WorldWideScience

Sample records for dutch obstetric system

  1. [The first Dutch debate on anaesthesia in obstetrics].

    Science.gov (United States)

    Bijker, Liselotte E

    2015-01-01

    After the publication of the Dutch medical guideline on pharmacological analgesia during childbirth in 2008, the question of whether pharmacological pain relief should be permissible during labour was hotly debated. This discussion has been going on since the second half of the 19th century when the introduction of ether and chloroform was extensively studied and described in Great Britain. This article looks back on the same debate in the Netherlands when inhalational anaesthetics were introduced into obstetrics. Study of historical journals and textbooks, originating in the Netherlands and elsewhere, and of historical medical literature on anaesthesia and obstetrics shows that the Dutch protagonists adopted more nuanced ideas on this issue than many of their foreign colleagues. This description of the first Dutch debate on anaesthesia in obstetrics shows that in fact the issues and arguments are timeless.

  2. Medicalization and obstetric care: an analysis of developments in Dutch midwifery.

    Science.gov (United States)

    Smeenk, Anke D J; ten Have, Henk A M J

    2003-01-01

    The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the practice of Dutch independent midwives, however it is less clear and outspoken than in hospital policies.

  3. The Dutch criminal justice system : third edition

    NARCIS (Netherlands)

    Tak, P.J.P.

    2008-01-01

    This book covers both the organization of the present Dutch criminal justice system and the main procedures used within the system. It deals with the basic principles that guide the operation of the Dutch criminal justice system. The latest statistical information available is that of the year 2006.

  4. Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study

    Science.gov (United States)

    2014-01-01

    Background Coordination between the autonomous professional groups in midwifery and obstetrics is a key debate in the Netherlands. At the same time, it remains unclear what the current coordination challenges are. Methods To examine coordination challenges that might present a barrier to delivering optimal care, we conducted a qualitative field study focusing on midwifery and obstetric professional’s perception of coordination and on their routines. We undertook 40 interviews with 13 community midwives, 8 hospital-based midwives and 19 obstetricians (including two resident obstetricians), and conducted non-participatory observations at the worksite of these professional groups. Results We identified challenges in terms of fragmented organizational structures, different perspectives on antenatal health and inadequate interprofessional communication. These challenges limited professionals' coordinating capacity and thereby decreased their ability to provide optimal care. We also found that pregnant women needed to compensate for suboptimal coordination between community midwives and secondary caregivers by taking on an active role in facilitating communication between these professionals. Conclusions The communicative role that pregnant women play within coordination processes underlines the urgency to improve coordination. We recommend increasing multidisciplinary meetings and training, revising the financial reimbursement system, implementing a shared maternity notes system and decreasing the expertise gap between providers and clients. In the literature, communication by clients in support of coordination has been largely ignored. We suggest that studies include client communication as part of the coordination process. PMID:24731478

  5. Pregnancy and labour in the dutch maternity care system: What is normal? The role division between midwives and obstetricians

    NARCIS (Netherlands)

    Amelink-Verburg, M.P.; Buitendijk, S.E.

    2010-01-01

    Introduction: In the Dutch maternity care system, the role division between independently practising midwives (who take care of normal pregnancy and childbirth) and obstetricians (who care for pathologic pregnancy and childbirth) has been established in the so-called " List of Obstetric Indications"

  6. Improving interprofessional coordination in Dutch midwifery and obstetrics: A qualitative study

    NARCIS (Netherlands)

    V.L.N. Schölmerich (Vera); A.G. Posthumus (Anke); H. Ghorashi (Halleh); W. Waelput (Wim); P.P. Groenewegen (Peter); S. Denktaş (Semiha)

    2014-01-01

    textabstractBackground: Coordination between the autonomous professional groups in midwifery and obstetrics is a key debate in the Netherlands. At the same time, it remains unclear what the current coordination challenges are. Methods: To examine coordination challenges that might present a barrier

  7. Improving interprofessional coordination in Dutch midwifery and obstetrics: A qualitative study

    NARCIS (Netherlands)

    V.L.N. Schölmerich (Vera); A.G. Posthumus (Anke); H. Ghorashi (Halleh); W. Waelput (Wim); P.P. Groenewegen (Peter); S. Denktaş (Semiha)

    2014-01-01

    textabstractBackground: Coordination between the autonomous professional groups in midwifery and obstetrics is a key debate in the Netherlands. At the same time, it remains unclear what the current coordination challenges are. Methods: To examine coordination challenges that might present a barrier

  8. Reproductive choices and obstetrical experience in Dutch carriers of haemophilia A and B

    NARCIS (Netherlands)

    Knol, H. M.; Voskuilen, M. A. J.; Holterman, F.; Kluin-Nelemans, J. C.; Meijer, K.

    2011-01-01

    Reproductive choices, pregnancy and childbirth are influenced by culture and traditions. This probably also plays a role in carriers of haemophilia. The aim of the study is to evaluate the reproductive choices and obstetrical experiences in the current generation of carriers of haemophilia in our Ha

  9. The Dutch Healthcare System in International Perspective

    NARCIS (Netherlands)

    Mikkers, Misja

    2016-01-01

    In this address, important aspects of the Dutch system of managed competition are discussed from the economic perspective, highlighting both its merits and the major challenges posed by the development of this system. Reasons for government intervention in healthcare markets are provided, and the ou

  10. The Dutch Healthcare System in International Perspective

    NARCIS (Netherlands)

    Mikkers, Misja

    2016-01-01

    In this address, important aspects of the Dutch system of managed competition are discussed from the economic perspective, highlighting both its merits and the major challenges posed by the development of this system. Reasons for government intervention in healthcare markets are provided, and the ou

  11. Dutch Perinatal System: performance and innovative strategies

    NARCIS (Netherlands)

    J. van der Kooy (Jacoba)

    2013-01-01

    textabstractThe organization of the Dutch perinatal care system is unique since, in contrast to most other high-income countries, certified community midwives play an independent role in the care for pregnant women. Community midwives care for pregnant women with an assumed or estimated low-risk for

  12. Quality systems in Dutch health care institutions.

    NARCIS (Netherlands)

    Casparie, A.F.; Sluijs, E.M.; Wagner, C.; Bakker, D.H. de

    1997-01-01

    The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire-derived fr

  13. The Dutch vocational education and training system

    NARCIS (Netherlands)

    Verhagen, A.M.C.

    2014-01-01

    The Dutch educational system is highly stratified from secondary education onwards3, and this also applies to MBO. Each MBO course can be followed in two different learning pathways, called the vocationally educating learning pathway (beroepsopleidende leerweg: BOL) and the vocationally guiding lear

  14. Relevant Obstetric Factors for Cerebral Palsy: From the Nationwide Obstetric Compensation System in Japan.

    Directory of Open Access Journals (Sweden)

    Junichi Hasegawa

    Full Text Available The aim of this study was to identify the relevant obstetric factors for cerebral palsy (CP after 33 weeks' gestation in Japan.This retrospective case cohort study (1:100 cases and controls used a Japanese national CP registry. Obstetric characteristics and clinical course were compared between CP cases in the Japan Obstetric Compensation System for Cerebral Palsy database and controls in the perinatal database of the Japan Society of Obstetrics and Gynecology born as live singleton infants between 2009 and 2011 with a birth weight ≥ 2,000 g and gestation ≥ 33 weeks.One hundred and seventy-five CP cases and 17,475 controls were assessed. Major relevant single factors for CP were placental abnormalities (31%, umbilical cord abnormalities (15%, maternal complications (10%, and neonatal complications (1%. A multivariate regression model demonstrated that obstetric variables associated with CP were acute delivery due to non-reassuring fetal status (relative risk [RR]: 37.182, 95% confidence interval [CI]: 20.028-69.032, uterine rupture (RR: 24.770, 95% CI: 6.006-102.160, placental abruption (RR: 20.891, 95% CI: 11.817-36.934, and preterm labor (RR: 3.153, 95% CI: 2.024-4.911, whereas protective factors were head presentation (RR: 0.199, 95% CI: 0.088-0.450 and elective cesarean section (RR: 0.236, 95% CI: 0.067-0.828.CP after 33 weeks' gestation in the recently reported cases in Japan was strongly associated with acute delivery due to non-reassuring fetal status, uterine rupture, and placental abruption.

  15. Relevant Obstetric Factors for Cerebral Palsy: From the Nationwide Obstetric Compensation System in Japan

    Science.gov (United States)

    Hasegawa, Junichi; Toyokawa, Satoshi; Ikenoue, Tsuyomu; Asano, Yuri; Satoh, Shoji; Ikeda, Tomoaki; Ichizuka, Kiyotake; Tamiya, Nanako; Nakai, Akihito; Fujimori, Keiya; Maeda, Tsugio; Masuzaki, Hideaki; Suzuki, Hideaki; Ueda, Shigeru

    2016-01-01

    Objective The aim of this study was to identify the relevant obstetric factors for cerebral palsy (CP) after 33 weeks’ gestation in Japan. Study design This retrospective case cohort study (1:100 cases and controls) used a Japanese national CP registry. Obstetric characteristics and clinical course were compared between CP cases in the Japan Obstetric Compensation System for Cerebral Palsy database and controls in the perinatal database of the Japan Society of Obstetrics and Gynecology born as live singleton infants between 2009 and 2011 with a birth weight ≥ 2,000 g and gestation ≥ 33 weeks. Results One hundred and seventy-five CP cases and 17,475 controls were assessed. Major relevant single factors for CP were placental abnormalities (31%), umbilical cord abnormalities (15%), maternal complications (10%), and neonatal complications (1%). A multivariate regression model demonstrated that obstetric variables associated with CP were acute delivery due to non-reassuring fetal status (relative risk [RR]: 37.182, 95% confidence interval [CI]: 20.028–69.032), uterine rupture (RR: 24.770, 95% CI: 6.006–102.160), placental abruption (RR: 20.891, 95% CI: 11.817–36.934), and preterm labor (RR: 3.153, 95% CI: 2.024–4.911), whereas protective factors were head presentation (RR: 0.199, 95% CI: 0.088–0.450) and elective cesarean section (RR: 0.236, 95% CI: 0.067–0.828). Conclusion CP after 33 weeks’ gestation in the recently reported cases in Japan was strongly associated with acute delivery due to non-reassuring fetal status, uterine rupture, and placental abruption. PMID:26821386

  16. 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

  17. Integrated System for Monitoring and Prevention in Obstetrics-Gynaecology.

    Science.gov (United States)

    Robu, Andreea; Gauca, Bianca; Crisan-Vida, Mihaela; Stoicu-Tivadar, Lăcrămioara

    2016-01-01

    A better monitoring of pregnant women, mainly during the third trimester of pregnancy and an easy communication between physician and patients are very important for the prevention and good health of baby and mother. The paper presents an integrated system as support for the Obstetrics - Gynaecology domain consisting in two modules: a mobile application, ObGynCare, dedicated to the pregnant women and a new component of the Obstetrics-Gynaecology Department Information System dedicated to the physicians for a better monitoring of the pregnant women. The mobile application informs the pregnant women about their status, permits them to introduce glycaemia and weight values and has as option pulse and blood pressure acquisition from a smart sensor and provides results in a graphic format. It also provides support for easy patient-doctor communication related to any health problems. ObGyn Care offers nutrition recommendations and gives the pregnant women the possibility to enter a social space of common interests using social networks (Facebook) to exchange useful and practical information. Data collected from patients and from sensor are stored on the cloud and the physician may access the information and analyse it. The extended module of the Obstetrics-Gynaecology Department Information System already developed supports the physicians to visualize weekly, monthly, or on a trimester, the patient data and to discuss with her through the chat module. The mobile application is in test by pregnant women and medical personnel.

  18. Haemorrhagia post partum; an implementation study on the evidence-based guideline of the Dutch Society of Obstetrics and Gynaecology (NVOG) and the MOET (Managing Obstetric Emergencies and Trauma-course) instructions; the Fluxim study

    Science.gov (United States)

    2010-01-01

    Background One of the most important causes of maternal mortality and severe morbidity worldwide is post partum haemorrhage (PPH). Factors as substandard care are frequently reported in the international literature and there are similar reports in the Netherlands. The incidence of PPH in the Dutch population is 5% containing 10.000 women a year. The introduction of an evidence-based guideline on PPH by the Dutch society of Obstetrics and Gynaecology (NVOG) and the initiation of the MOET course (Managing Obstetrics Emergencies and Trauma) did not lead to a reduction of PPH. This implies the possibility of an incomplete implementation of both the NVOG guideline and MOET-instructions. Therefore, the aim of this study is to develop and test a tailored strategy to implement both the NVOG guideline and MOET-instructions Methods/Design One step in the development procedure is to evaluate the implementation of the guideline and MOET-instructions in the current care. Therefore measurement of the actual care will be performed in a representative sample of 20 hospitals. This will be done by prospective observation of the third stage of labour of 320 women with a high risk of PPH using quality indicators extracted from the NVOG guideline and MOET instructions. In the next step barriers and facilitators for guideline adherence will be analyzed by performance of semi structured interviews with 30 professionals and 10 patients, followed by a questionnaire study among all Dutch gynaecologists and midwives to quantify the barriers mentioned. Based on the outcomes, a tailored strategy to implement the NVOG guideline and MOET-instructions will be developed and tested in a feasibility study in 4 hospitals, including effect-, process- and cost evaluation. Discussion This study will provide insight into current Dutch practice, in particular to what extent the PPH guidelines of the NVOG and the MOET-instructions have been implemented in the actual care, and into the barriers and

  19. Haemorrhagia post partum; an implementation study on the evidence-based guideline of the Dutch Society of Obstetrics and Gynaecology (NVOG and the MOET (Managing Obstetric Emergencies and Trauma-course instructions; the Fluxim study

    Directory of Open Access Journals (Sweden)

    Grol Richard P

    2010-01-01

    Full Text Available Abstract Background One of the most important causes of maternal mortality and severe morbidity worldwide is post partum haemorrhage (PPH. Factors as substandard care are frequently reported in the international literature and there are similar reports in the Netherlands. The incidence of PPH in the Dutch population is 5% containing 10.000 women a year. The introduction of an evidence-based guideline on PPH by the Dutch society of Obstetrics and Gynaecology (NVOG and the initiation of the MOET course (Managing Obstetrics Emergencies and Trauma did not lead to a reduction of PPH. This implies the possibility of an incomplete implementation of both the NVOG guideline and MOET-instructions. Therefore, the aim of this study is to develop and test a tailored strategy to implement both the NVOG guideline and MOET-instructions Methods/Design One step in the development procedure is to evaluate the implementation of the guideline and MOET-instructions in the current care. Therefore measurement of the actual care will be performed in a representative sample of 20 hospitals. This will be done by prospective observation of the third stage of labour of 320 women with a high risk of PPH using quality indicators extracted from the NVOG guideline and MOET instructions. In the next step barriers and facilitators for guideline adherence will be analyzed by performance of semi structured interviews with 30 professionals and 10 patients, followed by a questionnaire study among all Dutch gynaecologists and midwives to quantify the barriers mentioned. Based on the outcomes, a tailored strategy to implement the NVOG guideline and MOET-instructions will be developed and tested in a feasibility study in 4 hospitals, including effect-, process- and cost evaluation. Discussion This study will provide insight into current Dutch practice, in particular to what extent the PPH guidelines of the NVOG and the MOET-instructions have been implemented in the actual care, and into

  20. The Impact of Learning Analytics on the Dutch Education System

    NARCIS (Netherlands)

    Drachsler, Hendrik; Stoyanov, Slavi; Specht, Marcus

    2014-01-01

    Drachsler, H., Stoyanov, S. & Specht, M. (2014, March). The Impact of Learning Analytics on the Dutch Education System. Paper presented at The 4th International Conference on Learning Analytics and Knowledge, Indianapolis, Indiana, USA.

  1. The maternal venous system: the ugly duckling of obstetrics.

    Science.gov (United States)

    Tomsin, K

    2013-01-01

    In pregnancy, both maternal vascular tone and cardiac function are considered key players to reach a normal outcome for both mother and child. This complex story of maternal hemodynamics is intensely discussed in current scientific literature, however the role of the maternal veins has been strongly underestimated. We developed and evaluated a set of measurable objective parameters which give an indication of venous function, i.e. the venous impedance index and the venous pulse transit time. These parameters turned out to be subject to changes throughout normal pregnancy and in preeclampsia enabling their use in gestational hemodynamic -studies. From our studies, we concluded that the venous system is a crucial determinant of cardiac output, which can be estimated by impedance cardiography. The introduction of these non-invasive techniques in obstetrics enables profiling the maternal cardiovascular system, integrating both arteries and veins, as well as maternal cardiac -function. Studying the cascade of cardiovascular changes throughout pregnancy using such non-invasive, easily applicable, and highly accessible methods opens perspectives to introduce this maternal cardiovascular profile in several -clinical settings. The early discrimination between low and high risk patients, together with the classification of different pregnancy disorders may help guiding the clinical work-up of the pregnant population regarding both prevention and treatment, as well as follow-up. We illustrate that the venous system, being an "ugly duckling" at first neglected by the medical world, transforms and matures into a beautiful swan, accepted by the obstetric world. We are confident that this is the beginning of many other studies regarding the maternal venous system, an important piece of the gestational physiology puzzle.

  2. Nutritional status and food consumption in 10-11 year old Dutch boys (Dutch Nutrition Surveillance System)

    NARCIS (Netherlands)

    Poppel, G.van.; Schneijder, P.; Löwik, M.R.H.; Schrijver, J.; Kok, F.J.

    1991-01-01

    As part of the Dutch Nutrition Surveillance System, cardiovascular risk factors and food consumption (24 h recall) as well as haematological, Fe and vitamin status (A, B6, C) were assessed in 126 Dutch boys aged 10-11 years (response 71%). Body mass index (BMI) and the sum of four skinfolds were

  3. Kijkwijzer: The Dutch rating system for audiovisual productions

    NARCIS (Netherlands)

    Valkenburg, P.M.; Beentjes, J.W.J.; Nikken, P.; Tan, E.S.H.

    2002-01-01

    Kijkwijzer is the name of the new Dutch rating system in use since early 2001 to provide information about the possible harmful effects of movies, home videos and television programs on young people. The rating system is meant to provide audiovisual productions with both age-based and content-based

  4. Kijkwijzer: The Dutch rating system for audiovisual productions

    NARCIS (Netherlands)

    Valkenburg, P.M.; Beentjes, J.W.J.; Nikken, P.; Tan, E.S.H.

    2002-01-01

    Kijkwijzer is the name of the new Dutch rating system in use since early 2001 to provide information about the possible harmful effects of movies, home videos and television programs on young people. The rating system is meant to provide audiovisual productions with both age-based and content-based

  5. Security in the Dutch electronic patient record system

    NARCIS (Netherlands)

    van 't Noordende, G.

    2010-01-01

    In this article, we analyze the security architecture of the Dutch Electronic Patient Dossier (EPD) system. Intended as a mandatory infrastructure for exchanging medical records of most if not all patients in the Netherlands among authorized parties (particularly, physicians), the EPD has to address

  6. Quality management systems and clinical outcomes in Dutch nursing homes.

    NARCIS (Netherlands)

    Wagner, C.; Klein Ikkink, K.; Wal, G. van der; Spreeuwenberg, P.; Bakker, D.H. de; Groenewegen, P.P.

    2006-01-01

    The objective of the article is to explore the impact quality management systems and quality assurance activities in nursing homes have on clinical outcomes. The results are based on a cross-sectional study in 65 Dutch nursing homes. The management of the nursing homes as well as the residents (N =

  7. Quality management systems and clinical outcomes in Dutch nursing homes

    NARCIS (Netherlands)

    Wagner, Cordula; Klein Ikkink, Karen; Wal, Gerrit van der; Spreeuwenberg, Peter; Bakker, Dinny Herman de; Groenewegen, Peter Paulus

    2006-01-01

    The objective of the article is to explore the impact quality management systems and quality assurance activities in nursing homes have on clinical outcomes. The results are based on a cross-sectional study in 65 Dutch nursing homes. The management of the nursing homes as well as the residents (N= 1

  8. Perceived Health System Causes of Obstetric Fistula from Accounts of Affected Women in Rural Tanzania: A Qualitative Study.

