Peter Vermeir

Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome

OBJECTIVE To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS). METHODS Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders. RESULTS Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder. CONCLUSIONS A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.

Socio-economic, behavioural, (neuro)psychological and clinical determinants of HRQoL in people living with HIV in Belgium: a pilot study

Due to highly active antiretroviral therapy (HAART), HIV‐1 infection has evolved from a lethal to a chronic disease. As such, health‐related quality of life (HRQoL) has become an important outcome variable. The purpose of this study was to identify socio‐economic, behavioural, (neuro)psychological and clinical determinants of HRQoL among people living with HIV (PLHIV).

Communication in healthcare: a narrative review of the literature and practical recommendations.

Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare.

Determinants of adherence in a cohort of Belgian HIV patients: a pilot study

Abstract Since the era of highly active antiretroviral therapy (HAART), HIV is considered a chronic disease. Adherence to HAART is crucial for effectiveness. Non-adherence negatively impacts patient outcome and the larger economy. However, data on adherence among the Belgian HIV cohort are scarce. Therefore, the purpose of this pilot study was to identify determinants of adherence among HIV patients treated in Belgium. The study was conducted at the Aids Reference Centre of Ghent University Hospital between 1 January and 31 December 2012. Sociodemographic data were collected, along with the Simplified Medication Adherence Questionnaire (SMAQ), the Center for Adherence Support Evaluation (CASE) Adherence Index, the EuroQol-6D, the Medical Outcomes Study-HIV (MOS-HIV), the Beck Depression Inventory-II, and three neurocognitive complaints screening questions. To date, 218 patients participated in the study, among whom 173 (79·4%) were male. Mean age was 46·0±10·6 years and 133 patients (63·9%) were homosexual. According to the SMAQ and the CASE, 78·5% and 93·5% of the patients were adherent to antiretroviral therapy. Logistic regression analysis revealed that smoking, neurocognitive complaints, and female sex were independent determinants of non-adherence. In conclusion, there is an elevated risk for non-adherence in smokers, people experiencing neurocognitive problems, and women in our sample. The latter could reflect differences between male and female HIV patients in Belgium. Adherence improving initiatives should be tailored to these three risk groups.

Sexual experience and HIV-related knowledge among Belgian university students: a questionnaire study

BackgroundAdolescents are a risk group for acquiring sexually transmitted diseases, including HIV. Correct knowledge about transmission mechanisms is a prerequisite to taking appropriate precautions to avoid infection. This study aimed at assessing the level of HIV-related knowledge among university students as a first step in developing targeted interventions. We used a self-developed HIV knowledge questionnaire, supplemented with socio-demographic and sexual behaviour questions. The questionnaire was composed of 59 items from different existing questionnaires. It included general statements and statements about prevention, transmission and treatment of HIV.ResultsThere were 357 (79.7%) female and 93 (20.3%) male participants and their median age was 20 (IQR 19–21). On average 42/59 (71.2%) questions were answered correctly, 5/59 (8.5%) were answered incorrectly and 12/59 (20.3%) were unknown . The best and worse scores were seen on the prevention questions and the treatment questions, respectively. HIV-related knowledge is higher in older students and in students with a health-related education. Students with sexual experience, with five or more partners and students who have been tested on STDs have a higher HIV-related knowledge.ConclusionsKnowledge on prevention and transmission of HIV is fairly good among university students and knowledge is higher among students with more sexual experience. They still have some misconceptions (e.g. HIV is spread by mosquitoes) and they are ignorant of a substantial number of statements (e.g. risk for infection through oral sex).

Intraorganizational Communication and Job Satisfaction Among Flemish Hospital Nurses: An Exploratory Multicenter Study

Intraorganizational communication affects job satisfaction and turnover. The goal of this study was to explore relationships between communication and job satisfaction, intention to leave, and burnout among Flemish hospital nurses. A multicenter questionnaire study was conducted in three hospitals using the Communication Satisfaction Questionnaire, the Turnover Intention subscale of the Questionnaire on the Experience and Evaluation of Work, and the Maslach Burnout Inventory. A visual analog scale measured job satisfaction. The mean job satisfaction score was 7.49/10 (±1.43). Almost 7% of nurse participants (93/1,355) reported a high intent to leave, and 2.9% of the respondents (41/1,454) had a score indicative of burnout. All dimensions of communication were associated with job satisfaction. A low score on any dimension of communication satisfaction, except “Relationship With Employees,” was associated with higher intent to leave and burnout. Study findings support the need for management interventions to enhance efficient communication and ensure high-quality care and patient safety.

