement-evoked pain (MEP). • There is a need for standardized and sensitive assessment tools for measuring MEP., Background Low back pain is the leading cause of disability worldwide. The therapeutic management of patients with chronic LBP is challenging. Objectives The aim of this study is to evaluate the effects of heat and transcutaneous electrical nerve stimulation combined on pain relief in participants with chronic low back pain. Methods Fifty participants with chronic (≥3 months) low back pain were randomly assigned to two groups: HeatTens (n = 25) and control group (n = 25). Primary outcome was pain. Secondary outcomes were pressure pain thresholds, temporal summation, conditioned pain modulation, fear-avoidance and beliefs questionnaire, central sensitization inventory, quality of life, and medication use. The control group received no treatment and continued usual care. After four weeks of treatment, all measurements were repeated. Results Fifty individuals participated in this study. Significant higher pressure pain threshold measures after both 30 min and 4 weeks for the lower back region and the second plantar toe were found only in the experimental group. Conclusion The combination of heat and transcutaneous electrical nerve stimulation does not reduce pain scores in patients with chronic low back pain. Pressure pain threshold values significantly improved, showing beneficial effects of the experimental treatment. ClinicalTrials.gov: NCT03643731 (https://clinicaltrials.gov/ct2/show/NCT03643731).

Background: The outbreak of coronavirus disease 19 (COVID-19) has led to measures of social distancing and quarantine worldwide. This stressful period may lead to psychological problems, including increases in substance use. Objective: To investigate changes in alcohol, tobacco, and cannabis consumption before and during COVID-19 lockdown and motives for these changes in substance use. Method: A web-based survey was filled out by an unselected population during the social distancing measures of the COVID-19 pandemic in Belgium that assessed changes in alcohol, tobacco, and cannabis consumption in the period before and during the COVID-19 lockdown and also asked about reasons for change. Results: A total of 3,632 respondents (mean age 42.1 ± 14.6 years; 70% female) filled out the survey. Overall, respondents reported consuming more alcohol (d = 0.21) and smoking more cigarettes (d = 0.13) than before the COVID-19 pandemic (both p < 0.001), while no significant changes in the consumption of cannabis were noted. The odds of consuming more alcohol during the lockdown were associated with younger age (OR = 0.981, p < 0.001), more children at home (OR = 1.220, p < 0.001), non-healthcare workers (p < 0.001), and being technically unemployed related to COVID-19 (p = 0.037). The odds of smoking more cigarettes during the lockdown were associated with younger age (OR = 0.988, p = 0.027), current living situation (p < 0.001), lower education (p = 0.015), and working situation related to COVID-19 (p = 0.018). Boredom, lack of social contacts, loss of daily structure, reward after a hard-working day, loneliness, and conviviality were the main reasons for consuming more of the various substances. Conclusions: During the lockdown, individuals consumed slightly more alcohol and smoked marginally more cigarettes compared to the period before the lockdown. Further research focussing on follow-up of individuals at risk may be useful to provide appropriate care in post-COVID times.

After the national introduction of the ePrescription in Belgium to the broader public in 2014, community pharmacists are still not satisfied completely. Reasons are (1) low acceptance of the implementation due to slow systems, (2) high reported downtimes, and (3) alert fatigue due to technical and incomprehensible error messages. Therefore, we investigated which technical errors occur in the flow of handling an ePrescription and how these errors can be avoided. A cross-sectional design was used to capture interactions of all national community pharmacists connected to the national eHealth platform on a randomly chosen working day. Per interaction, the number of errors made was observed. In total, 567,883 interactions were registered and analyzed, of which the getPrescription interaction, to download the ePrescription from the national server, was most prevalent (n = 196,433; 37.21%). A difference of 14,961 interaction calls was observed without reaching a final state (delivered or undelivered). Reasons for these differences are repetitive calls for obtaining the ePrescription or by trying to obtain the prescription again when this should no longer be possible (e.g., when an ePrescription is already delivered or archived). When looking at the markAsDelivered, markAsUndelivered or markAsArchived interactions, most of the technical handling errors are due to attempts that generate not allowed state transitions. Most of these incorrect state transitions could have been avoided by maintaining the state diagram in the pharmacist's system to enforce legal transitions and by training the community pharmacists to handle ePrescriptions appropriately.

