CLEEMPUT, Irina; Franken, Margreet; Koopmanschap, Marc; le Polain, Maite
Objectives. In a democratic system, decision makers are accountable for the reasonableness of their decisions. This presumes (i) transparency, (ii) relevance of the decision criteria, (iii) revisability of decisions, and (iv) enforcement/regulation. We aim to (i) evaluate the extent to which drug reimbursement decision-making processes in different contexts meet these conditions and (ii) develop, starting from these findings, a framework for improving the transparency and the relevance of used decision criteria. Methods. We evaluated the Austrian, Belgian, French, Dutch, and Swedish drug reimbursement systems. Based on this evaluation, we developed a framework for improving the transparency of drug reimbursement decision-making...
Franken, Margreet; le Polain, Maite; CLEEMPUT, Irina; Koopmanschap, Marc
Objectives: The aim of our study is to compare five European drug reimbursement systems, describe similarities and differences, and obtain insight into their strengths and weaknesses and formulate policy recommendations. Methods: We used the analytical Hutton Framework to assess in detail drug reimbursement systems in Austria, Belgium, France, the Netherlands, and Sweden. We investigated policy documents, explored literature, and conducted fifty-seven interviews with relevant stakeholders. Results: All systems aim to balance three main objectives: system sustainability, equity and quality of care. System impact, however, is mainly assessed by drug expenditure. A national reimbursement agency evaluates reimbursement requests on a case-by-case...
Hellings, Niels; Janssens, Kris; Hendriks, Jerome; de Vries, H.; Vanwijmeersch, B.; Op't Eijnde, Bert; Van den Haute, C.; Baekelandt, Veerle; Stinissen, Piet; Slaets, H.
Purpose/Objective: The interleukin-6 class cytokines leukemia
inhibitory factor (LIF) and oncostatin M (OSM) are upregulated in
multiple sclerosis (MS) lesions, but their effects on CNS lesion
development are far from understood. LIF and OSM potentially
influence immune responses as well as CNS resident cells during
neuroinflammatory conditions. Importantly, since they activate different
receptors, LIF and OSM can influence these parameters to different
extents. This study was designed to elucidate the role of OSM
and LIF in MS lesion development.
Materials and methods: Stereotactic application of lentiviral vectors
was performed to achieve a stable expression and secretion of LIF or
OSM in the CNS of adult mice. Experimental autoimmune encephalomyelitis
(EAE) was induced...
BROUX, Bieke; VAN WIJMEERSCH, Bart; STINISSEN, Piet; HELLINGS, Johan
Purpose/Objective: Immune ageing or immunosenescence, contributes to the increased morbidity and mortality seen in the elderly. Premature immunosenescence is shown to occur in patients with multiple sclerosis(MS). The main characteristic of immunosenescence is the expansion of CD4+ CD28- T cells in the peripheral blood. We showed that these cells accumulate in brain lesions of MS patients CD24+ CD28- T cells have a cytotoxic profile, shown by expression of the cytotoxic molecules perforin, granzyme B and NKG2D, an activating natural killer (NK) cell receptor. For NK cells, it is known that NKG2D expression and cytotoxicity increase in response to interleukin (IL)-15,...
Vanheel, A.; Brone, B.; DANIELS, Ruth; Stinissen, P.; Noben, J. P.; Hellings, N.
Purpose/Objective: A more detailed insight into disease mechanisms of multiple sclerosis (MS) is crucial for the development of new and more effective theories. MS is a chronic inflammatory autoimmune disease of the central nervous system. The aim of this study is to identify novel disease associated proteins that are functionally involved in the MS brain pathology. Materials and methods: In a previous proteomics study, brainstem proteins were obtained from Lewis rats with MBP induced acute experimental autoimmune encephalomyelitis (EAE), a well characterized disease model of MS. Samples were collected at different time points: just before onset of symptoms, at the...
HELLINGS, Niels; THEWISSEN, Kristof; Nuyts, A. H.; Deckx, N.; Van Tendeloo, V. F. I.; STINISSEN, Piet; Berneman, Zwi N.; Cools, N.
