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Introduction: Poor treatment adherence among asthmatic patients currently remains a public health challenge. One of the most quoted determinants is the quality of the professional–patient relationship although it has clearly not been fully described.Purpose: This study aims at deeply exploring asthmatic patients’ needs and expectations about the accompaniment proposed by their healthcare professionals.Methods: A rigorous narrative review was performed.Results: According to patients, what they expect from professionals can be split into eight themes: getting exhaustive information, relying on an available healthcare professional, being more involved into life with one’s asthma, being accompanied by a multidisciplinary team, being respected in one’s uniqueness, being cared through a humanist approach, feeling the professional is skilled and Other needs.Discussion and conclusion: Asthmatic patients’ needs have little evolved in 20 years illustrating that if they are met, that would positively affect the way patients want to be followed by healthcare professionals and so, that would increase their treatment adherence. Several recommendations such as setting up a doctor – asthma nurse practitioner binomial or studying a concrete care pathway may help in fulfilling these needs. Finally, this research opens the way to other studies since similar results have been found in populations suffering from other chronic diseases than asthma.Keywords: asthma, needs assessment, professional–patient relations, patient compliance, info:eu-repo/semantics/published

Purpose: Centrally authorised medicinal products (CAMPs) in the European Union may offer added therapeutic value (ATV) but may be linked to high prices and limited efficiency. Health technology assessment (HTA) and managed entry schemes (MES) may facilitate the reimbursement decision by providing reliable estimates of the medicinal product’s value and costs and by controlling the remaining uncertainty, respectively. We investigated the impact of HTA criteria and the initiation of a MES on the reimbursement decision of CAMPs in Belgium. Methods: We selected all reimbursement submissions for new centrally authorised medicinal products in the 2010–2015 period. We retrieved data relating to the reimbursement decision, the HTA outcome and the use of a managed entry scheme. Results: The decision of the Minister was available for 115 dossiers, covering 36 (31.3%) orphan medicinal products (OMPs) and 79 ATV products. A MES was used in 41 submissions. A positive reimbursement decision was obtained in 65% of cases. The significant factors affecting the reimbursement decision were the approval of ATV, the medical need if it was considered ‘important or major’ and the use of a managed entry scheme. Price, budget impact and efficiency had no significant impact. Conclusions: Added therapeutic value and high medical need increase the odds for a positive reimbursement decision. No impact could be demonstrated of the cost-related HTA criteria. Cost elements may be biased by the use of a confidential MES. Without a MES, only 53% of the centrally authorised medicinal products, including OMPs, are reimbursed in Belgium., SCOPUS: ar.j, info:eu-repo/semantics/published

In anaesthesiology, little attention has been drawn to the role of anaesthesia nurses as support personnel on quality of care., SCOPUS: ar.j, info:eu-repo/semantics/published

Objective: Burnout is a global work-related phenomenon. Intensive care unit (ICU) nurses are at risk of burnout and the COVID-19 pandemic may increase this risk. The objectives of this study were to assess the prevalence of burnout risk and identify risk factors among ICU nurses during the COVID-19 pandemic. Research methodology: Web-based survey performed during the first wave of the COVID-19 pandemic in French speaking Belgium. Main outcome measures: Risk of burnout was assessed with the Maslach Burnout Inventory scale. Results: A total of 1135 ICU nurses responded to the questionnaire. The overall prevalence of burnout risk was 68%. A total of 29% of ICU nurses were at risk of depersonalisation (DP), 31% of reduced personal accomplishment (PA), and 38% of emotional exhaustion (EE). A 1:3 nurse-to-patient ratio increased the risk of EE (OR = 1.77, 95% CI: 1.07–2.95) and DP (OR = 1.38, 95% CI: 1.09–2.40). Those who reported having a higher perceived workload during the COVID-19 pandemic were at higher risk for all dimensions of burnout. Shortage of personal protective equipment increased the risk of EE (OR = 1.78, 95% CI: 1.35–3.34) and nurses who reported having symptoms of COVID-19 without being tested were at higher risk of EE (OR = 1.40, 95% CI: 1.68–1.87). Conclusions: Two-thirds of ICU nurses were at risk of burnout and this risk was associated with their working conditions during the first wave of the COVID-19 pandemic. We recommend monitoring the risk of burnout and implementing interventions to prevent and manage it, taking into account the factors identified in this study., SCOPUS: ar.j, info:eu-repo/semantics/published

