The in-house psychologist: do we speak the same language? Short report of a qualitative practice project

Interdisciplinary collaboration is gaining importance. Although general practices (GP’s) have a comprehensive experience in collaboration with psychologists, research on this topic is scarce. In house referrals to a psychologist are assumed to lower the thresholds for patients and GP’s. In this study it was investigated whether the GP’s reasons to refer in were accordance with the treatment strategy of the residing psychologist. The study is performed in a retrospective, observational cross section design. The studied population were the residing psychologist and GP’s. Both were asked to complete a questionnaire. Outcome measures where the referral reasons of the GP’s and the treatment strategy of the psychologist. A total sample of 92 patients of 6 GP’s was studied. Over 60% of the patients were referred for counseling but only in 25% of the cases this proposal was carried out by the psychologist. Overall, the referral reasons of the GP’s were not in accordance with the treatment strategy of the psychologist. A close collaboration and communication between general practitioners and psychologists is both difficult and indispensable. This practice research demonstrated that the referral motives of the GP’s usually do not correspond to the treatment policy of the psychologist. This observation is partly explained by a lack of understanding of the GP in the treatment strategies of the psychologists. Another part of the explanation is that there is a pre-selection of the GPs referrals rather influenced by patient characteristics than by pathology

Supporting Family Carers of Community-Dwelling Elder with Cognitive Decline: A Randomized Controlled Trial

Objective. Caring for a patient with cognitive decline has an important impact on the general well-being of family caregivers. Although highly appreciated, interventions in dementia home care remain mainly ineffective in terms of well-being. Consequently, in spite of an extensive support system, abrupt ending of home care remains more rule than exception. Method. The hypothesis was that the intervention of a care counselor, coordinating care in quasi-unstructured way during one year, will alleviate caregivers' feelings of depression. The study population was composed of community-dwelling patients with cognitive decline. A care counselor was at the exclusive disposal of the intervention group. Primary outcome measure was caregiver depression. Results. Finally, depression was 6.25 times less frequent in the intervention group. The actual intervention appeared minimal with only ten applications for more support followed by only three interventions effectively carried out. Although caregivers felt burdened and depressed, formal support remained stable. On the other hand, the availability of the care counselor made caregivers feel less depressed with the same amount of support. Conclusion. Carers do not always need to be surrounded with more professionals, but they want to feel more supported. In terms of policy, this could have some important implications

P300, Gray Matter Volume and Individual Characteristics Correlates in Healthy Elderly

We investigated whether P300-ERP and cognitive test performance differ for age, sex, and education in two groups of healthy elderly, and verified whether any correlations exist between P300 amplitude and latency and gray matter volume using whole brain voxel-by-voxel-based mapping, controlling for age, education, sex and Total Intracranial Volume (TIV). We used 32 channel electroencephalograms (EEG) to record the P300 responses and 3T Magnetic Resonance Imaging (MRI) to determine gray matter volume. We recruited 36 native-Dutch speaking healthy older subjects, equally divided in two sub-groups of 52–64 and 65–76 years old, administered a battery of cognitive tests and recorded their demographics, EEGs and task performance; additionally, 16 adults from the second sub-group underwent an MRI scan. We found significant differences between age groups in their cognitive tests performance, P300 amplitudes for the frontal and parietal electrodes for the most difficult task, and P300 latencies for frontal, central and parietal electrodes for all three tasks difficulty levels. Interesting, sex and education affected cognitive and P300 results. Higher education was related to higher accuracy, and P300 amplitudes and shorter latencies. Moreover, females exhibited higher P300 amplitudes and shorter latencies, and better cognitive tasks performance compared to males. Additionally, for the 16 adults underwent to MRI scan, we found positive correlations between P300 characteristics in frontal, central and parietal areas and gray matter volume, controlling for demographic variables and TIV, but also showing that age, sex, and education correlate with gray matter volume. These findings provide support that age, sex, and education affect an individual’s cognitive, neurophysiological and structural characteristics, and therefore motivate the need to further investigate these in relation to P300 responses and gray matter volume in healthy elderly

