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Sample records for dutch general practice

  1. Prescription in Dutch general practice.

    NARCIS (Netherlands)

    Dijk, L. van

    2006-01-01

    The second Dutch National Survey of General Practice (DNSGP-2) has combined registration data on morbidity and prescription, making it possible to unravel diagnosis-specific prescription behaviour of general practitioners(GPs). Prescription rates for different disorders vary considerably, especially

  2. Sex differences among recipients of benzodiazepines in Dutch general practice.

    NARCIS (Netherlands)

    Waals, F.W. van der; Mohrs, J.; Foets, M.

    1993-01-01

    Objective: To analyse sex differences among recipients of benzodiazepines in Dutch general practice. Design-Study of consultations and associated interventions as recorded in the Dutch national survey of general practice. Setting: Practices of 45 general practitioners monitored during 1 April to 30

  3. Multiple sclerosis: management in Dutch general practice.

    NARCIS (Netherlands)

    Donker, G.A.; Foets, M.; Spreeuwenberg, P.

    1996-01-01

    BACKGROUND AND OBJECTIVES: A descriptive study on 118 MS patients in general practice, to describe the family physician's role in diagnosis, treatment and follow-up of patients. METHOD: Random sample of 103 general practices (161 family physicians) throughout The Netherlands with a total list of 335

  4. Management of rhinosinusitis in Dutch general practice

    NARCIS (Netherlands)

    Hoffmans, R.; Schermer, T.R.J.; Weel, C. van; Fokkens, W.

    2011-01-01

    AIMS: To determine whether general practitioners (GPs) distinguish between the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS), especially with regard to prescription of antibiotics and nasal steroids. METHODS: A questionnaire on the management of rhinosinusitis was sent to

  5. [The practice guideline 'Anemia' from the Dutch College of General Practitioners; a response from the perspective of general practice medicine

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den

    2003-01-01

    The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general

  6. [The practice guideline 'Anemia' from the Dutch College of General Practitioners; a response from the perspective of general practice medicine

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den

    2003-01-01

    The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general practi

  7. Treatment of heart failure in Dutch general practice

    Science.gov (United States)

    Bongers, Frans JM; Schellevis, François G; Bakx, Carel; van den Bosch, Wil JHM; van der Zee, Jouke

    2006-01-01

    Background To study the relation between the prescription rates of selected cardiovascular drugs (ACE-inhibitors and Angiotensin receptor blockers, beta-blockers, diuretics, and combinations), sociodemographic factors (age, gender and socioeconomic class) and concomitant diseases (hypertension, coronary heart disease, cerebrovascular accident, heart valve disease, atrial fibrillation, diabetes mellitus and asthma/COPD) among patients with heart failure cared for in general practice. Methods Data from the second Dutch National Survey in General Practice, conducted mainly in 2001. In this study the data of 96 practices with a registered patient population of 374.000 were used. Data included diagnosis made during one year by general practitioners, derived from the electronic medical records, prescriptions for medication and sociodemographic characteristics collected via a postal questionnary (response 76%) Results A diagnosis of HF was found with 2771 patients (7.1 in 1000). Their mean age was 77.7 years, 68% was 75 years or older, 55% of the patients were women. Overall prescription rates for RAAS-I, beta-blockers and diuretics were 50%, 32%, 86%, respectively, whereas a combination of these three drugs was prescribed in 18%. Variations in prescription rates were mainly related to age and concomitant diseases. Conclusion Prescription is not influenced by gender, to a small degree influenced by socioeconomic status and to a large degree by age and concomitant diseases. PMID:16822303

  8. Treatment of heart failure in Dutch general practice

    Directory of Open Access Journals (Sweden)

    van den Bosch Wil JHM

    2006-07-01

    Full Text Available Abstract Background To study the relation between the prescription rates of selected cardiovascular drugs (ACE-inhibitors and Angiotensin receptor blockers, beta-blockers, diuretics, and combinations, sociodemographic factors (age, gender and socioeconomic class and concomitant diseases (hypertension, coronary heart disease, cerebrovascular accident, heart valve disease, atrial fibrillation, diabetes mellitus and asthma/COPD among patients with heart failure cared for in general practice. Methods Data from the second Dutch National Survey in General Practice, conducted mainly in 2001. In this study the data of 96 practices with a registered patient population of 374.000 were used. Data included diagnosis made during one year by general practitioners, derived from the electronic medical records, prescriptions for medication and sociodemographic characteristics collected via a postal questionnary (response 76% Results A diagnosis of HF was found with 2771 patients (7.1 in 1000. Their mean age was 77.7 years, 68% was 75 years or older, 55% of the patients were women. Overall prescription rates for RAAS-I, beta-blockers and diuretics were 50%, 32%, 86%, respectively, whereas a combination of these three drugs was prescribed in 18%. Variations in prescription rates were mainly related to age and concomitant diseases. Conclusion Prescription is not influenced by gender, to a small degree influenced by socioeconomic status and to a large degree by age and concomitant diseases.

  9. [The Dutch College of General Practitioners' practice guideline "Dizziness"; reaction from a general practitioner's perspective

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den

    2003-01-01

    The Dutch College of General Practitioners' practice guideline entitled 'Dizziness' concerns a complaint experienced by many people, yet it provides few scientific data to support the recommendations. The standard does, however, provide the general practitioner with some concrete advice: the diagnos

  10. Nutritional deficiency in Dutch primary care : data from general practice research and registration networks

    NARCIS (Netherlands)

    van Wayenburg, CAM; van de Laar, FA; de Waal, MWM; Okkes, IM; van den Akker, M; van der Veen, WJ; Schellevis, FG; van Staveren, WA; van Binsbergen, JJ; van Weel, C

    2005-01-01

    Objective: To explore incidence and prevalence rates of nutritional deficiency in adults in general practice. Methods: Six Dutch general practice research and registration networks supplied incidence and prevalence rates of nutritional deficiency by the International Classification of Primary Care (

  11. [Summary of the practice guideline 'Thyroid disorders' (first revision) from the Dutch College of General Practitioners

    NARCIS (Netherlands)

    Lieshout, J. van; Wessels, P.; Rijswijk, E. van; Boer, A.M; Wiersma, A.; Goudswaard, A.N.

    2007-01-01

    --The practice guideline 'Thyroid disorders' developed by the Dutch College of General Practitioners replaces the practice guideline 'Functional thyroid disorders' from 1996. Recommendations for palpable thyroid disorders have been added. --Hypothyroidism can often be treated by the general practiti

  12. Osteoarthritis of the hip and/or knee in Dutch general practice and physiotherapy practice.

    NARCIS (Netherlands)

    Barten, D.J.; Swinkels, I.C.; Dorsman, S.A.; Veenhof, C.

    2012-01-01

    Purpose: To describe demographic characteristics and the treatment process of patients with hip osteoarthritis (OA) or knee OA treated in Dutch general practice (GP) and/or physiotherapy practice. Additionally, to investigate whether there are differences in characteristics between referred and non-

  13. [The Dutch College of General Practitioners practice guideline 'The menopause'; reaction of the field of general practice

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den

    2002-01-01

    The Dutch College of General Practitioners' practice guideline on the menopause will not be any major cause for discussion. The hot issue of giving oestrogens to peri- and postmenopausal women to prevent osteoporosis or cardiovascular disease was already covered in the practice guideline on osteopor

  14. [The practice guideline 'Smoking cessation' from the Dutch College of General Practitioners; a response from the perspective of general practice

    NARCIS (Netherlands)

    Weel, C. van

    2008-01-01

    This article reviews the practice guideline from the Dutch College of General Practitioners on smoking cessation. General practitioners (GP) should strive after smoking cessation when patients consult and ask for support to stop smoking. Moreover, the practitioner should also show such initiative wh

  15. Management of bibliographic information by Dutch researchers in general practice

    NARCIS (Netherlands)

    Verhoeven, AAH; Jong, BMD

    1997-01-01

    Background. As a result of changes in information technology and the rapid growth of publications methods of searching the literature have changed. Systematic searching of the growing literature has become very important. It is not known whether researchers in general practice search systematically,

  16. Management of bibliographic information by Dutch researchers in general practice

    NARCIS (Netherlands)

    Verhoeven, AAH; Jong, BMD

    Background. As a result of changes in information technology and the rapid growth of publications methods of searching the literature have changed. Systematic searching of the growing literature has become very important. It is not known whether researchers in general practice search systematically,

  17. Quality of routine spirometry tests in Dutch general practices.

    NARCIS (Netherlands)

    Schermer, T.R.J.; Crockett, A.J.; Poels, P.J.P.; Dijke, J.J. van; Akkermans, R.P.; Vlek, H.F.; Pieters, W.R.

    2009-01-01

    BACKGROUND: Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care. AIM: To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics. DESIGN OF STUDY: Analysis

  18. The epidemiology of suicide and attempted suicide in Dutch general practice 1983-2003.

    NARCIS (Netherlands)

    Marquet, R.L.; Bartelds, A.I.M.; Kerkhof, A.J.F.M.; Schellevis, F.G.; Zee, J. van der

    2005-01-01

    BACKGROUND: Many patients attempting or committing suicide consult their general practitioner (GP) in the preceding period, indicating that GPs might play an important role in prevention. The aim of the present study was to analyse the epidemiology of suicidal behaviour in Dutch general practice in

  19. The epidemiology of suicide and attempted suicide in Dutch general practice 1983-2003.

    NARCIS (Netherlands)

    Marquet, R.L.; Bartelds, A.I.M.; Kerkhof, A.J.F.M.; Schellevis, F.G.; Zee, J. van der

    2005-01-01

    BACKGROUND: Many patients attempting or committing suicide consult their general practitioner (GP) in the preceding period, indicating that GPs might play an important role in prevention. The aim of the present study was to analyse the epidemiology of suicidal behaviour in Dutch general practice in

  20. Child and adolescent mental health care in Dutch general practice: time trend analyses.

    NARCIS (Netherlands)

    Zwaanswijk, M.; Dijk, C.E. van; Verheij, R.A.

    2011-01-01

    Background: Because most children and adolescents visit their general practitioner (GP) regularly, general practice is a useful setting in which child and adolescent mental health problems can be identified, treated or referred to specialised care. Measures to strengthen Dutch primary mental health

  1. Rhinosinusitis in morbidity registrations in Dutch General Practice: a retro-spective case-control study

    NARCIS (Netherlands)

    Hoffmans, R.; Schermer, T.R.; Linde, K. van der; Bor, H.; Boven, K. van; Weel, C. van; Fokkens, W.

    2015-01-01

    BACKGROUND: There is only limited accurate data on the epidemiology of rhinosinusitis in primary care. This study was conducted to assess the incidence of acute and chronic rhinosinusitis by analysing data from two Dutch general practice registration projects. Several patient characteristics and dis

  2. [Summary of the Dutch College of General Practitioners' practice guideline on food hypersensitivity

    NARCIS (Netherlands)

    Luning-Koster, M.N.; Lucassen, P.L.B.J.; Boukes, F.S.; Goudswaard, A.

    2011-01-01

    October 2010 the Dutch College of General Practitioners issued a revised version of their previous practice guideline of 1995 on food hypersensitivity in infants. If patients suspect either themselves or their child of having a food allergy, this is usually not demonstrated in subsequent investigati

  3. The incidence of suspected myocardial infarction in Dutch general practice in the period 1978-1994.

    NARCIS (Netherlands)

    Pal-de Bruin, K.M. van der; Verkleij, H.; Jansen, J.; Bartelds, A.; Kromhout, D.

    1998-01-01

    Aim: To evaluate how the incidence of suspected myocardial infarction has developed from 1978 to 1994 and to study the incidence of confirmed acute myocardial infarction in Dutch general practices during the period 1991-1994. Methods: In three periods (1978, 1983-1985 and 1991-1994) the incidence of

  4. The incidence of suspected myocardial infarction in Dutch general practice in the period 1978-1994.

    NARCIS (Netherlands)

    Pal-de Bruin, K.M. van der; Verkleij, H.; Jansen, J.; Bartelds, A.; Kromhout, D.

    1998-01-01

    Aim: To evaluate how the incidence of suspected myocardial infarction has developed from 1978 to 1994 and to study the incidence of confirmed acute myocardial infarction in Dutch general practices during the period 1991-1994. Methods: In three periods (1978, 1983-1985 and 1991-1994) the incidence of

  5. Frequency of ill-founded off-label prescribing in Dutch general practice.

    NARCIS (Netherlands)

    Gijsen, R.; Jochemsen, H.; Dijk, L. van; Caspers, P.

    2009-01-01

    Purpose: The aim of this study is to quantify the extent of ill-founded off-label drug prescriptions in Dutch general practice. The study is based upon information on both the prescription itself and the patient’s medical history. Methods: In total, 48 combinations of drugs and off-label indications

  6. [Summary of the Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'

    NARCIS (Netherlands)

    Weele, G.M. van der; Olde Rikkert, M.G.M.; Eizenga, W.H.; Assendelft, W.J.J.

    2003-01-01

    The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people' contains a number of key messages. These are: Consider the diagnosis of delirium in the case of changes in consciousness and attention, incoherent thinking or disorientation, if this picture developed over a

  7. Prevalence of STI related consultations in general practice: results from the second Dutch National Survey of General Practice

    Science.gov (United States)

    van Bergen, Jan EAM; Kerssens, Jan J; Schellevis, Francois G; Sandfort, Theo G; Coenen, Ton J; Bindels, Patrick J

    2006-01-01

    Background The role of the GP in the care of sexually transmitted infections (STIs) is unclear. Aim We studied the prevalence of STI related consultations in Dutch general practice in order to obtain insight into the contribution of the GP in STI control. Design of study A descriptive study. Setting The study took place within the framework of the second Dutch National Survey of General Practice in 2001, a large nationally representative population-based survey. Method During 1 year, data of all patient contacts with the participating GPs were recorded in electronic medical records. Contacts for the same health problem were clustered into disease episodes and their diagnosis coded according to the International Classification of Primary Care. All STI and STI related episodes were analysed. Results In total, 1 524 470 contacts of 375 899 registered persons in 104 practices were registered during 1 year and 2460 STI related episodes were found. The prevalence rate of STI was 39 per 10 000 persons and of STI/HIV related questions 23 per 10 000. More than half of all STIs were found in highly urbanised areas and STIs were overrepresented in deprived areas. Three quarters of all STIs diagnosed in the Netherlands are made in general practice. An important number of other reproductive health visits in general practice offer opportunities for meaningful STI counselling and tailored prevention. Discussion GPs contribute significantly to STI control, see the majority of patients with STI related symptoms and questions and are an important player in STI care. In particular, GPs in urban areas and inner-city practices should be targeted for accelerated sexual health programmes. PMID:16464323

  8. Continuous Morbidity Registration at Dutch Sentinel General Practice Network 2009.

    NARCIS (Netherlands)

    Donker, G.A.

    2011-01-01

    The Mexican flu pandemic was limited to a mild pandemic, although the flu incidence rate was higher than in the previous three seasons. At the peak of the epidemic 189 per 100.000 registered patients consulted their general practitioner (GP). The sentinel GP’s of NIVEL registered the number of new f

  9. Promotion of nutrition and physical activity in Dutch general practice

    NARCIS (Netherlands)

    Dillen, van S.; Hiddink, G.J.; Woerkum, van C.M.J.

    2011-01-01

    Introduction: Promotion of nutrition and physical activity is important to slow down the increase of overweight. General practitioners (GPs) are in an unique position to communicate with their patients about nutrition and physical activity, because of the high referral score, high perceived expertis

  10. Rhinosinusitis in morbidity registrations in Dutch General Practice: a retro-spective case-control study

    OpenAIRE

    2015-01-01

    BACKGROUND: There is only limited accurate data on the epidemiology of rhinosinusitis in primary care. This study was conducted to assess the incidence of acute and chronic rhinosinusitis by analysing data from two Dutch general practice registration projects. Several patient characteristics and diseases are related to the diagnosis rhinosinusitis. METHODS: The Continuous Morbidity Registration (CMR) and the Transitionproject (TP) are used to analyse the data on rhinosinusitis in primary prac...

  11. Do general practitioners adhere to the guideline on infectious conjunctivitis? Results of the Second Dutch National Survey of General Practice

    Science.gov (United States)

    Rietveld, Remco P; ter Riet, Gerben; Bindels, Patrick JE; Schellevis, François G; van Weert, Henk CPM

    2007-01-01

    Background In 1996 the guideline 'The Red Eye' was first published by the Dutch College of General Practitioners. The extent to which general practitioners adhere to this guideline is unclear. Recently, data on the management of infectious conjunctivitis by general practitioners became available from the Second Dutch National Survey of General Practice. We measured the age-specific incidence of infectious conjunctivitis, described its management by Dutch general practitioners, and then compared these findings with the recommendations made in the guideline. Methods In 2001, over a 12-month period, data from all patient contacts with 195 general practitioners were taken from electronic medical records. Registration was episode-oriented; all consultations dealing with the same health problem were grouped into disease episodes. Data concerning all episodes of infectious conjunctivitis (ICPC-code F70 and sub codes) were analysed. Results Over one year, 5,213 new and recurrent episodes of infectious conjunctivitis were presented to general practitioners from a population of N = 375,899, resulting in an overall incidence rate of 13.9 per 1000 person-years, varying from more than 80/1000 py in children up to one-year old, to less than 12/1000 py in children over the age of 4. Topical ophthalmic ointments were prescribed in 87% of the episodes, of which 80% was antibiotic treatment. Fusidic acid gel was most frequently prescribed (69%). In most episodes general practitioners did not adhere to the guideline. Conclusion In 2001, the management of infectious conjunctivitis by Dutch general practitioners was not in accordance with the recommendations of the consensus-based guideline published five years previously, despite its wide distribution. In 2006 this guideline was revised. Its successful implementation requires more than distribution alone. Probably the most effective way to achieve this is by following a model for systemic implementation. PMID:17868475

  12. Do general practitioners adhere to the guideline on infectious conjunctivitis? Results of the Second Dutch National Survey of General Practice

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2007-09-01

    Full Text Available Abstract Background In 1996 the guideline 'The Red Eye' was first published by the Dutch College of General Practitioners. The extent to which general practitioners adhere to this guideline is unclear. Recently, data on the management of infectious conjunctivitis by general practitioners became available from the Second Dutch National Survey of General Practice. We measured the age-specific incidence of infectious conjunctivitis, described its management by Dutch general practitioners, and then compared these findings with the recommendations made in the guideline. Methods In 2001, over a 12-month period, data from all patient contacts with 195 general practitioners were taken from electronic medical records. Registration was episode-oriented; all consultations dealing with the same health problem were grouped into disease episodes. Data concerning all episodes of infectious conjunctivitis (ICPC-code F70 and sub codes were analysed. Results Over one year, 5,213 new and recurrent episodes of infectious conjunctivitis were presented to general practitioners from a population of N = 375,899, resulting in an overall incidence rate of 13.9 per 1000 person-years, varying from more than 80/1000 py in children up to one-year old, to less than 12/1000 py in children over the age of 4. Topical ophthalmic ointments were prescribed in 87% of the episodes, of which 80% was antibiotic treatment. Fusidic acid gel was most frequently prescribed (69%. In most episodes general practitioners did not adhere to the guideline. Conclusion In 2001, the management of infectious conjunctivitis by Dutch general practitioners was not in accordance with the recommendations of the consensus-based guideline published five years previously, despite its wide distribution. In 2006 this guideline was revised. Its successful implementation requires more than distribution alone. Probably the most effective way to achieve this is by following a model for systemic implementation.

  13. [The practice guideline 'Bacterial skin infections' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice

    NARCIS (Netherlands)

    Olde Hartman, T.C.; Uijen, A.A.

    2008-01-01

    The revised guideline 'Bacterial skin infections' from the Dutch College ofGeneral Practitioners offers a clear and extensive overview of the most prevalent superficial and deep bacterial infections in general practice. Given the lack of evidence, it is no longer recommended to keep children with im

  14. [The practice guideline 'Problematic alcohol consumption' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den

    2006-01-01

    The recently revised version of the practice guideline 'Problematic alcohol consumption' from the Dutch College of General Practitioners offers realistic advice to general practitioners on how to manage problem drinkers. The number of patients with alcohol problems tends to increase among women of m

  15. [The practice guideline 'Smoking cessation' from the Dutch College of General Practitioners; a response from the perspective of pulmonary medicine].

    Science.gov (United States)

    van Spiegel, P I

    2008-06-28

    The practice guideline 'Smoking cessation' from the Dutch College of General Practitioners has been published. If general practitioners are going to use the standard, this can have a great impact on smoking in the Dutch population. A decrease in smokers among the population will also have an impact on several smoking-related chronic diseases from a preventive point of view. The guideline emphasizes that smoking cessation is not a one-stop shop but that it requires a long-term effort.

  16. [Summary of the Dutch College of General Practitioners' practice guideline on food hypersensitivity].

    Science.gov (United States)

    Luning-Koster, Marleen N; Lucassen, Peter L B J; Boukes, Froukje S; Goudswaard, A N Lex

    2011-01-01

    October 2010 the Dutch College of General Practitioners issued a revised version of their previous practice guideline of 1995 on food hypersensitivity in infants. If patients suspect either themselves or their child of having a food allergy, this is usually not demonstrated in subsequent investigation. Wrongly prescribed elimination diets may have adverse effects. Examination of serum specific IgE levels has no place in the diagnosis of food allergy in general practice. An open elimination challenge is especially suitable in order to exclude a food allergy. A sure diagnosis of food allergy can only be made by a double-blind placebo-controlled food challenge. There are no proven effective measures that can prevent food allergy.

  17. The epidemiology of suicide and attempted suicide in Dutch general practice 1983–2003

    Science.gov (United States)

    Marquet, Richard L; Bartelds, Aad IM; Kerkhof, Ad JFM; Schellevis, François G; van der Zee, Jouke

    2005-01-01

    Background Many patients attempting or committing suicide consult their general practitioner (GP) in the preceding period, indicating that GPs might play an important role in prevention. The aim of the present study was to analyse the epidemiology of suicidal behaviour in Dutch General Practice in order to find possible clues for prevention. Method Description of trends in suicide and suicide attempts occurring from 1983–2003 in the Dutch General Practice Sentinel Network, representing 1% of the Dutch population. The data were analysed with regard to: 1) suicidal behaviour trends and their association with household situation; 2) presence of depression, treatment of depression and referral rate by GPs; 3) contact with GP before suicide or suicide attempt and discussion of suicidal ideation. Results Between 1983 and 2003 the annual number of suicide and suicide attempts decreased by 50%. Sixty percent of the patients who committed or attempted suicide were diagnosed as depressed, of whom 91% were treated by their GP with an antidepressant. Living alone was a risk factor for suicide (odds ratio 1.99; 95% CI 1.50 to 2.64), whereas living in a household of 3 or more persons was a relative risk for a suicide attempt (odds ratio 1.81; 95% CI 1.34 to 2.46). Referral to a psychiatrist or other mental health professionals occurred in 65% of the cases. GPs recalled having discussed suicidal ideation in only 7% of the cases, and in retrospect estimated that they had foreseen suicide or suicide attempts in 31% and 22% of the cases, respectively, if there had been contact in the preceding month. Conclusion With regard to the prescription of antidepressants and referral of suicidal patients to a psychiatrist, Dutch GPs fulfil their role as gatekeeper satisfactorily. However, since few patients discuss their suicidal ideation with their GP, there is room for improvement. GPs should take the lead to make this subject debatable. It may improve early recognition of depressed

  18. The epidemiology of suicide and attempted suicide in Dutch general practice 1983–2003

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2005-11-01

    Full Text Available Abstract Background Many patients attempting or committing suicide consult their general practitioner (GP in the preceding period, indicating that GPs might play an important role in prevention. The aim of the present study was to analyse the epidemiology of suicidal behaviour in Dutch General Practice in order to find possible clues for prevention. Method Description of trends in suicide and suicide attempts occurring from 1983–2003 in the Dutch General Practice Sentinel Network, representing 1% of the Dutch population. The data were analysed with regard to: 1 suicidal behaviour trends and their association with household situation; 2 presence of depression, treatment of depression and referral rate by GPs; 3 contact with GP before suicide or suicide attempt and discussion of suicidal ideation. Results Between 1983 and 2003 the annual number of suicide and suicide attempts decreased by 50%. Sixty percent of the patients who committed or attempted suicide were diagnosed as depressed, of whom 91% were treated by their GP with an antidepressant. Living alone was a risk factor for suicide (odds ratio 1.99; 95% CI 1.50 to 2.64, whereas living in a household of 3 or more persons was a relative risk for a suicide attempt (odds ratio 1.81; 95% CI 1.34 to 2.46. Referral to a psychiatrist or other mental health professionals occurred in 65% of the cases. GPs recalled having discussed suicidal ideation in only 7% of the cases, and in retrospect estimated that they had foreseen suicide or suicide attempts in 31% and 22% of the cases, respectively, if there had been contact in the preceding month. Conclusion With regard to the prescription of antidepressants and referral of suicidal patients to a psychiatrist, Dutch GPs fulfil their role as gatekeeper satisfactorily. However, since few patients discuss their suicidal ideation with their GP, there is room for improvement. GPs should take the lead to make this subject debatable. It may improve early

  19. [Dutch College of General Practitioners' practice guideline 'Peripheral facial paralysis': a summary].

    Science.gov (United States)

    Klomp, M A Rien; Verdaasdonk, Aard L; Striekwold, Manuela P; Teunissen, H Eric; Opstelten, Wim; Goudswaard, A N Lex

    2010-01-01

    The practice guideline 'Peripheral facial paralysis' of the Dutch College of General Practitioners provides the general practitioner with guidelines for diagnosis and management of patients with a peripheral facial paralysis. In about two-thirds of cases of peripheral facial paralysis no cause can be found. The diagnosis of this so-called idiopathic peripheral facial paralysis is based on the patient's history and physical examination; additional investigations are not indicated. The natural course is usually good: without treatment 65-85% of patients will regain normal function of the facial muscles. Treatment with corticosteroids is recommended for all patients with an idiopathic peripheral facial paralysis, irrespective of the degree of the paralysis. This increases the chance of complete recovery by approximately 10%. Antiviral treatment is not recommended.

  20. Requests for euthanasia in general practice before and after implementation of the Dutch Euthanasia Act.

    Science.gov (United States)

    van Alphen, Jojanneke E; Donker, Gé A; Marquet, Richard L

    2010-04-01

    The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalizing euthanasia under strict conditions influences the number and nature of euthanasia requests. To investigate changes in the number of, and reasons for, requests for euthanasia in Dutch general practice after implementation of the Euthanasia Act. Retrospective dynamic cohort study comparing 5 years before (1998-2002) and 5 years after (2003-2007) implementation of the Act. Standardised registration forms were used to collect data on requests for euthanasia via the Dutch Sentinel Practice Network. This network of 45 general practices is nationally representative by age, sex, geographic distribution, and population density. The mean annual incidence of requests before implementation amounted to 3.1/10,000 and thereafter to 2.8/10,000 patients. However, trends differed by sex. The number of requests by males decreased significantly from 3.7/10,000 to 2.6/10,000 (P = 0.008); the requests by females increased non-significantly from 2.6/10,000 to 3.1/10,000. Before and after implementation, cancer remained the major underlying disease for requesting euthanasia: 82% versus 77% for men; 73% versus 75% for females. Pain was a major reason for a request, increasing in the period before implementation (mean 27%), but declining in the period thereafter (mean 22%). Loss of dignity became a less important reason after implementation (from 18% to 10%, P = 0.04), predominantly due to a marked decrease in the number of females citing it as a reason (from 17% to 6%, P = 0.02). There was no increase in demand for euthanasia after implementation of the Euthanasia Act. Pain as a reason for requesting euthanasia showed an increasing trend before implementation, but declined thereafter. Loss of dignity as a reason declined, especially in females.

  1. Requests for euthanasia in general practice before and after implementation of the Dutch Euthanasia Act

    Science.gov (United States)

    van Alphen, Jojanneke E; Donker, Gé A; Marquet, Richard L

    2010-01-01

    Background The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalising euthanasia under strict conditions influences the number and nature of euthanasia requests. Aim To investigate changes in the number of, and reasons for, requests for euthanasia in Dutch general practice after implementation of the Euthanasia Act. Design of study Retrospective dynamic cohort study comparing 5 years before (1998–2002) and 5 years after (2003–2007) implementation of the Act. Method Standardised registration forms were used to collect data on requests for euthanasia via the Dutch Sentinel Practice Network. This network of 45 general practices is nationally representative by age, sex, geographic distribution, and population density. Results The mean annual incidence of requests before implementation amounted to 3.1/10 000 and thereafter to 2.8/10 000 patients. However, trends differed by sex. The number of requests by males decreased significantly from 3.7/10 000 to 2.6/10 000 (P = 0.008); the requests by females increased non-significantly from 2.6/10 000 to 3.1/10 000. Before and after implementation, cancer remained the major underlying disease for requesting euthanasia: 82% versus 77% for men; 73% versus 75% for females. Pain was a major reason for a request, increasing in the period before implementation (mean 27%), but declining in the period thereafter (mean 22%). Loss of dignity became a less important reason after implementation (from 18% to 10%, P = 0.04), predominantly due to a marked decrease in the number of females citing it as a reason (from 17% to 6%, P = 0.02). Conclusion There was no increase in demand for euthanasia after implementation of the Euthanasia Act. Pain as a reason for requesting euthanasia showed an increasing trend before implementation, but declined thereafter. Loss of dignity as a reason declined, especially in females. PMID:20353671

  2. The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'; response from a geriatric perspective

    NARCIS (Netherlands)

    Izaks, GJ

    2003-01-01

    Delirium in elderly people is a severe condition that requires vigorous medical attention. Therefore, the Dutch College of General Practitioners has duly chosen to develop a practice guideline 'Delirium in elderly people'. It is likely that many general practitioners are only partly familiar with

  3. The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'; response from a geriatric perspective

    NARCIS (Netherlands)

    Izaks, GJ

    2003-01-01

    Delirium in elderly people is a severe condition that requires vigorous medical attention. Therefore, the Dutch College of General Practitioners has duly chosen to develop a practice guideline 'Delirium in elderly people'. It is likely that many general practitioners are only partly familiar with de

  4. Multimorbidity and comorbidity in the Dutch population – data from general practices

    Directory of Open Access Journals (Sweden)

    van Oostrom Sandra H

    2012-08-01

    Full Text Available Abstract Background Multimorbidity is increasingly recognized as a major public health challenge of modern societies. However, knowledge about the size of the population suffering from multimorbidity and the type of multimorbidity is scarce. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population and to explore disease clustering and common comorbidities. Methods We used 7 years data (2002–2008 of a large Dutch representative network of general practices (212,902 patients. Multimorbidity was defined as having two or more out of 29 chronic diseases. The prevalence of multimorbidity was calculated for the total population and by sex and age group. For 10 prevalent diseases among patients of 55 years and older (N = 52,014 logistic regressions analyses were used to study disease clustering and descriptive analyses to explore common comorbid diseases. Results Multimorbidity of chronic diseases was found among 13% of the Dutch population and in 37% of those older than 55 years. Among patients over 55 years with a specific chronic disease more than two-thirds also had one or more other chronic diseases. Most disease pairs occurred more frequently than would be expected if diseases had been independent. Comorbidity was not limited to specific combinations of diseases; about 70% of those with a disease had one or more extra chronic diseases recorded which were not included in the top five of most common diseases. Conclusion Multimorbidity is common at all ages though increasing with age, with over two-thirds of those with chronic diseases and aged 55 years and older being recorded with multimorbidity. Comorbidity encompassed many different combinations of chronic diseases. Given the ageing population, multimorbidity and its consequences should be taken into account in the organization of care in order to avoid fragmented care, in medical

  5. [The practice guideline 'Stable angina pectoris' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

    Science.gov (United States)

    Mazel, J A

    2004-11-06

    The Dutch College of General Practitioners' (Dutch acronym: NHG) practice guideline 'Stable angina pectoris' (second revision) provides clear guidelines for the diagnosis and treatment of patients who experience chest pains as a result of angina pectoris, especially if coronary artery disease is the underlying cause of the complaints. The practice guideline clearly indicates for which complaints the general practitioner should suspect angina pectoris and which information from the anamnesis, family history and risk factors can contribute to distinguishing between stable and unstable angina pectoris. However, the physical examination should not be omitted because this can provide important indications for coronary or pulmonary dysfunction. According to the practice guideline, the treatment policy is determined by the estimated risk of significant coronary artery disease. However, additional tests can be useful even in the case of a small risk, as these can reassure patients. The indications and contraindications for medicinal substances are clearly presented.

  6. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    NARCIS (Netherlands)

    M.H. Blanker (Marco); M. Koerhuis-Roessink (Marlies); S.J. Swart (Siebe); W.W.A. Zuurmond (Wouter); A. van der Heide (Agnes); R.S.G.M. Perez (Roberto); J.A.C. Rietjens (Judith)

    2012-01-01

    textabstractBackground: Little is known about pressure from patients or relatives on physician's decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice

  7. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    NARCIS (Netherlands)

    Blanker, Marco H.; Roessink, Marlies; Swart, Siebe J.; Zuurmond, Wouter W. A.; van der Heide, Agnes; Perez, Roberto S. G. M.; Rietjens, Judith A. C.

    2012-01-01

    Background: Little is known about pressure from patients or relatives on physician's decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using

  8. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    NARCIS (Netherlands)

    Blanker, Marco H.; Roessink, Marlies; Swart, Siebe J.; Zuurmond, Wouter W. A.; van der Heide, Agnes; Perez, Roberto S. G. M.; Rietjens, Judith A. C.

    2012-01-01

    Background: Little is known about pressure from patients or relatives on physician's decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using

  9. Adherence by midwives to the Dutch national guidelines on threatened miscarriage in general practice: a prospective study.

    NARCIS (Netherlands)

    Fleuren, M.; Grol, R.; Haan, M. de; Wijkel, D.; Oudshoorn, C.

    1997-01-01

    Objective: To determine the feasibility for midwives to adhere to Dutch national guidelines on threatened miscarriage in general practice. Design: Prospective recording of appointments by midwives who agreed to adhere to the guidelines on threatened miscarriage. Interviews with the midwives after th

  10. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    NARCIS (Netherlands)

    M.H. Blanker (Marco); M. Koerhuis-Roessink (Marlies); S.J. Swart (Siebe); W.W.A. Zuurmond (Wouter); A. van der Heide (Agnes); R.S.G.M. Perez (Roberto); J.A.C. Rietjens (Judith)

    2012-01-01

    textabstractBackground: Little is known about pressure from patients or relatives on physician's decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guid

  11. Impetigo: incidence and treatment in Dutch general practice in 1987 and 2001: results from two national surveys.

    NARCIS (Netherlands)

    Koning, S.; Mohammedamin, R.S.A.; Wouden, J.C. van der; Suijlekom-Smit, L.W.A. van; Schellevis, F.G.; Thomas, S.

    2006-01-01

    Background: Impetigo is a common skin infection in children. The epidemiology is relatively unkown, and the choice of treatment is subject to debate. Objective: The objective of our study was to determine the incidence and treatment of impetigo in Dutch general practice, and to assess trends between

  12. [Summary of the practice guideline 'allergic and non-allergic rhinitis' (first revision) from the Dutch College of General Practitioners

    NARCIS (Netherlands)

    Balen, J.A. van; Verduijn, M.M.; Sachs, A.P.; Berger, M.Y.; Lucassen, P.L.B.J.; Wiersma, T.J.; Goudswaard, A.N.

    2007-01-01

    The practice guideline 'Allergic and non-allergic rhinitis' of the Dutch College ofGeneral Practitioners has been revised based on developments that have occurred in recent years. The most important modifications are: Impermeable covers for beddings are advised only for patients with serious complai

  13. Consultation for and identification of child and adolescent psychological problems in Dutch general practice.

    NARCIS (Netherlands)

    Zwaanswijk, M.; Verhaak, P.F.M.; Ende, J. van der; Bensing, J.M.; Verhulst, F.C.

    2005-01-01

    BACKGROUND: Child and adolescent psychological problems are rarely brought to the attention of GPs. Children and adolescents with psychological problems who do visit their GP are seldom identified as such by GPs. OBJECTIVE: To investigate in a general population sample of 2,449 Dutch children and ad

  14. Determinants of prescribing of second-choice antibiotics for upper and lower respiratory tract in Dutch general practice.

    OpenAIRE

    Duijn, H.J. van; Kuyvenhoven, M M; Schellevis, F.; Verheij, T.J.M.

    2005-01-01

    Objectives: The aim of this study was to assess the association between general practitioners' (GPs') characteristics and the volume of second-choice antibiotics for acute respiratory tract (RT) episodes by GPs. Methods: Morbidity and antibiotic prescription data originated from the Second Dutch National Survey of General Practice (DNSGP-2). GPs' characteristics, including professional activities and views on RT symptoms and antibiotics, were measured by a written questionnaire. Multiple regr...

  15. Epidemiology of respiratory tract infections in Dutch general practice: a historical analysis.

    NARCIS (Netherlands)

    Schellevis, F.G.; Donker, G.

    2007-01-01

    Aims: To describe time trends in the incidence of respiratory tract infections in general practice in the Netherlands and its relation to sex and age. Design and Methods: Data will be presented from several morbidity surveys conducted in general practices in the Netherlands: the Intermittent Morbidi

  16. [The practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners; a response from the perspective of otorhinolaryngology

    NARCIS (Netherlands)

    Marres, H.A.M.

    2008-01-01

    In this comment, the practice guideline 'Sore throat' (second revision) is discussed. This guideline, composed by the Dutch College of General Practitioners, offers general practitioners a well-appreciated overview of the common practices regarding diagnostic tests and treatment of pharyngitis and t

  17. [The practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners; a response from the perspective of otorhinolaryngology

    NARCIS (Netherlands)

    Marres, H.A.M.

    2008-01-01

    In this comment, the practice guideline 'Sore throat' (second revision) is discussed. This guideline, composed by the Dutch College of General Practitioners, offers general practitioners a well-appreciated overview of the common practices regarding diagnostic tests and treatment of pharyngitis and t

  18. Twenty five years of requests for euthanasia and physician assisted suicide in Dutch general practice: trend analysis.

    NARCIS (Netherlands)

    Marquet, R.L.; Bartelds, A.; Visser, G.J.; Spreeuwenberg, P.; Peters, L.

    2003-01-01

    Concerns have been expressed that the Dutch policy on euthanasia (E) and physician assisted suicide (PAS) may lead to an exponential increase in the number of requests and use. Many Dutch general practitioners, nursing home physicians, and pharmacists have a fairly positive attitude and have become

  19. Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study.

    Science.gov (United States)

    Barten, Di-Janne J A; Swinkels, Llse C S; Dorsman, Sara A; Dekker, Joost; Veenhof, Cindy; de Bakker, Dinny H

    2015-06-27

    A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as well as the sequence of care. Furthermore, there is a lack of clarity regarding the role of different health care providers in the performance of OA care according to the SCS. Therefore, the main purpose of this study is to describe the content of primary care in patients with hip/knee OA, including the compliance to the SCS and taking into account the introduction of patient self-referral to physical therapy. Data were used from NIVEL Primary Care Database. In total, 12.118 patients with hip/knee OA who visited their GP or physical therapist were selected. Descriptive statistics were used to compare the content of care in GP-referred and self-referred patients to physical therapy. Content of care performed by GPs mostly concerned consultations, followed by NSAID prescriptions and referrals to secondary care. Both prescriptions of acetaminophen and referrals to physical therapy respectively dietary therapy were rarely mentioned. Nevertheless, still 65% of the patients in physical therapy practice were referred by their GP. Compared to GP-referred patients, self-referred patients more often presented recurrent complaints and were treated less often by activity-related exercise therapy. Education was rarely registered as singular intervention, neither in GP-referred nor in self-referred patients. In accordance with the SCS, less advanced interventions are more often applied than more advanced interventions. To optimize the adherence to the SCS, GPs could reconsider the frequent use of NSAIDs instead of analgesics and the low referral rate to allied health care. Self-referral to physical therapy partially distorts both the low referral rate in general practice and the low application

  20. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study.

    NARCIS (Netherlands)

    Kwok, W.Y.; Kwaadsteniet, M.C. de; Harmsen, M.; Suijlekom-Smit, L.W. van; Schellevis, F.G.; Wouden, J.C. van der

    2006-01-01

    BACKGROUND: We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. METHOD: During one calendar year, 195 general prac

  1. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study.

    NARCIS (Netherlands)

    Kwok, W.Y.; Kwaadsteniet, M.C.E. de; Harmsen, M.; Suijlekom-Smit, L.W.A. van; Schellevis, F.G.; Wouden, J.C. van der

    2006-01-01

    Background: We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method: During one calendar year, 195 general prac

  2. Twenty-five years requests for euthanasia and physician-assisted suicide in Dutch general practice.

    NARCIS (Netherlands)

    Marquet, R.L.; Visser, G.J.; Spreeuwenberg, P.; Peters, L.; Bartelds, A.

    2003-01-01

    Background: World-wide there is a great deal of interest in Dutch policy on euthanasia (E) and physician-assisted suicide (PAS). Apart from appreciation there is also concern that the increasing acceptance of E/PAS might lead to an ever growing number of requests for help to implement E/PAS.

  3. Twenty-five years requests for euthanasia and physician-assisted suicide in Dutch general practice.

    NARCIS (Netherlands)

    Marquet, R.L.; Visser, G.J.; Spreeuwenberg, P.; Peters, L.; Bartelds, A.

    2003-01-01

    Background: World-wide there is a great deal of interest in Dutch policy on euthanasia (E) and physician-assisted suicide (PAS). Apart from appreciation there is also concern that the increasing acceptance of E/PAS might lead to an ever growing number of requests for help to implement E/PAS. Method

  4. [Summary of the Dutch College of General Practitioners (NHG) practice guideline on 'Diverticulitis'].

    Science.gov (United States)

    de Wit, Niek J; Berger, Marjolein Y; Vogelenzang, Rogier; Wetzels, Raymond V; van Rijn-van Kortenhof, Nathalie M M; Opstelten, Wim; Goudswaard, A N Lex

    2012-01-01

    The NHG practice guideline on 'Diverticulitis' provides general practitioners with directions on the diagnosis and treatment of uncomplicated and complicated diverticulitis. Diverticulitis is primarily a clinical diagnosis which can be supported by assessment of CRP. Uncomplicated diverticulitis is strongly suspected if the patient reports the development of persistent sharp, stabbing pain in the lower left abdomen within a couple of days; if there is pressure or rebound tenderness only in the lower left abdomen; and if there are no alarm signals. Alarm signals of complicated diverticulitis are: guarded muscle response, signs of intestinal obstruction, locally palpable resistance, rectal loss of blood, hypotension, and high fever. The policy for uncomplicated diverticulitis is waiting without specific measures, provided that the general practitioner monitors the course actively. There is no indication for antibiotics in patients with uncomplicated diverticulitis. Patients with signs of complicated diverticulitis or with persisting symptoms should be referred.

  5. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study.