INTRODUCTION: The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE: To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN: This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING: Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS: The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p =

Introduction: The objectives of this research are (i) to describe the medicoadministrative profiles of inpatients aged 65 and over and (ii) to determine the main hospitalisation-related diseases in order (iii) to assess and identify predictors influencing hospital costs and lengths of stay thanks to data collected in hospital administrative databases. Methods: The study is based on 45,469 hospital stays of inpatients aged 65 and over, with data collected among ten Belgian general hospitals in 2014. We conduct a linear regression in order to isolate factors influencing hospital costs and length of stay. Results: The mean length of stay (SD) for older patients (65+) is 11 days (18.17) and the mean hospitalisation cost (SD) €6706 (9422). The main predictor of hospital costs is the length of stay. A linear regression (n = 41,348, R2 = 0.4520) reveals that predictors of a longer LOS for hospitalised older patients are: to be a male, to come from another hospital, to be sent to hospital by a general practitioner, to be admitted through the emergency department, to undergo a surgical procedure, to suffer from a major or extreme SOI or run a major or extreme mortality risk, to have a high score on the Charlson Comorbidity Index (CCI), to stay in an ICU, to belong to older age categories (85+), and to be institutionalised after discharge. Conclusion: Advanced age is by itself only a weak predictor of hospital cost, but it is a good predictor of a longer hospital stay., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction : Les hopitaux constatent regulierement que la duree de sejour a l’hopital de certains patients est prolongee bien que leur presence ne soit plus justifiee par des raisons medicales. Le manque d’infrastructures extrahospitalieres pouvant accueillir des patients apres une hospitalisation peut avoir un impact sur les couts des hopitaux.L’objectif de l’etude est d’etablir les profils des patients bed blockers, d’identifier les obstacles a leur sortie, le besoin en structures d’accueil adequates apres l’hospitalisation, de calculer la duree excedentaire du sejour, et d’en evaluer le cout pour les hopitaux.Methodes : Une enquete a ete realisee dans quatre hopitaux belges. Les patients qui sont toujours hospitalises, alors que l’autorisation medicale de sortie remonte a plus de 24 heures, ont ete recenses sur une periode de 21 ou 30 jours. L’etude se concentre sur 93 patients.Resultats : Nous distinguons quatre profils de patients bed blockers. 33% des patients sont en attente d’un lit en maison de repos et de soins (MRS) ou une maison de repos pour personnes âgees (MRPA) (groupe A). Ils ont une duree de sejour excedentaire moyenne (ecart type) de 13 jours (12), ce qui represente un cout moyen par patient de 8.197 EUR pour l’hopital. Les patients du groupe B ont besoin d’un accueil temporaire pour leur permettre de restaurer leur autonomie avant de retourner dans leur environnement familial naturel (21%). Ils ont une duree excedentaire moyenne de 3 jours (2), ce qui represente un cout moyen de 2.392 EUR. Les patients du groupe C necessitent de la revalidation apres l’hospitalisation (34%). Ils ont une duree de sejour excedentaire moyenne de 11 jours (18), ce qui represente un cout moyen par patient de 10.070 EUR. Le groupe D reprend les patients pour lesquels il n’existe pas ou peu de solutions de placement. Ils representent 11% de la population etudiee et ont des profils varies et heterogenes. L’obstacle principal a la sortie des patients de l’hopital est un probleme de disponibilite ou d’absence de l’offre de soins.Discussion/Conclusion : Les resultats montrent la necessite de developper des lits de revalidation et de maisons de repos comme premiere solution permettant la sortie de patients dans des delais raisonnables.