    Science.gov (United States)

    Mselle, Lilian T; Kohi, Thecla W

    2015-03-01

    Obstetric fistula is still a major problem in low income countries. While its main cause is untreated obstructed labour, misconceptions about it still persist. This study aimed at exploring and describing perceived health system causes of obstetric fistula from women affected by it in rural Tanzania. This exploratory qualitative study included twenty-eight women affected by obstetric fistula. Semi structured interviews and focus group discussions were held and thematic analysis used to analyse perceived health system causes of obstetric fistula from women's account. Perceived health system causes of obstetric fistula fundamentally reflected the poor quality of obstetric care women received at health care facilities relating to staff unaccountability, late referral, and torture by nurses. The women's perception emphasizes the importance of improving the quality of obstetric care provided by health care providers in health care facilities.

  9. An obstetric sphincter injury risk identification system (OSIRIS)

    DEFF Research Database (Denmark)

    Webb, Sara S; Hemming, Karla; Khalfaoui, Madhi Y

    2016-01-01

    INTRODUCTION AND HYPOTHESIS: To establish the contribution of maternal, fetal and intrapartum factors to the risk of incidence of obstetric anal sphincter injuries (OASIS) and assess the feasibility of an OASIS risk prediction model based on variables available to clinicians prior to birth. METHO...

  10. Obstetrical Ultrasound

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Obstetric Ultrasound Obstetric ultrasound uses sound waves to produce pictures ... limitations of Obstetrical Ultrasound Imaging? What is Obstetrical Ultrasound Imaging? Ultrasound is safe and painless, and produces ...

  11. Description and earlier quality review of the Dutch educational system (primary and secondary education)

    NARCIS (Netherlands)

    Scheerens, Jaap; Scheerens, J; Luyten, H.; van Ravens, J.

    2011-01-01

    The chapter starts out with a brief overview of the structure of the Dutch education system. As compared to other national educational systems the Dutch secondary school system is strongly differentiated, featuring several separate school categories and sub-categories. Next, attention is paid to oth

  12. The Dutch corporate governance code and its monitoring: a balanced system?

    NARCIS (Netherlands)

    Hof, B.; Kerste, M.; Rosenboom, N.; Rougoor, W.; de Jong, A.

    2013-01-01

    The compliance of exchange-listed companies with the Dutch corporate governance code is generally high. This research takes three hypothetical changes to the current system as a starting point to investigate the question: is the Dutch system of regulating and monitoring corporate governance balanced

  13. Op weg naar een accreditatiesysteem van Nederlandse ziekenhuizen [Towards an accreditation system of Dutch hospitals

    NARCIS (Netherlands)

    Gennip, E.M.S.J. van; Linnebank, F.; Sillevis Smitt, P.A.E.; Geldof, C.A.

    1999-01-01

    The development of the Netherlands system for accreditation of hospitals started in 1989 in the Pilotproject Accreditation (PACE). This resulted in the establishment of the Netherlands Institute for Accreditation of Hospitals (NIAH) early 1999, by the Dutch Association of Hospitals, the Dutch Associ

  14. Haemorrhagia post partum; an implementation study on the evidence-based guideline of the Dutch Society of Obstetrics and Gynaecology (NVOG) and the MOET (Managing Obstetric Emergencies and Trauma-course) instructions; the Fluxim study.

    NARCIS (Netherlands)

    Hermens, R.P.M.G.; Middeldorp, J.M.; Kremer, J.A.M.; Marcus, M.A.; Wouters, M.G.A.J.; Grol, R.P.T.M.; Lotgering, F.K.; Scheepers, H.C.J.; Woiski, M.D.

    2010-01-01

    BACKGROUND: One of the most important causes of maternal mortality and severe morbidity worldwide is post partum haemorrhage (PPH). Factors as substandard care are frequently reported in the international literature and there are similar reports in the Netherlands. The incidence of PPH in the Dutch

  15. A Simulation-based Analysis of Transition Pathways for the Dutch Electricity System

    NARCIS (Netherlands)

    Yucel, G.; Van Daalen, C.

    2011-01-01

    Recent developments constitute a backdrop of change for the Dutch electricity system. Institutional change driven by liberalization, changing economical competitiveness of the dominant fuels, new technologies, and changing end-user preferences regarding electricity supply are some examples of these

  16. Urban Climate Map System for Dutch spatial planning

    Science.gov (United States)

    Ren, Chao; Spit, Tejo; Lenzholzer, Sanda; Yim, Hung Lam Steve; Heusinkveld, Bert; van Hove, Bert; Chen, Liang; Kupski, Sebastian; Burghardt, René; Katzschner, Lutz

    2012-08-01

    Facing climate change and global warming, outdoor climatic environment is an important consideration factor for planners and policy makers because improving it can greatly contribute to achieve citizen's thermal comfort and create a better urban living quality for adaptation. Thus, the climatic information must be assessed systematically and applied strategically into the planning process. This paper presents a tool named Urban Climate Map System (UCMS) that has proven capable of helping compact cities to incorporate climate effects in planning processes in a systematic way. UCMS is developed and presented in a Geographic Information System (GIS) platform in which the lessons learned and experience gained from interdisciplinary studies can be included. The methodology of UCMS of compact cities, the construction procedure, and the basic input factors - including the natural climate resources and planning data - are described. Some literatures that shed light on the applicability of UMCS are reported. The Municipality of Arnhem is one of Dutch compact urban areas and still under fast urban development and urban renewal. There is an urgent need for local planners and policy makers to protect local climate and open landscape resources and make climate change adaptation in urban construction. Thus, Arnhem is chosen to carry out a case study of UCMS. Although it is the first work of Urban Climatic Mapping in The Netherlands, it serves as a useful climatic information platform to local planners and policy makers for their daily on-going works. We attempt to use a quick method to collect available climatic and planning data and create an information platform for planning use. It relies mostly on literature and theoretical understanding that has been well practiced elsewhere. The effort here is to synergize the established understanding for a case at hand and demonstrate how useful guidance can still be made for planners and policy makers.

  17. The Sectoral Innovation System of the Dutch Vegetable Breeding Industry

    NARCIS (Netherlands)

    Liu, Z.; Jongsma, M.A.; Huang, Caicheng; Dons, J.J.M.; Omta, S.W.F.

    2015-01-01

    In a number of studies, the Dutch vegetable breeding industry has been described as a highly innovative sector, but the root causes for its innovativeness have not yet been analysed systematically. In order to understand the factors that affect innovation and business performance, the Sectoral Innov

  18. Modelling climate change effects on a dutch coastal groundwater system using airborne electromagnetic measurements

    NARCIS (Netherlands)

    Faneca S̀anchez, M.; Gunnink, J.L.; Baaren, E.S. van; Oude Essink, G.H.P.; Siemon, B.; Auken, E.; Elderhorst, W.; Louw, P.G.B. de

    2012-01-01

    The forecast of climate change effects on the groundwater system in coastal areas is of key importance for policy makers. The Dutch water system has been deeply studied because of its complex system of low-lying areas, dunes, land won to the sea and dikes, but nowadays large efforts are still being

  19. Obstetrical paralysis.

    Science.gov (United States)

    Chung, S M; Nissenbaum, M M

    1975-04-01

    Most patients with obstetrical paralysis have some useful functional return, and early recognition and treatment help prevent rapidly developing shoulder contractures. Initial physical therapy includes passive range of motion exercises. Fixed contractures must be released prior to reconstructive surgery designed to improve funtion. An approach to the diagnosis, evaluation, and treatment of obstetrical paralysis is given.

  20. Modelling Animal Systems Paper: Update of the Dutch protein evaluation system for ruminants: the DVE/OEB2010 system

    NARCIS (Netherlands)

    Duinkerken, van G.; Blok, M.C.; Bannink, A.; Cone, J.W.; Dijkstra, J.; Vuuren, van A.M.; Tamminga, S.

    2011-01-01

    In the current Dutch protein evaluation system (the DVE/OEB1991 system), two characteristics are calculated for each feed: true protein digested in the intestine (DVE) and the rumen degradable protein balance (OEB). Of these, DVE represents the protein value of a feed, while OEB is the difference be

  1. Towards ontology-based decision support systems for complex ultrasound diagnosis in obstetrics and gynecology.

    Science.gov (United States)

    Maurice, P; Dhombres, F; Blondiaux, E; Friszer, S; Guilbaud, L; Lelong, N; Khoshnood, B; Charlet, J; Perrot, N; Jauniaux, E; Jurkovic, D; Jouannic, J-M

    2017-05-01

    We have developed a new knowledge base intelligent system for obstetrics and gynecology ultrasound imaging, based on an ontology and a reference image collection. This study evaluates the new system to support accurate annotations of ultrasound images. We have used the early ultrasound diagnosis of ectopic pregnancies as a model clinical issue. The ectopic pregnancy ontology was derived from medical texts (4260 ultrasound reports of ectopic pregnancy from a specialist center in the UK and 2795 Pubmed abstracts indexed with the MeSH term "Pregnancy, Ectopic") and the reference image collection was built on a selection from 106 publications. We conducted a retrospective analysis of the signs in 35 scans of ectopic pregnancy by six observers using the new system. The resulting ectopic pregnancy ontology consisted of 1395 terms, and 80 images were collected for the reference collection. The observers used the knowledge base intelligent system to provide a total of 1486 sign annotations. The precision, recall and F-measure for the annotations were 0.83, 0.62 and 0.71, respectively. The global proportion of agreement was 40.35% 95% CI [38.64-42.05]. The ontology-based intelligent system provides accurate annotations of ultrasound images and suggests that it may benefit non-expert operators. The precision rate is appropriate for accurate input of a computer-based clinical decision support and could be used to support medical imaging diagnosis of complex conditions in obstetrics and gynecology. Copyright © 2017. Published by Elsevier Masson SAS.

  2. Regulated competition in health care: switching and barriers to switching in the Dutch health insurance system.

    NARCIS (Netherlands)

    Reitsma-van Rooijen, M.; Jong, J.D. de; Rijken, M.

    2011-01-01

    Background: In 2006, a number of changes in the Dutch health insurance system came into effect. In this new system mobility of insured is important. The idea is that insured switch insurers because they are not satisfied with quality of care and the premium of their insurance. As a result, insurers

  3. The Dutch system of education and training in radiation protection. Past, present and future

    Energy Technology Data Exchange (ETDEWEB)

    Boersma, Hielke Freerk [Groningen Univ. (Netherlands). Office of the Univ. Health, Safety and Environment

    2013-09-01

    The earliest courses in 'Radiation Protection (RP) Education and Training in the Netherlands' date back to the late fifties, a time which saw major developments especially in both nuclear medicine and nuclear power. The Dutch Society for Radiation Protection (NVS - Nederlandse Vereinigung voor Strahlingshygiene), established in 1960, is in fact the result of one of the first RP courses for medical doctors. The current system of recognition of RP courses was implemented in 1984 in Dutch legislation, based on an advice of the Dutch Health Council from 1972 (.). The recognition system has fundamentally remained unchanged since then. Radiation protection courses in the Netherlands based on this system already started in the seventies. After many discussions in the past decade the system will change in the next years in close relation to the start of a system of registration of RPes. In this paper I will start with a short introduction of the Dutch system of RP education and training. I will consecutively describe the background of the future changes in our system. Finally the major changes will be given. In the end I hope to have convinced you of the fact that although we face some major changes in the near future, the basis of the current system of education and training in RP will remain. (orig.)

  4. Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Dubourg, Dominique; Makokha, Anselimo

    2014-01-01

    in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were...

  5. Innovating for the future? : An external assessment of the future-oriented governance of the Dutch innovation system

    NARCIS (Netherlands)

    Duin, van der P.; Graaf, de R.

    2010-01-01

    Purpose: The purpose of this paper is to analyze the future-orientation of the Dutch innovation system and formulate recommendations to improve it. Design/methodology/approach: The approach takes the form of in-depth interviews with Dutch experts who are sufficiently independent to formulate relevan

  6. Innovating for the future? : An external assessment of the future-oriented governance of the Dutch innovation system

    NARCIS (Netherlands)

    Duin, van der P.; Graaf, de R.

    2010-01-01

    Purpose: The purpose of this paper is to analyze the future-orientation of the Dutch innovation system and formulate recommendations to improve it. Design/methodology/approach: The approach takes the form of in-depth interviews with Dutch experts who are sufficiently independent to formulate relevan

  7. Do stakeholder groups influence environmental management system development in the Dutch agri-food sector?

    NARCIS (Netherlands)

    Bremmers, H.J.; Omta, S.W.F.; Kemp, R.G.M.; Haverkamp, D.J.

    2007-01-01

    This paper presents the results of a survey that included 492 companies in the Dutch agri-food sector with respect to the influence of stakeholder groups on the companies' level of environmental management system (EMS) implementation. It is concluded that primary stakeholders (government, clients) a

  8. Prevalence of claw disorders in Dutch dairy cows exposed to several floor systems

    NARCIS (Netherlands)

    Somers, J.G.C.J.; Frankena, K.; Noordhuizen-Stassen, E.N.; Metz, J.H.M.

    2003-01-01

    Claw health was examined in an observational study on Dutch dairy farms with either a slatted floor (SL), slatted floor with manure scraper (SL-SCR), solid concrete floor (SCF), a straw yard (SY), or a zero-grazing feeding system (ZG). Hooves of cows' hind legs were examined for the presence and sev

  9. Functional food monitoring as part of the new Dutch dietary monitoring system

    NARCIS (Netherlands)

    Rompelberg CJM; Jager M; Bakker MI; Buurma-Rethans EJM; Ocke MC; CVG

    2006-01-01

    Good data on functional food consumption necessary for an adequate Dutch nutrition policy are lacking. This lack may be overcome in future by including functional food monitoring in the new dietary monitoring system in the Netherlands. One specific form of monitoring could be an Internet-based quest

  10. Functional food monitoring as part of the new Dutch dietary monitoring system

    NARCIS (Netherlands)

    Rompelberg CJM; Jager M; Bakker MI; Buurma-Rethans EJM; Ocke MC; CVG

    2006-01-01

    Good data on functional food consumption necessary for an adequate Dutch nutrition policy are lacking. This lack may be overcome in future by including functional food monitoring in the new dietary monitoring system in the Netherlands. One specific form of monitoring could be an Internet-based quest

  11. Developing a national performance indicator framework for the Dutch health system.

    NARCIS (Netherlands)

    Asbroek, A.H.A. ten; Arah, O.A.; Geelhoed, J.; Custers, J.; Delnoij, D.M.; Klazinga, N.S.

    2004-01-01

    Objective. To report on the first phase of the development of a national performance indicator framework for the Dutch health system. Methods. In January 2002, we initiated an informed interactive process with the intended users-policymakers at the Ministry of Health, Welfare and Sport—and academics

  12. Functional food monitoring as part of the new Dutch dietary monitoring system

    NARCIS (Netherlands)

    Rompelberg CJM; Jager M; Bakker MI; Buurma-Rethans EJM; Ocke MC; CVG

    2006-01-01

    Good data on functional food consumption necessary for an adequate Dutch nutrition policy are lacking. This lack may be overcome in future by including functional food monitoring in the new dietary monitoring system in the Netherlands. One specific form of monitoring could be an Internet-based

  13. Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Dubourg, Dominique; Makokha, Anselimo;

    2014-01-01

    BackgroundDeveloping countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept...... in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were...

  14. Obstetric antiphospholipid syndrome.

    Science.gov (United States)

    Esteve-Valverde, E; Ferrer-Oliveras, R; Alijotas-Reig, J

    2016-04-01

    Obstetric antiphospholipid syndrome is an acquired autoimmune disorder that is associated with various obstetric complications and, in the absence of prior history of thrombosis, with the presence of antiphospholipid antibodies directed against other phospholipids, proteins called cofactors or PL-cofactor complexes. Although the obstetric complications have been related to the procoagulant properties of antiphospholipid antibodies, pathological studies of human placenta have shown the proinflammatory capacity of antiphospholipid antibodies via the complement system and proinflammatory cytokines. There is no general agreement on which antiphospholipid antibodies profile (laboratory) confers the greatest obstetric risk, but the best candidates are categories I and IIa. Combined treatment with low doses of aspirin and heparin achieves good obstetric and maternal outcomes. In this study, we also review the therapeutic possibilities in refractory cases, although the likelihood of progressing to other autoimmune diseases is low. We briefly comment on incomplete obstetric antiphospholipid syndrome, also known as antiphospholipid antibody-mediated pregnancy morbidity syndrome. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  15. Quality of Care and Disparities in Obstetrics.

    Science.gov (United States)

    Howell, Elizabeth A; Zeitlin, Jennifer

    2017-03-01

    Growing attention is being paid to obstetric quality of care as patients are pressing the health care system to measure and improve quality. There is also an increasing recognition of persistent racial and ethnic disparities prevalent in obstetric outcomes. Yet few studies have linked obstetric quality of care with racial and ethnic disparities. This article reviews definitions of quality of care, health disparities, and health equity as they relate to obstetric care and outcomes; describes current efforts and challenges in obstetric quality measurement; and proposes 3 steps in an effort to develop, track, and improve quality and reduce disparities in obstetrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Reasons for accepting or declining Down syndrome screening in Dutch prospective mothers within the context of national policy and healthcare system characteristics: a qualitative study.

    Science.gov (United States)

    Crombag, Neeltje M T H; Boeije, Hennie; Iedema-Kuiper, Rita; Schielen, Peter C J I; Visser, Gerard H A; Bensing, Jozien M

    2016-05-26

    Uptake rates for Down syndrome screening in the Netherlands are low compared to other European countries. To investigate the low uptake, we explored women's reasons for participation and possible influences of national healthcare system characteristics. Dutch prenatal care is characterised by an approach aimed at a low degree of medicalisation, with pregnant women initially considered to be at low risk. Prenatal screening for Down syndrome is offered to all women, with a 'right not to know' for women who do not want to be informed on this screening. At the time this study was performed, the test was not reimbursed for women aged 35 and younger. We conducted a qualitative study to explore reasons for participation and possible influences of healthcare system characteristics. Data were collected via ten semi-structured focus groups with women declining or accepting the offer of Down syndrome screening (n = 46). All focus groups were audio- and videotaped, transcribed verbatim, coded and content analysed. Women declining Down syndrome screening did not consider Down syndrome a condition severe enough to justify termination of pregnancy. Young women declining felt supported in their decision by perceived confirmation of their obstetric caregiver and reassured by system characteristics (costs and age restriction). Women accepting Down syndrome screening mainly wanted to be reassured or be prepared to care for a child with Down syndrome. By weighing up the pros and cons of testing, obstetric caregivers supported young women who accepted in the decision-making process. This was helpful, although some felt the need to defend their decision to accept the test offer due to their young age. For some young women accepting testing, costs were considered a disincentive to participate. Presentation of prenatal screening affects how the offer is attended to, perceived and utilised. By offering screening with age restriction and additional costs, declining is considered the

  17. Ecological and economic evaluation of Dutch egg production systems.

    NARCIS (Netherlands)

    Dekker, S.E.M.; Boer, de I.J.M.; Vermeij, I.; Aarnink, A.J.A.; Groot Koerkamp, P.W.G.

    2011-01-01

    The upcoming ban on battery cages in the European Union is expected to cause a shift in husbandry systems from predominantly battery cages to enriched cages and loose housing systems, such as barn, free range and organic systems. To gain insight into ecological and economic consequences of such a ba

  18. Workplace System Factors of Obstetric Nurses in Northeastern Ontario, Canada: Using a Work Disability Prevention Approach

    Directory of Open Access Journals (Sweden)

    Behdin Nowrouzi

    2015-12-01

    Conclusion: Work ability is closely related to job and career satisfaction, and perceived control at work among obstetric nursing. In order to improve work ability, nurses need to work in environments that support them and allow them to be engaged in the decision-making processes.

  19. Participation and coordination in Dutch health care policy-making. A network analysis of the system of intermediate organizations in Dutch health care.

    Science.gov (United States)

    Lamping, Antonie J; Raab, Jörg; Kenis, Patrick

    2013-06-01

    This study explores the system of intermediate organizations in Dutch health care as the crucial system to understand health care policy-making in the Netherlands. We argue that the Dutch health care system can be understood as a system consisting of distinct but inter-related policy domains. In this study, we analyze four such policy domains: Finances, quality of care, manpower planning and pharmaceuticals. With the help of network analytic techniques, we describe how this highly differentiated system of >200 intermediate organizations is structured and coordinated and what (policy) consequences can be observed with regard to its particular structure and coordination mechanisms. We further analyze the extent to which this system of intermediate organizations enables participation of stakeholders in policy-making using network visualization tools. The results indicate that coordination between the different policy domains within the health care sector takes place not as one would expect through governmental agencies, but through representative organizations such as the representative organizations of the (general) hospitals, the health care consumers and the employers' association. We further conclude that the system allows as well as denies a large number of potential participants access to the policy-making process. As a consequence, the representation of interests is not necessarily balanced, which in turn affects health care policy. We find that the interests of the Dutch health care consumers are well accommodated with the national umbrella organization NPCF in the lead. However, this is no safeguard for the overall community values of good health care since, for example, the interests of the public health sector are likely to be marginalized.

