[Creation and functioning of Covid-19 pre-hospital triage centres : experience of french-speaking GP-coordinators]

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.

"Patient participation" and related concepts: A scoping review on their dimensional composition

OBJECTIVES

Several concepts on collaboration between patients and healthcare systems have emerged in the literature but there is little consensus on their meanings and differences. In this study, "patient participation" and related concepts were studied by focusing on the dimensions that compose them. This review follows two objectives: (1) to produce a detailed and comprehensive overview of the "patient participation" dimensions; (2) to identify differences and similarities between the related concepts.

METHODS

A scoping review was performed to synthesize knowledge into a conceptual framework. An electronic protocol driven search was conducted in two bibliographic databases and a thematic analysis was used to analyse the data.

RESULTS

The search process returned 39 articles after exclusion for full data extraction and analysis. Through the thematic analysis, the dimensions, influencing factors and expected outcomes of "patient participation" were determined. Finally, differences between the included concepts were identified.

CONCLUSION

This global vision of "patient participation" allows us to go beyond the distinctions between the existing concepts and reveals their common goal to include the patient in the healthcare system.

PRACTICE IMPLICATIONS

This scoping review provides useful information to propose a conceptual model of "patient participation", which could impact clinical practice and medical training programs.

“Patient participation”: Towards a conceptual model and dimensions’ descriptions

Background

An extensive body of literature has emerged advocating concepts on the collaboration between patients and healthcare systems, such as patient-centred care, patient engagement and patient participation. Several authors have attempted to provide clear definitions of these concepts but no consensus has been agreed upon. This may have hampered their developments and implementation. We thus aim to propose an integrative conceptual model of “patient participation” and a description of its dimensions.

Methodology

Recently, a scoping review studied transversally the concepts related to this collaboration under a generic term “patient participation”. Based on this review a conceptual model and a description of its dimensions was developed. A summative approach was used to produce the dimensions’ description and consisted in systematically adding every new information mentioned in the 38 articles of the scoping review to the final description. The conceptual model was developed based on the theorization methodology of Paillé & Mucchieli (2016).

Results

The model included 28 dimensions, 6 influencing factors and 4 expected outcomes. They were described and modeled at the three levels of the healthcare system (micro, meso and macro). The model illustrate the relation between: (1) the healthcare professionals’ (HPs) and patients’ attitudes and skills, and the collaboration between these healthcare actors (micro level); (2) the organisational structure of healthcare institutions and the HPs’ and patients’ training and access to resources (meso level); (3) results at the macro level did not provide enough information to relate the retrieved dimensions.

Discussion: The production of a conceptual model and the description of its dimension may allow a consensus on the dimensions related to “patient participation”. Despite its complexity, this model may favour “patient participation’s” implementation and operationalization at all levels of the healthcare system.

Key messages

The results of this study address the confusion existing in the scientific literature on the generic concept of “patient participation”. The results of this study provide a global overview of “patient participation” and may impact clinical practice and can be a base for training programs for healthcare professionals and patients.

The role of civil society in child safety in Europe

Introduction

The complexity of injury and the multi-sectoral nature of its prevention demands a whole-of-society approach. Engaging with civil society in a form of collaborative governance is central to this approach. Civil society, defined as neither state, nor market, nor family, includes organisations such as advocacy groups, charities, professional associations etc. This study looks at the role of civil society organisations in the implementation of child injury prevention interventions in Europe.

Methods

The method was built upon an existing approach, known as ’organigraphs’. Mintzberg and van der Heyden developed the approach to depict how organisations actually work. We further developed its practical application to explore how interventions in child safety are developed, implemented and monitored across the local, regional, national and EU levels. Professionals working in child safety in 25 European countries were asked to draw organigraphs for an intervention in one of four child injury domains: road, water, home safety or intentional injury prevention. The analysis focused on the action surrounding civil society actors, represented by the connectors leading to and from those actors.

Results

We received 44 organigraphs in total from 31 participants in 24 countries; nine for intentional injury prevention, nine for water safety, 12 for road safety and 14 for home safety. Civil society actors were present in the majority of Organigraphs and they played multiple and diverse roles including: ’advising’, ’funding’ and ’implementing’ child safety initiatives.

