The current practice of palliative care in Belgium is far from the presently considered ideal palliative care approaches. Facilitators such as proactive communication and communication tools could contribute to the development of guidelines for family physicians and policymakers in primary care.

Patients with COPD are underserved in terms of palliative care compared to those with other chronic life-limiting diseases. Awareness of palliative care as an option for patients with COPD needs to increase in palliative care services, physicians and the general public.

Almost half of a general practice population of current smokers between 40 and 70 years of age, with a smoking history of at least 15 pack-years, was diagnosed with COPD, and roughly two thirds of these were newly detected as a result of the case finding programme.

Our results help to elucidate the tasks and roles required of FPs to make integration of a palliative care approach into the care continuum possible.

BackgroundMany people who might benefit from specialist palliative care services are not using them.AimWe examined the use of these services and the reasons for not using them in a population in potential need of palliative care.MethodsWe conducted a population-based survey regarding end-of-life care among physicians certifying a large representative sample (n = 6188) of deaths in Flanders, Belgium.ResultsPalliative care services were not used in 79% of cases of people with organ failure, 64% of dementia and 44% of cancer. The most frequently indicated reasons were that 1) existing care already sufficiently addressed palliative and supportive needs (56%), 2) palliative care was not deemed meaningful (26%) and 3) there was insufficient time to initiate palliative care (24%). The reasons differed according to patient characteristics: in people with dementia the consideration of palliative care as not meaningful was more likely to be a reason for not using it; in older people their care needs already being sufficiently addressed was more likely to be a reason. For those patients who were referred the timing of referral varied from a median of six days before death (organ failure) to 16 days (cancer).ConclusionsSpecialist palliative care is not initiated in almost half of the people for whom it could be beneficial, most frequently because physicians deem regular caregivers to be sufficiently skilled in addressing palliative care needs. This would imply that the safeguarding of palliative care skills in this regular ‘general’ care is an essential health policy priority.

Background: Headache is a highly prevalent disorder. Irrespective of the headache diagnosis it is often accompanied with neck pain and -stiffness. Due to this common combination of headache and neck pain, physical treatments of the cervical spine are often considered. The additional value of these treatments to standard medical care or usual care (UC) is insufficiently documented.

Background:Political and public health leaders increasingly recognize the need to take urgent action to address the problem of chronic diseases and multi-morbidity. European countries are facing unprecedented demand to find new ways to deliver care to improve patient-centredness and personalization, and to avoid unnecessary time in hospitals. People-centred and integrated care has become a central part of policy initiatives to improve the access, quality, continuity, effectiveness and sustainability of healthcare systems and are thus preconditions for the economic sustainability of the EU health and social care systems.Purpose:This study presents an overview of lessons learned and critical success factors to policy making on integrated care based on findings from the EU FP-7 Project Integrate, a literature review, other EU projects with relevance to this study, a number of best practices on integrated care and our own experiences with research and policy making in integrated care at the national and international level.Results:Seven lessons learned and critical success factors to policy making on integrated care were identified.Conclusion:The lessons learned and critical success factors to policy making on integrated care show that a comprehensive systems perspective should guide the development of integrated care towards better health practices, education, research and policy.

The present study aims to derive guidelines that identify patients for whom spirometry can reliably predict a reduced total lung capacity (TLC). A total of 12,693 lung function tests were analysed on Caucasian subjects, aged 18-70 yrs.Restriction was defined as a reduced TLC. Lower limits of normal (LLN) for TLC were obtained from the European Respiratory Society recommended reference equations. Reference equations from the National Health and Nutrition Examination Survey III were used for forced vital capacity (FVC) and forced expiratory volume in six seconds (FEV6). The performance of FVC and FEV6 to predict the presence of restriction was studied as follows: 1) using two-by-two (262) tables; and 2) by logistic regression analysis. Both analyses were performed in obstructive (defined as forced expiratory volume in one second (FEV1)/FVC or FEV1/FEV6 ,LLN) and nonobstructive subgroups, and separately for males and females.The 262 tables showed generally low positive and high negative predictive values for FVC or FEV6 below their LLN in predicting a reduced TLC. Logistic regression analysis showed that in nonobstructive subjects, restriction can be positively predicted if FVC or FEV6 is ,55% predicted (males) or ,40% pred (females). Restriction can be ruled out if FVC or FEV in six seconds is .100% pred (males) or .85% pred (females).In obstructive patients, spirometry cannot reliably diagnose a concomitant restrictive defect, but it can rule out restriction for patients with forced vital capacity or forced expiratory volume in six seconds .85% pred (males) or .70% pred (females).KEYWORDS: Forced expiratory volume in six seconds, forced vital capacity, restrictive ventilatory defect, spirometry, total lung capacity P ulmonary function tests are performed to diagnose or rule out obstructive, restrictive or mixed ventilatory defects [1]. Airway obstruction is directly defined by spirometry and is characterised by the presence of a low forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) or FEV1/ forced expiratory volume in six seconds (FEV6) ratio [1][2][3]. The spirometric diagnosis of restriction is more problematic; while the presence of a restrictive pulmonary impairment can be suspected if FVC or FEV6 are low, their positive predictive value (PPV) is low, e.g. 58% in a study population of 264 White patients with a low FVC and a normal FEV1/FVC ratio [4]. Current interpretative guidelines are based on the assumption that a reduced total lung capacity (TLC) is the gold standard for the diagnosis of a restrictive ventilatory defect, thus requiring lung volume measurement by gas dilution or whole body plethysmography techniques [1].Previous studies have demonstrated that FEV6 can be a reliable surrogate for FVC in the detection of obstruction as well as in the exclusion of restriction [2,3,5,6]. As FEV1/FVC (or FEV1/vital capacity (VC)) is considered as a ''de facto gold standard'' for the detection of obstruction, FEV6 can never be shown to outperform FVC (or VC) in the denominator ...