Belgian Health Care Knowledge Centre

Introduction: The study aimed to assess the feasibility of calculating the European Society of Breast Cancer Specialists (EUSOMA) quality indicators (QIs) using Belgian Cancer Registry data coupled to administrative health data and to provide national results. Methods: Women diagnosed with ductal carcinoma in situ (DCIS) or invasive breast cancer (IBC) in 2014–2018 were selected from the cancer registry. Fourteen EUSOMA QIs were chosen to assess the quality of care. Results: Overall, 46,035 patients with IBC and 3,973 patients with DCIS were included. Most QIs had to be rephrased so that they could be calculated with the available data. None of the selected QIs on systemic treatment could be calculated due to a lack of reliable receptor status information. For some Qis, there is ample room for improvement in Belgian clinical practice: cTNM stage reporting, multidisciplinary team meetings, sentinel lymph node biopsy only in IBC with clinically negative lymph nodes. The result was 1–5% lower than the target for mammography and breast ultrasound, pTNM reporting, start of treatment, single breast surgery in DCIS, and no axillary clearance in DCIS. For histological or cytological assessment, receptor status assessment, start of radiotherapy, and single breast surgery in IBC, the results were at or above the target. Conclusion: Several EUSOMA QIs can be calculated with routinely collected data, while for several important aspects of care additional data collection is indicated so that its quality can be assessed. The validity of the obtained results depends on the reporting accuracy.

ATMP’s (Advanced Therapy Medicinal Products) zijn complexe geneesmiddelen op basis van cellen, genen en weefsels. Ze worden momenteel vooral gebruikt en ontwikkeld voor de behandeling van bepaalde vormen van kanker of van genetische aandoeningen. De ATMP’s die momenteel door de industrie op de markt worden gebracht, zijn schaars en zijn dikwijls zeer duur, tot meerdere miljoenen euro per behandeling. Op verzoek van verschillende Belgische kankerverenigingen ging het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) na hoe de rol van de Belgische universiteiten hierin kan geoptimaliseerd worden, zodat patiënten gemakkelijker toegang tot deze geneesmiddelen krijgen. Het vereist dat zowel overheden als academici over een grondige expertise beschikken en nauwer samenwerken. Bovendien loopt de ontwikkeling van dit soort producten over meerdere jaren, en moet de financiering ook een voldoende lange periode bestrijken en minder versnipperd zijn.

Les médicaments de thérapie avancée (ATMP, Advanced Therapy Medicinal Products) sont des thérapies complexes basées sur des cellules, des gènes ou des tissus. À l’heure actuelle, ils sont surtout développés et utilisés pour le traitement de certaines formes de cancer ou de maladies génétiques. Les ATMP actuellement commercialisés par l’industrie sont peu nombreux et souvent proposés à un coût élevé, pouvant atteindre plusieurs millions d’euros par traitement. À la demande de plusieurs associations belges de lutte contre le cancer, le Centre Fédéral d’Expertise des Soins de Santé (KCE) a examiné comment optimiser le rôle des universités belges dans ce domaine, dans le but d’améliorer l’accès à ces médicaments pour les patients. Pour atteindre cet objectif, il sera indispensable que les acteurs académiques et les autorités disposent d’une expertise de pointe et collaborent de façon plus étroite. Par ailleurs, sachant que le développement de tels produits peut s’étendre sur de nombreuses années, il faut que le financement couvre une période suffisamment longue et soit moins fragmenté.

The Belgian Health Care Knowledge Centre (KCE) has explored the options offered by automation within the framework of the ESRO methodological report, with the aim of speeding up research processes without compromising the quality of studies. This article summarises the content of chapter 7 of this report, and complements it with a brief overview of the latest developments since the report publication, and the actions put in place at the KCE to ensure follow-up.

The aim of this study was to validate the Delirium Observation Screening Scale (DOSS) in a population of long-term care facility (LTCF) residents in Flanders. Currently there is no validated screening tool for delirium available for the population in this setting in Flanders. A multisite, cross-sectional study was conducted in six LTCFs. A total of 338 residents aged 65 years and older were included. Sociodemographic and clinical data, including data from the Montreal Cognitive Assessment (MoCA), Confusion Assessment Method (CAM) and DOSS, were obtained by three trained nurse researchers. For the DOSS, internal consistency was determined, and inter-rater reliability was calculated. To validate the DOSS, the sensitivity, specificity, and positive and negative predictive value of the DOSS relative to the CAM were determined through receiver operating characteristic analysis. This article adheres to the Strengthening the Reporting of Observational Studies (STROBE) checklist for observational research. For 338 residents, delirium assessments were completed during an early or late shift. The prevalence of delirium was 14.2% as measured with the DOSS. The reliability (α) for the CAM and DOSS was assessed, as was the inter-rater reliability (κ) and the area under the curve. The sensitivity and specificity for a cut-off value of 3 on the DOSS by Youden's index were very high, as was the negative predictive value. The positive predictive value was good. This study showed that the DOSS is a reliable and valid instrument to screen for delirium in LTCF residents in Flanders. Geriatr Gerontol Int 2024; 24: 619-625.