    NARCIS (Netherlands)

    W.Y. Kwok (Wing-Yee); M.C. Kwaadsteniet (Marjolein); M. Harmsen (Mirjam); L.W.A. van Suijlekom-Smit (Lisette); F.G. Schellevis (François); J.C. van der Wouden (Hans)

    2006-01-01

    textabstractBACKGROUND: We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. METHOD: During one calendar year, 195

  6. [Less ethnic knowledge in the Dutch College of General Practitioner's practice guidelines on type 2 diabetes mellitus, hypertension and asthma in adults than in the supporting literature

    NARCIS (Netherlands)

    Manna, D.R.; Bruijnzeels, M.A.; Mokkink, H.G.A.; Berg, M. van den

    2003-01-01

    OBJECTIVE: To assess whether ethnic differences present in the scientific literature used as the basis for the Dutch College of General Practitioner's (NHG) practice guidelines were reflected in the ethnic-specific information the guidelines contained. DESIGN: Analysis of published information.

  7. [The practice guideline 'Otitis externa' (first revision) from the Dutch College of General Practitioners; a response from the perspective of otorhinolaryngology

    NARCIS (Netherlands)

    Mylanus, E.A.M.

    2008-01-01

    The first revision of the practice guideline 'Otitis externa' from the Dutch College of General Practitioners describes diagnostic, therapeutic and preventive aspects of care and focuses mainly on the acute form of the disease. In comparison with the previous guideline, some modest but valuable impr

  8. Determinants of prescribing of second-choice antibiotics for upper and lower respiratory tract episodes in Dutch general practice.

    Science.gov (United States)

    van Duijn, Huug J; Kuyvenhoven, Marijke M; Schellevis, François G; Verheij, Theo J M

    2005-08-01

    The aim of this study was to assess the association between general practitioners' (GPs') characteristics and the volume of second-choice antibiotics for acute respiratory tract (RT) episodes by GPs. Morbidity and antibiotic prescription data originated from the Second Dutch National Survey of General Practice (DNSGP-2). GPs' characteristics, including professional activities and views on RT symptoms and antibiotics, were measured by a written questionnaire. Multiple regression was carried out to assess associations between possible determinants and volume of second-choice antibiotic prescriptions. In approximately 39% of acute RT episodes antibiotics were prescribed, with one-quarter being second-choice antibiotics, relatively more frequently in lower than in upper RT episodes: 30 versus 19%. GPs who were more frequently consulted by patients with RT episodes (beta = 0.29; 95% CI 0.13-0.41), who labelled RT episodes more as diagnoses than as symptoms (beta = 0.27; 95% CI 0.15-0.42), who less frequently used national GP guidelines (beta = -0.17; 95% CI -0.31 to -0.03) and who were more inclined to prescribe new drugs (beta = 0.26; 95% CI 0.13-0.40), prescribed more second-choice antibiotics. Given the growing number of prescriptions of second-choice antibiotics, it is important to implement professional guidelines in daily practice, while training in being reluctant to prescribe new drugs and being alert to the marketing activities of pharmaceutical companies should be started in the medical curriculum.

  9. Determinants of prescribing of second-choice antibiotics for upper and lower respiratory tract in Dutch general practice.

    NARCIS (Netherlands)

    Duijn, H.J. van; Kuyvenhoven, M.M.; Schellevis, F.; Verheij, T.J.M.

    2005-01-01

    Objectives: The aim of this study was to assess the association between general practitioners' (GPs') characteristics and the volume of second-choice antibiotics for acute respiratory tract (RT) episodes by GPs. Methods: Morbidity and antibiotic prescription data originated from the Second Dutch

  10. Views on respiratory tract symptoms and antibiotics of Dutch general practitioners, practice staff and patients

    NARCIS (Netherlands)

    van Duijn, HJ; Kuyvenhoven, MA; Schellevis, FG; Verheij, TJM

    2006-01-01

    Objectives: To explore views on respiratory tract symptoms (cough, sore throat and earache) and antibiotics of GPs, practice staff, and patients. Methods: In a nationwide study, 181 GPs, 204 practice staff members and 1250 patients from 90 practices participated by answering 14 items relating to vie

  11. Maintenance Use of Antidepressants in Dutch General Practice: Non-Guideline Concordant

    Science.gov (United States)

    Piek, Ellen; Kollen, Boudewijn J.; van der Meer, Klaas; Penninx, Brenda W. J. H.; Nolen, Willem A.

    2014-01-01

    Background There is hardly evidence on maintenance treatment with antidepressants in primary care. Nevertheless, depression guidelines recommend maintenance treatment i.e. treatment to prevent recurrences, in patients with high risk of recurrence, and many patients use maintenance treatment with antidepressants. This study explores the characteristics of patients on maintenance treatment with antidepressants in general practice, and compares these characteristics with guideline recommendations for maintenance treatment. Methods We used data (baseline, two-year and four-year follow-up) of primary care respondents with remitted depressive disorder (≥6 months) from the Netherlands Study of Depression and Anxiety (n = 776). Maintenance treatment was defined as the use of an antidepressant for ≥12 months. Multilevel logistic regression was used to describe the association between sociodemographic, clinical and care characteristics and use of maintenance treatment with antidepressants. Results Older patients, patients with a lower education, those using benzodiazepines or receiving psychological/psychiatric care and patients with a concurrent history of a dysthymic or anxiety disorder more often received maintenance treatment with antidepressants. Limitations Measurements were not made at the start of an episode, but at predetermined points in time. Diagnoses were based on interview (CIDI) data and could therefore in some cases have been different from the GP diagnosis. Conclusions Since patients with chronic or recurrent depression do not use maintenance treatment with antidepressants more often, characteristics of patients on maintenance treatment do not fully correspond with guideline recommendations. However, patients on maintenance treatment appear to be those with more severe disorder and/or more comorbidity. PMID:24858011

  12. Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice : an observational study

    NARCIS (Netherlands)

    Barten, Di-Janne J A; Swinkels, Llse C S; Dorsman, Sara A; Dekker, Joost; Veenhof, Cindy; de Bakker, Dinny H

    2015-01-01

    BACKGROUND: A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as

  13. Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study.

    NARCIS (Netherlands)

    Barten, D.J.A.; Swinkels, I.C.S.; Dorsman, S.A.; Dekker, J.; Veenhof, C.; Bakker, D.H. de

    2015-01-01

    Background: A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as

  14. Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice : an observational study

    NARCIS (Netherlands)

    Barten, Di-Janne J A; Swinkels, Llse C S; Dorsman, Sara A; Dekker, Joost; Veenhof, Cindy; de Bakker, Dinny H

    2015-01-01

    BACKGROUND: A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as

  15. Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study.

    NARCIS (Netherlands)

    Barten, D.J.A.; Swinkels, I.C.S.; Dorsman, S.A.; Dekker, J.; Veenhof, C.; Bakker, D.H. de

    2015-01-01

    Background: A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as

  16. [Summary of the practice guideline 'Urinary-tract infections' (second revision) from the Dutch College of General Practitioners].

    Science.gov (United States)

    van Pinxteren, B; van Vliet, S M; Wiersma, T J; Goudswaard, A N

    2006-04-01

    The 1999 practice guideline 'Urinary-tract infections' from the Dutch College of General Practitioners has been revised. Not only febrile urinary-tract infections are now regarded as 'complicated', but also all urinary-tract infections in men, pregnant women, children, and patients with kidney or urinary-tract disease, impaired immune response or an indwelling catheter. Under certain conditions, in women recognising the symptoms of an earlier uncomplicated urinary-tract infection, treatment may be instituted without performing supplementary urinalysis. The nitrite dipstick test and dipslide culturing are recommended for the diagnosis of urinary-tract infections; the value of the leukocyte esterase dipstick test is limited. A group-B streptococcal urinary-tract infection during pregnancy is an indication for intravenous antibiotic prophylaxis during the delivery. The recommended duration of treatment with nitrofurantoin is extended from three to five days. Both increased bacterial resistance to trimethoprim and the intention to reduce the use of fluoroquinolones in the treatment of uncomplicated urinary-tract infections were reasons for including phosphomycin in the guideline. In addition to antibiotic prophylaxis, cranberry products may be of value in the prevention of recurrent urinary-tract infections.

  17. Trends in suicidal behaviour in Dutch general practice 1983-2013.

    NARCIS (Netherlands)

    Donker, G.; Beurs, D.P. de

    2016-01-01

    Background: The EU Joint Action on Health Workforce Planning and Forecasting has taken up the challenge to let countries share and exchange practices in health workforce planning. It appears however, that not many countries actually apply (needs-based forecasting) models to support this. But does ev

  18. Nutrition Communication in Dutch General practice: integration of the patients' perspective and the family doctors' perspective

    NARCIS (Netherlands)

    Dillen, van S.M.E.

    2005-01-01

    A sound nutrition advice is important for patients with coronary heart disease, diabetes and obesity. The family doctor has high potential to promote nutrition to their patients through its broad reach, including the hard-to-reach low socio-economic class. Unfortunately, in daily practice of most fa

  19. Nutrition Communication in Dutch General practice: integration of the patients' perspective and the family doctors' perspective

    NARCIS (Netherlands)

    Dillen, van S.M.E.

    2005-01-01

    A sound nutrition advice is important for patients with coronary heart disease, diabetes and obesity. The family doctor has high potential to promote nutrition to their patients through its broad reach, including the hard-to-reach low socio-economic class. Unfortunately, in daily practice of most

  20. Antibiotics in Dutch general practice: nationwide electronic GP database and national reimbursement rates.

    NARCIS (Netherlands)

    Akkerman, A.E.; Kuyvenhoven, M.M.; Verheij, T.J.M.; Dijk, L. van

    2008-01-01

    PURPOSE: In order to assess whether different databases generate information which can be reliable compared with each other, this study aimed to assess to which degree prescribing rates for systemic antibiotics from a nationwide electronic general practitioner (GP) database correspond with national

  1. Vaginal symptoms of unknown etiology - a study in dutch general-practice

    NARCIS (Netherlands)

    Dekker, Janny H.; Boeke, A. Joan P.; Janssens, J; van Eijk, J.Th.M.

    1993-01-01

    Vaginal symptoms are frequently presented by women to general practitioners. In many cases, the aetiology of these symptoms remains unknown. This study focused on the factors associated with microbiologically unexplained vaginal symptoms, the course of symptoms and signs in these cases, and factors

  2. Vaginal symptoms of unknown etiology - a study in dutch general-practice

    NARCIS (Netherlands)

    Dekker, Janny H.; Boeke, A. Joan P.; Janssens, J; van Eijk, J.Th.M.

    Vaginal symptoms are frequently presented by women to general practitioners. In many cases, the aetiology of these symptoms remains unknown. This study focused on the factors associated with microbiologically unexplained vaginal symptoms, the course of symptoms and signs in these cases, and factors

  3. [The practice guideline 'Anxiety disorders' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

    Science.gov (United States)

    van Weel-Baumgarten, E M; van Rijswijk, E

    2005-05-28

    The recommendations provided by the revised guideline 'Anxiety disorders' are well suited to every-day practice. The multidisciplinary approach reflects the increasing cooperation between primary and secondary care in the management of mental-health problems. The description of the various anxiety disorders and the questions that can be asked to elicit the symptoms will facilitate recognition. The indications for treatment with medication are clear: a limited number of antidepressants should be used. Although it is agreed that patient education is an important part of treatment, the guidelines could have described in more detail how this should be done. Cognitive-behavioural techniques may be used but this requires extra training; its effectiveness when used by general practitioners needs further study. This guideline will add to existing knowledge and improve the skills of general practitioners in dealing with anxiety.

  4. Conditions for research in general practice: can the Dutch and British experiences be applied to other countries, for example Spain?

    NARCIS (Netherlands)

    Zee, J. van der; Kroneman, M.; Bolibar, B.

    2003-01-01

    The aim of this study is to identify conditions for research as part of professional development in general practice. Based on the work of Andrew Abbott, who studied the dynamics of professional development, five conditions were identified. These are: the creation of associations among professionals

  5. Development and implementation of a lifestyle intervention to promote physical activity and healthy diet in the Dutch general practice setting: the BeweegKuur programme

    Directory of Open Access Journals (Sweden)

    de Vries Nanne K

    2010-05-01

    Full Text Available Abstract Background The number of patients with diabetes is increasing. BeweegKuur (Dutch for 'Exercise Therapy' is a Dutch lifestyle intervention which aims to effectively and feasibly promote physical activity and better dietary behaviour in primary health care to prevent diabetes. Methods The goal of this paper is to present the development process and the contents of the intervention, using a model of systematic health promotion planning. The intervention consists of a 1-year programme for diabetic and prediabetic patients. Patients are referred by their general practitioner (GP to a lifestyle advisor (LSA, usually the practice nurse or a physiotherapist. Based on specific inclusion criteria and in close collaboration with the patient, an individual exercise programme is designed and supervised by the LSA. This programme can be attended at existing local exercise facilities or (temporarily under the supervision of a specialized exercise coach or physiotherapist. All participants are also referred to a dietician and receive diet-related group education. In the first pilot year (2008, the BeweegKuur programme was implemented in 7 regions in the Netherlands (19 GP practices and health centres, while 14 regions (41 GP practices and health centres participated during the second year. The aim is to implement BeweegKuur in all regions of the Netherlands by 2012. Discussion The BeweegKuur programme was systematically developed in an evidence- and practice-based process. Formative monitoring studies and (controlled effectiveness studies are needed to examine the diffusion process and the effectiveness and cost-effectiveness of the intervention.

  6. [The practice guideline 'Otitis externa' (first revision) from the Dutch College of General Practitioners; a response from the perspective of otorhinolaryngology].

    Science.gov (United States)

    Mylanus, E A M

    2008-05-24

    The first revision of the practice guideline 'Otitis externa' from the Dutch College of General Practitioners describes diagnostic, therapeutic and preventive aspects of care and focuses mainly on the acute form of the disease. In comparison with the previous guideline, some modest but valuable improvements have been made with regard to diagnosis and medical treatment. For acute otitis externa, treatment with acid and corticosteroid eardrops is considered the treatment of choice, rather than treatment with acid eardrops only. The guideline clearly discusses indications for referral of patients with otitis externa to an otorhinolaryngologist. Hypersensitivity and more severe pathology should be excluded in persistent cases. For chronic otitis externa, an otorhinolaryngologist can provide surgical treatment with a good chance of success and a low recurrence rate.

  7. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

    Science.gov (United States)

    Kwok, Wing-Yee; de Kwaadsteniet, Marjolein CE; Harmsen, Mirjam; van Suijlekom-Smit, Lisette WA; Schellevis, François G; van der Wouden, Johannes C

    2006-01-01

    Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral. PMID:16584577

  8. Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2006-04-01

    Full Text Available Abstract Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral.

  9. [The practice guideline 'Miscarriage' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice

    NARCIS (Netherlands)

    Lagro-Janssen, A.L.M.

    2005-01-01

    The practice guideline 'Miscarriage' has been reviewed for the second time in fifteen years. It provides the practitioner with distinct diagnostic tools for vaginal bleeding in the first sixteen weeks of pregnancy and a clear management algorithm. The management of miscarriage is based on a joint de

  10. [The practice guideline 'Anxiety disorders' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice

    NARCIS (Netherlands)

    Weel-Baumgarten, E.M. van; Rijswijk, E. van

    2005-01-01

    The recommendations provided by the revised guideline 'Anxiety disorders' are well suited to every-day practice. The multidisciplinary approach reflects the increasing cooperation between primary and secondary care in the management of mental-health problems. The description of the various anxiety d

  11. Reliability and responsiveness of the Dutch version of the Neck Disability Index in patients with acute neck pain in general practice.

    Science.gov (United States)

    Vos, Cees J; Verhagen, Arianne P; Koes, Bart W

    2006-11-01

    A prospective cohort study with a 1 week follow-up. To examine the reliability and responsiveness of the Dutch version of the Neck Disability Index (NDI) in patients with acute neck pain in general practice. An increasing number of studies on treatment options is published in which the NDI is used. Reports of the ability of the NDI to detect change over time, often called responsiveness, however have not yet been published. At baseline 187 patients (119 women, 68 men) were included. They completed a questionnaire on demographic variables, self-reported cause of their complaints and the NDI. After 1 week, 86 patients were sent the NDI again together with the perceived recovery scale which was used as our external criterion. The scale ranged from 1 (complete recovery) to 7 (complaints are worse than ever). Response rate was 93%. Test-retest scores on reliability were good (ICC = 0.90). A Bland and Altman plot and a graph of total sum score differences showed no visible tendency towards unequal spreading of the data. For patients that reported on the perceived recovery scale that they were "stable" we found a responsiveness ratio of 1.82. The standard error of measurement (SEM) was 0.60 what resulted in a minimal detectable change (MDC) of 1.66. The NDI has shown to be a reliable and responsive instrument in patients with acute neck pain in general practice.

  12. Health care in patients 1 year post-stroke in general practice: research on the utilisation of the Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident.

    Science.gov (United States)

    de Weerd, L; Rutgers, A W F; Groenier, K H; van der Meer, K

    2012-01-01

    This study evaluates the kind of aftercare that ischaemic stroke patients receive and the extent that aftercare fulfils the criteria of the 'Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident'. Fifty-seven patients were interviewed 1 year post-stroke about secondary prevention and aftercare. Forty general practitioners (GPs) completed a questionnaire about guidance and secondary prevention (concerning medication and lifestyle advice). Most patients would like to see their GP more regularly. More aftercare was required than was planned. The use of aspirin remained the same, fewer patients used statins and more used antihypertensives. Of the 40 GPs who participated, 12% did not apply prevention. Blood pressure, glucose and cholesterol were measured in 84%, 28% and 40% of patients. All of these measures were often elevated, but treatment was not given. Lifestyle advice was offered to one-quarter of patients. Considering all of the advice given in the Dutch Protocol, several aspects can be improved in relation to secondary prevention. Too little attention is paid to giving lifestyle advice, stricter medical checkups by GPs are necessary and there is a decrease in use of preventive medication, partly because GPs monitors use of medication inadequately. The use of the Dutch Protocol in aftercare can be improved by a more detailed description of advice.

  13. [The practice guideline 'Influenza and influenza vaccination' (first revision) from the Dutch College of General Practitioners; a response from the perspective of virology].

    Science.gov (United States)

    de Jong, J C

    2008-09-27

    The main value of the new guideline on influenza and influenza vaccination developed by the Dutch College of General Practitioners is that it provides an update of the old version from 1993. Developments in the fields of vaccination and treatment are adequately described and clearly explained in more detail in numerous notes to the main text. Notable updates include the fact that vaccination will be recommended for people aged more than 60 years rather than 65 years in the coming season, and the introduction ofneuraminidase inhibitors. The complex virological aspects of influenza are well covered.

  14. Risk factors and trends in attempting or committing suicide in Dutch general practice in 1983–2009 and tools for early recognition.

    NARCIS (Netherlands)

    Donker, G.A.; Wolters, I.; Schellevis, F.

    2010-01-01

    Background: Many patients visit their general practitioner (GP) before attempting or committing suicide. This study analyses determinants and trends of suicidal behaviour to enhance early recognition of risk factors in general practice. Method: Analysis of trends, patient and treatment

  15. The incidence of sexual dysfunction in patients attending Dutch general practitioners.

    NARCIS (Netherlands)

    Kedde, H.; Donker, G.; Leusink, P.; Kruijer, H.

    2011-01-01

    Data on patients with a sexual dysfunction were collected in 45 Dutch general practices between 2003 and 2008. The aim of the study was to determine the incidence of patients with a sexual dysfunction, associated health problems, and related interventions performed by their general practitioners (GP

  16. [Summary of the 'Stroke' guideline of the Dutch College of General Practitioners' (NHG)

    NARCIS (Netherlands)

    Verburg, A.F.; Tjon, A.T.M.R.; Verstappen, W.H.J.M.; Beusmans, G.H.M.I.; Wiersma, T.; Burgers, J.S.

    2014-01-01

    The Dutch College of General Practitioners (NHG) guideline 'Stroke' covers the diagnosis, management and long-term care of stroke in general practice. Patients with neurological symptoms suspected to be due to cerebral infarction or haemorrhage should be transferred directly to a stroke unit. The

  17. New platform, old habits? Candidates’ use of Twitter during the 2010 British and Dutch general election campaigns

    NARCIS (Netherlands)

    Graham, Todd; Jackson, Dan; Broersma, Marcel

    2016-01-01

    Twitter has become one of the most important online spaces for political communication practice and research. Through a hand-coded content analysis, this study compares how British and Dutch Parliamentary candidates used Twitter during the 2010 general elections. We found that Dutch politicians were

  18. New platform, old habits? Candidates’ use of Twitter during the 2010 British and Dutch general election campaigns

    NARCIS (Netherlands)

    Graham, Todd; Jackson, Dan; Broersma, Marcel

    Twitter has become one of the most important online spaces for political communication practice and research. Through a hand-coded content analysis, this study compares how British and Dutch Parliamentary candidates used Twitter during the 2010 general elections. We found that Dutch politicians were

  19. Undertreatment of urinary incontinence in general practice.

    NARCIS (Netherlands)

    Penning-van Beest, F.J.A.; Sturkenboom, M.C.; Bemelmans, B.L.H.; Herings, R.M.C.

    2005-01-01

    BACKGROUND: In the urinary incontinence guidelines that are issued by the Dutch College of General Practitioners, treatment guidelines are related to the type of incontinence. It is unknown whether treatment of urinary incontinence in general practice complies with these guidelines. OBJECTIVE: To de

  20. Health care in patients 1 year post-stroke in general practice : research on the utilisation of the Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident

    NARCIS (Netherlands)

    de Weerd, L.; Rutgers, A.W.F.; Groenier, K.H.; van der Meer, K.

    2012-01-01

    This study evaluates the kind of aftercare that ischaemic stroke patients receive and the extent that aftercare fulfils the criteria of the 'Dutch Transmural Protocol transient ischaemic attack/cerebrovascular accident'. Fifty-seven patients were interviewed 1 year post-stroke about secondary

  1. An applied general equilibrium model for Dutch agribusiness policy analysis

    NARCIS (Netherlands)

    Peerlings, J.

    1993-01-01

    The purpose of this thesis was to develop a basic static applied general equilibrium (AGE) model to analyse the effects of agricultural policy changes on Dutch agribusiness. In particular the effects on inter-industry transactions, factor demand, income, and trade are of interest.

  2. An applied general equilibrium model for Dutch agribusiness policy analysis

    NARCIS (Netherlands)

    Peerlings, J.

    1993-01-01

    The purpose of this thesis was to develop a basic static applied general equilibrium (AGE) model to analyse the effects of agricultural policy changes on Dutch agribusiness. In particular the effects on inter-industry transactions, factor demand, income, and trade are of

  3. An applied general equilibrium model for Dutch agribusiness policy analysis.

    NARCIS (Netherlands)

    Peerlings, J.H.M.

    1993-01-01

    The purpose of this thesis was to develop a basic static applied general equilibrium (AGE) model to analyse the effects of agricultural policy changes on Dutch agribusiness. In particular the effects on inter-industry transactions, factor demand, income, and trade are of interest.The model is fairly

  4. [Tetanus prophylaxis in general practice

    NARCIS (Netherlands)

    Boukes, F.S.; Wiersma, T.J.; Beaujean, D.; Burgmeijer, R.J.; Timen, A.

    2004-01-01

    In response to the report 'Immunisation against tetanus following injuries' from the Dutch Health Council, the Dutch College of General Practitioners, the National Coordinating Body for the Control of Infectious Diseases and The Netherlands Vaccine Institute have drawn up guidelines for tetanus

  5. [Tetanus prophylaxis in general practice

    NARCIS (Netherlands)

    Boukes, F.S.; Wiersma, T.J.; Beaujean, D.; Burgmeijer, R.J.; Timen, A.

    2004-01-01

    In response to the report 'Immunisation against tetanus following injuries' from the Dutch Health Council, the Dutch College of General Practitioners, the National Coordinating Body for the Control of Infectious Diseases and The Netherlands Vaccine Institute have drawn up guidelines for tetanus prop

  6. Improving population-based cervical cancer screening in general practice : effects of a national strategy

    NARCIS (Netherlands)

    Hermens, R P; Hak, E; Hulscher, M E; Mulder, J; Tacken, M A; Braspenning, J C; Grol, R P

    1999-01-01

    OBJECTIVE: To assess the effects of a Dutch national prevention programme, aimed at general practitioners (GPs), on the adherence to organizational guidelines for effective cervical cancer screening in general practice. To identify the characteristics of general practices determining success. DESIGN

  7. [Acute otitis media: do not change the Dutch practice guideline].

    Science.gov (United States)

    Damoiseaux, Roger A M J

    2012-01-01

    Two recent clinical trials have again shown that antibiotics are effective in the management of young children with acute otitis media (AOM). Should this change our reserved attitude towards the use of antibiotics? According to the rules for evidence-based medicine, we cannot ignore the vast body of evidence already existing unless new trials are methodologically better and their results differ from previous trials. This does not seem to be the case. The patient characteristics of these trials are similar to those of a previously published individual patient data meta-analysis. The primary outcome 'symptom scores' reported by Hoberman et al. is also comparable, but Tähtinen et al. may have overestimated the effect of antibiotics. Their primary outcome 'time to treatment failure' does not take later improvement or recovery into account. In both trials, the greatest benefit is related to otoscopic recovery of AOM, which is clinically not the most relevant outcome. For now, there is no reason to adapt the current AOM practice guideline of the Dutch College of General Practitioners.

  8. [Relationship between te general practice guidelines for the diagnosis of hypertension and the indication for treatment and practice in the Nijmegen region, the Netherlands, 1983-2001

    NARCIS (Netherlands)

    Bakx, J.C.; Deunk, L.; Gerwen, W.H.E.M. van; Aalst, M. van der; Hoogen, H.J.M. van den; Bosch, W.J.H.M. van den

    2003-01-01

    OBJECTIVE: To determine whether patients with hypertension in general practice are diagnosed and treated according to the criteria of the Dutch College of General Practitioners guidelines. DESIGN: Retrospective, descriptive. METHOD: Using data from 9 general practices belonging to the general

  9. Quality of stroke prevention in general practice: relationship with practice organization

    NARCIS (Netherlands)

    J.S. de Koning (Johan); N.S. Klazinga (Niek); P.J. Koudstaal (Peter Jan); A. Prins (Ad); G.J.J.M. Borsboom (Gerard); J.P. Mackenbach (Johan)

    2005-01-01

    textabstractOBJECTIVE: To investigate the relationship between elements of practice organization related to stroke prevention in general practice, and suboptimal preventive care preceding the occurrence of stroke. DESIGN: This study was conducted among 69 Dutch general practitioners in the Rotterda

  10. Parenting Practices and Quality of Life in Dutch and Portuguese Adolescents : A Cross-Cultural Study

    NARCIS (Netherlands)

    Nunes, Cristina; Bodden, Denise; Lemos, Ida; Lorence, Barbara; Jimenez, Lucia; Bodden, Denise

    2014-01-01

    The aim of this study was to examine differences in Quality of life (QoL) and parenting practices, as well as the impact of parenting practices on QoL in Dutch and Portuguese adolescents. A total of 168 Portuguese (44.64% girls, 55.36% boys) and 155 Dutch adolescents (55.68% girls, 44.32% boys) aged

  11. Parenting Practices and Quality of Life in Dutch and Portuguese Adolescents: A Cross-Cultural Study

    NARCIS (Netherlands)

    Nunes, C.; Bodden, D.H.M.; Lemos, I.; Lorence, B.; Jimenez, L.

    2014-01-01

    The aim of this study was to examine differences in Quality of life (QoL) and parenting practices, as well as the impact of parenting practices on QoL in Dutch and Portuguese adolescents. A total of 168 Portuguese (44.64% girls, 55.36% boys) and 155 Dutch adolescents (55.68% girls, 44.32% boys) aged

  12. Parenting Practices and Quality of Life in Dutch and Portuguese Adolescents : A Cross-Cultural Study

    NARCIS (Netherlands)

    Nunes, Cristina; Bodden, Denise; Lemos, Ida; Lorence, Barbara; Jimenez, Lucia; Bodden, Denise|info:eu-repo/dai/nl/297688499

    2014-01-01

    The aim of this study was to examine differences in Quality of life (QoL) and parenting practices, as well as the impact of parenting practices on QoL in Dutch and Portuguese adolescents. A total of 168 Portuguese (44.64% girls, 55.36% boys) and 155 Dutch adolescents (55.68% girls, 44.32% boys) aged

  13. [Manual therapy in general practice].

    Science.gov (United States)

    Березуцкий, Владимир И

    2016-01-01

    The article is devoted to manual therapy practice for diagnostics and treatment of vertebrogenic pain syndrome in general practice. Analytical roundup of sources proves medical advantage of implementation of manual therapy basic methods by general practice specialists.

  14. Implant removal of osteosynthesis: the Dutch practice. Results of a survey

    Directory of Open Access Journals (Sweden)

    Vos Dagmar

    2012-08-01

    Full Text Available Abstract Background The aim of this survey study was to evaluate the current opinion and practice of trauma and orthopaedic surgeons in the Netherlands in the removal of implants after fracture healing. Methods A web-based questionnaire consisting of 44 items was sent to all active members of the Dutch Trauma Society and Dutch Orthopaedic Trauma Society to determine their habits and opinions about implant removal. Results Though implant removal is not routinely done in the Netherlands, 89% of the Dutch surgeons agreed that implant removal is a good option in case of pain or functional deficits. Also infection of the implant or bone is one of the main reasons for removing the implant (> 90%, while making money was a motivation for only 1% of the respondents. In case of younger patients (p = 0.002. Though the far majority removes elastic nails in children (95%. Most of the participants (56% did not agree that leaving implants in is associated with an increased risk of fractures, infections, allergy or malignancy. Yet in case of the risk of fractures, residents all agreed to this statement (100% whereas staff specialists disagreed for 71% (p  Conclusion This survey indicates that there is no general opinion about implant removal after fracture healing with a lack of policy guidelines in the Netherlands. In case of symptomatic patients a majority of the surgeons removes the implant, but this is not standard practice for every surgeon.

  15. Planning in Dutch health promotion practice: a comprehensive view.

    Science.gov (United States)

    Lezwijn, Jeanette; Wagemakers, Annemarie; Vaandrager, Lenneke; Koelen, Maria; van Woerkum, Cees

    2014-06-01

    Health promotion has a strong tradition of using planning models based on an a priori set of goals and processes defined by professionals. Those rational models only partly fit with today's view and practice of health promotion, where programmes can be considered as processes because they are guided by principles such as community participation and intersectoral collaboration. The aim of this paper is to provide a comprehensive view on approaches to planning in health promotion practice. To investigate these, Whittington's typology has been used. Whittington identifies four approaches to planning, i.e. classical, evolutionary, processual and systemic. In a retrospective multiple case study, we describe actual planning processes used in the development and implementation of a healthy ageing programme in three Dutch municipalities. These processes were described using data gathered by: interviews, participant observation and document analysis, and external auditing. Characteristics of the four planning approaches were used to interpret the data. The results show that, in practice, all forms of planning approaches were used, depending on the degree of complexity and dynamics of the context, the phase of the health promotion programme, and the time available. Our findings suggest that in the emergent practice of health promotion different approaches to planning are used. To make those planning approaches explicit and manageable for practice and science, discussion and reflection between stakeholders are essential.

  16. Social Workers' Orientation toward the Evidence-Based Practice Process: A Dutch Survey

    Science.gov (United States)

    van der Zwet, Renske J. M.; Kolmer, Deirdre M. Beneken genaamd; Schalk, René

    2016-01-01

    Objectives: This study assesses social workers' orientation toward the evidence-based practice (EBP) process and explores which specific variables (e.g. age) are associated. Methods: Data were collected from 341 Dutch social workers through an online survey which included a Dutch translation of the EBP Process Assessment Scale (EBPPAS), along with…

  17. A comparison of disease prevalence in general practice in the Netherlands and in England & Wales.

    NARCIS (Netherlands)

    Fleming, D.; Schellevis, F.; Linden, M. van der; Westert, G.

    2006-01-01

    General practice-based morbidity surveys have been conducted in the Netherlands and in England and Wales primarily to estimate disease prevalence and examine health inequalities. We have compared disease prevalence in general practice reported in the second Dutch Natinal Survey of General Practice (

  18. A comparison of disease prevalence in general practice in the Netherlands and in England & Wales.

    NARCIS (Netherlands)

    Fleming, D.; Schellevis, F.; Linden, M. van der; Westert, G.

    2006-01-01

    General practice-based morbidity surveys have been conducted in the Netherlands and in England and Wales primarily to estimate disease prevalence and examine health inequalities. We have compared disease prevalence in general practice reported in the second Dutch Natinal Survey of General Practice (

  19. Psychometric properties of the Dutch version of the Evidence-Based Practice Attitude Scale (EBPAS).

    Science.gov (United States)

    van Sonsbeek, Maartje A M S; Hutschemaekers, Giel J M; Veerman, Jan W; Kleinjan, Marloes; Aarons, Gregory A; Tiemens, Bea G

    2015-11-16

    The Evidence-Based Practice Attitude Scale (EBPAS) was developed in the United States to assess attitudes of mental health and welfare professionals toward evidence-based interventions. Although the EBPAS has been translated in different languages and is being used in several countries, all research on the psychometric properties of the EBPAS within youth care has been carried out in the United States. The purpose of this study was to investigate the psychometric properties of the Dutch version of the EBPAS. After translation into Dutch, the Dutch version of the EBPAS was examined in a diverse sample of 270 youth care professionals working in five institutions in the Netherlands. We examined the factor structure with both exploratory and confirmatory factor analyses and the internal consistency reliability. We also conducted multiple linear regression analyses to examine the association of EBPAS scores with professionals' characteristics. It was hypothesized that responses to the EBPAS items could be explained by one general factor plus four specific factors, good to excellent internal consistency reliability would be found, and EBPAS scores would vary by age, sex, and educational level. The exploratory factor analysis suggested a four-factor solution according to the hypothesized dimensions: Requirements, Appeal, Openness, and Divergence. Cronbach's alphas ranged from 0.67 to 0.89, and the overall scale alpha was 0.72. The confirmatory factor analyses confirmed the factor structure and suggested that the lower order EBPAS factors are indicators of a higher order construct. However, Divergence was not significantly correlated with any of the subscales or the total score. The confirmatory bifactor analysis endorsed that variance was explained both by a general attitude towards evidence-based interventions and by four specific factors. The regression analyses showed an association between EBPAS scores and youth care professionals' age, sex, and educational level. The

  20. Impetigo in General Practice

    NARCIS (Netherlands)

    S. Koning (Sander)

    2005-01-01

    textabstractImpetigo is a common skin infection, usually caused by Staphylococcus aureus that mainly occurs in children. Patients with impetigo usually consult their general practitioner, who also treats the vast majority of cases. Impetigo is considered highly infectious, and consequently childr

  1. Behavioural science in general practice.

    Science.gov (United States)

    Wood, D R

    1979-10-01

    Dr Peter Sowerby has written an important criticism of Michael Balint's work based on his understanding of Karl Popper's writings. I dispute Sowerby's interpretation of Popper and disagree with his conclusions, which I suggest would lead general practice into a retreat. I believe Balint made a major contribution to general practice and has helped us towards practising whole-person medicine.

  2. Recruitment of general practices

    DEFF Research Database (Denmark)

    Riis, Allan; Jensen, Cathrine Elgaard; Maindal, Helle Terkildsen;

    2016-01-01

    Introduction: Health service research often involves the active participation of healthcare professionals. However, their ability and commitment to research varies. This can cause recruitment difficulties and thereby prolong the study period and inflate budgets. Solberg has identified seven R......, which was fewer than planned (100 practices). In this evaluation, five of Solberg’s seven R-factors were successfully addressed and two factors were not. The need to involve (reciprocity) end users in the development of new software and the amount of time needed to conduct recruitment (resolution) were...

  3. Methodological practicalities in analytical generalization

    DEFF Research Database (Denmark)

    Halkier, Bente

    2011-01-01

    In this article, I argue that the existing literature on qualitative methodologies tend to discuss analytical generalization at a relatively abstract and general theoretical level. It is, however, not particularly straightforward to “translate” such abstract epistemological principles into more...... operative methodological strategies for producing analytical generalizations in research practices. Thus, the aim of the article is to contribute to the discussions among qualitatively working researchers about generalizing by way of exemplifying some of the methodological practicalities in analytical...... and processes in producing the three different ways of generalizing: ideal typologizing, category zooming, and positioning....

  4. Evaluation of the Dutch general exemption level for voluntary fortification with folic acid

    Directory of Open Access Journals (Sweden)

    Janneke Verkaik-Kloosterman

    2012-04-01

    Full Text Available Introduction: Fortification with folic acid was prohibited in the Netherlands. Since 2007, a general exemption is given to fortify with folic acid up until a maximum level of 100 µg/100 kcal. This maximum level was based on a calculation model and data of adults only. The model requires parameters on intake (diet, supplements, energy and on the proportion of energy that may be fortified. This study aimed to evaluate the model parameters considering the changing fortification market. In addition, the risk of young children exceeding the UL for folic acid was studied. Methods: Folic acid fortified foods present on the Dutch market were identified in product databases and by a supermarket inventory. Together with data of the Dutch National Consumption Survey-Young Children (2005/2006 these inventory results were used to re-estimate the model parameters. Habitual folic acid intake of young children was estimated and compared to the UL for several realistic fortification scenarios. Results: Folic acid fortified foods were identified in seven different food groups. In up to 10% of the population, the proportion of energy intake of folic acid fortified foods exceeded 10% – the original model parameter. The folic acid intake from food supplements was about 100 µg/day, which is lower than the intake assumed as the original model parameter (300 µg. In the scenarios representing the current market situation, a small proportion (<5% of the children exceeded the UL. Conclusion: The maximum fortification level of 100 µg/100 kcal is sufficiently protective for children in the current market situation. In the precautionary model to estimate the maximum fortification levels, subjects with high intakes of folic acid from food and supplements, and high energy intakes are protected from too high folic acid intakes. Combinations of high intakes are low in this population. The maximum levels should be monitored and revised with increasing fortification and

  5. Does media use result in more active communicators? Differences between native Dutch and Turkish-Dutch patients in information-seeking behavior and participation during consultations with general practitioners

    NARCIS (Netherlands)

    Schinkel, S.; van Weert, J.C.M.; Kester, J.A.M.; Smit, E.G.; Schouten, B.C.

    2015-01-01

    This study investigates differences between native Dutch and Turkish-Dutch patients with respect to media usage before and patient participation during medical consultations with general practitioners. In addition, the authors assessed the relation between patient participation and communication

  6. [Summary of the 'Thyroid disorders' guideline of the Dutch College of General Practitioners' (NHG)

    NARCIS (Netherlands)

    Sijbom, M.; Lieshout, J. van; Felix-Schollaart, B.; Burgers, J.S.; Bouma, M.

    2013-01-01

    - The 'Thyroid disorders' guideline of the Dutch College of General Practitioners (NHG) provides recommendations for the diagnosis and management of hypothyroidism, hyperthyroidism and changes in the size of the thyroid gland, such as goitre and thyroid nodules. - Hypothyroid patients younger than 6

  7. Vulvovaginal candidiasis: Diagnostic and therapeutic approaches used by Dutch general practitioners

    NARCIS (Netherlands)

    Engberts, M.K.; Korporaal, H.; Vinkers, M.T.; Belkum, A. van; Binsbergen, J.J. van; Lagro-Janssen, A.L.M.; Helmerhorst, T.J.M.; Meijden, W.I. van der

    2008-01-01

    Objective: To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis. Methods: Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis. Furthermore, information

  8. Vulvovaginal candidiasis: diagnostic and therapeutic approaches used by Dutch general practitioners.

    NARCIS (Netherlands)

    Engberts, M.K.; Korporaal, H.; Vinkers, M.T.; Belkum, A. van; Binsbergen, J.J. van; Lagro-Janssen, A.L.M.; Helmerhorst, T.J.M.; Meijden, W.I. van der

    2008-01-01

    OBJECTIVE: To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis. METHODS: Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis. Furthermore, information

  9. Vulvovaginal candidiasis: diagnostic and therapeutic approaches used by Dutch general practitioners.

    NARCIS (Netherlands)

    Engberts, M.K.; Korporaal, H.; Vinkers, M.T.; Belkum, A. van; Binsbergen, J.J. van; Lagro-Janssen, A.L.M.; Helmerhorst, T.J.M.; Meijden, W.I. van der

    2008-01-01

    OBJECTIVE: To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis. METHODS: Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis. Furthermore, information

  10. Vulvovaginal candidiasis: Diagnostic and therapeutic approaches used by Dutch general practitioners

    NARCIS (Netherlands)

    Engberts, M.K.; Korporaal, H.; Vinkers, M.T.; Belkum, A. van; Binsbergen, J.J. van; Lagro-Janssen, A.L.M.; Helmerhorst, T.J.M.; Meijden, W.I. van der

    2008-01-01

    Objective: To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis. Methods: Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis. Furthermore, information

  11. Diagnosis and interpretation of injuries: a study of Dutch general practitioners

    NARCIS (Netherlands)

    Reijnders, U.J.L.; Baasbank, van M.C.; Wal, van der G.

    2005-01-01

    This study explores the ability of Dutch general practitioners (GPs) in recognising types of injury. In the three sample cases, 48-91% classified the injury correctly. Only 9% of GPs recognised self-harm injury and in the 3rd case (child abuse) only 15% referred to the improbability of the account g

  12. Comorbid disorders and sociodemographic variables in temporomandibular pain in the general Dutch population

    NARCIS (Netherlands)

    Visscher, C.M.; Ligthart, L.; Schuller, A.A.; Lobbezoo, F.; de Jongh, A.; van Houtem, C.M.H.H.; Boomsma, D.I.

    2015-01-01

    Aims: (1) To determine the prevalence of temporomandibular disorder (TMD)-pain complaints in the general Dutch population; (2) to investigate its relationship with age, sex, educational attainment, and country of birth; (3) to determine its association with other pain complaints; and (4) to determin

  13. Comorbid Disorders and Sociodemographic Variables in Temporomandibular Pain in the General Dutch Population

    NARCIS (Netherlands)

    Visscher, Corine M.; Ligthart, Lannie; Schuller, Annemarie A.; Lobbezoo, Frank; de Jongh, Ad; van Houtem, Caroline M. H. H.; Boomsma, Dorret I.

    2015-01-01

    Aims: (1) To determine the prevalence of temporomandibular disorder (TMD) pain complaints in the general Dutch population; (2) to investigate its relationship with age, sex, educational attainment, and country of birth; (3) to determine its association with other pain complaints; and (4) to determin

  14. Internet and social media for health-related information and communication in health care: preferences of the Dutch general population.

