Pre-hospital triage centres were created during the first wave of Covid-19 in March 2020. The intention was to examine patients in appropriate sanitary conditions and prevent emergency departments from overcrowding. This study describes triage centres in the Federation Wallonia-Brussels. The aim of the study was to collect key aspects of triage centres, implementation and information about the daily functioning interpreted positively or negatively by the GP-coordinators in charge of their management. This study was divided into two parts : an online questionnaire and semi-structured interviews. Overall, 14 questionnaires and 6 interviews were collected among the 44 initially contacted GP-coordinators. Our results point to a highly heterogeneous organisation of the triage centres, nevertheless adapted to local contexts, as well as a gap between local effective dynamics and challenges regarding federal/regional cooperation. This study may help for further crisis management plans.
Lors de la première vague de l'épidémie COVID-19, en mars 2020, des centres de tri (CDT) pré-hospitaliers ont été créés. Leur objectif était double : examiner les patients dans les conditions sanitaires adéquates et limiter l'afflux de patients aux urgences. L'étude vise à décrire ces CDT en Fédération Wallonie-Bruxelles. L'objectif était de relever, auprès des médecins généralistes (MG) coordinateurs de ces centres, les éléments ressentis comme positifs et négatifs dans la mise en place et le fonctionnement quotidien des CDT afin d'améliorer le dispositif pour de futures implémentations. Cette étude comportait deux volets : un questionnaire en ligne et des entretiens semi-structurés. Sur les 44 MG coordinateurs contactés, 14 questionnaires et 6 entretiens ont été récoltés. Nous avons mis en évidence une organisation très hétérogène des CDT, adaptée au contexte local, ainsi qu'un décalage entre la dynamique locale, décrite comme efficace, et les difficultés de coopération avec les niveaux fédéral et régional. Les résultats de cette étude pourraient aider dans l'implémentation de prochains plans de prise en charge en période de crise sanitaire.
COVID-19 , Triage , Emergency Service, Hospital , Hospitals , Humans , SARS-CoV-2
PURPOSE: Infectious complications (ICs) after mesh-reinforced ventral hernioplasty often lead to prolonged and complicated hospitalizations. As early diagnosis and management can mitigate complications, early prediction is important. Our aim was to determine whether postoperative blood tests are valuable predictors of IC. METHODS: We retrospectively analyzed 373 patients who underwent conventional ventral hernioplasty with mesh augmentation between 2008 and 2011. The clinical outcome was correlated with postoperative serum C-reactive protein (CRP) and white blood cell counts (WBC) and assessed by area under the curve (AUC) analysis of the receiver operating characteristics curve. RESULTS: ICs occurred in 51 (13.7%) patients, who required further management. Among these, 48 patients developed a procedure-related complication, the most frequent being surgical site infection (n = 44). The infections appeared after a median postoperative delay of 12 days. Serum CRP was superior to WBC in the prediction of a complicated course. A maximum CRP < 105 mg/L on postoperative day (POD) 2 or 3 had the highest negative predictive value (NPV; 100%) in ruling out ICs [positive predictive value (PPV) 29%; sensitivity 100%; specificity 55%]. The PPV for occurrence of IC improved each day after surgery, reaching up to 46% on POD 5 or 6 for a CRP cut-off of 63.2 mg/L (NPV 93%; sensitivity 69%; specificity 83%). The AUC was 0.80 at both time points. CONCLUSIONS: Our results indicate that postoperative serum CRP allows for early prediction of the postoperative course. Low CRP during the initial PODs is associated with lower risk of ICs. Higher levels on POD 5 or 6 behoove close surveillance.
C-Reactive Protein/metabolism , Hernia, Ventral/surgery , Herniorrhaphy/adverse effects , Surgical Mesh/adverse effects , Surgical Wound Infection/diagnosis , Biomarkers , Cohort Studies , Female , Humans , Leukocyte Count , Male , Middle Aged , Predictive Value of Tests , ROC Curve , Retrospective Studies , Sensitivity and Specificity , Surgical Wound Infection/blood
OBJECTIVES: Several concepts on collaboration between patients and healthcare systems have emerged in the literature but there is little consensus on their meanings and differences. In this study, "patient participation" and related concepts were studied by focusing on the dimensions that compose them. This review follows two objectives: (1) to produce a detailed and comprehensive overview of the "patient participation" dimensions; (2) to identify differences and similarities between the related concepts. METHODS: A scoping review was performed to synthesize knowledge into a conceptual framework. An electronic protocol driven search was conducted in two bibliographic databases and a thematic analysis was used to analyse the data. RESULTS: The search process returned 39 articles after exclusion for full data extraction and analysis. Through the thematic analysis, the dimensions, influencing factors and expected outcomes of "patient participation" were determined. Finally, differences between the included concepts were identified. CONCLUSION: This global vision of "patient participation" allows us to go beyond the distinctions between the existing concepts and reveals their common goal to include the patient in the healthcare system. PRACTICE IMPLICATIONS: This scoping review provides useful information to propose a conceptual model of "patient participation", which could impact clinical practice and medical training programs.