Is pain at discharge a risk factor for unplanned hospital readmission

Introduction: Unplanned readmissions are associated with a high cost to health insurances and the incidence of preventable readmissions could be considered as a quality indicator for the initial hospital admission. We aimed to assess the predictive value for unplanned readmission of higher pain scores at discharge of the initial admission as well as of other pain and demographic characteristics. The documentation of significant associations would provide further support for a structured pain management policy. Methods: A retrospective analysis of a large single university hospital data-set of 33.122 admissions within a 13-month period allowed for the assessment of the predictive relationship of pain toward unplanned readmission at 7 and at 30 days after discharge through logistic regression, and of other characteristics through linear regression. Results: Pain scores at discharge of the initial admission were not significantly different (p > 0.05) with or without unplanned readmission and hence have no predictive value on the individual patient level. The prediction of the number of patients for each group, for example the number of patients that will be readmitted (size of the group), shows significance for pain at the moment of discharge (p_initial = 0.000), pain medication (p = 0.0044), and age (p = 0.0017). Pathology (p = 0.6151) and gender (p = 0.7029) have no significant predictive value. Conclusion: Pain as dichotomous variable upon discharge cannot be used as single risk predictor for unplanned readmission. However, the pain score at discharge in combination with the use of pain medication and age is a risk factor for the number of short-term unplanned readmissions.

The patient perspective on the effects of medical record accessibility: a systematic review.

Background: Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement. Objectives: To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient–physician relationship and quality of medical care. Methods: Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords ‘medical record’, ‘patient record’, ‘communication’, ‘patient participation’, ‘doctor–patient relationship’, ‘physician–patient relationship’ between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality. Results: Out of 557 papers screened, only 12 studies qualified for the systematic review. Only a minority of patients spontaneously request access to their medical file, in contrast to frequent awareness of this patient right and the fact that patients in general have a positive view on open visit notes. The majority of those who have actually consulted their file are positive about this experience. Access to personal files improves adequacy and efficiency of communication between physician and patient, in turn facilitating decision-making and self-management. Increased documentation through patient involvement and feedback on the medical file reduces medical errors, in turn increasing satisfaction and quality of care. Information improvement through personal medical file accessibility increased reassurance and a sense of involvement and responsibility. Conclusion: From the patient perspective medical record accessibility contributes to co-management of personal health care.

Patient perspectives on electronic health record accessibility and patient participation: a questionnaire survey

ABSTRACT Objectives To explore patient perceptions on personal comfort with participation in their own care process and on support of this patient participation through electronic health record (EHR) accessibility. Methods Explorative quantitative questionnaire study in ambulatory patients visiting the departments of General Internal Medicine or Head, Neck and Maxillo-Facial Surgery of a Belgian tertiary referral center. Results Patients were recruited by convenience sampling of 438 out of the total of 1270 patients visiting either one of these departments within a time period of two weeks. Overall response rate was 97.3% (n = 426; 45.3% male; mean age 42.5 ± 15.4 years). Most patients (89.7%) indicated a desire to make healthcare decisions in partnership with their physician. They were in need of transparent and comprehensible health information. The EHR was perceived as a suitable and effective means to inform patients about their health and to increase involvement in care and treatment (77.6%). Furthermore, access to the EHR was perceived to result in a more effective communication transfer between physician and patient (65.5%), increased patient compliance (64.3%), and satisfaction (57.4%). Conclusion Patients indicate a desire for proactive participation in their individual care process. They felt that medical record accessibility could support decision-making and assist in managing and coordinating individual and personalized care choices.

Job Satisfaction in Relation to Communication in Health Care Among Nurses: A Narrative Review and Practical Recommendations:

Worldwide, nurse shortage and high turnover rates are observed. Job satisfaction is a major determinant of retention and is influenced by intraorganizational communication and perceived communication satisfaction. This article presents a narrative review on communication satisfaction, job satisfaction, and their mutual relationship as well as their impact on turnover intention and burnout risk in the nursing profession. A literature search was conducted in the databases PubMed, Web of Science, and The Cochrane Library, and 47 articles were included. Descriptive analysis identified different types of social networks in the health care workplace. There is a positive association between communication and job satisfaction among nurses, translating into decreased turnover intention and burnout risk. Job satisfaction is required both for organizational stability as for coguaranteeing patient safety. This will be best achieved through an organization-wide multimodal prevention and intervention program, aimed at optimizing different modalities of interprofessional communication, workload, and job satisfaction.