Conclusions

The role of civil society, described in this data set, appears to be relatively well-developed. Strong, functional and long-standing partnerships between civil society actors across policy sectors and government may lead to greater capacity to address the complexity of child injury.

Key messages

Effective child injury prevention requires multi-sectoral action to address its complexity. Stakeholders come from the public and private sector and from civil society. Greater engagement with civil society may represent an opportunity for countries and regions to improve their response to the challenges of injury prevention among children.

[Patient partner approach into question]

Patient engagement in health care system can be regarded as a lever for the general improvement of people's health, the quality and safety of care. Among the many approaches that co-exist, the model of Patient Partner is relatively recent and declares itself as the most successful to promote this engagement. The authors of this article propose to present briefly the above model and to raise the remaining questions on its operational application. We will then present the research program «Patient Partner Approach to Care» (INTERREG Va) that questions the Patient Partner model in an interregional context (Wallonia - Grand Duchy of Luxembourg - Lorraine - Rhineland-Palatinate and Saarland).

Proton pump inhibitor use is associated with an increased risk for microscopic colitis: a case-control study

BACKGROUND

Microscopic colitis causes chronic watery diarrhoea. Recent studies have suggested an aetiological role for various medications, including proton pump inhibitors, in the pathogenesis of microscopic colitis.

AIM

To determine whether an association exists between microscopic colitis and proton pump inhibitor use in patients with documented microscopic colitis vs. age- and gender-matched controls.

METHODS

In this retrospective case-control study, cases of microscopic colitis from a secondary and tertiary referral medical centre diagnosed in the last 5 years were reviewed. Demographic characteristics, clinical, histological and endoscopic records, as well as exposure to PPIs and NSAIDs were assessed. Controls from the population were matched to cases by gender and by age.

RESULTS

During the investigated period, 136 cases were identified in both hospitals. Of these, 95 cases of microscopic colitis were retrieved for detailed analysis. Exposure to proton pump inhibitors at the time of the histological diagnosis was significantly higher in patients with collagenous colitis than in controls [38% vs. 13%, P < 0.001; adjusted OR of 4.5 (95% CI 2.0-9.5)].

CONCLUSIONS

This observation confirms the presumed association between microscopic colitis and PPI use, and it supports the possible aetiological role of PPI exposure in the development of microscopic colitis.

Prevention of radiocontrast-media-induced nephropathy in patients with pre-existing renal insufficiency by hydration in combination with the adenosine antagonist theophylline

BACKGROUND

Radiographic contrast media (CM) application causes a decline in renal function, especially in patients with pre-existing renal dysfunction. In addition to hydration, several vasodilating substances have been evaluated for their ability to prevent renal damage after CM application. In a prospective, double-blind, placebo-controlled study we investigated the effect of the oral administration of theophylline, an adenosine receptor antagonist, on changes in renal haemodynamics and tubular injury induced by CM in well-hydrated patients with mild-to-moderate renal insufficiency.

METHODS

We studied 80 patients with pre-existing chronic renal insufficiency (creatinine > 1.5 mg/dl) who received more than 100 ml iopromide. Hydration (either oral or intravenous) started at least 24 h before and lasted until 24 h after CM application. In addition, patients were randomly assigned to receive either theophylline (810 mg daily) or placebo. Serum creatinine and creatinine clearance were measured before and for 3 days after CM application. Urine was collected to measure N-acetyl-beta-glucosaminidase (NAG) enzymuria for the same period. Sixty-four patients completed the entire study protocol (theophylline, n = 35 and placebo, n = 29).

RESULTS

During the study period serum creatinine concentration and creatinine clearance did not change significantly in either group. Acute renal failure (increase of serum creatinine of at least 0.5 mg/dl) could be observed in two patients from the theophylline group (5.7%) and one from the placebo group (3.4%). The increase in NAG excretion reached statistical significance (P < 0.05) in the placebo group on days 2 and 3 after CM application.

CONCLUSIONS

Our results indicate a role for adenosine in CM-induced tubulotoxicity. However, the glomerular filtration rate is preserved by hydration alone in these patients. The application of theophylline did not bring an additional benefit. The use of adenosine antagonists may be beneficial in patients where sufficient hydration may be impossible or in patients with a concomitant decrease in renal blood flow (e.g. congestive heart failure).