  20. Feasibility of target communities in a Dutch brook valley system

    NARCIS (Netherlands)

    Prins, AH; Bekker, RM

    As a reaction to the ongoing deterioration of nature conservation interest in The Netherlands, an offensive nature strategy was formulated in the 1990 Nature Policy Plan. In this Plan, target communities and target plant species are mentioned. For the 'Drentse A brook valley system', target

  1. Feasibility of target communities in a Dutch brook valley system

    NARCIS (Netherlands)

    Prins, AH; Bekker, RM

    1998-01-01

    As a reaction to the ongoing deterioration of nature conservation interest in The Netherlands, an offensive nature strategy was formulated in the 1990 Nature Policy Plan. In this Plan, target communities and target plant species are mentioned. For the 'Drentse A brook valley system', target communit

  2. The need to include obstetric nurses in prenatal care visits in the public health system

    Directory of Open Access Journals (Sweden)

    Selma Aparecida Lagrosa Garcia

    2010-06-01

    Full Text Available Objective: To investigate, with a qualitative approach, the role of Obstetric Nurses at the primary level of care given to women’s health as a vital component of the multidisciplinary team, which today is fundamental for providing care, prevention as well as health education and promotion, especially in programs whose activities are geared towards primary care of pregnant, parturient, and puerpera women. Methods: Brazilian laws and the determinations of Nursing Councils in reference to the activities of the obstetric nurse were researched, including the nurse’s responsibilities and limits. The bibliographic search was conducted in health-related journals, lay publications, and the Internet. Results: The conflicts between professional physicians and nurses were discussed. Conclusions: It was concluded that the activities of the nurse, conducting low-risk prenatal clinical visits in the basic healthcare network, has legal and ethical support and provides true benefit to the clients.

  3. A validation of an operational wave and surge prediction system for the Dutch Coast

    Directory of Open Access Journals (Sweden)

    L. Sembiring

    2014-05-01

    Full Text Available Knowledge of the actual condition of hydrodynamics in the nearshore and coastal area is essential for coastal monitoring activities. To this end, a coastal operational model system can serve as a tool in providing recent and up-to-date state of the hydrodynamics along the coast. In this paper we apply CoSMoS (Coastal Storm Modeling System, a generic operational model system applied here to predict storm impact on dunes along the Dutch Coast. The CoSMoS application is not limited to storm impact prediction on the Dutch coast, but can also be applied to other coastal hazards such as rip currents and coastal flooding, in other environments. In this paper, we present the set-up of the CoSMoS system and validation of the wave and surge model within it using deep water wave buoy data and tidal gauge measurements as ground truth validation material. The evaluation is presented as monthly error measures between computed parameters and observed ones. Hindcast results over the whole year of 2009 show that the simulated wave parameters and surge elevation from the CoSMoS are in good agreement with data, with average root mean square error over the year of 0.14 m for the surge elevation and 0.24 m for the significant wave height. It is noted that there is a tendency of the wave model to underestimate the height of northerly waves with lower frequencies (swell. Additionally, when a wave separation algorithm is applied on the overall spectrum, results show consistent underestimation of the swell component by the model, which for the Dutch Coast, will mainly come from the North where the North Sea is open to the Atlantic Ocean. In the proposed model system, the swell boundary can have a significant effect on the simulated wave results, suggesting room for improvement for the swell boundary conditions on the North and the swell propagation within the Dutch Continental Shelf Model. Finally we show that in forecast mode, CoSMoS can provide reasonably good wave

  4. ASSESSMENT OF THE VOLUNTEERED GEOGRAPHIC INFORMATION FEEDBACK SYSTEM FOR THE DUTCH TOPOGRAPHICAL KEY REGISTER

    Directory of Open Access Journals (Sweden)

    M. Grus

    2015-08-01

    Full Text Available Since Topographical Key Register has become an open data the amount of users increased enormously. The highest grow was in the private users group. The increasing number of users and their growing demand for high actuality of the topographic data sets motivates the Dutch Kadaster to innovate and improve the Topographical Key Register (BRT. One of the initiatives was to provide a voluntary geographical information project aiming at providing a user-friendly feedback system adjusted to all kinds of user groups. The feedback system is a compulsory element of the Topographical Key Register in the Netherlands. The Dutch Kadaster is obliged to deliver a feedback system and the key-users are obliged to use it. The aim of the feedback system is to improve the quality and stimulate the usage of the data. The results of the pilot shows that the user-friendly and open to everyone feedback system contributes enormously to improve the quality of the topographic dataset.

  5. Some pain, no gain: experiences with the no-claim rebate in the Dutch health care system

    NARCIS (Netherlands)

    J. Holland; N.J.A. van Exel (Job); F.T. Schut (Erik); W.B.F. Brouwer (Werner)

    2009-01-01

    textabstractTo contain expenditures in an increasingly demand driven health care system, in 2005 a no-claim rebate was introduced in the Dutch health insurance system. Since demand-side cost sharing is a very controversial issue, the no-claim rebate was launched as a consumer friendly bonus system t

  6. Obstetric medicine

    Directory of Open Access Journals (Sweden)

    L. Balbi

    2013-05-01

    Full Text Available BACKGROUND Obstetric assistance made major advances in the last 20 years: improved surgical technique allows quicker caesarean sections, anaesthesiology procedures such as peripheral anaesthesia and epidural analgesia made safer operative assistance, remarkably reducing perioperative morbidity and mortality, neonatology greatly improved the results of assistance to low birth weight newborns. A new branch of medicine called “obstetric medicine” gained interest and experience after the lessons of distinguished physicians like Michael De Swiet in England. All together these advances are making successful pregnancies that 20 years ago would have been discouraged or even interrupted: that’s what we call high risk pregnancy. High risk of what? Either complications of pregnancy on pre-existing disease or complications of pre-existing disease on pregnancy. Nowadays, mortality in pregnancy has a medical cause in 80% of cases in Western countries (Confidential Enquiry on Maternal Deaths, UK, 2004. DISCUSSION The background is always changing and we have to take in account of: increase of maternal age; widespread use of assisted fertilization techniques for treatment of infertility; social feelings about maternity desire with increasing expectations from medical assistance; immigration of medically “naive” patients who don’t know to have a chronic disease, but apt and ready to conceive; limited knowledge of feasibility of drug use in pregnancy which may induce both patients and doctors to stopping appropriate drug therapy in condition of severe disease. Preconception counseling, planning the pregnancy, wise use of drugs, regular follow-up throughout the pregnancy and, in selected cases, preterm elective termination of pregnancy may result in excellent outcome both for mother and foetus. CONCLUSIONS Highly committed and specifically trained physicians are required to counsel these patients and to plan their treatment before and during pregnancy.

  7. Characterization of Dutch dairy farms using sensor systems for cow management.

    Science.gov (United States)

    Steeneveld, W; Hogeveen, H

    2015-01-01

    To improve cow management in large dairy herds, sensors have been developed that can measure physiological, behavioral, and production indicators on individual cows. Recently, the number of dairy farms using sensor systems has increased. It is not known, however, to what extent sensor systems are used on dairy farms, and the reasons why farmers invest or not in sensor systems are unclear. The first objective of this study was to give an overview of the sensor systems currently used in the Netherlands. The second objective was to investigate the reasons for investing or not investing in sensor systems. The third objective was to characterize farms with and without sensor systems. A survey was developed to investigate first, the reasons for investing or not in sensor systems and, then, how the sensor systems are used in daily cow management. The survey was sent to 1,672 Dutch dairy farmers. The final data set consisted of 512 dairy farms (response rate of 30.6%); 202 farms indicated that they had sensor systems and 310 farms indicated that they did not have sensor systems. A wide variety of sensor systems was used on Dutch dairy farms; those for mastitis detection and estrus detection were the most-used sensor systems. The use of sensor systems was different for farms using an automatic milking system (AMS) and a conventional milking system (CMS). Reasons for investing were different for different sensor systems. For sensor systems attached to the AMS, the farmers made no conscious decision to invest: they answered that the sensors were standard in the AMS or were bought for reduced cost with the AMS. The main reasons for investing in estrus detection sensor systems were improving detection rates, gaining insights into the fertility level of the herd, improving profitability of the farm, and reducing labor. Main reasons for not investing in sensor systems were economically related. It was very difficult to characterize farms with and without sensor systems. Farms

  8. Het Nederlands signaleringscentrum kindergeneeskunde; een kwaliteitsinstrument voor preventie en onderzoek [The Dutch Paediatric Surveillance System; a quality-focused instrument for prevention and research

    NARCIS (Netherlands)

    Hirasing, R.A.; Rodrigues Pereira, R.

    2002-01-01

    The Dutch Paediatric Surveillance System was initiated by the Dutch Paediatric Society and is housed within the TNO Prevention and Health office. The purpose of the surveillance system is (a) to gain insight on a population level into the prevalence of rare and new diseases in youths (0-18 year),

  9. Explaining Ethnic Inequality in the Juvenile Justice System, an analysis of the outcomes of Dutch Prosecutorial Decision Making

    NARCIS (Netherlands)

    Weenink, D.

    2009-01-01

    Most studies of the treatment of minorities in criminal justice systems show that ethnic minorities are punished more harshly. This paper aims to explain ethnic inequality in prosecutorial decision making in the Dutch juvenile justice system. Based on statistical analyses of 409 case files, it emerg

  10. Strategic decision making in higher education: an analysis of the new planning system in Dutch higher education

    NARCIS (Netherlands)

    Maassen, P.A.M.; Potman, Henry; Potman, Henry P.

    1990-01-01

    One of the main objects of the recently developed policy for Dutch higher education regards the creation of a more diversified higher education system with flexible and adaptive institutions. The nature of the proposed system should, among other things, reveal itself in meaningful and discriminating

  11. Double Dutch: A Tool for Designing Combinatorial Libraries of Biological Systems.

    Science.gov (United States)

    Roehner, Nicholas; Young, Eric M; Voigt, Christopher A; Gordon, D Benjamin; Densmore, Douglas

    2016-06-17

    Recently, semirational approaches that rely on combinatorial assembly of characterized DNA components have been used to engineer biosynthetic pathways. In practice, however, it is not practical to assemble and test millions of pathway variants in order to elucidate how different DNA components affect the behavior of a pathway. To address this challenge, we apply a rigorous mathematical approach known as design of experiments (DOE) that can be used to construct empirical models of system behavior without testing all variants. To support this approach, we have developed a tool named Double Dutch, which uses a formal grammar and heuristic algorithms to automate the process of DOE library design. Compared to designing by hand, Double Dutch enables users to more efficiently and scalably design libraries of pathway variants that can be used in a DOE framework and uniquely provides a means to flexibly balance design considerations of statistical analysis, construction cost, and risk of homologous recombination, thereby demonstrating the utility of automating decision making when faced with complex design trade-offs.

  12. Obstetric Safety and Quality.

    Science.gov (United States)

    Pettker, Christian M; Grobman, William A

    2015-07-01

    Obstetric safety and quality is an emerging and important topic not only as a result of the pressures of patient and regulatory expectations, but also because of the genuine interest of caregivers to reduce harm, improve outcomes, and optimize care. Although each seeks to improve care by using scientific approaches beyond human physiology and pathophysiology, patient safety methodologies seek to avoid preventable adverse events, whereas health care quality projects aim to achieve the best possible outcomes. It is well-documented that an increasingly complex medical system controlled by human workers is a circumstance subject to recurrent failure. A safety culture encourages a proactive approach to mitigate failure before, during, and after it occurs. This article highlights the key concepts in health care safety and quality and reviews the background of the quality improvement sciences with particular emphasis on obstetric outcomes and quality measures.

  13. Regulated competition in health care: Switching and barriers to switching in the Dutch health insurance system

    Directory of Open Access Journals (Sweden)

    Rijken Mieke

    2011-05-01

    Full Text Available Abstract Background In 2006, a number of changes in the Dutch health insurance system came into effect. In this new system mobility of insured is important. The idea is that insured switch insurers because they are not satisfied with quality of care and the premium of their insurance. As a result, insurers will in theory strive for a better balance between price and quality. The Dutch changes have caught the attention, internationally, of both policy makers and researchers. In our study we examined switching behaviour over three years (2007-2009. We tested if there are differences in the numbers of switchers between groups defined by socio-demographic and health characteristics and between the general population and people with chronic illness or disability. We also looked at reasons for (not-switching and at perceived barriers to switching. Methods Switching behaviour and reasons for (not-switching were measured over three years (2007-2009 by sending postal questionnaires to members of the Dutch Health Care Consumer Panel and of the National Panel of people with Chronic illness or Disability. Data were available for each year and for each panel for at least 1896 respondents - a response of between 71% and 88%. Results The percentages of switchers are low; 6% in 2007, 4% in 2008 and 3% in 2009. Younger and higher educated people switch more often than older and lower educated people and women switch more often than men. There is no difference in the percentage of switchers between the general population and people with chronic illness or disability. People with a bad self-perceived health, and chronically ill and disabled, perceive more barriers to switching than others. Conclusion The percentages of switchers are comparable to the old system. Switching is not based on quality of care and thus it can be questioned whether it will lead to a better balance between price and quality. Although there is no difference in the frequency of switching

  14. The design of PoliDocs: a web information system for the disclosure of Dutch parliamentary publications

    NARCIS (Netherlands)

    Gielissen, T.; Marx, M.

    2009-01-01

    The development of PoliDocs.nl, a Web Information System for the disclosure of Dutch parliamentary publications, is an effort to improve the disclosure of parliamentary publications in The Netherlands. The data is distributed over three sources and is available through different Web Information Syst

  15. The design of PoliDocs: a web information system for the disclosure of Dutch parliamentary publications

    NARCIS (Netherlands)

    Gielissen, T.; Marx, M.

    2009-01-01

    The development of PoliDocs.nl, a Web Information System for the disclosure of Dutch parliamentary publications, is an effort to improve the disclosure of parliamentary publications in The Netherlands. The data is distributed over three sources and is available through different Web Information

  16. How to allocate public funding to nongovernmental development organizations: A critical assessment of the Dutch co-financing system

    NARCIS (Netherlands)

    Ruben, R.; Schulpen, L.W.M.

    2009-01-01

    The Dutch co-financing system for nongovernmental development organizations (NGDOs) is unique in Europe. Almost a quarter of public development aid is channeled through a selective group of NGDOs that have to satisfy a broad range of institutional and operational criteria. The procedures for definin

  17. Improving the energy and IAQ performance of ventilation systems in Dutch dwellings

    NARCIS (Netherlands)

    Holsteijn, R.C.A. van; Li, W.L.; Valk, H.J.J.; Kornaat, W.

    2016-01-01

    MONICAIR - MONItoring & Control of Air quality in Individual Rooms - is a pre-competitive field research project of a broad consortium of Dutch ventilation unit manufacturers and research institutes, supported by the Dutch government. The first aim of the project is to investigate and compare the

  18. System theory and safety models in Swedish, UK, Dutch and Australian road safety strategies.

    Science.gov (United States)

    Hughes, B P; Anund, A; Falkmer, T

    2015-01-01

    Road safety strategies represent interventions on a complex social technical system level. An understanding of a theoretical basis and description is required for strategies to be structured and developed. Road safety strategies are described as systems, but have not been related to the theory, principles and basis by which systems have been developed and analysed. Recently, road safety strategies, which have been employed for many years in different countries, have moved to a 'vision zero', or 'safe system' style. The aim of this study was to analyse the successful Swedish, United Kingdom and Dutch road safety strategies against the older, and newer, Australian road safety strategies, with respect to their foundations in system theory and safety models. Analysis of the strategies against these foundations could indicate potential improvements. The content of four modern cases of road safety strategy was compared against each other, reviewed against scientific systems theory and reviewed against types of safety model. The strategies contained substantial similarities, but were different in terms of fundamental constructs and principles, with limited theoretical basis. The results indicate that the modern strategies do not include essential aspects of systems theory that describe relationships and interdependencies between key components. The description of these strategies as systems is therefore not well founded and deserves further development.

  19. 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…

  20. 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…

  1. Competency-Based Medical Education: Developing a Framework for Obstetrics and Gynaecology.

    Science.gov (United States)

    Caccia, Nicolette; Nakajima, Amy; Scheele, Fedde; Kent, Nancy

    2015-12-01

    The development of a Canadian competency-based medical education (CBME) curriculum in obstetrics and gynaecology, slated to begin in 2017, must be rooted in, and aligned with, the principles of CanMEDS 2015 and Competence by Design. It must also reflect the unique realities of the practice of the specialty. The Dutch Society of Obstetrics and Gynaecology has been at the forefront of the movement to design and implement competency-based training for obstetrics and gynaecology. The Dutch curriculum represents a practical example of how such a program could be developed. Several CBME curricular initiatives have now also begun across Canada.

  2. Defining and describing birth centres in the Netherlands - a component study of the Dutch Birth Centre Study.

    Science.gov (United States)

    Hermus, M A A; Boesveld, I C; Hitzert, M; Franx, A; de Graaf, J P; Steegers, E A P; Wiegers, T A; van der Pal-de Bruin, K M

    2017-07-03

    During the last decade, a rapid increase of birth locations for low-risk births, other than conventional obstetric units, has been seen in the Netherlands. Internationally some of such locations are called birth centres. The varying international definitions for birth centres are not directly applicable for use within the Dutch obstetric system. A standard definition for a birth centre in the Netherlands is lacking. This study aimed to develop a definition of birth centres for use in the Netherlands, to identify these centres and to describe their characteristics. International definitions of birth centres were analysed to find common descriptions. In July 2013 the Dutch Birth Centre Questionnaire was sent to 46 selected Dutch birth locations that might qualify as birth centre. Questions included: location, reason for establishment, women served, philosophies, facilities that support physiological birth, hotel-facilities, management, environment and transfer procedures in case of referral. Birth centres were visited to confirm the findings from the Dutch Birth Centre Questionnaire and to measure distance and time in case of referral to obstetric care. From all 46 birth locations the questionnaires were received. Based on this information a Dutch definition of a birth centre was constructed. This definition reads: "Birth centres are midwifery-managed locations that offer care to low risk women during labour and birth. They have a homelike environment and provide facilities to support physiological birth. Community midwives take primary professional responsibility for care. In case of referral the obstetric caregiver takes over the professional responsibility of care." Of the 46 selected birth locations 23 fulfilled this definition. Three types of birth centres were distinguished based on their location in relation to the nearest obstetric unit: freestanding (n = 3), alongside (n = 14) and on-site (n = 6). Transfer in case of referral was necessary for all

  3. [A proposal for introduction of Europeristat-compatible information system aiming a unified quality control of obstetrical and perinatological care in Hungary].

    Science.gov (United States)

    Berkő, Péter

    2016-05-01

    It is a regrettable deficiency in the Hungarian healthcare that the culture and the system of quality control of cure have not been formed (except for a few subspecialties, units or wards). If hospital wards do not have a national, professionally unified and modern information system presenting the most important quantity and quality indicators of their medicinal activity annually, a stable basis for definition of future tasks is absent. The author puts forward a proposal for the establishment of the information systems for different professional fields. On the basis of experience of perinatological information system operating for over 3 decades in Borsod-Abaúj-Zemplén county, he also proposes introduction of a nationally unified, Europeristat-compatible information system following Tauffer-statistics which may serve as a uniform quality control of obstetrics and perinatological care, as well as introduction of its base, the dataform "TePERA" (Form of Obstetrics and Perinatological Care Risk).

  4. Third Dutch Process Security Control Event

    NARCIS (Netherlands)

    Luiijf, H.A.M.