Resume Position du probleme Les soins de sante representent un secteur a forte intensite en capital humain dans lequel les ressources humaines constituent la moitie des depenses totales. Le nombre de professionnels, ainsi que la repartition de leurs competences, font donc l’objet d’une attention soutenue de la part des decideurs tant au niveau national qu’au niveau international. L’objectif de cet article est d’analyser les differents modeles europeens de projection de l’offre medicale et de la demande en medecins. Methodes Afin de decrire les outils de projection utilises pour la planification medicale en Europe, une revue de la litterature grise a ete menee via la consultation de rapports techniques de l’OCDE, de l’OMS et de l’Union europeenne, et a ete completee par la consultation des bases de donnees bibliographiques Pubmed, Medine, Embase et Econlit. Resultats Les methodes quantitatives d’evaluation de l’offre medicale reposent generalement sur une modelisation de type « stock and flow » et plus rarement sur une dynamique systemique. Les parametres inclus dependent largement de la disponibilite et de la qualite de ces donnees. Les modelisations des besoins en medecins se limitent a la consommation de soins et n’envisagent que rarement les besoins dans leur globalite ou des objectifs de sante. Outre les methodes quantitatives, l’« Horizon scanning » est une technique permettant d’apprecier l’evolution de l’offre et de la demande dans un futur incertain a l’aide de techniques qualitatives telles que celles des enquetes semi-structurees, des panels Delphi ou des« focus group ». Enfin, les modeles de projection de l’offre et de la demande doivent etre regulierement mis a jour pour verifier la realisation des hypotheses de travail. De plus, une analyse post-hoc est egalement necessaire mais trop rarement realisee. Conclusion La planification des ressources humaines medicales est tres inegalement implantee en Europe. L’implementation politique des resultats des exercices de projection est cruciale pour une planification efficace. Cependant des donnees importantes comme celles relatives a la mobilite entre les Etats membres sont mal connues, compliquant les politiques de regulation de l’offre medicale. Ces politiques se limitent generalement a la regulation de la formation et n’envisagent que trop rarement la delegation et la substitution.

Death rates after surgery are increasingly analysed for clinical audit and quality assessment. Many studies commonly provide information only on deaths that occur during hospital stay, known as in-hospital death rates. By using hospital data set linked to death certificate registry, we recorded in- and out-hospital deaths within 30 and 60 post-operative days.The study included all consecutive surgical procedures (denominator) under general or locoregional anaesthesia in adult patients admitted for elective or non-elective inpatient surgery. Patients undergoing planned day-case surgery or obstetrical procedures were excluded. The primary outcome was 30- and 60-day post-operative mortality rate (numerator) whether before or after discharge.The study material consisted of a sample of 36,494 surgical procedures corresponding to 28,202 patients. At 30-day, 384 (crude mortality rate of 1.1%) patients died, 314 (82%) during their hospitalisation and 70 (18%) after discharge. Factors that were associated with in-hospital mortality are ASA scores, emergency, duration of surgery and rate of admission to critical care unit. Within the 30-60 days interval, we recorded 231 supplemental deaths, 103 (45%) after discharge.In-hospital mortality alone is an incomplete measure of mortality even within 30 days of care. To identify the missing deaths, hospital records need to be linked to data from death certificate. This connection with the national death registry will allow obtaining the rate of in-hospital and out-hospital death.

A lot of studies have demonstrated the possibility of reducing the number of post-operative complications in the domain of major surgical procedures with the use of medical preventive techniques. However, complications following surgical procedures are unfortunately frequent and are a major problem, not only because of the impact for the patient, but also because of economic consequences that they provoke. The aim of the present study is to evaluate the extra length of stay and the extra cost, born by the hospital and the social security, linked to complications, incurring after major surgical procedures.Study based on the data from 13 Belgian hospitals for the year 2012. Complications were extracted through medical discharge summaries. The cost born by the social security was assessed on the basis of the billing data, hospital cost are taken from cost accounting studies.The rate of complication for all the hospitals is 6.6%. About 30.3% of inpatient stays having a major or extreme severity of index had a complication during the stay, 1.8% of stays with a minor or moderate severity of index had a complication. The extra length of stay is 19.38 days when the stay has had a complication (p 0.001). The additional mean cost borne from the hospital perspective is €21 353.07 and €8 026.65 for the social security. This additional mean cost varies greatly from one hospital to another.The present study has shown that the actual financing do not cover real hospital costs in the field of major surgical procedures having caused complications. Results should encourage Belgian authorities to propose and finance preventive measures in order to reduce these complications, which represent major economic impacts, not only for authorities but also for hospitals.

