المؤلفون: Leroy, Roos

المساهمون: Declerck, Dominique

مصطلحات موضوعية: Adult, Belgium, Cross-Sectional Studies, Journal Article, Longitudinal Studies, Middle Aged, National Health Programs, Peer Review, Pilot Projects, W 1 Serials. Periodicals

الوصف: p.36-42 ; Reports on oral health-service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health-care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health-care utilization and socio-demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental-attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral-treatment needs.

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=4088; https://kce.docressources.info/index.php?lvl=notice_display&id=4088Test; 4088

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=4088Test

المؤلفون: Leroy, Roos

المساهمون: Declerck, Dominique, Marks, L.

مصطلحات موضوعية: Adolescent, Adult, Belgium, Comparative Study, Dental Caries, Denturists, Journal Article, Mouth Diseases, Peer Review, W 1 Serials. Periodicals

الوصف: p. 68-73 ; To describe and evaluate the oral condition and oral treatment needs of the participants of the Special Olympics Special Smiles program organised in Belgium in 2008. A cross-sectional study where the data were collected through interviews and clinical examinations. 687 Belgian Special Smiles athletes participated, mean age 33 years. More than 70% had at least one missing tooth. Distinct signs of gingivitis and visible caries experience were observed in 44% and 22% of dentate athletes respectively. Dutch-speaking athletes were less likely to present with untreated caries (OR: 0.46; 95% CI: 0.31-0.68) or with gingivitis (OR: 0.51; 95% CI: 0.37-0.71) compared to their French-speaking colleagues. Signs of past injury were identified in 12% of athletes. Of those athletes with an edentulous mandible, only 53% presented with a removable denture; 73% of athletes missing some maxillary anterior teeth and 30% of those missing all anterior teeth had no prosthetic replacement in the maxilla. Nearly two fifths of athletes were referred for treatment: in 12% of athletes dental treatment was considered urgent. The results suggest that there is a tremendous unmet need for dental treatment in the Belgian Special Smiles population, with French-speaking athletes in greatest need. Improvements in data collection should be encouraged for example. more detailed screening methods (e.g. caries screening including enamel lesions, full periodontal examination) and questionnaires (e.g. inclusion of questions related to dietary habits, dental attendance). In this way barriers to optimal oral health (care) in this population could be further explored, attempts made to reduce them and so reduce health inequalities.

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=4063; https://kce.docressources.info/index.php?lvl=notice_display&id=4063Test; 4063

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=4063Test

المؤلفون: Vrijens, France

المساهمون: Stordeur, Sabine, Beirens, Koen, Devriese, Stephan, Van Eycken, E., Vlayen, Joan

مصطلحات موضوعية: R150, Adult, Aged, 80 and over, Belgium, Breast Neoplasms, Hospital Mortality, statistics and numerical data [Subheading], Outcome Assessment (Health Care), Quality Indicators, Health Care, W 1 Serials. Periodicals

الوقت: 2008-52

الوصف: 261-266 ; PURPOSE: To compare processes of care and survival for breast cancer by hospital volume in Belgium, based on 11 validated process quality indicators. METHODS: Three databases were linked at the patient level: the Cancer Registry, the population and the claims databases. All women with a diagnosis of invasive breast cancer between 2004 and 2006 were selected. Hospitals were classified according to their annual volume of treated patients: <50 (very low), 50-99 (low), 100-149 (medium) and >/= 150 patients (high). Cox and logistic regression models were used to test differences in 5-year survival and in achievement of process indicators across volume categories, adjusting for age, tumor grade and stage. RESULTS: A total of 25178 women with invasive breast cancer were treated in 111 hospitals. Half of the hospitals (N=57) treated <50 patients per year. Six of eleven process indicators showed higher rates in high-volume hospitals: multidisciplinary team meeting, cytological and/or histological assessment before surgery, use of neoadjuvant chemotherapy, breast-conserving surgery rate, adjuvant radiotherapy after breast-conserving surgery, and follow-up mammography. Higher volume was also associated with improved survival. The 5-year observed survival rates were 74.9%, 78.8%, 79.8% and 83.9% for patients treated in very-low-, low-, medium- and high-volume hospitals respectively. After case-mix adjustment, patients treated in very-low- or low-volume hospitals had a hazard ratio for death of 1.26 (95% CI 1.12, 1.42) and 1.15 (95% CI 1.01, 1.30) respectively compared with high-volume hospitals. CONCLUSION: Survival benefits reported in high-volume hospitals suggest a better application of recommended processes of care, justifying the centralization of breast cancer care in such hospitals.

