Luxembourg: HiT in brief

The Luxembourgish health system is facing unique challenges amongst EU member states. First, it has the highest per capita health spending in PPP amongst European countries. Secondly, Luxembourg is lacking capacity to train health personnel and is facing shortages in some specialty care, which also necessitates a generous policy towards receiving care abroad. Reforms in 2008 and 2010 have targeted these challenges by establishing a single health insurance fund envisioned to play a stronger role in cost-containment and introducing e-health. Especially in hospital care there is room for efficiency gains. An average length of stay that remains high, combined with low bed occupancy rates reflect the lack of incentives in the financing mechanism which is based on patient-days from a global hospital budget. Current reforms aim at the implementation of national structured health information system for hospital services, which is prerequisite to further announced reforms such as the introduction of a DRGs based system. Additionally, patient empowerment was strengthened in 2014, which gave patients the right to receive all relevant information on health status and treatment options. In line with the 2011 European cross-border Directive, patients are now able to obtain information on treatment options abroad and related costs. In 2012, 16% of patients received care abroad, which is the highest number in the EU and far above the EU average of 4%.

Infantile myofibromatosis: a series of 28 cases.

BACKGROUND: Infantile myofibromatosis (IM) is a rare disorder of fibroblastic/myofibroblastic proliferation in children. OBJECTIVES: We sought to document common and unusual characteristics of patients with IM. METHODS: This was a retrospective study of 28 children diagnosed with histopathologically confirmed IM between 1992 and 2012. Epidemiologic, clinical, and treatment data were reviewed. RESULTS: IM was more frequent in boys (60.8%). Skin lesions were congenital in 64.3% of cases. The solitary form accounted for 50% of cases. Most nodules were painless, arising in cutaneous or subcutaneous tissue. The multicentric form accounted for 39% of cases; the skin, subcutaneous tissue, or muscle was involved in 97.8% of cases, and the bones in 50% of cases. The generalized form had a mortality rate of 33% (one-third of cases). Multicentric and generalized forms regressed spontaneously; severe local complications were observed, and late recurrent nodules developed in a few cases. LIMITATIONS: The retrospective review and the ascertainment of patients (from the departments of obstetrics and pediatrics) may have introduced bias in the analysis of severity of the different forms of IM. CONCLUSION: The diagnosis of IM must be confirmed histopathologically because the clinical presentation can be misleading. The prognosis is usually good, although local morbidity can occur. The generalized and multicentric forms merit long-term follow-up.

Visual deficits following stroke: maximizing participation in rehabilitation.

This article reviews the literature regarding the prevalence, etiology, and clinical symptoms of various visual deficits including those that are age related and those that are a result of neurological damage to the brain, such as in traumatic brain injury or stroke. It discusses treatment options provided by an occupational therapist, along with other members of the rehabilitation team, to educate the patient and family members regarding vision loss, to accommodate for visual loss, and to optimize independence with activities of daily living. This article also briefly reviews the literature and discusses possibilities for individuals who identify computer access and return to driving as goal areas.