[Creation and functioning of Covid-19 pre-hospital triage centres : experience of french-speaking GP-coordinators]. / Face à la COVID-19. Création et fonctionnement des centres de tri pré-hospitaliers : expérience des médecins généralistes coordinateurs francophones.

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.

[Long-term follow-up of survivors of cancer : general practitioner's role and resources]. / Suivi à long terme des patients survivant à un cancer : le rôle et les moyens du médecin généraliste.

More and more patients surviving cancer consult again their general practitioner for various reasons. The aim of this article is to consider ways to reinforce the role of the general practitioners in the follow-up protocol. Two candidates for general practice synthetized, based on literature review, cancer follow-up information of childhood cancer, breast and colorectal cancers. Their concise presentations are examples of useful documents for their colleagues. The general practitioner must receive all information concerning the cancer disease, the treatment and the agenda of the follow-up examinations to guarantee continuity of care. Collaboration between general practitioners and cancer specialists is necessary to provide best care to the patients, to share clear and relevant information and to train future general practitioners.

De plus en plus de patients survivent à un cancer. Le médecin généraliste les revoit à diverses occasions. L'article a pour but d'envisager des pistes pour soutenir le médecin généraliste dans cette fonction de suivi. Deux candidates médecins généralistes ont synthétisé, à partir de revues de la littérature, des informations de suivi de certains cancers (cancer survenu dans l'enfance, cancer du sein, cancer colorectal). Leurs présentations sous une forme concise sont des exemples de documents utiles aux praticiens. Pour assurer la continuité des soins, le médecin généraliste doit disposer d'informations concernant la maladie, le traitement subi et les examens à réaliser pendant le suivi à long terme. Une collaboration des médecins généralistes et spécialistes est suggérée pour assurer les meilleurs soins aux patients, pour partager des informations claires et pertinentes et pour former les futurs médecins généralistes.

[Exacerbations in asthma and chronic obstructive pulmonary disease (COPD) Survey on the criteria of pescription of systemic corticoids and antibiotics by general practicioners and chest physicians]. / Le concept d'exacerbation dans l'asthme et la BPCO : enquête sur les critères de prescription de corticoïdes systémiques et d'antibiotiques chez les généralistes et les pneumologues.

Exacerbations in asthma and chronic obstructive pulmonary disease (COPD) are critical events in the evolution of the disease. They are generally defined by the need to be temporarily treated by systemic corticoids and/or antibiotics. Very few studies have examined the criteria on which clinicians including general practitioners (GP) and chest physicians are basing their decision to prescribe. Here we report the results of a survey conducted in GP and chest physicians that looked at the clinical criteria judged as important to initiate a course of systemic corticoids or antibiotics in asthma and COPD. Our finding show discrepancy between GP and chest physicians regarding systemic corticoids but also, more surprisingly, within the same professional group. In contrast, criteria to prescribe antibiotics are more coherent between and within the groups.

Les exacerbations dans l'asthme et la bronchopneumopathie chronique obstructive (BPCO) sont des événements importants qui rythment l'évolution clinique de ces deux maladies obstructives. Elles sont généralement définies par la nécessité d'un recours temporaire aux corticoïdes systémiques ou aux antibiotiques. Peu d'études se sont cependant penchées sur les critères précis qui motivaient les cliniciens à prescrire ces médications en cas de maladies obstructives déstabilisées. Nous rapportons ici les résultats d'une enquête menées auprès de médecins généralistes et de pneumologues sur les raisons précises de prescription de cure d'antibiotiques et de corticoïdes. Nos résultats concernant la prescription de corticoïdes systémiques montrent des divergences entre les deux groupes professionnels, mais aussi à l'intérieur d'un même groupe alors que les critères de prescription d'antibiotiques sont nettement plus cohérents entres les praticiens qu'ils soient généralistes ou pneumologues.

[Multidisciplinary team meetings : experiences and difficulties of ambulatory care professionals. A qualitative study.] / Concertation multidisciplinaire: l'expérience et les difficultés des professionnels du secteur ambulatoire. Une étude qualitative.