    Science.gov (United States)

    Van de Belt, Tom H; Engelen, Lucien J L P G; Berben, Sivera A A; Teerenstra, Steven; Samsom, Melvin; Schoonhoven, Lisette

    2013-10-02

    Health care is increasingly featured by the use of Web 2.0 communication and collaborative technologies that are reshaping the way patients and professionals interact. These technologies or tools can be used for a variety of purposes: to instantly debate issues, discover news, analyze research, network with peers, crowd-source information, seek support, and provide advice. Not all tools are implemented successfully; in many cases, the nonusage attrition rates are high. Little is known about the preferences of the Dutch general population regarding the use of the Internet and social media in health care. To determine the preferences of the general population in the Netherlands regarding the use of the Internet and social media in health care. A cross-sectional survey was disseminated via a popular Dutch online social network. Respondents were asked where they searched for health-related information, how they qualified the value of different sources, and their preferences regarding online communication with health care providers. Results were weighed for the Dutch population based on gender, age, and level of education using official statistics. Numbers and percentages or means and standard deviations were presented for different subgroups. One-way ANOVA was used to test for statistical differences. The survey was completed by 635 respondents. The Internet was found to be the number one source for health-related information (82.7%), closely followed by information provided by health care professionals (71.1%). Approximately one-third (32.3%) of the Dutch population search for ratings of health care providers. The most popular information topics were side effects of medication (62.5%) and symptoms (59.7%). Approximately one-quarter of the Dutch population prefer to communicate with a health care provider via social media (25.4%), and 21.2% would like to communicate via a webcam. The Internet is the main source of health-related information for the Dutch population

  15. Using MIQUEST in General Practice

    Directory of Open Access Journals (Sweden)

    Victoria Hammersley

    1998-11-01

    Full Text Available This paper describes ten months' experience with MIQUEST software used for the collection of data from computerised databases in General Practice. We report on the following: the MIQUEST software in use, the time costs to the practice, the completeness of confidentiality barriers and the accuracy of data collected using MIQUEST compared with similar data collected by the practice system (EMIS. There were no problems encountered with installation of MIQUEST-related software. With experience, MIQUEST was equal to the practice system for speed and ease of use. The confidentiality safeguards were found to be in accordance with the GMSC/RCGP Guidelines - patients could not be directly, or indirectly, identified from the data extracted by external searches. Inaccuracies in the data collected using MIQUEST were identified, but these were largely attributable to problems with the EMIS-written interpreter available on the practice system at the time, or with the coding schemes used by the practice. In an individual practice, MIQUEST represents an alternative data collection method to the practice-based software. For data collection from multiple general practices it should prove an invaluable tool for Health Authorities and research organisations.

  16. Dutch occupational physicians and general practitioners wish to improve cooperation

    NARCIS (Netherlands)

    Buijs, P.; Amstel, R. van; Dijk, F. van

    1999-01-01

    Objectives - To investigate cooperation between occupational physicians (OPs) and general practitioners (GPs). Methods - Literature review; structured interviews; questionnaires sent to randomised samples of OPs (n = 232) and GPs (n = 243). Results - Actual cooperation is poor. However, more than 80

  17. The place of female sexual dysfunction in the urological practice : Results of a Dutch Survey

    NARCIS (Netherlands)

    Bekker, Milou; Beck, Jacky; Putter, Hein; van Driel, Mels; Pelger, Rob; Nijeholt, August Lycklama A.; Elzevier, Henk

    2009-01-01

    Introduction. Female sexual dysfunction (FSD) is a highly prevalent and often underestimated problem. There is a strong association between urological complaints and FSD. Aims. The purpose of this survey was to evaluate how Dutch urologists address FSD in their daily practice. Methods. We performed

  18. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, R.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.; Hendriks, E.J.

    2015-01-01

    RATIONALE: To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. GUIDELINE DEVELOPMENT: A systematic literature search was performed to formulate

  19. Dutch Dataset Pain Rehabilitation in daily practice : Content, patient characteristics and reference data

    NARCIS (Netherlands)

    Koke, A. J. A.; Smeets, R. J. E. M.; Schreurs, K. M.; van Baalen, B.; de Haan, P.; Remerie, S. C.; Preuper, H. R. Schiphorst; Reneman, M. F.

    Background: No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings. Methods: The Dutch Dataset Pain

  20. Dutch Adolescents' Tolerance of Practices by Muslim Actors: The Effect of Issue Framing

    Science.gov (United States)

    Gieling, Maike; Thijs, Jochem; Verkuyten, Maykel

    2012-01-01

    This research, conducted in the Netherlands, examines whether native adolescents' tolerance of practices by Muslim immigrants (e.g., the founding of Islamic schools) is affected by the type of considerations (e.g., educational freedom vs. integration of Muslims in Dutch society). Using an experimental questionnaire design (N = 970), the findings…

  1. Exercise-based cardiac rehabilitation in patients with chronic heart failure : a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, A.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.A. (Tinus); Hendriks, E.J.M.

    2015-01-01

    Rationale To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. Guideline development A systematic literature search was performed to formulate c

  2. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, R.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.; Hendriks, E.J.

    2015-01-01

    RATIONALE: To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. GUIDELINE DEVELOPMENT: A systematic literature search was performed to formulate

  3. Dutch Dataset Pain Rehabilitation in daily practice: content, patient characteristics and reference data

    NARCIS (Netherlands)

    Köke, A.J.A.; Smeets, R.J.E.M.; Schreurs, K.M.; Baalen, van B.; Haan, de P.; Remerie, S.C.; Schiphorst Preuper, H.R.; Reneman, M.F.

    2016-01-01

    Background No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings. Methods The Dutch Dataset Pain Rehabi

  4. Dutch Dataset Pain Rehabilitation in daily practice : Content, patient characteristics and reference data

    NARCIS (Netherlands)

    Köke, A J A; Smeets, R J E M; Schreurs, K M; van Baalen, B; de Haan, P; Remerie, S C; Schiphorst Preuper, H R; Reneman, M F

    2016-01-01

    BACKGROUND: No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings. METHODS: The Dutch Dataset Pain Rehab

  5. Management of children's urinary tract infections in Dutch family practice: A cohort study

    NARCIS (Netherlands)

    M. Harmsen (Mirjam); M.E. Wensing (Michel); J.C.C. Braspenning (Jozé); R.J. Wolters (René); J.C. van der Wouden (Hans); R.P.T.M. Grol (Richard)

    2007-01-01

    textabstractBackground. Optimal clinical management of childhood urinary tract infections (UTI) potentiates long-term positive health effects. Insight into the quality of care in Dutch family practices for UTIs was limited, particularly regarding observation periods of more than a year. Our aim was

  6. Bioethics in practice: Addressing ethically sensitive requests in a Dutch fertility clinic

    NARCIS (Netherlands)

    Gerrits, T.; Reis, R.; Braat, D.D.M.; Kremer, J.A.M.; Hardon, A.P.

    2013-01-01

    This article provides insight into how ethically sensitive requests for the use of assisted reproductive technologies (ARTs) are dealt within the daily practice of a Dutch fertility clinic. The findings presented are part of an ethnographic study conducted in this clinic from September 2003 until Ap

  7. Identities, Communities, and Practices in the Transition Towards Sustainable Mussel Fishery in the Dutch Wadden Sea

    NARCIS (Netherlands)

    Puente Rodriguez, D.; Swart, J.A.A.; Middag, M.; Windt, v.d. H.J.

    2015-01-01

    The Dutch mussel fishery in the Wadden Sea, a World Natural Heritage Site, is currently involved in a step-by-step transition from the traditional but controversial method of dredging mussel seed from natural beds using trawl nets to alternative sustainable practices. The main objectives of the tran

  8. Female Sexual Abuse Evaluation in the Urological Practice : Results of a Dutch Survey

    NARCIS (Netherlands)

    Beck, Jack; Bekker, Milou; Van Driel, Mels; Putter, Hein; Pelger, Rob; Nijeholt, A. A. B. Lycklama A.; Elzevier, Henk Willem

    2010-01-01

    Introduction. There is a strong association between urological complaints and a history of sexual abuse, especially in females. It is not known whether urologists integrate these facts in their daily practice. Aim. To evaluate whether Dutch urologists address the issues of sexual abuse in their fema

  9. Female Sexual Abuse Evaluation in the Urological Practice : Results of a Dutch Survey

    NARCIS (Netherlands)

    Beck, Jack; Bekker, Milou; Van Driel, Mels; Putter, Hein; Pelger, Rob; Nijeholt, A. A. B. Lycklama A.; Elzevier, Henk Willem

    Introduction. There is a strong association between urological complaints and a history of sexual abuse, especially in females. It is not known whether urologists integrate these facts in their daily practice. Aim. To evaluate whether Dutch urologists address the issues of sexual abuse in their

  10. Management of children's urinary tract infections in Dutch family practice: a cohort study

    NARCIS (Netherlands)

    Harmsen, M.; Wensing, M.J.P.; Braspenning, J.C.C.; Wolters, R.J.; Wouden, J.C. van der; Grol, R.P.T.M.

    2007-01-01

    BACKGROUND: Optimal clinical management of childhood urinary tract infections (UTI) potentiates long-term positive health effects. Insight into the quality of care in Dutch family practices for UTIs was limited, particularly regarding observation periods of more than a year. Our aim was to describe

  11. A survey of cusp fractures in a population of general dental practices.

    NARCIS (Netherlands)

    Fennis, W.M.M.; Kuys, R.H.; Kreulen, C.M.; Roeters, F.J.M.; Creugers, T.J.; Burgersdijk, R.C.W.

    2002-01-01

    PURPOSE: This study was conducted to expand the knowledge on the incidence of complete cusp fractures of posterior teeth in Dutch general practices. MATERIALS AND METHODS: During a 3-month period, data were obtained from 28 general practitioners, representing 46,394 patients. For each new case of co

  12. Consultations for mental problems in general practices with and without mental health nurses.

    NARCIS (Netherlands)

    Magnée, T.; Beurs, D. de; Verhaak, P.

    2016-01-01

    Background & Aim: It seems cost-effective to provide mental health care to patient with mild mental problems in general practices instead of in specialized care, but general practitioners (GPs) often lack time or expertise. Since 2008, Dutch GPs have been collaborating with nurses with mental health

  13. Consultations for mental problems in general practices with and without mental health nurses.

    NARCIS (Netherlands)

    Magnée, T.; Beurs, D. de; Verhaak, P.

    2016-01-01

    Background & Aim: It seems cost-effective to provide mental health care to patient with mild mental problems in general practices instead of in specialized care, but general practitioners (GPs) often lack time or expertise. Since 2008, Dutch GPs have been collaborating with nurses with mental health

  14. Epilepsy care in general practice.

    LENUS (Irish Health Repository)

    Varley, J

    2009-06-01

    Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

  15. Epilepsy care in general practice.

    Science.gov (United States)

    Varley, J; Fitzsimons, M; Delanty, N; Collins, C; Boland, M; Normand, C

    2009-06-01

    Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

  16. Mental health care as delivered by Dutch general practitioners between 2004 and 2008

    NARCIS (Netherlands)

    Verhaak, Peter F. M.; van Dijk, Christel E.; Nuijen, Jasper; Verheij, Robert A.; Schellevis, Francois G.

    2012-01-01

    Objective. In the field of mental health care, a major role for general practice is advocated. However, not much is known about the treatment and referral of mental health problems in general practice. This study aims at the volume and nature of treatment of mental health problems in general practic

  17. Collecting information in general practice: 'just by pressing a single button'?

    NARCIS (Netherlands)

    Verheij, R.; Zee, J. van der

    2006-01-01

    What did we have to do to get the data for the second Dutch National Survey of General Practice (DNSGP-2)? Will all this be necessary for a possible third survey as well? Can policy information be derived from raw electric medical records, just by pressing a single button? These questions will

  18. 'Burnout' among Dutch midwives.

    NARCIS (Netherlands)

    Bakker, R.H.C.; Groenewegen, P.P.; Jabaaij, L.; Meijer, W.; Sixma, H.; Veer, A. de

    1996-01-01

    OBJECTIVE: to determine the effect of workload on 'burnout' having considered work capacity. DESIGN: cross-sectional study. SETTING: Dutch community midwives in independent practice. PARTICIPANTS: 200 Dutch community midwives. MEASUREMENTS: three-week diary recordings, a questionnaire on practice

  19. Prescribing antibiotics in general practice:

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

    Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how...... the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data...

  20. Population-based prevention of influenza in Dutch general practice

    NARCIS (Netherlands)

    Hak, E; Hermens, R P; van Essen, G A; Kuyvenhoven, M M; de Melker, R A

    1997-01-01

    BACKGROUND: Although the effectiveness of influenza vaccination in high-risk groups has been proven, vaccine coverage continues to be less than 50% in The Netherlands. To improve vaccination rates, data on the organizational factors, which should be targeted in population-based prevention of influen

  1. Trends in Antibiotic Prescribing in Adults in Dutch General Practice

    NARCIS (Netherlands)

    M.B. Haeseker (Michiel); N.H.T.M. Dukers-Muijrers (Nicole); C.J.P.A. Hoebe (Christian); C.A. Bruggeman (Cathrien); J.W.L. Cals (Jochen); A. Verbon (Annelies)

    2012-01-01

    textabstractBackground: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this stud

  2. Trends in Antibiotic Prescribing in Adults in Dutch General Practice

    NARCIS (Netherlands)

    M.B. Haeseker (Michiel); N.H.T.M. Dukers-Muijrers (Nicole); C.J.P.A. Hoebe (Christian); C.A. Bruggeman (Cathrien); J.W.L. Cals (Jochen); A. Verbon (Annelies)

    2012-01-01

    textabstractBackground: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this

  3. Trends in Antibiotic Prescribing in Adults in Dutch General Practice

    NARCIS (Netherlands)

    M.B. Haeseker (Michiel); N.H.T.M. Dukers-Muijrers (Nicole); C.J.P.A. Hoebe (Christian); C.A. Bruggeman (Cathrien); J.W.L. Cals (Jochen); A. Verbon (Annelies)

    2012-01-01

    textabstractBackground: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this stud

  4. Contractual Control and Labour-Related CSR Norms in the Supply Chain: Dutch Best Practices

    Directory of Open Access Journals (Sweden)

    Louise Vytopil

    2012-01-01

    Full Text Available Multinational companies attempt to gain contractual control of their supply chain, in the face of possible reputational and legal risks with regard to corporate social responsibility. This article sets out the choices that fourteen Dutch multinational companies make: do they choose contracts, general terms and conditions and/or codes of conduct to regulate CSR in their supply chains? Furthermore, it explores the possibilities and limitations of these choices in terms of contract law. A model with three possible options that companies may choose is proposed. It is concluded that most Dutch multinationals do not rely on codes of conduct alone; nearly all anchor their codes of conduct by means of contractual mechanisms. Furthermore, nearly all 'strong' choices include perpetual clauses in relation to sub-tier suppliers.

  5. Contractual Control and Labour-Related CSR Norms in the Supply Chain: Dutch Best Practices

    Directory of Open Access Journals (Sweden)

    Louise Vytopil

    2012-01-01

    Full Text Available Multinational companies attempt to gain contractual control of their supply chain, in the face of possible reputational and legal risks with regard to corporate social responsibility. This article sets out the choices that fourteen Dutch multinational companies make: do they choose contracts, general terms and conditions and/or codes of conduct to regulate CSR in their supply chains? Furthermore, it explores the possibilities and limitations of these choices in terms of contract law. A model with three possible options that companies may choose is proposed. It is concluded that most Dutch multinationals do not rely on codes of conduct alone; nearly all anchor their codes of conduct by means of contractual mechanisms. Furthermore, nearly all 'strong' choices include perpetual clauses in relation to sub-tier suppliers.

  6. Mental health care as delivered by Dutch general practitioners between 2004 and 2008

    NARCIS (Netherlands)

    Verhaak, Peter F. M.; van Dijk, Christel E.; Nuijen, Jasper; Verheij, Robert A.; Schellevis, Francois G.

    Objective. In the field of mental health care, a major role for general practice is advocated. However, not much is known about the treatment and referral of mental health problems in general practice. This study aims at the volume and nature of treatment of mental health problems in general

  7. Opinions about euthanasia and advanced dementia: a qualitative study among Dutch physicians and members of the general public.

    Science.gov (United States)

    Kouwenhoven, Pauline S C; Raijmakers, Natasja J H; van Delden, Johannes J M; Rietjens, Judith A C; van Tol, Donald G; van de Vathorst, Suzanne; de Graeff, Nienke; Weyers, Heleen A M; van der Heide, Agnes; van Thiel, Ghislaine J M W

    2015-01-28

    The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia. In this qualitative study, 16 medical specialists, 19 general practitioners, 16 elderly physicians and 16 members of the general public were interviewed and asked for their opinions about a vignette on euthanasia based on an AED in a patient with advanced dementia. Members of the general public perceived advanced dementia as a debilitating and degrading disease. Physicians emphasized the need for direct communication with the patient when making decisions about euthanasia. Respondent from both groups acknowledged difficulties in the assessment of patients' autonomous wishes and the unbearableness of their suffering. Legally, an AED may replace direct communication with patients about their request for euthanasia. In practice, physicians are reluctant to forego adequate verbal communication with the patient because they wish to verify the voluntariness of patients' request and the unbearableness of suffering. For this reason, the applicability of AEDs in advanced dementia seems limited.

  8. Intercultural communication in general practice.

    Science.gov (United States)

    van Wieringen, Joke C M; Harmsen, Johannes A M; Bruijnzeels, Marc A

    2002-03-01

    Little is known about the causes of problems in communication between health care professionals and ethnic-minority patients. Not only language difficulties, but also cultural differences may result in these problems. This study explores the influence of communication and patient beliefs about health (care) and disease on understanding and compliance of native-born and ethnic-minority patients. In this descriptive study seven general practices located in a multi-ethnic neighbourhood in Rotterdam participated. Eighty-seven parents who visited their GP with a child for a new health problem took part: more than 50% of them belonged to ethnic-minorities. The consultation between GP and patient was recorded on video and a few days after the consultation patients were interviewed at home. GPs filled out a short questionnaire immediately after the consultation. Patient beliefs and previous experiences with health care were measured by different questionnaires in the home interview. Communication was analysed using the Roter Interaction Analysis System based on the videos. Mutual understanding between GP and patient and therapy compliance was assessed by comparing GP's questionnaires with the home interview with the parents. In 33% of the consultations with ethnic-minority patients (versus 13% with native-born patients) mutual understanding was poor. Different aspects of communication had no influence on mutual understanding. Problems in the relationship with the GP, as experienced by patients, showed a significant relation with mutual understanding. Consultations without mutual understanding more often ended in non-compliance with the prescribed therapy. Ethnic-minority parents more often report problems in their relationship with the GP and they have different beliefs about health and health care from native-born parents. Good relationships between GP and patients are necessary for mutual understanding. Mutual understanding has a strong correlation with compliance

  9. The personal in the politicalthe use of Twitter during the 2010 British and Dutch General Election Campaigns : the use of Twitter during the 2010 British and Dutch General Election Campaigns

    NARCIS (Netherlands)

    Graham, Todd; Jackson, Daniel; Broersma, Marcel

    2014-01-01

    This study investigates the personal in political candidates’ tweets during the 2010 British and Dutch general election campaigns. Besides campaign updates and promotion, Twitter is being used to give citizens a glimpse into a candidate’s personal life, for example to raise confidence and establish

  10. The personal in the politicalthe use of Twitter during the 2010 British and Dutch General Election Campaigns : the use of Twitter during the 2010 British and Dutch General Election Campaigns

    NARCIS (Netherlands)

    Graham, Todd; Jackson, Daniel; Broersma, Marcel

    2014-01-01

    This study investigates the personal in political candidates’ tweets during the 2010 British and Dutch general election campaigns. Besides campaign updates and promotion, Twitter is being used to give citizens a glimpse into a candidate’s personal life, for example to raise confidence and establish

  11. Clinical Presentation of General Paralysis of the Insane in a Dutch Psychiatric Hospital, 1924-1954.

    Science.gov (United States)

    Daey Ouwens, Ingrid M; Lens, C Elisabeth; Fiolet, Aernoud T L; Ott, Alewijn; Koehler, Peter J; Verhoeven, Willem M A

    2015-01-01

    General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalization. Nowadays, physicians consider GPI to be exceptional. It should be noted, however, that syphilis re-emerged worldwide at the turn of the 20th to 21st century and a revival of GPI can, therefore, be expected. Advanced diagnosis is crucial in that treatment in the early, inflammatory phase is warranted before irreversible tissue damage occurs. Therefore, a renewed clinical awareness of the broad spectrum of psychiatric and neurologic signs and symptoms of GPI is needed. In this historical cohort study, comprising 105 patients with GPI admitted to the Dutch Vincent van Gogh Psychiatric Hospital in the period 1924-1954, the clinical presentation of this invalidating disorder is investigated and described in detail.

  12. Sources of dietary protein in relation to blood pressure in a general Dutch population.

    Directory of Open Access Journals (Sweden)

    Wieke Altorf-van der Kuil

    Full Text Available BACKGROUND: Little is known about the relation of different dietary protein types with blood pressure (BP. We examined whether intake of total, plant, animal, dairy, meat, and grain protein was related to BP in a cross sectional cohort of 20,820 Dutch adults, aged 20-65 y and not using antihypertensive medication. DESIGN: Mean BP levels were calculated in quintiles of energy-adjusted protein with adjustment for age, sex, BMI, education, smoking, and intake of energy, alcohol, and other nutrients including protein from other sources. In addition, mean BP difference after substitution of 3 en% carbohydrates or MUFA with protein was calculated. RESULTS: Total protein and animal protein were not associated with BP (p(trend = 0.62 and 0.71 respectively, both at the expense of carbohydrates and MUFA. Systolic BP was 1.8 mmHg lower (p(trend36 g/d than in the lowest (<27 g/d quintile of plant protein. This inverse association was present both at the expense of carbohydrates and MUFA and more pronounced in individuals with untreated hypertension (-3.6 mmHg than in those with normal (+0.1 mmHg or prehypertensive BP (-0.3 mmHg; p(interaction<0.01. Meat and grain protein were not related to BP. Dairy protein was directly associated with systolic BP (+1.6 mmHg, p(trend<0.01, but not with diastolic BP (p(trend = 0.24. CONCLUSIONS: Total protein and animal protein were not associated with BP in this general untreated Dutch population. Plant protein may be beneficial to BP, especially in people with elevated BP. However, because high intake of plant protein may be a marker of a healthy diet and lifestyle in general, confirmation from randomized controlled trials is warranted.

  13. Reflections from Dutch advanced nursing practice students on psychiatric mental healthcare in the United States.

    Science.gov (United States)

    Maas, Lillian Garcia; Ezeobele, Ifeoma Ezebuiro

    2014-12-01

    An international clinical learning experience is a unique opportunity to witness another nursing and healthcare system. The Master of Advanced Nursing Practice (MANP) program at Rotterdam University of Applied Sciences in the Netherlands, mandates an international experience. Semi-structured qualitative interviews, a focus group session and written reflections were used for data collection with 6 Dutch MANP nursing students who specialized in psychiatric mental healthcare. Five major themes were revealed from the data. The themes identified were as follows: (1) pride and passion for mental health profession (2) role diversity within psychiatric mental health nursing (3) nursing leadership at the organization level (4) comparable Westernized approaches to mental healthcare and (5) differences in access to care. Incorporating a mandatory international clinical experience is a beneficial tool to promote a global understanding of the unique advanced practice nursing student's academic and professional development. The international clinical learning experience is considered a highlight of the 2-year MANP program. The students are able to gain a new and broader vision of the APN role and a greater appreciation for the Dutch healthcare system. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Prevalence of medicinal drugs in suspected impaired drivers and a comparison with the use in the general Dutch population

    NARCIS (Netherlands)

    Bezemer, Karlijn D B; Smink, Beitske E; van Maanen, Rianne; Verschraagen, Miranda; de Gier, Johan J

    2014-01-01

    The aim of this study was to investigate the prevalence of psychotropic medicines in drivers suspected of driving under the influence of medicinal and illicit drugs in The Netherlands and to compare the prevalence of selected impairing medicines with the use of these medicines in the general Dutch p

  15. A comparison of attitudes towards end-of-life decisions: survey among the Dutch general public and physicians

    NARCIS (Netherlands)

    Rietjens, J.A.C.; Heide, van der J.A.; Philipsen, B.D.; Maas, van der P.J.; Wal, van der G.

    2005-01-01

    In The Netherlands, there has been a continuing public debate about the acceptability and regulatory system for medical decision-making concerning the end of life. We studied attitudes of the Dutch general public towards different types of end-of-life decisions in various situations and compared the

  16. [Psychotic disorders: special aspects in general practice].

    Science.gov (United States)

    Kurmann, Julius

    2015-09-30

    In emergency situations the general practitioner is often the first professional contact psychotic patients have. The following article conveys basic knowledge about psychotic disorders and their clinical features typically seen in general practice.

  17. [Psychotropic drugs in general practice].

    Science.gov (United States)

    Zimmer, Alexander

    2014-06-18

    The article presents a user-friendly overview of psychotropic drugs which are helpful for the prescription in a primary care practice. The author recommends to get familiar with just a small selection of drugs first and second line. This means to know well about their effectiveness, short-and long-term side effects, interactions with other drugs and the necessary monitoring that should be done.

  18. Profiling healthy eaters. Determining factors that predict healthy eating practices among Dutch adults.

    Science.gov (United States)

    Swan, Emily; Bouwman, Laura; Hiddink, Gerrit Jan; Aarts, Noelle; Koelen, Maria

    2015-06-01

    Research has identified multiple factors that predict unhealthy eating practices. However what remains poorly understood are factors that promote healthy eating practices. This study aimed to determine a set of factors that represent a profile of healthy eaters. This research applied Antonovsky's salutogenic framework for health development to examine a set of factors that predict healthy eating in a cross-sectional study of Dutch adults. Data were analyzed from participants (n = 703) who completed the study's survey in January 2013. Logistic regression analysis was performed to test the association of survey factors on the outcome variable high dietary score. In the multivariate logistic regression model, five factors contributed significantly (p eating, and self-efficacy for healthy eating. Findings complement what is already known of the factors that relate to poor eating practices. This can provide nutrition promotion with a more comprehensive picture of the factors that both support and hinder healthy eating practices. Future research should explore these factors to better understand their origins and mechanisms in relation to healthy eating practices. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Nothing more to do: euthanasia, general practice, and end-of-life discourse in the Netherlands.

    Science.gov (United States)

    Norwood, Frances

    2007-01-01

    Euthanasia in the Netherlands, which has been legal since 1984, is often talked about; yet, only rarely does it culminate in a euthanasia death. In 2001, for example, only 1 in 10 of those who initiated a request for euthanasia with their physician died a euthanasia death. Using data gathered during a 15-month ethnographic study with general practitioners, families, and patients, this article explores the practice of euthanasia, a practice based mainly in talk. Applying a Foucauldian concept of discourse, I will examine euthanasia as a script for how people think, feel, and act at the end of Dutch life, attempting to answer the question: What are Dutch people talking about when they talk about euthanasia? This article is intended to provide ethnographic data not currently available on the modern-day practice of euthanasia and to add to a growing body of literature on death, dying, and the role of the state.

  20. Palliative sedation : not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation

    NARCIS (Netherlands)

    Janssens, Rien; van Delden, Johannes J. M.; Widdershoven, Guy A. M.

    2012-01-01

    The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse t

  1. Postgraduate education to increase adherence to a Dutch physiotherapy practice guideline for hip and knee OA: a randomized controlled trial

    NARCIS (Netherlands)

    Peter, W.F.; Wees, P.J. van der; Verhoef, J.; Jong, Z. de; Bodegom-Vos, L. van; Hilberdink, W.K.H.A.; Fiocco, M.; Vliet Vlieland, T.P.M.

    2013-01-01

    OBJECTIVE: To compare the effectiveness of two educational courses aiming to improve adherence to recommendations in a Dutch physiotherapy practice guideline for hip and knee OA. METHODS: Physiotherapists (PTs) from three regions in The Netherlands were invited to participate in a study comparing an

  2. Belonging through Languagecultural Practices in the Periphery : The Politics of Carnival in the Dutch Province of Limburg

    NARCIS (Netherlands)

    Cornips, L.M.E.A.; de Rooij, V.

    2015-01-01

    In this article, we will present two case studies of language and cultural practices that are part of or strongly related to carnival, in the Dutch peripheral province of Limburg, and more precisely in the southern Limburgian city of Heerlen, which in turn is considered peripheral vis-à-vis the

  3. Belonging through languagecultural practices in the periphery: the politics of carnival in the Dutch province of Limburg

    NARCIS (Netherlands)

    Cornips, L.; de Rooij, V.

    2015-01-01

    In this article, we will present two case studies of language and cultural practices that are part of or strongly related to carnival, in the Dutch peripheral province of Limburg, and more precisely in the southern Limburgian city of Heerlen, which in turn is considered peripheral vis-à-vis the

  4. Continuous improvement in the Netherlands: current practices and experiences in Dutch manufacturing industry (awarded with ANBAR Citation of excellence)

    NARCIS (Netherlands)

    Gieskes, J.F.B.; Baudet, F.C.M.; Baudet, Frank; Schuring, R.W.; Boer, Harm

    1997-01-01

    In order to get insight into the current continuous-improvement practices in European industry, EuroCINet carried out a survey in its member countries. In this article, continuous-improvement activities in a sample of 135 Dutch industrial companies are described. The results show that CI is a

  5. Veterinary advice for entrepreneurial Dutch dairy farmers : From curative practice to coach-consultant: what needs to be changed?

    NARCIS (Netherlands)

    Noordhuizen, J.P.T.M.; Egmond, van M.J.; Jorritsma, R.; Hogeveen, H.; Lievaart, J.J.

    2008-01-01

    Dairy farms are tending to become larger, with a milk quota of more than 8 tons a year, and are managed by entrepreneurial dairy farmers with their own specific characteristics and farming style. Some Dutch veterinary practices appear unable to respond to this different style and often do not serve

  6. Does age modify the relationship between morbidity severity and physical health in English and Dutch family practice populations?

    NARCIS (Netherlands)

    Kadam, U.T.; Schellevis, F.G.; Lewis, M.; Windt, D.A.W.M. van der; Vet, H.C. de; Bouter, L.M.; Croft, P.R.

    2009-01-01

    PURPOSE: To investigate the co-influences of age and morbidity severity on physical health in adult family practice populations. METHODS: Morbidity data in a 12-month period for 7,833 older English consulters aged 50 years and over and 6,846 Dutch consulters aged 18 years and over was linked to thei

  7. Palliative sedation : not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation

    NARCIS (Netherlands)

    Janssens, Rien; van Delden, Johannes J. M.; Widdershoven, Guy A. M.

    2012-01-01

    The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse t

  8. Dutch general practitioners’ weight management policy for overweight and obese patients.

    NARCIS (Netherlands)

    Kloek, C.J.J.; Tol, J.; Veenhof, C.; Wulp, I. van der; Swinkels, I.C.S.

    2014-01-01

    Background: General practitioners (GPs) can play an important role in both the prevention and management of overweight and obesity. Current general practice guidelines in the Netherlands allow room for GPs to execute their own weight management policy. Objective: To examine GPs’ current weight

  9. Dutch general practitioners’ weight management policy for overweight and obese patients.

    NARCIS (Netherlands)

    Kloek, C.J.J.; Tol, J.; Veenhof, C.; Wulp, I. van der; Swinkels, I.C.S.

    2014-01-01

    Background: General practitioners (GPs) can play an important role in both the prevention and management of overweight and obesity. Current general practice guidelines in the Netherlands allow room for GPs to execute their own weight management policy. Objective: To examine GPs’ current weight manag

  10. ADHD medication prescription: effects of child, sibling, parent and general practice characteristics.

    OpenAIRE

    Heins, M.J.; Bruggers, I.; van Dijk, L; Korevaar, J.C.

    2016-01-01

    Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication prescription. We included 1259 Dutch children aged 6-18 years with a diagnostic code of ADHD or related behavioural problems (ICPC codes P20-P22) in NIVEL primary care database. Using multilevel an...

  11. Gastroenteritis in sentinel general practices, the Netherlands.

    NARCIS (Netherlands)

    Wit, M.A.S. de; Koopmans, M.P.G.; Kortbeek, L.M.; Leeuwen, N.J. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van

    2001-01-01

    From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for gastroe

  12. Generalizing and Skepticism: Bringing Research to Practice

    Science.gov (United States)

    Yopp, David A.; Ellsworth, Jacob L.

    2016-01-01

    Empirical arguments rely on examples without necessarily addressing all cases. Students should be skeptical of empirical evidence and should seek more secure arguments for generalizations, such as those that explain why a generalization is true for all cases. Generalizing on the basis of patterns in data is an important mathematical practice;…

  13. Gastroenteritis in sentinel general practices, the Netherlands.

    NARCIS (Netherlands)

    Wit, M.A.S. de; Koopmans, M.P.G.; Kortbeek, L.M.; Leeuwen, N.J. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van

    2001-01-01

    From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for

  14. The role of general parenting and cannabis-specific parenting practices in adolescent cannabis and other illicit drug use

    NARCIS (Netherlands)

    Smit, E.; Verdurmen, J.E.E.; Engels, R.C.M.E.; Vollebergh, W.A.M.

    2015-01-01

    Aims: To investigate general and cannabis-specific parenting practices in relation to adolescent cannabis and other illicit drug use. Methods: Data were derived from the Dutch National School Survey on Substance Use among students (N = 3209; aged 12-16 years) and one of their parents in 2011. Result

  15. The role of general parenting and cannabis-specific parenting practices in adolescent cannabis and other illicit drug use

    NARCIS (Netherlands)

    Smit, E.; Verdurmen, J.E.E.; Engels, R.C.M.E.; Vollebergh, W.A.M.

    2015-01-01

    Aims: To investigate general and cannabis-specific parenting practices in relation to adolescent cannabis and other illicit drug use. Methods: Data were derived from the Dutch National School Survey on Substance Use among students (N = 3209; aged 12-16 years) and one of their parents in 2011. Result

  16. The role of general parenting and cannabis-specific parenting practices in adolescent cannabis and other illicit drug use

    NARCIS (Netherlands)

    Smit, E.; Verdurmen, J.E.E.; Engels, R.C.M.E.; Vollebergh, W.A.M.

    2015-01-01

    Aims: To investigate general and cannabis-specific parenting practices in relation to adolescent cannabis and other illicit drug use. Methods: Data were derived from the Dutch National School Survey on Substance Use among students (N = 3209; aged 12-16 years) and one of their parents in

  17. Reported incidence and treatment of dermatophytosis in children in general practice: a comparison between 1987 and 2001.

    NARCIS (Netherlands)

    Mohammedamin, R.S.A.; Wouden, J.C. van der; Koning, S.; Schellevis, F.G.; Suijlekom-Smit, L.W.A. van; Koes, B.W.

    2007-01-01

    Introduction: Dermatophytosis is a common skin infection in children. Although the epidemiology is relatively unknown it is becoming a major health problem in some countries. We determine the incidence and management of dermatophytosis in Dutch general practice in 1987 and 2001. Methods: We used da

  18. Accreditation in general practice in Denmark

    DEFF Research Database (Denmark)

    Andersen, Merethe K; Pedersen, Line B; Siersma, Volkert

    2017-01-01

    practice and mortality. All outcomes relate to quality indicators included in the Danish Healthcare Quality Program, which is based on general principles for accreditation. Discussion: The consequences of accreditation and standard-setting processes are generally under-researched, particularly in general......Background: Accreditation is used increasingly in health systems worldwide. However, there is a lack of evidence on the effects of accreditation, particularly in general practice. In 2016 a mandatory accreditation scheme was initiated in Denmark, and during a 3-year period all practices, as default......, should undergo accreditation according to the Danish Healthcare Quality Program. The aim of this study is primarily to evaluate the effects of a mandatory accreditation scheme. Methods/design: The study is conducted as a cluster-randomized controlled trial among 1252 practices (clusters) with 2211...

  19. Organization and change in general practice

    DEFF Research Database (Denmark)

    Andersen, John Sahl

    Organization and change in general practice Abstract for a symposium at Nordic Congress for General Practice Thursday 14 May at 15.30-17.00 General practice is under increasing pressure to assume new tasks, adopt new technologies and engage in new organizational structures. However, in a field...... of multiple actors and concerns such visions are rarely straightforward to realize. This symposium explores the significance of various organizational, cultural and regulative features of general practice in relation to proposals for change in the sector. Presentations: Thorkil Thorsen, Marius Kousgaard......, Ann Dorrit Guassora. Providing coherent care: Case-managers and other modes of coordination. A case-manager is often understood as a person coordinating health care services. It has been suggested that GPs should carry out this function for several types of diseases. The question addressed is whether...

  20. Is the incidence of diabetes increasing in all age-groups in The Netherlands?: Results of the second study in the Dutch Sentinel Practice Network

    NARCIS (Netherlands)

    Ruwaard, D.; Gijsen, R.; Bartelds, A.I.M.; Hirasing, R.A.; Verkleij, H.; Kromhout, D.

    1996-01-01

    OBJECTIVE - To assess possible changes in the incidence of diabetes in all age-groups in The Netherlands during a 10-year period (1980-1983/1990-1992). RESEARCH DESIGN AND METHODS - Since 1970, a network of sentinel stations (the Dutch Sentinel Practice Network) consisting of ∼1% of the Dutch popula

  1. The ambiguity of patient-centred practices: the case of a Dutch fertility clinic

    Science.gov (United States)

    Gerrits, Trudie

    2014-01-01

    When in-vitro fertilization (IVF) was introduced in the 1970s, doctors were criticized for not properly informing prospective users about its possible risks and limited success rates as well as for medicalizing fertility problems. Nowadays, many fertility clinics are seeking to improve their accountability to stakeholders through patient-centred practices. Based on an ethnographic study of a Dutch fertility clinic, outspoken in its aims to provide patient-centred medicine and to empower clients, this paper addresses how patient-centred medicine affects couples’ decision-making to use IVF and related reproductive technologies. The author contends that while patient-centred practices facilitate informed decision-making and support couples emotionally, they may also have unintended disciplining and normalizing effects. The information and support provided, the trust couples have in clinic staff, the ongoing visualization of conception mediated by medical technology – all can be seen as practices that strengthen lay people's ‘medical gaze’ in how they come to view their bodies, fertility problems and possible solutions. These unintended effects are labelled ‘the ambiguity of patient-centeredness’ as they (may) interfere with processes of autonomous decision-making. PMID:24827743

  2. Improving evidence-based general practice

    NARCIS (Netherlands)

    Kortekaas, MF

    2016-01-01

    This thesis provides knowledge on how to improve the practice of evidence-based medicine (EBM) by general practitioners (GPs) and GP trainees. EBM is defined as the integration of clinical expertise, patient values and the best available clinical evidence in daily clinical practice. We describe the

  3. The Dutch health care system: how are we organised?

    NARCIS (Netherlands)

    Jabaaij, L.

    2006-01-01

    The Netherlands has a unique and complex healthcare organisation and financing system. Insight into the peculiarities of the Dutch system helps one to understand the position of general practice. This chapter opens with a short outline of Dutch demographics: who are we and how many are we? Subsequen

  4. Small business, cash budgets and general practice.

    Science.gov (United States)

    Jackson, A R

    1991-01-01

    In practice management, general practice falls into the category of small business with all its attendant generic problems. Disciplined planning and good financial management are not often seen in small business. These are required if general practitioners are to continue (or return to) the provision of high quality medical services. An effective budget process, especially cash-flow budgeting, is the key to successful planning and financial management. Budgeting will bring Control, Co-ordination, and Credibility to your practice. It will enable you to set goals and to achieve them.

  5. Effect of Fish Oil Supplementation on Quality of Life in a General Population of Older Dutch Subjects: A Randomized, Double-Blind, Placebo-Controlled Trial.

    NARCIS (Netherlands)

    Rest, van de O.; Geleijnse, J.M.; Kok, F.J.; Staveren, van W.A.; OldeRikkert, M.G.M.; Beekman, A.T.F.; Groot, de C.P.G.M.

    2009-01-01

    OBJECTIVES: To investigate the effect of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation on quality of life (QOL). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Independently living individuals from the general older Dutch population. PARTICIPANTS:

  6. Effect of fish oil supplementation on quality of life in a general population of older Dutch subjects: a randomized, double-blind, placebo-controlled trial.

    NARCIS (Netherlands)

    Rest, O. van de; Geleijnse, J.M.; Kok, F.J.; Staveren, W.A. van; Olde Rikkert, M.G.M.; Beekman, A.T.; Groot, L.C. de

    2009-01-01

    OBJECTIVES: To investigate the effect of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation on quality of life (QOL). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Independently living individuals from the general older Dutch population. PARTICIPANTS:

  7. Effect of fish oil supplementation on quality of life in a general population of older Dutch subjects: a randomized, double-blind, placebo-controlled trial

    NARCIS (Netherlands)

    Rest, van de O.; Geleijnse, J.M.; Kok, F.; Staveren, van W.A.; Olderikkert, M.G.M.; Beekman, A.T.F.; Groot, de L.C.P.G.M.

    2009-01-01

    OBJECTIVES: To investigate the effect of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation on quality of life (QOL). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Independently living individuals from the general older Dutch population. PARTICIPANTS:

  8. Toward A Practical General Systems Methodological Theory

    OpenAIRE

    Nagib Callaos; Belkis Sánchez de Callaos

    2003-01-01

    Our main purpose in this paper is to describe the way in which we have been relating General System Theory (GST) to practice and to the design of a General Systems Methodology (GSM). Our first step was to apply GST to design a methodology for software development. Then, in a second step, by means of the experience/knowledge learned from applying the methodology to developing specific information systems, a continuous designing and re-designing process started, which simultaneously generalized...

  9. Governing climate change in Dutch cities: anchoring local climate strategies in organisation, policy and practical implementation

    NARCIS (Netherlands)

    Exter, den R.; Lenhart, J.L.; Kern, K.

    2015-01-01

    Although Dutch cities were among the forerunners in local climate policy, a systematic overview on climate mitigation and adaptation policy is still missing. This study aims to fill this gap by analysing 25 Dutch cities using indicators for the level of anchoring in policy, organisation and

  10. Adherence to asthma guidelines in general practices.

    Science.gov (United States)

    Roghmann, M C; Sexton, M

    1999-06-01

    Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Society's (BTS) Guidelines for Management of Asthma in Adults to determine if the patient's asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.

  11. Dairy Intake, Blood Pressure, and Incident Hypertension in a General Dutch Population

    NARCIS (Netherlands)

    Engberink, M.F.; Geleijnse, J.M.; Jong, N.; Smit, H.A.; Kok, F.J.; Verschuren, W.M.M.

    2009-01-01

    Diet and lifestyle are important for maintaining a healthy blood pressure (BP). The role of dairy in the prevention of hypertension, however, is not yet clear. We studied the relation of dairy intake with BP in 21,553 Dutch participants aged 20¿65 y who did not use antihypertensive medication. In ad

  12. Dairy Intake, Blood Pressure, and Incident Hypertension in a General Dutch Population

    NARCIS (Netherlands)

    Engberink, M.F.; Geleijnse, J.M.; Jong, N.; Smit, H.A.; Kok, F.J.; Verschuren, W.M.M.

    2009-01-01

    Diet and lifestyle are important for maintaining a healthy blood pressure (BP). The role of dairy in the prevention of hypertension, however, is not yet clear. We studied the relation of dairy intake with BP in 21,553 Dutch participants aged 20¿65 y who did not use antihypertensive medication. In ad

  13. Implementation of simulation in surgical practice: minimally invasive surgery has taken the lead: the Dutch experience.

    Science.gov (United States)

    Schreuder, Henk W R; Oei, Guid; Maas, Mario; Borleffs, Jan C C; Schijven, Marlies P

    2011-01-01

    Minimal invasive techniques are rapidly becoming standard surgical techniques for many surgical procedures. To develop the skills necessary to apply these techniques, box trainers and/or inanimate models may be used, but these trainers lack the possibility of inherent objective classification of results. In the past decade, virtual reality (VR) trainers were introduced for training minimal invasive techniques. Minimally invasive surgery (MIS) is, by nature, very suitable for this type of training. The specific psychomotor skills and eye-hand coordination needed for MIS can be mastered largely using VR simulation techniques. It is also possible to transfer skills learned on a simulator to real operations, resulting in error reduction and shortening of procedural operating time. The authors aim to enlighten the process of gaining acceptance in the Netherlands for novel training techniques. The Dutch Societies of Surgery, Obstetrics and Gynecology, and Urology each developed individual training curricula for MIS using simulation techniques, to be implemented in daily practice. The ultimate goal is to improve patient safety. The authors outline the opinions of actors involved, such as different simulators, surgical trainees, surgeons, surgical societies, hospital boards, government, and the public. The actual implementation of nationwide training curricula for MIS is, however, a challenging step.

