Queen Elisabeth Medical Foundation

Inhalation therapy is the cornerstone of chronic obstructive pulmonary disease (COPD) management. However, errors frequently occur since every type of inhalation device has different characteristics, complicating their use. The clinical pharmacist is an expert on these devices and can be involved in the care and education of inhaler use in patients with COPD. The feasibility of a pharmaceutical care protocol specifically for patients with COPD in a rehabilitation hospital was assessed in a quality improvement study (mixed-methods). First, the clinical pharmacist had 6 contact moments with hospitalized patients between January and April 2022, which contained appropriateness evaluations and educational moments that were focused on inhalation techniques. Subsequently, a focus group discussion with all involved health care professionals (HCPs) took place to evaluate the preliminary results of the protocol's implementation. A total of 19 patients entered the study with the protocol resulting in a decrease of critical device errors (38.5% at baseline, to 7.7% at discharge). The HCPs concluded that it was feasible to implement the protocol given certain adjustments. A multidisciplinary collaboration between pharmacists and nurses is necessary to permit the practical implementation, as well as an individualization of the protocol based on the patient's needs. In patient follow-up, transmural care is essential including the HCPs in primary care, and the outpatient clinic. The evaluation of the protocol by the involved HCPs emphasizes the importance of a clinical pharmacist in the care of patients with COPD as part of the multidisciplinary team, not only in the community or in an acute hospital setting, but also in a rehabilitation hospital.

The Belgian Special Operations Regiment undergoes an 8-week basic training course (SOF Basic Course) following the Military Initiation Phase. The aims of the present study were to estimate energy expenditure and changes in body composition during SOF Basic Course. A multi frequency body composition analyser assessed baseline and endpoint body composition. For the purpose of estimating energy expenditure, 41 participants were fitted with triaxial accelerometers. T-tests were performed on paired and unpaired samples in order to estimate statistical significance. Effect size was estimated with Cohen's d. SOF Basic Course was completed by 88 out of 126 participants. The participants' mean (SD) age was 25.0 (4.1) years, weight was 77.6 (8.6) kg, and body fat percentage was 15.3% (3.3). Body weight of completers decreased from 78.3 (8.8) kg to 76.4 (8.0) kg (P = 0.01). Also, body fat decreased by 3.1 (1.8) kg (P = 0.01), and muscle mass increased by 1.2 (1.7) kg (P = 0.01). There was a decrease in body fat percentage from 15.3% (3.3) to 11.6% (3.4) (P = 0.01), with a Cohen's effect size of 1.86.The loss of 3.1 kg of body fat corresponds to a loss of 21,700.0 kcal (90.3 MJ) or 362.0 kcal.d-1 (1.5 MJ.d-1). The mean (SD) energy expenditure by physical activity was 1,943.0 (653.8) kcal.d-1 (14.6 [2.7] MJ.d-1). The average (SD) total energy expenditure was 4,088.0 (710.0) kcal.d-1 (36.8 [3.8] MJ.d-1). Tactical athletes must perform in hypo-energetic environment. Research in the future should investigate the impact of increased energy intake on body composition.

Background: Quality programs that step into the intrinsic motivation of healthcare providers (HCPs) are believed to be effective in improving quality of care. The fact that they are not part of an external regulatory or performance management process seems to be crucial. We therefore aimed to develop a quality program based on internal workflows and HCPs feedback. Methods: The project took place at the rehabilitation hospital Koningin Elisabeth Instituut (RH-KEI) in Oostduinkerke (Belgium) during the years 2017-2022. A quality coordinator (QC) was appointed who subsequently developed and implemented an interdisciplinary quality program in concordance with the care strategic plan. The quality program was optimized through surveys among patients and caretakers on the one hand and employees on the other. Involved employees were physicians, nurses, physiotherapists, pharmacists and pharmacy technicians, occupational therapists, psychologists, speech therapists and employees of the facility departments (such as maintenance staff). Results: The QC had to be an individual that could coach teams and would be trusted by all departments. This person also embodies independence from and neutrality towards staff and management, so HCPs would feel free to discuss any (institutional) hurdles towards quality of care. The developed quality program was subdivided in four domains with three key strategic objectives. This included that (1) RH-KEI ensures a continuous and dynamic improvement of quality of care based on a set of indicators, (2) RH-KEI holds a culture of quality that is actively supported by all involved employees and (3) RH-KEI continuously improves and guarantees patient safety by developing a well-functioning safety management system. The program was first developed in 2017 for the period 2018 up to and including 2022. After five years, quality and safety is embedded in the culture of RH-KEI. Employees are proud of the progress and work together on an integrated quality story. As well, RH-KEI renewed the quality project for the period 2023-2027, with an even greater focus on patient and caretaker participation, care experience, communication and digitalization. Conclusion: The active support by all involved employees turned out to be essential to secure the set objectives on the work floor and to make them part of the daily routine.

