The FlaQuM-Quickscan: A starting point to include primary care professionals' perspectives in the evaluation of hospital quality priorities.

INTRODUCTION: Today, primary care professionals' (PCPs) perspectives on hospital quality are unknown when evaluating hospital quality priorities. The aims of the present study were to identify key healthcare quality attributes from PCPs' perspective, to validate an instrument that measures PCPs' experiences of healthcare quality multidimensionally and to define hospital quality priorities based on PCPs' experiences. MATERIAL AND METHODS: Focus groups with PCPs were conducted to identify quality attributes through a qualitative in-depth analysis. A multicentre study of 18 hospitals was used to quantitatively assess construct, discriminant and criterion validity of the FlaQuM-Quickscan, an instrument that measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). To set quality priorities, scores on quality domains were analyzed descriptively and between-hospital variation was examined by evaluating differences in hospitals' mean scores on the quality domains using one-way Analysis of Variance (ANOVA). RESULTS: Identified key attributes largely corresponded with Lachman's multidimensional quality model. Including 'Communication' as a new quality domain was recommended. The FlaQuM-Quickscan was completed by 550 PCPs. Confirmatory factor analyses showed reasonable to good fit, except for the Root Mean Square Error of Approximation (RMSEA) in part 2. The 'Equity' domain scored the highest in parts 1 and 2. Domains 'Kin-centred care' and 'Accessibility and timeliness' scored the lowest in part 1 and 'Resilience' and 'Partnership and co-production' in part 2. Significant variation in hospitals' mean scores was observed for eleven domains in part 1 and sixteen domains in part 2. CONCLUSIONS: The results gained a better understanding of PCPs' perspective on quality. The FlaQuM-Quickscan is a valid instrument to measure PCPs' experiences of hospital quality. Identified priorities indicate that hospital management should focus on multifaceted quality strategies, including technical domains, person-and kin-centredness, core values and catalysts.

[Detection and prevention in later life: risk profiles for physical, psychological, social and environmental frailty.] / Detectie en preventie van kwetsbaarheid: Op zoek naar risicoprofielen voor fysieke, psychische, sociale en omgevingskwetsbaarheid.

In order to provide proactive care and support for older people attention is needed for the prevention of frailty among older adults. Subsequently, accurate case finding of those who are more at risk of becoming frail is crucial to undertake specific preventive actions. This study investigates frailty and risk profiles of frailty among older people in order to support proactive detection. Hereby, frailty is conceived not only as a physical problem, but also refers to emotional, social, and environmental hazards. Using data generated from the Belgian Ageing Studies (N = 21,664 home-dwelling older people), a multinomial logistic regression model was tested which included socio-demographic and socio-economic indicators as well as the four dimensions of frailty (physical, social, psychological and environmental). Findings indicate that for both men and women having moved in the previous 10 years and having a lower household income are risk factors of becoming multidimensional frail. However, studying the different frailty domains, several risk profiles arise (e. g. marital status is important for psychological frailty), and gender-specific risk groups are detected (e. g. non-married men). This paper elaborates on practical implications and formulates a number of future research recommendations to tackle frailty in an ageing society.

Appropriate Prescribing for Older People: A New Tool for the General Practitioner.

BACKGROUND: Appropriate prescribing for older people is a challenge. General practitioners (GPs) are aware of their key position in relation to prescribing practice in the elderly. However, they often feel powerless and report a need for simple GP friendly tools to assess and support their prescribing practice. OBJECTIVES: In this study such a tool is developed: the Appropriate Medication for Older people-tool (AMO-tool). The purpose of the study is to investigate whether GPs consider the use of the AMO-tool to be practically feasible and resulting in more appropriate prescribing. DESIGN: This pilot study with an interventional design was conducted over a period of six months. SETTING: The study was conducted in nursing homes visited by GPs. PARTICIPANTS: The studied population consisted of nine GPs and 67 nursing home residents. INTERVENTION: The intervention consisted of the use of the AMO-tool. MEASUREMENTS: The Short Form (SF)-12 questionnaire was administered to the patients. Patients' medication lists were recorded. The GPs completed a semi-quantitative questionnaire on their experiences with the AMO-tool. A descriptive qualitative and semi-quantitative analysis was carried out on the GP questionnaire. The results of the SF-12 questionnaires and medication lists were analysed quantitatively. A multivariate analysis was carried out. RESULTS: In the perception of GPs, applying the AMO-tool to medication lists of nursing home residents was feasible and resulted in more appropriate prescribing. A slight reduction was recorded in the number of medications prescribed. Self-reported well-being improved and rose in parallel with the number of medication changes. CONCLUSION: According to GPs, the AMO-tool offers GPs the support in their prescribing practice. Changes are made to medication lists and improvements occur in patients' self-reported well-being. Future research should objectify the appropriateness of prescriptions before and after using the tool. Furthermore, it should investigate the possible causal relationship between the use of the AMO-tool, an increase in appropriateness of medication lists and an improvement of general well-being.

Antimicrobial susceptibility of sixty human fecal isolates of Aeromonas species.

The MICs of 21 antimicrobial agents were determined for 60 strains of Aeromonas spp. isolated from human feces. All isolates tested were susceptible to aztreonam, tetracycline, imipenem, moxalactam, pipemidic acid, gentamicin, trimethoprim-sulfamethoxazole, pefloxacin and ciprofloxacin. Resistance to erythromycin and streptomycin was observed in all 60 strains. Aeromonas caviae was less susceptible to cefamandole, cefotaxime, norfloxacin, chloramphenicol, tetracycline, sulfamethoxazole and trimethoprim than was either Aeromonas hydrophila or Aeromonas sobria. It was concluded that cotrimoxazole or one of the newer quinolones can be considered for treatment of aeromonas-associated diarrhea.

Phenotypic characterization and DNA relatedness in human fecal isolates of Aeromonas spp.

Phenotypic characteristics were used to identify 189 Aeromonas strains isolated from human feces. One hundred forty-two of these strains were placed in 11 DNA hybridization groups, and the genetic and phenotypic data were compared. According to the criteria of Popoff, 66% of the strains were identified as Aeromonas caviae, 18% were identified as A. sobria, and 16% were identified as A. hydrophila. Some biochemical characteristics differed from the criteria of Popoff; 19 of 40 (48%) of tested strains were encapsulated, 42 of 124 (34%) of A. caviae strains were nonmotile, and all A. sobria strains were resistant to KCN. Gas production from D-glucose was temperature dependent; 11 of 64 (17%) A. hydrophila and A. sobria strains produced gas only at 22 degrees C. Of 142 Aeromonas strains, 57% belonged to hybridization group 4, 25% belonged to group 8, 11% belonged to group 1, 4% belonged to group 5A, 2% belonged to group 3, and 1% belonged to group 2. Of 26 strains phenotypically identified as A. hydrophila, 8 (31%) were in hybridization group 8, which contains strains of the new species A. veronii. It therefore appears that our ability to identify Aeromonas strains phenotypically is not sufficiently specific. Either additional definitive biochemical markers must be found or phenotypic identification, at least for some Aeromonas groups, must be regarded as only presumptive.