  14. Prognostic factors for neckpain in general practice.

    NARCIS (Netherlands)

    Hoving, J.L.; Vet, H.C.W. de; Twisk, J.W.R.; Devillé, W.L.J.M.; Windt, D. van der; Koes, B.W.; Bouter, L.M.

    2004-01-01

    Prognostic studies on neck pain are scarce and are typically restricted to short-term follow-up only. In this prospective cohort study, indicators of short- and long-term outcomes of neck pain were identified that can easily be measured in general practice. Patients between 18 and 70 years of age, s

  15. Comorbidity of chronic diseases in general practice.

    NARCIS (Netherlands)

    Schellevis, F.G.; Velden, J. van der; Lisdonk, E. van de; Eijk, J.T.M. van; Weel, C. van

    1993-01-01

    With the increasing number of elderly people in The Netherlands the prevalence of chronic diseases will rise in the next decades. It is recognized in general practice that many older patients suffer from more than one chronic disease (comorbidity). The aim of this study is to describe the extent of

  16. Acute Neck Pain in General Practice

    NARCIS (Netherlands)

    C.J. Vos (Kees)

    2006-01-01

    textabstractWe performed a prospective cohort study with one-year follow-up of patients with acute neck pain in general practice. Patients above 18 years of age consulting their GP for non-specific acute neck pain lasting no longer than six weeks were invited to participate. Self-administered quest

  17. Effects of electronic communication in general practice

    NARCIS (Netherlands)

    van der Kam, WJ; Moorman, PW; Koppejan-Mulder, MJ

    2000-01-01

    Objective: To obtain insight into the effects of electronic communication on GPs by studying those publications in literature describing the effects of structured electronic clinical communication in general practice. Methods: We retrieved all publications in the English language indexed in MEDLINE

  18. Guidelines for computer security in general practice

    Directory of Open Access Journals (Sweden)

    Peter Schattner

    2007-06-01

    Conclusions This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake.

  19. 'Burnout' among Dutch midwives.

    NARCIS (Netherlands)

    Bakker, R.H.C.; Groenewegen, P.P.; Jabaaij, L.; Meijer, W.; Sixma, H.; Veer, A. de

    1996-01-01

    OBJECTIVE: to determine the effect of workload on 'burnout' having considered work capacity. DESIGN: cross-sectional study. SETTING: Dutch community midwives in independent practice. PARTICIPANTS: 200 Dutch community midwives. MEASUREMENTS: three-week diary recordings, a questionnaire on practice an

  20. [Local registries in general/family practice].

    Science.gov (United States)

    Cindrić, Jasna

    2007-02-01

    Entering medical records into registries of all sorts has always been a part of everyday work of a general/family physician. There is a distinction between public/population registries on the one hand, and internal, local registries on the other hand. Local registries refer to the catchment population of a particular general/family practice. While keeping population-registries has become a routine with a high level of uniformity in collecting, delivering, recording, analyzing and controlling information, there are no recommendations or standards for keeping local registries, although their importance as well as indisputable necessity have been recognized. They are invaluable for providing an insight into the condition and history of a particular disease in a particular area, planning and taking preventive measures and activities, supervising therapy and medical treatment, as well as for statistical analyses and scientific studies. The most important registry in the field of general practice is the one called "List of health care under the supervision of chosen general/family physicians", which can serve as an index for any other individual record or record of diseases by name kept at a particular general/family practice. Although local registries have "evolved" from notebooks into modern informatic databases, the problem of up-to-dateness cannot be solved until the whole health care system has been connected for competent and authorized persons to be able to record changes of data where and when they take place.

  1. Management of upper dyspepsia in general practice

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte

    of dyspepsia, dyspeptic episodes, main symptom, previous contact to general practice, previous gastroscopia, use of antacids or NSAID's, Helicobacter Pylori status and mental/physical well being (SF-36 measurement scale) (Table 1). After two weeks the GPs assessed 46 % of the patients to be free of symptoms...... Aim: To compare the effect of two strategies for management of dyspepsia. Evaluation based on GP's assessment after two weeks and patients assessment after three months.   Design: Prospective randomised controlled trial in general practice   Methods: 357 patients with dyspepsia where the general...... after 3 months.   Results: Response rate GPs after two weeks were 92% (330/357). Response rate patients after three months were 71% (252/357). There were no significant difference between the groups randomised to strategy 1(PPI group) and strategy 2 (endoscopy group) concerning, age, gender, duration...

  2. Accreditation in general practice in Denmark

    DEFF Research Database (Denmark)

    Andersen, Merethe K; Pedersen, Line B; Siersma, Volkert;

    2017-01-01

    , should undergo accreditation according to the Danish Healthcare Quality Program. The aim of this study is primarily to evaluate the effects of a mandatory accreditation scheme. METHODS/DESIGN: The study is conducted as a cluster-randomized controlled trial among 1252 practices (clusters) with 2211...... practice and mortality. All outcomes relate to quality indicators included in the Danish Healthcare Quality Program, which is based on general principles for accreditation. DISCUSSION: The consequences of accreditation and standard-setting processes are generally under-researched, particularly in general...... to assess changes due to accreditation; (3) availability of data from registers with no self-reporting data. The primary outcome is the number of prescribed drugs in patients older than 65 years. Secondary outcomes are changes in outcomes related to other perspectives of safe medication, good clinical...

  3. Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

    Directory of Open Access Journals (Sweden)

    Patrick Hoek

    Full Text Available Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations. We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Of the 44,443 initial consultations, most were requested by general practitioners (73% and most concerned patients with cancer (86%. Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12 or COPD (OR 1.39; 95% CI: 1.15-1.69 than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40, agitation/delirium (OR 1.57; 95% CI: 1.47-1.68, exhaustion (OR 2.89; 95% CI: 2.61-3.20, euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96 or existential issues (OR 1.55; 95% CI: 1.31-1.83.In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

  4. The new Australian after-hours general practice incentive payment mechanism: equity for rural general practice?

    Science.gov (United States)

    Neil, Amanda L; Nelson, Mark; Palmer, Andrew J

    2016-07-01

    In July 2015, a national scheme for after-hours incentive funding for general practices was re-introduced in Australia, 2-years after funding was transferred to regional primary health care organisations (Medicare Locals). The re-introduction was recommended in a 2014 review of after-hours primary care reflecting the "overwhelming desire" among general practice. Given the centrality of after-hours care provision in rural and remote practices identified in the review, we compare and contrast the current and historical after-hours incentive funding mechanisms focussing on fairness towards rural general practices. While there are similarities between the current and historical mechanisms, significant differences exist. The comparison is not straightforward. The major consistency is utilisation of practice standardised whole patient equivalents (SWPE) as the basis of funding, inherently favouring large urban general practices. This bias is expected to increase given a shift in focus from practices with no option but to provide 24/7 care to any practice providing 24/7 care; and an associated increased funding per SWPE. Differences primarily pertain to classification processes, in which the realities of rural service provision and recognition of regional support mechanisms are given minimal consideration. Rapid introduction of the new general practice after-hours incentive funding mechanism has led to inconsistencies and has exacerbated inherent biases, particularly inequity towards rural providers. Impact on morale and service provision in non-urban areas should be monitored.

  5. Moderately overweight and obese patients in general practice: a population based survey

    Directory of Open Access Journals (Sweden)

    Schuit Albertine J

    2006-07-01

    Full Text Available Abstract Background Obesity is a main threat to public health in the Western world and is associated with diseases such as diabetes mellitus and coronary heart diseases. Up to now a minority of research studied the relation between obesity and the use of primary health care. In the Netherlands the general practitioner (GP is the main primary health care provider. The objective of this article is to evaluate GP consultation and prescription of drugs in moderate and severely overweight (obese persons in the Netherlands. Methods Data were used from a representative survey of morbidity in Dutch general practice in 2001. Our study sample consisted of 8,944 adult respondents (18+ years who participated in an extensive health interview. Interview data were linked to morbidity and prescription registration data from 95 general practices where respondents were listed. Body mass index (BMI was calculated using self-reported height and weight. Analyses were controlled for clustering within practices as well as for socio-demographic and life style characteristics. Results Obesity (BMI ≥ 30 kg/m2 was observed in 8.9% of men and 12.4% of women; for moderate overweight (BMI 25- Conclusion Obesity increases the workload of Dutch general practitioners and the use of prescribed medication. The current increase in the prevalence of obesity will further increase the use of health care and related costs. Since a large majority of Dutch persons visit their GP over the course of one year, GPs' potential role in effective prevention strategies cannot be denied.

  6. Relational Coordination in Danish General Practice

    DEFF Research Database (Denmark)

    Lundstrøm, Sanne Lykke

    and relationship networks through which work is coordinated across functional and organisational boundaries. Previous studies have shown that relational coordination is positively associated with delivery of care for patients with chronic illness. Organisational social capital is used when analysing...... the psychosocial work environment in organisations, and is seen as a powerful resources for improving organisational performance. Relational coordination and organisational social capital may oer new insight and opportunities for general practice to learn. General practice provides cost-efficient, first....... The dissertation present the research study and a collection of three research papers prepared during the period from May 2010 to June 2014. Relational coordination and organisational social capital are measures of novel aspects of an organisation's performance. Relational coordination analyse the communication...

  7. E-dietician in general practice

    DEFF Research Database (Denmark)

    Brandt, Carl J.; Arendal, Cecilia; Glintborg, Dorte

    2010-01-01

    of 46 obese patients in general practice were offered participation in a cohort study during May 15th to December 1st 2008. Patients from three different health centers were included. 32 patients gave informed consent to participate and were given access to weekly e-mail consultations with a dietician...... and the amount of consultations (p=0.3). The individual expense to prevention- and e-mail consultations was 1,165DKK. In comparison the expense of 3 months of conventional treatment with 6-8 visits would be 1,300-1,700DKK. We conclude that weight loss as a result of econsultations is comparable with conventional...... weight loss treatments in general practice. The utilization of e-mail consultations can furthermore result in a saving in expenses and premises if the e-mail correspondences are held outside of the health centre....

  8. Antibiotic Prescription in Danish General Practice

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Plejdrup Hansen, Malene; Pedersen, Line Bjørnskov

    2016-01-01

    will explore how the GPs prescription behaviour is influenced by selected factors. Antibiotics are essential when treating potentially lethal infections. An increasing development of resistant bacteria is considered one of the primary threats to public health. The majority of antibiotics (90%) are prescribed...... from general practice. The prescription of broad-spectrum antibiotics can cause unnecessary side effects for the individual and increases the risk of development of bacteria resistant to antibiotic treatment. Both the prescription of broad-spectrum antibiotics and the level of resistant bacteria......1. Background & Aim The overall aim of the project is to describe antibiotic consumption in Danish general practice with emphasis on specific types of antibiotics. The project will shed light on the impact of microbiological diagnostic methods (MDM) on the choice of antibiotic and the project...

  9. Adherence to COPD guidelines in general practice

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Sørensen, Tina Brandt; Højmark, Torben Brunse

    2013-01-01

    BACKGROUND: The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD). AIMS: To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD...... guidelines. METHODS: A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted...... were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity. RESULTS: Data for 102 participating GP practices were analysed...

  10. Management of psychosis in Australian general practice.

    Science.gov (United States)

    Charles, Janice; Miller, Graeme; Ng, Anthea

    2006-03-01

    The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations involving the management of psychoses. In this analysis we have included schizophrenia, affective disorders/bipolar, organic psychoses, and senile psychoses, with undefined psychosis and chronic brain syndrome grouped as 'other'. This synopsis provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.

  11. [The Tijdschrift voor Gerontologie en Geriatrie: a practice-oriented journal of gerontology and geriatrics for the Dutch-speaking scientific community].

    Science.gov (United States)

    Diesfeldt, H F A

    2008-02-01

    In 2008 the Dutch-language journal of gerontology and geriatrics goes into its 39th year of publication. Most of the scientific papers published by the Journal in 2007 serve a practical purpose. The Journal is oriented towards the scientific community of Dutch speaking geriatricians, nursing home physicians, psychologists, sociologists and other scientific professionals. Besides theory-driven empirical studies in gerontology and geriatrics, the Journal publishes comments and criticism on government policy on geriatric care and services for the elderly.

  12. Dutch Dataset Pain Rehabilitation in daily practice: Content, patient characteristics and reference data.

    Science.gov (United States)

    Köke, A J A; Smeets, R J E M; Schreurs, K M; van Baalen, B; de Haan, P; Remerie, S C; Schiphorst Preuper, H R; Reneman, M F

    2017-03-01

    No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings. The Dutch Dataset Pain Rehabilitation was developed which included the six domains of the IMMPACT core set and three new domains relevant in the field of rehabilitation (medical consumption, patient-specific goals and activities/participation). Between 2010 and 2013 the core set was implemented in 32 rehabilitation facilities throughout the Netherlands. A total of 8200 adult patients with chronic pain completed the core set at first consultation with the rehabilitation physician. Adult patients (18-90 years) suffering from a long history of pain (38% >5 years) were referred. Patients had high medical consumption and less than half were working. Although patients were referred with diagnosis of low back pain or neck or shoulder pain, a large group (85%) had multisite pain (39% 2-5 painful body regions; 46% >5 painful body regions). Scores on psychosocial questionnaires were high, indicating high case complexity of referred patients. Reference data for subgroups based on gender, pain severity, pain locations and on pain duration are presented. The data from this clinical core set can be used to compare patient characteristics of patients of other treatment setting and/or scientific publications. As treatment success might depend on case complexity, which is high in the referred patients, the advantages of earlier referral to comprehensive multidisciplinary treatment were discussed. A detailed description of case complexity of patients with chronic pain referred for pain rehabilitation. Insight in case complexity of patients within subgroups on the basis of gender, pain duration, pain severity and pain location. These descriptions can be used as reference data for daily practice in the field of pain rehabilitation and

  13. Health problems of people with intellectual disabilities: the impact for general practice

    Science.gov (United States)

    Straetmans, Jos MJAA; van Schrojenstein Lantman-de Valk, Henny MJ; Schellevis, Francois G; Dinant, Geert-Jan

    2007-01-01

    This study aimed to analyse the health problems and prescriptions of people with intellectual disabilities registered with GPs. Within the Second Dutch National Survey of General Practice evidence was gathered on the differences in health problems between people with intellectual disabilities and control persons (without intellectual disabilities). In a 1:5 matched sample, people with intellectual disabilities paid 1.7 times more visits to GPs. They presented a different morbidity pattern, and received four times as many repeat prescriptions. People with intellectual disabilities increase a GP's workload. PMID:17244427

  14. Patient safety culture measurement in general practice. Clinimetric properties of 'SCOPE'

    Directory of Open Access Journals (Sweden)

    Zwart Dorien LM

    2011-11-01

    Full Text Available Abstract Background A supportive patient safety culture is considered to be an essential condition for improving patient safety. Assessing the current safety culture in general practice may be a first step to target improvements. To that end, we studied internal consistency and construct validity of a safety culture questionnaire for general practice (SCOPE which was derived from a comparable questionnaire for hospitals (Dutch-HSOPS. Methods The survey was conducted among caregivers of Dutch general practice as part of an ongoing quality accreditation process using a 46 item questionnaire. We conducted factor analyses and studied validity by calculating correlations between the subscales and testing the hypothesis that respondents' patient safety grade of their practices correlated with their scores on the questionnaire. Results Of 72 practices 294 respondents completed the questionnaire. Eight factors were identified concerning handover and teamwork, support and fellowship, communication openness, feedback and learning from error, intention to report events, adequate procedures and staffing, overall perceptions of patient safety and expectations and actions of managers. Cronbach's alpha of the factors rated between 0.64 and 0.85. The subscales intercorrelated moderately, except for the factor about intention to report events. Respondents who graded patient safety highly scored significantly higher on the questionnaire than those who did not. Conclusions The SCOPE questionnaire seems an appropriate instrument to assess patient safety culture in general practice. The clinimetric properties of the SCOPE are promising, but future research should confirm the factor structure and construct of the SCOPE and delineate its responsiveness to changes in safety culture over time.

  15. Intrauterine contraception: the role of general practitioners in four Dutch general practices.

    NARCIS (Netherlands)

    Vos, A.A.; Veldhuis, H.M.; Lagro-Janssen, A.L.M.

    2004-01-01

    The intrauterine device (IUD) use in the Netherlands and the United States is limited to a small group of women, though the risk of infection and pregnancy is small. Therefore, it was of interest to investigate the characteristics of women who choose an IUD as contraceptive method and the influence

  16. The proof of the pudding is in the eating: Net neutrality in practice, the Dutch example

    NARCIS (Netherlands)

    van Eijk, N.

    2014-01-01

    The Netherlands is among the few countries that have put specific net neutrality standards in place. It was the first country to do so in the European Union. Contrary to the original European Union approach, which lacks a material implementation of net neutrality principles, the Dutch parliament

  17. Informed consent in Dutch dental practice: Knowledge, attitudes and self-efficacy of dentists.

    NARCIS (Netherlands)

    Hoogstraten, J.; den Dekker, J.; Eijkman, M.A.J.; Schouten, B.

    2001-01-01

    The introduction of the 'Medical Treatment Contract Act' in the Netherlands 5 years ago, established some major rights and duties of both patients and members of the medical profession. The aim of this study was to assess Dutch dentists' knowledge, attitudes and self-efficacy with regard to several

  18. Outcomes of a Dutch workshop on improvements for the 3Rs in daily practice

    NARCIS (Netherlands)

    Luijk, J. van; Leenaars, M.; Dongen, A.M. van; Vaart, L. van der; Ritskes-Hoitinga, M.

    2012-01-01

    This article describes the outcome of a workshop that was held to generate new ideas to improve the use of the 3R principles in science. The participants of the workshop represented Dutch researchers, Animal Welfare Officers, and members of Animal Ethics Committees from various affiliations, includi

  19. Practice-Oriented Research: The Extended Function of Dutch Universities of Applied Sciences

    NARCIS (Netherlands)

    Weert, de Egbert; Leijnse, Frans; Kyvik, Svein; Lepori, Benedetto

    2010-01-01

    This chapter seeks to analyse the legitimate research claims of Dutch universities of applied sciences. It subsequently analyses how the research function has been conceived in national policies, the emerging funding schemes for research, strategies developed by these institutions regarding organisa

  20. Putting advertising and marketing communications strategy into practice: Case of dutch companies

    NARCIS (Netherlands)

    A. Mosmans (Andy); W.J.M.I. Verbeke (Willem)

    1992-01-01

    textabstractWillem Verbeke and Andy Mosmans have undertaken a large survey of Dutch companies focusing on how effectively advertising and marketing communications compaigns are implemented. Their interesting results show, among other things, the extensive involvement of top management in advertising

  1. The proof of the pudding is in the eating: Net neutrality in practice, the Dutch example

    NARCIS (Netherlands)

    van Eijk, N.

    2014-01-01

    The Netherlands is among the few countries that have put specific net neutrality standards in place. It was the first country to do so in the European Union. Contrary to the original European Union approach, which lacks a material implementation of net neutrality principles, the Dutch parliament dec

  2. Fish-Friendly Pumping Stations Principles, Practices and Outcomes in Dutch Water Management

    NARCIS (Netherlands)

    Moria, Laura

    2008-01-01

    In the Netherlands polder water levels are managed with almost 3000 pumping stations that pump excess water from polders to reservoir canals or sea. These pumping stations might threaten Dutch fish stocks. Migrating fish are often unable to pass a pumping

  3. Physiotherapy management of low back pain: does practice match the Dutch guidelines?

    NARCIS (Netherlands)

    Swinkels, I.C.S.; Ende, C.H.M. van den; Bosch, W. van den; Dekker, J.; Wimmers, R.H.

    2005-01-01

    The purpose of this study is to explore adherence by Dutch physiotherapists to the physiotherapists’ guideline for non-specific low back pain. For this study data from the National Information Service for Allied Health Care were used. This is a registration network that continuously collects informa

  4. Physiotherapy management of low back pain: does practice match the Dutch guidelines?

    NARCIS (Netherlands)

    Swinkels, I.C.; Ende, C.H.M. van den; Bosch, W.J.H.M. van den; Dekker, J.; Wimmers, R.H.

    2005-01-01

    The purpose of this study is to explore adherence by Dutch physiotherapists to the physiotherapists' guideline for non-specific low back pain. For this study data from the National Information Service for Allied Health Care were used. This is a registration network that continuously collects informa

  5. Acute Neck Pain in General Practice

    OpenAIRE

    2006-01-01

    textabstractWe performed a prospective cohort study with one-year follow-up of patients with acute neck pain in general practice. Patients above 18 years of age consulting their GP for non-specific acute neck pain lasting no longer than six weeks were invited to participate. Self-administered questionnaires were collected from patients at baseline and after 6, 12, 26 and 52 weeks. 187 patients were included and we have follow-up data of 138 patients (74%). After one-year 47% still reported ne...

  6. Management of upper dyspepsia in general practice

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte

     Aim: To compare the effect of two strategies for management of dyspepsia. Evaluation based on GP's assessment after two weeks and patients assessment after three months.   Design: Prospective randomised controlled trial in general practice   Methods: 357 patients with dyspepsia where the general......) for two weeks. If symptoms were unchanged after to weeks => referral to endoscopy. Later recurrence of symptoms => endoscopy (> 45 year) or management strategy according to helicobacter pylori status and/or clinical reflux (measures......)   Conclusion In management of dyspepsia therapy does have a better short term effect than endoscopy concerning symptom relief, but after 3 months the endoscopy strategy had a better effect than PPI concerning symptom relief  ...

  7. Clinical Activity in General Practice and Cancer

    DEFF Research Database (Denmark)

    Hjertholm, Peter

    2015-01-01

    BACKGROUND AND AIMS Cancer is a common, serious disease and early diagnosis is a cornerstone in the effort to improve the outcome from cancer disease. The general practitioner (GP) plays a crucial role in achieving this goal. Little is known about GPs’ suspicion of cancer and the activities the GPs...... institute in relation to such suspicion. Knowledge is also sparse on any effects of different diagnostic activities in general practice. The overall aims of this thesis were therefore: -to describe how often Danish GPs suspected cancer or other serious diseases and how they acted on the suspicion......, and to analyse how a suspicion influenced the demand for health care services and predicted a future diagnosis of serious disease - to investigate whether variation in GPs’ diagnostic activity influences cancer patients’ prognosis in relation to prostate-specific antigen (PSA) testing and prostate cancer...

  8. Outcomes of endodontic therapy in general practice

    Science.gov (United States)

    Bernstein, Susan D.; Horowitz, Allan J.; Man, Martin; Wu, Hongyu; Foran, Denise; Vena, Donald A.; Collie, Damon; Matthews, Abigail G.; Curro, Frederick A.; Thompson, Van P.; Craig, Ronald G.

    2014-01-01

    Background The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy. Methods Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion. Results P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity. Conclusions These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data. Clinical Implications The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for

  9. The Dutch health insurance reform: switching between insurers, a comparison between the general population and the chronically ill and disabled

    Directory of Open Access Journals (Sweden)

    Groenewegen Peter P

    2008-03-01

    Full Text Available Abstract Background On 1 January 2006 a number of far-reaching changes in the Dutch health insurance system came into effect. In the new system of managed competition consumer mobility plays an important role. Consumers are free to change their insurer and insurance plan every year. The idea is that consumers who are not satisfied with the premium or quality of care provided will opt for a different insurer. This would force insurers to strive for good prices and quality of care. Internationally, the Dutch changes are under the attention of both policy makers and researchers. Questions answered in this article relate to switching behaviour, reasons for switching, and differences between population categories. Methods Postal questionnaires were sent to 1516 members of the Dutch Health Care Consumer Panel and to 3757 members of the National Panel of the Chronically ill and Disabled (NPCD in April 2006. The questionnaire was returned by 1198 members of the Consumer Panel (response 79% and by 3211 members of the NPCD (response 86%. Among other things, questions were asked about choices for a health insurer and insurance plan and the reasons for this choice. Results Young and healthy people switch insurer more often than elderly or people in bad health. The chronically ill and disabled do not switch less often than the general population when both populations are comparable on age, sex and education. For the general population, premium is more important than content, while the chronically ill and disabled value content of the insurance package as well. However, quality of care is not important for either group as a reason for switching. Conclusion There is increased mobility in the new system for both the general population and the chronically ill and disabled. This however is not based on quality of care. If reasons for switching are unrelated to the quality of care, it is hard to believe that switching influences the quality of care. As yet there

  10. Policy statements and practice guidelines for medical end-of-life decisions in Dutch health care institutions: Developments in the past decade

    NARCIS (Netherlands)

    Pasman, H.R.W.; Wolf, de JT; Hesselink, B.A.M.; Heide, van der A.; Wal, van der G.; Maas, van der P.J.; Philipsen, B.D.

    2009-01-01

    OBJECTIVES: To describe the existence of policy statements on euthanasia and physician-assisted suicide (EAS) and practice guidelines for all medical end-of-life decisions in Dutch health care institutions in 2005, whether the existence of practice guidelines is related to characteristics of institu

  11. The estimation of patients' views on organizational aspects of a general dental practice by general dental practitioners: a survey study

    Directory of Open Access Journals (Sweden)

    Truin Gert-Jan

    2011-10-01

    Full Text Available Abstract Background Considering the changes in dental healthcare, such as the increasing assertiveness of patients, the introduction of new dental professionals, and regulated competition, it becomes more important that general dental practitioners (GDPs take patients' views into account. The aim of the study was to compare patients' views on organizational aspects of general dental practices with those of GDPs and with GDPs' estimation of patients' views. Methods In a survey study, patients and GDPs provided their views on organizational aspects of a general dental practice. In a second, separate survey, GDPs were invited to estimate patients' views on 22 organizational aspects of a general dental practice. Results For 4 of the 22 aspects, patients and GDPs had the same views, and GDPs estimated patients' views reasonably well: 'Dutch-speaking GDP', 'guarantee on treatment', 'treatment by the same GDP', and 'reminder of routine oral examination'. For 2 aspects ('quality assessment' and 'accessibility for disabled patients' patients and GDPs had the same standards, although the GDPs underestimated the patients' standards. Patients had higher standards than GDPs for 7 aspects and lower standards than GDPs for 8 aspects. Conclusion On most aspects GDPs and patient have different views, except for social desirable aspects. Given the increasing assertiveness of patients, it is startling the GDP's estimated only half of the patients' views correctly. The findings of the study can assist GDPs in adapting their organizational services to better meet the preferences of their patients and to improve the communication towards patients.

  12. A qualitative study of collaboration in general practice: understanding the general practice nurse's role.

    Science.gov (United States)

    McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth

    2017-07-01

    To explore the nature of collaboration between registered nurses and general practitioners in Australian general practice. There is international recognition that collaboration between health professionals can improve care coordination, enhance health outcomes, optimise the work environment and reduce healthcare costs. However, effective collaboration requires a clear understanding of each team member's role. A qualitative approach guided by Naturalistic Inquiry was used to elicit and interpret participant narratives. Eight general practitioners and fourteen registered nurses working in general practice were purposefully recruited. Data were collected via individual, semi-structured face-to-face interviews during February to May 2015. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Data revealed three overarching themes. This study presents the data for the overarching theme 'Understanding the general practice registered nurse's role'. Many general practitioner participants lacked clarity around the role and scope of practice of the registered nurse. At the same time, nursing participants often articulated their role as an assistant rather than as an independent health professional. This limited collaboration and the nurses' role within the team. Collaboration was enhanced when general practitioners actively sought an understanding of the registered nurses scope of practice. Clarifying the nurses' role promotes collaboration and supports nurses to work to the full extent of their practice. This is important in terms of optimising the nurses' role within the team and reinforcing their professional identity. Identification of key issues around understanding the nurses' role may help inform strategies that improve collaboration and workplace relations. © 2016 John Wiley & Sons Ltd.

  13. Talking about psychosocial problems: An observational study on changes in doctor-patient communicacion in general practice between 1977 and 2008

    NARCIS (Netherlands)

    Butalid, L; Bensing, J.; Verhaak, P.F.

    2014-01-01

    Objective: To examine whether GPs’ communication styles have changed since the introduction and implementation of clinical guidelines for psychosocial problems in Dutch general practice in the 1990s. Methods: From a database of 5184 consultations videotaped between 1977 and 2008, 512 consultations a

  14. General practice in the Nordic countries

    Directory of Open Access Journals (Sweden)

    Kim Rose Olsen

    2016-04-01

    Full Text Available Background: General practice systems in the Nordic countries share certain common features. The sector is based on the Nordic model of a tax-financed supply of services with a political objective of equal access for all. The countries also share the challenges of increased political expectations to deliver primary prevention and increased workload as patients from hospital care are discharged earlier. However, within this common framework, primary care is organized differently. This is particularly in relation to the private-public mix, remuneration systems and the use of financial and non-financial incentives. Objective: The objective of this paper is to compare the differences and similarities in primary care among the Nordic countries, to create a mapping of the future plans and reforms linked to remuneration and incentives schemes, and to discuss the pros and cons for these plans with reference to the literature. An additional objective is to identify gaps in the literature and future research opportunities. Results/Conclusions: Despite the many similarities within the Nordic health care systems, the primary care sectors function under highly different arrangements. Most important are the differences in the gate-keeping function, private versus salaried practices, possibilities for corporate ownership, skill-mix and the organisational structure. Current reforms and political agendas appear to focus on the side effects of the individual countries’ specific systems. For example, countries with salaried systems with geographical responsibility are introducing incentives for private practice and more choices for patients. Countries with systems largely based on private practice are introducing more monitoring and public regulation to control budgets. We also see that new governments tends to bring different views on the future organisation of primary care, which provide considerable political tension but few actual changes. Interestingly

  15. Paediatric vaccination practice in a division of general practice.

    Science.gov (United States)

    Cook, I F; Murtagh, J

    2001-12-01

    Currently the National Health and Medical Research Council (NH&MRC) recommend the use of a 23 gauge, 25 mm long needle inserted 45-60 degrees into the anterolateral thigh for paediatric vaccination. To assess the compliance of general practitioners (GPs) in a rural practice division with vaccination practice (site and needle size and gauge) prescribed for infants and toddlers by the NH&MRC. In 1999, a questionnaire survey was sent by the divisional office to all 150 GPs in the Hunter Rural Division of General Practice. The questionnaire collected demographic data (age, gender, university of graduation, number of paediatric vaccines administered per week) and elicited responses about the site of vaccination and the size and gauge of needle to be used for children 2-18 months and 18 months and older. Completed questionnaires were available from 112 GPs (74.6% completion rate). There was a high level of compliance with the NH&MRC proscription of buttock vaccination with only 4.3% and 4.1% of responses to the question of vaccination site at 2-18 months and 18 months and older respectively nominating this site. The anterolateral thigh was the favoured site for vaccination in children 2-18 months old (77.5% of responses) with the deltoid being the favoured site in children 18 months and older (59.2% of responses). There was a very low level of compliance with the NH&MRC recommended standard needle (23 gauge, 25 mm long, blue hub needle) (3.5% of responses). The orange hub needle (25 gauge, 16 mm long needle) was most favoured (48.7% of responses) with additional strong support for the 25 gauge, 25 mm long needle (40.2% of responses). In the Hunter Rural Division of General Practice there was good compliance with the NH&MRC's recommendations for site of vaccination, but not needle size and gauge to be used in infants and small children. Imprecise wording of these recommendations has created apparent uncertainty about the site of vaccination of children at 18 months of age.

  16. [Midazolam sedation in the general dental practice].

    Science.gov (United States)

    Bertens, J; Abraham-Inpijn, L; Meuwissen, P J

    1994-03-01

    The general dental practitioner is occasionally confronted with patients who, on the basis of psychological--and often somatic--criteria, are difficult to treat. Medicinal sedation in combination with anxiety reduction may be deemed appropriate for such patients. In the Netherlands inhalation sedation by means of a combination of oxygen and nitrous oxide is generally used. The limitations and disadvantages of this method have directed attention towards sedation by means of midazolam, a quick-acting benzodiazepine. In view of the complications which may accompany the administration of midazolam, the general practitioner working alone or in a group practice is advised against using midazolam sedation. Such use should be reserved for a dentist working in a hospital setting, who is able to consult with a physician regarding the advisability of administering midazolam. Even then, the safety of the patient requires that the practitioners have a proper insight into the physical state of the patient, work according to a protocol and in accordance with clearly defined responsibilities, and provide adequate accommodation during and after treatment.

  17. Putting advertising and marketing communications strategy into practice: Case of dutch companies

    OpenAIRE

    Mosmans, Andy; Verbeke, Willem

    1992-01-01

    textabstractWillem Verbeke and Andy Mosmans have undertaken a large survey of Dutch companies focusing on how effectively advertising and marketing communications compaigns are implemented. Their interesting results show, among other things, the extensive involvement of top management in advertising policy, that creative advertising copy is subject to little testing by managers, and that companies evaluate advertising agencies on the basis of supplying creative products. The authors conclude ...

  18. Improving infection control in general practice.

    Science.gov (United States)

    Farrow, S C; Zeuner, D; Hall, C

    1999-03-01

    Infection control measures in the health care setting should protect patients and staff from cross-infection. The prevention of harm is an essential part of good medical practice and failure might result in professional misconduct proceedings by the General Medical Council (GMC) and prosecution under the Health and Safety at Work legislation, as well as civil liability. For a health authority, overall responsibility for public health includes arrangements for the control of communicable diseases and infection in hospital and the community (NHS Management Executive, 1993), a function usually led by the Consultant in Communicable Disease Control (CCDC). This paper describes one district's collaborative approach between public health and GPs to assess and improve local infection control standards.

  19. Discontinuation of Preventive Drugs in General Practice

    DEFF Research Database (Denmark)

    Andersen, John Sahl; Lindberg, Laura Maria Glahder; Nixon, Michael Simon

    the most preventive drugs are prescribed in general practice. Special considerations exist in relation to medication of elderly patients. The prevalence of polypharmacy and the subsequent increased risk of side effects and drug interactions is high. Drug-related problems represent the fifth leading cause...... of death in the United States. The public expenses to drug treatment are constantly increasing. The possibility to withdraw the medication must be taken into account but the decision to discontinue drugs is complex and poorly understood. Planned studies: 1. Patients’ views upon discontinuation...... of preventive drugs. Qualitative interviews with patients experiencing discontinuation of preventive drugs addressing: Which attitudes do the patients have towards preventive drugs? Which thoughts do the patients have in relation to discontinuation of the drugs? How do they understand their own and the GP...

  20. An approach to vertigo in general practice.

    Science.gov (United States)

    Dommaraju, Sindhu; Perera, Eshini

    2016-04-01

    Dizziness is a common and very distressing presentation in general practice. In more than half of these cases, the dizziness is due to vertigo, which is the illusion of movement of the body or its surroundings. It can have central or peripheral causes, and determining the cause can be difficult. The aim of this article is to provide a clear framework for approaching patients who present with vertigo. A suggested approach to the assessment of vertigo is outlined. The causes of vertigo may be central (involving the brainstem or cerebellum) or peripheral (involving the inner ear). A careful history and physical examination can distinguish between these causes. The most common causes of vertigo seen in primary care are benign paroxysmal positional vertigo (BPPV), vestibular neuronitis (VN) and Ménière's disease. These peripheral causes of vertigo are benign, and treatment involves reassurance and management of symptoms.

  1. Rating scales in general practice depression

    DEFF Research Database (Denmark)

    Bech, Per; Paykel, Eugene; Sireling, Lester

    2015-01-01

    within major depressive disorder. The CID was compared to the Hamilton Depression Rating Scale (HAM-D17). METHODS: 146 patients from a previous study in general practice with the CID were investigated. The item response theory model established by Rasch was used to investigate the scalability (a scale......׳s psychometric adequacy) of the subscales, and principal component analysis was used to identify subsyndromes with the symptoms of major depression according to DSM-5 or ICD-10. RESULTS: Whereas the HAM-D17 was found not to have an acceptable scalability, the three brief CID subscales for depression (six items......), anxiety (five items), and apathy (five items) all had an acceptable scalability. Within the major depressive symptoms, principal component analysis identified the CID items of hypersomnia, increased appetite or weight gain as defining the subsyndrome of atypical depression. In total 29 patients...

  2. ‘A necessary evil that does not “really” cure disease’: The domestication of biomedicine by Dutch holistic general practitioners

    NARCIS (Netherlands)

    N.J. Raaphorst (Nadine); D. Houtman (Dick)

    2015-01-01

    textabstractAgainst the background of studies about the domestication of complementary and alternative medicine into biomedical settings, this article studies how biomedicine is integrated into holistic settings. Data from 19 in-depth interviews with Dutch holistic general practitioners who combine

  3. ‘A necessary evil that does not “really” cure disease’: The domestication of biomedicine by Dutch holistic general practitioners

    NARCIS (Netherlands)

    N.J. Raaphorst (Nadine); D. Houtman (Dick)

    2015-01-01

    textabstractAgainst the background of studies about the domestication of complementary and alternative medicine into biomedical settings, this article studies how biomedicine is integrated into holistic settings. Data from 19 in-depth interviews with Dutch holistic general practitioners who combine

  4. General linguistics and the study of Dutch. The case of C.F.P. Stutterheim (1903-1991)

    NARCIS (Netherlands)

    Noordegraaf, J.

    The mingling of linguistics and philosophy of language is characteristic of structuralism in the Netherlands. In this paper the case of the Dutch linguist C.F.P. Stutterheim (1903-1991), professor of Dutch language in the University of Leiden, is used to examine the extent to which this alliance

  5. General linguistics and the study of Dutch. The case of C.F.P. Stutterheim (1903-1991)

    NARCIS (Netherlands)

    Noordegraaf, J.

    The mingling of linguistics and philosophy of language is characteristic of structuralism in the Netherlands. In this paper the case of the Dutch linguist C.F.P. Stutterheim (1903-1991), professor of Dutch language in the University of Leiden, is used to examine the extent to which this alliance bet

  6. Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations.

    NARCIS (Netherlands)

    Dillen, S.M.E. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.

    2014-01-01

    Background/Objective: To examine the content of Dutch practice nurses’ (PNs’) advices about weight, nutrition and physical activity to overweight and obese patients. Subjects/Methods: A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were sele

  7. Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations

    NARCIS (Netherlands)

    Dillen, S.M. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.

    2014-01-01

    BACKGROUND/OBJECTIVE: To examine the content of Dutch practice nurses' (PNs') advices about weight, nutrition and physical activity to overweight and obese patients. SUBJECTS/METHODS: A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were

  8. Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations.

    NARCIS (Netherlands)

    Dillen, S.M.E. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.

    2014-01-01

    Background/Objective: To examine the content of Dutch practice nurses’ (PNs’) advices about weight, nutrition and physical activity to overweight and obese patients. Subjects/Methods: A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were

  9. Differences in treatment approach between Dutch paediatric dentists and general practitioners, a case control study

    NARCIS (Netherlands)

    Kuin, D.; Veerkamp, J.S.J.

    2012-01-01

    AIM: This case control study was to assess whether paediatric dentists perform significantly more diagnostic, preventive and curative care in a clinical setting then do general dental practitioners. METHODS: 16 paediatric dentists were approached and a matching control group of 16 general dental pra

  10. Hybrid practices as a means to implement quality improvement: A comparative qualitative study in a Dutch and Swedish hospital.

    Science.gov (United States)

    Quartz-Topp, Julia; Sanne, Johan M; Pöstges, Heide

    2016-11-15

    Managers and scholars commonly perceive resistance from professionals as hampering the implementation of quality improvement (QI) and refer to the incompatibility of clinical and managerial approaches to QI as a reason. Yet a growing body of research indicates that, in practice, these two approaches rather blend into hybrid practices that embody different types of QI-related knowledge and values. This opens up a new perspective on implementation challenges that moves attention away from resistance against managerial QI toward difficulties for clinicians to draw together different types of knowledge and values within their clinical work. So far, little is known about how managers can support clinicians to generate hybrid QI practices. The aim of this study was to deepen our understanding of how managers can support the generation of hybrid practices that help clinicians to integrate QI into their everyday work. We draw on comparative qualitative research including 21 semistructured interviews, documentary analysis, and participant observation that we conducted in one Dutch and one Swedish hospital over a period of 8 months in 2011/2012. Hospital managers designed hybrid forums, tools, and professional roles in order to facilitate the integration of different QI practices, knowledge, and values. This integration generated new hybrid practices and an infrastructure for QI that has potential to support clinicians in their efforts to align different demands. New opportunities to implement QI emerge when we change the implementation problem from clinical resistance to the need of support for clinicians to develop hybrid QI practices. Hospital managers then have to intentionally organize for the generation of hybrid practices by designing, for example, hybrid forums, tools, and professional roles that integrate different knowledge and values in a nonhierarchical way.

  11. The influence of population characteristics on variation in general practice based morbidity estimations

    Directory of Open Access Journals (Sweden)

    van den Dungen C

    2011-11-01

    Full Text Available Abstract Background General practice based registration networks (GPRNs provide information on morbidity rates in the population. Morbidity rate estimates from different GPRNs, however, reveal considerable, unexplained differences. We studied the range and variation in morbidity estimates, as well as the extent to which the differences in morbidity rates between general practices and networks change if socio-demographic characteristics of the listed patient populations are taken into account. Methods The variation in incidence and prevalence rates of thirteen diseases among six Dutch GPRNs and the influence of age, gender, socio economic status (SES, urbanization level, and ethnicity are analyzed using multilevel logistic regression analysis. Results are expressed in median odds ratios (MOR. Results We observed large differences in morbidity rate estimates both on the level of general practices as on the level of networks. The differences in SES, urbanization level and ethnicity distribution among the networks' practice populations are substantial. The variation in morbidity rate estimates among networks did not decrease after adjusting for these socio-demographic characteristics. Conclusion Socio-demographic characteristics of populations do not explain the differences in morbidity estimations among GPRNs.

  12. Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations.

    Science.gov (United States)

    van Dillen, S M E; Noordman, J; van Dulmen, S; Hiddink, G J

    2014-01-01

    To examine the content of Dutch practice nurses' (PNs') advices about weight, nutrition and physical activity to overweight and obese patients. A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were selected. An observational checklist was developed to assess frequency and content. Personalization of advices was scored, as also the guidelines on which PNs based their advices. Content analysis was used to identify different categories of advices. About one quarter of advices concerned weight, over two-thirds nutrition and one-third physical activity. Lose weight, eat less fat and be more physically active in general were the main categories for each type of advice. Despite high clarity of advices, lower scores were found for specificity and personalization. Very few nutrition advices were provided in combination with physical activity advices. Weight advices often related to the patient's complaint. PNs seldom set a concrete weight goal. Although benefits of physical activity were discussed, often no practical advices were provided about how to achieve this. Integrated lifestyle advice was not common: advices about nutrition and physical activity were fragmented throughout the consultation. Obesity prevention needs more emphasis in PNs' educational programs.

  13. Two decades of external peer review of cancer care in general hospitals; the Dutch experience

    NARCIS (Netherlands)

    Kilsdonk, M.J.; Siesling, S.; Otter, R.; Harten, van W.H.