Background: Several benefits and problems of electronic prescribing (ePrescribing) are described in scientific literature, though problems remain in the implementation. In this study, we evaluated the pharmacist's perception of the ePrescription implementation within the community pharmacy software in Belgium, and the frequency and hindrance of encountered problems. Material and methods: A cross-sectional study was conducted among community pharmacists in Belgium to measure satisfaction with the ePrescribing implementation and factors influencing this satisfaction. Results: In total 246 pharmacists (3.3 % response rate) rated the implementation in their software with an average score of 6.46 ± 2.16 (SD) on a scale of 10. In Belgium, French-speaking pharmacists gave a significantly higher satisfaction score compared to Dutch-speaking pharmacists (P = 0.032), whereas Dutch-speaking pharmacists perceived to process significantly more ePrescriptions compared to French-speaking pharmacists (P < 0.001). Satisfaction with the implementation of the ePrescription was significantly associated with the software package (P < 0.001), the knowledge of the ePrescribing workflow (P = 0.036), the frequency of slow responses of the software (P < 0.001) and the perception of unavailability of the system (P = 0.003). Conclusions: The Belgian pharmacist was moderately satisfied with the implementation of the ePrescription. Problems with the availability of Belgian eHealth systems and interoperability issues with national codes used between prescriber and dispenser have to be resolved in the future in order to meet the Belgian community pharmacist's needs.

Introduction: Vector control tools are needed to combat leishmaniasis. A semi-synthetic version of a Lutzomyia longipalpis aggregation/sex pheromone (9-methlygermacrene-B) has been developed, and shown efficacy to attract sandflies in the lab and to chicken sheds in the field. Here, we present results from a cluster-randomised trial performed in Brazil where we test the efficacy of the pheromone deployed with insecticide, a novel lure-and-kill intervention, to reduce leishmaniasis transmission to the canine reservoir. Aim: Investigate the efficacy of sandfly sex pheromone baited + insecticide treated chicken roosts to reduce transmission of Leishmania infantum among the reservoir population (dogs). Methods: We conducted a cluster-randomised trial across 42 communities in Brazil. Pheromone lures plus insecticide were applied in 14 communities, and outcomes compared to that of 28 other communities that received either a placebo (sham lure + insecticide) or deltamethrin-impregnated collars fitted to dogs. We quantify the primary intervention effects by comparison of the number of uninfected dogs that seroconverted in each arm over the course of the 2-year trial. Results: A reduction in canine incidence is attributed to the pheromone + insecticide intervention, which is consistent across the levels of hierarchical analysis, though the errors are broad. The performance of the pheromone followed similar patterns as the collar arm which significantly reduced seroconversion incidence. Conclusion: These data represent the first trial of a synthetic vector pheromone applied in public health control, and the first cluster-randomised trial of dog collars in Brazil. Both methods show potential for the control of zoonotic visceral leishmaniasis in the Americas; developments of the pheromone lure-and-kill strategy are underway.

Background: Spermatogonial stem cell transplantation (SSCT) could become a fertility restoration tool for childhood cancer survivors. However, since in mice, the colonization efficiency of transplanted spermatogonial stem cells (SSCs) is only 12%, the efficiency of the procedure needs to be improved before clinical implementation is possible. Co-transplantation of mesenchymal stem cells (MSCs) might increase colonization efficiency of SSCs by restoring the SSC niche after gonadotoxic treatment.Methods: A mouse model for long-term infertility was developed and used to transplant SSCs (SSCT, n = 10), MSCs (MSCT, n = 10), a combination of SSCs and MSCs (MS-SSCT, n = 10), or a combination of SSCs and TGFß1-treated MSCs (MSi-SSCT, n = 10).Results: The best model for transplantation was obtained after intraperitoneal injection of busulfan (40 mg/kg body weight) at 4 weeks followed by CdCl2 (2 mg/kg body weight) at 8 weeks of age and transplantation at 11 weeks of age. Three months after transplantation, spermatogenesis resumed with a significantly better tubular fertility index (TFI) in all transplanted groups compared to non-transplanted controls (P P = 0.036) but did not differ statistically compared to SSCT (78.2 ± 12.5%). In contrast, TFI after MSCT (50.2 ± 22.5%) was significantly lower compared to SSCT (P P P P Conclusion: Co-transplanting SSCs and TGFß1-treated MSCs significantly improves the recovery of endogenous SSCs and increases the homing efficiency of transplanted SSCs. This procedure could become an efficient method to treat infertility in a clinical setup, once the safety of the technique has been proven.

