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Since 2000, the faculty of Medicine at the University of Liège has integrated problem-based learning (PBL) seminars from year two to seven in its seven-year curriculum. The PBL approach has been developed to facilitate students' acquisition of reasoning capacity. This contextualized learning raises the question of the de- and re-contextualization process and its development during medical education. The aim is to assess transfer capacity of knowledge acquired through contextualized learning. A script concordance test (SCT) to assess clinical reasoning was administered to 104 volunteer students from year three to six of the Faculty of Medicine, and to a reference panel. The SCT has been created to measure, in a standardized way, reasoning capacity for ill-defined clinical problems. We used clinical cases from PBL seminars related to endocrinology from the third- and fifth-year (APP [Apprentissage Par Problèmes] and ARC [Apprentissage du Raisonnement Clinique] seminars). Two SCT scenarios aiming at the same learning objectives were created: one in the original learning context and one in a different, new context. Irrespective of the learning context, the reference panel showed higher scores than all groups of students. Students in year five and six obtained higher scores than younger students. A significant difference was also found in relation to the context (original/new) of the question. Higher scores were unexpectedly obtained for questions related to ARC cases than APP cases and in new contexts versus original ones, irrespective of the study level. The highest score was obtained for fifth-year cases in a new context. This study shows that from third year, students are able to transfer the knowledge acquired throughout PBL seminars for application to questions with information out of the learning context. Moreover, reasoning capacity grows with experience, irrespective of the process of transfer.

BACKGROUND In Western countries, COVID-19 has been particularly deadly for care home residents. OBJECTIVE To understand the role of age and sex structures, health frailty, and contamination dynamics in COVID-19 mortality in populations living inside and outside care homes. METHODS We compared COVID-19 death data recorded in March-June 2020 in Wallonia (southern Belgium) for populations living inside and outside care homes, using annual death data (all-cause mortality in 2017) to assess the health condition of each population. RESULTS Sixty-four percent of COVID-19 deaths were residents in care homes, where the outbreak started after that in the external population, but at a faster pace. The death rate varied between 0‰ and 340‰ (mean 43‰) per care home, increasing with the number of both residents and staff. All-cause and COVID-19 mortality rates increased exponentially with age but were much higher in care homes. The ratio of male (M) to female (F) death rates was 1.6 for all-cause mortality and 2.0 for COVID-19 mortality (both confirmed and suspected). The COVID-19 mortality reached 24% (M) and 18% (F) of the all-cause mortality rate in care homes, compared to 5% (M) and 4% (F) outside care homes. CONCLUSIONS The COVID-19 mortality rate was 130x higher inside than outside care homes, due to the near multiplicative effects of differences in the residents' age and sex structure (11x), health frailty (3.8x), and infection risk (probably 3.5x). [ABSTRACT FROM AUTHOR]

Introduction: Une approche pluridisciplinaire centrée sur l’Éducation Thérapeutique du Patient (ETP) est une opportunité pour la prévention et le traitement du diabète et de l’obésité. Le projet EDUDORA2 (« EDUcation thérapeutique et préventive face au Diabète et à l’Obésité à Risque chez l’Adulte et l’Adolescent ») vise à améliorer la prise en charge de ces pathologies par l’ETP en Lorraine, Grand-Duché du Luxembourg et Wallonie. La présente étude fait état des pratiques d’ETP pour les adultes dans des institutions hospitalières des provinces de Liège et de Luxembourg, contexte belge dépourvu actuellement de législation en matière d’ETP. Matériels et méthodes: La récolte des données s’est réalisée sur base d’entretiens semi-structurés établis à partir des recommandations françaises en ETP (HAS). Un échantillon raisonné de 11 équipes hospitalières a été interrogé. Chaque équipe est composée d’endocrino-diabétologues, infirmiers, diététiciens. Deux équipes seulement comportent un psychologue. Toutes les équipes prennent en charge l’obésité, le diabète de type 1 et de type 2 chez l’adulte et l’adolescent. Résultats: Bien que des consultations soient consacrées à l’éducation, il n’existe aucun programme structuré en ETP : absence de diagnostic éducatif mais réalisation d’anamnèses, fixation informelle et implicite d’objectifs, pas de formalisation de l’évaluation des acquis du patient, nombre variable ou indéterminé de séances. Les outils d’informations sont les supports les plus utilisés. Une majorité des séances éducatives sont consacrées au transfert de compétences techniques et d’informations au patient. Elles sont adaptées à partir de la perception qu’a le soignant du patient. La majorité des équipes n’intègrent pas systématiquement un psychologue. Conclusion: Les carences objectivées dans cette enquête en Wallonie imposent une restructuration et une formalisation de l’ETP visant à valoriser les activités des professionnels au service d’un patient actif dans le processus. Il s’agit d’un objectif prioritaire du programme EDUDORA2 dans un esprit transfrontalier, en s’inspirant notamment de l’expérience récente de la Lorraine. [Copyright &y& Elsevier]

Background: Vaccine-induced antibodies to envelope proteins frequently cause HIV seroconversion in uninfected recipients of HIV vaccine candidates and may thus have an impact on the vaccinee's ability to donate blood or acquire a life insurance policy., Objective: To determine the occurrence of positive test results when commonly used HIV immunoassays are used to screen sera of HIV-uninfected volunteers who received an adjuvanted HIV-1 vaccine candidate containing HIV-1 antigens p24, reverse transcriptase, Nef and p17., Study Design: Sera of 50 subjects who received this polyprotein vaccine in a single center in Belgium were tested with 6 HIV screening assays and 1 confirmation test. All samples were drawn one year after the administration of the first of two vaccine doses given with one month interval., Results: Forty-five (90%) sera showed a positive test result in at least one of the 7 HIV tests used. The positivity rates were 88% in the Elecsys HIV Combi assay, 74% in the ADVIA Centaur EHIV and 48% in the PRISM HIV O Plus assay., Conclusions: Interpretation of HIV test results is becoming increasingly complex with the growing number of volunteers participating in prophylactic HIV vaccine trials worldwide and the rising number of viral antigens included in these vaccine candidates. The results of this study in recipients of a highly immunogenic adjuvanted polyprotein HIV vaccine candidate devoid of envelope proteins, illustrate the increasing need for approaches that can discriminate HIV infection-induced antibodies from those elicited by a vaccine., (Copyright © 2011 Elsevier B.V. All rights reserved.)