    2015-01-01

    External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews we

  14. Professional autonomy - is it the future of general practice?

    Science.gov (United States)

    Fraser, John

    2006-05-01

    Internationally, rising financial costs and increasing expectations of health care delivery have increased regulation and decreased the autonomy of general practitioners and other health care professionals. This article explores professional autonomy within Australian general practice, and outlines the importance of autonomy in systems approaches to organisational change in general practice.

  15. Diarrhoea in general practice: when should a Clostridium difficile infection be considered? Results of a nested case-control study.

    Science.gov (United States)

    Hensgens, M P M; Dekkers, O M; Demeulemeester, A; Buiting, A G M; Bloembergen, P; van Benthem, B H B; Le Cessie, S; Kuijper, E J

    2014-12-01

    Clostridium difficile infections (CDIs) are frequent in hospitals, but also seem to increase in the community. Here, we aim to determine the incidence of CDI in general practice and to evaluate current testing algorithms for CDI. Three Dutch laboratories tested all unformed faeces (12,714) for C. difficile when diagnostic testing (for any enteric pathogen) was requested by a general practitioner (GP). Additionally, a nested case-control study was initiated, including 152 CDI patients and 304 age and sex-matched controls. Patients were compared using weighted multivariable logistic regression. One hundred and ninety-four samples (1.5%) were positive for C. difficile (incidence 0.67/10,000 patient years). This incidence was comparable to that of Salmonella spp. Compared with diarrhoeal controls, CDI was associated with more severe complaints, underlying diseases, antibiotic use and prior hospitalization. In our study, GPs requested a test for C. difficile in 7% of the stool samples, thereby detecting 40% of all CDIs. Dutch national recommendations advise testing for C. difficile when prior antibiotic use or hospitalization is present (18% of samples). If these recommendations were followed, 61% of all CDIs would have been detected. In conclusion, C. difficile is relatively frequent in general practice. Currently, testing for C. difficile is rare and only 40% of CDI in general practice is detected. Following recommendations that are based on traditional risk factors for CDI, would improve detection of CDI.

  16. Adapting the SLIM diabetes prevention intervention to a Dutch real-life setting: joint decision making by science and practice.

    Science.gov (United States)

    Jansen, Sophia C; Haveman-Nies, Annemien; Duijzer, Geerke; Ter Beek, Josien; Hiddink, Gerrit J; Feskens, Edith J M

    2013-05-08

    Although many evidence-based diabetes prevention interventions exist, they are not easily applicable in real-life settings. Moreover, there is a lack of examples which describe the adaptation process of these interventions to practice. In this paper we present an example of such an adaptation. We adapted the SLIM (Study on Lifestyle intervention and Impaired glucose tolerance Maastricht) diabetes prevention intervention to a Dutch real-life setting, in a joint decision making process of intervention developers and local health care professionals. We used 3 adaptation steps in accordance with current adaptation frameworks. In the first step, the elements of the SLIM intervention were identified. In the second step, these elements were judged for their applicability in a real-life setting. In the third step, adaptations were proposed and discussed for those elements which were deemed not applicable. Participants invited for this process included intervention developers and local health care professionals (n=19). In the first adaptation step, a total of 22 intervention elements were identified. In the second step, 12 of these 22 intervention elements were judged as inapplicable. In the third step, a consensus was achieved for the adaptations of all 12 elements. The adapted elements were in the following categories: target population, techniques, intensity, delivery mode, materials, organisational structure, and political and financial conditions. The adaptations either lay in changing the SLIM protocol (6 elements) or the real-life working procedures (1 element), or a combination of both (4 elements). The positive result of this study is that a consensus was achieved within a relatively short time period (nine months) between the developers of the SLIM intervention and local health care professionals on the adaptations needed to make SLIM applicable in a Dutch real-life setting. Our example shows that it is possible to combine the perspectives of scientists and

  17. Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

    Directory of Open Access Journals (Sweden)

    Geense Wytske W

    2013-02-01

    Full Text Available Abstract Background The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based health promotion activities conducted by Dutch general practitioners (GPs and practice nurses (PNs are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder

  18. Dutch audiology.

    Science.gov (United States)

    Grobben, L M; van Ligtenberg, C L

    1977-01-01

    In the Netherlands audiological care is given at different stages. An attempt is made to screen the hearing of all Dutch babies between the ages of 8 and 12 months. At the age of 4 or over, general audiological care is given by the school medical service; referral is first to a family doctor, who may refer to an otolaryngologist. Curative medical care (examination and therapy) is the province of the family doctor and the otolaryngologist. Otolaryngologists and pediatricians can refer patients to one of 19 Audiological Centers distributed around the country, where a number of workers in different disciplines cooperate for habilitation and rehabilitation. These may include an otolaryngologist in charge, a psychologist, a speech and hearing therapist, an audiologist (usually a physicist or university-trained engineer), social worker, technician, ortho-pedagogue, audiology assistant, and teacher. There are at the moment 25 schools for the hard of hearing and 5 institutes for the deaf. These are often found in conjunction with Audiological Centers, the latter providing paramedical assistance to the pupils by agreement. Finally, the Dutch Organization for Preventive Medicine works to prevent hearing loss in noisy industries.

  19. Effectiveness of empathy in general practice: a systematic review

    OpenAIRE

    Derksen, F.; BENSING, J; Lagro-Janssen, A

    2013-01-01

    Background: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. This literature review explores the effectiveness of empathy in general practice. Effects that are discussed are: patient satisfaction and adherence, feelings of anxiety and stress, patient enablemen...

  20. Laser therapy in general dental practice

    Science.gov (United States)

    Darbar, Arun A.

    2006-02-01

    This is a clinical presentation on the use of laser therapy in a private dental practice using a 810nm diode. A wide range of conditions involving pain management, treatment and as an adjunct to procedures to enhance patient comfort and experience. This will include cases treated for TMD (Temporo mandibular dysfunction), apthous ulcers, angular chelitis, cold sores, gingival retraction, periodontal treatment and management of failing dental implants. The case presentation will include the protocols used and some long term reviews. The results have been very positive and will be shared to enable this form of treatment to be used more frequently and with confidence within dental practice.

  1. The existential dimension in general practice

    DEFF Research Database (Denmark)

    Assing Hvidt, Elisabeth; Søndergaard, Jens; Ammentorp, Jette

    2016-01-01

    . As a way to enhance a practice culture in which GPs pay more explicit attention to the patients’ multidimensional concerns, opportunities for professional development could be offered (courses or seminars) that focus on mutual sharing of existential reflections, ideas and communication competencies. Key...

  2. Objectives for an internship internal medicine : from the Dutch Blueprint (Raamplan 1994) to implementation into a practical logbook

    NARCIS (Netherlands)

    Raghoebar-Krieger, HMJ; Sleijfer, DT; Kreeftenberg, HG; Hofstee, WKB; Bender, W

    1999-01-01

    Background: The Dutch Blueprint 1994 (Raamplan 1994) describes the objectives of undergraduate medical education. The Blueprint, developed in order to improve medical education in the Netherlands, is accepted by all Dutch medical schools and has been legislated Aim: Translation of global objectives

  3. General dentist orthodontic practice in foreign legal systems

    Directory of Open Access Journals (Sweden)

    Ivan Toshio Maruo

    2012-04-01

    Full Text Available OBJECTIVE: General dentist orthodontic practice is a controversial issue and this paper aims to analyze it comparing foreign laws to Brazilian Legal System. METHODS: Regulations and scientific texts concerning orthodontic practice by general dentists, in Portuguese or English language, were sought. RESULTS AND CONCLUSION: Portugal clearly forbids general dentist orthodontic practice; United States of America do not clearly forbid general dentist orthodontic practice, but do regulate and promote campaigns to encourage public to seek specialist service; in Australia and England, corrective orthodontics are offered both by orthodontists and general dentists; it was not possible to evaluate how orthodontic services are provided in Eastern Europe; and the fact that general dentists are forbidden to practice corrective orthodontics in Brazilian Legal System is compatible to other countries policy.

  4. Clinical guidelines: their implementation in general practice.

    OpenAIRE

    M Conroy; Shannon, W

    1995-01-01

    In recent years the development of clinical guidelines has received increasing attention from medical educators and those involved in standard setting, and has been initiated at both central and local levels. This review article outlines the current state of knowledge with regard to clinical guideline implementation in medical practice. It deals with the main aspects of the current guideline debate, such as, clinical freedom and doctor autonomy, the importance of ownership in guideline implem...

  5. Profiling healthy eaters: determining factors that predict healthy eating practices among Dutch adults

    NARCIS (Netherlands)

    Swan, E.; Bouwman, L.; Hiddink, G.J.; Aarts, N.; Koelen, M.

    2015-01-01

    Research has identified multiple factors that predict unhealthy eating practices. However what remains poorly understood are factors that promote healthy eating practices. This study aimed to determine a set of factors that represent a profile of healthy eaters. This research applied Antonovsky's

  6. Profiling healthy eaters. Determining factors that predict healthy eating practices among Dutch adults

    NARCIS (Netherlands)

    Swan, E.C.; Bouwman, L.I.; Hiddink, G.J.; Aarts, N.; Koelen, M.

    2015-01-01

    Research has identified multiple factors that predict unhealthy eating practices. However what remains poorly understood are factors that promote healthy eating practices. This study aimed to determine a set of factors that represent a profile of healthy eaters. This research applied Antonovsky's

  7. Dealing with uncertainty in general practice: an essential skill for the general practitioner

    NARCIS (Netherlands)

    O'Riordan, M.; Dahinden, A.; Akturk, Z.; Ortiz, J.M.; Dagdeviren, N.; Elwyn, G.; Micallef, A.; Murtonen, M.; Samuelson, M.; Struk, P.; Tayar, D.; Thesen, J.

    2011-01-01

    Many patients attending general practice do not have an obvious diagnosis at presentation. Skills to deal with uncertainty are particularly important in general practice as undifferentiated and unorganised problems are a common challenge for general practitioners (GPs). This paper describes the mana

  8. Improvisational Practices in Elementary General Music Classrooms

    Science.gov (United States)

    Gruenhagen, Lisa M.; Whitcomb, Rachel

    2014-01-01

    Despite historic and ongoing support for the inclusion of improvisation in the elementary general music curriculum, music educators consistently report challenges with implementation of improvisational activities in their classes. This study was designed to examine (a) the extent to which improvisational activities were occurring in the…

  9. Accuracy and precision of desktop spirometers in general practices.

    NARCIS (Netherlands)

    Schermer, T.R.J.; Verweij, E.H.; Cretier, R.; Pellegrino, J.E.M.C.; Crockett, A.J.; Poels, P.J.E.

    2012-01-01

    BACKGROUND: Spirometry has become an essential tool for general practices to diagnose and monitor chronic airways diseases, but very little is known about the performance of the spirometry equipment that is being used in general practice settings. The use of invalid spirometry equipment may have con

  10. Effectiveness of empathy in general practice: a systematic review

    NARCIS (Netherlands)

    Derksen, F.; Bensing, J.; Lagro-Janssen, A.

    2013-01-01

    BACKGROUND: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. Th

  11. Effectiveness of empathy in general practice: a systematic review.

    NARCIS (Netherlands)

    Derksen, F.; Bensing, J.; Lagro-Janssen, A.

    2013-01-01

    Background: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. Th

  12. [Euthanasia and general practice in Belgium].

    Science.gov (United States)

    Thomas, J M

    2014-09-01

    In Belgium, the GP can perform euthanasia or be called as a consultant. He must know the laws concerning the end of life and be able to explain his rights to his patients. He will know the best practices and techniques for euthanasia. If necessary, he will call help or refer to a more competent colleague. He negotiates with the patient an advanced care planning following the evolution of its pathologies and will witness its wishes regarding end of life against other institutions and doctors.

  13. Networked practices of intangible urban heritage: the changing public role of Dutch heritage professionals

    NARCIS (Netherlands)

    A.J.C. van der Hoeven (Arno)

    2016-01-01

    textabstractThis study examines the changing roles of heritage professionals by focusing on the participatory practices of intangible urban heritage. Developments towards democratisation in the heritage sector led to a growing expectation that heritage profe

  14. Computerisation of general practice in the Republic of Croatia: experience gained in general practice use.

    Science.gov (United States)

    Bergman-Marković, Biserka; Katić, Milica; Kern, Josipa

    2007-01-01

    Well-organised medical records are the prerequisite for achieving a high level of performance in primary healthcare settings. Recording balanced structured and coded data as well as free text can improve both quality and organisation of work in the office. It provides a more substantiated support of financial transactions and accountancy, allows better communication with other facilities and institutions, and is a source of valuable scientific research material. This article is the result of an individual experience gained in general practice use of various programs/systems employed within the family medicine frame, and the frame of evaluation of available and commonly-exploited program solutions. The use of various programs allows for systematic adjustments as to the increasingly complex requirements imposed on electronic medical records (EMRs). The experience of a general practitioner, presented in this paper, confirms the assumption that an adequate program to be employed with EMRs should be developed, provided that family medicine practitioners, that is, the final users, have been involved in each and every stage of its development, adjustment, implementation and evaluation.

  15. Computerisation of general practice in the Republic of Croatia: experience gained in general practice use

    Directory of Open Access Journals (Sweden)

    Biserka Bergman-Markovi_

    2007-09-01

    Full Text Available Well-organised medical records are the prerequisite for achieving a high level of performance in primary healthcare settings. Recording balanced structured and coded data as well as free text can improve both quality and organisation of work in the office. It provides a more substantiated support of financial transactions and accountancy, allows better communication with other facilities and institutions, and is a source of valuable scientific research material. This article is the result of an individual experience gained in general practice use of various programs/ systems employed within the family medicine frame, and the frame of evaluation of available and commonly- exploited program solutions. The use of various programs allows for systematic adjustments as to the increasingly complex requirements imposed on electronic medical records (EMRs. The experience of a general practitioner, presented in this paper, confirms the assumption that an adequate program to be employed with EMRs should be developed, provided that family medicine practitioners, that is, the final users, have been involved in each and every stage of its development, adjustment, implementation and evaluation.

  16. Improving the safety features of general practice computer systems

    OpenAIRE

    Anthony Avery; Boki Savelyich; Sheila Teasdale

    2003-01-01

    General practice computer systems already have a number of important safety features. However, there are problems in that general practitioners (GPs) have come to rely on hazard alerts when they are not foolproof. Furthermore, GPs do not know how to make best use of safety features on their systems. There are a number of solutions that could help to improve the safety features of general practice computer systems and also help to improve the abilities of healthcare professionals to use these ...

  17. Prevalence of alcohol problems in general practice

    DEFF Research Database (Denmark)

    Rambaldi, A; Todisco, N; Gluud, C

    1996-01-01

    The Michigan Alcoholism Screening Test (MAST) and the response to a question about heavy alcohol consumption were used to assess the prevalence of alcohol problems in consecutive patients (77 males and 46 females) consulting a general practitioner in an urban area in the South of Italy (Castellam...... as a screening question in order to detect alcohol problems and give advice regarding reduction of alcohol consumption.......The Michigan Alcoholism Screening Test (MAST) and the response to a question about heavy alcohol consumption were used to assess the prevalence of alcohol problems in consecutive patients (77 males and 46 females) consulting a general practitioner in an urban area in the South of Italy...... (Castellammare di Stabia). Alcohol problems, which were defined by a cut-off score of 5 on the MAST and/or by heavy alcohol consumption (corresponding to at least 60 g of ethanol daily for males and 36 g of ethanol daily for females for at least 2 years), were identified in 54 patients [43.9%; 95% confidence...

  18. Quality of life in rehabilitation outpatients : normal values and a comparison with the general Dutch population and psychiatric patients

    NARCIS (Netherlands)

    Schrier, Ernst; Schrier, Irene; Geertzen, Jan H. B.; Dijkstra, Pieter U.

    2016-01-01

    To provide Dutch normal values for rehabilitation outpatients with chronic pain or musculoskeletal diseases utilizing the World Health Organization Quality of Life questionnaire abbreviated version (WHOQOL-BREF) and analyse influence of diagnosis and patient characteristics on normal values and incr

  19. Opinions about euthanasia and advanced dementia : a qualitative study among Dutch physicians and members of the general public

    NARCIS (Netherlands)

    Kouwenhoven, Pauline S. C.; Raijmakers, Natasja J. H.; van Delden, Johannes J. M.; Rietjens, Judith A. C.; van Tol, Donald G.; van de Vathorst, Suzanne; de Graeff, Nienke; Weyers, Heleen A. M.; van der Heide, Agnes; van Thiel, Ghislaine J. M. W.

    2015-01-01

    Background: The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing op

  20. Opinions about euthanasia and advanced dementia : a qualitative study among Dutch physicians and members of the general public

    NARCIS (Netherlands)

    Kouwenhoven, Pauline S C|info:eu-repo/dai/nl/34166698X; Raijmakers, Natasja J H; van Delden, Johannes J M|info:eu-repo/dai/nl/086541331; Rietjens, Judith A C; van Tol, Donald G; van de Vathorst, Suzanne; de Graeff, Nienke; Weyers, Heleen A M; van der Heide, Agnes; van Thiel, Ghislaine J M W|info:eu-repo/dai/nl/150583265

    2015-01-01

    BACKGROUND: The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing op

  1. Opinions about euthanasia and advanced dementia: A qualitative study among Dutch physicians and members of the general public

    NARCIS (Netherlands)

    P.S.C. Kouwenhoven (Pauline); N.J.H. Raijmakers (Natasja); J.J.M. van Delden (Johannes); J.A.C. Rietjens (Judith); D. van Tol (Donald); S. van de Vathorst (Suzanne); N. de Graeff (Nienke); H.A.M. Weyers (Heleen); A. van der Heide (Agnes); G.J.M.W. van Thiel (Ghislaine)

    2015-01-01

    textabstractBackground: The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the

  2. Spreading the word of the concept 'inherent safety' in a general industrial setting in the Dutch province of Zeeland

    NARCIS (Netherlands)

    Jongen, M.J.M.; Dijkman, A.; Zwanikken, S.; Zwetsloot, G.I.J.M.; Gort, J.

    2007-01-01

    Recent accidents in The Netherlands in different kinds of industries, like fire works storage, catering and energy industry, triggered the Dutch government to start a national program to enhance the enforcement of industrial safety at the regional and municipal level. Stimulated by this program the

  3. Opinions about euthanasia and advanced dementia : a qualitative study among Dutch physicians and members of the general public

    NARCIS (Netherlands)

    Kouwenhoven, Pauline S C; Raijmakers, Natasja J H; van Delden, Johannes J M; Rietjens, Judith A C; van Tol, Donald G; van de Vathorst, Suzanne; de Graeff, Nienke; Weyers, Heleen A M; van der Heide, Agnes; van Thiel, Ghislaine J M W

    2015-01-01

    BACKGROUND: The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing op

  4. Spreading the word of the concept 'inherent safety' in a general industrial setting in the Dutch province of Zeeland

    NARCIS (Netherlands)

    Jongen, M.J.M.; Dijkman, A.; Zwanikken, S.; Zwetsloot, G.I.J.M.; Gort, J.

    2007-01-01

    Recent accidents in The Netherlands in different kinds of industries, like fire works storage, catering and energy industry, triggered the Dutch government to start a national program to enhance the enforcement of industrial safety at the regional and municipal level. Stimulated by this program the

  5. [General practice--linear thinking and complexity].

    Science.gov (United States)

    Stalder, H

    2006-09-27

    As physicians, we apply and teach linear thinking. This approach permits to dissect the patient's problem to the molecular level and has contributed enormously to the knowledge and progress of medicine. The linear approach is particularly useful in medical education, in quantitative research and helps to resolve simple problems. However, it risks to be rigid. Living beings (such as patients and physicians!) have to be considered as complex systems. A complex system cannot be dissected into its parts without losing its identity. It is dependent on its past and interactions with the outside are often followed by unpredictable reactions. The patient-centred approach in medicine permits the physician, a complex system himself, to integrate the patient's system and to adapt to his reality. It is particularly useful in general medicine.

  6. General practice and primary health care in Denmark

    DEFF Research Database (Denmark)

    Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergård, Jens

    2012-01-01

    General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized...... education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges....... Practice units are fairly small: close to 2 GPs per unit plus nurses and secretaries. The units are fully computerized, that is, with computer-based patient records and submission of prescriptions digitally to pharmacies etc. Over the past few years a decrease in solo practices has been seen...

  7. Determinants of the range of drugs prescribed in general practice: a cross-sectional analysis

    Directory of Open Access Journals (Sweden)

    van Dijk Liset

    2007-08-01

    Full Text Available Abstract Background Current health policies assume that prescribing is more efficient and rational when general practitioners (GPs work with a formulary or restricted drugs lists and thus with a limited range of drugs. Therefore we studied determinants of the range of drugs prescribed by general practitioners, distinguishing general GP-characteristics, characteristics of the practice setting, characteristics of the patient population and information sources used by GPs. Methods Secondary analysis was carried out on data from the Second Dutch Survey in General Practice. Data were available for 138 GPs working in 93 practices. ATC-coded prescription data from electronic medical records, census data and data from GP/practice questionnaires were analyzed with multilevel techniques. Results The average GP writes prescriptions for 233 different drugs, i.e. 30% of the available drugs on the market within one year. There is considerable variation between ATC main groups and subgroups and between GPs. GPs with larger patient lists, GPs with higher prescribing volumes and GPs who frequently receive representatives from the pharmaceutical industry have a broader range when controlled for other variables. Conclusion The range of drugs prescribed is a useful instrument for analysing GPs' prescribing behaviour. It shows both variation between GPs and between therapeutic groups. Statistically significant relationships found were in line with the hypotheses formulated, like the one concerning the influence of the industry. Further research should be done into the relationship between the range and quality of prescribing and the reasons why some GPs prescribe a greater number of different drugs than others.

  8. Epidemiology of unintentional injuries in childhood: a population-based survey in general practice

    Science.gov (United States)

    Otters, Hanneke; Schellevis, François G; Damen, Jurgen; van der Wouden, Johannes C; van Suijlekom-Smit, Lisette W A; Koes, Bart W

    2005-01-01

    This study aimed to assess the incidence of unintentional injuries presented in general practice, and to identify children at risk from experiencing an unintentional injury. We used the data of all 0–17-year-old children from a representative survey in 96 Dutch general practices in 2001. We computed incidence rates and multilevel multivariate regression analysis in different age strata and identified patient and family characteristics associated with an elevated injury risk. Nine thousand four hundred and eighty-four new injury episodes were identified from 105 353 new health problems presented in general practice, giving an overall incidence rate of 115 per 1000 person years (95% confidence interval [CI] = 113 to 118). Sex and residence in rural areas are strong predictors of injury in all age strata. Also, in children aged 0–4 years, a higher number of siblings is associated with elevated injury risk (≥3 siblings odds ratio [OR] = 1.57, 95% CI = 1.19 to 2.08) and in the 12–17-year-olds, ethnic background and socioeconomic class are associated with experiencing an injury (non-western children OR = 0.67, 95% CI = 0.54 to 0.81; low socioeconomic class OR = 1.39, 95% CI = 1.22 to 1.58). Unintentional injury is a significant health problem in children in general practice, accounting for 9% of all new health problems in children. In all age groups, boys in rural areas are especially at risk to experience an injury. PMID:16105373

  9. Going for gold: the health promoting general practice.

    Science.gov (United States)

    Watson, Michael

    2008-01-01

    The World Health Organization's Ottawa Charter for Health Promotion has been influential in guiding the development of 'settings' based health promotion. Over the past decade, settings such as schools have flourished and there has been a considerable amount of academic literature produced, including theoretical papers, descriptive studies and evaluations. However, despite its central importance, the health-promoting general practice has received little attention. This paper discusses: the significance of this setting for health promotion; how a health promoting general practice can be created; effective health promotion approaches; the nursing contribution; and some challenges that need to be resolved. In order to become a health promoting general practice, the staff must undertake a commitment to fulfil the following conditions: create a healthy working environment; integrate health promotion into practice activities; and establish alliances with other relevant institutions and groups within the community. The health promoting general practice is the gold standard for health promotion. Settings that have developed have had the support of local, national and European networks. Similar assistance and advocacy will be needed in general practice. This paper recommends that a series of rigorously evaluated, high-quality pilot sites need to be established to identify and address potential difficulties, and to ensure that this innovative approach yields tangible health benefits for local communities. It also suggests that government support is critical to the future development of health promoting general practices. This will be needed both directly and in relation to the capacity and resourcing of public health in general.

  10. Diagnostic labelling as determinant of antibiotic prescribing for acute respiratory tract episodes in general practice

    Science.gov (United States)

    van Duijn, Huug J; Kuyvenhoven, Marijke M; Tiebosch, Hanneke M; Schellevis, François G; Verheij, Theo JM

    2007-01-01

    Background Next to other GP characteristics, diagnostic labelling (the proportion of acute respiratory tract (RT) episodes to be labelled as infections) probably contributes to a higher volume of antibiotic prescriptions for acute RT episodes. However, it is unknown whether there is an independent association between diagnostic labelling and the volume of prescribed antibiotics, or whether diagnostic labelling is associated with the number of presented acute RT episodes and consequently with the number of antibiotics prescribed per patient per year. Methods Data were used from the Second Dutch National Survey of General Practice (DNSGP-2) with 163 GPs from 85 Dutch practices, serving a population of 359,625 patients. Data over a 12 month period were analysed by means of multiple linear regression analysis. Main outcome measure was the volume of antibiotic prescriptions for acute RT episodes per 1,000 patients. Results The incidence was 236.9 acute RT episodes/1,000 patients. GPs labelled about 70% of acute RT episodes as infections, and antibiotics were prescribed in 41% of all acute RT episodes. A higher incidence of acute RT episodes (beta 0.67), a stronger inclination to label episodes as infections (beta 0.24), a stronger endorsement of the need of antibiotics in case of white spots in the throat (beta 0.11) and being male (beta 0.11) were independent determinants of the prescribed volume of antibiotics for acute RT episodes, whereas diagnostic labelling was not correlated with the incidence of acute RT episodes. Conclusion Diagnostic labelling is a relevant factor in GPs' antibiotic prescribing independent from the incidence of acute RT episodes. Therefore, quality assurance programs and postgraduate courses should emphasise to use evidence based prognostic criteria (e.g. chronic respiratory co-morbidity and old age) as an indication to prescribe antibiotics in stead of single inflammation signs or diagnostic labels. PMID:17883832

  11. Diagnostic labelling as determinant of antibiotic prescribing for acute respiratory tract episodes in general practice

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2007-09-01

    Full Text Available Abstract Background Next to other GP characteristics, diagnostic labelling (the proportion of acute respiratory tract (RT episodes to be labelled as infections probably contributes to a higher volume of antibiotic prescriptions for acute RT episodes. However, it is unknown whether there is an independent association between diagnostic labelling and the volume of prescribed antibiotics, or whether diagnostic labelling is associated with the number of presented acute RT episodes and consequently with the number of antibiotics prescribed per patient per year. Methods Data were used from the Second Dutch National Survey of General Practice (DNSGP-2 with 163 GPs from 85 Dutch practices, serving a population of 359,625 patients. Data over a 12 month period were analysed by means of multiple linear regression analysis. Main outcome measure was the volume of antibiotic prescriptions for acute RT episodes per 1,000 patients. Results The incidence was 236.9 acute RT episodes/1,000 patients. GPs labelled about 70% of acute RT episodes as infections, and antibiotics were prescribed in 41% of all acute RT episodes. A higher incidence of acute RT episodes (beta 0.67, a stronger inclination to label episodes as infections (beta 0.24, a stronger endorsement of the need of antibiotics in case of white spots in the throat (beta 0.11 and being male (beta 0.11 were independent determinants of the prescribed volume of antibiotics for acute RT episodes, whereas diagnostic labelling was not correlated with the incidence of acute RT episodes. Conclusion Diagnostic labelling is a relevant factor in GPs' antibiotic prescribing independent from the incidence of acute RT episodes. Therefore, quality assurance programs and postgraduate courses should emphasise to use evidence based prognostic criteria (e.g. chronic respiratory co-morbidity and old age as an indication to prescribe antibiotics in stead of single inflammation signs or diagnostic labels.

  12. Chlamydia trachomatis infection during pregnancy: knowledge, test practices, and attitudes of Dutch midwives.

    NARCIS (Netherlands)

    Pereboom, M.T.R.; Manniën, J.; Rours, G.I.J.G.; Spelten, E.R.; Hutton, E.K.; Schellevis, F.G.

    2014-01-01

    Background: Chlamydia trachomatis infection in pregnancy may lead to adverse pregnancy outcomes. In the Netherlands, testing for C. trachomatis is based on risk assessment. We assessed midwives' knowledge, test practices, assessment of risk behavior, and attitudes regarding testing for C. trachomati

  13. Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study.

    NARCIS (Netherlands)

    Asselt, D.Z.B. van; Bokhorst-de van der Schueren, M.A. van; Cammen, T.J.M. van der; Disselhorst, L.G.; Janse, A.; Lonterman-Monasch, S.; Maas, H.A.; Popescu, M.E.; Schölzel-Dorenbos, C.J.M.; Sipers, W.M.; Veldhoven, C.M. van; Wijnen, H.H.M; Olde Rikkert, M.

    2012-01-01

    OBJECTIVE: scientific evidence regarding the optimal management of malnutrition in geriatric patients is scarce. Our aim was to develop a consensus statement for geriatric hospital practice concerning six elements: (i) definition of malnutrition, (ii) screening and assessment, (iii) treatment and mo

  14. Alcohol-Specific Socialization Practices and Alcohol Use in Dutch Early Adolescents

    Science.gov (United States)

    Koning, Ina M.; Engels, Rutger C. M. E.; Verdurmen, Jacqueline E. E.; Vollebergh, Wilma A. M.

    2010-01-01

    The present study examined the associations of alcohol-specific socialization practices and heavy parental drinking with alcohol use in early adolescents. Cross-sectional nationwide survey data from 2599 parent-adolescent (mean age = 12.16) dyads were used to conduct logistic regression analyses. Onset of alcohol use as well as infrequent and…

  15. High performance work practices in the health care sector: A dutch case study

    NARCIS (Netherlands)

    Boselie, J.P.P.E.F.

    2010-01-01

    Purpose – This paper aims to present an empirical study of the effect of high performance work practices on commitment and citizenship behaviour in the health care sector. The theory suggests that individual employees are willing “to go the extra mile” when they are given the opportunity to develop

  16. Beyond size : Predicting engagement in environmental management practices of Dutch SMEs

    NARCIS (Netherlands)

    Uhlaner, L.M.; Berent-Braun, M.M.; Jeurissen, R.J.M.; Wit, de G.

    2012-01-01

    This study focuses on the prediction of the engagement of small- and medium-sized enterprises (SMEs) in environmental management practices, based on a random sample of 689 SMEs. The study finds that several endogenous factors, including tangibility of sector, firm size, innovative orientation, famil

  17. The epidemiology of teaching and training General Practices in England.

    Science.gov (United States)

    Rees, Eliot L; Gay, Simon P; McKinley, Robert K

    2016-11-01

    There is no national picture of teaching and training practices or the communities they serve. We aimed to describe the association between general practices' engagement with education and their characteristics, locality and patients' health-status and satisfaction. This data linkage study of all English practices calculated odds ratios for teaching and training status and practice, locality and patient variables. Teaching and training practices are larger than practices which do neither (mean list size (SD) 7074 (3736), 10112 (4934), and 5327 (3368) respectively, p quality and outcomes framework scores (0.507 (0.211, 0.804)) and (0.996 (0.650, 1.342)) respectively than those which did not. Educationally engaged practices are unrepresentative in serving less ethnically diverse and (for training practices) less urban environments. Investment is needed to increase the proportion of educational practices in diverse urban localities.

  18. A concept for a decision support system based on practical experiences from a national disease emergency. The Dutch experience.

    Science.gov (United States)

    Crauwels, A P; de Koning, R; Nielen, M; Elbers, A R; Dijkhuizen, A A; Tielen, M J

    2001-01-01

    In 1997-1998, the Netherlands experienced a large epidemic of classical swine fever (CSF). The magnitude of this epidemic stressed the role information systems could play in supporting the management during an eradication campaign. The enforcement of an eradication strategy can become very complicated, especially with large epidemics, due to time pressure and many different procedures that have to be executed at the same time. The application of comprehensive information systems may result in more control over the process and in a relief of the operational management. After a brief description of the Dutch epidemic the authors provide an overview and the general application of four different types of information systems, classified as decision support systems. The application of these information systems in animal disease control is illustrated by providing concepts for a system architecture for transaction processing, management and executive information support and decision support. The application of a data warehouse as part of this systems architecture is explained. The eradication of CSF from the Netherlands was complicated by several factors. It is important to notice that information systems cannot prevent these factors. However, information systems can support disease control authorities in controlling these factors.

  19. A Concept for a Decision Support System Based on Practical Experiences from a National Disease Emergency The Dutch Experience

    Directory of Open Access Journals (Sweden)

    Dijkhuizen AA

    2001-03-01

    Full Text Available In 1997–1998, the Netherlands experienced a large epidemic of classical swine fever (CSF. The magnitude of this epidemic stressed the role information systems could play in supporting the management during an eradication campaign. The enforcement of an eradication strategy can become very complicated, especially with large epidemics, due to time pressure and many different procedures that have to be executed at the same time. The application of comprehensive information systems may result in more control over the process and in a relief of the operational management. After a brief description of the Dutch epidemic the authors provide an overview and the general application of four different types of information systems, classified as decision support systems. The application of these information systems in animal disease control is illustrated by providing concepts for a system architecture for transaction processing, management and executive information support and decision support. The application of a data warehouse as part of this systems architecture is explained. The eradication of CSF from the Netherlands was complicated by several factors. It is important to notice that information systems cannot prevent these factors. However, information systems can support disease control authorities in controlling these factors.

  20. Unravelling the concept of integrated public health policy: Concept mapping with Dutch experts from science, policy, and practice.

    Science.gov (United States)

    Tubbing, Luuk; Harting, Janneke; Stronks, Karien

    2015-06-01

    While expectations of integrated public health policy (IPHP) promoting public health are high, assessment is hampered by the concept's ambiguity. This paper aims to contribute to conceptual clarification of IPHP as first step in further measurement development. In an online concept mapping procedure, we invited 237 Dutch experts, 62 of whom generated statements on characteristics of IPHP. Next, 100 experts were invited, 24 of whom sorted the statements into piles according to their perceived similarity and rated the statements on relevance and measurability. Data was analyzed using concept mapping software. The concept map consisted of 97 statements, grouped into 11 clusters and five themes. Core themes were 'integration', concerning 'policy coherence' and 'organizing connections', and 'health', concerning 'positioning health' and 'addressing determinants'. Peripheral themes were 'generic aspects', 'capacities', and 'goals and setting', which respectively addressed general notions of integrated policy making, conditions for IPHP, and the variety in manifestations of IPHP. Measurability ratings were low compared to relevance. The concept map gives an overview of interrelated themes, distinguishes core from peripheral dimensions, and provides pointers for theories of the policy process. While low measurability ratings indicate measurement difficulties, the core themes provide pointers for systematic insight into IPHP through measurement. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Colloquial Dutch.

    Science.gov (United States)

    Bloomfield, Leonard

    This course in colloquial Dutch was originally prepared for use by American Armed Forces personnel who needed to develop a working command of the spoken language in a short period of time. Thirty-one lessons, based on activities common to Dutch culture, are contained in the text. Each lesson provides three parallel columns of sentences: the…

  2. Colloquial Dutch.

    Science.gov (United States)

    Bloomfield, Leonard

    This course in colloquial Dutch was originally prepared for use by American Armed Forces personnel who needed to develop a working command of the spoken language in a short period of time. Thirty-one lessons, based on activities common to Dutch culture, are contained in the text. Each lesson provides three parallel columns of sentences: the…

  3. General practice ethnicity data: evaluation of a tool

    Directory of Open Access Journals (Sweden)

    Neuwelt P

    2014-03-01

    Full Text Available INTRODUCTION: There is evidence that the collection of ethnicity data in New Zealand primary care is variable and that data recording in practices does not always align with the procedures outlined in the Ethnicity Data Protocols for the Health and Disability Sector. In 2010, The Ministry of Health funded the development of a tool to audit the collection of ethnicity data in primary care. The aim of this study was to pilot the Ethnicity Data Audit Tool (EAT in general practice. The goal was to evaluate the tool and identify recommendations for its improvement. METHODS: Eight general practices in the Waitemata District Health Board region participated in the EAT pilot. Feedback about the pilot process was gathered by questionnaires and interviews, to gain an understanding of practices’ experiences in using the tool. Questionnaire and interview data were analysed using a simple analytical framework and a general inductive method. FINDINGS: General practice receptionists, practice managers and general practitioners participated in the pilot. Participants found the pilot process challenging but enlightening. The majority felt that the EAT was a useful quality improvement tool for handling patient ethnicity data. Larger practices were the most positive about the tool. CONCLUSION: The findings suggest that, with minor improvements to the toolkit, the EAT has the potential to lead to significant improvements in the quality of ethnicity data collection and recording in New Zealand general practices. Other system-level factors also need to be addressed.

  4. Readiness for organisational change among general practice staff.

    Science.gov (United States)

    Christl, B; Harris, M F; Jayasinghe, U W; Proudfoot, J; Taggart, J; Tan, J

    2010-10-01

    Increasing demands on general practice to manage chronic disease may warrant organisational change at the practice level. Staff's readiness for organisational change can act as a facilitator or barrier to implementing interventions aimed at organisational change. To explore general practice staff readiness for organisational change and its association with staff and practices characteristics. This is a cross-sectional study of practices in three Australian states involved in a randomised control trial on the effectiveness of an intervention to enhance the role of non-general practitioner staff in chronic disease management. Readiness for organisational change, job satisfaction and practice characteristics were assessed using questionnaires. 502 staff from 58 practices completed questionnaires. Practice characteristics were not associated with staff readiness for change. A multilevel regression analysis showed statistically significant associations between staff readiness for organisational change (range 1 to 5) and having a non-clinical staff role (vs general practitioner; B=-0.315; 95% CI -0.47 to -0.16; pchange which addresses the mix of practice staff. Moderately low job satisfaction may be an opportunity for organisational change.

  5. Corporate social responsibility practices in the Nigerian oil sector: The case of Royal Dutch Shell

    Science.gov (United States)

    Rwabizambuga, Alexis

    The thesis contributes to the perspective on the role of stakeholder engagement in negotiating corporate social responsibility (CSR) policies and practices in developing country context. It critically examines the role of societal pressures as drivers of Shell's CSR agenda, and explores the forms of relationships existing between Shell and its stakeholders in Nigeria, as the company implements its CSR programme, both in the light of its strategic business objectives and of its social responsibilities and environmental liabilities. Furthermore, it examines the role of government in the oil MNCs' CSR agenda, and explores the conditions under which the government, in its dual role as business partner and as state authority, promotes CSR policies and practices in Nigeria. Shell's CSR policies and practices in Nigeria were examined under the theoretical lenses of the resource-based view perspective extended to notions of legitimacy and the licence to operate. Additionally, the stakeholder engagement perspective was applied as the theoretical framework for examining Shell's stakeholder engagement, and the role of the company's stakeholders in negotiating its current CSR policies and practices in Nigeria. Data collection was undertaken during field research in Nigeria. The evidence presented is drawn from individual interviews with corporate executives at Shell Nigeria, Shell International, several stakeholders in the Nigerian oil sector, and from an online survey conducted in 2005 on Shell Nigeria's stakeholders. Both quantitative and qualitative methods were used throughout the analysis presented in the thesis. The research findings suggest that the relationship between the firm's pursuit of the social licence to operate through CSR initiatives and stakeholder engagement is more complex than assumed. It adds to the understanding of the dynamics of a MNC's stakeholder engagement in the local context. It highlights the various interdependencies that develop between

  6. Structuring diabetes care in general practices: many improvements, remaining challenges.

    LENUS (Irish Health Repository)

    Jennings, S

    2009-08-07

    BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

  7. [MODERN EDUCATIONAL TECHNOLOGY MASTERING PRACTICAL SKILLS OF GENERAL PRACTITIONERS].

    Science.gov (United States)

    Kovalchuk, L I; Prokopchuk, Y V; Naydyonova, O V

    2015-01-01

    The article presents the experience of postgraduate training of general practitioners--family medicine. Identified current trends, forms and methods of pedagogical innovations that enhance the quality of learning and mastering the practical skills of primary professionals providing care.

  8. How to improve mental health competency in general practice training?--a SWOT analysis.

    Science.gov (United States)

    van Marwijk, Harm

    2004-06-01

    It is quite evident there is room for improvement in the primary care management of common mental health problems. Patients respond positively when GPs adopt a more proactive role in this respect. The Dutch general practice curriculum is currently being renewed. The topics discussed here include the Strengths, Weaknesses, Opportunities and Threats (SWOT) of present primary mental healthcare teaching. What works well and what needs improving? Integrated teaching packages are needed to help general practice trainees manage various presentations of psychological distress. Such packages comprise training videotapes, in which models such as problem-solving treatment (PST) are demonstrated, as well as roleplaying material for new skills, self-report questionnaires for patients, and small-group video feedback of consultations. While GP trainees can effectively master such skills, it is important to query the level of proficiency required by registrars. Are these skills of use only to connoisseur GPs, or to all? More room for specialisation and differentiation among trainees may be the way forward. We have just developed a new curriculum for the obligatory three-month psychiatry housemanship. It is competency oriented, self-directed and assignment driven. This new curriculum will be evaluated in due course.

  9. ADHD medication prescription: Effects of child, sibling, parent and general practice characteristics.

    Science.gov (United States)

    Heins, Marianne J; Bruggers, Inge; van Dijk, Liset; Korevaar, Joke C

    2016-10-05

    Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication prescription. We included 1259 Dutch children aged 6-18 years with a diagnostic code of ADHD or related behavioural problems (ICPC codes P20-P22) in NIVEL primary care database. Using multilevel analyses, we examined predictors of ADHD medication prescription. Children diagnosed as 'hyperactive' were 16 times more likely to be prescribed ADHD medication than those with 'behavioural concerns'. Children with a parent or sibling receiving ADHD medication were three to four times more likely to be prescribed ADHD medication themselves. Children from GP practices with a high percentage of children with ADHD were twice as likely to be prescribed ADHD medication. Concluding, factors on the individual, family and GP practice level determine ADHD medication prescription. Future research into the decision-making process for ADHD medication is warranted.

  10. A survey of statistics in three UK general practice journal

    Directory of Open Access Journals (Sweden)

    Campbell Michael J

    2004-12-01

    Full Text Available Abstract Background Many medical specialities have reviewed the statistical content of their journals. To our knowledge this has not been done in general practice. Given the main role of a general practitioner as a diagnostician we thought it would be of interest to see whether the statistical methods reported reflect the diagnostic process. Methods Hand search of three UK journals of general practice namely the British Medical Journal (general practice section, British Journal of General Practice and Family Practice over a one-year period (1 January to 31 December 2000. Results A wide variety of statistical techniques were used. The most common methods included t-tests and Chi-squared tests. There were few articles reporting likelihood ratios and other useful diagnostic methods. There was evidence that the journals with the more thorough statistical review process reported a more complex and wider variety of statistical techniques. Conclusions The BMJ had a wider range and greater diversity of statistical methods than the other two journals. However, in all three journals there was a dearth of papers reflecting the diagnostic process. Across all three journals there were relatively few papers describing randomised controlled trials thus recognising the difficulty of implementing this design in general practice.