In a cross-sectional study, we evaluated the perception of the community pharmacist in Belgium about his satisfaction with the implementation of the electronic prescription in his software. 246 community pharmacists scored the implementation in their software with an average of 6.46±2.16(SD) on a score of 10. This satisfaction is associated with the software used (p0.001), the frequency of slow responses (p0.001), the perception of unavailability of systems (p=0.003) and the knowledge of the pharmacist (p=0.036).

The increased use of eHealth services has shifted focus towards quality and interoperability. This study quantifies the technical quality of the ePrescription in Belgium by validating the construction of the Kind Messages for Electronic Health Records (KMEHR) used for communicating between prescriber and pharmacist, and by validating the digital signature within the ePrescription. A two-way cluster randomized subset of prescriptions of the tarification service Koninklijk Limburgs Apothekers Verbond (KLAV) is used (n = 82,952). Here, 38,032 prescriptions (45.85%) were handled electronically, but 180 prescriptions (0.22%) contained an empty KMEHR message at tarification. All 37,852 ePrescriptions (100%) passed the XSD Schema validation, but only 29,428 ePrescriptions (77.74%) passed the Software Development Kit (SDK) XPath validation rule set of the national Recip-e project. 37,622 ePrescriptions (99.39%) passed the validity test for having a correct digital signature. Improvement towards the construction and the digital signature is required in order to fully dematerialize the ePrescription workflow.

Belgium is in a transition from paper-based prescriptions to electronic prescriptions (ePrescriptions). Since patients still receive a paper proof of the ePrescription, this proof is sometimes used as a paper-based prescription. In this study, the frequency of incorrect use of the paper proof was evaluated and possible reasons for incorrect use were hypothesized. In 10,000 prescriptions, 226 ePrescriptions (2.26 %) were handled incorrectly. Possible reasons for this handling are (1) non-compliance of the community pharmacist; (2) errors in software or handling of the community pharmacist; (3) errors at the prescriber side or patient tries to fraud; (4) incorrectly revoking the ePrescription; and (5) errors in prescriber's software. The presence of incentives and penalties might help in preventing this erroneous type of handling.

RESEARCH QUESTION: Does recombinant human vascular endothelial growth factor (VEGF-165) improve the efficiency of human immature testis tissue (ITT) xenotransplantation? DESIGN: ITT fragments from three prepubertal boys were cultured for 5 days with VEGF-165 or without (control) before xenotransplantation into the testes of immunodeficient mice. Xenotransplants were recovered at 4 and 9 months post-transplantation and vascularization, seminiferous tubule integrity, number of spermatogonia and germ cell differentiation were evaluated by histology and immunohistochemistry. RESULTS: Transplants from donor 1 and donor 2 treated with VEGF demonstrated higher vascular surface (P = 0.004) and vessel density (P = 0.011) overall and contained more intact seminiferous tubules (P = 0.039) with time, compared with controls. The number of spermatogonia was increased over time (P < 0.001) irrespective of treatment and donor, whereas, for the VEGF-treated transplants, the increase was even higher over time (P = 0.020). At9 months, spermatocytes were present in the xenotransplants, irrespective of treatment. No transplants could be recovered from donor 3, who had already received treatment with cyclosporine for aplastic anaemia before biopsy. CONCLUSIONS: In-vitro pre-treatment of human prepubertal testis tissue with VEGF improved transplant vascularization in two out of three cases, resulting in improved seminiferous tubule integrity and spermatogonial survival during xenotransplantation. Although further studies are warranted, we suggest VEGF to be considered as a factor for improving the efficiency of immature testis tissue transplantation in the future.