Purpose/Objective: Dendritic cells (DC) are widely known as professional antigen-presenting cells and provide an important link to the adaptive immune system where they regulate the balance between immunity and tolerance. Alternations in the DC compartment can ultimately lead to the induction or perpetuation of autoimmune diseases such as multiple sclerosis (MS). This study aims to identify alterations in DC phenotype and functionality in MS. Moreover, the contribution of genetic risk factors to DC alterations was determined. Materials and methods: An ex vivo analysis of myeloid (mDC) and plasmacytoid DC (pDC) was carried out on peripheral blood of MS patients(n=104) and...
Bergs, Jochen; Zurel, Ozhan; Cleemput, Irina; Hellings, Johan; Vandijck, Dominique
Leupe, P.; Hox, V.; Debruyne, F.; Schrooten, W.; Claes, Neree; Lemkens, N.; Lemkens, P.
Tonsillectomy compared to acute tonsillitis in children: a comparison study of societal cost. Introduction and aim: Tonsillectomy is one of the most commonly performed surgical procedures in children; its main indications are recurrent episodes of acute tonsillitis and adenotonsillar hypertrophy. The effectiveness of tonsillectomy for severe recurrent tonsillitis is generally accepted; however its socio-economic cost is less well investigated. This study aims to determine and compare the societal cost of a tonsillectomy and a severe throat infection. Materials and methods: The costs for both tonsillectomy and severe throat infection were evaluated. Costs of the surgical procedure and hospital stay were...
Vlayen, Annemie; Marquet, Kristel; Schrooten, Ward; Vleugels, Arthur; Hellings, Johan; De Troy, Elke; Weekers, Frank; Claes, Neree
BACKGROUND: Adverse events are unintended patient injuries that arise from healthcare management resulting in disability, prolonged hospital stay or death. Adverse events that require intensive care admission imply a considerable financial burden to the healthcare system. The epidemiology of adverse events in Belgian hospitals has never been assessed systematically.
FINDINGS: A multistage retrospective review study of patients requiring a transfer to a higher level of care will be conducted in six hospitals in the province of Limburg. Patient records are reviewed starting from January 2012 by a clinical team consisting of a research nurse, a physician and a clinical pharmacist. Besides...
Vlayen, Annemie; Hellings, Johan; Claes, Neree; Peleman, Hilde; Schrooten, Ward
Objective: To measure patient safety culture in Belgian hospitals and to examine the homogeneous grouping of underlying safety culture dimensions.
Methods: The Hospital Survey on Patient Safety Culture was distributed organisation-wide in 180 Belgian hospitals participating in the federal program on quality and safety between 2007 and 2009. Participating hospitals were invited to submit their data to a comparative database. Homogeneous groups of underlying safety culture dimensions were sought by hierarchical cluster analysis.
Results: 90 acute, 42 psychiatric and 11 long-term care hospitals submitted their data for comparison to other hospitals. The benchmark database included 55 225 completed questionnaires (53.7% response...
Claes, Neree; Van Laethem, Christophe; Goethals, Marnix; Goethals, Peter; Mairesse, Georges H.; Schwagten, Bruno; Nuyens, Dieter; Schrooten, Ward; Vijgen, Johan
Objective Atrial fibrillation (AF) is a common arrhythmia in clinical practice. AF fulfils many of the criteria for a screening programme. No data about the prevalence of AF in non-hospitalized patients are available in Belgium. The aim of the study was to assess feasibility and effectiveness of a nationwide-organized voluntary screening programme in the general population in Belgium. Methods A total of 13.564 participants were screened, of whom 10,758 were older than 40 years (GSP group). Participants filled in stroke risk stratification questionnaires (CHADS2 and CHA2DS2-VASc). A one-lead electrocardiogram was performed. Results 228 participants had AF at the time of...
Limburg Sterk Merk
Limburg Sterk Merk
Vlayen, Annemie; Schrooten, Ward; Hellings, Johan; Claes, Neree
Objectives: To examine whether safety culture evolved in Belgian hospitals after a period of three years and to explore the opportunities for benchmarking.
Methods: Patient safety culture was measured on 12 dimensions using the validated versions of the Belgian Hospital Survey on Patient Safety Culture. Hospitals were invited to participate in a second nationwide benchmark database.
Results: In total, the benchmark database contains the safety culture perceptions of 115 764 respondents from 176 hospitals. Of these, 147 hospitals conducted a first measurement (53.6% response rate) and 140 hospitals repeated the measurement after three years (50.6% response rate). For 111 hospitals which participated...
