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In recent research, Google Trends data has been identified as a potentially useful data source to complement or even replace otherwise traditional data for predicting migration flows. However, the research on this is in its infancy, and as of yet suffers from a distinctive Western bias both in the topics covered as in the applicability of the methods. To examine its wider utility, this paper evaluates the predictive potential of Google Trends data, which captures Google search frequencies, but applies it to the case of Japanese migration flows to Europe. By doing so, we focus on some of the specific challenging aspects of the Japanese language, such as its various writing systems, and of its migration flows, characterized by its relative stability and sometimes limit size. In addition, this research investigates to what extent Google Trends data can be used to empirically test theory in the form of the aspirations and (cap)ability approach. The results show that after careful consideration, this method has the potential to reach satisfactory predictions, but that there are many obstacles to overcome. As such, sufficient care and prior investigation are paramount when attempting this method for less straightforward cases, and additional studies need to address some of the key limitations more in detail to validate or annul some of the findings presented here.The online version contains supplementary material available at 10.1007/s11135-022-01560-0.

BackgroundFor GPs to implement early palliative care, the first step is to identify patients with palliative care needs. The surprise question (SQ) is a screening tool that aims to aid this identification; for example, a response of 'no' to the SQ — 'Would you be surprised if this patient would die within a year?' — would suggest palliative care may be needed.AimTo describe setting-specific screening results of patients eligible for early palliative care in family practices, which is defined as patients aged ≥45 years with GPs' responses of 'no' to the SQ.Design & settingA secondary analysis was undertaken using a cross-sectional descriptive study in family practices in five areas in Belgium.MethodGPs were recruited by targeted sampling. As a first part of an implementation research project, participating GPs provided demographic information about themselves and also provided a response to the SQ for all patients who came to the practice in 10 consecutive office days. A summary table describing the sex, age, location of contact (GP surgeries, patients' homes, or nursing homes) of the patients was provided by each GP.ResultsFifty-six GPs provided complete data for the practice summary tables. In total, 9150 patients were described (all ages, all settings), of which 506 patients (6%) had a GP response of 'no' to the SQ. The distribution of SQ-no-as-answer patients per setting was: 152/7659 (2%) patients seen in family practice surgeries; 139/998 (14%) patients seen in their homes; and 215/493 (44%) patients seen in nursing homes.ConclusionThere was a large number of patients with SQ-no-as-answer, with possible palliative care needs. To enhance implementation of early palliative care, future research should compare results of SQ and other screening tools with palliative care symptoms assessments.

Background To deliver optimal palliative care, a Care Pathway for Primary Palliative Care (CPPPC) was developed. This CPPPC was implemented by general practitioners (GPs) in territories of five Belgian palliative care networks (2014–2016). Belgian doctors have much therapeutic freedom, and do not commonly follow guidelines. Objectives To assess how palliative care was provided by GPs before the CPPPC and its implementation project were presented publicly. Methods Between 2013 and 2015, seven focus groups with GPs were conducted. Participants included 15 GPs in three French-speaking focus groups and 26 GPs in four Dutch-speaking focus groups, with diversity for age, gender, palliative care experience and practice context. Some GPs implemented the CPPPC later. Results GPs considered each palliative care case unique and disliked strict protocols. However, they expressed a need for peer review and reflective frameworks. GPs felt it is important to identify palliative care patients ‘timely’, but found this difficult. Screening methods help, but are not widely used. GPs struggled most with identifying palliative care needs in non-oncological patients. Bad news breaking was considered difficult. Continuity of care was considered very important. However, advance care planning seemed more widely practised by Dutch-speaking GPs than by French-speaking GPs. The taboo of palliative care provoked emotional discussions. Conclusion Palliative care frameworks which help GPs to deliver ‘tailor-made’ care have more chance to be adopted than strict protocols. GPs should be given education for bad news breaking. Palliative care and advance care planning practices differ locally: guideline dissemination plans should respect these local differences.