BackgroundKetorolac has been associated with a lower risk of recurrence in retrospective studies, especially in patients with positive inflammatory markers. It is still unknown whether a single dose of pre-incisional ketorolac can prolong recurrence-free survival.MethodsThe KBC trial is a multicenter, placebo-controlled, randomized phase III trial in high-risk breast cancer patients powered for 33% reduction in recurrence rate (from 60 to 40%). Patients received one dose of ketorolac tromethamine or a placebo before surgery. Eligible patients were breast cancer patients, planned for curative surgery, and with a Neutrophil-to-Lymphocyte Ratio≥4, node-positive disease or a triple-negative phenotype. The primary endpoint was Disease-Free Survival (DFS) at two years. Secondary endpoints included safety, pain assessment and overall survival.FindingsBetween February 2013 and July 2015, 203 patients were assigned to ketorolac (n = 96) or placebo (n = 107). Baseline characteristics were similar between arms. Patients had a mean age of 55.7 (SD14) years.At two years, 83.1% of the patients were alive and disease free in the ketorolac vs. 89.7% in the placebo arm (HR: 1.23; 95%CI: 0.65–2.31) and, respectively, 96.8% vs. 98.1% were alive (HR: 1.09; 95%CI: 0.34–3.51).ConclusionsA single administration of 30 mg of ketorolac tromethamine before surgery does not increase disease-free survival in high risk breast cancer patients. Overall survival difference between ketorolac tromethamine group and placebo group was not statistically significant. The study was however underpowered because of lower recurrence rates than initially anticipated. No safety concerns were observed.Trial registrationClinicalTrials.gov NCT01806259.

Context. An inguinoscrotal swelling occurring during an acute pancreatitis is very rare. Case Report. We report a case of right inguinoscrotal swelling appearing in connection with an interstitial edematous acute pancreatitis. We have noticed a spontaneous complete reduction of the right inguinoscrotal swelling after 10 days. Conclusion. The management of a scrotal swelling should be the least invasive possible method but also the most complete possible method to avoid unnecessary interventions. The exclusion of a pathology that could affect the vital prognosis of the testis remains the absolute priority. An acute scrotum swelling must be carried out by the clinical management by a professional and must be completed with an ultrasonography of the scrotum. Despite all that, if the original etiology of the acute scrotum remains unknown, an abdominopelvic CT scan could provide more details and so could offer a different diagnosis of exclusion, different from the diagnosis of acute idiopathic scrotal edema (AISE). This rare complication of acute pancreatitis reported could be mistaken for a more common pathology. If that complication is identified, it will not require a surgical intervention if there is a correct management of the acute pancreatitis which could justify a broader CT scan.

Background: Pulmonary hypertension secondary to COPD is characterized principally by impairment of vasoreactivity and vascular remodeling. While the structural changes have been described in all stages of COPD, the impairment of vasoreactivity in response to ET-1, a potent vasoconstrictor, has not been well understood. Materials and methods: Proximal pulmonary arteries were obtained from non-smokers, smokers with normal lung function, and COPD patients who underwent lung resection for other diseases (n=6 in each group). Pulmonary arterial contraction induced by ET-1 was assessed without or with the presence of ET-1 receptor antagonists (BQ- 123 and BQ-788). Expressions of ET-1 receptors were measured by immunohistochemistry, western blot, and qRTPCR. Results: ET-1-induced pulmonary arterial contraction increased significantly in COPD patients in comparison with control subjects and non-COPD smokers (P<0.05) and the use of ET-1 receptor antagonists could not prevent this contraction. The hypercontraction was not associated with the increase of ET-1 and ET-1 receptors expression in pulmonary arterial vessels. Conclusion: In patients with COPD, pulmonary arterial contraction induced by ET-1 has increased significantly and could not be prevented by using ET-1 receptor antagonist alone. This alteration might be related to the upreguation of other signalling pathways in pulmonary arterial vessels of COPD patients.

To investigate associated dimensions of fatigue regarding cognitive impairment, psychomotor performances, muscular effort power and circulating cytokine levels and their relations to symptom intensity in a sample of pure chronic fatigue syndrome (CFS) patients without overlapping objective sleepiness or sleep disorders. 16 CFS patients were compared to 14 matched controls. We assessed structured symptom-scales, polysomnography, multiple sleep latency tests, attention (Zazzo-Cancellation ZCT, digit-symbol-substitution DSST), psychomotor vigilance and speed (PVT, finger tapping test, FTT), dynamometer handgrip force (tonic and phasic trials) and circulating cytokines (IFN-γ, IL-1b, IL-6, IL-8, IL-10, TNF-α). In addition to fatigue, CFS patients presented with higher affective symptom intensity and worse perceived sleep quality. Polysomnography showed more slow-wave sleep and microarousals in CFS but similar sleep time, efficiency and light-sleep durations than controls. Patients presented with impaired attention (DSST, ZCT), slower reaction times (PVT) but not with lower hit rates (FTT). Notwithstanding lower grip strength during tonic and phasic trials, CFS also presented with higher fatigability during phasic trials. Cytokine levels were increased for IL-1b, IL-8, IL-10 and TNF-α and fatigue intensity was correlated to grip strength and IL-8. In contrast to sleepiness, chronic fatigue is a more complex phenomenon that cannot be reduced to one single measured dimension (i.e., sleep propensity). Showing its relations to different measurements, our study reflects this multidimensionality, in a psychosomatic disorder such as CFS. To obtain objective information, routine assessments of fatigue should rule out sleepiness, combine aspects of mental and physical fatigue and focus on fatigability.