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=3734; https://kce.docressources.info/index.php?lvl=notice_display&id=3734Test; 3734

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=3734Test

المؤلفون: Stordeur, Sabine

المساهمون: Vrijens, France, Devriese, Stephan, Beirens, Koen, Van Eycken, E., Vlayen, Joan

مصطلحات موضوعية: Adult, Aged, Belgium, Breast Neoplasms, Health Status, Journal Article, Peer Review, Quality of Life, R150, Survival Analysis, W 1 Serials. Periodicals

الوقت: 2008-52

الوصف: 253-260 ; PURPOSE: This study aimed at developing and measuring a set of indicators to monitor the quality of breast cancer care, to make comparisons over time and to support quality improvement for all practitioners and centres involved in the care of breast cancer women. METHODS: Quality indicators were identified from a systematic literature search and the 2010 Belgian evidence-based clinical practice guideline. The selection process involved an expert panel evaluating reliability, relevance, interpretability and actionability of each indicator. The quality indicators were tested using the Belgian Cancer Registry data linked with claims data for all women registered with breast cancer in Belgium between 2001 and 2006 (n=50,039). RESULTS: The selection process led to a final set of 32 indicators. Of these, 12 were measurable using the available data, while 1 indicator was measurable using proxy information. Five-year relative survival was 98%, 87%, 68% and 29% for pStage I, II, III and cStage IV respectively. Overall 5-year survival slightly improved for pStage II, III and cStage IV between 2001 and 2004. Of the surgically treated women, 60% underwent breast conserving surgery, 85% received adjuvant systemic treatment and 86% were irradiated postoperatively. In 80% of women treated for breast cancer, at least one mammography was performed within one year after the last treatment. CONCLUSION: The present study demonstrates the feasibility to develop a multidisciplinary set of quality indicators for breast cancer. Using national cancer registry data linked to claims data, 13 indicators were measurable, showing results that largely correspond to other studies in the field.

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=3733; https://kce.docressources.info/index.php?lvl=notice_display&id=3733Test; 3733

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=3733Test

المؤلفون: Van Herck, P

المساهمون: Sermeus, Walter, Jylha, V., Van Den Heede, Koen

مصطلحات موضوعية: Adolescent, Adult, Aged, 80 and over, Belgium, Child, Evidence-Based Medicine, Health Knowledge, Attitudes, Practice, Intensive Care Units, Journal Article, Medical Informatics Applications, Peer Review, Pressure Ulcer, Quality of Health Care, statistics and numerical data [Subheading], W 1 Serials. Periodicals

الوصف: p. 375-382 ; RATIONALE, AIMS AND OBJECTIVES: Issues of overuse, underuse and misuse are paramount and lead to avoidable morbidity and mortality. Although evidence-based practice is advocated, the widespread implementation of this kind of practice remains a challenge. This is also the case for evidence-based practice related to the prevention of pressure ulcers, which varies widely in process and outcome in Belgian hospital care. One major obstacle to bridging this knowledge-to-action gap is data availability. We propose using large-scale hospital administrative data combined with the latest evidence-based methods as part of the solution to this problem. METHOD: To test our proposal, we applied this approach to pressure ulcer prevention, using an administrative dataset with regard to 6030 patients in 22 Belgian hospitals as a sample of nationally available data. Methods include a systematic review approach, evidence grading, recommendations formulation, algorithm construction, programming of the rule set and application on the database. RESULTS: We found that Belgian hospitals frequently failed to provide appropriate prevention care. Significant levels of underuse, up to 28.4% in pressure ulcer prevention education and 17.5% in the use of dynamic systems mattresses, were detected. Figures for overuse were mostly not significant. Misuse couldn't be assessed. CONCLUSIONS: These results demonstrate that this approach can indeed be successfully used to bridge the knowledge-to-action gap in medical practice, by implementing an innovative method to assess underuse and overuse in hospital care. The integrative use of administrative data and clinical applications should be replicated in other patient groups, other datasets and other countries.