  11. Antidepressant prescriptions in first and second generation ethnic minorities in Dutch general practice.

    NARCIS (Netherlands)

    Dijk, L. van; Volkers, A.C.; Verheij, R.A.

    2007-01-01

    Background: Ethnic minorities have poor access and different pathways to mental health care as compared to indigenous populations, but less is known about differences in antidepressant treatment in depressed patients among ethnic minorities. This papers studies antidepressant treatment in depressed

  12. Requests for euthanasia in general practice before and after implementation of the Dutch Euthanasia Act.

    NARCIS (Netherlands)

    Alphen, J.E. van; Donker, G.A.; Marquet, R.L.

    2010-01-01

    The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalising euthanasia under strict conditions influences the number and nature of euthanasia requests. AIM: To investigate changes in the number of, and reasons for, requests for euthanasi

  13. Off-label and unlicensed prescribing of psychotropics in children in Dutch general practice .

    NARCIS (Netherlands)

    Volkers, A.; Dijk, L. van

    2006-01-01

    Background: Unsafe drug use is a point of concern in children with psychotropics. Methylfenidate is licensed to prescribe above the age of 6 years, but most of the antidepressants and benzodiazepines are not approved in children. We studied the off-label and unlicensed prescribing of psychotropics i

  14. [Summary of the practice guideline 'Rheumatoid arthritis' (first revision) from the Dutch College of General Practitioners

    NARCIS (Netherlands)

    Wiersma, T.J.; Flikweert, S.; Bosch, W.J.H.M. van den

    2004-01-01

    The guideline covers the evaluation of patients with one or more painful joints without previous injury and focuses on the distinction between rheumatoid arthritis and other joint complaints. In the case of rheumatoid arthritis, the arthritis is based on aseptic synovitis and is nearly always associ

  15. Allergic rhinitis in children: incidence and treatment in Dutch general practice in 1987 and 2001

    NARCIS (Netherlands)

    Bot, Chantal; Moed, H.; Schellevis, F.G.; Groot, de H.; Wijk, van R.; Wouden, van der J.

    2009-01-01

    30,000 inhabitants) and suburban areas (30,000-50,000 inhabitants). Compared to 1987, there was a significant increase in incidence in the central part of the Netherlands in 2001. In both years, the incidence was higher in spring compared with the other seasons. In 2001, children of natives and west

  16. [Summary of the Dutch College of General Practitioners' (NHG) practice guideline 'ADHD in children'].

    Science.gov (United States)

    van Avendonk, Mariëlle J P; Hassink-Franke, Lieke J A; Stijntjes, Freek; Wiersma, Tjerk; Burgers, Jako S

    2015-01-01

    The diagnosis of ADHD may be considered if a child is hyperactive, impulsive or inattentive, and if this behaviour results in evidently impaired functioning in multiple settings. Children with behavioural problems and slightly impaired functioning may benefit from patient information, education and parenting advice. From the age of 6 years, children can be offered diagnostic testing and professional support within the primary care setting, provided sufficient knowledge and expertise is available and there is collaboration with other health care providers. Management of a child with ADHD but no comorbid psychiatric disorder, consists of a step-by-step plan including education, parent and teacher guidance and, optionally, behavioural therapy for the child. In consultation with parents, child and other therapists, methylphenidate can be prescribed if behavioural interventions are not sufficiently effective. Children taking medication for ADHD should be monitored periodically, including assessment of the effectiveness and side effects.

  17. The effect of pharmaceutical marketing on the prescription of rofecoxib in Dutch general practice.

    NARCIS (Netherlands)

    Somai, D.; Dijk, L. van; Verheij, R.; Bakker, D. de

    2004-01-01

    Background: In 2000 the new painkiller rofecoxib was introduced in the Netherlands as an alternative for NSAIDs. It was extensively marketed by the pharmaceutical industry stressing its gastro protective qualities and significant pain reduction. Rofecoxib vastly obtained a significant market share.

  18. The quality of COPD care in general practice in Denmark

    DEFF Research Database (Denmark)

    Lange, Peter; Rasmussen, Finn Vejlø; Borgeskov, Hanne;

    2007-01-01

    We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence...

  19. Positive experiences with a specialist as facilitator in general practice

    DEFF Research Database (Denmark)

    Kousgaard, Marius Brostrøm; Thorsen, Thorkil

    2012-01-01

    The use of facilitators for quality improvement in general practice has accelerated during the past decade. As general practitioners (GPs) or pharmacists have typically been used as facilitators, there is a lack of knowledge of how other professionals function as facilitators. This article explor...

  20. Implant Dentistry in General Practice. Part 1: Introduction.

    Science.gov (United States)

    Nicholson, Ken

    2016-06-01

    This paper, the first of two, provides an introduction to implant dentistry for the general dental practitioner. CPD/Clinical Relevance: Implant placement and restoration is becoming more common place in general dental practice to the point where it may already be considered a routine treatment option.

  1. The quality of COPD care in general practice

    DEFF Research Database (Denmark)

    Rasmussen, F.V.; Borgeskov, H.; Dollerup, J.;

    2008-01-01

    We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were...... included in the first audit and 2394 in the second audit. We observed a significantly increased utilisation of spirometry from the first (52.7%) to the second audit (71.4%) (p quality of management. We conclude that participation in an educational...... programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25...

  2. The Use of General Practice Computer Systems for Data Handling and Clinical Audit - A Survey of General Practices in Leicestershire

    Directory of Open Access Journals (Sweden)

    Farooqi A

    1998-11-01

    Conclusion: Despite considerable investment in GP computer systems there is evidence of both under-utilisation and inefficient use. Most practices identified a number of training needs. This suggests that lack of training is a barrier to the effective use of computers. Health authorities and general practices need urgently to develop strategies to improve computer skills.

  3. The state, the market, and general practice: the Australian case.

    Science.gov (United States)

    White, K N

    2000-01-01

    This article examines the development of general practice in the latter half of the 20th century, documenting the issues of concern to both the profession and the state. General practice developed hand in hand with the welfare state in Australia. As the structural changes associated with restructuring of the welfare state have advanced, so have the fortunes of general practice declined, despite significant attempts in the 1970s and 1980s to "save" general practice by both the profession and the state. These structural changes have operated on two fronts, the economic and the cultural. On the economic, changes to the employment of general practitioners clearly indicate ongoing proletarianization, particularly in a changing environment of labor-capital relations. At the cultural level, development of the self-help and the women's movements and the elective affinity of these groups with the individualism of the new right are leading to deprofessionalization. The author advances this argument in a review of general practice over the last 40 years and in a case study of community health services. Theoretically he argues for a combination of the proletarianization and the deprofessionalization theses.

  4. Video-assisted feedback in general practice internships using German general practitioner's guidelines.

    Science.gov (United States)

    Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

    2012-01-01

    The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient - student - consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The Following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence

  5. Empathy and the application of the 'unbearable suffering' criterion in Dutch euthanasia practice.

    Science.gov (United States)

    van Tol, Donald G; Rietjens, Judith A C; van der Heide, Agnes

    2012-05-01

    A pivotal due care criterion for lawful euthanasia in the Netherlands is that doctors must be convinced that a patient requesting for euthanasia, suffers unbearably. Our study aims to find out how doctors judge if a patient suffers unbearably. How do doctors bridge the gap from 3rd person assessment to 1st person experience? We performed a qualitative interview study among 15 physicians, mainly general practitioners, who participated earlier in a related quantitative survey on the way doctors apply the suffering criterion. Results show that doctors follow different 'cognitive routes' when assessing a patients suffering in the context of a euthanasia request. Sometimes doctors do this imagining how she herself would experience the situation of the patient ('imagine self'). Doctors may also try to adopt the perspective of the patient and imagine what the situation is like for this particular patient ('imagine other'). Besides this we found that the (outcome of the) assessment is influenced by a doctor's private norms, values and emotions considering (the performance of) euthanasia. We conclude by arguing why doctors should be aware of both the 'cognitive route' followed as well as the influence of their own personal norms on the assessment of suffering in the context of euthanasia requests.

  6. Sleep habits and sleep disturbances in Dutch children: a population-based study

    OpenAIRE

    Litsenburg, van, R.R.L.; Waumans, R.C.; Berg, van den, Aad; Gemke, R.J.B.J.

    2010-01-01

    Sleep disorders can lead to significant morbidity. Information on sleep in healthy children is necessary to evaluate sleep disorders in clinical practice, but data from different societies cannot be simply generalized. The aims of this study were to (1) assess the prevalence of sleep disturbances in Dutch healthy children, (2) describe sleep habits and problems in this population, (3) collect Dutch norm data for future reference, and (4) compare sleep in children from different cultural backg...

  7. The Implementation of the AIFMD in Dutch Tax Law

    NARCIS (Netherlands)

    Vermeulen, H.; Elink Schuurman, J.H.

    2014-01-01

    In this article, the authors explain the amendments to Dutch tax law as a result of the recent implementation of the Alternative Investment Fund Managers Directive. Changes were made to the Dutch Corporate Income Tax Act, the Dutch Dividend Withholding Tax Act and the Dutch General Tax Act. Given th

  8. The Implementation of the AIFMD in Dutch Tax Law

    NARCIS (Netherlands)

    Vermeulen, H.; Elink Schuurman, J.H.

    2014-01-01

    In this article, the authors explain the amendments to Dutch tax law as a result of the recent implementation of the Alternative Investment Fund Managers Directive. Changes were made to the Dutch Corporate Income Tax Act, the Dutch Dividend Withholding Tax Act and the Dutch General Tax Act. Given th

  9. Spot-checks to measure general hygiene practice.

    Science.gov (United States)

    Sonego, Ina L; Mosler, Hans-Joachim

    2016-01-01

    A variety of hygiene behaviors are fundamental to the prevention of diarrhea. We used spot-checks in a survey of 761 households in Burundi to examine whether something we could call general hygiene practice is responsible for more specific hygiene behaviors, ranging from handwashing to sweeping the floor. Using structural equation modeling, we showed that clusters of hygiene behavior, such as primary caregivers' cleanliness and household cleanliness, explained the spot-check findings well. Within our model, general hygiene practice as overall concept explained the more specific clusters of hygiene behavior well. Furthermore, the higher general hygiene practice, the more likely children were to be categorized healthy (r = 0.46). General hygiene practice was correlated with commitment to hygiene (r = 0.52), indicating a strong association to psychosocial determinants. The results show that different hygiene behaviors co-occur regularly. Using spot-checks, the general hygiene practice of a household can be rated quickly and easily.

  10. Prevalence of anal symptoms in general practice: a prospective study.

    Science.gov (United States)

    Tournu, Géraldine; Abramowitz, Laurent; Couffignal, Camille; Juguet, Frédéric; Sénéjoux, Agnès; Berger, Stéphane; Wiart, Anne-Laure; Bernard, Marc; Provost, Françoise; Pillant-Le Moult, Hélène; Bouchard, Dominique; Aubert, Jean-Pierre

    2017-08-03

    Anal disorders are largely underestimated in general practice. Studies have shown patients conceal anal symptoms leading to late diagnosis and treatment. Management by general practitioners is poorly described. The aim of this study is to assess the prevalence of anal symptoms and their management in general practice. In this prospective, observational, national study set in France, all adult patients consulting their general practitioner during 2 days of consultation were included. Anal symptoms, whether spontaneously revealed or not, were systematically collected and assessed. For symptomatic patients, the obstacles to anal examination were evaluated. The general practitioner's diagnosis was collected and a proctologist visit was systematically proposed in case of anal symptoms. If the proctologist was consulted, his or her diagnosis was collected. From October 2014 to April 2015, 1061 patients were included by 57 general practitioners. The prevalence of anal symptoms was 15.6% (95% CI: 14-18). However, 85% of these patients did not spontaneously share their symptoms with their doctors, despite a discomfort rating of 3 out of 10 (range 1-5). Although 65% of patients agreed to an anal examination, it was not proposed in 45% of cases with anal symptoms. Performing the examination was associated with a significantly higher diagnosis rate of 76% versus 20% (p anal symptoms are significant in general practice despite the impact on quality of life. Anal examination is seldom done. Improved training of general practitioners is required to break the taboo.

  11. Converging on business-IT alignment best practices: Lessons learned from a Dutch cross-governmental partnership

    NARCIS (Netherlands)

    Santana Tapia, Roberto

    2009-01-01

    An empirical study that explores business-IT alignment processes in a Dutch cross-governmental partnership is summarized in this paper. The aim of the study was to identify processes that contribute to improve such alignment. This study represents a continuation of previous validation efforts that h

  12. The Internet as a parameter of strategic planning: A study of E-Marketing practices of Dutch SMBs

    NARCIS (Netherlands)

    Constantinides, Efthymios

    2006-01-01

    This paper proposes a methodology for the identification and evaluation of Internet-based strategies and examines the role of the Internet as element of the strategic planning of Small and Medium Businesses (SMBs) from a variety of Dutch industrial sectors. The study has an explorative character and

  13. Contested e-literacies in Dutch as a Second Language : Exploring the Interface between Policy and ICT Practices

    NARCIS (Netherlands)

    Spotti, M.; Kurvers, J.J.H.

    2014-01-01

    Building on an overview of the history of civic integration policy in the Netherlands, we show how – parallel to the development of a stricter integration policy – we see an exponential growth of ICT in the Dutch as a second language sector. While ICT used to be a means for learning support in secon

  14. The role of general practice in postgraduate basic training

    DEFF Research Database (Denmark)

    Kjaer, Niels Kristian; Kodal, Troels; Qvesel, Dorte

    2010-01-01

    BACKGROUND: In recent years, there has been growing interest in the role of primary care in postgraduate training. Relatively little has been published about benefits of early and sustained postgraduate basic training in general practice, especially for doctors with other ambitions than family me...... identity. The educational environment in general practice is rated highly. CONCLUSION: The inclusion of family medicine in postgraduate basic training should be considered for all doctors.......BACKGROUND: In recent years, there has been growing interest in the role of primary care in postgraduate training. Relatively little has been published about benefits of early and sustained postgraduate basic training in general practice, especially for doctors with other ambitions than family...

  15. “Yeah, and What’s the Problem?” Embodiment, Cultural Practices and Working out in a Dutch Gym

    Directory of Open Access Journals (Sweden)

    Alexis Sossa

    2017-05-01

    Full Text Available In this paper, I present empirical data from ethnographic work carried out in a Dutch gym, where people, especially students, from different countries work out, interact and explore ideas and practices related to their cultures and to other people’s cultures. I will analyse and explain four things: first, the social skills required to successfully interact in a multicultural space; second, the cultural and physical skills that people who have worked out in this gym for a long time have embodied; third, the skills and culture that foreigners have to quickly learn; and finally, how this affects the relationships and the activities considered important in this gym.

  16. Study with lormetazepam as a hypnotic in general practice.

    Science.gov (United States)

    Pöldinger, W; Sastre-y-Hernández, M; Fichte, K

    1983-01-01

    Due to the increasing pressure to investigate new drugs under conditions met with in practice, Lormetazepam (0.5 mg) was investigated in nine general practices under the direction and collaboration of a psychiatrist used to investigations with psychopharmaceuticals. The results of a double-blind study, carried out in comparison to triazolam (0.5 mg), in a total of 94 ambulatory patients are presented.

  17. An exemplar of naturalistic inquiry in general practice research.

    Science.gov (United States)

    McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth

    2017-01-23

    Background Before beginning any research project, novice researchers must consider which methodological approach will best address their research questions. The paucity of literature describing a practical application of naturalistic inquiry adds to the difficulty they may experience. Aim To provide a practical example of how naturalistic inquiry was applied to a qualitative study exploring collaboration between registered nurses and general practitioners working in Australian general practice. Discussion Naturalistic inquiry is not without its critics and limitations. However, by applying the axioms and operational characteristics of naturalistic inquiry, the authors captured a detailed 'snapshot' of collaboration in general practice in the time and context that it occurred. Conclusion Using qualitative methods, naturalistic inquiry provides the scope to construct a comprehensive and contextual understanding of a phenomenon. No individual positivist paradigm could provide the level of detail achieved in a naturalistic inquiry. Implications for practice This paper presents a practical example of naturalistic inquiry for the novice researcher. It shows that naturalistic inquiry is appropriate when the researcher seeks a rich and contextual understanding of a phenomenon as it exists in its natural setting.

  18. Social environment and frequent attendance in Danish general practice

    DEFF Research Database (Denmark)

    Vedsted, Peter; Olesen, Frede

    2005-01-01

    inequalities in health or whether social factors in themselves determine the use of general practice. AIM: To examine if social factors are associated with frequent attendance in general practice after adjusting for physical and psychological health variables. DESIGN OF STUDY: Population-based cross...... during the period November 1997-October 1998. A questionnaire about physical, psychological and social factors was sent to the patients. The associations between social factors and frequent attendance were adjusted for physical and psychological health and tendency towards somatisation. RESULTS: A total...

  19. Healthcare assistants in general practice: practical and conceptual issues of skill-mix change.

    Science.gov (United States)

    Bosley, Sara; Dale, Jeremy

    2008-02-01

    The emergence of healthcare assistants (HCAs) in general practice raises questions about roles and responsibilities, patients' acceptance, cost-effectiveness, patient safety and delegation, training and competence, workforce development, and professional identity. There has been minimal research into the role of HCAs and their experiences, as well as those of other staff working with HCAs in general practice. Lessons may be learned from their role and evidence of their effectiveness in hospital settings. Such research highlights blurred and contested role boundaries and threats to professional identity, which have implications for teamwork, quality of patient care, and patient safety. In this paper it is argued that transferability of evidence from hospital settings to the context of general practice cannot be assumed. Drawing on the limited research in general practice, the challenges and benefits of developing the HCA role in general practice are discussed. It is suggested that in the context of changing skill-mix models, viewing roles as fluid and dynamic is more helpful and reflective of individuals' experiences than endeavouring to impose fixed role boundaries. It is concluded that HCAs can make an increasingly useful contribution to the skill mix in general practice, but that more research and evaluation are needed to inform their training and development within the general practice team.

  20. Video-assisted feedback in general practice internships using German general practitioner's guidelines

    NARCIS (Netherlands)

    Bolter, R.; Freund, T.; Ledig, T.; Boll, B.; Szecsenyi, J.; Roos, M.

    2012-01-01

    Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the

  1. Discourse analysis in general practice: a sociolinguistic approach.

    Science.gov (United States)

    Nessa, J; Malterud, K

    1990-06-01

    It is a simple but important fact that as general practitioners we talk to our patients. The quality of the conversation is of vital importance for the outcome of the consultation. The purpose of this article is to discuss a methodological tool borrowed from sociolinguistics--discourse analysis. To assess the suitability of this method for analysis of general practice consultations, the authors have performed a discourse analysis of one single consultation. Our experiences are presented here.

  2. Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar

    Directory of Open Access Journals (Sweden)

    Scott-Jones J

    2013-09-01

    Full Text Available INTRODUCTION: Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. AIM: To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. METHODS: A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. RESULTS: The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. DISCUSSION: Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.

  3. Practical experiences with a CO2/R410A cascade system in a Dutch supermarket; Praktijkervaringen met CO2/R410A cascadesysteem in Nederlandse supermarkt

    Energy Technology Data Exchange (ETDEWEB)

    Jans, R. [Adviseur Consultancy, Breda (Netherlands)

    2009-07-15

    In spite of a few minor start-up problems the general experiences with the CO2/R410A cascade system are positive. The calculated and expected saving of 15% on the power consumption of the compressors was nearly realized. Evaluation after one-year operation resulted in a 12% reduction of the energy consumption by the compressors. [Dutch] Behoudens enkele aanloopproblemen zijn de ervaringen met het CO2/R410A cascadesysteem positief te noemen. De op voorhand bepaalde besparingen van 15% op het energiegebruik van de compressoren worden redelijk benaderd. Evaluatie na een jaar bedrijf resulteerde in een energiebesparing van 12% op het opgenomen compressorvermogen.

  4. Sustainability economics. General versus specific, and conceptual versus practical

    Energy Technology Data Exchange (ETDEWEB)

    Baumgaertner, Stefan [Department of Sustainability Sciences, Leuphana University of Lueneburg (Germany); Department of Economics, Leuphana University of Lueneburg (Germany); Quaas, Martin [Department of Economics, University of Kiel (Germany)

    2010-09-15

    We clarify the definition and interpretation of 'sustainability economic' (Baumgaertner and Quaas, 2010) in response to recent comments by van den Bergh (2010), Bartelmus (2010) and others. For that sake, we distinguish between general and specific definitions of sustainability and sustainability economics, as well as between conceptual and practical approaches. (author)

  5. Antibiotic prescribing in Danish general practice 2004-13

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Siersma, Volkert; Hansen, Malene Plejdrup;

    2016-01-01

    general practice relative to the entire primary care sector. METHODS: This was a registry-based study including all patients who redeemed an antibiotic prescription between July 2004 and June 2013 at a Danish community pharmacy. Antibiotic use was expressed as DDDs and treatments/1000 inhabitants...

  6. General practice and primary health care in Denmark

    DEFF Research Database (Denmark)

    Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergaard, Jens

    2012-01-01

    education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges...

  7. Transmission and treatment of cutaneous warts in general practice

    NARCIS (Netherlands)

    Bruggink, Sjoerd Cristoffel

    2013-01-01

    Cutaneous warts are caused by the human papillomavirus (HPV). Although warts are one of the most common reasons to consult general practice, there is a considerable lack of evidence on the transmission and treatment of warts. This thesis presents epidemiological data from a cohort of primary school

  8. Respiratory Diseases in Children: studies in general practice

    NARCIS (Netherlands)

    J.H.J.M. Uijen (Hans)

    2011-01-01

    textabstractThe work presented in this thesis covers various aspects of the epidemiology, diagnosis and management of various respiratory symptoms and diseases in children frequently encountered in general practice. These respiratory tract symptoms and diseases can be categorized into symptoms and d

  9. Persistent presentation of medically unexplained symptoms in general practice.

    NARCIS (Netherlands)

    Verhaak, P.F.M.; Meijer, S.A.; Visser, A.P.; Wolters, G.

    2006-01-01

    OBJECTIVES: To estimate the prevalence of persistent presentation of medically unexplained physical symptoms (MUPS) in general practice. To assess socio-demographic characteristics, health status and use of health services of patients who frequently present MUPS, compared with reference groups. DESI

  10. Transmission and treatment of cutaneous warts in general practice

    NARCIS (Netherlands)

    Bruggink, Sjoerd Cristoffel

    2013-01-01

    Cutaneous warts are caused by the human papillomavirus (HPV). Although warts are one of the most common reasons to consult general practice, there is a considerable lack of evidence on the transmission and treatment of warts. This thesis presents epidemiological data from a cohort of primary school

  11. The British Telecom radiopaging service in general practice.

    Science.gov (United States)

    Cole, F H

    1981-10-01

    This paper reports a new radiopaging service supplied by British Telecom that will eventually cover the whole United Kingdom. The use of this service by a three-man practice is described. The service is considered to be a major development in communications that will be of interest to most general practitioners.

  12. Potentials and pitfalls for nutrition counselling in general practice

    NARCIS (Netherlands)

    Verheijden, M.W.; Bakx, J.C.; Weel, C. van; Staveren, W.A. van

    2005-01-01

    This paper was based on collaborative research efforts from Wageningen University and the University Medical Centre St Radboud in The Netherlands and describes the rationale for web-based nutrition counselling applications in general practice as well as some of the frequently used models and theorie

  13. Prognostic Factors in Adults With Knee Pain in General Practice

    NARCIS (Netherlands)

    Belo, J. N.; Berger, M. Y.; Koes, B. W.; Bierma-Zeinstra, S. M. A.

    2009-01-01

    Objective. To predict the 1-year outcome of incident nontraumatic knee symptoms in adults presenting in general practice. Methods. Adults age >35 years with nontraumatic knee symptoms (n = 480) were followed for 1 year. At baseline, data on knee symptoms and demographics were collected and a

  14. Nurses in Australian general practice: implications for chronic disease management.

    Science.gov (United States)

    Halcomb, Elizabeth J; Davidson, Patricia M; Salamonson, Yenna; Ollerton, Richard; Griffiths, Rhonda

    2008-03-01

    The purpose of this study was to describe the demographic and employment characteristics of Australian practice nurses and explore the relationship between these characteristics and the nurses' role. Nursing in general practice is an integral component of primary care and chronic disease management in the United Kingdom and New Zealand, but in Australia it is an emerging specialty and there is limited data on the workforce and role. National postal survey embedded in a sequential mixed method design. 284 practice nurses completed a postal survey during 2003-2004. Descriptive statistics and factor analysis were utilized to analyse the data. Most participants were female (99%), Registered Nurses (86%), employed part-time in a group practice, with a mean age of 45.8 years, and had a hospital nursing certificate as their highest qualification (63%). The tasks currently undertaken by participants and those requiring further education were inversely related (R2 = -0.779). Conversely, tasks perceived to be appropriate for a practice nurse and those currently undertaken by participants were positively related (R2 = 0.8996). There was a mismatch between the number of participants who perceived that a particular task was appropriate and those who undertook the task. This disparity was not completely explained by demographic or employment characteristics. Extrinsic factors such as legal and funding issues, lack of space and general practitioner attitudes were identified as barriers to role expansion. Practice nurses are a clinically experienced workforce whose skills are not optimally harnessed to improve the care of the growing number of people with chronic and complex conditions. Relevance to clinical practice. Study data reveal a need to overcome the funding, regulatory and interprofessional barriers that currently constrain the practice nurse role. Expansion of the practice nurse role is clearly a useful adjunct to specialist management of chronic and complex disease

  15. Theory and interpretation in qualitative studies from general practice

    DEFF Research Database (Denmark)

    Malterud, Kirsti

    2016-01-01

    Objective: In this article, I want to promote theoretical awareness and commitment among qualitative researchers in general practice and suggest adequate and feasible theoretical approaches.  Approach: I discuss different theoretical aspects of qualitative research and present the basic foundations...... theory is a consistent and soundly based set of assumptions about a specific aspect of the world, predicting or explaining a phenomenon. Qualitative research is situated in an interpretative paradigm where notions about particular human experiences in context are recognized from different subject...... in qualitative analysis are presented, emphasizing substantive theories to sharpen the interpretative focus. Such approaches are clearly within reach for a general practice researcher contributing to clinical practice by doing more than summarizing what the participants talked about, without trying to become...

  16. Participatory design of a preliminary safety checklist for general practice.

    Science.gov (United States)

    Bowie, Paul; Ferguson, Julie; MacLeod, Marion; Kennedy, Susan; de Wet, Carl; McNab, Duncan; Kelly, Moya; McKay, John; Atkinson, Sarah

    2015-05-01

    The use of checklists to minimise errors is well established in high reliability, safety-critical industries. In health care there is growing interest in checklists to standardise checking processes and ensure task completion, and so provide further systemic defences against error and patient harm. However, in UK general practice there is limited experience of safety checklist use. To identify workplace hazards that impact on safety, health and wellbeing, and performance, and codesign a standardised checklist process. Application of mixed methods to identify system hazards in Scottish general practices and develop a safety checklist based on human factors design principles. A multiprofessional 'expert' group (n = 7) and experienced front-line GPs, nurses, and practice managers (n = 18) identified system hazards and developed and validated a preliminary checklist using a combination of literature review, documentation review, consensus building workshops using a mini-Delphi process, and completion of content validity index exercise. A prototype safety checklist was developed and validated consisting of six safety domains (for example, medicines management), 22 sub-categories (for example, emergency drug supplies) and 78 related items (for example, stock balancing, secure drug storage, and cold chain temperature recording). Hazards in the general practice work system were prioritised that can potentially impact on the safety, health and wellbeing of patients, GP team members, and practice performance, and a necessary safety checklist prototype was designed. However, checklist efficacy in improving safety processes and outcomes is dependent on user commitment, and support from leaders and promotional champions. Although further usability development and testing is necessary, the concept should be of interest in the UK and internationally. © British Journal of General Practice 2015.

  17. Open-access ultrasound referrals from general practice.

    LENUS (Irish Health Repository)

    Hughes, P

    2015-03-01

    Direct access referral for radiological investigations from General Practice (GP) provides an indispensable diagnostic tool and avoids the inherently long waiting time that referral through a hospital based specialty would entail. Improving access to hospital based radiology services is one of Health Information and Quality Authority\\'s key recommendations in its report on patient referrals from general practice. This study aimed to review all GP referrals for ultrasound investigations to a tertiary referral teaching hospital over a seven month period with respect to their demographics, waiting times and diagnostic outcomes. 1,090 ultrasounds originating in general practice were carried out during the study period. Positive findings were recorded in 332 (30.46%) examinations. The median waiting time from receipt of referral to the diagnostic investigation was 56 days (range 16 - 91 years). 71 (6.5%) patients had follow-up imaging investigations while recommendation for hospital based specialty referral was made in 35 cases (3.2%). Significant findings included abdominal aortic aneurysms, metastatic disease and lymphoma. Direct access to ultrasound for general practitioners allows the referring physician to make an informed decision with regard to the need for specialist referral. We believe these findings help support the case for national direct access to diagnostic ultrasound for general practitioners.

  18. Sexual orientation and mental and physical health status: findings from a Dutch population survey.

    NARCIS (Netherlands)

    Sandfort, T.G.M.; Bakker, F.; Schellevis, F.G.; Vanwesenbeeck, I.

    2006-01-01

    OBJECTIVES: We sought to determine whether sexual orientation is related to mental and physical health and health behaviors in the general population. METHODS: Data was derived from a health interview survey that was part of the second Dutch National Survey of General Practice, carried out in 2001

  19. Shortage in general practice despite the feminisation of the medical workforce: a seeming paradox? A cohort study

    Directory of Open Access Journals (Sweden)

    Boode Beppie

    2008-12-01

    Full Text Available Abstract Background Female medical students often prefer primary care specialties, while male students appear to be attracted to hospital specialties. Notwithstanding the steady feminisation of medicine, in many countries there are still difficulties in recruiting trainees for general practice. This seeming paradox raises the question on what specific role gender plays in a specialty choice. The authors looked at the (a the role of gender in general practice specialty choice of Dutch medical students, (b the decisive factors in career choice and relation of gender to these, and (c differences in how male and female students are influenced by the GP clerkship. Methods A cohort of 206 final year medical students at the Maastricht University, the Netherlands were asked to complete a questionnaire focusing on career preferences before and after a 12-week general practice clerkship and at graduation, a couple of months later. Results Gender was significantly related to willingness to become a GP in bivariate analysis. Adding variables in multivariate analysis made this effect disappear. While females expressed overall higher preference for general practice than males, after the GP clerkship likelihood of choosing general practice increased with 38% among male and 22% among female students. After graduation, interest in general practice had dropped, mainly among females. Attitudes predicting a GP career choice were: extrinsic career motivation before the clerkship, and the content of GP work (patient contacts, treatments and motivation to work with chronic and palliative patients after the clerkship. Conclusion Gender 'as such' appeared not to be a distinctive predictor of specialty choice. It is students' attitudes towards GP work and preferred patient category that determine the career choice in general practice. However, more male students were positively influenced by the GP clerkship than female students. The motivating effect of the clerkship is

  20. The purpose of the general practice consultation from the patients perspective - theoretical aspects

    DEFF Research Database (Denmark)

    Thorsen, Hanne; Witt, Klaus; Malterud, Kirsti

    2001-01-01

    Consultation purposes, general practice, patients´expectations, patients satosfaction, patientcenteredness......Consultation purposes, general practice, patients´expectations, patients satosfaction, patientcenteredness...

  1. Intimate partner violence - identification and response in general practice.

    Science.gov (United States)

    Hegarty, Kelsey; O'Doherty, Lorna

    2011-11-01

    Intimate partner violence is a common problem among women attending general practice, with around one in 10 women currently experiencing physical, sexual or emotional abuse by a partner. Abused women frequently present with physical and psychosocial issues. Yet intimate partner violence often remains concealed and addressing it poses challenges for the clinician and patient alike. Although some of the general recommendations in this review may also apply to same-sex relationships and to women who abuse men, this article discusses identifying intimate partner violence in women who present to general practice. Identifying intimate partner violence is important in clinical practice as it underlies many common physical and mental health presentations. Facilitating disclosure and responding effectively requires good communication skills. Safety assessment of women and their families, pinpointing level of readiness to contemplate action, and providing appropriate referral options and ongoing nonjudgmental support are elements of an effective response. General practitioners have the potential to identify women and support them safely on a pathway to recovery, thereby avoiding the long term impacts of intimate partner violence.

  2. Open Access to General Practice Was Associated with Burnout among General Practitioners.

    Science.gov (United States)

    Vedsted, Peter; Sokolowski, Ineta; Olesen, Frede

    2013-01-01

    Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without. In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach Burnout Inventory. Analyses using logistic regression were adjusted for gender, age, marital status, job satisfaction, minutes per consultation, practice organisation, working hours, number of listed patients per GP, number of contacts per GP, continuing medical education- (CME-) activities, and clusters of GPs. In all, 8% of GPs had open access and the prevalence of burnout was 24%. GPs with walk-in open access were more likely to suffer from burnout. Having open access was associated with a 3-fold increased likelihood of burnout (OR = 3.1 (95% CI: 1.1-8.8, P = 0.035)). Although the design cannot establish causality, it is recommended to closely monitor possible negative consequences of open access in general practice.

  3. Spoken Dutch.

    Science.gov (United States)

    Bloomfield, Leonard

    This course in spoken Dutch is intended for use in introductory conversational classes. The book is divided into five major parts, each containing five learning units and one unit devoted to review. Each unit contains sections including (1) basic sentences, (2) word study and review of basic sentences, (3) listening comprehension, and (4)…

  4. Spoken Dutch.

    Science.gov (United States)

    Bloomfield, Leonard

    This course in spoken Dutch is intended for use in introductory conversational classes. The book is divided into five major parts, each containing five learning units and one unit devoted to review. Each unit contains sections including (1) basic sentences, (2) word study and review of basic sentences, (3) listening comprehension, and (4)…

  5. Screening for type 2 diabetes in general practice

    NARCIS (Netherlands)

    Janssen, P.G.H.

    2008-01-01

    The presented studies were conducted within the framework of the international ADDITION study (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care), a randomised controlled trial in 3,057 screen-detected type 2 diabetic patients. The aim of ADDITIO

  6. Reimbursement restriction moderately decreases Benzodiazepine use in general practice.

    NARCIS (Netherlands)

    Hoebert, J.M.; Souverein, P.C.; Mantel-Teeuwisse, A.K.; Leufkens, H.G.M.; Dijk, L. van

    2011-01-01

    Problem Statement: On January 1st 2009, benzodiazepines were excluded from the Dutch positive reimbursement list when used as anxiolytic, hypnotic or sedative, to limit misuse and for cost savings. Thus far, the (un)intended effects of this reimbursement restriction are unknown. Objective(s): To ass

  7. Reimbursement restriction moderately decreases benzodiazepine use in general practice.

    NARCIS (Netherlands)

    Hoebert, J.M.; Souverein, P.C.; Mantel, A.K.; Leufkens, B.G.M.; Dijk, L. van

    2011-01-01

    Background: On January 1st 2009, benzodiazepines were excluded from the Dutch positive reimbursement list when used as anxiolytic, hypnotic or sedative, to limit misuse and for cost savings. Thus far, the (un)intended effects of this reimbursement restriction are unknown. Objectives: To assess the i

  8. The uses and implications of standards in general practice consultations

    DEFF Research Database (Denmark)

    Lippert, Maria Laura; Reventlow, Susanne; Kousgaard, Marius Brostrøm

    2017-01-01

    was observed among general practitioners who strictly adhered to the procedural standards on the interactional aspects of care. Thus, when allowed to function as an overall frame for consultations, those standards supported adherence to general recommendations regarding which elements to be included in chronic...... standards for the ‘softer’ aspects of care. This article explores the consequences of both kinds of quality standards for chronic care consultations. The article presents findings from an explorative qualitative field study in Danish general practice where a standardized technology for quality development...... disease consultations. However, at the same time, adherence to those standards was observed to narrow the focus of doctor–patient dialogues and to divert general practitioners’ attention from patients’ personal concerns. Similar consequences of quality standards have previously been framed...

  9. Practical definition of averages of tensors in general relativity

    CERN Document Server

    Boero, Ezequiel F

    2016-01-01

    We present a definition of tensor fields which are average of tensors over a manifold, with a straightforward and natural definition of derivative for the averaged fields; which in turn makes a suitable and practical construction for the study of averages of tensor fields that satisfy differential equations. Although we have in mind applications to general relativity, our presentation is applicable to a general n-dimensional manifold. The definition is based on the integration of scalars constructed from a physically motivated basis, making use of the least amount of geometrical structure. We also present definitions of covariant derivative of the averaged tensors and Lie derivative.

  10. The prevalence of humeral epicondylitis: a survey in general practice

    OpenAIRE

    1986-01-01

    The characteristics of all patients with humeral epicondylitis who presented over a two-year period in a group practice were examined to clarify the epidemiological features of this condition. In all 77 patients were seen. There was no observed difference in incidence between the sexes, lateral epicondylitis being more common than medial in both sexes. Medial epicondylitis is more common in the community than is generally recognized. Epicondylitis is a relapsing condition with a strong bias t...

  11. Prosthodontics in a general practice program of advanced dental education.

    Science.gov (United States)

    Plekavich, E J

    1976-01-01

    The problems involved in teaching prosthodontics in a general practice program outwardly appear to be due to the lack of sufficient basic prosthodontic training dispensed by the dental schools. This lack of sufficient training is not the fault of dental school faculties. The students are not learning what they are taught. What they need is more repetition, which means more time. The problems are not insurmountable. We just must find the route.

  12. Communicating fatigue in general practice and the role of gender

    OpenAIRE

    Meeuwesen, L.; BENSING, J; Brink-Muinen, A. van den

    2002-01-01

    From the viewpoint of quality of care, doctor-patient communication has become more and more important. Gender is an important factor in communication. Besides, cultural norms and values are likely to influence doctor-patient communication as well. This study examined (1) whether or not communication patterns of gender-dyads in general practice consultations differ across and between Western-European countries, and (2) if so, whether these differences continue to exist when controlling for pa...

  13. Impact of an audiology clinic in one general practice.

    Science.gov (United States)

    Khunti, K; Carr, M

    1997-01-01

    There is a large demand for the provision of hearing aids. However, there are lengthy delays involved between referral and fitment of National Health Service (NHS) hearing aids. This report shows that a general practice based audiology clinic can lead to an increase in the number of patients referred and fitted with a hearing aid. The introduction of the clinic also led to reduced waiting times for patients to be fitted with hearing aids. PMID:9474829

  14. Caring for refugees in general practice: perspectives from the coalface.

    Science.gov (United States)

    Farley, Rebecca; Askew, Deborah; Kay, Margaret

    2014-01-01

    This qualitative research project explored the experiences of primary health care providers working with newly arrived refugees in Brisbane. Data from 36 participants (20 general practitioners, five practice nurses and 11 administrative staff) involved in five focus groups and four semi-structured interviews were analysed. The results indicated that despite difficulties, providers are committed and enthusiastic about working with refugees. The flexibility of the general practice setting enables innovative approaches. The establishment of a specialised refugee health service in Brisbane has improved providers' capacity to deliver refugee health care. However, most practices continue to feel isolated as they search for solutions, and the need for greater supports and a more coordinated approach to care were emphasised. The themes of communication, knowledge and practice and health care systems encapsulated the factors that influence health care providers' ability to care for refugees and provide a framework for improving available supports. Australian primary health care is currently undergoing great change, which provides an opportunity to make significant gains in the provision of care for refugees and other minority groups within our community. As health care reforms are implemented it is essential that they are responsive to the expressed needs of health care providers working in these areas.

  15. Implementation of an Arranged Preventive Consultation in Danish General Practice

    DEFF Research Database (Denmark)

    Junge, Anne Gram; Kirkegaard, Pia; Thomsen, Janus Laust

    Background: In 2006 an arranged preventive consultation (0106-service) was implemented in Danish general practice. The purpose of the consultation is an attempt to improve the systematic prevention of the main chronic lifestyle diseases. Aim: This study examines the GP's experiences with the arra...... interaction between the GP/nurse and the patient, and therefore the GPs/nurses can in some respects experience it as difficult to apply the theoretical guidelines of the new consultation to their daily work with the patients.......Background: In 2006 an arranged preventive consultation (0106-service) was implemented in Danish general practice. The purpose of the consultation is an attempt to improve the systematic prevention of the main chronic lifestyle diseases. Aim: This study examines the GP's experiences...... with the arranged preventive consultation with focus on facilitators and barriers in the implementation of the consultation. Material & Method: Semi-structured interviews with 10 GPs and nurses in general practice. Results & Conclusions: Economically lucrative services are not an isolated motivation for the GPs...

  16. Management of acute rhinosinusitis in Danish general practice: a survey

    Directory of Open Access Journals (Sweden)

    Hansen JG

    2011-07-01

    Full Text Available Jens Georg HansenDepartment of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aalborg, DenmarkPurpose: To evaluate whether the ongoing debate over diagnostic problems and treatment choices for acute rhinosinusitis has had any influence on the management of the disease.Methods: We randomly selected 300 Danish general practitioners (GPs from the files of the Research Unit for General Practice at Aarhus University. Invitations to participate and a questionnaire were sent to the GPs by mail.Results: A total of 149 (49% GPs answered the questionnaire. When asked about symptoms, the highest priority was given to sinus pain and signs of tenderness. The most frequent examinations were objective examination of the ear-nose-throat (ENT, palpation of the maxillofacial area, and C-reactive protein point-of-care testing (or CRP rapid test. Nearly all GPs prescribed local vasoconstrictors, and in 70% of cases, antibiotics were prescribed. Phenoxymethylpenicillin was the preferred antibiotic. Use of the CRP rapid test, years in practice, or employment in an ENT department did not have a significant impact on the diagnostic certainty and antibiotic prescribing rate.Conclusion: The clinical diagnoses are based on a few symptoms, signs, and the CRP rapid test. Other examinations, including imaging techniques, are seldom used. Phenoxymethylpenicillin is the preferred antibiotic, and the GPs' diagnostic certainty was 70%.Keywords: general practice, acute rhinosinusitis, diagnosis, treatment, antibiotic

  17. General practice training and virtual communities of practice - a review of the literature

    Directory of Open Access Journals (Sweden)

    Barnett Stephen

    2012-08-01

    Full Text Available Abstract Background Good General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research. Methods Major online databases Scopus, Psychlit and Pubmed were searched for the terms “Community of Practice” (CoP AND (Online OR Virtual OR Electronic AND (health OR healthcare OR medicine OR “Allied Health”. Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training. Results The framework developed by Probst is mirrored in the health literature, albeit with some variations. In particular the roles of facilitator or moderator and leader whilst overlapping, are different. VCoPs are usually collaborations between stakeholders

  18. Dutch perfusion incident survey.

    Science.gov (United States)

    Groenenberg, Ingrid; Weerwind, Patrick W; Everts, Peter A M; Maessen, Jos G

    2010-09-01

    Cardiopulmonary bypass procedures remain complex, involving many potential risks. Therefore, a nationwide retrospective study was conducted to gain insight into the number of incidents and accidents in Dutch adult perfusion practice. An anonymous postal survey (85 questions about hardware, disposables, fluids and medication, air emboli, anticoagulation, practice, and safety measures) was sent to all Dutch perfusionists involved in adult cardiovascular perfusion during 2006 and 2007. To guarantee complete anonymity, respondents were asked to return the survey to a notary who discarded personal information. The net response rate was 72% and covered 23,500 perfusions. Individual respondents performed 240 ± 103 perfusions during the 2-year study period and had 13.8 ± 8.7 years of practical experience. The incident rate was 1 per 15.6 perfusions and the adverse event rate was 1 per 1,236 perfusions. The three most reported incidents were: (1) persistent inability to raise the activated coagulation time above 400s during perfusion (184 incidents); (2) an allergic or anaphylactic reaction to drugs, fluids, or blood products (114 incidents); and (3) clotting formation in the extracorporeal circuit (74 incidents). Furthermore, pre-bypass safety measures showed no statistically significant association with the reported incidents. In comparison with data from the recent literature, the reported number of incidents is high. Nevertheless, the adverse outcome rate is well matched to other published surveys. The relatively high response rate conveys the impression that the Dutch perfusionist is vigilant and willing to report incidents. Hence, a web-based Dutch perfusion incident registration system is recommended.