Collaborative ontology-engineering methods usually prescribe a set of processes, activities, stakeholders, and the roles each stakeholder plays in these activities. We, however, believe that (a) the stakeholder community of each ontology-engineering project is different, and (b) one can observe different types of user behavior. It may thus very well be that the prescribed set of stakeholder types and roles do not suffice. If one were able to identify these user behavior types, which we will call user profiles, one can compliment or revisit those predefined roles. For instance, those user profiles can be used to provide customized interfaces for optimizing activities in certain ontology-engineering projects. We present a method for discovering different user profiles based on the interactions users have with each other on a collaborative ontology-engineering environment. Our approach clusters users based on the types of interactions they perform, which are retrieved from datasets that were annotated with an interaction ontology—built on top of SIOC—that we have developed. We demonstrate our method using the database of two instances of the GOSPL ontology-engineering tool. The databases contain the interactions of two distinct ontology-engineering projects involving, respectively, 42 and 36 users. For each dataset, we discuss the findings by analyzing the different clusters. We found that we are able to discover different user profiles, indicating that the approach we have taken is viable, though more experiments are needed to validate the results and to discover patterns across ontology-engineering projects.

BACKGROUND: Belgian family physicians use several local and international sources for evidence-based medicine (EBM). AIM: This study aims to investigate the quality of these EBM sources according to the Belgian family physicians. METHODS: A sample of Belgian family physicians completed a digital survey on the quality of EBM sources. RESULTS: Respondents evaluated the quality of the information for the major part of the local and international EBM sources good to excellent. More than 50% of the respondents found in the major part of the sources an answer to the question. More than half of the respondents found the necessary information in less than 5 minutes in most of the sources. Younger participants self-evaluated their search skills better than older participants. CONCLUSION: The quality of most frequently used EBM sources in Belgium is evaluated as good and client-friendly. More than half of the respondents found an answer to their questions in most of the sources and this within 5 minutes.

Background: Worldwide, the burden of allergies—in particular, drug allergies—is growing. In the process of prescribing, dispensing, or administering a drug, a medication error may occur and can have adverse consequences; for example, a drug may be given to a patient with a documented allergy to that particular drug. Computerized physician order entry (CPOE) systems with built-in clinical decision support systems (CDSS) have the potential to prevent such medication errors and adverse events. Objective: The aim of this review is to provide a comprehensive overview regarding all aspects of CDSS for drug allergy, including documenting, coding, rule bases, alerts and alert fatigue, and outcome evaluation. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as much as possible and searches were conducted in 5 databases using CPOE, CDSS, alerts, and allergic or allergy as keywords. Bias could not be evaluated according to PRISMA guidelines due to the heterogeneity of study types included in the review. Results: Of the 3160 articles considered, 60 met the inclusion criteria. A further 9 articles were added based on expert opinion, resulting in a total of 69 articles. An interrater agreement of 90.9% with a reliability Κ=.787 (95% CI 0.686-0.888) was reached. Large heterogeneity across study objectives, study designs, study populations, and reported results was found. Several key findings were identified. Evidence of the usefulness of clinical decision support for drug allergies has been documented. Nevertheless, there are some important problems associated with their use. Accurate and structured documenting of information on drug allergies in electronic health records (EHRs) is difficult, as it is often not clear to healthcare providers how and where to document drug allergies. Besides the underreporting of drug allergies, outdated or inaccurate drug allergy information in EHRs poses an important problem. Research on the use of coding terminologies for documenting drug allergies is sparse. There is no generally accepted standard terminology for structured documentation of allergy information. The final key finding is the consistently reported low specificity of drug allergy alerts. Current systems have high alert override rates of up to 90%, leading to alert fatigue. Important challenges remain for increasing the specificity of drug allergy alerts. We found only one study specifically reporting outcomes related to CDSS for drug allergies. It showed that adverse drug events resulting from overridden drug allergy alerts do not occur frequently. Conclusions: Accurate and comprehensive recording of drug allergies is required for good use of CDSS for drug allergy screening. We found considerable variation in the way drug allergy are recorded in EHRs. It remains difficult to reduce drug allergy alert overload while maintaining patient safety as the highest priority. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. Also, the effect on patient outcomes and cost-effectiveness should be evaluated.