Evolution of benzodiazepine receptor agonist prescriptions in general practice: A registry-based study

BackgroundContrary to most European guidelines, benzodiazepine receptor agonists (BZRA) are often used continuously at a low dosage, being the most common form of long-term use. In Belgium, BZRA use is monitored by analyzing self-report data about medication use in the last 24 h. This method provides insufficient insight into the terms of use of these psychoactive drugs.AimTo describe trends in BZRA prescribing in Flanders, Belgium, between 2000 and 2019.Design and settingPopulation-based trend analysis and a case-control study for the year 2019 were done with data from a morbidity registry in general practice.MethodsRepeated cross-sectional and joinpoint regression analyses revealed trends in sex- and age-standardized prescription rates among adult patients (18+).ResultsOverall, BZRA prescriptions increased. The highest overall increase was found among male patients 18–44 years old, with an average annual percentage change of 2.5 (95% CI: 0.9, 4.3). Among 65+ female patients, a decrease was found since 2006, with an annual percentage change of −0.7 (95% CI: −1.3, −0.1). In 2019, 12% of registered patients received minimally one prescription, long-term use was observed in 5%, back pain was the most common morbidity significantly associated with a rise in BZRA prescriptions, and zolpidem was the most prescribed BZRA (22%).ConclusionDespite some statistically significant decreasing trends, an overall increase in BZRA prescriptions was observed throughout the 19-year study period, especially among long-term users of 18–44 years and 65-plus. Zolpidem became the most prescribed BZRA and warrants more attention

Diagnosing dementia: No easy job

<p>Abstract</p> <p>Background</p> <p>From both clinical experience and research we learned that in complex progressive disorders such as dementia, diagnosis includes multiple steps, each with their own clinical and research characteristics.</p> <p>Discussion</p> <p>Diagnosing starts with a trigger phase in which the GP gradually realizes that dementia may be emerging. This is followed by a disease-oriented diagnosis and subsequently a care -oriented diagnosis. In parallel the GP should consider the consequences of this process for the caregiver and the interaction between both. As soon as a comprehensive diagnosis and care plan are available, monitoring follows.</p> <p>Summary</p> <p>We propose to split the diagnostic process into four diagnostic steps, followed by a monitoring phase. We recommend to include these steps when designing studies on screening, diagnosis and monitoring of patients with dementia and their families.</p

Blended care to discontinue BZRA use in patients with chronic insomnia disorder: a pragmatic cluster randomized controlled trial in primary care.

peer reviewed[en] STUDY OBJECTIVES: International guidelines recommend using benzodiazepine receptor agonists (BZRA) for maximally four weeks. Nevertheless, long-term use for chronic insomnia disorder remains a common practice. This study aimed to test the effectiveness of blended care for discontinuing long-term BZRA use in general practice. METHODS: A pragmatic cluster randomized controlled superiority trial compared blended care to usual care through urine toxicology screening. In the intervention, care by the general practitioner (GP) was complemented by an interactive e-learning program, based on cognitive behavioral therapy for insomnia. Adults using BZRA daily for minimally six months were eligible. Participants were clustered at the level of the GP surgery for allocation (1:1). Effectiveness was measured as the proportion of patients who had discontinued at one-year follow-up. Data analysis followed intention-to-treat principles. RESULTS: In total, 916 patients in 86 clusters, represented by 99 GPs, were randomized. Primary outcome data was obtained from 727 patients (79%). At one-year follow-up, 82 patients (18%) in blended care, compared to 91 patients (20%) in usual care, had discontinued. There was no statistically significant effect for the intervention (OR: 0·924; 95% CI: 0·60, 1·43). No adverse events were reported to the research team. CONCLUSIONS: The findings did not support the superiority of blended care over usual care. Both strategies showed clinical effectiveness, with an average of 19% of patients having discontinued at one-year follow-up. Further research is important to study the effect of structurally implementing digital interventions in general practice

