Impact of the COVID-19 Pandemic on Patients and Staff in Radiation Oncology Departments in Belgium: A National Survey

Purpose: COVID-19 reached Belgium in February and quickly became a major public health challenge. It is of importance to evaluate the actual impact of COVID-19 on patients and staff in Belgian radiotherapy departments (RTDs). This was evaluated through a weekly national survey sent to departments measuring key factors that were affected by the pandemic.Materials and Methods: The Belgian SocieTy for Radiation Oncology (BeSTRO) together with the Belgian College for physicians in Radiation Oncology invited all 26 RTD to participate in a survey that started on March 2nd and was re- submitted weekly for 4 months to assess variations in time. The survey focused on: (1) the COVID-19 status of patients and staff; (2) the management of clinically suspected COVID patients and COVID positive patients; (3) the impact of COVID-19 on RTD activities; (4) its impact in radiotherapy indications and fractionation schemes.Results: Seventy-three percent of 26 RTDs completed the first survey and 57% responded to all weekly surveys. In the RTD staff, 24 members were COVID-positive of whom 67% were RTTs. Over the study period, the number of patients treated dropped by a maximum of 18.8% when compared to March 2nd. In 32.3% of COVID-positive and 54% of COVID suspected patients, treatment was continued without any interruptions. Radiotherapy indications were adapted within the 1st weeks of the survey in 47.4% of RTD, especially for urological and breast tumors. Fractionation schemes were changed in 68.4% of RTD, mainly for urological, breast, gastro-intestinal, and lung tumors.Conclusions: Between March and June 2020, the COVID-19 pandemic resulted in an important decrease in treatment activity in RTD in Belgium (18.8%). The COVID-19 infection status of patients influenced the continuity of the radiotherapy schedule. Changes in indications and fractionation schedules of radiotherapy were rapidly incorporated in the different RTD.

What is the most threatening for citizens of a mid-latitude city: cold stress or heat stress?

<p>Both heat and cold waves cause extreme human thermal discomfort and a clear excess in mortality. This shows the importance of knowing the prevailing thermal comfort conditions and how thermal comfort conditions vary in various environments so measures can be taken. Microclimatic and outdoor human thermal comfort conditions are investigated in various built-up and green areas in the city of Ghent (Belgium) using meteorological measurements of six weather stations of the MOCCA (Monitoring the Cities Climate and Atmosphere) network in combination with calculations done by RayMan.</p><p>Normal to extreme summer heat wave periods show that dangerous strong heat stress prevails during the daytime periods at all locations. Comparison of thermal comfort during normal and extreme summer heat wave periods showed that heat stress is more extreme when a heat wave is more intense. Overall the urban park in Ghent was the most comfortable location during heat waves since it effectively mitigates heat stress in the city. These results should be taken into account in urban planning and design to keep mid-latitude cities livable.</p><p>Further, a one year data series revealed that outdoor cold stress was more apparent during 2017 in the mid-latitude city of Ghent that experiences a mild maritime climate. During spring and summer, both heat stress and cold stress occurred due to the larger diurnal temperature range compared to the other seasons. Even though high Physiological Equivalent Temperatures (PET) were obtained during a heat wave in summer, heat stress did not occur as intensely and as frequently compared to cold stress on annual level. It could thus be stated that outdoors, cold stress is a bigger threat than heat stress. However, one should keep in mind that the study was executed for outdoor thermal heat comfort and that people will take shelter or take measures when feeling uncomfortable. The question is thus rather, how are citizens protected against heat and cold stress? Currently, the Belgian society is better adapted to cold stress since most buildings contain central heating, while air conditioning is not standard. Future projections predict an increase in temperature, causing more occurrence of extreme heat stress, while extreme cold stress will be reduced. Additionally, the urban heat island effect currently has mainly a positive effect on the average annual outdoor thermal comfort conditions, while it will become a negative effect in the warmer future. Measures should thus be taken to reduce the threat of future heat stress.</p>