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=4121; https://kce.docressources.info/index.php?lvl=notice_display&id=4121Test; 4121

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=4121Test

المؤلفون: Camberlin, Cécile

المساهمون: Ramaekers, Dirk

مصطلحات موضوعية: W 1 Serials. Periodicals, Peer Review, Journal Article, Netherlands, Belgium, Adolescent, Adult, Anti-Bacterial Agents, Child, Preschool, Prescriptions, Drug, Drug Resistance, Microbial, Drug Utilization, Female, Guideline adherence

الوصف: 143-51

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=2012; https://kce.docressources.info/index.php?lvl=notice_display&id=2012Test; 2012

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=2012Test

المؤلفون: Thiry, Nancy

المساهمون: De Laet, Chris, Hulstaert, Frank, Neyt, Mattias, Huybrechts, Michel, Cleemput, Irina

مصطلحات موضوعية: W 1 Serials. Periodicals, Journal Article, Peer Review, Great Britain, Adolescent, Adult, Belgium, Child, Cohort Studies, Cost-Benefit Analysis, Female, Humans, Health Care Costs, Markov Chains, Mass Screening, Papillomavirus Vaccines, Quality-Adjusted Life Years

الوصف: 161-170 ; OBJECTIVES: The cost-effectiveness of adding a human papillomavirus (HPV) vaccination program in 12-year-old females to the recommended cervical cancer screening in Belgium is examined. Moreover, the health and economic consequences of a potential decline in screening uptake after initiation of a HPV vaccination program are investigated. METHODS: A static Markov model is developed to estimate the direct effect of vaccination on precancerous lesions and cervical cancers. RESULTS: Vaccination is estimated to avoid 20 percent of the cervical cancers occurring in a 12-year-old girls' cohort and to cost 32,665 euro per quality-adjusted life-year (QALY) gained (95 percent credibility interval [CrI]: 17,447 euro to 68,078 euro), assuming a booster injection after 10 years, a limited duration of protection and discounting costs and effects at 3 percent and 1.5 percent, respectively. Assuming lifelong protection, HPV vaccination is estimated to cost 14,382 euro (95 percent CrI: 9,238 euro to 25,644 euro) per QALY gained, while avoiding 50 percent of the cervical cancer cases. In the base-case, a 10 percent reduction in screening compliance after vaccination obliterates the effect of vaccination on cervical cancer cases avoided, whereas further declines in the level of screening compliance even turned out to be detrimental for the cohort's health, inducing a mean loss in QALYs and life-year gained compared with the situation prevaccination. CONCLUSIONS: An HPV vaccination program should only be considered if the level of screening after vaccination can be maintained.

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=2200; https://kce.docressources.info/index.php?lvl=notice_display&id=2200Test; 2200

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=2200Test

المؤلفون: Peetermans, W.E.

المساهمون: Van de Vyver, N, Van Laethem, Y., Van Damme, Pierre, Thiry, Nancy, Trefois, P., Geerts, P., Schetgen, M., Peleman, R, Swennen, B., Verhaegen, J.

مصطلحات موضوعية: administration and dosage, Adult, Aged, Belgium, complications, Cost-Benefit Analysis, Economics, Humans, Journal Article, Peer Review, Pneumococcal Infections, Pneumococcal Vaccines, Practice Guideline [Publication type], prevention and control, Treatment outcome, W 1 Serials. Periodicals

الوصف: 329-337 ; A multidisciplinary expert panel, appointed by the High Council for Public Health, evaluated the scientific evidence on which the recommendations for the appropriate use of the pneumococcal vaccine was based and reviewed the studies that became available since previous reports. The conclusions of the working group, presented in this manuscript, resulted in an update of the Belgian recommendations for pneumococcal vaccination.

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=1770; https://kce.docressources.info/index.php?lvl=notice_display&id=1770Test; 1770

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=1770Test

المؤلفون: Philip, George

المساهمون: Nayak, A.S., Berger, W.E., Leynadier, F., Vrijens, France, Dass, S.B., Reiss, T.F.