Patient Participation , Humans
Patient engagement in health care system can be regarded as a lever for the general improvement of people's health, the quality and safety of care. Among the many approaches that co-exist, the model of Patient Partner is relatively recent and declares itself as the most successful to promote this engagement. The authors of this article propose to present briefly the above model and to raise the remaining questions on its operational application. We will then present the research program «Patient Partner Approach to Care¼ (INTERREG Va) that questions the Patient Partner model in an interregional context (Wallonia - Grand Duchy of Luxembourg - Lorraine - Rhineland-Palatinate and Saarland).
L'engagement des patients dans le système de santé peut être considéré comme un levier pour l'amélioration générale de la santé des populations ainsi que la qualité et la sécurité des soins. Parmi les nombreuses approches qui co-existent, le modèle du « Patient Partenaire ¼ est relativement récent et se déclare le plus abouti pour favoriser cet engagement. Les auteurs de cet article proposent de présenter, brièvement, le modèle susmentionné et de soulever les questions qui demeurent sur son application opérationnelle. Nous présenterons ensuite le programme de recherche «Approche Patient Partenaire de Soins¼ (INTERREG Va) qui questionne ce modèle de Patient Partenaire dans un contexte interrégional (Wallonie - Grand-Duché du Luxembourg - Lorraine - Rhénanie- Palatinat et Sarre).
Models, Organizational , Patient Participation , Humans
BACKGROUND: Microscopic colitis causes chronic watery diarrhoea. Recent studies have suggested an aetiological role for various medications, including proton pump inhibitors, in the pathogenesis of microscopic colitis. AIM: To determine whether an association exists between microscopic colitis and proton pump inhibitor use in patients with documented microscopic colitis vs. age- and gender-matched controls. METHODS: In this retrospective case-control study, cases of microscopic colitis from a secondary and tertiary referral medical centre diagnosed in the last 5 years were reviewed. Demographic characteristics, clinical, histological and endoscopic records, as well as exposure to PPIs and NSAIDs were assessed. Controls from the population were matched to cases by gender and by age. RESULTS: During the investigated period, 136 cases were identified in both hospitals. Of these, 95 cases of microscopic colitis were retrieved for detailed analysis. Exposure to proton pump inhibitors at the time of the histological diagnosis was significantly higher in patients with collagenous colitis than in controls [38% vs. 13%, P < 0.001; adjusted OR of 4.5 (95% CI 2.0-9.5)]. CONCLUSIONS: This observation confirms the presumed association between microscopic colitis and PPI use, and it supports the possible aetiological role of PPI exposure in the development of microscopic colitis.
Colitis, Microscopic/drug therapy , Diarrhea/chemically induced , Proton Pump Inhibitors/adverse effects , Case-Control Studies , Colitis, Microscopic/pathology , Female , Humans , Male , Middle Aged , Netherlands , Retrospective Studies , Risk Factors , Statistics as Topic , Surveys and Questionnaires
BACKGROUND: Radiographic contrast media (CM) application causes a decline in renal function, especially in patients with pre-existing renal dysfunction. In addition to hydration, several vasodilating substances have been evaluated for their ability to prevent renal damage after CM application. In a prospective, double-blind, placebo-controlled study we investigated the effect of the oral administration of theophylline, an adenosine receptor antagonist, on changes in renal haemodynamics and tubular injury induced by CM in well-hydrated patients with mild-to-moderate renal insufficiency. METHODS: We studied 80 patients with pre-existing chronic renal insufficiency (creatinine > 1.5 mg/dl) who received more than 100 ml iopromide. Hydration (either oral or intravenous) started at least 24 h before and lasted until 24 h after CM application. In addition, patients were randomly assigned to receive either theophylline (810 mg daily) or placebo. Serum creatinine and creatinine clearance were measured before and for 3 days after CM application. Urine was collected to measure N-acetyl-beta-glucosaminidase (NAG) enzymuria for the same period. Sixty-four patients completed the entire study protocol (theophylline, n = 35 and placebo, n = 29). RESULTS: During the study period serum creatinine concentration and creatinine clearance did not change significantly in either group. Acute renal failure (increase of serum creatinine of at least 0.5 mg/dl) could be observed in two patients from the theophylline group (5.7%) and one from the placebo group (3.4%). The increase in NAG excretion reached statistical significance (P < 0.05) in the placebo group on days 2 and 3 after CM application. CONCLUSIONS: Our results indicate a role for adenosine in CM-induced tubulotoxicity. However, the glomerular filtration rate is preserved by hydration alone in these patients. The application of theophylline did not bring an additional benefit. The use of adenosine antagonists may be beneficial in patients where sufficient hydration may be impossible or in patients with a concomitant decrease in renal blood flow (e.g. congestive heart failure).
Contrast Media/adverse effects , Fluid Therapy , Kidney Diseases/chemically induced , Kidney Diseases/prevention & control , Kidney Failure, Chronic/therapy , Theophylline/therapeutic use , Acetylglucosaminidase/urine , Adenosine/antagonists & inhibitors , Aged , Combined Modality Therapy , Creatinine/metabolism , Double-Blind Method , Female , Humans , Kidney Failure, Chronic/diagnostic imaging , Kidney Failure, Chronic/physiopathology , Male , Middle Aged , Prospective Studies , Radiography