Current ERCP practice in Belgium: the BSGIE survey

Background and study aims : Data on procedural outcome and quality of endoscopic retrograde cholangiopancreatography (ERCP) in Belgian practice are scarce. The aim of this study is to assess current status of ERCP-performance in Belgium. Methods : National multi-institutional survey (online question-naire) among members of the Belgian Society of Gastrointestinal Endoscopy (BSGIE), conducted in the period June-August 2018. The RIZIV/INAMI provided real-life data on the total number of ERCPs performed in Belgium. Results : Forty-five responders completed the survey (for43 centers performing ERCP), providing information for 8368 ERCPs performed in 45% (43/95) of institutions performing ERCP in Belgium. Fifty-eight percent of centers performed > 100 ERCPs/year and 7% of centers (n=3) performed < 50 ERCPs/year. According to the RIZIV/INAMI data, low case-volume centers are underrepresented in this survey. The most common ERCP-indication was stone extraction (52%). 74% of endoscopists had more than 10 years of experience in performing ERCP. The majority of centers had their own written protocol (84%) for microbiological duodenoscope surveillance. Monitoring of cannulation rate and post-ERCP pancreatitis (PEP) was only performed in a minority of centers (30%). The majority of centers (76%) provided verbal informed consent relating to the ERCP-procedure ; a minority also requested a written informed consent (23%). 65% of centers systematically use NSAIDs for PEP-prophylaxis. Conclusion : This is the first survey of ERCP performance in Belgium. There were wide variations in practice. Adherence to key performance measures and measurement and evaluation of ERCP performance in daily practice at center and endoscopist level are not uniformly widespread.

The “Fonds Georges Brohée” : a longstanding Belgian national initiative to stimulate research in hepatogastroenterology

The Fonds Brohée/Brohée fund was created in 1964 at the initiative of 16 Belgian physicians, in the memory of Georges Brohée, the founder of the Belgian Society of Gastroenterology in 1928 and of its Journal in 1933, first published under the name “Le Journal Belge de Gastro-entérologie”, then until today as “Acta Gastro-Enterologica Belgica”. The goal of the Fonds is to stimulate research in the field of gastroenterology in Belgium, by awarding a young researcher (< 40 years) for an outstanding work in the clinical, translational or fundamental setting. Since 1966, 26 remarkable works have been awarded in various areas of interest in gastrointestinal diseases, whether in IBD, functional disorders, digestive oncology and, last but not least, hepatology. Since the recognition of their work, many of the awardees have become recognized for their expertise well beyond Belgium. Hopefully, the Foundation will continue to thrive and flourish after 55 years, as the members of its board and its healthy finances will allow to continue to promote and encourage high-quality research by young hepato-gastroenterologists in Belgium.

„Meat Should Be Prescribed in Very Small Doses, Arsenic-like”. How Josephine Joteyko and Varia Kipiani Pioneered Medical Research to Improve Vegetarianism in 1906

This compilation is based on the original report on a clinical survey conducted in Brussels (1905-1906) by Josephine Joteyko and Varia Kipiani with 43 vegetarians. Having advanced expertise in physiology and experimentalism, Joteyko (with Lithuanian and Polish origins) and Kipiani (with Georgian origins) discussed their findings at the Congress of the Belgian Society for Vegetarianism in 1906. For both children and adults, females and males, regardless of age, the findings demonstrated vegetarian dietary habits to be beneficiary for human development, the subjects’ physical and mental health, welfare, and physical and intellectual efficiency. Surprisingly, Joteyko and Kipiani confirmed C. Darwin’s observation across various nutritional cultures that vegetarian food would increase the energetic balance of the human body. Additionally, their focus on the moteur humain shows affinities with Taylorism, the modernist utopias of labor, the enhancement of human faculties, the protection of workers and their rights from automation, and applied social science represented by Joteyko and Kipiani as multidisciplinary investigators. The compilation was made on: J. Joteyko & V. Kipiani, Enquête scientifique sur les Végétariens de Bruxelles, Conférence donnée à la Société végétarienne de Belgique, le 4 décembre 1906, pp. 1–77, with no further correction.