  19. Chinese hotel general managers' perspectives on energy-saving practices

    Science.gov (United States)

    Zhu, Yidan

    As hotels' concern about sustainability and budget-control is growing steadily, energy-saving issues have become one of the important management concerns hospitality industry face. By executing proper energy-saving practices, previous scholars believed that hotel operation costs can decrease dramatically. Moreover, they believed that conducting energy-saving practices may eventually help the hotel to gain other benefits such as an improved reputation and stronger competitive advantage. The energy-saving issue also has become a critical management problem for the hotel industry in China. Previous research has not investigated energy-saving in China's hotel segment. To achieve a better understanding of the importance of energy-saving, this document attempts to present some insights into China's energy-saving practices in the tourist accommodations sector. Results of the study show the Chinese general managers' attitudes toward energy-saving issues and the differences among the diverse hotel managers who responded to the study. Study results indicate that in China, most of the hotels' energy bills decrease due to the implementation of energy-saving equipments. General managers of hotels in operation for a shorter period of time are typically responsible for making decisions about energy-saving issues; older hotels are used to choosing corporate level concerning to this issue. Larger Chinese hotels generally have official energy-saving usage training sessions for employees, but smaller Chinese hotels sometimes overlook the importance of employee training. The study also found that for the Chinese hospitality industry, energy-saving practices related to electricity are the most efficient and common way to save energy, but older hotels also should pay attention to other ways of saving energy such as water conservation or heating/cooling system.

  20. A Virtual Community of Practice for General Practice Training: A Preimplementation Survey

    OpenAIRE

    Barnett, Stephen; Jones, Sandra C; Bennett, Sue; Iverson, Don; Robinson, Laura

    2016-01-01

    Background Professional isolation is an important factor in low rural health workforce retention. Objective The aim of this study was to gain insights to inform the development of an implementation plan for a virtual community of practice (VCoP) for general practice (GP) training in regional Australia. The study also aimed to assess the applicability of the findings of an existing framework in developing this plan. This included ascertaining the main drivers of usage, or usefulness, of the VC...

  1. Improving communication: a practical programme for teaching trainees about communication issues in the general practice consultation.

    Science.gov (United States)

    Boulton, M; Griffiths, J; Hall, D; McIntyre, M; Oliver, B; Woodward, J

    1984-07-01

    This paper describes a teaching programme, for use in general practice vocational training, which provides a theoretical and practical framework for exploring key aspects of the consultation with trainees. A particular emphasis is on the educational or 'cognitive' outcomes of the consultation and skills for improving them. The five stages of the programme are described and an example of experience of each stage is given. The paper concludes with an evaluation of the programme by the trainers, trainees and social scientist involved.

  2. Process evaluation of a practice nurse-led smoking cessation trial in Australian general practice: views of general practitioners and practice nurses.

    Science.gov (United States)

    Halcomb, Elizabeth J; Furler, John S; Hermiz, Oshana S; Blackberry, Irene D; Smith, Julie P; Richmond, Robyn L; Zwar, Nicholas A

    2015-08-01

    Support in primary care can assist smokers to quit successfully, but there are barriers to general practitioners (GPs) providing this support routinely. Practice nurses (PNs) may be able to effectively take on this role. The aim of this study was to perform a process evaluation of a PN-led smoking cessation intervention being tested in a randomized controlled trial in Australian general practice. Process evaluation was conducted by means of semi-structured telephone interviews with GPs and PNs allocated in the intervention arm (Quit with PN) of the Quit in General Practice trial. Interviews focussed on nurse training, content and implementation of the intervention. Twenty-two PNs and 15 GPs participated in the interviews. The Quit with PN intervention was viewed positively. Most PNs were satisfied with the training and the materials provided. Some challenges in managing patient data and follow-up were identified. The Quit with PN intervention was acceptable to participating PNs and GPs. Issues to be addressed in the planning and wider implementation of future trials of nurse-led intervention in general practice include providing ongoing mentoring support, integration into practice management systems and strategies to promote greater collaboration in GPs and PN teams in general practice. The ongoing feasibility of the intervention was impacted by the funding model supporting PN employment and the competing demands on the PNs time. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Periodontal Treatment Protocol (PTP) for the general dental practice.

    Science.gov (United States)

    Sweeting, Larry A; Davis, Karen; Cobb, Charles M

    2008-10-01

    A sequence of interrelated steps is inherent to effective periodontal treatment: early and accurate diagnosis, comprehensive treatment, and continued periodontal maintenance and monitoring. A primary goal of periodontal therapy is to reduce the burden of pathogenic bacteria and thereby reduce the potential for progressive inflammation and recurrence of disease. Emerging evidence of possible perio-systemic links further reinforces the need for good periodontal health. In the private practice setting, the treatment of patients with periodontal disease is best accomplished within the structure of a uniform and consistent Periodontal Treatment Protocol (PTP). Such a protocol would reinforce accurate and timely diagnosis, treatment needs based on a specific diagnosis, and continual assessment and monitoring of outcomes. This is best achieved if everyone in the practice setting has a general understanding of the etiology of periodontal diseases, the benefits of treatment, and potential consequences of nontreatment. Communication skills and patient education are vital components of effective therapy since slight and even moderate stages of the disease often have few noticeable symptoms to the patient. Accurate documentation and reporting of procedures for dental insurance reimbursement, coupled with scheduling considerations, assist general practice settings in effectively managing the increasing volume of patients that can benefit from early diagnosis and treatment of periodontal diseases. This article presents the essential elements of a PTP including diagnosis, treatment planning, implementation of therapy, assessment and monitoring of therapy, insurance coding, introduction of the patient to periodontal therapy, and enhanced verbal skills. In addition, considerations for implementation of adjunctive local delivery antimicrobials is presented.

  4. Educational assessment of general practice experience for psychiatric trainees.

    Science.gov (United States)

    Burns, T; MacDonald, L; Sibbald, B; Gask, L; Roberts, G

    1995-03-01

    Eighteen psychiatric trainees spent 6 months each as general practice trainees. The educational impact of the experience was assessed by a self-assessment questionnaire, a semi-structured interview and a videotaped interview with a psychiatric patient. Each assessment was conducted at a baseline and after 12 months. A control group of 14 trainees was recruited from the same rotation. On the self-assessment questionnaire, the study registrars rated their abilities to solve general medical problems significantly improved compared to controls. They had also acquired greater understanding of the limitation of their knowledge and their legal responsibilities towards their patients. The semi-structured interview failed to distinguish between the two groups. Videotapes for rating at baseline and follow-up were available for only 17 of the trainees. Assessment of the tapes used the Maguire Scale and the Interview Behaviour Scale. Neither scale demonstrated any intervention effect. The interviews were all characterized by a preponderance of 'closed psychological' and 'checking-out' questions. It appears that psychiatric trainees' interviewing styles had not been influenced by the experience. This study suggests that psychiatric trainees gain greater confidence in their role as a doctor and greater understanding of the scope and nature of general practice by such an attachment. It is unclear whether or not supplementary interviewing skills had been acquired which were not utilized in the taped interview, which conforms very much to traditional psychiatric examination behaviour. Trainees were reassured that they had increased their knowledge without losing any of their specific professional skills.

  5. [General anaesthesia in children: a French survey of practices].

    Science.gov (United States)

    Constant, I; Louvet, N; Guye, M-L; Sabourdin, N

    2012-09-01

    The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France. One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated. There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N(2)O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the

  6. Prevalence of myofascial pain in general internal medicine practice.

    OpenAIRE

    Skootsky, S A; Jaeger, B; Oye, R K

    1989-01-01

    Myofascial pain is a regional pain syndrome characterized in part by a trigger point in a taut band of skeletal muscle and its associated referred pain. We examined a series of 172 patients presenting to a university primary care general internal medicine practice. Of 54 patients whose reason for a visit included pain, 16 (30%) satisfied criteria for a clinical diagnosis of myofascial pain. These patients were similar in age and sex to other patients with pain, and the frequency of pain as a ...

  7. Data Content and Exchange in General Practice: a Review

    Science.gov (United States)

    Kalankesh, Leila R; Farahbakhsh, Mostafa; Rahimi, Niloofar

    2014-01-01

    Background: efficient communication of data is inevitable requirement for general practice. Any issue in data content and its exchange among GP and other related entities hinders continuity of patient care. Methods: literature search for this review was conducted on three electronic databases including Medline, Scopus and Science Direct. Results: through reviewing papers, we extracted information on the GP data content, use cases of GP information exchange, its participants, tools and methods, incentives and barriers. Conclusion: considering importance of data content and exchange for GP systems, it seems that more research is needed to be conducted toward providing a comprehensive framework for data content and exchange in GP systems. PMID:25648317

  8. Response to intravenous midazolam sedation in general dental practice.

    Science.gov (United States)

    Ellis, S

    1996-06-08

    The object of this study was to grade the response of patients undergoing a variety of dental procedures with the aid of intravenous midazolam sedation in general dental practice and to explore any relationships between the patients preoperative anxiety assessment and the clinician's assessment of co-operation whilst under sedation. One hundred consecutive patients aged between 18 and 58 years (mean 32 years; sd 10 years) and in ASA Class I or II were prospectively studied. Results showed that despite attempts to grade patient's behaviour it was not possible to reliably predict patient's responses under intravenous sedation. In addition to these findings, the great individual variation in sensitivity to midazolam was confirmed.

  9. Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

    DEFF Research Database (Denmark)

    Gadegaard Jensen, Anders; Callesen, T; Hagemo, J S;

    2010-01-01

    Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care...... Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients...

  10. Risk Reduction Technologies in General Practice and Social Work

    Directory of Open Access Journals (Sweden)

    Devin Rexvid

    2012-12-01

    Full Text Available General practitioners (GPs and social workers (SWs are professions whose professional autonomy and discretion have changed in the so-called risk and audit society. The aim of this article is to compare GPs’ and SWs’ responses to Evidence-Based and Organizational Risk Reduction Technologies (ERRT and ORRT. It is based on a content analysis of 54 peer-reviewed empirical articles. The results show that both professions held ambivalent positions towards ERRT. The response towards ORRT differed in that GPs were sceptical whilst SWs took a more pragmatic view. Furthermore the results suggest that SWs might experience professional benefits by adopting an adherent approach to the increased dissemination of risk reduction technologies (RRT. GPs, however, did not seem to experience such benefits. Keywords: Profession, risk, social worker, general practitioner, risk reduction technologies, evidence-based practice/medicine 

  11. [Cannabis use: what to do in general practice?].

    Science.gov (United States)

    Benard, Victoire; Rolland, Benjamin; Messaadi, Nassir; Petit, Aymeric; Cottencin, Olivier; Karila, Laurent

    2015-01-01

    Cannabis use is now more frequent than alcohol drinking or tobacco smoking among young people (15-34years), whereas it may induce numerous medical aftermaths. Identifying and assessing cannabis use in general practice have become a current public health issue. The two steps of screening consist in spotting risky use of cannabis, and then in checking criteria for cannabis use disorder (CUD). Risky use requires a "brief intervention" by the general practitioner (GP). In case of CUD, the new DSM-5 criteria allow measuring the severity of the subsequent disorder, and listing the medical and social consequences. Using these criteria can help the GP to decide when the patient should be referred to an addiction-specialized unit. The GP has also to spot the different physical and psychiatric complications of cannabis use, in order to coordinate care between the different specialists.

  12. [Associations with Muslim patients in general practice surgeries--a survey among German general practicioners].

    Science.gov (United States)

    Kronenthaler, A; Hiltner, H; Eissler, M

    2014-07-01

    Due to the increasing numbers of Muslims in Germany(1)--about 4.3 million at the moment--more Muslim patients are medicated in the practices of family doctors. Their heterogeneous cultural and religious backgrounds are nontheless unknown and unfamiliar for the treating general practitioner. Based on the daily experiences of the latter and in order to capture their development of intercultural competence, in the present study a brainwriting with general practitioners was conducted to record their spontaneous associations with Muslim patients. Individually and without exchange 90 general practitioners (66 male, 24 female) listed subjective thoughts regarding "Muslim patients" on a prepared sheet of paper. Additionally, sex, age, number of years as physician in a private practice and the frequency of treatment of Muslim patients in their own practice were requested. The content of the notes were evaluated using MAXQDA and were clustered in the categories of "language", "company", "violence", "men"/"women", "psychosomatic medicine", "compliance", "understanding of illness", "physical examination" and "head scarf". The ideas listed show that the majority of interviewed general practitioners regarded the treatment of Muslim patients as difficult. They associate Muslim patients with communication problems, a different type of disease understanding and a fear of contact, which hampers the examination situation. Less frequently, positive associations and unproblematic examination situations were noted. Due to a lack of knowledge about cultural and religious contexts Muslim patients are often described by using stereotypes. This underlines the necessity to foster intercultural competences and self-reflection in daily practice and its systematic inclusion in medical education. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Practice nurses in general practice: a rapidly growing profession in The Netherlands.

    NARCIS (Netherlands)

    Heiligers, P.J.M.; Noordman, J.; Korevaar, J.; Dorsman, S.W.; Hingstman, L.; Dulmen, S. van; Bakker, D. de

    2012-01-01

    Background: In 1999, nurse practitioners were introduced. The main objectives were to improve quality of care for chronic ill and to reduce workload of general practitioners. In ten years the number of practice nurses has grown tremendously. Meanwhile there are new tasks as a result of aging. Practi

  14. The management of otitis externa in UK general practice.

    Science.gov (United States)

    Pabla, L; Jindal, M; Latif, K

    2012-03-01

    Acute otitis externa is common and provides a heavy workload for general practitioners. We aim to determine the first-line treatment used by general practitioners in the management of otitis externa and subsequent second-line treatment in a hospital ENT clinic. In addition, this study aims to ascertain whether local and national guidelines are being followed appropriately. A prospective observational study on the management of otitis externa in consecutive patients referred to an ENT emergency clinic was undertaken. Data were collected and analysed on symptoms, initial management by general practitioners, findings and treatment in the ENT clinic. A total of 106 patients were studied. The mean duration of symptoms before presentation to clinic was 13 days; 42% of patients received no treatment by their GP prior to referral to the ENT emergency clinic. Only 14% of patients received topical antibiotics alone, whilst 44% received oral antibiotics, either alone or in conjunction with topical antibiotics by their GP. Of the 106 patients, 86% received topical antibiotics in the ENT emergency clinic and oral antibiotics were reserved for those presenting with complicated acute otitis externa. Topical antibiotics are associated with a decrease in disease persistence, whilst oral antibiotics are associated with an increase. However, general practitioners are prescribing oral antibiotics more often than required. There are few regional guidelines and no explicit national guidelines on the management of acute otitis externa for GPs to refer to. We suggest the implementation of national guidelines to aid clinical practice.

  15. Open Access to General Practice Was Associated with Burnout among General Practitioners

    DEFF Research Database (Denmark)

    Vedsted, Peter; Sokolowski, Ineta; Olesen, Frede

    2013-01-01

    Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without....... In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach...... of GPs. In all, 8% of GPs had open access and the prevalence of burnout was 24%. GPs with walk-in open access were more likely to suffer from burnout. Having open access was associated with a 3-fold increased likelihood of burnout (OR = 3.1 (95% CI: 1.1-8.8, P = 0.035)). Although the design cannot...

  16. Striking variations in consultation rates with general practice reveal family influence

    Directory of Open Access Journals (Sweden)

    Spreeuwenberg Peter

    2007-01-01

    Full Text Available Abstract Background The reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. The objective of this study was to explore which family factors can explain the differences between strikingly high, and correspondingly low, family consultation rates in families with children aged up to 21. Methods Data were used from the second Dutch national survey of general practice. This survey extracted from the medical records of 96 practices in the Netherlands, information on all consultations with patients during 2001. We defined, through multilevel analysis, two groups of families. These had respectively, predominantly high, and low, contact frequencies due to a significant family influence upon the frequency of the individual's first contacts. Binomial logistic regression analyses were used to analyse which of the family factors, related to shared circumstances and socialisation conditions, can explain the differences in consultation rates between the two groups of families. Results In almost 3% of all families, individual consultation rates decrease significantly due to family influence. In 11% of the families, individual consultation rates significantly increase due to family influence. While taking into account the health status of family members, family factors can explain family consultation rates. These factors include circumstances such as their economic status and number of children, as well as socialisation conditions such as specific health knowledge and family beliefs. The chance of significant low frequencies of contact due to family influences increases significantly with factors such as, paid employment of parents in the health care sector, low expectations of general practitioners' care for minor ailments and a western cultural background. Conclusion Family

  17. The impact of intervening in green space in Dutch deprived neighbourhoods on physical activity and general health: results from the quasi-experimental URBAN40 study.

    Science.gov (United States)

    Droomers, Mariël; Jongeneel-Grimen, Birthe; Kramer, Daniëlle; de Vries, Sjerp; Kremers, Stef; Bruggink, Jan-Willem; van Oers, Hans; Kunst, Anton E; Stronks, Karien

    2016-02-01

    Many problems concentrate in deprived neighbourhoods, among which is poor health. One possible way to address these health problems is to invest in the green space in deprived neighbourhoods. The number of evaluations of the public health impact of actual changes in neighbourhood green space is still limited. This study investigated the impact of real-life changes in the quality or quantity of green space in severely deprived neighbourhoods on physical activity and perceived general health. Repeated cross-sectional surveys from 2004 till 2011 yielded self-reported information on leisure time walking, cycling and sports, and perceived general health of 48,132 adult residents. We fitted generalised mixed models to assess the rate of change per half year, estimate the linear trend, and the change in trends before and after the start of the urban regeneration mid-2008. Using a quasi-experimental design, we compared the trends in the intervention neighbourhoods with different selections of control areas. The deprived neighbourhoods that intervened in green space did not show more favourable changes in the trend of physical activity and good general health compared to all the different groups of control areas. We did not observe short-term positive effects on physical activity and general health among adults from improvements in green space in deprived neighbourhoods. This suggests that greening interventions that have been carried out in the context of the Dutch District Approach did not achieve short-term health gains among adults. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Adherence to COPD guidelines in general practice: impact of an educational programme delivered on location in Danish general practices.

    Science.gov (United States)

    Ulrik, Charlotte Suppli; Sørensen, Tina Brandt; Højmark, Torben Brunse; Olsen, Kim Rose; Vedsted, Peter

    2013-03-01

    The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD). To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD guidelines. A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted of a 3-hr teaching lesson with a respiratory specialist and five visits by a representative from the sponsoring pharmaceutical company focusing on assessment and management of patients including written algorithms. A one-to-one propensity-matched control group of practices was selected. Register data were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity. Data for 102 participating GP practices were analysed. Participating clinics had a significant increase in preventive consultations and influenza vaccinations (ppractices may improve adherence to COPD guidelines, not least for clinics with a high potential for improvement.

  19. Generalized linear models with coarsened covariates: a practical Bayesian approach.

    Science.gov (United States)

    Johnson, Timothy R; Wiest, Michelle M

    2014-06-01

    Coarsened covariates are a common and sometimes unavoidable phenomenon encountered in statistical modeling. Covariates are coarsened when their values or categories have been grouped. This may be done to protect privacy or to simplify data collection or analysis when researchers are not aware of their drawbacks. Analyses with coarsened covariates based on ad hoc methods can compromise the validity of inferences. One valid method for accounting for a coarsened covariate is to use a marginal likelihood derived by summing or integrating over the unknown realizations of the covariate. However, algorithms for estimation based on this approach can be tedious to program and can be computationally expensive. These are significant obstacles to their use in practice. To overcome these limitations, we show that when expressed as a Bayesian probability model, a generalized linear model with a coarsened covariate can be posed as a tractable missing data problem where the missing data are due to censoring. We also show that this model is amenable to widely available general-purpose software for simulation-based inference for Bayesian probability models, providing researchers a very practical approach for dealing with coarsened covariates.

  20. Poetry in general practice education: perceptions of learners.

    Science.gov (United States)

    Foster, William; Freeman, Elaine

    2008-08-01

    There has been little research into poetry-based medical education. Few studies consider learners' perceptions in depth. To explore general practice registrars' (GPRs) perceptions of two poetry-based sessions. GPRs in one general practice vocational training scheme experienced two poetry sessions. In one, the facilitator selected poems; in the other, poems were chosen by registrars. Poems were read and discussed, with emphasis on personal response. Data were obtained through in-depth semi-structured interviews with six registrars. Interviews were audiotaped, transcribed and analysed using interpretative phenomenological analysis. Identification of individual ideas and shared themes enabled exploration of the registrars' experiences. Registrars described how poetry helped them explore emotional territory. They recognized a broadening of education, describing how poems helped them consider different points of view, increasing their understanding of others. Vicarious experience, development of empathy and self-discovery were also reported. Participants speculated on how this might impact on patient care and professional practice. Facilitator-selected poems provided variety and ambiguity, provoking discussions with clinical relevance. Learner-selected poems enabled involvement, self-revelation and understanding of peers and developed emotional expression. These registrars reported difficulties expressing feelings in the culture of science-based medical training. Poetry sessions may provide an environment for emotional exploration, which could broaden understanding of self and others. Poetry-based education may develop emotional competence. The participants recognized development of key skills including close reading, attentive listening and interpretation of meaning. These skills may help doctors to understand individual patient's unique experience of illness, encouraging personalized care that respects patients' perspectives.

  1. Shareholder voice on executive pay : A decade of Dutch say on pay

    NARCIS (Netherlands)

    van der Elst, Christoph; Lafarre, Anne

    2017-01-01

    The Netherlands adopted shareholders’ say on pay over a decade ago. The general meeting of shareholders must approve the remuneration policy and any amendments to it. This Dutch approach offers fruitful insights into how say on pay works in practice. In the light of the recent European proposal to

  2. Weight management in general practice: what do patients want?

    Science.gov (United States)

    Tan, Daisy; Zwar, Nicholas A; Dennis, Sarah M; Vagholkar, Sanjyot

    2006-07-17

    To explore patients' views of the role of general practitioners in weight management. Waiting-room questionnaire survey, including measurement of height, weight and waist circumference, May-August 2005. 227 patients from five general practices located in metropolitan and rural New South Wales. Patients' views on: the role of GPs in weight management; the usefulness of weight-loss strategies; and the likelihood of following the GP's advice about weight loss. Most patients (78%) felt that GPs had a role in weight management, but only 46% thought that GPs would be able to spend enough time to provide effective weight loss advice. Over 80% of patients perceived advice on healthy eating and physical activity to be useful or very useful, and were likely to follow weight-loss recommendations; 78% were in favour of regular review. Patients indicated they would be less likely to see a dietitian or to attend information sessions, and unlikely to take weight-loss medication. Views of overweight and obese patients were generally similar to those of normal weight patients, but there were significant differences in perceptions of the usefulness of information on weight and weight-related medical conditions, as well as willingness to change lifestyle, possibly reflecting resistance to change among obese or overweight patients. These findings have implications for the design of primary care interventions for managing obesity.

  3. The importance of gender-stratified antibiotic resistance surveillance of unselected uropathogens: a Dutch nationwide extramural surveillance study.

    NARCIS (Netherlands)

    Heijer, C.D.J. den; Penders, J.; Donker, G.A.; Bruggeman, C.A.; Stobberingh, E.E.

    2013-01-01

    Few studies have been performed on urinary tract infections (UTIs) in men. In the present study, general practitioners (n = 42) from the Dutch Sentinel General Practice Network collected urinary samples from 560 male patients (≥18 years) suspected of UTI and recorded prescribed antibiotic treatment.

  4. Routine oral examination: differences in characteristics of Dutch general dental practitioners related to type of recall interval.

    NARCIS (Netherlands)

    Mettes, Th.G.P.H.; Bruers, J.J.M.; Sanden, W.J.M. van der; Verdonschot, E.H.A.M.; Mulder, J.; Grol, R.P.T.M.; Plasschaert, A.J.M.

    2005-01-01

    OBJECTIVES: The aim of this study was to explore differences in behaviour (characteristics and opinions) among general dental practitioners (GDPs), using either a fixed (Fx) or an individualized recall interval (Iv) between successive routine oral examinations (ROEs). METHODS: In the year 2000, data

  5. Are lower urinary tract symptoms associated with cardiovascular disease in the Dutch general population? Results from the Krimpen study

    NARCIS (Netherlands)

    Bouwman, Inge I.; Blanker, Marco H.; Schouten, Boris W. V.; Bohnen, Arthur M.; Nijman, Rien J. M.; van der Heide, Wouter K.; Bosch, J. L. H. Ruud

    To describe the association between lower urinary tract symptoms (LUTS) and cardiovascular diseases (CVD), with adjustment for age and other confounders. We were specifically interested in the possible predictive value of LUTS to the incidence of CVD in the future in the general population. We

  6. Are lower urinary tract symptoms associated with cardiovascular disease in the Dutch general population? Results from the Krimpen study

    NARCIS (Netherlands)

    Bouwman, Inge I.; Blanker, Marco H.; Schouten, Boris W. V.; Bohnen, Arthur M.; Nijman, Rien J. M.; van der Heide, Wouter K.; Bosch, J. L. H. Ruud

    PURPOSE: To describe the association between lower urinary tract symptoms (LUTS) and cardiovascular diseases (CVD), with adjustment for age and other confounders. We were specifically interested in the possible predictive value of LUTS to the incidence of CVD in the future in the general population.

  7. Dealing with uncertainty in general practice: an essential skill for the general practitioner.

    Science.gov (United States)

    O'Riordan, Margaret; Dahinden, André; Aktürk, Zekeriya; Ortiz, José Miguel Bueno; Dağdeviren, Nezih; Elwyn, Glyn; Micallef, Adrian; Murtonen, Mikko; Samuelson, Marianne; Struk, Per; Tayar, Danny; Thesen, Janecke

    2011-01-01

    Many patients attending general practice do not have an obvious diagnosis at presentation. Skills to deal with uncertainty are particularly important in general practice as undifferentiated and unorganised problems are a common challenge for general practitioners (GPs). This paper describes the management of uncertainty as an essential skill which should be included in educational programmes for both trainee and established GPs. Philosophers, psychologists and sociologists use different approaches to the conceptualisation of managing uncertainty. The literature on dealing with uncertainty focuses largely on identifying relevant evidence and decision making. Existing models of the consultation should be improved in order to understand consultations involving uncertainty. An alternative approach focusing on shared decision making and understanding the consultation from the patient's perspective is suggested. A good doctor-patient relationship is vital, creating trust and mutual respect, developed over time with good communication skills. Evidence-based medicine should be used, including discussion of probabilities where available. Trainers need to be aware of their own use of heuristics as they act as role models for trainees. Expression of feelings by trainees should be encouraged and acknowledged by trainers as a useful tool in dealing with uncertainty. Skills to deal with uncertainty should be regarded as quality improvement tools and included in educational programmes involving both trainee and established GPs.

  8. Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Beurskens Anna J

    2007-10-01

    Full Text Available Abstract Background Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation. A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain. This trial investigates whether mental practice can contribute to a quicker and/or better recovery of stroke in two Dutch nursing homes. The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual. In addition, we will investigate prognostic variables and feasibility (process evaluation. Methods A randomised, controlled, observer masked prospective trial will be conducted with adult stroke patients in the (subacute phase of stroke recovery. Over a six weeks intervention period the control group will receive multi professional therapy as usual. Patients in the experimental group will be instructed how to perform mental practice, and will receive care as usual in which mental practice is embedded in physical, occupation and speech therapy sessions. Outcome will be assessed at six weeks and six months. The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale. Secondary outcomes are: Motricity Index, Nine Hole Peg Test, Barthel Index, Timed up and Go, 10 metres walking test, Rivermead Mobility Index. A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility. All patients are asked to keep a log to determine unguided training intensity. Discussion Advantages and disadvantages of several aspects of the chosen design are discussed. Trial registration ISRCTN27582267

  9. High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands.

    NARCIS (Netherlands)

    Hombergh, P. van den; Kunzi, B.; Elwyn, G.; Doremalen, J.H.M. van; Akkermans, R.P.; Grol, R.P.T.M.; Wensing, M.J.P.

    2009-01-01

    BACKGROUND: The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. METHODS: Secondary analysis of data fr

  10. Adherence to cancer treatment guidelines: influence of general and cancer-specific guideline characteristics.

    NARCIS (Netherlands)

    Heins, M.J.; Jong, J.D. de; Spronk, I.; Ho, V.K.; Brink, M.; Korevaar, J.C.

    2016-01-01

    Background: Guideline adherence remains a challenge in clinical practice, despite guidelines’ ascribed potential to improve patient outcomes. We studied the level of adherence to recommendations from Dutch national cancer treatment guidelines, and the influence of general and

  11. Determinants related to gender differences in general practice utilization

    DEFF Research Database (Denmark)

    Jørgensen, Jeanette Therming; Andersen, John Sahl; Tjønneland, Anne

    2016-01-01

    OBJECTIVE: This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50-65 years. DESIGN: Cohort-based cross-sectional study. SETTING: Danish general practice. SUBJECTS: Totally, 54,849 participants of the Danish Diet, Cancer...... explain a large proportion, but not all of the gender difference in GP utilization. Medical conditions (somatic and mental) and unemployment are the main determinants of GP utilization in men and women, while lifestyle has minor effect. Key points: Female gender remained a dominant determinant of GP...... utilization, after adjustment for lifestyle, socio-demography, medical and gender specific factors, with females consulting their GP 18% more often than males. Female reproductive factors (use of postmenopausal hormone therapy and gravidity) explained a large proportion of the gender variation in use of GP...

  12. Implementing portfolio in postgraduate general practice training. Benefits and recommendations.

    Science.gov (United States)

    Alotaibi, Fawaz S

    2012-10-01

    This paper presents a review to explore the literature focusing on portfolio in postgraduate general practice (GP) training, and to examine the impact of implementation of portfolio on learning process, as well as proposing recommendations for its implementation in postgraduate GP training. An electronic search was carried out on several databases for studies addressing portfolio in postgraduate GP training. Six articles were included to address specifically the effectiveness of portfolio in postgraduate GP training. Five of them described successful experiences of portfolio-based learning implementation. Only one article addressed portfolio-based assessment in postgraduate GP training. The existing evidence provides various benefits of professional portfolio-based learning. It does appear to have advantages of stimulating reflective learning, promoting proactive learning, and bridging the hospital experiences of the learners to GP. Moreover, the challenges to implementation of portfolio-based learning are often based on orientation and training of stakeholders.

  13. The motivation to teach as a registrar in general practice.

    Science.gov (United States)

    Thampy, Harish; Agius, Steven; Allery, Lynne A

    2013-07-01

    The General Medical Council (GMC) states that teaching should be an integral part of the doctor's role and the Royal College of General Practitioners (RCGP) have incorporated teaching outcomes into the GP training curriculum. However, there are suggestions that the teaching role of a GP trainee declines as they move from hospital posts to the registrar community year. Using doctors in training as near-peer tutors offers multiple advantages. Trainees themselves benefit as teaching others is a strong driver of the tutor's own learning. In addition there are also practical incentives to mobilising this under-utilised pool of primary care clinical teachers given the continuing shift of focusing medical education in the community. This study forms part of a larger body of work exploring the attitudes and perceived learning needs of GP registrars with regards to developing a teaching role. A primary area of investigation was trainees' motivation to teach. This paper describes our attempts to establish: a) how strongly motivated are GP registrars to take on teaching roles? b) in consequence how strongly motivated are they to learn more about teaching? c) what are the factors which affect motivation to teach? Three themes emerged from the data. First, teaching was felt to be of low priority in comparison to competing clinical learning needs. Secondly, the clinical dominance to both formative and summative assessment during training further compounded this situation. Thirdly, registrars identified a number of practical barriers and incentives that influenced their teaching engagement. This included potential negative views from trainers as to their trainee's ability and requirement to be involved with teaching activities.By understanding and addressing these issues, it is hoped that GP trainees' engagement with teaching activities can be better engendered with subsequent benefits for both the trainee and those they teach.

  14. Sampling in forests for radionuclide analysis. General and practical guidance

    Energy Technology Data Exchange (ETDEWEB)

    Aro, Lasse (Finnish Forest Research Inst. (METLA) (Finland)); Plamboeck, Agneta H. (Swedish Defence Research Agency (FOI) (Sweden)); Rantavaara, Aino; Vetikko, Virve (Radiation and Nuclear Safety Authority (STUK) (Finland)); Straalberg, Elisabeth (Inst. Energy Technology (IFE) (Norway))

    2009-01-15

    The NKS project FOREST was established to prepare a guide for sampling in forest ecosystems for radionuclide analysis. The aim of this guide is to improve the reliability of datasets generated in future studies by promoting the use of consistent, recommended practices, thorough documentation of field sampling regimes and robust preparation of samples from the forest ecosystem. The guide covers general aims of sampling, the description of major compartments of the forest ecosystem and outlines key factors to consider when planning sampling campaigns for radioecological field studies in forests. Recommended and known sampling methods for various sample types are also compiled and presented. The guide focuses on sampling practices that are applicable in various types of boreal forests, robust descriptions of sampling sites, and documentation of the origin and details of individual samples. The guide is intended for scientists, students, forestry experts and technicians who appreciate the need to use sound sampling procedures in forest radioecological projects. The guide will hopefully encourage readers to participate in field studies and sampling campaigns, using robust techniques, thereby fostering competence in sampling. (au)

  15. Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice

    NARCIS (Netherlands)

    Dillen, van S.; Noordman, J.; Dulmen, van S.; Hiddink, G.J.

    2015-01-01

    Objective Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight

  16. Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice

    NARCIS (Netherlands)

    Dillen, S.M. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.

    2015-01-01

    OBJECTIVE: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight

  17. Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice.

    NARCIS (Netherlands)

    Dillen, S.M.E. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.

    2015-01-01

    Objective: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight

  18. Expanding access to rheumatology care: the rheumatology general practice toolbox.

    Science.gov (United States)

    Conway, R; Kavanagh, R; Coughlan, R J; Carey, J J

    2015-02-01

    Management guidelines for many rheumatic diseases are published in specialty rheumatology literature but rarely in general medical journals. Musculoskeletal disorders comprise 14% of all consultations in primary care. Formal post-graduate training in rheumatology is limited or absent for many primary care practitioners. Primary care practitioners can be trained to effectively treat complex diseases and have expressed a preference for interactive educational courses. The Rheumatology General Practice (GP) Toolbox is an intensive one day course designed to offer up to date information to primary care practitioners on the latest diagnostic and treatment guidelines for seven common rheumatic diseases. The course structure involves a short lecture on each topic and workshops on arthrocentesis, joint injection and DXA interpretation. Participants evaluated their knowledge and educational experience before, during and after the course. Thirty-two primary care practitioners attended, who had a median of 13 (IQR 6.5, 20) years experience in their specialty. The median number of educational symposia attended in the previous 5 years was 10 (IQR-5, 22.5), with a median of 0 (IQR 0, 1) in rheumatology. All respondents agreed that the course format was appropriate. Numerical improvements were demonstrated in participant's confidence in diagnosing and managing all seven common rheumatologic conditions, with statistically significant improvements (p Rheumatology Toolbox is an effective educational method for disseminating current knowledge in rheumatology to primary care physicians and improved participant's self-assessed competence in diagnosis and management of common rheumatic diseases.

  19. A study of the safety of tenoxicam in general practice.

    Science.gov (United States)

    Caughey, D; Waterworth, R F

    1989-11-08

    An open, noncomparative study was undertaken to examine the safety of tenoxicam, a new nonsteroidal antiinflammatory drug (NSAID) in general practice. One thousand two hundred and sixty-seven patients with rheumatic conditions were recruited by 392 general practitioners throughout New Zealand. Forty-three point six percent of patients recruited were over 65 years of age, 62.5% had some form of concomitant disease and 76.3% of patients were already receiving NSAIDs. Three hundred and four (23.9%) patients experienced adverse drug reactions, the commonest being gastrointestinal (11.4%), central and peripheral nervous system disorders (2.8%) and skin reactions (2.5%). The profile of adverse drug reactions in those more than 65 was similar to those in patients under 65 years. Of the reactions reported, 14.7% were considered severe. Three peptic ulcers were reported. There were no unexpected adverse drug reactions. Eight hundred and forty-nine patients completed 6 months treatment. Subjective assessments of overall efficacy, pain at night, pain on movement and stiffness made before treatment and at 1, 3 and 6 months posttreatment showed that tenoxicam significantly improved all parameters. The clinical response was maintained throughout the 6 month study period and was not different in patients less than or greater than 65 years.

  20. The role of culture in the general practice consultation process.

    Science.gov (United States)

    Ali, Nasreen; Atkin, Karl; Neal, Richard

    2006-11-01

    In this paper, we will examine the importance of culture and ethnicity in the general practice consultation process. Good communication is associated with positive health outcomes. We will, by presenting qualitative material from an empirical study, examine the way in which communication within the context of a general practitioner (GP) consultation may be affected by ethnicity and cultural factors. The aim of the study was to provide a detailed understanding of the ways in which white and South Asian patients communicate with white GPs and to explore any similarities and differences in communication. This paper reports on South Asian and white patients' explanations of recent videotaped consultations with their GP. We specifically focus on the ways in which issues of ethnic identity impacted upon the GP consultation process, by exploring how our sample of predominantly white GPs interacted with their South Asian patients and the extent to which the GP listened to the patients' needs, gave patients information, engaged in social conversation and showed friendliness. We then go on to examine patients' suggestions on improvements (if any) to the consultation. We conclude, by showing how a non-essentialist understanding of culture helps to comprehend the consultation process when the patients are from Great Britain's ethnicised communities. Our findings, however, raise generic issues of relevance to all multi-racial and multi-ethnic societies.

  1. Best Practice Guidelines for the Use of Next-Generation Sequencing Applications in Genome Diagnostics : A National Collaborative Study of Dutch Genome Diagnostic Laboratories

    NARCIS (Netherlands)

    Weiss, Marjan M.; Van der Zwaag, Bert; Jongbloed, Jan D. H.; Vogel, Maartje J.; Bruggenwirth, Hennie T.; Deprez, Ronald H. Lekanne; Mook, Olaf; Ruivenkamp, Claudia A. L.; van Slegtenhorst, Marjon A.; van den Wijngaard, Arthur; Waisfisz, Quinten; Nelen, Marcel R.; van der Stoep, Nienke

    2013-01-01

    Next-generation sequencing (NGS) methods are being adopted by genome diagnostics laboratories worldwide. However, implementing NGS-based tests according to diagnostic standards is a challenge for individual laboratories. To facilitate the implementation of NGS in Dutch laboratories, the Dutch Societ

  2. The importance of gender of patients and general practitioners in relation to treatment practices for overweight

    DEFF Research Database (Denmark)

    Rohde, Jeanett Friis; Hessner, Marie Vik; Lous, Jørgen

    2014-01-01

    and treatment practices among Danish general practitioners (GPs), in relation to treatment of overweight, while taking gender of both the patients and practitioners into account. DESIGN: Questionnaire inventory covertly examining attitudes and practices among Danish general practitioners towards treatment...

  3. Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer.

    NARCIS (Netherlands)

    Poels, P.J.E.; Schermer, T.R.J.; Jacobs, A.; Akkermans, R.P.; Hartman, J.; Bottema, B.J.A.M.; Weel, C. van

    2006-01-01

    OBJECTIVE: To explore spirometry utilization among general practitioners and identify practitioner and practice-related factors associated with spirometry utilization. DESIGN: Multivariate multilevel cross-sectional analysis of a questionnaire survey. SETTING: Some 61 general practices involved in a

  4. Variation in examination and treatment offers to patients with allergic diseases in general practice

    DEFF Research Database (Denmark)

    Hansen, Dorte Gilså; Jarbøl, Dorte Ejg; Munck, Anders Peter

    2010-01-01

    BACKGROUND: Knowledge about practice characteristics associated with the spectrum of examination and treatment offered in general practice are important for organisational planning. We aimed to analyse physician and practice characteristics associated with examination and treatment offered in gen...

  5. Cross-cultural differences in the practices of hotel managers: A study of Dutch and Belgian hotel managers

    NARCIS (Netherlands)

    M. Jansen-Verbeke (Myriam)

    1996-01-01

    textabstractIn the service sector there has been debate and research on whether it is the culture of the organization or that of the location that shapes hotel management practice - particularly given the internationalization of certain, mostly US-style practices. Here Myriam Jansen-Verbeke and Lies

  6. Cross-cultural differences in the practices of hotel managers: A study of Dutch and Belgian hotel managers

    NARCIS (Netherlands)

    M. Jansen-Verbeke (Myriam)

    1996-01-01

    textabstractIn the service sector there has been debate and research on whether it is the culture of the organization or that of the location that shapes hotel management practice - particularly given the internationalization of certain, mostly US-style practices. Here Myriam Jansen-Verbeke and

  7. Cross-cultural differences in the practices of hotel managers: A study of Dutch and Belgian hotel managers

    NARCIS (Netherlands)

    M. Jansen-Verbeke (Myriam)

    1996-01-01

    textabstractIn the service sector there has been debate and research on whether it is the culture of the organization or that of the location that shapes hotel management practice - particularly given the internationalization of certain, mostly US-style practices. Here Myriam Jansen-Verbeke and Lies

  8. Pedagogical context of practical dance classes in higher education: A case of Dutch choreography and technique teachers

    NARCIS (Netherlands)

    Leijen, Ä.; Wildschut, E.M.M.; Admiraal, W.; Simons, P.R.J.

    2006-01-01

    The aim of the study was to identify, which features of the pedagogical context in practical dance classes could be viewed as the basis for developing a suitable web-based ICT application. The sample consisted of 20 practical dance teachers from four Dance Academies in the Netherlands. Data about th

  9. The identification of the general practice registrar needing assistance

    Directory of Open Access Journals (Sweden)

    Gladman G

    2011-06-01

    Full Text Available BackgroundDoctors undertaking vocational training in general practicein Australia may require assistance, in addition to thenormal training offered as part of their training programme.Issues requiring assistance may go undetected for a periodof time. Delay in the identification of issues leads to delay inthe provision of the assistance. The aim of this study is todetermine the most common reasons registrars requireextra assistance, and how these issues are identified. Thefindings of this study will provide direction for 21 regionallybased training providers (RTPs to develop improved toolsto ensure earlier detection of registrars requiring assistance.MethodThis study is based on qualitative research methods, usingsemi-structured interviews with senior medical educationstaff of four regional general practice training providers inVictoria, Australia.ResultsIssues identified included language and cultural issues,applied knowledge and skills, attitude and professionalism,and health and family issues.The principal method that training providers identifiedissues was via the GP supervisor. This was predominantly byinformal communication, rather than formal evaluationsheets. Other methods included the external clinicalteaching visit and other training formative assessments.These more formalised procedures were more likely toidentify issues later than desired. They were also used as away of clarifying suspected problems. The selection processwas not felt to be helpful, and the examinations providedinformation too late.ConclusionAn increased awareness of the potential issues leading to aregistrar to require assistance enables identification andsubsequent action to occur in a more timely and moreuseful fashion. Informal communication between practicesand training programme staff should be encouraged toenable these issues to be dealt with early in training.