    2009-01-01

    On June 4th, 2009, the third Dutch Process Control Security Event took place in Amsterdam. The event, organised by the Dutch National Infrastructure against Cybercrime (NICC), attracted both Dutch process control experts and members of the European SCADA and Control Systems Information Exchange (Eur

  5. Prevalence of claw disorders in Dutch dairy cows exposed to several floor systems.

    Science.gov (United States)

    Somers, J G C J; Frankena, K; Noordhuizen-Stassen, E N; Metz, J H M

    2003-06-01

    Claw health was examined in an observational study on Dutch dairy farms with either a slatted floor (SL), slatted floor with manure scraper (SL-SCR), solid concrete floor (SCF), a straw yard (SY), or a zero-grazing feeding system (ZG). Hooves of cows' hind legs were examined for the presence and severity of claw disorders during hoof trimming events at the end of the pasture (P-study) and housing period (H-study). The number of cows in each study was 3078 (49 herds) and 3190 (47 herds), respectively. Due to a different hoof trimming strategy, data collected during both observation periods in SY herds (638 cows; 16 herds) were combined. Cows in straw yards (SY) had by far the lowest numbers of claw disorders. Over 80% of cows exposed to concrete flooring had at least one claw disorder at the time of observation, whereas on SY surfaces, this percentage was between 55 and 60. Cows on SL-SCR were less frequently affected by interdigital dermatitis/heel erosion (IDHE) and digital dermatitis (DD) than cows on SL (reference floor system). Little difference in claw health was found between SF and SL. The ZG cows were at higher risk (OR > 2) for most claw disorders in the P-study, whereas in the H-study, ZG cows showed less IDHE, sole hemorrhage, and sole ulcer. All herds on concrete flooring (SL, SL-SCR, SCF, ZG) were infected by DD, resulting in an average cow level prevalence of 30%. This indicates that the level of DD infection has increased considerably over the last 10 yr in The Netherlands.

  6. Calculated iodine intake before and after simulated iodization (Dutch Nutrition Surveillance System)

    NARCIS (Netherlands)

    Brussaard, J.H.; Hulshof, K.F.A.M.; Löwik, M.R.H.

    1995-01-01

    To estimate the effect of possible goitre prophylactic measures on the intake of iodine among population groups, simulation studies, based on the first Dutch National Food Consumption Survey, were carried out. Iodine intake figures and prevalence of low intakes were calculated after fictively iodizi

  7. Total greenhouse gas emissions related to the Dutch crop production system

    NARCIS (Netherlands)

    Kramer, K.J.; Moll, H.C.; Nonhebel, S.

    1999-01-01

    This article discusses the greenhouse gas emissions (CO2, CH4, N2O) related to Dutch agricultural crop production. Emissions occur during agricultural processes (direct emissions) as well as in the life cycle of the required inputs (indirect emissions). An integrated approach assesses the total

  8. Modelling climate change in a Dutch polder system using the FutureViewR modelling suite

    NARCIS (Netherlands)

    Immerzeel, W.W.; Heerwaarden, van C.C.; Droogers, P.

    2009-01-01

    This paper describes the development of a hydrological modelling suite, FutureViewR, which enables spatial quantification of the complex interaction between climate change, land use and soil in the Quarles van Ufford (QvU) polder entangled in and under influence of the Dutch river delta. The soil¿wa

  9. Classifying sediments on Dutch riverbeds using multi-beam echo-sounder systems

    NARCIS (Netherlands)

    Eleftherakis, D.

    2013-01-01

    The economic importance of the Dutch rivers is very high as they are heavily used for inland waterway transport between the Netherlands and their neighbouring countries. A minimum depth must be guaranteed to keep the rivers navigable but also to ensure that the ships can carry maximum cargo. An attr

  10. The Dutch approach to road safety : towards a sustainable safe road traffic system.

    NARCIS (Netherlands)

    Wegman, F.C.M.

    2006-01-01

    From the introduction process of Sustainable Safety specific lessons have been learned to be at least supportive or were even a prerequisite, for successful action. Intelligent ways to commit stakeholders have to be found a major one. Sustainable Safety forms an integral part of Dutch transport an

  11. Electricity in flux : sociotechnical change in the Dutch electricity system, 1970-2000

    NARCIS (Netherlands)

    Hofman, Peter; Marquart, N.E.

    2001-01-01

    This report is part of a project funded by the Dutch National Research Programme on Global Air Pollution and Climate Change (NRP) called MATRIC: Management of Technology Responses to the Climate Challenge. Central to the Matric project is the question "How to modulate the ongoing dynamics of

  12. Calculated iodine intake before and after simulated iodization (Dutch Nutrition Surveillance System)

    NARCIS (Netherlands)

    Brussaard, J.H.; Hulshof, K.F.A.M.; Löwik, M.R.H.

    1995-01-01

    To estimate the effect of possible goitre prophylactic measures on the intake of iodine among population groups, simulation studies, based on the first Dutch National Food Consumption Survey, were carried out. Iodine intake figures and prevalence of low intakes were calculated after fictively iodizi

  13. Social Uncertainties in Social-Ecological Systems: Policy dynamics in the Dutch Delta Programme

    NARCIS (Netherlands)

    Wijermans, F.E.H.; Vreugdenhil, H.

    2012-01-01

    Policy arenas are of major importance for long-term water management. Here, decisions are made. Nevertheless, the uncertainties deriving from the policy arenas have gained very limited attention so far in future studies. We analyse longterm water management in The Netherlands, i.e. the Dutch Delta P

  14. The Dutch and the Portuguese in West Africa : empire building and Atlantic system (1580-1674)

    NARCIS (Netherlands)

    Ribeiro da Silva, Filipa Isabel

    2009-01-01

    This thesis examines in comparative perspective the Dutch and the Portuguese Atlantic empires in the 17th century, using West Africa as a case study. The book is divided into two parts. In Part I, we study how the conditions in the home countries influenced the building of the empires. Here we exam

  15. Availability and use of emergency obstetric care services in public hospitals in Laos PDR: a systems analysis.

    Science.gov (United States)

    Douangphachanh, Xaysomphou; Ali, Moazzam; Outavong, Phathammavong; Alongkon, Phengsavanh; Sing, Menorath; Chushi, Kuroiwa

    2010-12-01

    The maternal mortality ratio in Laos in 2005 was 660 per 100,000 lives birth which was the third highest in Asia-Pacific Region. The objective was to determine the availability and use of emergency obstetric care (EmOC) in provincial and district hospitals in Borikhamxay, Khammouane, and Savannakhet provinces using UN guidelines. A hospital-based cross sectional survey was conducted from January to March 2008. All district (30) and provincial hospitals (3) from three provinces were included. Analysis was based on hospital records reflecting 12 months of facility data. Data indicates that only 14 hospitals (42.4%) were providing EmOC services, i.e., 9 basic, 5 comprehensive services. The proportion of births in EmOC facilities was only 11.2%, the met need was a very low 14.5%, and the cesarean section rate was only 0.9%. The case fatality rate in Borikhanxay province was 2.8%; in Khammouane and in Savannakhet provinces it was less than 1%. Record keeping at hospitals was poor. Signal functions provided in the last three months showed only 48.5% of the facilities performed assisted vaginal delivery. This is the first study in Lao PDR to assess EmOC services. Almost all the indicators were below the UN recommendations. Health planners must take evidence-based decisions to rectify and improve the situation in the hospitals regarding EmOC services. These data can therefore help government to assign and allocate budgets appropriately, and help policymakers and planners to identify systemic bottlenecks and prioritize solutions and will help in improving maternal health.

  16. 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)…

  17. 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)…

  18. The Fine Dutch Tradition

    NARCIS (Netherlands)

    Hooimeijer, F.L.

    2012-01-01

    Publication of the exhibition and symposium on water adaptive urban planning and architecture in Bangkok. The Urban Fine Dutch Tradition is a dynamic tradition of making urban designs using the parameters of the natural system – incorperating in an efficient way the hydrological cycle, the soil and

  19. Flower Power at the Dutch Flower Auctions? Application of an Inverse Almost Ideal Demand System

    OpenAIRE

    Steen, Marie

    2006-01-01

    Information on price-quantity relationships will enable flower producers to reduce risk and raise profits through better timing of rotations as well as better utilization of limited greenhouse space. The present paper presents econometric evidence on such price-quantity relationships for major species of cut flowers at the Dutch flower auctions. Specifically, an inverse linear approximate almost ideal demand model with seasonal adjustments is applied. This paper is introducing trigonometric f...

  20. Teaching primary care obstetrics

    Science.gov (United States)

    Koppula, Sudha; Brown, Judith B.; Jordan, John M.

    2014-01-01

    Abstract Objective To explore the experiences and recommendations for recruitment of family physicians who practise and teach primary care obstetrics. Design Qualitative study using in-depth interviews. Setting Six primary care obstetrics groups in Edmonton, Alta, that were involved in teaching family medicine residents in the Department of Family Medicine at the University of Alberta. Participants Twelve family physicians who practised obstetrics in groups. All participants were women, which was reasonably representative of primary care obstetrics providers in Edmonton. Methods Each participant underwent an in-depth interview. The interviews were audiotaped and transcribed verbatim. The investigators independently reviewed the transcripts and then analyzed the transcripts together in an iterative and interpretive manner. Main findings Themes identified in this study include lack of confidence in teaching, challenges of having learners, benefits of having learners, and recommendations for recruiting learners to primary care obstetrics. While participants described insecurity and challenges related to teaching, they also identified positive aspects, and offered suggestions for recruiting learners to primary care obstetrics. Conclusion Despite describing poor confidence as teachers and having challenges with learners, the participants identified positive experiences that sustained their interest in teaching. Supporting these teachers and recruiting more such role models is important to encourage family medicine learners to enter careers such as primary care obstetrics. PMID:24627402

  1. Reading Development in two Alphabetic Systems Differing in Orthographic Consistency: A longitudinal study of French-speaking children enrolled in a Dutch immersion program

    Directory of Open Access Journals (Sweden)

    Katia Lecocq

    2009-06-01

    Full Text Available Studies examining reading development in bilinguals have led to conflicting conclusions regarding the language in which reading development should take place first. Whereas some studies suggest that reading instruction should take place in the most proficient language first, other studies suggest that reading acquisition should take place in the most consistent orthographic system first. The present study examined two research questions: (1 the relative impact of oral proficiency and orthographic transparency in second-language reading acquisition, and (2 the influence of reading acquisition in one language on the development of reading skills in the other language. To examine these questions, we compared reading development in French-native children attending a Dutch immersion program and learning to read either in Dutch first (most consistent orthography or in French first (least consistent orthography but native language. Following a longitudinal design, the data were gathered over different sessions spanning from Grade 1 to Grade 3. The children in immersion were presented with a series of experimental and standardised tasks examining their levels of oral proficiency as well as their reading abilities in their first and, subsequently in their second, languages of reading instruction. Their performances were compared to the ones of French and Dutch monolinguals. The results showed that by the end of Grade 2, the children instructed to read in Dutch first read in both languages as well as their monolingual peers. In contrast, the children instructed to read in French first lagged behind the other Dutch-speaking groups in Dutch reading tasks. These findings extend the notion that differences across languages in terms of orthographic transparency impact on reading development to the French-Dutch pair, and strongly support the view that there are potentially significant benefits to learn to read in the most consistent orthographic system first

  2. Nigerian obstetric patients

    African Journals Online (AJOL)

    combination of Mallampati and Thyro-mental distance had values of ... difficult tracheal intubation is not precisely known but failed ... predictive values in a sample of Nigeria Obstetric Patients. ... the mentum to the thyroid notch was measured.

  3. Critically ill obstetric patients

    Directory of Open Access Journals (Sweden)

    Kirti Rajesh Bendre

    2015-04-01

    Methods: This is a retrospective study carried out in a medical college with tertiary hospital facility in Mumbai. The ICU admissions for a period of 5 years from October 2005 to October 2010 were reviewed. Results: Over 5 years, 48 out of 10800 obstetric patients were admitted in ICU (0.4%. Most common reasons for admissions were obstetric hemorrhage and preeclampsia. The most common intervention done was transfusion of blood and blood products. Conclusions: We need better information about high risk obstetrics in order to improve maternal care. The study identifies the risk factors for maternal mortality and severe maternal morbidity, most significant being obstetric hemorrhage. Lack of antenatal care and delay in referral to intensive care unit adversely affect the maternal outcome. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 370-372

  4. Pregnancy in patients with rheumatic diseases: obstetric management and monitoring.

    Science.gov (United States)

    Branch, D W

    2004-01-01

    The obstetric management of the pregnant rheumatic patient is largely dictated by the specific disease and the degree to which it is associated with recognizable and treatable adverse obstetric outcomes, maternal or fetal. This review will cover the obstetric management of women with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), rheumatoid arthritis (RA) and systemic sclerosis (SSc). Most experts agree that a co-ordinated management effort on the part of obstetricians and rheumatologists will likely yield the optimal achievable results.

  5. Obstetrics and Ernest Hemingway.

    Science.gov (United States)

    King, C R

    1989-07-01

    Ernest Hemingway is one of the most popular and important American writers of the 20th century. His fiction, ranging from the short story to the novel, is well known, but his medical knowledge, and in particular his knowledge of obstetrics, often is not recognized. To achieve the realistic depiction of the childbirth scenes in A Farewell to Arms required that Hemingway acquire special knowledge of obstetrics practice.

  6. The Empathy and Systemizing Quotient : The Psychometric Properties of the Dutch Version and a Review of the Cross-Cultural Stability

    NARCIS (Netherlands)

    Groen, Y.; Fuermaier, A. B. M.; Den Heijer, A. E.; Tucha, O.; Althaus, M.

    2015-01-01

    The 'Empathy Quotient' (EQ) and 'Systemizing Quotient' (SQ) are used worldwide to measure people's empathizing and systemizing cognitive styles. This study investigates the psychometric properties of the Dutch EQ and SQ in healthy participants (n = 685), and high functioning males with autism spectr

  7. The Empathy and Systemizing Quotient: The Psychometric Properties of the Dutch Version and a Review of the Cross-Cultural Stability

    Science.gov (United States)

    Groen, Y.; Fuermaier, A. B. M.; Den Heijer, A. E.; Tucha, O.; Althaus, M.

    2015-01-01

    The "Empathy Quotient" (EQ) and "Systemizing Quotient" (SQ) are used worldwide to measure people's empathizing and systemizing cognitive styles. This study investigates the psychometric properties of the Dutch EQ and SQ in healthy participants (n = 685), and high functioning males with autism spectrum disorder (n = 42). Factor…

  8. Quantifying the residual volume transport through a multiple-inlet system in response to wind forcing: The case of the western Dutch Wadden Sea

    NARCIS (Netherlands)

    Duran-Matute, M.; Gerkema, T.; Sassi, M.

    2016-01-01

    In multiple-inlet coastal systems like the western Dutch Wadden Sea, the tides (and their interaction with the bathymetry), the fresh water discharge, and the wind drive a residual flow through the system. In the current paper, we study the effect of the wind on the residual volume transport through

  9. Understanding innovation system build up : the rise and fall of the Dutch PV Innovation System

    NARCIS (Netherlands)

    Negro, S.O.; Vasseur, V.; Sark, W.G.J.H.M. van; Hekkert, M.P.

    2009-01-01

    Renewable energy technologies have a hard time to break through in the existing energy regime. In this paper we focus on analysing the mechanisms behind this problematic technology diffusion. We take the theoretical perspective of innovation system dynamics and apply this to photovoltaic solar energ

  10. Understanding innovation system build up. The rise and fall of the Dutch PV Innovation System

    Energy Technology Data Exchange (ETDEWEB)

    Negro, S.O.; Vasseur, V.; Hekkert, M.P. [Department of Innovation Studies, Copernicus Institute for Sustainable Development and Innovation, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht (Netherlands); Van Sark, W.G.J.H.M. [Department of Science, Technology and Society, Copernicus Institute for Sustainable Development and Innovation, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht (Netherlands)

    2009-03-15

    Renewable energy technologies have a hard time to break through in the existing energy regime. In this paper we focus on analysing the mechanisms behind this problematic technology diffusion. We take the theoretical perspective of innovation system dynamics and apply this to photovoltaic solar energy technology (PV) in the Netherlands. The reason for this is that there is a long history of policy efforts in The Netherlands to stimulate PV but results in terms of diffusion of PV panels is disappointingly low, which clearly constitutes a case of slow diffusion. The history of the development of the PV innovation system is analysed in terms of seven key processes that are essential for the build up of innovation systems. We show that the processes related to knowledge development are very stable but that large fluctuations are present in the processes related to 'guidance of the search' and 'market formation'. Surprisingly, entrepreneurial activities are not too much affected by fluctuating market formation activities. We relate this to market formation in neighbouring countries and discuss the theoretical implications for the technological innovation system framework.

  11. Reasons for accepting or declining Down syndrome screening in Dutch prospective mothers within the context of national policy and healthcare system characteristics : a qualitative study

    NARCIS (Netherlands)

    Crombag, Neeltje M T H; Boeije, Hennie; Iedema-Kuiper, Rita; Schielen, Peter C J I; Visser, Gerard H A; Bensing, Jozien M

    2016-01-01

    BACKGROUND: Uptake rates for Down syndrome screening in the Netherlands are low compared to other European countries. To investigate the low uptake, we explored women's reasons for participation and possible influences of national healthcare system characteristics. Dutch prenatal care is characteris

  12. Exploring Normalized Systems Potential for Dutch MoD’s Agility: A Proof of Concept on Flexibility, Time-to-market, Productivity and Quality

    NARCIS (Netherlands)

    Op 't Land, M.; Krouwel, M.R.; Van Dipten, E.G.; Verelst, J.

    2011-01-01

    Both the Command and Control Support Centre (C2SC) of the Dutch Ministry of Defense, and Capgemini are constantly exploring better ways of building and maintaining information systems which ef- fectively support strategy and operations of an enterprise. In a Proof of Concept conducted in March and A

  13. A Randomized Controlled Trial of a Dutch Version of Systems Training for Emotional Predictability and Problem Solving for Borderline Personality Disorder

    NARCIS (Netherlands)

    Bos, Elisabeth H.; van Wel, E. Bas; Appelo, Martin T.; Verbraak, Marc J. P. M.

    2010-01-01

    Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for persons with borderline personality disorder (BPD) that is relatively easy to implement. We investigated the efficacy of a Dutch version of this treatment (VERS). Seventy-nine DSM-IV BPD patients were

  14. Assessing transition trajectories towards a sustainable energy system: A case study on the Dutch transition to climate-neutral transport fuel chains

    NARCIS (Netherlands)

    Suurs, R.A.A.; Hekkert, M.P.; Meeus, M.T.H.; Nieuwlaar, E.

    2004-01-01

    This paper proposes a method for the ex ante evaluation of technological trajectories. As a case we study the Dutch transport energy system and its transition to climate neutrality. Two technological trajectories are proposed: (i) a sequence of transition steps based on radical infrastructural chang

  15. Exploring Normalized Systems Potential for Dutch MoD’s Agility: A Proof of Concept on Flexibility, Time-to-market, Productivity and Quality

    NARCIS (Netherlands)

    Op 't Land, M.; Krouwel, M.R.; Van Dipten, E.G.; Verelst, J.

    2011-01-01

    Both the Command and Control Support Centre (C2SC) of the Dutch Ministry of Defense, and Capgemini are constantly exploring better ways of building and maintaining information systems which ef- fectively support strategy and operations of an enterprise. In a Proof of Concept conducted in March and

  16. Made in the USA: the import of American Consumer Assessment of Health Plan Surveys (CAHPS) into the Dutch social insurance system.

    NARCIS (Netherlands)

    Delnoij, D.; Asbroek, G. ten; Arah, O.; Koning, J. de; Stam, P.; Poll, A.; Klazinga, N.S.

    2004-01-01

    Background: In the Dutch social insurance system, based on regulated competition, sickness funds should attract clients by contracting efficient and qualitatively good services. For that sake, sickness funds need information about their own performance and about the quality of care they contract, as

  17. Made in the USA: the import of American Consumer Assessment of Health Plan Surveys (CAPHS) into the Dutch social insurance system.

    NARCIS (Netherlands)

    Delnoij, D.M.J.; Asbroek, G. ten; Arah, O.; Koning, J. de; Stam. P.; Poll, A.; Vriens, B.; Schmidt, P.; Klazinga, N.S.

    2006-01-01

    Background: In the Dutch social insurance system, based on regulated competition, sickness funds should attract clients by contracting efficient and qualitatively good services. For that sake, sickness funds need information about their own performance and about the quality of care they contract, as

  18. Do individual characteristics matter? The quality of work during the implementation of a workflow management system in a Dutch social insurance company.

    NARCIS (Netherlands)

    Waal, B.M.E. de; Breman, P.; Batenburg, R.