Vlayen, Annemie; Schrooten, Ward; Aerts, Marc; Wami, Welcome; Claes, Neree; Hellings, Johan
The aim of this study was to measure differences in safety culture between work areas and professional groups. The aggregated data (47635 respondents) of the Hospital Survey on Patient Safety Culture from 90 acute Belgian hospitals were used for quantitative analysis. We found differences in response rates between medical staff (34.9%) and employees (55%). Handoffs and transitions, Staffing and Management support for patient safety were considered as major problem areas. Positive dimensional scores were higher for respondents working in pediatrics, psychiatry and revalidation in comparison with the emergency department, operating theatre and multiple hospital units. We found an important gap...
Vlayen, Annemie; Hellings, Johan; Claes, Neree; Peleman, Hilde; Schrooten, Ward
The objectives of this study were to measure patient safety culture in Belgian hospitals using the Hospital Survey on Patient Safety Culture and to provide benchmarking of the results. The benchmark database includes 55 225 respondents from 90 acute, 42 psychiatric and 11 long-term care hospitals (53.7% response rate). Overall dimensional scores were low, although scores were found to be higher for psychiatric and long-term care hospitals than for acute hospitals.The nationwide safety culture assessment confirms the need for a long-term national initiative to improve patient safety culture and provides each hospital with a baseline patient safety culture profile to...
Lemkens, N.; Lemkens, P.; Egondi, T.W.; Schrooten, W.; Jorissen, M.; Mertens, R.; de Raeve, G.; Preal, R.; Debruyne, F.
OBJECTIVE A tonsillectomy, with or without an adenotomy ((A)TE), is a common surgical procedure in children. The most important indications are recurrent tonsillitis and upper airway obstruction secondary to adenotonsillar hypertrophy. The aim of this study was to investigate whether the current (A)TE practice in Belgium reduced the need for medical care. STUDY DESIGN AND METHODS The database of the Christelijke Mutualiteit, one of the most important health insurance organizations in Belgium, provided data on approximately 11,000 (A)TE's in children aged 0 to 15 years, performed by different ENT-specialists from Jan 1st 2002 to Sept 30th 2003. We compared the...
Hellings, Johan; Schrooten, Ward; Klazinga, Niek S.; Vleugels, Arthur
PURPOSE: Improving hospital patient safety means an open and stimulating culture is needed. This article aims to describe a patient safety culture improvement approach in five Belgian hospitals. DESIGN/METHODOLOGY/APPROACH: Patient safety culture was measured using a validated Belgian adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Studies before (autumn 2005) and after (spring 2007) the improvement approach was implemented were completed. Using HSOPSC, safety culture was measured using 12 dimensions. Results are presented as evolving dimension scores. FINDINGS: Overall, 3,940 and 3,626 individuals responded respectively to the first and second surveys (overall response rate was 77 and...
Piessens, P.; Hens, G.; Lemkens, N.; Schrooten, W.; Debruyne, F.; Lemkens, P.
OBJECTIVE: Recurrent tonsillitis and upper respiratory tract obstruction due to adenotonsillar hypertrophy are the most common indications for (adeno)tonsillectomy ((A)TE). Symptoms of upper respiratory tract infection and obstruction can, however, be attributed to lower airway pathology and thus treated with respiratory medication - this is non-antimicrobial medication used for lower respiratory diseases like bronchitis, bronchiolitis, asthma and episodic wheezing. The aim of this study is to investigate the effect of the current (A)TE practice in Belgium on the use of respiratory medication in subjects aged 0-15. METHODS: Retrospective data on 11.114 subjects aged 0-15years old who underwent (A)TE from January...
Jack, Noreen; Ravasi, Giovanni; Schrooten, Ward; Sutherland, Donald; Ghidinelli, Massimo; Del Riego, Amalia
A key component of the World Health Organization's (WHO's) Global HIV Drug Resistance (HIVDR) prevention and assessment strategy is to monitor HIVDR early-warning indicators (EWIs), which provide strategic information for HIVDR containment. The Pan American Health Organization (PAHO)/WHO supported implementation of HIVDR EWI monitoring in 16 Caribbean countries. Results from 15 countries were analyzed by year of patient initiation of antiretroviral therapy for the period 2005-2009. This report demonstrates the need for capacity-building to standardize prescribing practices and to strengthen adherence strategies and antiretroviral drug procurement management systems.