Nederland telt tientallen consultatieteams palliatieve zorg, die doorgaans op afstand – pas nadat een zorgprofessional hen heeft ingeschakeld – bij de begeleiding en/of behandeling van palliatieve patiënten worden betrokken. De Vlaamse evenknie is de multidisciplinaire begeleidingsequipe. Bert Leysen en Tine de Vlieger schrijven over de werkwijze van deze MBE’s, die behalve door zorgprofessionals ook door patiënten en familie ingeschakeld kunnen worden en altijd minstens één huisbezoek afleggen.

The aim of this exploratory survey was to provide an overview of physiotherapeutic and occupational therapeutic techniques and outcome measures applied in practice within palliative care. An anonymous web-based questionnaire was distributed to physiotherapists and occupational therapists in Flanders, Belgium between December 2017 and February 2018. A total of 91 respondents were included. Frequently applied interventions were: massage (51%), mobilization (49%), exercise therapy (46%), manual lymphatic drainage (42%), walking rehabilitation (40%) and breathing therapy (32%). Additional therapeutic aspects such as 'comfort care' and 'creating a therapeutic alliance' were mentioned by 34% of all therapists and cannot be ignored as an important part of treatment. Outcome measures were not always used to evaluate treatment because of time constraints and because progress was considered difficult to conceptualize in a palliative care context. The most frequently used outcome measures were a visual analogue scale (VAS) and the 6-minute walk test. In this study, the most frequently applied physiotherapeutic and occupational therapeutic interventions within palliative care were massage, mobilization and exercise therapy. However, therapists stress that these techniques are not mandatory, since care is always informed by the individual comfort and daily functioning of patients. Other than a VAS, outcome measures were used minimally.

Background The implementation of early palliative care within a primary care setting is a recent academic topic. Recruiting General Practitioners (GPs) to participate in a palliative care study can be challenging. The pro-Spinoza project implemented a Care Pathway for Primary Palliative Care in 5 areas in Belgium. During this project, the feasibility of the recruitment of GPs and palliative care patients was evaluated. Methods The recruitment process was recorded in detail via an electronic logbook combining quantitative and qualitative data. Quantitative recordings included the contact types and the number of contacts with eligible GPs and were analysed descriptively. Qualitative recordings included field notes with feedback from the GPs and other stakeholders and were thematically analysed starting from the Grol and Wensing framework for professional behaviour change. Results Of 4065 eligible GPs working in 5 areas under research, 787 GPs (19%) were contacted individually, 398 GPs (9,8%) were contacted face-to-face and most of these 398 GPs showed high interest in the topic. 112 GPs (2,8%) signed the collaboration agreement, but finally only 65 GPs (1,6%) delivered at least a completed baseline-questionnaire. Despite the initial interest in participating, the unpredictable and busy daily workloads of the GPs, as well as inexperience with research protocols, impeded the ability of the GPs to fully engage in the study. This resulted in the high dropout rate. Participating GPs reported that they had underestimated the effort required to effectively participate in the project. Conclusions Recruitment of GPs to palliative care research is challenging. Primary care is a vital service to engage in palliative care research however the practical limitations reduce the ability of the service to effectively engage in the research. More research is needed to determine how GPs might be better supported in research. Trial registration ClinicalTrials.gov, NCT02266069, Registered 16th October 2014, retrospectively registered.

Het Transmuraal Zorgpad breekt radicaal met de patient als afhankelijke zorgvrager. In de plaats hiervan kiest dit zorgpad voor de patient als klant. Heidi Tanghe, coordinator en trekker van dit project, legt uit waarom.

We read with interest the article by Blum and Schönfeld [1]. Early introduction of palliative care (EPC) in the management of patients with advanced lung cancer is recommended because it improves quality of life and tends to produce better survival [2]. Hospital-based palliative teams mainly focus on terminal care for hospitalised patients. Involvement of the treating pulmonologist in this setting is warranted, as stated by Blum and Schönfeld [1]. We would like to show you how we started EPC in collaboration with the palliative team in our hospital (table 1).

Veel huisartsen vinden palliatieve zorg een belangrijk deel van hun taak. Toch zijn er ook barrières bij huisartsen om aan vroegtijdige zorgplanning te doen.