    2012-01-01

    Do individual characteristics influence how the quality of work is related to the use of a workflow management system (WFM) in a Dutch social insurance organisation? This key question is addressed in this paper. Building upon DeLone and McLean’s model, we investigated the effects of gender, age, edu

  19. Do individual characteristics matter? The quality of work during the implementation of a workflow management system in a Dutch social insurance company

    NARCIS (Netherlands)

    Waal, Benny de; Breman, Paul; Batenburg, Ronald

    2012-01-01

    Do individual characteristics influence how the quality of work is related to the use of a workflow management system (WFM) in a Dutch social insurance organisation? This key question is addressed in this paper. Building upon DeLone and McLean’s model, we investigated the effects of gender, age, edu

  20. Reasons for accepting or declining Down syndrome screening in Dutch prospective mothers within the context of national policy and healthcare system characteristics : a qualitative study

    NARCIS (Netherlands)

    Crombag, Neeltje M T H; Boeije, Hennie; Iedema-Kuiper, Rita; Schielen, Peter C J I; Visser, Gerard H A; Bensing, Jozien M

    2016-01-01

    BACKGROUND: Uptake rates for Down syndrome screening in the Netherlands are low compared to other European countries. To investigate the low uptake, we explored women's reasons for participation and possible influences of national healthcare system characteristics. Dutch prenatal care is characteris

  1. Reasons for accepting or declining Down syndrome screening in Dutch prospective mothers within the context of national policy and healthcare system characteristics: a qualitative study.

    NARCIS (Netherlands)

    Crombag, N.M.T.H.; Boeije, H.; Iedema-Kuiper, R.; Schielen, P.C.J.I.; Visser, G.H.A.; Bensing, J.M.

    2016-01-01

    Background Uptake rates for Down syndrome screening in the Netherlands are low compared to other European countries. To investigate the low uptake, we explored women’s reasons for participation and possible influences of national healthcare system characteristics. Dutch prenatal car

  2. Very long term development of the Dutch Inland Waterway Transport System: Policy analysis, transport projections, shipping scenarios, and a new perspective on economic growth and future discounting

    NARCIS (Netherlands)

    Van Dorsser, J.C.M.

    2015-01-01

    This thesis addresses how a new method for the evaluation of policies with a very long term impact on the Dutch Inland Waterway Transport (IWT) system can be developed. It proposes an outline for a very long term transport model, prepares a number of very long term scenarios, and indicates that a di

  3. Exploring Normalized Systems Potential for Dutch MoD’s Agility: A Proof of Concept on Flexibility, Time-to-market, Productivity and Quality

    NARCIS (Netherlands)

    Op 't Land, M.; Krouwel, M.R.; Van Dipten, E.G.; Verelst, J.

    2011-01-01

    Both the Command and Control Support Centre (C2SC) of the Dutch Ministry of Defense, and Capgemini are constantly exploring better ways of building and maintaining information systems which ef- fectively support strategy and operations of an enterprise. In a Proof of Concept conducted in March and A

  4. 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.

  5. Adequacy of a vegetarian diet at old age (Dutch Nutrition Surveillance System).

    Science.gov (United States)

    Brants, H A; Löwik, M R; Westenbrink, S; Hulshof, K F; Kistemaker, C

    1990-08-01

    To assess the adequacy of a vegetarian diet at old age, the dietary intake (assessed through dietary history with cross-check) of 44 apparently healthy lacto-(ovo-)vegetarians, aged 65-97 years, was evaluated. Adequacy was assessed by a comparison of nutrient intake with (Dutch) recommendations and by evaluating data on nutritional status. The results were also compared with data of elderly omnivores. In contrast to elderly omnivores, percentages of energy from protein (13%), fat (37%), and carbohydrates (50%) as well as P/S ratio (0.63) were close to or within the range of Dutch guidelines regarding a healthy diet (percentages of energy from protein, fat, and carbohydrates 10-15, 30-35, and 55%, respectively: P/S ratio 0.5-1.0). For most of the micronutrients studied intake was adequate, and nutrient density of the vegetarian diet was higher than of the omnivorous diet. However, the supply of zinc (average daily intake 8.5 and 7.6 mg for men and women, respectively), iron (because of lower bioavailability of nonheme iron), vitamin B12 (women only: intake 2.3 micrograms/day), and water (daily intake less than 1600 ml for 30% of the vegetarians) need special attention, considering the relatively high prevalence of a marginal status of these nutrients. In conclusion, a lacto-(ovo-)vegetarian diet can be adequate at old age, provided that it is carefully planned, especially with respect to the supply of iron, zinc, and vitamin B12.

  6. 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.

  7. 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.

  8. Dutch ministerial visit

    CERN Multimedia

    2007-01-01

    Dutch Minister of Education, Culture and Science R. Plasterk (third from left) in the ATLAS cavern with NIKHEF Director F. Linde, CERN Chief Scientific Officer J. Engelen, Ambassador J. van Eenennaam, ATLAS Collaboration Spokesperson P. Jenni, Mission Representative G. Vrielink and ATLAS Magnet Project Leader H. ten Kate.Minister of Education, Culture and Science from the Kingdom of the Netherlands, Ronald Plasterk, visited CERN on 25th October. With Jos Engelen, CERN Scientific Director, as his guide he visited Point 1 of the LHC tunnel and ATLAS, where Nikhef (the national institute for subatomic physics, a Dutch government and university collaboration) constructed all 96 of the largest muon drift chambers in the barrel as well as parts of the magnet system, the inner detector, the DAQ and triggering. Overall the Netherlands contribute 4.5% to the annual CERN budget and the minister’s visit celebrated the contributions of the 79 ...

  9. [Airway management in obstetrics].

    Science.gov (United States)

    Boutonnet, M; Faitot, V; Keïta, H

    2011-09-01

    Reviewing problems related to the airway management in obstetrics, taking into account the recent evolutions of the anaesthetic practices in obstetrics. A review of the literature in English and French was performed in the Pumed database in April 2010. The first research used the following MeshTerms: "Anesthesia, Obstetrical" [Mesh] AND "Intubation, Intratracheal" [Mesh]. Complementary research used alone or in combination the following keywords: difficult tracheal intubation; failed tracheal intubation; airway; prediction of difficult tracheal intubation; maternal mortality; maternal morbidity; liability; aspiration pneumonia and obstetrical anesthesia. All the publications were retained excluding the correspondence. Data analysis for the airway management in obstetrics, the prediction of difficult intubation, the prevention of pulmonary inhalation of gastric fluid, but also on maternal morbi-mortality in link with general anesthesia in obstetrics. Airway management in obstetrics remains a true challenge for various reasons. The physiological and anatomical modifications related to pregnancy are responsible for a faster hypoxemia, a reduction of the diameter of the pharyngolaryngal tract, as well as an increase of the risk of inhalation of gastric contents after 16 weeks of amenorrhea. The emergency or extreme emergency context and the presence of diseases like obesity or preeclampsia raise the risks of difficulties with airway management. The logical evolution of the practices, with the considerable rise of the regional anesthesia/analgesia limits the training and the maintenance of competences for intratracheal intubation in obstetrics. The training per simulation appears particularly interesting on the subject and this approach needs to be developed. The literature indicates that the incidence of difficult intubation is of one per 30. The impossible intubation is one per 280 in obstetrics, eight times greater than in the general population. No criterion of

  10. Using a Caesarean Section Classification System based on characteristics of the population as a way of monitoring obstetric practice

    Directory of Open Access Journals (Sweden)

    Milanez Helaine M

    2010-06-01

    Full Text Available Abstract Objective to compare the distribution of caesarean rates in the Robson's 10 groups classification in order to see if any change occurred after the implementation of an audit and feedback intervention. Design: cross sectional, before and after an audit and feedback study. Setting: a university hospital in Brazil. Methods clinical records of all births during two three months-periods were evaluated. Each case of CS was classified into one of ten mutually exclusive categories according to obstetric characteristics. The proportion of CS in each group was compared in both periods. Results total number of deliveries and the high rate of CS were similar in both periods. Group 3 (multiparous excluding previous CS, single, cephalic, ≥ 37 weeks, spontaneous labour accounted for the largest proportion of deliveries, 28.5 and 26.8% in both periods. Group 1 (nulliparous, single, cephalic, ≥ 37 weeks, spontaneous labour was the second largest one, while Group 5 (previous caesarean section, single, cephalic, and ≥ 37 weeks was the third but the largest contributor to CS, accounting for 16.6 and 14.9% among all deliveries in both periods. Groups 2 (nulliparous, single, cephalic, ≥ 37 weeks, induction or CS before labour and 4 (multiparous excluding previous CS, single, cephalic, ≥ 37 weeks, induction or CS before labour were less prevalent, however had higher rates of CS. Only in Group 10 (All single, cephalic, ≤ 36 weeks, including previous CS, there was a significant decrease of CS rate from 70.5 to 42.6% between periods. Conclusion Robson's classification did not identify any significant change in the pattern of CS rates with the audit and feedback process, but showed to be useful for comparing trends among similar obstetric populations.

  11. Is obstetric triage necessary?

    Directory of Open Access Journals (Sweden)

    Seetha Panicker

    2014-02-01

    Conclusions: Obstetric triage would improve efficiency of care and reduce waiting time. The suggestions for improvement were also discussed. There should be clear guidelines and protocols for the initial assessment and action for each level of severity. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 44-47

  12. Ultrasonogram in obstetric field

    Energy Technology Data Exchange (ETDEWEB)

    Joo, K. B.; Song, C. H.; Lee, H. B. [Eul-Ji General Hospital, Seoul (Korea, Republic of)

    1980-06-15

    The clinical evaluation of 535 cases of sonogram from Mar. 1, 1979 to Oct. 30, 1979 in obstetric field at Department of Radiology and Ob. and Gy. Eul-Ji General Hospital. We present these cases: normal pregnancy, missed abortion, twin pregnancy, hydatidiform mole and ectopic pregnancy, with brief review of literature.

  13. 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.

  14. The innovation system for the Dutch greenhouse sector in 2020; Het innovatiesysteem voor de glastuinbouw in 2020

    Energy Technology Data Exchange (ETDEWEB)

    Alkemade, F.; Hekkert, M.; Farla, J. [Universiteit Utrecht, Copernicus Instituut, Innovatiewetenschappen, Utrecht (Netherlands)

    2010-12-15

    InnovationNetwork and SIGN want to obtain insight into the changes that are necessary in the greenhouse innovation system to guarantee a vibrant sector in the long term. Accordingly, the primary research question is: What should an effective Dutch greenhouse innovation system look like in 2020? Attention is paid to the greenhouse sector's current stage of development as well as the current focus of innovation within the sector. The analysis showed that the existing innovation system in the greenhouse sector mainly facilitates process innovations, and largely neglects other innovation strategies. Two other innovation strategies that are important in the mature stage of a sectors' development involve (1) initiating new life cycles through product innovation and (2) realizing higher margins through product differentiation based on marketing innovations. Strategy 1 is a niche strategy and can only be pursued successfully by a small number of entrepreneurs. Encouraging this type of innovative behaviour can best take place by building a new innovation system outside of existing institutions and structures. If effective, this new innovation system will help to bring about a cultural change in the entire greenhouse sector. Unlike strategy 1, strategy 2 is suitable for the entire greenhouse sector. It offers a means of shifting away from cost competition towards product competition, both internationally and within the Dutch greenhouse sector. Though challenging, this strategy can be realized by adjusting the current innovation system. Process innovation will always remain important. Both with strategy 1 and strategy 2 the evolution path of process innovations will be influenced by the selected product or marketing innovation strategy. Another vital factor for the innovation system which applies for both strategy 1 and 2, is the reduction of the distance between the primary entrepreneur and end consumer [Dutch] InnovatieNetwerk en SIGN hebben behoefte aan inzicht

  15. Sustainable interprofessional teamwork needs a team-friendly healthcare system: Experiences from a collaborative Dutch programme.

    Science.gov (United States)

    van Dijk-de Vries, Anneke; van Dongen, Jerôme Jean Jacques; van Bokhoven, Marloes Amantia

    2017-03-01

    The significance of effective interprofessional teamwork to improve the quality of care has been widely recognised. Effective interprofessional teamwork calls on good collaboration between professionals and patients, coordination between professionals, and the development of teamwork over time. Effective development of teams also requires support from the wider organisational context. In a Dutch village, healthcare professionals work closely together, and mutual consultations as well as interprofessional meetings take place on a regular basis. The network was created as a precondition for sustainable interprofessional teamwork in elderly care. However, several external barriers were experienced regarding the supportive structure and cooperative attitude of the healthcare insurer and municipality. The aim of the article is to examine these experience-based issues regarding internal organisation, perspective, and definition of effective teamwork. Complicating factors refer to finding the right key figures, and the different perspectives on team development and team effectiveness. Our conclusion is that the organisation of healthcare insurance companies needs to implement fundamental changes to facilitate an interprofessional care approach. Furthermore, municipalities should work on their vision of the needs and benefits of a fruitful collaboration with interprofessional healthcare teams. The challenge for healthcare teams is to learn to speak the language of external partners. To support the development of interprofessional teams, external parties need to recognise and trust in a shared aim to provide quality of care in an efficient and effective way.

  16. Dutch health care performance report 2008.

    NARCIS (Netherlands)

    Westert, G.P.; Berg, M.J. van den; Koolman, X.; Verkleij, H.

    2008-01-01

    This is the second national report on the performance of the Dutch health care system. Its focus is on quality, access and costs in 2006/7. The Dutch Health Care Performance Report presents a broad picture based on 110 indicators. Where possible, comparisons in time and between countries are

  17. Cross-language measurement equivalence of the Center for Epidemiologic Studies Depression (CES-D scale in systemic sclerosis: a comparison of Canadian and Dutch patients.

    Directory of Open Access Journals (Sweden)

    Linda Kwakkenbos

    Full Text Available OBJECTIVES: Increasingly, medical research involves patients who complete outcomes in different languages. This occurs in countries with more than one common language, such as Canada (French/English or the United States (Spanish/English, as well as in international multi-centre collaborations, which are utilized frequently in rare diseases such as systemic sclerosis (SSc. In order to pool or compare outcomes, instruments should be measurement equivalent (invariant across cultural or linguistic groups. This study provides an example of how to assess cross-language measurement equivalence by comparing the Center for Epidemiologic Studies Depression (CES-D scale between English-speaking Canadian and Dutch SSc patients. METHODS: The CES-D was completed by 922 English-speaking Canadian and 213 Dutch SSc patients. Confirmatory factor analysis (CFA was used to assess the factor structure in both samples. The Multiple-Indicator Multiple-Cause (MIMIC model was utilized to assess the amount of differential item functioning (DIF. RESULTS: A two-factor model (positive and negative affect showed excellent fit in both samples. Statistically significant, but small-magnitude, DIF was found for 3 of 20 items on the CES-D. The English-speaking Canadian sample endorsed more feeling-related symptoms, whereas the Dutch sample endorsed more somatic/retarded activity symptoms. The overall estimate in depression scores between English and Dutch was not influenced substantively by DIF. CONCLUSIONS: CES-D scores from English-speaking Canadian and Dutch SSc patients can be compared and pooled without concern that measurement differences may substantively influence results. The importance of assessing cross-language measurement equivalence in rheumatology studies prior to pooling outcomes obtained in different languages should be emphasized.

  18. Some pain, no gain: experiences with the no-claim rebate in the Dutch health care system.

    Science.gov (United States)

    Holland, J; Van Exel, N J A; Schut, F T; Brouwer, W B F

    2009-10-01

    To contain expenditures in an increasingly demand driven health care system, in 2005 a no-claim rebate was introduced in the Dutch health insurance system. Since demand-side cost sharing is a very controversial issue, the no-claim rebate was launched as a consumer friendly bonus system to reward prudent utilization of health services. Internationally, the introduction of a mandatory no-claim rebate in a social health insurance scheme is unprecedented. Consumers were entitled to an annual rebate of 255 eruos if no claims were made. During the year, all health care expenses except for GP visits and maternity care were deducted from the rebate until the rebate became zero. In this article, we discuss the rationale of the no-claim rebate and the available evidence of its effect. Using a questionnaire in a convenience sample, we examined people's knowledge, attitudes, and sensitivity to the incentive scheme. We find that only 4% of respondents stated that they would reduce consumption because of the no-claim rebate. Respondents also indicated that they were willing to accept a high loss of rebate in order to use a medical treatment. However, during the last month of the year many respondents seemed willing to postpone consumption until the next year in order to keep the rebate of the current year intact. A small majority of respondents considered the no-claim rebate to be unfair. Finally, we briefly discuss why in 2008 the no-claim rebate was replaced by a mandatory deductible.

  19. Obstetric anal sphincter injuries

    Institute of Scientific and Technical Information of China (English)

    Remon Keriakos; Deepa Gopinath

    2015-01-01

    Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  20. Obstetric anal sphincter injuries

    Directory of Open Access Journals (Sweden)

    Remon Keriakos

    2015-10-01

    Full Text Available Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  1. Obstetric antiphospholipid syndrome.

    Science.gov (United States)

    Galarza-Maldonado, Claudio; Kourilovitch, Maria R; Pérez-Fernández, Oscar M; Gaybor, Mariana; Cordero, Christian; Cabrera, Sonia; Soroka, Nikolai F

    2012-02-01

    Antiphospholipid syndrome (APS) in pregnancy has a serious impact on maternal and fetal morbidity. It causes recurrent pregnancy miscarriage and it is associated with other adverse obstetric findings like preterm delivery, intrauterine growth restriction, preeclampsia, HELLP syndrome and others. The 2006 revised criteria, which is still valid, is used for APS classification. Epidemiology of obstetric APS varies from one population group to another largely due to different inclusion criteria and lack of standardization of antibody detection methods. Treatment is still controversial. This topic should include a multidisciplinary team and should be individualized. Success here is based on strict control and monitoring throughout pregnancy and even in the preconception and postpartum periods. Further research in this field and unification of criteria are required to yield better therapeutic strategies in the future.

  2. '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

  3. 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...

  4. Re-Minding the Dutch

    Directory of Open Access Journals (Sweden)

    H. Pols

    2009-01-01

    Full Text Available Re-Minding the DutchVerward van Geest is commended because of its careful, balanced, detailed, meticulously researched, and comprehensive approach of the development of the psychiatric profession in the Netherlands. The authors relate Dutch developments to initiatives abroad, some of which were taken up by Dutch psychiatrists and developed further. The development of the extensive network of out-patient mental health facilities in particular, which makes the Dutch system stand apart from that of most others, receives a lot of attention. Unfortunately, the history of psychiatry in the former Dutch colonial empire is not covered. The study is applauded for providing a wealth of material that could give a new impulse to discussions about the nature of mental health in the Netherlands, such as the following: How are supply and demand in mental health care related to each other? Do individuals with a lower socio-economic status have adequate access to care? How did the relationship between biological, social, and psychological approaches to mental illness and individual distress change over time?

  5. 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

  6. OBSTETRIC RENAL FAILURE

    Directory of Open Access Journals (Sweden)

    Rajeshwari

    2015-11-01

    Full Text Available Renal failure in obstetrics is rare but important complication, associated with significant mortality and long term morbidity.1,2 It includes acute renal failure due to obstetrical complications or due to deterioration of existing renal disease. AIMS AND OBJECTIVES: To evaluate the etiology and outcome of renal failure in obstetric patients. METHODS: We prospectively analyzed 30 pregnant and puerperal women with acute renal failure or pre-existing renal disease developing renal failure during pregnancy between November 2007 to sep-2009. Patients who presented/developed ARF during the hospital stay were included in this study. RESULTS: Among 30 patients, mean age was 23 years and 33 years age group. 12 cases (40% patients were primigravidae and 9(30% patients were multigravidae and 9 cases (30% presented in post-partum period. Eighteen cases (60% with ARF were seen in third trimester, followed by in postpartum period 9 cases (30%. Most common contributing factors to ARF were Pre-eclampsia, eclampsia and HELLP syndrome 60%, sepsis 56.6%, post abortal ARF 10%. DIC 40%. Haemorrhage as the aetiology for ARF was present 46%, APH in 20% and PPH in 26.6%. The type of ARF was renal in (63% and prerenal (36%; Oliguric seen in 10 patients (33% and high mortality (30%. Among the 20 pregnant patients with ARF, The average period of gestation was 33±2 weeks (30 -36 weeks, 5 cases (25% presented with intrauterine fetal demise and 18 cases (66% had preterm vaginal delivery and 2 cases (10% had induced abortion. And the average birth weight was 2±0.5 kg (1.5 kg. Eight cases (26% required dialysis. 80% of patients recovered completely of renal functions. 63% patients recovered without renal replacement therapy whereas 17% required dialysis. the maternal mortality was 20%, the main reason for mortality was septic shock and multi organ dysfunction (66%. CONCLUSION: ARF related pregnancy was seen commonly in the primigravidae and in the third trimester, the most

  7. Obstetric medical care in Canada.

    Science.gov (United States)

    Magee, Laura A; Cote, Anne-Marie; Joseph, Geena; Firoz, Tabassum; Sia, Winnie

    2016-09-01

    Obstetric medicine is a growing area of interest within internal medicine in Canada. Canadians continue to travel broadly to obtain relevant training, particularly in the United Kingdom. However, there is now a sufficient body of expertise in Canada that a cadre of 'home-grown' obstetric internists is emerging and staying within Canada to improve maternity care. As this critical mass of practitioners grows, it is apparent that models of obstetric medicine delivery have developed according to local needs and patterns of practice. This article aims to describe the state of obstetric medicine in Canada, including general internal medicine services as the rock on which Canadian obstetric medicine has been built, the Canadian training curriculum and opportunities, organisation of obstetric medicine service delivery and the future.