مصطلحات موضوعية: Acetates, Adolescent, Adult, Aged, Allergy and Immunology, Asthma, Double-Blind Method, Treatment outcome, W 1 Serials. Periodicals

الوصف: p. 1549-1558 ; OBJECTIVE: The objective of this study was to evaluate montelukast 10 mg daily as treatment for allergic rhinitis in patients with symptomatic allergic rhinitis and active asthma during the allergy season. METHODS: This was a multicenter study of 831 patients (ages 15 years-85 years) with seasonal allergen sensitivity, active symptoms of seasonal allergic rhinitis, and active asthma. Following a single-blind, placebo run-in period of 3 days-5 days, patients were randomized to oral montelukast 10 mg (n = 415) or placebo (n = 416) daily during the 2-week, double-blind, active-treatment period. MAIN OUTCOME MEASURES: The primary endpoint was Daily Rhinitis Symptoms score, average of Daytime Nasal Symptoms and Nighttime Symptoms, as self-rated by patients on a 0-3 scale on daily diaries. RESULTS: Montelukast reduced the Daily Rhinitis Symptoms score: difference between montelukast and placebo in mean change from baseline was -0.12 [95% CI -0.18, -0.06; p < or = 0.001]. Similar improvements were seen in Daytime Nasal Symptoms (-0.14 [-0.21, -0.07; p < or = 0.001]) and Nighttime Symptoms (-0.10 [-0.16, -0.04; p < or = 0.001]). Improvements (p < 0.05) were seen in Daytime Eye Symptoms and in the secondary endpoints of Global Evaluations of AR by Patient and by Physician, and Rhinoconjunctivitis Quality of Life. In exploratory analyses, improvement in rhinitis symptoms was numerically (though not statistically) larger in patients with greater levels of asthma at study start. Montelukast provided benefit in the Global Evaluations of Asthma by Patient and by Physician: mean differences were -0.24 [-0.41, -0.06; p = 0.008] and -0.17 [-0.33, -0.01; p = 0.037]. Similarly, as-needed beta-agonist use (puffs/day) was reduced with montelukast (p < or = 0.005). CONCLUSION: Montelukast provides significant relief from symptoms of seasonal allergic rhinitis, while also conferring a benefit for asthma, in patients with both allergic rhinitis and asthma.

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=4075; https://kce.docressources.info/index.php?lvl=notice_display&id=4075Test; 4075

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=4075Test

المؤلفون: Brandes, J.

المساهمون: Visser, W.H., Farmer, M.V., Schuhl, A.L., Malbecq, W., Vrijens, France, Lines, C.R., Reines, S.A.

مصطلحات موضوعية: Acetates, Adult, Double-Blind Method, Female, Humans, Journal Article, Leukotriene Antagonists, Male, Migraine Disorders, Peer Review, prevention and control, R149, Treatment outcome, W 1 Serials. Periodicals

الوقت: 2008-52

الوصف: 581-6 ; OBJECTIVE: To evaluate the efficacy and tolerability of montelukast 20 mg in the prophylactic treatment of migraine. BACKGROUND: A previous small open-label study in migraine patients suggested prophylactic efficacy for montelukast, an antagonist of the cysteinyl leukotriene receptor that is used in the treatment of asthma. We sought to confirm these findings in a randomized controlled trial. METHODS: This multicenter, randomized, double-blind, placebo-controlled, parallel-groups study enrolled adult migraine outpatients who experienced > or =3 and < or =8 migraine attacks per month for the last 6 months. Patients were entered into a 2-month, single-blind, placebo run-in phase. Only patients who experienced > or =3 migraine attacks in the second month were eligible to enter the subsequent 3-month, double-blind treatment phase of the study. The primary efficacy endpoint was the percentage of patients reporting at least a 50% decrease in migraine attack frequency per month during the double-blind treatment period (months 3-5) compared to baseline (run-in month 2). RESULTS: A total of 93 patients were randomized to montelukast 20 mg and 84 patients to placebo at the end of the placebo run-in month 2; 76 patients on montelukast and 72 patients on placebo completed the double-blind treatment period. Over 3 months of treatment, there was no significant difference between the two groups in the percentage of patients who reported at least a 50% decrease in migraine attack frequency per month: 15.4% for montelukast versus 10.3% for placebo (P= .304). In addition, montelukast 20 mg was not significantly superior to placebo on any of the secondary endpoints. There were no differences between treatment groups for adverse events. CONCLUSION: Montelukast 20 mg was well tolerated in migraine patients but was not an effective prophylactic for prevention of migraine.

العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=2547; https://kce.docressources.info/index.php?lvl=notice_display&id=2547Test; 2547

الإتاحة: https://kce.docressources.info/index.php?lvl=notice_display&id=2547Test