Videoconsultaties: van VHS tot Videolab

Het trainen van communicatieve vaardigheden is een essentieel onderdeel van elke artsenopleiding. Het vervolmaken en beheersen van deze vaardigheden vereist behalve inzicht in de theoretische kaders ook een training in de dagelijkse praktijk. Training, terugkoppeling en remediëring zijn hier onlosmakelijk met elkaar verbonden. Voor deze doeleinden raakt het gebruik van beeldmateriaal meer een meer ingeburgerd in de stagepraktijk. In deze ‘narrative review’ wordt op basis van de literatuur en de jarenlange ervaring van de trainers in de Universitaire Groepspraktijk Leuven dieper ingegaan op het gebruik van video-opnames tijdens de consultaties.status: publishe

Proficiency testing for admission to the postgraduate family medicine education

Theory: In Belgium, there are no family medicine admission requirements. A three‑phase admission program is developed and implemented by the collaboration of four involved universities. Hypotheses: A pilot testing of phase 2, comprising actual proficiency test, is designed as answer to two research questions: What is the validity and reliability of a multicomponent proficiency test? How does a multicomponent proficiency test proportionate to the final grades of family medicine master candidates? Methods: The population consisted of all last master‑phase students applying for family medicine education in Flanders. Students completed a machine‑assisted test on knowledge and situational judgment skills and evidence‑based medicine appraisal. Results: In total, 322 students completed the test. A regression analysis measuring the relationship between the master grades and the test score revealed an odds ratio of 1.1. Analysis of variance showed that the differences were significant between the upper quartile and the lowest quartile of the test results. A qualitative appraisal of the test results showed that the highest and lowest quartiles of the full‑test score included the students who were, respectively, known as “very good” or “very poor.” Conclusion: The test scores were in agreement with the performance and profiling of the participating students. The test succeeded in identifying poor‑performing students and in confirming competences of the average‑ and high‑performing students. In the future, retesting will add to the statements on reliability and will refine the test construction. Follow‑up will address validity.status: publishe

The objective structured clinical examination revisited for postgraduate trainees in general practice

To investigate if the psychometric qualities of an OSCE consisting of more complex simulated patient encounters remain valid and reliable in the assessment of postgraduate trainees in general practice.status: publishe

Interventions to prevent aggression against doctors: a systematic review

OBJECTIVE: To find out if there is evidence on interventions to prevent aggression against doctors. DESIGN: This systematic review searched the literature and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: Pubmed, Embase, Turning Research into Practice (TRIP), Cochrane and Psycharticle, GoogleScholar and www.guideline.gov were consulted. ELIGIBILITY CRITERIA: Abstracts published in English between January 2000 and January 2018 were screened. Eligible studies focused on prevention and risk factors of type II workplace violence in general healthcare, psychiatric departments, emergency departments, emergency primary care, general practice. DATA EXTRACTION AND SYNTHESIS: The selected intervention studies were grouped into quantitative and qualitative studies. Systematic reviews were reported separately. For each study, the design, type of intervention and key findings were analysed. Quality rating was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQUAL). RESULTS: 44 studies are included. One randomised controlled trial (RCT) provided moderate evidence that a violence prevention programme was effective in decreasing risks of violence. Major risk factors are long waiting times, discrepancy between patients' expectations and services, substance abuse by the patient and psychiatric conditions. Appropriate workplace design and policies aim to reduce risk factors but there is no hard evidence on the effectiveness. One RCT provided evidence that a patient risk assessment combined with tailored actions decreased severe aggression events in psychiatric wards. Applying de-escalation techniques during an aggressive event is highly recommended. Postincident reporting followed by root cause analysis of the incident provides the basic input for review and optimisation of violence prevention programmes. CONCLUSIONS: This review documented interventions to prevent and de-escalate aggression against doctors. Aggression against physicians is a serious occupational hazard. There is moderate evidence that an integrated violence prevention programme decreases the risks of patient-to-worker violence. The review failed to gather sufficient numerical data to perform a meta-analysis. A large-scale cohort study would add to a better understanding of the effectiveness of interventions.status: Published onlin