The global plasticizer market is projected to increase from $17 billion in 2022 to $22.5 billion in 2027. Various emerging/alternative plasticizers entered the market following the ban on several phthalate plasticizers because of their harmful effects. However, there is limited data (especially peer-reviewed) on emerging plasticizers’ toxicity and environmental impact. This review compiles available data on toxicity, exposure, environmental effects, and safe production of emerging plasticizers. It identifies gaps in scientific research and provides evidence that emerging plasticizers are potential cases of regrettable substitution. Several alternative plasticizers, such as acetyl tributyl citrate (ATBC), diisononyl cyclohexane-1,2 dicarboxylate (DINCH), tris-2-ethylhexyl phosphate (TEHP), tricresyl phosphate (TCP), tris-2-ethylhexyl phosphate (TPHP), bis-2-ethylhexyl terephthalate (DEHT), and tris-2-ethylhexyl trimellitate (TOTM), show potential as endocrine disrupting properties and other toxic characteristics. Some chemicals like bis-2-ethylhexyl adipate (DEHA), diisobutyl adipate (DIBA), ATBC, DINCH, bis-2-ethylhexyl sebacate (DOS), diethylene glycol dibenzoate (DEGDB), DEHT, and phosphate esters showed the potential to cause toxicity in aquatic species. Plus, there is great lack of information on compounds like diisononyl adipate (DINA), dibutyl adipate (DBA), diisodecyl adipate (DIDA), dipropylene glycol dibenzoate (DPGDB), dibutyl sebacate (DBS), alkylsulfonic phenyl ester (ASE), trimethyl pentanyl diisobutyrate (TXIB), DEGDB and bis-2-ethylhexyl sebacate (DOS). Some compounds like epoxidized soybean oil (ESBO), castor-oil-mono-hydrogenated acetate (COMGHA), and glycerin triacetate (GTA) are potentially safer or less toxic. Alternative plasticizers such as adipates (LogKow 4.3–10.1), cyclohexane dicarboxylic acids (LogKow 10), phosphate esters (LogKow 2.7–9.5), sebacates (LogKow 6.3–10.1), terephthalates (LogKow 8.4), and vegetable oil derivatives (LogKow 6.4–14.8) have logKow values that are comparable to phthalate plasticizers (LogKow 7.5–10.4), indicating potential bioaccumulation and health consequences. Field studies have demonstrated that phosphate esters can undergo bioaccumulation and biomagnification, but there is a lack of bioaccumulation studies for other compounds. We also discuss the metabolism of emerging plasticizers, though data is limited. Our article highlights that numerous alternative compounds display potential health and ecological risks, indicating they might not be suitable substitutes for legacy plasticizers. There is also a lack of scientific data on most emerging plasticizers. This way, we call for increased research and timely regulatory action to prevent global contamination and health risks. Finally, this study presents a scientifically robust protocol to avoid harmful substitutions and ensure the production of safer chemicals.

Abstract Background Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of individual (e.g. age and ethnicity), interpersonal (e.g. provider trust), and organizational (e.g. perceived workload) factors on general practitioners’ (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with a MB and for a depressed patient without a MB. Methods An experimental study was carried out in which GPs were shown one of two video-vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797) had to decide on their diagnosis, treatment, and referral. ANOVA and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. Results Overall, we found that there were ethnic differences in GPs’ decisions regarding diagnosis and treatment recommendations (F = 3.56, p < 0.001). GPs also considered the symptoms of the patient with a MB less severe (F = 7.68, p < 0.01) and were less likely to prescribe a combination of medical and non-medical treatment to patients with a MB (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was malingering or exaggerating his distress. Conclusions This paper showed that GPs’ trust in their patients and GPs’ workload affect ethnic bias in medical decisions. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs’ trust in their migrant patients. Key messages • This research provides an insight into the discriminatory decisions made by GPs in mental healthcare. • Future research should take interpersonal and organizational factors into account when developing new interventions to improve quality of care for migrants with mental health problems.