A wide range of thresholds define intraoperative hypotension and can be used to guide intraoperative blood pressure management. Many clinicians use the systolic blood pressure (SBP)80 mmHg, the mean arterial pressure (MAP)60 mmHg and the SBP percent drop from baseline (ΔSBP)20% as alarming limits that should not be exceeded. Whether these common thresholds are valid limits that can inform clinicians on a possible increased risk of post-operative complications, particularly 30-day mortality, is currently unclear.We performed a retrospective registry-based cohort study between January 2015 and July 2016 using departmental hospital databases and the National Death Registry. Uni- and multivariate analyses were performed to assess the association between each of these three thresholds and 30-day post-operative mortality. Six specific markers of hypotension were used.Of 11 304 patients, 86 (0.76%) died within 30 days following surgery. All intraoperative hypotension markers for SBP 80 mmHg and MAP 60 mmHg were significantly associated with 30-day mortality (P .005). Markers of ΔSBP 20% were not significant. After adjustment for age, gender, American Society of Anesthesiologists (ASA) score, emergency status and risk related to the type of surgery, both SBP 80 mmHg and MAP 60 mmHg (the per cent area under the threshold marker) showed the strongest associations with 30-day mortality, with odds ratios (ORs) of 3.02 (95% confidence interval (CI) 1.81-5.07) and 3.77 (95% CI 2.25-6.31) respectively.Commonly accepted thresholds of intraoperative hypotension, such as an SBP of 80 mmHg and an MAP of 60 mmHg, are valid alarming limits that are significantly and independently associated with 30-day mortality.

Resume Cette etude multi-methodes vise a decrire les avantages de la tenue du journal des apprentissages en stage clinique infirmier en termes de qualite d’encadrement et d’apprentissage des etudiants de l’INMeS au Benin. Un canevas de presentation d’un journal structure inspire des modeles de « l’apprentissage experientiel » (Kolb, 1984) et du « savoir-apprendre experientiel » (Chevrier et Charbonneau, 1990, 2000) est propose, ainsi qu’un guide de redaction issu des « formules pour mieux ecrire ses apprentissages » et du « mode d’emploi du journal des apprentissages » developpes par Duffez (2010), et des exemples de directives et questions ouvertes pour l’ecriture du journal des apprentissages proposees par Menard (2007). L’analyse de contenu des journaux est realisee a l’aide d’une grille issue des elements descriptifs des cinq types de journaux de Scheepers (2008) et, celle des commentaires des superviseurs selon la demarche de Scheepers et al. (2006). Un questionnaire auto-administre a permis d’identifier les perceptions de l’outil par les etudiants. D’apres les resultats, 97,5 % des stagiaires s’approprient l’outil avec 58 % de journaux mosaiques ce qui temoigne d’une pratique reflexive, de l’apprentissage autoregule et favorise le dialogue metacognitif entre eux et les superviseurs.