  10. Impact of social prescribing on general practice workload and polypharmacy.

    Science.gov (United States)

    Loftus, A M; McCauley, F; McCarron, M O

    2017-07-01

    Social prescribing has emerged as a useful tool for helping patients overcome some of the social and behavioural determinants of poor health. There has been little research on the impact of social prescribing on use of primary healthcare resources. This study sought to determine whether social prescribing activities influenced patient-general practitioner (GP) contacts and polypharmacy. Quality-improvement design with social prescribing activity interventions from an urban general practice in Northern Ireland. Patients over 65 years of age with a chronic condition who attended their GP frequently or had multiple medications were offered a social prescribing activity. Participants' contacts with GP and the new repeat prescriptions before and during the social prescribing activity were measured. The total number of repeat prescriptions per patient was compared at the time of referral and 6-12 months later. Indications for referral, primary diagnoses and reasons for declining participation in a social prescribing activity after referral were prospectively recorded. Sixty-eight patients agreed to participate but only 28 (41%) engaged in a prescribed social activity. There was no statistically significant difference in GP contacts (visits to GP, home visits or telephone calls) or number of new repeat prescriptions between referral and completion of 12 weeks of social prescribing activity. Similarly there was no statistically significant difference in the total number of repeat prescriptions between referral and 6-12 months after social prescribing activity in either intention to treat or per protocol analyses. Social prescribing participants had similar demographic factors. Mental health issues (anxiety and/or depression) were more common among participants than those who were referred but declined participation in a social prescribing activity (P = 0.022). While social prescribing may help patients' self-esteem and well-being, it may not decrease GP workload. Further

  11. Expanding access to rheumatology care: the rheumatology general practice toolbox.

    LENUS (Irish Health Repository)

    Conway, R

    2015-02-01

    Management guidelines for many rheumatic diseases are published in specialty rheumatology literature but rarely in general medical journals. Musculoskeletal disorders comprise 14% of all consultations in primary care. Formal post-graduate training in rheumatology is limited or absent for many primary care practitioners. Primary care practitioners can be trained to effectively treat complex diseases and have expressed a preference for interactive educational courses. The Rheumatology General Practice (GP) Toolbox is an intensive one day course designed to offer up to date information to primary care practitioners on the latest diagnostic and treatment guidelines for seven common rheumatic diseases. The course structure involves a short lecture on each topic and workshops on arthrocentesis, joint injection and DXA interpretation. Participants evaluated their knowledge and educational experience before, during and after the course. Thirty-two primary care practitioners attended, who had a median of 13 (IQR 6.5, 20) years experience in their specialty. The median number of educational symposia attended in the previous 5 years was 10 (IQR-5, 22.5), with a median of 0 (IQR 0, 1) in rheumatology. All respondents agreed that the course format was appropriate. Numerical improvements were demonstrated in participant\\'s confidence in diagnosing and managing all seven common rheumatologic conditions, with statistically significant improvements (p < 0.05) in 11 of the 14 aspects assessed. The Rheumatology Toolbox is an effective educational method for disseminating current knowledge in rheumatology to primary care physicians and improved participant\\'s self-assessed competence in diagnosis and management of common rheumatic diseases.

  12. Internalizing sustainable practices: A configurational approach on sustainable forest management of the Dutch wood trade and timber industry

    NARCIS (Netherlands)

    Chappin, M.M.H.; Cambre, Bart; Vermeulen, Patrick; Lozano, R.

    2015-01-01

    A number of environmental labels and certificates have been developed to inform consumers of the environmental impacts. This paper explored different configurations of institutional and organizational conditions for the internalization of sustainable practices. For the institutional conditions the l

  13. Internalizing sustainable practices: a configurational approach on sustainable forest management of the Dutch wood trade and timber industry

    NARCIS (Netherlands)

    Chappin, M.; Cambré, B.; Vermeulen, P.A.M.; Lozano, R.

    2015-01-01

    A number of environmental labels and certificates have been developed to inform consumers of the environmental impacts. This paper explored different configurations of institutional and organizational conditions for the internalization of sustainable practices. For the institutional conditions the l

  14. The existential dimension in general practice: identifying understandings and experiences of general practitioners in Denmark.

    Science.gov (United States)

    Assing Hvidt, Elisabeth; Søndergaard, Jens; Ammentorp, Jette; Bjerrum, Lars; Gilså Hansen, Dorte; Olesen, Frede; Pedersen, Susanne S; Timm, Helle; Timmermann, Connie; Hvidt, Niels Christian

    2016-12-01

    The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP-patient encounter. A qualitative methodology with semi-structured focus group interviews was employed. General practice setting in Denmark. Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews. Although understood to involve broad life conditions such as present and future being and identity, connectedness to a society and to other people, the existential dimension was primarily reported integrated in connection with life-threatening diseases and death. Furthermore, integration of the existential dimension was characterized as unsystematic and intuitive. Communication about religious or spiritual questions was mostly avoided by GPs due to shyness and perceived lack of expertise. GPs also reported infrequent referrals of patients to chaplains. GPs integrate issues related to the existential dimension in implicit and non-standardized ways and are hindered by cultural barriers. As a way to enhance a practice culture in which GPs pay more explicit attention to the patients' multidimensional concerns, opportunities for professional development could be offered (courses or seminars) that focus on mutual sharing of existential reflections, ideas and communication competencies. Key points Although integration of the existential dimension is recommended for patient care in general practice, little is known about GPs' understanding and integration of this dimension in the GP-patient encounter. The existential dimension is understood to involve broad and universal life conditions having no explicit reference to spiritual or religious aspects. The integration of the existential dimension is delimited to patient cases where life-threatening diseases, life crises and unexplainable patient

  15. Assessment of general education teachers' Tier 1 classroom practices: contemporary science, practice, and policy.

    Science.gov (United States)

    Reddy, Linda A; Fabiano, Gregory A; Jimerson, Shane R

    2013-12-01

    Progress monitoring is a type of formative assessment. Most work on progress monitoring in elementary school settings has been focused on students. However, teachers also can benefit from frequent evaluations. Research addressing teacher progress monitoring is critically important given the recent national focus on teacher evaluation and effectiveness. This special topic section of School Psychology Quarterly is the first to showcase the current research on measuring Tier 1 instructional and behavioral management practices used by prekindergarten and elementary school teachers in general education settings. The three studies included in the special section describe the development and validation efforts of several teacher observational and self-report measures of instruction and/or behavioral management. These studies provide evidence for the utility of such assessments for documenting the use of classroom practices, and these assessment results may be leveraged in innovative coaching models to promote best practice. These articles also offer insight and ideas for the next generation of teacher practice assessment for the field. Finally, the special topic is capped by a commentary synthesizing the current work and offers "big ideas" for future measurement development, policy, and professional development initiatives. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  16. Bion's 'protomental system' and psychosomatic illness in general practice.

    Science.gov (United States)

    Sanders, K

    1984-06-01

    The work of Wilfred Bion, developing the psychoanalytic theories of Freud and Klein on the origins of anxiety in childhood, includes the hypothesis of a protomental system. This he defined as a matrix in the human organism in which physical and mental are at first undifferentiated. His postulate is that this system which equips human beings for life in a group is in conflict with their needs as individuals. The view of the world mediated by basic assumptions, relatively mindless, functioning by unconscious common consent, has a close association with psychosomatic illness. But individuals feel the need for a working relationship with others, where thought can be applied to problems before taking action. Within the family--a special case of a work group--the continuing experience by the infant of parental containment of its anxieties, through a process of projection and introjection, develops its capacity for thinking about frustration rather than evading it. The hypothesis is, that without this experience, frustration may lead to basic assumption mentality and psychosomatic illness rather than emotionality and thought. These ideas have been found useful in general practice as in the five cases described.

  17. Nutrition Knowledge, Attitudes, and Confidence of Australian General Practice Registrars

    Directory of Open Access Journals (Sweden)

    Caryl A. Nowson

    2015-01-01

    Full Text Available Nutrition knowledge, attitudes, and confidence were assessed in General Practice Registrars (GPRs throughout Australia. Of approximately 6,000 GPRs invited to complete a nutrition survey, 93 respondents (2% completed the online survey, with 89 (20 males, 69 females providing demographic and educational information. Fifty-one percent had graduated from medical school within the last two years. From a list of 11 dietary strategies to reduce cardiovascular risk, respondents selected weight loss (84%, reducing saturated fats (90%, a maximum of two alcoholic drinks/day (82%, and increasing vegetables (83% as “highly appropriate” strategies, with only 51% indicating that salt reduction was “highly appropriate.” Two-thirds of registrars felt “moderately” (51% or “very” confident (16% providing nutrition advice. Most of them (84% recalled receiving information during training, but only 34% recalled having to demonstrate nutritional knowledge. The results indicate that this group of Australian GPRs understood most of the key dietary recommendations for reducing cardiovascular risk but lacked consensus regarding the recommendation to reduce salt intake and expressed mixed levels of confidence in providing nutritional advice. Appropriate nutrition education before and after graduation is recommended for GPRs to ensure the development of skills and confidence to support patients to make healthy dietary choices and help prevent chronic diseases.

  18. Description of a practice model for pharmacist medication review in a general practice setting

    DEFF Research Database (Denmark)

    Brandt, Mette; Hallas, Jesper; Hansen, Trine Graabæk;

    2014-01-01

    BACKGROUND: Practical descriptions of procedures used for pharmacists' medication reviews are sparse. OBJECTIVE: To describe a model for medication review by pharmacists tailored to a general practice setting. METHODS: A stepwise model is described. The model is based on data from the medical chart...... and clinical or laboratory data. The medication review focuses on the diagnoses of the patient instead of the individual drugs. Patient interviews are not part of the model. The model was tested in a pilot study by conducting medical reviews on 50 polypharmacy patients (i.e. receiving 7 or more drugs...... concerned the reporting of interventions and the considerations of the GPs. 208 interventions were proposed among the 50 patients. The acceptance rate among the GPs was 82%. The most common interventions were lack of clinical or laboratory data (n=57, 27%) and drugs that should be discontinued as they had...

  19. Dutch museum marks Einstein anniversary

    Science.gov (United States)

    van Calmthout, Matijn

    2016-01-01

    A new painting of Albert Einstein's field equation from his 1915 general theory of relativity was unveiled in a ceremony in November 2015 by the Dutch physicist Robbert Dijkgraaf, who is director of the Princeton Institute for Advanced Study in the US.

  20. Organisational development in general practice: lessons from practice and professional development plans (PPDPs

    Directory of Open Access Journals (Sweden)

    Hocking Paul

    2000-12-01

    Full Text Available Abstract Background Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. Results Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development and education (self-directed adult learning theories and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4 where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of

  1. Organisational development in general practice: lessons from practice and professional development plans (PPDPs)

    Science.gov (United States)

    Elwyn, Glyn; Hocking, Paul

    2000-01-01

    Background Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices) that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. Results Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development) and education (self-directed adult learning theories) and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4) where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of introducing expert external

  2. Patterns of healthcare utilization in patients with generalized anxiety disorder in general practice in Germany

    Directory of Open Access Journals (Sweden)

    Ariel Berger

    2009-06-01

    Full Text Available Background and Objectives: To describe patterns of healthcare utilization among patients with generalized anxiety disorder (GAD in general practitioner (GP settings in Germany. Methods: Using a large computerized database with information from GP practices across Germany, we identified all patients, aged > 18 years, with diagnoses of, or prescriptions for, GAD (ICD-10 diagnosis code F41.1 between October 1, 2003 and September 30, 2004 ("GAD patients". We also constituted an age- and sex-matched comparison group, consisting of randomly selected patients without any GP encounters or prescriptions for anxiety or depression (a common comorbidity in GAD during the same period. GAD patients were then compared to those in the matched comparison group over the one-year study period. Results: The study sample consisted of 3340 GAD patients and an equal number of matched comparators. Mean age was 53.2 years; 66.3% were women. Over the 12-month study period, GAD patients were more likely than matched comparators to have encounters for various comorbidities, including sleep disorders (odds ratio [OR] = 6.75 [95% CI = 5.31, 8.57], substance abuse disorders (3.91 [2.89, 5.28], and digestive system disorders (2.62 [2.36, 2.91] (all p <0.01. GAD patients averaged 5.6 more GP encounters (10.5 [SD = 8.8] vs 4.9 [5.7] for comparison group and 1.4 more specialist referrals (2.3 [2.9] vs 0.9 [1.7] (both p <0.01. Only 58.3% of GAD patients received some type of psychotropic medication (i.e., benzodiazepines, antidepressants, and/or sedatives/hypnotics. Conclusions: Patients with GAD in GP practices in Germany have more clinically recognized comorbidities and higher levels of healthcare utilization than patients without anxiety or depression.

  3. Biomedicine, holism and general medical practice: responses to the 2004 General Practitioner contract.

    Science.gov (United States)

    Checkland, Kath; Harrison, Stephen; McDonald, Ruth; Grant, Suzanne; Campbell, Stephen; Guthrie, Bruce

    2008-07-01

    In 2004 a new contract was introduced for General Practitioners in the UK, which introduced a significant element of 'pay-for-performance', including both clinical and organisational targets. The introduction of this contract has caused interest across the world, particularly amongst those responsible for commissioning primary care services. It can be argued that the clinical targets in the contract (known as the Quality and Outcomes Framework, QOF) represent a move towards a more biomedical model of health and illness, which is contrary to the ideal of providing holistic (or biopsychosocial) care that has been traditionally espoused by GPs. This paper reports results from two linked studies (in England and Scotland) investigating the early stages of the new contract. We describe the way in which four practices with different organisational approaches and espoused identities have all changed their practice structures, consultations and clinical care in response to QOF in ways which will result in patients receiving a more biomedical type of care. In spite of these observed changes, respondents continued to maintain discursive claims to holism. We discuss how this disconnection between rhetoric and reality can be maintained, and consider its implications for the future development of GPs' claims to a professional identity.

  4. Influence of population and general practice characteristics on prescribing of minor tranquilisers in primary care

    Directory of Open Access Journals (Sweden)

    Wagner AC

    2010-09-01

    Full Text Available Prevalence of generalised anxiety disorders is widespread in Great Britain. Previous small-scale research has shown variations in minor tranquiliser prescribing, identifying several potential predictors of prescribing volume. Objective: This study aimed to investigate the relationship between general practice minor tranquiliser prescribing rates and practice population and general practice characteristics for all general practices in England.Methods: Multiple regression analysis of minor tranquiliser prescribing volumes during 2004/2005 for 8,291 English general practices with general practice and population variables obtained from the General Medical Services (GMS statistics, Quality and Outcomes Framework (QOF, 2001 Census and 2004 Index of Multiple Deprivation (IMD. Results: The highest rates of minor tranquiliser prescribing were in areas with the greatest local deprivation while general practices situated in areas with larger proportions of residents of black ethnic origin had lower rates of prescribing. Other predictors of increased prescribing were general practices with older general practitioners and general practices with older registered practice populations.Conclusion: Our findings show that there is wide variation of minor tranquilisers prescribing across England which has implications regarding access to treatment and inequity of service provision. Future research should determine the barriers to equitable prescribing amongst general practices serving larger populations of black ethnic origin.

  5. A spatial analysis of the expanding roles of nurses in general practice

    Directory of Open Access Journals (Sweden)

    Pearce Christopher

    2012-08-01

    Full Text Available Abstract Background Changes to the workforce and organisation of general practice are occurring rapidly in response to the Australian health care reform agenda, and the changing nature of the medical profession. In particular, the last five years has seen the rapid introduction and expansion of a nursing workforce in Australian general practices. This potentially creates pressures on current infrastructure in general practice. Method This study used a mixed methods, ‘rapid appraisal’ approach involving observation, photographs, and interviews. Results Nurses utilise space differently to GPs, and this is part of the diversity they bring to the general practice environment. At the same time their roles are partly shaped by the ways space is constructed in general practices. Conclusion The fluidity of nursing roles in general practice suggests that nurses require a versatile space in which to maximize their role and contribution to the general practice team.

  6. Carpal tunnel syndrome in general practice (1987 and 2001): incidence and the role of occupational and non-occupational factors

    Science.gov (United States)

    Bongers, Frans JM; Schellevis, Francois G; van den Bosch, Wil JHM; van der Zee, Jouke

    2007-01-01

    Background Most studies on the incidence of the carpal tunnel syndrome and the relation of this disorder with occupation are population-based. In this study we present data from general practice. Aim To compare incidence rates of carpal tunnel syndrome in 1987 with those in 2001, and to study the relationship between carpal tunnel syndrome and occupation. Design of study Analysis of the data of the first and second Dutch National Survey of General Practice, conducted in 1987 and 2001, respectively. Setting General practices in The Netherlands. Method One hundred and three general practices in 1987 with 355 201 listed patients, and 96 practices with 364 998 listed patients in 2001, registered all patients who presented with a new episode of carpal tunnel syndrome. Patient and GP populations were representative for The Netherlands. Results The crude incidence rate was 1.3 per 1000 (95% confidence interval [CI] = 1.0 to 1.5) in 1987, and 1.8 per 1000 (95% CI = 1.7 to 2.0) in 2001. In males it was 0.6 (95% CI = 0.5 to 0.7) and 0.9 (95% CI = 0.8 to 1.0) respectively; in females 1.9 (95% CI = 1.7 to 2.1) and 2.8 (95% CI = 2.6 to 3.1). At both study periods, peak incidence rate occurred in the 45–64-year age group: in 2001 this peak reached 4.8 per 1000 (95 CI = 4.1 to 5.4) for females and 1.6 (95 CI = 1.2 to 2.0) for males. Women who performed unskilled and semi-skilled work had 1.5 times greater risk of acquiring carpal tunnel syndrome than women with higher-skilled jobs (P<0.001). In men no relationship of this kind was found. Conclusion In 2001 the crude incidence rate of carpal tunnel syndrome was 1.5 times higher than in 1987, but the difference was not statistically significant after subdividing by age and sex. In both years the female:male ratio was 3:1. Incidence rates were related to the job level of women, but not of men. PMID:17244422

  7. Long-term cost–effectiveness of Oncotype DX® versus current clinical practice from a Dutch cost perspective

    NARCIS (Netherlands)

    Kip, Michelle Maria Aleida; Monteban, Helma; Steuten, Lotte Maria Gertruda

    2015-01-01

    This study analyzes the incremental cost–effectiveness of Oncotype DX® testing to support adjuvant chemotherapy recommendations, versus current clinical practice, for patients with estrogen receptor-positive (ER+), node-negative or micrometastatic (pN1mic) early-stage breast cancer in The

  8. The lower prevalence of female genital mutilation in the Netherlands: a nationwide study in Dutch midwifery practices

    NARCIS (Netherlands)

    Korfker, D.G.; Reis, R.; Rijnders, M.E.B.; Meijer-van Asperen, S.; Read, L.; Sanjuan, M.; Herschderfer, K.; Buitendijk, S.E.

    2012-01-01

    Objectives To determine the prevalence of female genital mutilation (FGM) in women giving birth in 2008 in the Netherlands. Method A retrospective questionnaire study was conducted. The study covered all 513 midwifery practices in the Netherlands. The data were analysed with SPSS 17.0. Results The r

  9. Long-term cost–effectiveness of Oncotype DX® versus current clinical practice from a Dutch cost perspective

    NARCIS (Netherlands)

    Kip, Michelle; Monteban, Helma; Steuten, Lotte

    2015-01-01

    This study analyzes the incremental cost–effectiveness of Oncotype DX® testing to support adjuvant chemotherapy recommendations, versus current clinical practice, for patients with estrogen receptor-positive (ER+), node-negative or micrometastatic (pN1mic) early-stage breast cancer in The Netherland

  10. [Deafness in adults. Study of practices in general medicine].

    Science.gov (United States)

    Leveque, P; Kossowski, M; Pons, Y

    2012-01-01

    Deafness is a sensory disability responsible for communication disorder, sometimes impairing social life. In children, the hearing is an important concern for all stakeholders in early childhood (systematic neonatal screening, etc.). On the other hand, in the adult, it is rarely tested, and patients do consult when their audiometric status is already badly impaired. But their care is all the better if the deafness diagnosis is made early, as for the audio-prosthetic rehabilitation for example. Today, the general practitioner is the first link of the diagnostic and therapeutic management chain. The objective of this study was to evaluate the diagnostic practices of practitioners in front of deafness in adults. This prospective study included 74 practitioners based in "Ile de France" interviewed using a multiple choice questionnaire (MCQ) on otoscopic and audiometric diagnostics and a Script Concordance test (SC) on clinical adult deafness situations validated by a 5 experts panel. The obtained average score was 66.35% of correct answers to the MCQ and 47.76% to the SC. In our study, the surveyed practitioners showed a good level of otoscopic and audiometric diagnosis in the MCQ. However, their answers were not concordant with those of the expert panel in the SC. They have been particularly poorly performing on issues related to functional signs and their use in a given clinical situation, often driving to establish an otoscopic misdiagnosis while their diagnostic recognition of a pathological eardrum in the MCQ was rather good. These results reflect a lack of confidence in their otoscopic diagnosis related to the lack of knowledge of the causes of deafness in adults and their symptoms.

  11. Appealing to the female vote. Dutch political parties and their approach of women voters in general election campaigns, c. 1922-1980

    NARCIS (Netherlands)

    Kaal, H.G.J.

    2015-01-01

    This article explores the effects of female enfranchisement on the nature of political identity formation in Dutch election campaigns between 1922 and the early 1980s. It argues that women voters played a key role in the imagination of the Netherlands as a ‘pillarised society’ in which political con

  12. Evaluation of the representativeness of a Dutch non-malformed control group for the general pregnant population : are these controls useful for EUROCAT?

    NARCIS (Netherlands)

    Jentink, J.; Zetstra-van der Woude, A.P.; Bos, Jens; De Jong-Van den Berg, L.T.

    2011-01-01

    Purpose A case-control study is the most powerful design to test the risk of specific congenital malformations associated with a specific drug. However, malformation registries often lack non-malformed controls. For the Dutch EUROCAT, we collected a non-malformed control group: the 'Healthy Pregnant

  13. Consumer satisfaction with practice nursing: a cross-sectional survey in New Zealand general practice.

    Science.gov (United States)

    Halcomb, Elizabeth; Davies, Deborah; Salamonson, Yenna

    2015-01-01

    An important consideration in health service delivery is ensuring that services meet consumer needs. Whilst nursing services in primary care have grown internationally, there has been limited exploration of consumer satisfaction with these services. This paper reports a descriptive survey that sought to evaluate consumers' perceptions of New Zealand practice nurses (PNs). One thousand, five hundred and five patients who received nursing services at one of 20 participating New Zealand general practices completed a survey tool between December 2010 and December 2011. The 64-item self- report survey tool contained the 21-item General Practice Nurse Satisfaction (GPNS) scale. Data were analysed using both descriptive and inferential statistics. Internal consistency of the GPNS scale was high (Cronbach's α 0.97). Participants aged over 60 years and those of European descent were significantly less satisfied with the PN (P = 0.001). Controlling for these characteristics, participants who had visited the PN more than four times previously were 1.34 times (adjusted odds ratio 1.34 (95% CI: 1.06-1.70) more satisfied than the comparison group (up to 4 previous visits to PN). In addition to the further validation of the psychometric properties of the GPNS scale in a different setting, the study also revealed a high level of satisfaction with PNs, with increased satisfaction with an increased number of visits. Nevertheless, the lower levels of satisfaction with PNs in the older age group as well as those of European descent, warrants further examination. The study also highlights the need for PNs and consumers to discuss consumer's expectations of services and create a shared understanding of treatment goals.

  14. The Dutch model for legalizing end-of-life decisions.

    Science.gov (United States)

    Kater, Loes

    2003-01-01

    The Dutch experience with euthanasia is used as a model for other countries for regulating end-of-life decisions. Several elements of the Dutch debate, for example the definition of euthanasia, are copied and imported to other debates. This paper studies the specific Dutch construction of regulating euthanasia and the concept of the requirements of prudent practice. The requirements of prudent practice embody the conditions for careful medical management in end-of-life decisions. It is argued that the requirements of prudent practice are a relatively acceptable way of regulating the Dutch practice of euthanasia as they are embedded in an elaborate network of relations, standards and values. As a consequence of this local character and the way the requirements of prudent practice relate to the Dutch practice of euthanasia it is difficult to simply transport them to other countries in order to regulate euthanasia.

  15. Internationalisation of Dutch SMEs

    OpenAIRE

    Jolanda Hessels

    2005-01-01

    Whereas the Dutch business sector as a whole is among the largest exporters, importers and foreign direct investors, Dutch SMEs, as compared to SMEs from other European countries, occupy a position in the middle with respect to the share of enterprises that export, import or invest abroad. In the coming years an increase in the international involvement of Dutch SMEs is expected. In this report the following subjects are adressed: Overview of the internationalisation of Dutch SME's, the inter...

  16. Quinine, Malaria, and the Cinchona Bureau: Marketing Practices and Knowledge Circulation in a Dutch Transoceanic Cinchona-Quinine Enterprise (1920s-30s).

    Science.gov (United States)

    Van Der Hoogte, Arjo Roersch; Pieters, Toine

    2016-04-01

    In this study, we will show how a Dutch pharmaceutical consortium of cinchona producers and quinine manufacturers was able to capitalize on one of the first international public health campaigns to fight malaria, thereby promoting the sale of quinine, an antimalarial medicine. During the 1920s and 1930s, the international markets for quinine were controlled by this Dutch consortium, which was a transoceanic cinchona-quinine enterprise centered in the Cinchona Bureau in the Netherlands. We will argue that during the interwar period, the Cinchona Bureau became the decision-making center of this Dutch cinchona-quinine pharmaceutical enterprise and monopolized the production and trade of an essential medicine. In addition, we will argue that capitalizing on the international public health campaign in the fight against malaria by the Dutch cinchona-quinine enterprise via the Cinchona Bureau can be regarded as an early example of corporate colonization of public health by a private pharmaceutical consortium. Furthermore, we will show how commercial interests prevailed over scientific interests within the Dutch cinchona-quinine consortium, thus interfering with and ultimately curtailing the transoceanic circulation of knowledge in the Dutch empire.

  17. Dutch for Reading Knowledge

    NARCIS (Netherlands)

    van Baalen, C.; Blom, F.R.E.; Hollander, I.

    2012-01-01

    This first Dutch for Reading Knowledge book on the market promotes a high level of reading and translation competency by drawing from Dutch grammar, vocabulary and reading strategies, and providing many translation "shortcuts" and tips when tackling complex texts in Dutch. Aimed at students, researc

  18. Correlates of the Orthodontic Aspects of the General Dentist's Practice.

    Science.gov (United States)

    Manasse, Robert J.; Dooley, Raynard J.

    1980-01-01

    A study undertaken to determine the extent of orthodontic referrals and treatment performed by general dentists is discussed. Results indicate that general practitioners who graduated after 1945 tend to make more referrals, and general practitioners who had treated patients orthodontically in their predoctoral training tend to continue in…

  19. Correlates of the Orthodontic Aspects of the General Dentist's Practice.

    Science.gov (United States)

    Manasse, Robert J.; Dooley, Raynard J.

    1980-01-01

    A study undertaken to determine the extent of orthodontic referrals and treatment performed by general dentists is discussed. Results indicate that general practitioners who graduated after 1945 tend to make more referrals, and general practitioners who had treated patients orthodontically in their predoctoral training tend to continue in…

  20. Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study

    Science.gov (United States)

    Harding, Alex; Rosenthal, Joe; Al-Seaidy, Marwa; Gray, Denis Pereira; McKinley, Robert K

    2015-01-01

    Background Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning Aim This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision. Design and setting A cross-sectional questionnaire in the UK. Method A questionnaire regarding provision of undergraduate teaching was sent to the general practice teaching leads in all UK medical schools. Information was gathered on the amount of undergraduate teaching, how this was supported financially, and whether there was an integrated department of general practice. The data were then compared with results from previous studies of teaching provision. The provision of postgraduate teaching in general practice was also examined. Results General practice teaching for medical students increased from teaching in 1968 to 13.0% by 2008; since then, the percentage has plateaued. The total amount of general practice teaching per student has fallen by 2 weeks since 2002. Medical schools providing financial data delivered 14.6% of the clinical curriculum and received 7.1% of clinical teaching funding. The number of departments of general practice has halved since 2002. Provision of postgraduate teaching has tripled since 2000. Conclusion Current levels of undergraduate teaching in general practice are too low to fulfil future workforce requirements and may be falling. Financial support for current teaching is disproportionately low and the mechanism counterproductive. Central intervention may be required to solve

  1. A Virtual Community of Practice for General Practice Training: A Preimplementation Survey

    Science.gov (United States)

    Jones, Sandra C; Bennett, Sue; Iverson, Don; Robinson, Laura

    2016-01-01

    Background Professional isolation is an important factor in low rural health workforce retention. Objective The aim of this study was to gain insights to inform the development of an implementation plan for a virtual community of practice (VCoP) for general practice (GP) training in regional Australia. The study also aimed to assess the applicability of the findings of an existing framework in developing this plan. This included ascertaining the main drivers of usage, or usefulness, of the VCoP for users and establishing the different priorities between user groups. Methods A survey study, based on the seven-step health VCoP framework, was conducted with general practice supervisors and registrars—133 usable responses; 40% estimated response rate. Data was analyzed using the t test and the chi-square test for comparisons between groups. Factor analysis and generalized linear regression modeling were used to ascertain factors which may independently predict intention to use the VCoP. Results In establishing a VCoP, facilitation was seen as important. Regarding stakeholders, the GP training provider was an important sponsor. Factor analysis showed a single goal of usefulness. Registrars had a higher intention to use the VCoP (Psupervisors. Usefulness independently predicted intention to actively use the VCoP (Psupervisors to want allied health professional and specialist involvement (Pfeedback about site activity. Regarding technology and community, training can be online, but trust is better built face-to-face. Supervisors were significantly more likely than registrars to perceive that registrars needed help with knowledge (P=.01) and implementation of knowledge (P<.001). Conclusions Important factors for a GP training VCoP include the following: facilitation covering administration and expertise, the perceived usefulness of the community, focusing usefulness around knowledge sharing, and overcoming professional isolation with high-quality content. Knowledge needs

  2. A competency based selection procedure for Dutch postgraduate GP training: a pilot study on validity and reliability

    NARCIS (Netherlands)

    Vermeulen, M.I.; Tromp, F.; Zuithoff, N.P.; Pieters, R.H.; Damoiseaux, R.A.; Kuyvenhoven, M.M.

    2014-01-01

    Abstract Background: Historically, semi-structured interviews (SSI) have been the core of the Dutch selection for postgraduate general practice (GP) training. This paper describes a pilot study on a newly designed competency-based selection procedure that assesses whether candidates have the compete

  3. A competency based selection procedure for Dutch postgraduate GP training: a pilot study on validity and reliability

    NARCIS (Netherlands)

    Vermeulen, M.I.; Tromp, F.; Zuithoff, N.P.; Pieters, R.H.; Damoiseaux, R.A.; Kuyvenhoven, M.M.

    2014-01-01

    Abstract Background: Historically, semi-structured interviews (SSI) have been the core of the Dutch selection for postgraduate general practice (GP) training. This paper describes a pilot study on a newly designed competency-based selection procedure that assesses whether candidates have the

  4. Training medical students in general practice: a qualitative study among general practitioner trainers in Sri Lanka.

    Science.gov (United States)

    Ramanayake, R P J C; De Silva, A H W; Perera, D P; Sumanasekera, R D N; Athukorala, L A C L; Fernando, K A T

    2015-01-01

    Worldwide Family Medicine has gained an important place in the undergraduate medical curriculum over the last few decades and general practices have become training centers for students. Exposure to patients early in the disease process, out patient management of common problems, follow up of chronic diseases and psychosocial aspects of health and disease are educational advantages of community based training but such training could have varying impact on patients, students and trainers. This study explored the views of General Practitioner (GP) trainers on their experience in training students. This qualitative study was conducted among GP trainers of the faculty of medicine, University of Kelaniya, Sri Lanka, to explore their experience on wide range of issues related to their role as GP trainers. The interviews were recorded and transcribed verbatim. Themes expressed were identified. Altruistic reasons, self-satisfaction, self-esteem and opportunity to improve their knowledge were the motivations for their involvement in teaching. Teachers were confident of their clinical and teaching skills. They perceived that patients were willing participants of the process and benefited from it. There was a positive impact on consultation dynamics. Time pressure was the major problem and ideal number of trainees per session was two. They were willing to attend teacher training workshops to update their knowledge. GP trainers driven by altruistic reasons were willing participants of student training process. The perceived advantages of involvement of teaching for trainers and patients were an encouragement for potential trainers. University should organize training sessions for trainers which will boost their knowledge, confidence and teaching skills which will eventually benefit students.

  5. Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners

    Directory of Open Access Journals (Sweden)

    Lucia Zannini

    2012-07-01

    Full Text Available Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB, Italy, to develop general practitioners’ (GPs care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i clinical pathways can result in GPs working in a more efficient and effective fashion; ii they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.

  6. Making educational reforms practical for teachers : using a modular, success-oriented approach to make a context-based educational reform practical for implementation in Dutch biology education

    NARCIS (Netherlands)

    Dam, Michiel

    2014-01-01

    For a successful implementation of an educational reform, teachers need to regard the proposal as being practical. I used a modular, success-oriented approach to make a context-based reform practical for implemtentation in Duthc biology education. educational reform, modular, teachers, biology, succ

  7. Themes and methods of research presented at European General Practice Research Network conferences.

    NARCIS (Netherlands)

    Kruschinski, C.; Lange, Maaike; Lionis, C.; Weel, C. van; Hummers-Pradier, E.

    2010-01-01

    BACKGROUND: The World Organization of Family Doctors (Wonca) defined core characteristics of general practice and general practitioners' competencies. It is unclear to which extent research has addressed these issues so far. OBJECTIVE: To determine themes and research methods of general practice res

  8. Practices, patients and (imperfect data - feasibility of a randomised controlled clinical drug trial in German general practices

    Directory of Open Access Journals (Sweden)

    Hummers-Pradier Eva

    2011-04-01

    Full Text Available Abstract Background Randomised controlled clinical (drug trials supply high quality evidence for therapeutic strategies in primary care. Until now, experience with drug trials in German general practice has been sparse. In 2007/2008, the authors conducted an investigator-initiated, non-commercial, double-blind, randomised controlled pilot trial (HWI-01 to assess the clinical equivalence of ibuprofen and ciprofloxacin in the treatment of uncomplicated urinary tract infection (UTI. Here, we report the feasibility of this trial in German general practices and the implementation of Good Clinical Practice (GCP standards as defined by the International Conference on Harmonisation (ICH in mainly inexperienced general practices. Methods This report is based on the experience of the HWI-01 study conducted in 29 German general practices. Feasibility was defined by 1 successful practice recruitment, 2 sufficient patient recruitment, 3 complete and accurate data collection and 4 appropriate protection of patient safety. Results The final practice recruitment rate was 18%. In these practices, 79 of 195 screened UTI patients were enrolled. Recruitment differed strongly between practices (range 0-12, mean 2.8 patients per practice and was below the recruitment goal of approximately 100 patients. As anticipated, practice nurses became the key figures in the screening und recruitment of patients. Clinical trial demands, in particular for completing symptom questionnaires, documentation of source data and reporting of adverse events, did not agree well with GPs' documentation habits and required support from study nurses. In many cases, GPs and practice staff seemed to be overwhelmed by the amount of information and regulations. No sudden unexpected serious adverse reactions (SUSARs were observed during the trial. Conclusions To enable drug trials in general practice, it is necessary to adapt the setup of clinical research infrastructure to the needs of GPs and

  9. Management and marketing for the general practice dental office.

    Science.gov (United States)

    Clarkson, Earl; Bhatia, Sanjeev

    2008-07-01

    This article reviews trends in the dental marketplace. Marketing is an essential element of dentistry. Communicating treatment options with patients is one aspect of marketing. Treatment planning helps patients understand the relationships between oral health, occlusion, temporomandibular joint function, and systemic health. Through marketing, dental practice owners inform patients of ever-changing treatment modalities. Understanding treatment options allows patients to make better, informed choices. More options leads to a higher level of care and more comprehensive dental treatment. Managing a practice requires tracking its financial health. Economic statistics measure the effect of management decisions that mark the direction of a dental practice.

  10. Influences on final year medical students’ attitudes to general practice as a career

    Directory of Open Access Journals (Sweden)

    Parker JE

    2014-03-01

    Full Text Available INTRODUCTION: General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. METHODS: This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. FINDINGS: General practitioners (GPs play a key role in influencing medical students’ attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. CONCLUSION: GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.

  11. Relational Coordination and Organisational Social Capital Association with Characteristics of General Practice

    DEFF Research Database (Denmark)

    Lundstrøm, Sanne Lykke; Edwards, Kasper; Bøllingtoft Knudsen, Thomas;

    2014-01-01

    Background. Relational coordination (RC) and organisational social capital (OSC) aremeasures of novel aspects of an organisation’s performance, which have not previously been analysed together, in general practice. Objectives.The aim of this studywas to analyse the associations between RC and OSC......, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC...... and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type...

  12. neurological practIce analysis in neurosciences design general ...

    African Journals Online (AJOL)

    SA MEDICAL JOURNAL VOLUME 63 5 FEBRUARY 1983 neurological. •. practIce ... One was an analy- sis of neurological disorders in patients admitted to a university hospital, with an ... Alcohol and drug abuse, anxiety, depression ...

  13. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice.

    Science.gov (United States)

    McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth

    2015-09-01

    To identify facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general (family) practice. Internationally, a shortage of doctors entering and remaining in general practice and an increasing burden of chronic disease has diversified the nurse's role in this setting. Despite a well-established general practice nursing workforce, little attention has been paid to the ways doctors and nurses collaborate in this setting. Integrative literature review. CINAHL, Scopus, Web of Life, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews and Trove (dissertation and theses) were searched for papers published between 2000 and May 2014. This review was informed by the approach of Whittemore and Knafl (2005). All included papers were assessed for methodological quality. Findings were extracted, critically examined and grouped into themes. Eleven papers met the inclusion criteria. Thematic analysis revealed three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities; (2) respect, trust and communication; and (3) hierarchy, education and liability. This integrative review has provided insight into issues around role definition, communication and organizational constraints which influence the way nurses and general practitioners collaborate in a team environment. Future research should investigate in more detail the ways doctors and nurses work together in general practice and the impact of collaboration on nursing leadership and staff retention. © 2015 John Wiley & Sons Ltd.

  14. Vulnerability and the 'slippery slope' at the end-of-life: a qualitative study of euthanasia, general practice and home death in The Netherlands.

    Science.gov (United States)

    Norwood, Frances; Kimsma, Gerrit; Battin, Margaret P

    2009-12-01

    One enduring criticism of the Dutch euthanasia policy is the 'slippery slope' argument that suggests that allowing physicians to conduct legal euthanasia or assisted suicide would eventually lead to patients being killed against their will. What we currently know about euthanasia and its practices in The Netherlands is predominantly based on retrospective quantitative or interview-based studies, but these studies fail to detail the mechanisms of day-to-day practice. To examine the practices that surround euthanasia, particularly among vulnerable patients, using qualitative observation-based data. A 15-month qualitative, observation-based study of home death and general practice in the greater Amsterdam region of The Netherlands. Study included observation and interviews with a sample of 15 (GPs and 650 of their patients, 192 of whom were living with terminal or life-threatening illness (with and without requests for euthanasia). Euthanasia practice typically involves extensive deliberations, the majority of which do not end in a euthanasia death. Euthanasia discussions or 'euthanasia talk' share at least two consequences: (i) the talk puts the onus on patients to continue discussions towards a euthanasia death and (ii) there is a socio-therapeutic component, which tends to affirm social bonds and social life. While this qualitative evidence cannot disprove existence of abuse, it suggests that euthanasia practices have evolved in such a way that patients are more likely to talk about euthanasia than to die a euthanasia death.

  15. General parenting, smoking-specific parenting practices and adolescent smoking in Hong Kong

    OpenAIRE

    2014-01-01

    Introduction Though the associations of general parenting styles and smoking-specific parenting practices with adolescent smoking have received much attention in recent years, important questions remain. Most general parenting studies focused on Caucasian parents but much less in the literature is known about Chinese parents. As for smoking-specific parenting practices in the household, anti-smoking practices have been the focus, with pro-smoking practices seldom being studied. The ob...

  16. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population : a cross sectional study

    NARCIS (Netherlands)

    Albers, Iris Sophie; Zwerver, Johannes; Diercks, Ronald Leo; Dekker, Janny Hendrika; Van den Akker-Scheek, Inge

    2016-01-01

    Background: Lower extremity tendinopathy is a common sports injury, but it can also affect non-athletes. Because tendinopathy is difficult to treat and has negative effects on the ability to work and quality of life, development of preventive interventions is important. The first step in the Van Mec

  17. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population: A cross sectional study

    NARCIS (Netherlands)

    Albers, Iris Sophie; Zwerver, Johannes; Diercks, Ronald Leo; Dekker, Janny Hendrika; Van den Akker-Scheek, Inge

    2016-01-01

    Background: Lower extremity tendinopathy is a common sports injury, but it can also affect non-athletes. Because tendinopathy is difficult to treat and has negative effects on the ability to work and quality of life, development of preventive interventions is important. The first step in the Van Mec

  18. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population : a cross sectional study

    NARCIS (Netherlands)

    Albers, Iris Sophie; Zwerver, Johannes; Diercks, Ronald Leo; Dekker, Janny Hendrika; Van den Akker-Scheek, Inge

    2016-01-01

    Background: Lower extremity tendinopathy is a common sports injury, but it can also affect non-athletes. Because tendinopathy is difficult to treat and has negative effects on the ability to work and quality of life, development of preventive interventions is important. The first step in the Van

  19. Does disaster affect immigrant victims more than non-immigrant victims in Dutch general practice: a matched cohort study.

    NARCIS (Netherlands)

    Soeteman, R.J.H.; Yzermans, C.J.; Spreeuwenberg, P.M.M.; Dorn, T.; Kerssens, J.J.; Bosch, W.J.H.M. van den; Zee, J. van der

    2009-01-01

    Background: In the literature, immigrant victims appear to be more vulnerable to health effects of a disaster than indigenous victims. Most of these studies were performed without pre-disaster measurement and without using a control group. Aim: The objective of the study is to monitor differences be

  20. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population: A cross sectional study

    NARCIS (Netherlands)

    Albers, Iris Sophie; Zwerver, Johannes; Diercks, Ronald Leo; Dekker, Janny Hendrika; Van den Akker-Scheek, Inge

    2016-01-01

    Background: Lower extremity tendinopathy is a common sports injury, but it can also affect non-athletes. Because tendinopathy is difficult to treat and has negative effects on the ability to work and quality of life, development of preventive interventions is important. The first step in the Van Mec