  8. [The optimization of organizational technologies in obstetrics service of the Ryazan oblast].

    Science.gov (United States)

    Petrova, Ye I; Medvedeva, O V

    2014-01-01

    The article emphasizes that, the protection of health of mother and child is actual especially in the present conditions considering demographic characteristics of particular territory. Hence, the development of optimal strategy in system of rendering of obstetrics and perinatal care and organization of operation of obstetrics institutions are the most important issues of modern obstetrics. The analysis is presented concerning conditions and main directions of optimization of organizational technologies in the system of obstetrics of the Ryazan oblast. The purpose and tasks of mechanism of optimization of rendering obstetrics and perinatal care are determined.

  9. Biogenic amine production by Lactococcus lactis subsp. cremoris strains in the model system of Dutch-type cheese.

    Science.gov (United States)

    Flasarová, Radka; Pachlová, Vendula; Buňková, Leona; Menšíková, Anna; Georgová, Nikola; Dráb, Vladimír; Buňka, František

    2016-03-01

    The aim of this study was to compare the biogenic amine production of two starter strains of Lactococcus lactis subsp. cremoris (strains from the Culture Collection of Dairy Microorganisms - CCDM 824 and CCDM 946) with decarboxylase positive activity in a model system of Dutch-type cheese during a 90-day ripening period at 10°C. During ripening, biogenic amine and free amino acid content, microbiological characteristics and proximate chemical properties were observed. By the end of the ripening period, the putrescine content in both samples with the addition of the biogenic amine producing strain almost evened out and the concentration of putrescine was >800mg/kg. The amount of tyramine in the cheeses with the addition of the strain of CCDM 824 approached the limit of 400mg/kg by the end of ripening. In the cheeses with the addition of the strain of CCDM 946 it even exceeded 500mg/kg. In the control samples, the amount of biogenic amines was insignificant.

  10. Rural-urban inequity in unmet obstetric needs and functionality of emergency obstetric care services in a Zambian district

    DEFF Research Database (Denmark)

    Phiri, Selia Ng'Anjo; Fylkesnes, Knut; Moland, Karen Marie;

    2016-01-01

    Background: Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district....... Method: A cross-sectional survey was conducted in 2011 as part of the 'Response to Accountable priority setting for Trust in health systems' (REACT) project. Data on all childbirths that occurred in emergency obstetric care facilities in 2010 were obtained retrospectively. Sources of information included...... registers from maternity ward admission, delivery and operation theatre, and case records. Data included age, parity, mode of delivery, obstetric complications, and outcome of mother and the newborn. An approach using estimated major obstetric interventions expected but not done in health facilities...

  11. System Innovation as Synchronization: innovation atempts in the Dutch traffic management field

    NARCIS (Netherlands)

    B. Pel (Bonno)

    2012-01-01

    textabstractCurrent sustainability challnges are increasingly acknowledged to be of a systemic nature. Instead of procrastinating further through incremental changes, societal systems (mobility, energy, agriculture) are therefore considered to be in need of system innovations and transitions. Thus f

  12. Obstetric controversies in thyroidology

    Directory of Open Access Journals (Sweden)

    Ambika Gopalakrishnan Unnikrishnan

    2013-01-01

    Full Text Available It is well known that thyroid disorders commonly affect women. The care of pregnant women affected by thyroid disease is an important clinical challenge for endocrinologists. Hypothyroidism is the commonest problem, and maternal hypothyroxinemia has been linked to adverse feto-maternal outcomes. This article would discuss the controversy regarding first-trimester thyroid hormone deficiency and fetal brain development. Certain obstetric controversies in the management of hyperthyroidism in pregnancy, including the indications of TSH receptor antibody measurements and fetal thyroid status monitoring would also be discussed.

  13. The management experience of nursing risk three class control system of gynaecology and obstetrics%妇产科护理风险三级控制体系的管理体会

    Institute of Scientific and Technical Information of China (English)

    黄丽英; 李锡蓉

    2014-01-01

    Objective Discuss the effective nursing risk management system of gynaecology and obstetrics. Method Structure the three class control system of nursing risk of the gynaecology and obstetrics that with the head nurse、nurse group leader,and charge nurse.And develop the system construction. Result Improve obviously overal quality of nurse team in gynaecology and obstetrics and improve obviously risk management ability by the construction of nursing risk three class control system. Conclusion The high quality of the control system can multilevel control risk and can maximum limit mistakes .%目的:探讨有效的妇产科护理风险管理体系。方法:构建由护士长、护理组长、责任护士组成的妇产科护理风险三级控制体系,并做好体系建设。结果:通过妇产科护理风险三级控制体系的建设,妇产科护理团队的整体素质明显改善,风险管理能力显著提高。结论:高素质的妇产科护理风险三级控制体系,多层次控制风险发生,最大限度杜绝差错事故发生。

  14. Major obstetric hemorrhage.

    Science.gov (United States)

    Mercier, Frederic J; Van de Velde, Marc

    2008-03-01

    Major obstetric hemorrhage remains the leading cause of maternal mortality and morbidity worldwide, and is associated with a high rate of substandard care. A well-defined and multidisciplinary approach that aims to act quickly and avoid omissions or conflicting strategies is key. The most common etiologies of hemorrhage are abruptio placenta, placenta previa/accreta, uterine rupture in the antepartum period and retained placenta, uterine atony, and genital-tract trauma in the postpartum period. Basic treatment of postpartum hemorrhage relies on manual removal of the placenta or manual exploration of the uterus plus bladder emptying and oxytocin administration. If this does not arrest bleeding, or if there is any suspicion of genital-tract trauma, examination of the vagina and cervix with appropriate valves and analgesia/anesthesia must follow quickly. Postpartum uterine atony resistant to oxytocin must be treated with prostaglandin within 15 to 30 minutes; uterine balloon tamponade can be also useful at this stage. Aggressive transfusion therapy and resuscitation are mandatory in major obstetric hemorrhage. Specific invasive treatment must be considered within no more than 30 to 60 minutes, if previous measures have failed -- and even earlier in some particular etiologies. The two main options are radiologic embolization and surgical artery ligations. Recombinant factor VIIa may also be considered, but should not delay the performance of a life-saving procedure such as embolization or surgery. Hysterectomy must be implemented when all other interventions have failed.

  15. Antiphospohlipid syndrome in obstetrics.

    Science.gov (United States)

    Danza, Alvaro; Ruiz-Irastorza, Guillermo; Khamashta, Munther

    2012-02-01

    Antiphospholipid syndrome is characterised by a variety of clinical and immunological manifestations. The clinical hallmarks of this syndrome are thrombosis and poor obstetric outcomes, including miscarriages, fetal loss and severe pre-eclampsia. The main antiphospholipid antibodies include lupus anticoagulant, anticardiolipin and anti-β2-glycoprotein I. The combination of aspirin and heparin is considered the standard of care for women with antiphospholipid syndrome and embryo-fetal losses; however, aspirin in monotherapy may have a place in women with recurrent early miscarriage. A good benefit-risk ratio of low-molecular-weight heparin in pregnancy thrombosis treatment has been reported. Warfarin must be avoided if possible throughout the first trimester of pregnancy. Adequate pregnancy management of women with antiphospholipid syndrome should include co-ordinated medical-obstetrical care, a close follow-up protocol and a good neonatal unit. Close blood pressure control and early detection of proteinuria, together with Doppler studies of the utero-placental circulation should be included in the management protocol.

  16. Solar Eclipse: The rise and "dusk" of the Dutch PV Innovation System

    NARCIS (Netherlands)

    Negro, S.O.; Vasseur, V.; Sark, W.G.J.H.M. van; Hekkert, M.P.

    2012-01-01

    In this paper, we take the theoretical perspective of innovation system dynamics and apply this to Photovoltaic (PV) solar energy technology in the Netherlands. The history of the development of the PV innovation system is analysed in terms of seven key processes that are essential for the build-up

  17. Characterization of Dutch dairy farms using sensor systems for cow management

    NARCIS (Netherlands)

    Steeneveld, W.; Hogeveen, H.

    2015-01-01

    To improve cow management in large dairy herds, sensors have been developed that can measure physiological, behavioral, and production indicators on individual cows. Recently, the number of dairy farms using sensor systems has increased. It is not known, however, to what extent sensor systems are

  18. Neonatal and obstetric outcomes in diet- and insulin-treated women with gestational diabetes mellitus : a retrospective study

    NARCIS (Netherlands)

    Koning, Sarah H; Hoogenberg, Klaas; Baas, Mick G; Korteweg, Fleurisca J; Sollie, Krystyna M; Schering, Bertine J; van Loon, Aren J; Wolffenbuttel, Bruce H R; van den Berg, Paul P; Lutgers, Helen L

    2016-01-01

    BACKGROUND: To evaluate the neonatal and obstetric outcomes of pregnancies complicated by gestational diabetes mellitus (GDM). Screening and treatment - diet-only versus additional insulin therapy - were based on the 2010 national Dutch guidelines. METHODS: Retrospective study of the electronic medi

  19. Obstetrical disseminated intravascular coagulation score.

    Science.gov (United States)

    Kobayashi, Takao

    2014-06-01

    Obstetrical disseminated intravascular coagulation (DIC) is usually a very acute, serious complication of pregnancy. The obstetrical DIC score helps with making a prompt diagnosis and starting treatment early. This DIC score, in which higher scores are given for clinical parameters rather than for laboratory parameters, has three components: (i) the underlying diseases; (ii) the clinical symptoms; and (iii) the laboratory findings (coagulation tests). It is justifiably appropriate to initiate therapy for DIC when the obstetrical DIC score reaches 8 points or more before obtaining the results of coagulation tests. Improvement of blood coagulation tests and clinical symptoms are essential to the efficacy evaluation for treatment after a diagnosis of obstetrical DIC. Therefore, the efficacy evaluation criteria for obstetrical DIC are also defined to enable follow-up of the clinical efficacy of DIC therapy.

  20. Solar eclipse. The rise and 'dusk' of the Dutch PV innovation system

    Energy Technology Data Exchange (ETDEWEB)

    Negro, S.O.; Hekkert, M.P. [Department of Innovation Studies, Copernicus Institute for Sustainable Development and Innovation, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht (Netherlands); Vasseur, V. [International Centre for Integrated Assessment and Sustainable Development, University Maastricht, P.O. Box 616, 6200 MD Maastricht (Netherlands); Van Sark, W.G.J.H.M. [Department of Science, Technology and Society, Copernicus Institute for Sustainable Development and Innovation, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht (Netherlands)

    2012-07-01

    In this paper, we take the theoretical perspective of innovation system dynamics and apply this to Photovoltaic (PV) solar energy technology in the Netherlands. The history of the development of the PV innovation system is analysed in terms of seven key processes that are essential for the build-up of innovation systems. We show that large fluctuations are present in the processes related to guidance of the search and market formation. Surprisingly, entrepreneurial activities are not too much affected by fluctuating market formation activities. We relate this to market formation in neighbouring countries and discuss the implications for policy making.

  1. Alcohol and Tobacco Sales to Underage Buyers in Dutch Supermarkets: Can the Use of Age Verification Systems Increase Seller's Compliance?

    Science.gov (United States)

    Roodbeen, Ruud T J; Schelleman-Offermans, Karen; Lemmens, Paul H H M

    2016-06-01

    Age limits are effective in reducing alcohol- and tobacco-related harm, however, their effectiveness depends on the extent to which they are complied with. This study aimed to investigate the effectiveness of different age verification systems (AVSs) implemented by 400 Dutch supermarkets on requesting a valid age verification (ID) and on sellers' compliance. A mixed method design was used. Compliance was measured by 800 alcohol and tobacco purchase attempts by 17-year-old mystery shoppers. To analyze the effectiveness of AVSs, logistic regression analyses were performed. Insight into facilitating and hindering factors in the purchase process was obtained by 13 interviews with supermarket managers. Only a tendency toward a positive effect of the presence of the keying-on-date-of-birth AVS or ID swiper/checker was found on ID request for both alcohol and tobacco purchase attempts. The use of the keying-on-date-of-birth AVS or ID swiper/checker significantly increased the odds for compliance after an ID was requested, for both alcohol and tobacco purchase attempts. Managers indicated that ID requests and compliance could be facilitated by providing cashiers with sufficient managerial support, technical support, and regular training about the purchase process and use of the AVS. The usage of AVSs calculating and confirming whether the customer reached the legal purchase age for cashiers significantly increases the odds for cashiers to comply with age limits of alcohol and tobacco. Future research should gain insight into how usage of effective AVSs can be improved and explore the feasibility of implementation and effectiveness in other outlets. Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  2. Anaerobic co-digestion in the Netherlands. A system analysis on greenhouse gas emissions from Dutch co-digesters.

    NARCIS (Netherlands)

    Groenewold, Henk

    2013-01-01

    Summary Anaerobic digestion (AD) is a biological process whereby, in the absence of oxygen, organic matter is transformed into biogas and digestate. In recent years AD has received new attention in the Dutch agricultural sector by introducing the co-dige

  3. Anaerobic co-digestion in the Netherlands. A system analysis on greenhouse gas emissions from Dutch co-digesters.

    NARCIS (Netherlands)

    Groenewold, Henk

    2013-01-01

    Summary Anaerobic digestion (AD) is a biological process whereby, in the absence of oxygen, organic matter is transformed into biogas and digestate. In recent years AD has received new attention in the Dutch agricultural sector by introducing the co-dige

  4. Early Course in Obstetrics Increases Likelihood of Practice Including Obstetrics.

    Science.gov (United States)

    Pearson, Jennifer; Westra, Ruth

    2016-10-01

    The Department of Family Medicine and Community Health Duluth has offered the Obstetrical Longitudinal Course (OBLC) as an elective for first-year medical students since 1999. The objective of the OBLC Impact Survey was to assess the effectiveness of the course over the past 15 years. A Qualtrics survey was emailed to participants enrolled in the course from 1999-2014. Data was compiled for the respondent group as a whole as well as four cohorts based on current level of training/practice. Cross-tabulations with Fisher's exact test were applied and odds ratios calculated for factors affecting likelihood of eventual practice including obstetrics. Participation in the OBLC was successful in increasing exposure, awareness, and comfort in caring for obstetrical patients and feeling more prepared for the OB-GYN Clerkship. A total of 50.5% of course participants felt the OBLC influenced their choice of specialty. For participants who are currently physicians, 51% are practicing family medicine with obstetrics or OB-GYN. Of the cohort of family physicians, 65.2% made the decision whether to include obstetrics in practice during medical school. Odds ratios show the likelihood of practicing obstetrics is higher when participants have completed the OBLC and also are practicing in a rural community. Early exposure to obstetrics, as provided by the OBLC, appears to increase the likelihood of including obstetrics in practice, especially if eventual practice is in a rural community. This course may be a tool to help create a pipeline for future rural family physicians providing obstetrical care.

  5. Consumer mobility in the Dutch health insurance system: the role of collectives.

    NARCIS (Netherlands)

    Brabers, A.E.M.; Reitsma-van Rooijen, M.; Jong, J.D. de

    2012-01-01

    Background: In the last decades, health care reforms based on introducing managed competition have been implemented in several countries. The policy assumption is that managed competition leads to lower prices and increases the quality of health care. In The Netherlands the system of managed competi

  6. Eliciting User Input for Requirements on Personalization: The Case of a Dutch ERP System

    NARCIS (Netherlands)

    Velsen, van Lex; Huijs, Corrie; Geest, van der Thea

    2008-01-01

    For small and medium-sized companies, the fit between their business processes and their Enterprise Resource Planning (ERP) system is a critical success factor. The functions and features for essential tasks must be geared to the demands and skills of the individual users. This article reports on th

  7. User dynamics in a Dutch cafeteria system Consistent choices, inconsistent participation

    NARCIS (Netherlands)

    van der Meer, Peter; van Veen, Kees

    2009-01-01

    Purpose - This paper aims to contribute to the empirical literature on cafeteria systems within employment relations by analysing employees' decisions on whether or not to participate, which employees chose what options and how the factors vary over time. Design/methodology/approach - The approach t

  8. Christianity, neutrality and public schooling: The origins of the Dutch educational system, 1801-1920

    NARCIS (Netherlands)

    J.F.A. Braster (Sjaak)

    2013-01-01

    markdownabstractINTRODUCTION. In the Netherlands, The first national law on education dates back to 1801. It laid the foundation for a system of public education that was accessible to children of all denominations: Protestant, Catholic, and Jewish. The identity of public schools was based on genera

  9. Gaby: a computer-based support system for integrated pest management in Dutch apple orchards

    NARCIS (Netherlands)

    Ende, van den E.; Blommers, L.; Trapman, M.

    1996-01-01

    In The Netherlands, a computerized advisory system (called Gaby) for integrated pest management (IPM) in apple has been developed to support the decision making of individual fruit growers. Gaby provides clear monitoring recommendations when this is appropriate for a particular pest in (a defined ar

  10. Dutch Micro Systems Technology for the Next Generation of Small Satellites

    NARCIS (Netherlands)

    Gill, E.; Monna, G.L.E.; Scherpen, J.M.A.; Verhoeven, C.J.M.

    2007-01-01

    Advanced microelectronics and Micro Systems Technology (MST) enable an increased functional performance of small satellites with decreased demands on mass, size and power. The research and development cluster MISAT stimulates the design and development of advanced small satellite platforms based on

  11. Energy Transition Dynamics; Understanding Policy Resistance in the Dutch Energy System

    NARCIS (Netherlands)

    Gooyert, V. de; Rouwette, E.A.J.A.; Kranenburg, H.L. van; Freeman, R.; Breen, H.J. van

    2014-01-01

    Various countries seek to establish an energy transition, a structural change towards a more sustainable energy system. Countries implement a combination of energy policies aimed at establishing an energy transition, but these policies frequently result in unintended negative consequences. This stud

  12. Towards Robust Visual Speech Recognition: Automatic Systems for Lip Reading of Dutch

    NARCIS (Netherlands)

    Chitu, A.G.

    2010-01-01

    In the last two decades we witnessed a rapid increase of the computational power governed by Moore's Law. As a side effect, the affordability of cheaper and faster CPUs increased as well. Therefore, many new “smart” devices flooded the market and made informational systems widely spread. The number

  13. Christianity, neutrality and public schooling: The origins of the Dutch educational system, 1801-1920

    NARCIS (Netherlands)

    J.F.A. Braster (Sjaak)

    2013-01-01

    markdownabstractINTRODUCTION. In the Netherlands, The first national law on education dates back to 1801. It laid the foundation for a system of public education that was accessible to children of all denominations: Protestant, Catholic, and Jewish. The identity of public schools was based on

  14. Consumer mobility in the Dutch health insurance system: the role of collectives.

    NARCIS (Netherlands)

    Brabers, A.E.M.; Reitsma-van Rooijen, M.; Jong, J.D. de

    2012-01-01

    Background: In the last decades, health care reforms based on introducing managed competition have been implemented in several countries. The policy assumption is that managed competition leads to lower prices and increases the quality of health care. In The Netherlands the system of managed

  15. Model Predictive Control for Operational Water Management: A Case Study of the Dutch Water System

    NARCIS (Netherlands)

    Tian, X.

    2015-01-01

    Water is needed everywhere to satisfy domestic, agricultural and industrial water demands, to maintain navigation systems, and to preserve healthy and sustainable ecosystems. In order to protect us from floods and to reallocate water resources in a man-made environment, the 'hardware', water-related

  16. Development and application of a multi-attribute sustainability function for Dutch dairy farming systems

    NARCIS (Netherlands)

    Calker, van K.J.; Berentsen, P.B.M.; Romero, C.; Giesen, G.W.J.; Huirne, R.B.M.