Introduction: The objectives of this research are (i) to describe the medico-administrative characteristics of inpatients aged 65 and more who are hospitalized for hip joint replacement, (ii) to evaluate the complete hospital cost into costs of medical procedures, drugs costs, prostheses costs, and the administrative costs, and (iii) to identify and to evaluate from administrative database predictors influencing the complete hospital costs. Methods: The study was based on 961 inpatient stays aged 65 and more, with the APR-DRG 301 “Hip joint replacement”. The sample for this study was based on data collected in 2014 among nine Belgian general hospitals. We used the linear regression method for isolating predictors of hospital cost. Results: The study highlights three different types of patients hospitalized for hip replacement, depending on the primary diagnosis: osteoarthritis problems (57%), femur neck fracture (30%), or other reasons (13%) (complications, infections, or problems with the existing hip prosthesis). The median length of stay (P25–P75) was 9 days (6.29–20.91). The median cost (P25–P75) was 8,023.91 EUR (6678.32–13,670.78). The total cost was composed of the direct hospital cost (30%), the cost of medical procedures (31%), cost of drugs (4%), the cost of hip prosthesis (18%), and other costs (17%). The linear regression reveals that an extreme SOI or risk of mortality, an ICU stay, an in-hospital death, an index of Charlson comorbidities of 4 or 5, to be hospitalized for a hip replacement because of complications, infections, or problems with the existing hip prosthesis, and the length of stay, were predictors of an increase in hospital cost. Conclusion: The cost is not increasing with the age of the patient, but mainly with the length of stay and the comorbidities linked to the age which are considered in the severity of illness and the Charlson comorbidities index. The hospital cost is higher for patients hospitalized for complications linked to an existing hip prosthesis than for a hip replacement linked to osteoarthritis problems., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction :l’asthme constitue un problème majeur de Santé Publique avec 300.000.000 de personnes touchées au niveau mondial et un faible taux d’adhésion au traitement. Contexte :peu d’auteurs se sont penchés sur un des déterminants de cette adhésion :l’accompagnement proposé par les professionnels de la santé. Objectifs :décrire les besoins et les attentes des personnes vivant avec un asthme chronique quant à cet accompagnement. Méthode :approche qualitative à visée descriptive avec échantillonnage raisonné. Huit entretiens individuels semi-directifs ont été réalisés avec des patients adultes asthmatiques chroniques puis ont fait l’objet d’une analyse de contenu inductive, soumise à validation par les participants. Résultats :les besoins et attentes se répartissent en six grands thèmes :le souhait que s’installe une relation de confiance, la nécessité de percevoir la compétence professionnelle, l’importance de la disponibilité du professionnel, la volonté d’être davantage acteur de sa vie avec la maladie, le désir que le professionnel adopte une posture humaniste et prenne en compte la singularité du patient. Conclusion :une meilleure compréhension des attentes non rencontrées contribuerait à l’amélioration de l’adhésion au traitement. Cette recherche qualitative ouvre diverses pistes de réflexion et peut constituer le terreau d’autres études., Introduction: Asthma remains a major public health problem, with 300 million people affected worldwide and a low rate of adherence to treatment. Context :Few authors have considered one of the determinants of asthmatic patients’ adherence to treatment :the accompaniment offered by health care professionals. Aim :To describe the expectations and needs of people living with chronic asthma regarding their accompaniment. Methods :A descriptive qualitative approach with reasoned sampling. Eight individual semi-structured interviews were conducted among chronic asthmatic adult patients and analyzed by an inductive approach. This was submitted to participants for validation.Results: Needs and expectations are branched out into six main themes :the wish to establish a trusting relationship, the need to perceive professional competence, the importance of the professional’s availability, the wish to be more involved in one’s life with the disease, the desire for the professional to adopt a humanist posture and to take into account patient singularity. Conclusion :A better understanding of non-met expectations would help the adherence to treatment rate to improve. This qualitative research opens various avenues for reflection that are worth thinking about and provides the breeding ground for other studies., info:eu-repo/semantics/published

The objective of this study was to estimate the total hospital cost per patient admitted through the emergency department with a primary diagnosis of pulmonary embolism (PE), and to identify the main components and predictors of costs.Actual costs of care of 652 consecutive patients hospitalised in 10 general hospitals in Belgium, including 31 outlier patients in terms of length of stay (4.8%), were obtained by aggregating all cost components contributing to care of each patient.In both inlier and outlier patients, the mean total cost per patient increased linearly with the degree of severity of illness classes related to the All Patient Refined Diagnosis Related Group (pAn increasing burden of comorbid illness was strongly associated with increasing actual cost for caring hospitalised patients for PE. Increasing age was associated with an increase in all main cost components.