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BACKGROUND: Chronic illnesses are a major public health problem in low-income countries. In the Democratic Republic of the Congo (DRC), few data are available, especially in palliative care. In this context, the present study aimed at describing the patterns of diseases in Kinshasa hospitals as well as risk factors associated with patients' evolving status and length of hospital stay. METHODS: A prospective study was conducted in ten hospitals of Kinshasa, over a 1-year period. A total of 2699 patients with a chronic condition (non-communicable diseases (NCD) and/or AIDS) were consecutively enrolled in the study between January and December, 2013. RESULTS: Out of 2699 patients studied, 36.9% were suffering from cardiovascular diseases, 29.7% from comorbidity and 17.5% from AIDS. 27.5% of patients died while hospitalized, and 67.4% were lost to follow-up. The risk factors independently associated with death in hospitals were AIDS (adjusted OR = 2.2) and age over 65 years old (adjusted OR = 1.7). Peri-urban and rural areas were significantly associated with a mean adjusted hospital stay longer than 3 days. The length of stay (LOS) was shorter for women and patients living in urban areas. Patients survived for a median of 10 days (range 7-20 days). CONCLUSIONS: This study reveals the high proportion of patients suffering from advanced chronic diseases, including cardiovascular diseases, AIDS and comorbidity. It demonstrates the need for palliative care (PC) in medical practices in Kinshasa, the capital of the Democratic Republic of the Congo.

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A systematic review of the international literature concerning the organisation of the Geriatric Day Hospital (GDH) was performed. From 1987 till now, few papers were found describing the activity and the effectiveness of the GDH. All the studies comparing specific geriatric approaches to regular medicine demonstrate the efficiency of geriatric care, particularly the geriatric assessment. So, with a degree of evidence 1a, a better outcome is found for patients undergoing a geriatric assessment and intervention, compared to patients having no geriatric assessment at all. However, there is no evidence of benefit for the geriatric day hospital compared to patients treated in a geriatric ward or other location of geriatric care. Moreover, there is no clear consensus on the settings and activities of a geriatric day hospital. Terms as day unit, day hospital, day care, are used interchangeably and are not always covering the same activity. The same remark can be made on the exact composition of the geriatric multidisciplinary team and its role. However nurses and paramedical workers are always mentioned as all performing geriatric assessment. The diagnostic activities on the GDH are seldom described and studied. More information is available on rehabilitation activity, often developed in specific patient populations such as stroke patients, dementia patients, cardiac patients or patients with other chronic diseases. In this selected patient populations positive effects on outcome are shown in the GDH (level of evidence 1a). Another problem is the heterogeneity of the population. For scientific reason the GDH should focus on organising care for specific medical problems. Diseases as dementia, stroke, cardiac insufficiency, could be good models to investigate the efficiency of geriatric assessment and interventions within the setting of a GDH.

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OBJECTIVES: The objective is to evaluate the use of the Appropriateness Evaluation Protocol (AEP) as a screening tool for determining the causes of the non-justified days to help hospitals to decrease the length of stay while preserving the quality of care. METHODS: Three successive cross-sectional surveys were conducted from 2003 till 2005, in 23 Belgian hospitals. During this period, 10921 days were audited by means of the AEP. This study is focused on adult acute non-intensive care units. The appropriateness of each day of the sample was assessed, and for those considered as inappropriate, the reasons explaining the prolongation of the stay were investigated. RESULTS: The proportion of inappropriate days was 24.61%. There is a high variability across specialties and hospitals. Regarding inappropriate days, the analysis of causes of prolongation, globally, by bed index or by hospital, indicated clearly internal and external factors that lengthen stays. The most frequent reasons are waits for an examination (22%) and the lack of extra-hospital structures (31%). CONCLUSIONS: The use of AEP as a tool of internal audit to measure the proportion of non-justified days and their causes turns out to be possible and the obtained results has provided some accurate and useful information for the participating, and allowed them to take concrete decisions which lead to shrinking of the length of hospital stay.