Multidisciplinary work is gaining importance with the ageing of the population, an increase in the number of chronically ill patients, and patients' preference for homebased healthcare. Multidisciplinary team meetings (MDTMs) were designed to foster dialogue between care providers of patients with decreasing autonomy. Despite being financed by the Health Insurance, few professionals use it. This study aimed at an exploration of the professionals' reasons for this lack of MDTM. Semi-structured interviews with health and social care providers who had participated in an MDTM were analysed thematically by two researchers working independently. All of the professionals recognised the importance of MDTMs in improving support for patients and their relatives. Each person's presence at the MDTM helped participants to define their scope of action, to become acquainted with one another, and to coordinate their work. Administrative and logistical limitations were cited as obstacles, as was the absence of a multidisciplinary working culture. MDTMs place the patient at the forefront, and allow professionals to meet and agree on a treatment plan. A range of different working practices and cultures challenges the method.

Le vieillissement de la population, l'augmentation des maladies chroniques, et la préférence des patients pour les soins à domicile demandent plus de travail d'équipe. La Concertation Multidisciplinaire (CM) est une modalité favorisant le dialogue entre différents prestataires de soins au bénéfice des patients en perte d'autonomie. Bien que financée par l'assurance-maladie, elle est peu utilisée. Cette étude qualitative visait à explorer les raisons de ce manque d'utilisation de la CM par les professionnels de santé. Des entretiens semi-structurés individuels ont été menés avec des prestataires d'aide et de soins ayant déjà participé à une CM. Une analyse thématique a été menée par deux chercheurs de façon indépendante. Pour les répondants, la CM est importante pour améliorer le soutien aux patients et à leur famille. Elle permet de définir leur champ d'action, de se rencontrer et de se coordonner. Par contre, les tâches administratives, les contraintes logistiques et l'absence de culture de travail multidisciplinaire sont mentionnées comme des obstacles. La CM place le patient au centre, et permet aux professionnels de se rencontrer et de définir ensemble un plan de traitement. La variété des pratiques et des cultures de travail limite l'intérêt de la méthode.

The ecology of health care in a Belgian area.

INTRODUCTION: Focusing on the monthly prevalence of health problems and recourse to different levels of care of the population is an interesting approach to demonstrate the respective roles of different levels of health care. In the present study, the ecology of health care was studied in the region of Liège, Belgium. METHOD: A survey questioning people about their health problems was conducted in 2009 in two communes of the province of Liège. For each health problem, 'health care' was defined as contact with any qualified care provider. For each consultation, three elements were recorded: the profession of the health care provider; the place where the care was provided and the kind of health care received. RESULTS: A total of 537 people were interviewed. The monthly prevalence of people who experienced a health problem during the previous month was 85.1%. The monthly prevalence of people who turned to a health care provider at least once during the month was 62.2%. The proportion of people turning to doctors, primarily local doctors, for a simple consultation was important (49.2%). DISCUSSION: Our results are highly comparable with those of other studies. Recourse to a doctor is high (49%), which probably reflects the broad accessibility of health care in Belgium and maybe its overuse. Additional questions on the current and future organisation of the Belgian health care system are debated.

Retrospective analysis of a suburban out-of-hours clinic in Belgium.

INTRODUCTION: In many countries, out-of-hours medical care is under scrutiny. The aim of this article is to study the activities recorded by the first out-of-hours clinic that has been opened, as a pilot study, in two Walloon communes. MATERIAL AND METHOD: A retrospective analysis of anonymized data was conducted for 2009. Coding of diagnoses was conducted using the International Classification of Primary Care (ICPC-2). RESULTS: A total of 3949 contacts were recorded in 2009 with the out-of-hours clinic, 3294 related to inhabitants of the two communes covered, which was equivalent to 13% of the total population in question. Compared to 7·2% of contacts between midnight and 8 a.m., 82·9% of contacts took place between 8 a.m. and 9 p.m., and 91·6% of contacts were handled locally, with only 8·4% resulting in hospitalization. In addition, 52% of contacts were with patients aged between 25 and 65; 29·9% of contacts were with paediatric patients (<15 years). Patients over the age of 65 made up 18% of contacts. The most common pathologies were respiratory (R). Analysis of flu diagnoses identified two epidemic peaks. DISCUSSION: The suburban out-of-hours clinic studied fulfilled an important role in managing the demand for health care. The large majority of health problems were resolved locally, and the inhabitants did not need to go to hospital. Appointments between midnight and 8 a.m. were in the minority, which points towards adjusting the organization of the out-of-hours service during the night. The geriatric population is not highly over-represented contrary to what might be expected considering its largest number of pathologies. The on-call doctor's skills profile should take account of the populations and morbidities encountered. Out-of-hours clinics could possibly play a sentinel role in terms of flu epidemics. CONCLUSION: This study describes a pilot suburban out-of-hours clinic which met three of recommendations set by the KCE in its report on out-of-hours care in general medicine: the organization of an out-of-hours clinic with logistical support, the use of a single telephone number and merging out-of-hours areas. While debate exists on the management of out-of-hours care, this study provides evidence on the role of the physician during these hours.