    2006-01-01

    Sustainability in dairy farming is determined by using aspects (economic, social and ecological). Per aspect a number of measurable attributes is selected. Difficulty for determining the sustainability of farming systems is the combination of the different attribute measures into a sustainability

  17. Towards Robust Visual Speech Recognition: Automatic Systems for Lip Reading of Dutch

    NARCIS (Netherlands)

    Chitu, A.G.

    2010-01-01

    In the last two decades we witnessed a rapid increase of the computational power governed by Moore's Law. As a side effect, the affordability of cheaper and faster CPUs increased as well. Therefore, many new “smart” devices flooded the market and made informational systems widely spread. The number

  18. Model Predictive Control for Operational Water Management: A Case Study of the Dutch Water System

    NARCIS (Netherlands)

    Tian, X.

    2015-01-01

    Water is needed everywhere to satisfy domestic, agricultural and industrial water demands, to maintain navigation systems, and to preserve healthy and sustainable ecosystems. In order to protect us from floods and to reallocate water resources in a man-made environment, the 'hardware', water-related

  19. Application of quantitative signal detection in the Dutch spontaneous reporting system for adverse drug reactions

    NARCIS (Netherlands)

    van Puijenbroek, Eugène; Diemont, Willem; van Grootheest, Kees

    2003-01-01

    The primary aim of spontaneous reporting systems (SRSs) is the timely detection of unknown adverse drug reactions (ADRs), or signal detection. Generally this is carried out by a systematic manual review of every report sent to an SRS. Statistical analysis of the data sets of an SRS, or quantitative

  20. Eliciting User Input for Requirements on Personalization: The Case of a Dutch ERP System

    NARCIS (Netherlands)

    van Velsen, Lex Stefan; Huijs, C.; van der Geest, Thea

    2008-01-01

    For small and medium-sized companies, the fit between their business processes and their Enterprise Resource Planning (ERP) system is a critical success factor. The functions and features for essential tasks must be geared to the demands and skills of the individual users. This article reports on

  1. Development and application of a multi-attribute sustainability function for Dutch dairy farming systems

    NARCIS (Netherlands)

    Calker, van K.J.; Berentsen, P.B.M.; Romero, C.; Giesen, G.W.J.; Huirne, R.B.M.

    2006-01-01

    Sustainability in dairy farming is determined by using aspects (economic, social and ecological). Per aspect a number of measurable attributes is selected. Difficulty for determining the sustainability of farming systems is the combination of the different attribute measures into a sustainability fu

  2. Perceptions About The ISO 9000 Quality System Standard Revision And Its Value: The Dutch Experience

    NARCIS (Netherlands)

    A. van der Wiele (Ton); J.D. van Iwaarden (Jos); A.R.T. Williams (Roger); B.G. Dale (Barry)

    2004-01-01

    textabstractThe aim of the research reported in this paper is to assess the relative value of the 2000 version of the ISO 9000 series of quality management system standards in comparison to the 1994 version. 773 organisations in the Netherlands which have all been certified to the ISO 9000 standard

  3. Dutch Micro Systems Technology for the Next Generation of Small Satellites

    NARCIS (Netherlands)

    Gill, E.; Monna, G.L.E.; Scherpen, J.M.A.; Verhoeven, C.J.M.

    2007-01-01

    Advanced microelectronics and Micro Systems Technology (MST) enable an increased functional performance of small satellites with decreased demands on mass, size and power. The research and development cluster MISAT stimulates the design and development of advanced small satellite platforms based on

  4. Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial.

    Science.gov (United States)

    Fransen, A F; van de Ven, J; Merién, A E R; de Wit-Zuurendonk, L D; Houterman, S; Mol, B W; Oei, S G

    2012-10-01

    To determine whether obstetric team training in a medical simulation centre improves the team performance and utilisation of appropriate medical technical skills of healthcare professionals. Cluster randomised controlled trial. The Netherlands. The obstetric departments of 24 Dutch hospitals. The obstetric departments were randomly assigned to a 1-day session of multiprofessional team training in a medical simulation centre or to no such training. Team training was given with high-fidelity mannequins by an obstetrician and a communication expert. More than 6 months following training, two unannounced simulated scenarios were carried out in the delivery rooms of all 24 obstetric departments. The scenarios, comprising a case of shoulder dystocia and a case of amniotic fluid embolism, were videotaped. The team performance and utilisation of appropriate medical skills were evaluated by two independent experts. Team performance evaluated with the validated Clinical Teamwork Scale (CTS) and the employment of two specific obstetric procedures for the two clinical scenarios in the simulation (delivery of the baby with shoulder dystocia in the maternal all-fours position and conducting a perimortem caesarean section within 5 minutes for the scenario of amniotic fluid embolism). Seventy-four obstetric teams from 12 hospitals in the intervention group underwent teamwork training between November 2009 and July 2010. The teamwork performance in the training group was significantly better in comparison to the nontraining group (median CTS score: 7.5 versus 6.0, respectively; P = 0.014). The use of the predefined obstetric procedures for the two clinical scenarios was also significantly more frequent in the training group compared with the nontraining group (83 versus 46%, respectively; P = 0.009). Team performance and medical technical skills may be significantly improved after multiprofessional obstetric team training in a medical simulation centre. © 2012 The Authors BJOG An

  5. Medical devices; obstetrical and gynecological devices; classification of the assisted reproduction embryo image assessment system. Final order.

    Science.gov (United States)

    2015-02-26

    The Food and Drug Administration (FDA) is classifying the Assisted Reproduction Embryo Image Assessment System into class II (special controls). The special controls that will apply to the device are identified in this order, and will be part of the codified language for the Assisted Reproduction Embryo Image Assessment System classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

  6. 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.

  7. Application of quantitative signal detection in the Dutch spontaneous reporting system for adverse drug reactions.

    Science.gov (United States)

    van Puijenbroek, Eugène; Diemont, Willem; van Grootheest, Kees

    2003-01-01

    The primary aim of spontaneous reporting systems (SRSs) is the timely detection of unknown adverse drug reactions (ADRs), or signal detection. Generally this is carried out by a systematic manual review of every report sent to an SRS. Statistical analysis of the data sets of an SRS, or quantitative signal detection, can provide additional information concerning a possible relationship between a drug and an ADR. We describe the role of quantitative signal detection and the way it is applied at the Netherlands Pharmacovigilance Centre Lareb. Results of the statistical analysis are implemented in the traditional case-by-case analysis. In addition, for data-mining purposes, a list of associations of ADRs and suspected drugs that are disproportionally present in the database is periodically generated. Finally, quantitative signal generation can be used to study more complex relationships, such as drug-drug interactions and syndromes. The results of quantitative signal detection should be considered as an additional source of information, complementary to the traditional analysis. Techniques for the detection of drug interactions and syndromes offer a new challenge for pharmacovigilance in the near future.

  8. The educational needs of people with systemic sclerosis: a cross-sectional study using the Dutch version of the Educational Needs Assessment Tool (D-ENAT).

    Science.gov (United States)

    Schouffoer, Anne; Ndosi, Mwidimi E; Vliet Vlieland, Thea P M; Meesters, Jorit J L

    2016-02-01

    The Dutch Educational Needs Assessment Tool (D-ENAT) systematically assesses educational needs of patients with rheumatic diseases. The present study aims to describe the educational needs of Dutch patients with systemic sclerosis (SSc). The D-ENAT was sent to 155 SSc patients registered at the outpatient clinic of a university hospital. The D-ENAT consists of 39 items in seven domains. "Each domain has different number of items therefore we normalized each domain score: (domain score/maximum) × 100) and expressed in percentage to enable comparisons between domains." A total D-ENAT score (0-156) is calculated by summing all 39 items. In addition, age, disease duration, gender, educational level, present information need (yes/no) and information need (1-4; wanting to know nothing-everything) were recorded. Univariate regression analysis was used to examine factors associated with the D-ENAT scores. The response rate was 103 out of 155 (66 %). The mean % of educational needs scores (0-100 %; lowest-highest) were 49 % for "D-ENAT total score," 46 % for "Managing pain," 41 % for "Movement," 43 % for "Feelings," 59 % for "Disease process," 44 % for "Treatments from health professionals," 61 % for "Self-help measures" and 51 % for "Support systems." No associations between the D-ENAT total score and age, disease duration, gender and educational level were found. The D-ENAT demonstrated its ability to identify educational needs of Dutch SSc patients. SSc patients demonstrated substantial educational needs, especially in the domains: "Disease process" and "Self-help measures." The validity and practical applicability of the D-ENAT to make an inventory of SSc patients' educational needs require further investigation.

  9. Biotechnology: A Dutch perspective

    NARCIS (Netherlands)

    Van Apeldoorn, J.H.F.

    1981-01-01

    Biotechnology: a Dutch Perspective assesses the future potential of biotechnology in the Netherlands. It has been published in English because it is felt that the Dutch case could be of relevance to other industrialised nations. Although the report is aimed primarily at policy planners and decision

  10. '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

  11. Biotechnology: A Dutch perspective

    NARCIS (Netherlands)

    Van Apeldoorn, J.H.F.

    1981-01-01

    Biotechnology: a Dutch Perspective assesses the future potential of biotechnology in the Netherlands. It has been published in English because it is felt that the Dutch case could be of relevance to other industrialised nations. Although the report is aimed primarily at policy planners and decision

  12. An experiment with regulated competition and individual mandates for universal health care: the new Dutch health insurance system.

    Science.gov (United States)

    Rosenau, Pauline Vaillancourt; Lako, Christiaan J

    2008-12-01

    The 2006 Enthoven-inspired Dutch health insurance reform, based on regulated competition with a mandate for individuals to purchase insurance, will interest U.S. policy makers who seek universal coverage. This ongoing experiment includes guaranteed issue, price competition for a standardized basic benefits package, community rating, sliding-scale income-based subsidies for patients, and risk equalization for insurers. Our assessment of the first two years is based on Dutch Central Bank statistics, national opinion polls, consumer surveys, and qualitative interviews with policy makers. The first lesson for the United States is that the new Dutch health insurance model may not control costs. To date, consumer premiums are increasing, and insurance companies report large losses on the basic policies. Second, regulated competition is unlikely to make voters/citizens happy; public satisfaction is not high, and perceived quality is down. Third, consumers may not behave as economic models predict, remaining responsive to price incentives. Finally, policy makers should not underestimate the opposition from health care providers who define their profession as more than simply a job. If regulated competition with individual mandates performs poorly in auspicious circumstances such as the Netherlands, how will this model fare in the United States, where access, quality, and cost challenges are even greater? Might the assumptions of economic theory not apply in the health sector?

  13. The future of obstetrics/gynecology in 2020: a clearer vision. Transformational forces and thriving in the new system.

    Science.gov (United States)

    Lagrew, David C; Jenkins, Todd R

    2015-01-01

    Revamping the delivery of women's health care to meet future demands will require a number of changes. In the first 2 articles of this series, we introduced the reasons for change, suggested the use of the 'Triple Aim' concept to (1) improve the health of a population, (2) enhance the patient experience, and (3) control costs as a guide post for changes, and reviewed the transformational forces of payment and care system reform. In the final article, we discuss the valuable use of information technology and disruptive clinical technologies. The new health care system will require a digital transformation so that there can be increased communication, availability of information, and ongoing assessment of clinical care. This will allow for more cost-effective and individualized treatments as data are securely shared between patients and providers. Scientific advances that radically change clinical practice are coming at an accelerated pace as the underlying technologies of genetics, robotics, artificial intelligence, and molecular biology are translated into tools for diagnosis and treatment. Thriving in the new system not only will require time-honored traits such as leadership and compassion but also will require the obstetrician/gynecologist to become comfortable with technology, care redesign, and quality improvement.

  14. Teamwork in obstetric critical care

    OpenAIRE

    Guise, Jeanne-Marie; Segel, Sally

    2008-01-01

    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well t...

  15. Rural-urban inequity in unmet obstetric needs and functionality of emergency obstetric care services in a Zambian district

    DEFF Research Database (Denmark)

    Phiri, Selia Ng'Anjo; Fylkesnes, Knut; Moland, Karen Marie

    2016-01-01

    Background: Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district....... Method: A cross-sectional survey was conducted in 2011 as part of the 'Response to Accountable priority setting for Trust in health systems' (REACT) project. Data on all childbirths that occurred in emergency obstetric care facilities in 2010 were obtained retrospectively. Sources of information included...... was used to assess deficit of life-saving interventions in urban and rural areas. Results: A total of 2114 urban and 1226 rural childbirths occurring in emergency obstetric care facilities (excluding abortions) were analysed. Facility childbirth constituted 81% of expected births in urban and 16% in rural...

  16. The making of Dutch flower culture: Auctions, networks, and aesthetics

    OpenAIRE

    2014-01-01

    Centered around five inquiries, this thesis uses several concepts to analyze Dutch horticulture and FloraHolland Aalsmeer: moral economy, commodity, world system, networks, horticulture, aesthetics, masculinity, cooperative, and the market. It explores how Dutch horticulture was and is embedded in national planning, policy, infrastructure, and aesthetics, both in the early stages of Dutch horticulture in the seventeenth century, with its environment of an emerging consumer culture and commodi...

  17. Improved obstetric safety through programmatic collaboration.

    Science.gov (United States)

    Goffman, Dena; Brodman, Michael; Friedman, Arnold J; Minkoff, Howard; Merkatz, Irwin R

    2014-01-01

    Healthcare safety and quality are critically important issues in obstetrics, and society, healthcare providers, patients and insurers share a common goal of working toward safer practice, and are continuously seeking strategies to facilitate improvements. To this end, 4 New York City voluntary hospitals with large maternity services initiated a unique collaborative quality improvement program. It was facilitated by their common risk management advisors, FOJP Service Corporation, and their professional liability insurer, Hospitals Insurance Company. Under the guidance of 4 obstetrics and gynecology departmental chairmen, consensus best practices for obstetrics were developed which included: implementation of evidence based protocols with audit and feedback; standardized educational interventions; mandatory electronic fetal monitoring training; and enhanced in-house physician coverage. Each institution developed unique safety related expertise (development of electronic documentation, team training, and simulation education), and experiences were shared across the collaborative. The collaborative group developed robust systems for audit of outcomes and documentation quality, as well as enforcement mechanisms. Ongoing feedback to providers served as a key component of the intervention. The liability carrier provided financial support for these patient safety innovations. As a result of the interventions, the overall AOI for our institutions decreased 42% from baseline (January-June 2008) to the most recently reviewed time period (July-December 2011) (10.7% vs 6.2%, p < 0.001). The Weighted Adverse Outcome Score (WAOS) also decreased during the same time period (3.9 vs 2.3, p = 0.001.) Given the improved outcomes noted, our unique program and the process by which it was developed are described in the hopes that others will recognize collaborative partnering with or without insurers as an opportunity to improve obstetric patient safety.

  18. Adolescent alcohol intoxication in the dutch hospital departments of pediatrics: A 2-year comparison study

    NARCIS (Netherlands)

    Hoof, J.J. van; Lely, N. van der; Bouthoorn, S.H.; Dalen, W.E. van; Pereira, R.R.

    2011-01-01

    Purpose: To monitor the prevalence of, and the circumstances leading to, adolescent alcohol intoxication admissions in Dutch hospital departments of pediatrics. Methods: Data were collected in 2007 and 2008, using the Dutch Pediatric Surveillance System, in which pediatricians received questionnaire

  19. Non-haemorrhagic obstetric shock.

    Science.gov (United States)

    Thomson, A J; Greer, I A

    2000-02-01

    The causes of non-haemorrhagic obstetric shock (pulmonary thromboembolism, amniotic fluid embolism, acute uterine inversion and sepsis) are uncommon but responsible for the majority of maternal deaths in the developed world. Clinically suspected pulmonary thromboembolism should be treated initially with heparin and objective testing should be performed. If the diagnosis is confirmed, heparin is usually continued until delivery, following which anticoagulation in the puerperium is achieved with either warfarin or heparin. Amniotic fluid embolism is a rare complication of pregnancy, occurring most commonly during labour. The management of amniotic fluid embolism involves maternal oxygenation, the maintenance of cardiac output and blood pressure, and the management of any associated coagulopathy. Acute uterine inversion arises most commonly following mismanagement of the third stage of labour. The shock in uterine inversion is neurogenic in origin, although there may also be profound haemorrhage. The management of this condition includes maternal resuscitation and replacement of the uterus either manually, surgically or by hydrostatic pressure. Genital tract sepsis remains a significant cause of maternal death, the most common predisposing factor being prolonged rupture of the fetal membranes. The management of septic shock in pregnancy includes resuscitation, identification of the source of infection and alteration of the systemic inflammatory response.

  20. Neurotrophin in obstetrics and gynaecology.

    Science.gov (United States)

    Bose, Chinmoy K

    2009-01-01

    Since Rita Levi Montalcini and Stanley Cohen received Nobel Prize for their pioneering work on nerve growth factor (NGF), its role in female reproductive system has been reinforced in last two decades. The neurotrophins (NT) including nerve growth factor (NGF) are a family of related growth factors and their respective receptor tyrosine kinases that are of major importance in the regulation of neuronal survival and differentiation. While role of NGF in mast cell-mediated egg implantation and inhibition of rejection were primary concern at their time, in the ovary NGF can help in the differentiation process by which ovarian follicles become responsive to gonadotrophins. They help in follicular maturation, steroid secretion and ovulation in the ovary, by inducing the FSH receptor (FSHR). Due to the pleiotropism, NGF is mandatory for the success of pregnancy, while progesterone helping to maintain local levels of NGF in utero. In endometriosisi and polycystic ovarian disease it has major role to play. An autocrine role of NGF in breast cancer and epithelial ovarian cancer (EOC) is evident now. Thus its study will infuse new insight in diseases of both obstetrics and gynaecology.

  1. Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system.

    Science.gov (United States)

    Boonen, Lieke H H M; Schut, Frederik T

    2011-04-01

    We investigate the impact of the transition towards managed competition in the Dutch health care system on health insurers' contracting behaviour. Specifically, we examine whether insurers have been able to take up their role as prudent buyers of care and examine consumers' attitudes towards insurers' new role. Health insurers' contracting behaviour is investigated by an extensive analysis of available information on purchasing practices by health insurers and by interviews with directors of health care purchasing of the four major health insurers, accounting for 90% of the market. Consumer attitudes towards insurers' new role are investigated by surveys among a representative sample of enrollees over the period 2005-2009. During the first four years of the reform, health insurers were very reluctant to engage in selective contracting and preferred to use 'soft' positive incentives to encourage preferred provider choice rather than engaging in restrictive managed care activities. Consumer attitudes towards channelling vary considerably by type of provider but generally became more negative in the first two years after the reform. Insurers' reluctance to use selective contracting can be at least partly explained by the presence of a credible-commitment problem. Consumers do not trust that insurers with restrictive networks are committed to provide good quality care. The credible-commitment problem seems to be particularly relevant to the Netherlands, since Dutch enrollees are not used to restrictions on provider choice. Since consumers are quite sensitive to differences in provider quality, more reliable information about provider quality is required to reduce the credible-commitment problem.