Background Proximal migration of the first metacarpal can be seen after total trapeziectomy and various techniques have been described to prevent this subsidence. Purpose We hypothesized the insertion of a poly-L/D-lactide spacer to prevent proximal migration of the first metacarpal without the need of an additional ligament reconstruction, allowing early mobilization and less demanding rehabilitation. Patients and Methods Ten thumbs were treated with a total trapeziectomy and insertion of a poly-L/D-lactide scaffold. Clinical and radiological evaluation was performed after 6 months and 1 year. Patient satisfaction, pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, mobility of the thumb, and strength were assessed. Results Pain according to the visual analog scale decreased (p = 0.01) and QuickDASH score decreased (p = 0.02) significantly after 1 year. Radiological evaluation after 12 months showed a collapse of the scaphometacarpal distance of 45% (p = 0.01). Osteolysis of the distal scaphoid pole and/or proximal metacarpal was seen in 6 out of 10 cases. Because of the osteolysis, the use of the poly-L/D-lactide scaffold was discontinued in our practice. Conclusion In this limited series, total trapeziectomy with the use of the poly-L/D-lactide scaffold provides significant pain reduction and improvement of overall function. Radiographic evaluation shows significant collapse of the scaphometacarpal distance after 1 year and frequent signs of osteolysis. We do not encourage the use of the poly-L/D-lactide scaffold with total trapeziectomy before long-term clinical and radiological follow-ups of the osteolysis are available.

Clinical coding is a requirement to provide valuable data for billing, epidemiology and health care resource allocation. In sub-Saharan Africa, we observe a growing awareness of the need for coding of clinical data, not only in health insurances, but also in governments and the hospitals. Presently, coding systems in sub-Saharan Africa are often used for billing purposes. In this paper we consider the use of a nomenclature to also have a clinical impact. Often coding systems are assumed to be complex and too extensive to be used in daily practice. Here, we present a method for constructing a new nomenclature based on existing coding systems by considering a minimal subset in the sub-Saharan region. Evaluation of completeness will be done nationally using the requirements of national registries. The nomenclature requires an extension character for dealing with codes that have to be used for multiple registries. Hospitals will benefit most by using this extension character.

BACKGROUND Worldwide, the burden of allergies—in particular, drug allergies—is growing. In the process of prescribing, dispensing, or administering a drug, a medication error may occur and can have adverse consequences; for example, a drug may be given to a patient with a documented allergy to that particular drug. Computerized physician order entry (CPOE) systems with built-in clinical decision support systems (CDSS) have the potential to prevent such medication errors and adverse events. OBJECTIVE The aim of this review is to provide a comprehensive overview regarding all aspects of CDSS for drug allergy, including documenting, coding, rule bases, alerts and alert fatigue, and outcome evaluation. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as much as possible and searches were conducted in 5 databases using CPOE, CDSS, alerts, and allergic or allergy as keywords. Bias could not be evaluated according to PRISMA guidelines due to the heterogeneity of study types included in the review. RESULTS Of the 3160 articles considered, 60 met the inclusion criteria. A further 9 articles were added based on expert opinion, resulting in a total of 69 articles. An interrater agreement of 90.9% with a reliability Κ=.787 (95% CI 0.686-0.888) was reached. Large heterogeneity across study objectives, study designs, study populations, and reported results was found. Several key findings were identified. Evidence of the usefulness of clinical decision support for drug allergies has been documented. Nevertheless, there are some important problems associated with their use. Accurate and structured documenting of information on drug allergies in electronic health records (EHRs) is difficult, as it is often not clear to healthcare providers how and where to document drug allergies. Besides the underreporting of drug allergies, outdated or inaccurate drug allergy information in EHRs poses an important problem. Research on the use of coding terminologies for documenting drug allergies is sparse. There is no generally accepted standard terminology for structured documentation of allergy information. The final key finding is the consistently reported low specificity of drug allergy alerts. Current systems have high alert override rates of up to 90%, leading to alert fatigue. Important challenges remain for increasing the specificity of drug allergy alerts. We found only one study specifically reporting outcomes related to CDSS for drug allergies. It showed that adverse drug events resulting from overridden drug allergy alerts do not occur frequently. CONCLUSIONS Accurate and comprehensive recording of drug allergies is required for good use of CDSS for drug allergy screening. We found considerable variation in the way drug allergy are recorded in EHRs. It remains difficult to reduce drug allergy alert overload while maintaining patient safety as the highest priority. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. Also, the effect on patient outcomes and cost-effectiveness should be evaluated.