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BACKGROUND: Internationally, nursing is not well represented in hospital financing systems. In Belgium a nursing weight system exists to adjust budget allocation for differences in nurse staffing requirements, but there is a need for revision. Arguments include the availability of a nursing minimum dataset and the adverse consequences of the current historically based nursing weight system. OBJECTIVES: The development and validation of nursing resource weights for the revised Belgium nursing minimum dataset (NMDS). DESIGN: Two independent cross sectional Delphi-surveys. SETTING AND PARTICIPANTS: A convenience sample of 222 head nurses from 69 Belgian hospitals participated in the cross sectional survey methods. To assess validity 112 patient case records from 61 nursing wards of 35 Belgian general hospitals representing general, surgical, pediatric, geriatric and intensive care were selected. METHODS: Nursing resource weights were constructed based on Delphi survey results by NMDSII intervention. The patient case Delphi survey results were used as the primary source for validation. A series of additional validation measures were calculated, based on the different patient classification systems. Finally, three validated nursing resource weighting systems were compared to the constructed NMDSII weighting system: the use of 'Closon', 'Ghent' and WIN weights. RESULTS: A coherent set of nursing resource weights was developed. The comparison of nurse resource weights, based on the survey per NMDS intervention versus the survey on patient cases, yielded high correlations: r=0.74 to r=0.97 (p<0.01) between three case rating questions, as an indication of reliability in terms of internal consistency, and r=0.90 (p<0.01) between summed intervention weights and patient case weights, as an indication of criterion validity in terms of concurrent validity. Other concurrent validity measures based on summed intervention weights versus patient classification dependency weights showed a correlation ranging from r=0.14 to r=0.74. The correlation of summed intervention weights with the Closon, Ghent and WIN weights ranged from r=0.93 to r=0.96 (p<0.01), as a third indication of concurrent validity. CONCLUSIONS: A system of valid nursing resource weights has been developed. The system should be further validated within an international context.

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The Ministry of Public Health commissioned a research project to the Catholic University of Leuven and the University Hospital of Liège to revise the Belgian Nursing Minimum Dataset (B-NMDS). The study started in 2000 and will end with the implementation of the revised B-NMDS in January 2007. The study entailed four major phases. The first phase involved the development of a conceptual framework based on a literature review and secondary data analysis. The second phase focused on language development and development of a data collection tool. The third phase focused on data collection and validation of the new tool. In the fourth phase the validity and reliability of the dataset was tested. The new dataset is without avail if it is not leading to new information. Four applications of the dataset has been defined from the beginning: evaluation of the appropriateness of stay (AEP) in the hospital, nurse staffing, hospital financing and quality management. The aim of this paper is to describe how the B-NMDS can contribute to each of these applications.

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BACKGROUND AND AIMS: Our aim was to provide age- and sex-stratified prevalence estimates of physical disabilities and handicap in the general Belgian population. METHODS: A cross-sectional and demographically representative health interview survey was conducted nationwide in Belgium in 1997. The 8836 persons aged 15 years and over who answered the health interview were included in this study. Seventeen items from the survey encompassing main activities of daily living (ADL) and confining were analyzed. To provide prevalence estimates as detailed as possible, neither aggregation nor dichotomization were applied. RESULTS: Women consistently reported more disability than men: mobility (p < 0.001), transfer in-out bed (p < 0.001), transfer in-out chair (p < 0.001), dressing (p = 0.004), washing hands and face (p = 0.029), getting to and using toilet (p = 0.003), continence (p < 0.001), seeing (p < 0.001) and mastication (p < 0.001). As expected, there was a marked trend for increased prevalence of disability with increasing age for both sexes. Moderate disability arose mainly from the 25-34 age group for both sexes. For both genders, severe disability appeared mainly at higher ages, particularly for the 65-74 age group. Nevertheless, the data suggest that continence problems for women, mobility and transfer issues for men, as well as mastication problems for both genders, clearly emerge earlier than age 65. Regarding handicap, observed prevalence rates were increasing, in age as was the case for disability, but no differences were found between men or women, except for confinement to house/garden, for which women presented a higher rate in general (p < 0.001) and in the 75-84 age group (p = 0.036) in particular. CONCLUSIONS: This study shows the wide range of disability types in the general population and their association with handicap. While elderly individuals consistently report higher degrees of disability and handicap, attention should also be paid to younger age groups. Disability calls for wide, coherent and relevant medical as well as social responses.

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