The use of decision aids on early detection of prostate cancer: views of men and general practitioners

While decision support tools such as decision aids can contribute to shared decision making, implementing these tools in daily practice is challenging. To identify and address issues around the use of decision support tools in routine care, this study explores the views of men and general practitioners on using a DA for early detection of prostate cancer.status: publishe

Deterioro de la autorregulación cerebral mediante espectroscopia de infrarrojo cercano y su relación con los resultados clínicos en bebés prematuros

The concordance between the change in the Mean Arterial Blood Pressure (MABP) and the Cerebral Blood Flow (CBF) is studied using the Correlation, Coherence and Partial Coherence methods in order to detect Impaired Cerebral Autoregulation in Neonates. The presence of impaired autoregulation is assessed by the use of the Critical Percentage of Recording Time (CPRT). The changesinCBF are reflected by the measurement of changesin cerebral intravascular oxygenation (HbD), regional cerebral oxygen saturation (rSO2), and cerebral tissue oxygenation (TOI), as measured by Near-Infrared Spectroscopy (NIRS) (INVOS4100 and NIRO300). The relation between impaired autoregulation and long term clinical outcomes in premature infants is studied

Assessment of the priority target group of mental health service networks within a nation-wide reform of adult psychiatry in Belgium

Background: Belgium is currently implementing a nation-wide reform of mental health care delivery based on service networks. These networks are supposed to strengthen the community-based supply of care, reduce the resort to hospitals, and improve the continuity of care. They are also intended to supply comprehensive care to all adult mental health users. It is unclear, however, if one single model of network can target the needs of the whole adult population with mental health problems. Methods: In 2011, ten networks were commissioned and assessed. Networks included a total of 635 services of different types. Services were asked to select 10 users by systematic sampling and to state whether these users were considered as a priority for care in the network. Sociodemographic, social integration level, diagnoses, and psycho-social functioning variables were also collected. Results: Two thousand four hundred ninety users were included, and 1564 were given priority for network care. Priority was higher for men than for women (69.9 % versus 56.2 %), and for non-nationals than for Belgians (72.6 % versus 61.9 %). Users were designated priority when they had poor psycho-social functioning (HoNOS > 17, OR = 3.15, p < 0.001), personality disorder or schizophrenia (OR = 1.54, p < 0.001), and a medium level of social integration (SIX = [2,3], OR = 1.57, p < 0.001). Less socially integrated patients (SIX < 1, OR = 0.53, p < 0.001) and users of community and social services were less likely to be selected. Conclusion: Although the reform was intended for the whole population of adults with mental health problems, the users selected have a profile of severe mentally-ill users with social deprivation and poor social functioning. Policy may have been over-ambitious trying to address the whole population with one single type of service network. The actual selection process of users makes it less likely that the reform will achieve all its objectives

Assessment of the priority target group of mental health service networks within a nation-wide reform of adult psychiatry in Belgium

Background: Belgium is currently implementing a nation-wide reform of mental health care delivery based on service networks. These networks are supposed to strengthen the community-based supply of care, reduce the resort to hospitals, and improve the continuity of care. They are also intended to supply comprehensive care to all adult mental health users. It is unclear, however, if one single model of network can target the needs of the whole adult population with mental health problems. Methods: In 2011, ten networks were commissioned and assessed. Networks included a total of 635 services of different types. Services were asked to select 10 users by systematic sampling and to state whether these users were considered as a priority for care in the network. Sociodemographic, social integration level, diagnoses, and psycho-social functioning variables were also collected. Results: Two thousand four hundred ninety users were included, and 1564 were given priority for network care. Priority was higher for men than for women (69.9 % versus 56.2 %), and for non-nationals than for Belgians (72.6 % versus 61.9 %). Users were designated priority when they had poor psycho-social functioning (HoNOS > 17, OR = 3. 15, p < 0.001), personality disorder or schizophrenia (OR = 1.54, p < 0.001), and a medium level of social integration (SIX = [2,3], OR = 1.57, p < 0.001). Less socially integrated patients (SIX < 1, OR = 0.53, p < 0.001) and users of community and social services were less likely to be selected. Conclusion: Although the reform was intended for the whole population of adults with mental health problems, the users selected have a profile of severe mentally-ill users with social deprivation and poor social functioning. Policy may have been over-ambitious trying to address the whole population with one single type of service network. The actual selection process of users makes it less likely that the reform will achieve all its objectives.status: publishe