An indoline-derived compound that markedly reduces mouse body weight.

OBJECTIVE: We describe how a single intraperitoneal injection of an indoline-derived drug (SN 28127) reduced mouse body weight (25-45% loss) and adipose tissue mass (∼75%). METHODS AND RESULTS: The reductions in body weight peaked at ∼21-28 days post drug injection and were maintained throughout the study (160 days). The mice ate as much as vehicle-treated control mice. A more potent SN 28127 analog (SN 29220) reversed high-fat diet-induced obesity and type 2 diabetes in C57BL/6J mice on a high-fat diet. Insulin induced a sustained reduction in blood glucose in fasted SN 29220-treated mice compared with the vehicle-treated mice. All drug-treated mice exhibited a transient increase in water intake from ∼10 days post drug injection that lasted for ∼70 days. Following a single injection of (3)H-labeled SN 29220, radioactivity accumulated within 4 h in the liver, bile duct and ileum with little detected in the brain; within 1-2 days, most of the radioactivity was found in the pancreas, spleen, liver, bile duct, stomach, kidneys and white adipose tissue. High levels of glucose were detected in urine collected from SN 29220 but not vehicle-treated C57BL/6J mice at ∼60 days post injection, while fecal triacylglycerols and cholesterol were not different between SN 29220 and vehicle-treated mice. These data lead us to hypothesize that the hepatic system is the primary drug target. Genes involved in fatty acid synthesis (FASn, SCD1 and PPARγ) and appetite stimulation (AGRP) were upregulated at 160 days post drug treatment, indicative of adaptation to reduced body weight. CONCLUSION: We hypothesize that indoline-derived drug-induced chronic toxicity to the hepatic system leads to a reduction in white adipose tissue mass. The mice adapt to this drug-induced toxicity with reduced steady-state body weight. Understanding molecular mechanisms underlying these responses has potential to identify novel targets for prevention and treatment of obesity.

Genome-wide screening for genetic changes in a matched pair of benign and prostate cancer cell lines using array CGH.

Copy number alterations in a matched pair of benign epithelial and prostate cancer cell lines derived from the same patient were assessed using array-based comparative genomic hybridisation (aCGH). The cancer cell line showed a gain of chromosome 7, deletion of chromosome 8, gains (including high level) and losses on chromosome 11, loss of 18p and gain of 20q. Deletions on chromosome 8 were confirmed with microsatellite markers. The aCGH results were compared to gene expression data obtained using DNA microarrays and suggested the involvement of caspases and ICEBERG on 11q and E2F1 on chromosome 20q.

Shiga-like toxin production and attaching effacing activity of Escherichia coli associated with calf diarrhea.

Four hundred twenty-nine isolates of Escherichia coli from calves were tested for the production of HeLa cell cytotoxin(s). Isolates that produced enough cytotoxin to be detected in culture supernatants of iron-depleted broth were considered to produce increased amounts of cytotoxins. Isolates also were tested for homology with a DNA probe for a gene that encodes localized adherence of human enteropathogenic E coli. Four isolates produced increased amounts of cytotoxin that was neutralized by Shiga antitoxin (toxin designated as Shiga-like toxin-I [SLT-I]). A 5th isolate produced increased amounts of cytotoxin (SLT+) that was not neutralized by the Shiga antitoxin, but was neutralized by antitoxin against a variant of SLT (toxin designated as SLT-II). None of the isolates hybridized with the probe for the localized adherence gene. Three of the SLT+ isolates belonged to human enteropathogenic E coli serogroups O26 and O111. All 5 of the SLT+ isolates were from calves with diarrhea, but none of the 5 SLT+ isolates contained genes for classic heat-labile or heat-stable enterotoxins, for K99 fimbriae, or for invasiveness; neither did any of them adhere to HeLa cells in culture. Three of the 5 SLT+ isolates had attaching and effacing activities when inoculated into ligated intestinal loops of rabbits. One of the isolates with attaching and effacing activity in rabbits was originally isolated from a calf with lesions characteristic of those produced by attaching effacing E coli (AEEC). Calves inoculated with this SLT+ AEEC isolate developed focal colonic lesions characteristic of those produced by AEEC, but did not develop diarrhea.(ABSTRACT TRUNCATED AT 250 WORDS)