International audience; The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer. There is a great need to identify these patients and integrate an early palliative approach according to their individual needs in all settings, as suggested by the World Health Organization. Several tools have recently been developed in different European regions to identify patients with chronic conditions who might benefit from palliative care. Similarly, several models of integrated palliative care have been developed, some with a public health approach to promote access to all in need. We describe the characteristics of these initiatives and suggest how to develop a comprehensive and integrated palliative approach in primary and hospital care and to design public health and community-oriented practices to assess and respond to the needs in the whole population. Additionally, we report ethical challenges and prognostic issues raised and emphasize the need for research to test the various tools and models to generate evidence about the benefits of these approaches to patients, their families, and to the health system. (C) 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

In haar doctoraat pleit psychologe Kim Beernaert voor een dringende aanpassing van het palliatief statuut. Deze zorg moet vroeger opgestart kunnen worden en niet enkel door gespecialiseerde diensten gebeuren.

Het beleidsdocument ‘Together we change’ omvat een visie over de eerstelijnsgezondheidszorg en geeft aanzetten voor een uit te werken strategie. Het is knap dat dit gedragen wordt door de vier Vlaamse vakgroepen huisartsgeneeskunde. Zo kan de politiek dit verhaal moeilijk naast zich neerleggen.

Als negendejaars is het de bedoeling dat ik al eens nadenk hoe ik mijn eigen praktijk wil vormgeven. Dit boek heeft mij deels een antwoord gegeven op mijn vragen. Alles staat kort uitgelegd en is goed te volgen, zonder dat er te veel in detail wordt getreden. In het eerste hoofdstuk rond contractregeling worden de voor- en nadelen van de verschillende manieren op tafel gelegd. Dit is meteen een antwoord op de meest prangende vraag van huisartsen die willen samenwerken.

Het is gekend dat hypoglycemie vaker voorkomt bij ouderen en ook meer ernstige gevolgen kan hebben. Dat zijn de belangrijkste redenen waarom de streefglycemie bij een oudere populatie hoger ligt.

Veel artsen vermijden gesprekken met patienten over vroegtijdige zorgplanning (VZP) omdat ze vrezen dat dit bij patienten leidt tot psychologische stress.

Starting with early identification of palliative care patients by general practitioners (GPs), the Care Pathway for Primary Palliative Care (CPPPC) is believed to help primary health care workers to deliver patient- and family-centered care in the last year of life. The care pathway has been pilot-tested, and will now be implemented in 5 Belgian regions: 2 Dutch-speaking regions, 2 French-speaking regions and the bilingual capital region of Brussels. The overall aim of the CPPPC is to provide better quality of primary palliative care, and in the end to reduce the hospital death rate. The aim of this article is to describe the quantitative design and innovative data collection strategy used in the evaluation of this complex intervention. A quasi-experimental stepped wedge cluster design is set up with the 5 regions being 5 non-randomized clusters. The primary outcome is reduced hospital death rate per GPs’ patient population. Secondary outcomes are increased death at home and health care consumption patterns suggesting high quality palliative care. Per research cluster, GPs will be recruited via convenience sampling. These GPs -volunteering to be involved will recruit people with reduced life expectancy and their informal care givers. Health care consumption data in the last year of life, available for all deceased people having lived in the research clusters in the study period, will be used for comparison between patient populations of participating GPs and patient populations of non-participating GPs. Description of baseline characteristics of participating GPs and patients and monitoring of the level of involvement by GPs, patients and informal care givers will happen through regular, privacy-secured web-surveys. Web-survey data and health consumption data are linked in a secure way, respecting Belgian privacy laws. To evaluate this complex intervention, a quasi-experimental stepped wedge cluster design has been set up. Context characteristics and involvement level of participants are important parameters in evaluating complex interventions. It is possible to securely link survey data with health consumption data. By appealing to IT solutions we hope to be able to partly reduce respondent burden, a known problem in palliative care research. ClinicalTrials.gov Identifier: NCT02266069 .