Cerebral Tissue Oxygenation and Regional Oxygen Saturation Can Be Used to Study Cerebral Autoregulation in Prematurely Born Infants

The coupling of cerebral intravascular oxygenation (dHbD) with mean arterial blood pressure (MABP) was taken as a reflection of autoregulation assuming constant arterial oxygen content. However, this method is sensitive to movement artifacts. We examined whether the cerebral tissue oxygenation index (cTOI) and regional oxygen saturation (rScO(2)) may replace dHbD and change in total Hb (dHbT), respectively. Correlation (COR) and coherence (COH) were used to measure the agreement of MABP with rScO(2)/dHbT and cTOI/dHbD. dHbD/cTOI and dHbT/rScO(2) recordings of, respectively, 34 and 20 preterm infants in need for intensive care were studied during the first days of life. dHbD and cTOI were obtained with the NIRO300 and rScO(2) and dHbT with the INVOS4100. Invasive MABP was measured continuously. COR and COH scores of MABP versus dHbD/dHbT were compared with the corresponding ones by replacing dHbD/dHbT by cTOI/rScO(2), respectively. Generally, no significant score differences were found for dHbD/cTOI. Differences for dHbT/rScO(2) were slightly larger but still within the normal variation of the parameters. Differences become insignificant when restricting calculations to epochs of larger variation in MABP (>10 mm Hg). Hence, we suggest that cTOI and rScO(2) can be used to study cerebral autoregulation in newborns. (Pediatr Res 69: 548-553, 2011

La oxigenación del tejido cerebral y la saturación regional de oxígeno se pueden utilizar para estudiar la autorregulación cerebral en bebés prematuros.

The coupling of cerebral intravascular oxygenation (dHbD) with mean arterial blood pressure (MABP) was taken as a reflection of autoregulation assuming constant arterial oxygen content. However, this method is sensitive to movement artifacts. We examined whether the cerebral tissue oxygenation index (cTOI) and regional oxygen saturation (rScO2) may replace dHbD and changes in total Hb (dHbT), respectively. Correlation (COR) and coherence (COH) were used to measure the agreement of MABP with rScO2/dHbT and cTOI/dHbD. dHbD/cTOI and dHbT/rScO2 recordings of, respectively, 34 and 20 preterm infants in need for intensive care were studied during the first days of life. dHbD and cTOI were obtained with the NIRO300 and rScO2 and dHbT with the INVOS4100. Invasive MABP was measured continuously. COR and COH scores of MABP versus dHbD/dHbT were compared with the corresponding ones by replacing dHbD/dHbT by cTOI/rScO2, respectively. Generally, no significant score differences were found for dHbD/cTOI. Differences for dHbT/rScO2 were slightly larger but still within the normal variation of the parameters. Differences become insignificant when restricting calculations to epochs of larger variation in MABP (>10 mm Hg). Hence, we suggest that cTOI and rScO2 can be used to study cerebral autoregulation in newborns

La oxigenación del tejido cerebral y la saturación regional de oxígeno se pueden utilizar para estudiar la autorregulación cerebral en bebés prematuros.

The coupling of cerebral intravascular oxygenation (dHbD) with mean arterial blood pressure (MABP) was taken as a reflection of autoregulation assuming constant arterial oxygen content. However, this method is sensitive to movement artifacts. We examined whether the cerebral tissue oxygenation index (cTOI) and regional oxygen saturation (rScO2) may replace dHbD and changes in total Hb (dHbT), respectively. Correlation (COR) and coherence (COH) were used to measure the agreement of MABP with rScO2/dHbT and cTOI/dHbD. dHbD/cTOI and dHbT/rScO2 recordings of, respectively, 34 and 20 preterm infants in need for intensive care were studied during the first days of life. dHbD and cTOI were obtained with the NIRO300 and rScO2 and dHbT with the INVOS4100. Invasive MABP was measured continuously. COR and COH scores of MABP versus dHbD/dHbT were compared with the corresponding ones by replacing dHbD/dHbT by cTOI/rScO2, respectively. Generally, no significant score differences were found for dHbD/cTOI. Differences for dHbT/rScO2 were slightly larger but still within the normal variation of the parameters. Differences become insignificant when restricting calculations to epochs of larger variation in MABP (>10 mm Hg). Hence, we suggest that cTOI and rScO2 can be used to study cerebral autoregulation in newborns

Doctors' experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data

Objectives: To examine doctors’ experiences of complaints, including which aspects are most stressful. We also investigated how doctors felt complaints processes could be improved. Design and methods: A qualitative study based on a cross-sectional survey of members of the British Medical Association (BMA). We asked the following: (1) Try to summarise as best as you can your experience of the complaints process and how it made you feel. (2) What were the most stressful aspects of the complaint? (3) What would you improve in the complaints system? Participants: We sent the survey to 95 636 doctors, and received 10 930 (11.4%) responses. Of these, 6146 had a previous, recent or current complaint and 3417 (31.3%) of these respondents answered questions 1 and 2. We randomly selected 1000 answers for analysis, and included 100 using the saturation principle. Of this cohort, 93 responses for question 3 were available. Main results: Doctors frequently reported feeling powerless, emotionally distressed, and experiencing negative feelings towards both those managing complaints and the complainants themselves. Many felt unsupported, fearful of the consequences and that the complaint was unfair. The most stressful aspects were the prolonged duration and unpredictability of procedures, managerial incompetence, poor communication and perceiving that processes are biased in favour of complainants. Many reported practising defensively or considering changing career after a complaint, and few found any positive outcomes from complaints investigations. Physicians suggested procedures should be more transparent, competently managed, time limited, and that there should be an open dialogue with complainants and policies for dealing with vexatious complaints. Some felt more support for doctors was needed. Conclusions: Complaints seriously impact on doctors’ psychological wellbeing, and are associated with defensive practise. This is not beneficial to patient care. To improve procedures, doctors propose they are simplified, time limited and more transparent.status: publishe

Etude de faisabilité: Recherche évaluative du programme de réforme fédérale "vers de meillleurs soins en santé mentale"

In dit rapport worden de resultaten voorgesteld van de haalbaarheidsstudie rond de wetenschappelijke evaluatie en opvolging van het hervormingsprogramma ‘Naar een betere geestelijke gezondheidszorg (artikel 107)’. Deze studie bestaat uit 3 onderzoeksluiken en werd uitgevoerd door drie wetenschappelijke equipes, namelijk KU Leuven LUCAS, UCL - IRSS en VUB - OPIH. Het eerste deel van dit rapport bevat de resultaten van het eerste onderzoeksluik, dat werd uitgevoerd door de VUB – OPIH. Dit luik betreft de analyse van de geografische afbakening en de netwerksamenstelling van de hervorming. Het tweede deel van dit rapport bevat een overzicht van het onderzoekswerk, met bijkomende resultaten, conclusies en aanbevelingen, aangaande het tweede en derde onderzoeksluik. Het tweede onderzoeksluik werd uitgevoerd door UCL- IRSS en heeft betrekking op de analyse van het gebruik van diensten. Het derde luik tenslotte werd uitgevoerd door een samenwerking van UCL- IRSS en KU Leuven LUCAS en betreft het onderzoek bij patiënten, zorgverstrekkers en familieleden/mantelzorgers

Triple receptor comparison between primary breast cancer and metachronous or synchronous liver metastasis

status: publishe