  2. MOOC Introduction to Dutch

    NARCIS (Netherlands)

    den Hollander, Franciscus; Piersma, Kristien

    2015-01-01

    Interview met Margriet Hidding, Birgit Lijmbach en Jeroen van Engen, medewerkers van het Talencentrum en de makers van de Massive Open Online Course (MOOC) Introduction to Dutch over het grote succes van deze cursus

  3. Analysis of Application Effect of Performance Appraisal System in the Nursing Management in the Department of Obstetrics%绩效考核制度在产科护理管理中的应用效果探析

    Institute of Scientific and Technical Information of China (English)

    毛英

    2016-01-01

    Objective To study the application effect of performance appraisal system in the nursing management in the de-partment of obstetrics. Methods 32 nurses in the department of obstetrics in our hospital were selected and divided into two groups with 16 cases in each, the control group adopted conventional appraisal system, the observation group adopted per-formance appraisal system, the satisfactory degree, health education effect, rate of pure breast-feeding after leaving hospital , occurrence case with nursing defect in the department of obstetrics before and after implementation and nursing quality in the department of obstetrics before and after implementation were compared between the two groups. Results The satisfacto-ry degree, health education effect score and rate of pure breast-feeding after leaving hospital in the observation group were better than those in the control group [ 80%, (69.75±4.89), 75% vs 98%, (88.75±7.89), 96%], the defect case after imple-mentation in the control group was obviously higher than that in the observation group, and the nursing quality in the de-partment of obstetrics after implementation in the observation group was better than that in the control group, and the dif-ferences between the two groups were obvious with statistical significance (P<0.05). Conclusion The performance appraisal system can improve the work efficacy of nursing staff in the nursing management in the department of obstetrics, rationally allocate the time, improve the work quality, which is of great significance to the department management.%目的:探究绩效考核制度在产科护理管理中的应用效果。方法选取该院产科32位护士,分为对照组和观察组,各16位;对照组采取常规考核制度,观察组采取绩效考核制度,比较两组的患者满意度,健康教育效果,出院纯母乳喂养率,实施前后产科护理缺陷发生例数,实施前后的产科护理质量。结果对

  4. Obstetric Thromboprophylaxis: The Swedish Guidelines

    Directory of Open Access Journals (Sweden)

    Pelle G. Lindqvist

    2011-01-01

    Full Text Available Obstetric thromboprophylaxis is difficult. Since 10 years Swedish obstetricians have used a combined risk estimation model and recommendations concerning to whom, at what dose, when, and for how long thromboprophylaxis is to be administrated based on a weighted risk score. In this paper we describe the background and validation of the Swedish guidelines for obstetric thromboprophylaxis in women with moderate-high risk of VTE, that is, at similar or higher risk as the antepartum risk among women with history of thrombosis. The risk score is based on major risk factors (i.e., 5-fold increased risk of thromboembolism. We present data on the efficacy of the model, the cost-effectiveness, and the lifestyle advice that is given. We believe that the Swedish guidelines for obstetric thromboprophylaxis aid clinicians in providing women at increased risk of VTE with effective and appropriate thromboprophylaxis, thus avoiding both over- and under-treatment.

  5. The Nordic Obstetric Surveillance Study

    DEFF Research Database (Denmark)

    Colmorn, Lotte B.; Petersen, Kathrine B; Jakobsson, Maija

    2015-01-01

    OBJECTIVE: To assess the rates and characteristics of women with complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery in the Nordic countries. DESIGN: Prospective, Nordic collaboration. SETTING: The Nordic Obstetric Surveillance Study...... (NOSS) collected cases of severe obstetric complications in the Nordic countries from April 2009 to August 2012. SAMPLE AND METHODS: Cases were reported by clinicians at the Nordic maternity units and retrieved from medical birth registers, hospital discharge registers, and transfusion databases...... hysterectomy was 3.5/10 000 deliveries. Of the women, 25% had two or more complications. Women with complications were more often >35 years old, overweight, with a higher parity, and a history of cesarean delivery compared with the total population. CONCLUSION: The studied obstetric complications are rare...

  6. [Sheehan's syndrome after obstetric hemorrhage].

    Science.gov (United States)

    Ramos-López, L; Pons-Canosa, V; Juncal-Díaz, J L; Núñez-Centeno, M B

    2014-12-01

    Sheehan's syndrome is described as panhypopituitarism secondary to a pituitary hypoperfusion during or just after obstetric hemorrhage. Advances in obstetric care make this syndrome quite unusual, but some cases are reported in underdeveloped countries. Clinical presentation may change depending on the severity of the hormone deficiencies. The diagnosis is clinical, but abnormalities are observed in the magnetic resonance in up to 70% of patients. We present a case of a woman with hypotension, hypothermia and edemas in relation to a previous massive postpartum hemorrhage. Failure in lactation was the clue to the diagnosis. A review of its main features, its diagnosis and treatment in the current literature is also presented.

  7. Current applications of big data in obstetric anesthesiology.

    Science.gov (United States)

    Klumpner, Thomas T; Bauer, Melissa E; Kheterpal, Sachin

    2017-06-01

    The narrative review aims to highlight several recently published 'big data' studies pertinent to the field of obstetric anesthesiology. Big data has been used to study rare outcomes, to identify trends within the healthcare system, to identify variations in practice patterns, and to highlight potential inequalities in obstetric anesthesia care. Big data studies have helped define the risk of rare complications of obstetric anesthesia, such as the risk of neuraxial hematoma in thrombocytopenic parturients. Also, large national databases have been used to better understand trends in anesthesia-related adverse events during cesarean delivery as well as outline potential racial/ethnic disparities in obstetric anesthesia care. Finally, real-time analysis of patient data across a number of disparate health information systems through the use of sophisticated clinical decision support and surveillance systems is one promising application of big data technology on the labor and delivery unit. 'Big data' research has important implications for obstetric anesthesia care and warrants continued study. Real-time electronic surveillance is a potentially useful application of big data technology on the labor and delivery unit.

  8. Very long term development of the Dutch Inland Waterway Transport System: Policy analysis, transport projections, shipping scenarios, and a new perspective on economic growth and future discounting: Extended summary report

    NARCIS (Netherlands)

    Van Dorsser, J.C.M.

    2015-01-01

    This report, that provides an extended summary of a similar named thesis, addresses how a new method for the evaluation of policies with a very long term impact on the Dutch Inland Waterway Transport (IWT) system can be developed. It proposes an outline for a very long term transport model, prepares

  9. Preventive measures of urinary system infections in gynaecology and obstetrics patients%妇产科患者泌尿系感染的预防措施

    Institute of Scientific and Technical Information of China (English)

    黄李芸; 饶红超; 罗梅莲

    2014-01-01

    OBJECTIVE To investigate the preventive measures and nursing countermeasures of patients in gynae-cology and obstetrics with urinary system infections , so as to reduce the infection rate in urinary system . METHODS The retrospective analysis for gynecologic abdominal operation patients from Jan .2011 to Oct .2012 was taken .The 563 cases of patients with gynecologic abdominal operation performed during Dec .2011 to Oct . 2012 were treated as observation group .A total of 498 cases of patients with gynecologic abdominal operation from Jan .2011 to Nov .2011 in our department were treated as control group .The control group was given the routine nursing ,the observation group was given routine nursing on strengthening the preventive measures and nursing countermeasures of urinary system infection .Nursing care satisfaction and urinary system infection rates of two groups were compared .SPSS16 .0 software was used for statistic analysis .RESULTS A total of 79 patients in control group got urinary tract infection ,accounting for 15 .86% ,9 cases in observation group ,accounting for 1 .60% .The patients satisfaction in control group was 82 .53% ,observation group 99 .47% ,with significant differences (P<0 .05) .CONCLUSION The strengthening of preventive measures and nursing countermeasures for urinary tract infection has obvious advantages than the traditional nursing method ,which can effectively reduce the urinary tract infection rate ,improve the patients'satisfaction to nursing care .%目的:探讨妇产科手术患者泌尿系感染的预防措施和护理对策,以降低泌尿系感染率。方法回顾性分析2011年1月-2012年10月医院妇产科手术患者临床资料,将2011年12月-2012年10月手术患者563例作为观察组,2011年1-11月手术患者498例作为对照组;对照组采用常规护理方法,观察组在常规护理方法的基础上加强了泌尿系统感染的预防措施和护理对策,比较两组患者护理满

  10. Beyond the current Dutch spatial planning system: Towards a beneficial spatial system that accommodates today’s complex societal needs

    NARCIS (Netherlands)

    L.M. Lodder (Marleen); J. Rotmans (Jan); M. Braungart (Michael)

    2014-01-01

    textabstractThis paper will analyse the developments in the spatial planning system in the Netherlands, as of the industrial revolution, as it has led to good practices of international recognition, but now seems to be under pressure because of the increasing complexity and multiple crises induced b

  11. The comparability of English, French and Dutch scores on the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F: an assessment of differential item functioning in patients with systemic sclerosis.

    Directory of Open Access Journals (Sweden)

    Linda Kwakkenbos

    Full Text Available OBJECTIVE: The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F is commonly used to assess fatigue in rheumatic diseases, and has shown to discriminate better across levels of the fatigue spectrum than other commonly used measures. The aim of this study was to assess the cross-language measurement equivalence of the English, French, and Dutch versions of the FACIT-F in systemic sclerosis (SSc patients. METHODS: The FACIT-F was completed by 871 English-speaking Canadian, 238 French-speaking Canadian and 230 Dutch SSc patients. Confirmatory factor analysis was used to assess the factor structure in the three samples. The Multiple-Indicator Multiple-Cause (MIMIC model was utilized to assess differential item functioning (DIF, comparing English versus French and versus Dutch patient responses separately. RESULTS: A unidimensional factor model showed good fit in all samples. Comparing French versus English patients, statistically significant, but small-magnitude DIF was found for 3 of 13 items. French patients had 0.04 of a standard deviation (SD lower latent fatigue scores than English patients and there was an increase of only 0.03 SD after accounting for DIF. For the Dutch versus English comparison, 4 items showed small, but statistically significant, DIF. Dutch patients had 0.20 SD lower latent fatigue scores than English patients. After correcting for DIF, there was a reduction of 0.16 SD in this difference. CONCLUSIONS: There was statistically significant DIF in several items, but the overall effect on fatigue scores was minimal. English, French and Dutch versions of the FACIT-F can be reasonably treated as having equivalent scoring metrics.

  12. The making of Dutch flower culture: Auctions, networks, and aesthetics

    NARCIS (Netherlands)

    Gebhardt, A.C.

    2014-01-01

    Centered around five inquiries, this thesis uses several concepts to analyze Dutch horticulture and FloraHolland Aalsmeer: moral economy, commodity, world system, networks, horticulture, aesthetics, masculinity, cooperative, and the market. It explores how Dutch horticulture was and is embedded in n

  13. The impact of microgeneration upon the Dutch balancing market

    NARCIS (Netherlands)

    Van der Veen, R.A.C.; De Vries, L.J.

    2009-01-01

    The share of microgeneration (power generation at the level of households and small businesses) in the Dutch electricity system continues to grow. Over time, this development may pose a threat to the reliability and efficiency of the Dutch electricity balancing market. We investigated possible chang

  14. Creating an Information Retrieval test corpus for Dutch

    NARCIS (Netherlands)

    Hiemstra, D.; Leeuwen, van D.A.; Theune, M.; Nijholt, A.; Hondorp, G.H.W.

    2002-01-01

    This paper describes the first large-scale evaluation of information retrieval systems using Dutch documents and queries. We describe in detail the characteristics of the Dutch test data, which is part of the official CLEF multilingual test corpus, and give an overview of the experimental results of

  15. A Dutch Achievement Testing Program for Guidance and Program Evaluation.

    Science.gov (United States)

    Wijnstra, Johan M.

    1984-01-01

    The Eindtoets Basisonderwijs (final primary school test) is a Dutch national achievement test taken annually by 90,000 pupils. This article overviews the Dutch educational system and describes this testing program, emphasizing test equating methods. Evaluation findings from 1980 and resulting changes in test content and evaluation reports are also…

  16. The making of Dutch flower culture: Auctions, networks, and aesthetics

    NARCIS (Netherlands)

    Gebhardt, A.C.

    2014-01-01

    Centered around five inquiries, this thesis uses several concepts to analyze Dutch horticulture and FloraHolland Aalsmeer: moral economy, commodity, world system, networks, horticulture, aesthetics, masculinity, cooperative, and the market. It explores how Dutch horticulture was and is embedded in

  17. Dutch research on organic agriculture: approaches and characteristics

    NARCIS (Netherlands)

    Wijnands, F.G.; Koopmans, C.J.; Sukkel, W.; Hommes, M.

    2009-01-01

    Dutch research on organic agriculture began in the late 1970s. Key characteristics of this research were the systems approach and the strong participation of farmers and stakeholders. The ambitions for a fully sustainable organic agriculture as formulated by the Dutch organic sector set the research

  18. Euthanasia in the Broader Framework of Dutch Penal Policies

    NARCIS (Netherlands)

    Groenhuijsen, M.S.; van Laanen, F.; Groenhuijsen, M.S.; van Laanen, F.

    2006-01-01

    The authors have regarded euthanasia in the broader framework of Dutch penal policies. They present euthanasia as a typical example of the pragmatic - rather than dogmatic - way the Dutch try to tackle difficult moral problems in connection with the criminal justice system. Definitions, statutory la

  19. Euthanasia in the Broader Framework of Dutch Penal Policies

    NARCIS (Netherlands)

    Groenhuijsen, M.S.; van Laanen, F.; Groenhuijsen, M.S.; van Laanen, F.

    2006-01-01

    The authors have regarded euthanasia in the broader framework of Dutch penal policies. They present euthanasia as a typical example of the pragmatic - rather than dogmatic - way the Dutch try to tackle difficult moral problems in connection with the criminal justice system. Definitions, statutory

  20. Definitions of Obstetric and Gynecologic Hospitalists.

    Science.gov (United States)

    McCue, Brigid; Fagnant, Robert; Townsend, Arthur; Morgan, Meredith; Gandhi-List, Shefali; Colegrove, Tanner; Stosur, Harriet; Olson, Rob; Meyer, Karenmarie; Lin, Andrew; Tessmer-Tuck, Jennifer

    2016-02-01

    The obstetric hospitalist and the obstetric and gynecologic hospitalist evolved in response to diverse forces in medicine, including the need for leadership on labor and delivery units, an increasing emphasis on quality and safety in obstetrics and gynecology, the changing demographics of the obstetric and gynecologic workforce, and rising liability costs. Current (although limited) research suggests that obstetric and obstetric and gynecologic hospitalists may improve the quality and safety of obstetric care, including lower cesarean delivery rates and higher vaginal birth after cesarean delivery rates as well as lower liability costs and fewer liability events. This research is currently hampered by the use of varied terminology. The leadership of the Society of Obstetric and Gynecologic Hospitalists proposes standardized definitions of an obstetric hospitalist, an obstetric and gynecologic hospitalist, and obstetric and gynecologic hospital medicine practices to standardize communication and facilitate program implementation and research. Clinical investigations regarding obstetric and gynecologic practices (including hospitalist practices) should define inpatient coverage arrangements using these standardized definitions to allow for fair conclusions and comparisons between practices.

  1. Gender-Marked Determiners Help Dutch Learners' Word Recognition when Gender Information Itself Does Not

    Science.gov (United States)

    van Heugten, Marieke; Johnson, Elizabeth K.

    2011-01-01

    Dutch, unlike English, contains two gender-marked forms of the definite article. Does the presence of multiple definite article forms lead Dutch learners to be delayed relative to English learners in the acquisition of their determiner system? Using the Preferential Looking Procedure, we found that Dutch-learning children aged 1 ; 7 to 2 ; 0 use…

  2. Generating generosity. Financing poor relief through charitable collections in Dutch towns, c. 1600-1800

    NARCIS (Netherlands)

    Teeuwen, N.M.

    2014-01-01

    The early modern Dutch welfare system has often been described as relatively generous and efficient. Not only foreigners visiting the Dutch Republic, but also present-day historians have asserted that the Dutch, together with their English neighbours, stood out in early modern Europe in terms of sol

  3. NitroGenius: a nitrogen decision support system. A game to develop the optimal policy to solve the Dutch nitrogen pollution problem.

    Science.gov (United States)

    Erisman, Jan Willem; Hensen, Arjan; de Vries, Wim; Kros, Hans; van de Wal, Tamme; de Winter, Wim; Wien, Jan Erik; van Elswijk, Mark; Maat, Matthijs; Sanders, Kaj

    2002-03-01

    A nitrogen decision support system in the form of a game (NitroGenius) was developed for the Second International Nitrogen Conference. The aims were to: i) improve understanding among scientists and policy makers about the complexity of nitrogen pollution problems in an area of intensive agricultural, industrial, and transportation activity (The Netherlands); and ii) search for optimal policy solutions to prevent pollution effects at lowest economic and social costs. NitroGenius includes a model of nitrogen flows at relevant spatial and temporal scales including emissions of ammonia and nitrogen oxides and contamination of surface- and groundwaters. NitroGenius also includes an economic model describing relationships for important sectors and impacts of different nitrogen control measures on Gross Domestic Product (GDP), unemployment, energy use, and environmental costs. About 50 teams played NitroGenius during the Second International Nitrogen Conference. The results show that careful planning and selection of abatement options can solve Dutch nitrogen problems at reasonable cost.

  4. Measuring educational needs among patients with systemic lupus erythematosus (SLE) using the Dutch version of the Educational Needs Assessment Tool (D-ENAT).

    Science.gov (United States)

    Zirkzee, E J M; Ndosi, M E; Vliet Vlieland, T P M; Meesters, J J L

    2014-11-01

    The Educational Needs Assessment Tool (ENAT) was developed in the United Kingdom (UK) to systematically assess the educational needs of patients with rheumatic diseases. The aim of the present study was to describe the educational needs of Dutch patients with systemic lupus erythematosus (SLE) by means of a Dutch version of the ENAT (D-ENAT). The D-ENAT was sent to a random sample of 244 SLE patients registered at the outpatient clinic of a university hospital. D-ENAT consists of 39 items in seven domains. The D-ENAT domain scores range from 0-16 to 0-28 (higher scoring equals higher educational needs) depending of the number of items in the domain. A total D-ENAT score (0-156) is calculated by summing all 39 items. In addition, age, disease duration, gender, educational level, present information need (yes/no) and the extent of information need (1-4: nothing-everything) were recorded. Univariate regression analysis was used to examine the D-ENAT's potential determinants. The response rate was 122 out of 244 (50%). The mean (% of maximum score) educational needs scores were 56% for 'D-ENAT total score', 62% for 'Self-help measures', 60% for 'Disease process', 58% for 'Feelings', 56% for 'Treatments', 50% for 'Movement', 49% for 'Support systems' and 46% for 'Managing pain'. Being female was significantly associated with higher scoring on the D-ENAT total score (β 23.0; 95% CI 5.9, 40.3). SLE patients demonstrated substantial educational needs, especially in the domains: 'Self-help measures', 'Disease process' and 'Feelings'. The validity and practical applicability of the D-ENAT to make an inventory of SLE patients' educational needs requires further investigation. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  5. Obstetric complications in Marfan syndrome

    NARCIS (Netherlands)

    Meijboom, LJ; Drenthen, W; Pieper, PG; Groenink, M; Van der Post, JAM; Timmermans, J; Voors, AA; Roos-Hesselink, JW; van Veldhuisen, DJ; Mulder, BJM

    2006-01-01

    Objective: To investigate the obstetric maternal and neonatal outcome of pregnancy in women with Marfan syndrome. Methods: Retrospective observational multi-center study based on congenital heart disease registry. Results: Sixty-three of the 122 enrolled women with Marfan syndrome had been pregnant

  6. DutchParl: A corpus of parliamentary documents in Dutch

    NARCIS (Netherlands)

    Marx, M.; Schuth, A.; Calzolari, N.; Choukri, K.; Maegaard, B.; Mariani, J.; Odijk, J.; Piperidis, S.; Rosner, M.; Tapias, D.

    2010-01-01

    A corpus called DutchParl is created which aims to contain all digitally available parliamentary documents written in the Dutch language. The first version of DutchParl contains documents from the parliaments of The Netherlands, Flanders and Belgium. The corpus is divided along three dimensions: per

  7. Dutch School in Geneva

    CERN Multimedia

    2011-01-01

    The Dutch School in Geneva organizes Dutch education for children in the primary and secondary school. For the school year 2011-2012 the Dutch School in Geneva is looking for qualified part time teachers Dutch for the primary and secondary school. If you are interested, please send your application and curriculum vitae in Dutch by email to the NTC coordinator, Mrs. Anne Saeys (anne.saeys@free.fr). More info : www.ntcgeneve.info De vereniging Nederlandse Taal en Cultuur De Taalfontein, kortweg NTC Genève, is een oudervereniging, die tot doel heeft de Nederlandse taal en de Nederlandse en Vlaamse cultuur in de regio Genève te stimuleren. Dit geschiedt d.m.v. het organiseren van Nederlandse les voor leerlingen zowel in het basisonderwijs als het voortgezet onderwijs. Voor het volgende schooljaar zoekt NTC parttime docenten (M/V) vanaf 2 uur per week, zowel voor het Primair Onderwijs als voor het Voortgezet Onderwijs, met name voor de IB-opleiding. Voor het Primair Onderwijs dienen ge&...

  8. The Dutch health insurance reform: consumer mobility.

    NARCIS (Netherlands)

    Jong, J.D. de; Groenewegen, P.P.; Rijken, M.

    2006-01-01

    On 1 January 2006, a number of far-reaching changes in the Dutch health insurance system came into effect. There is now one type of health care insurance for all. The standard package is compulsory for everyone who lives in The Netherlands or pays wage tax in The Netherlands. In the new system of ma

  9. Employment protection in Dutch collective labour agreements

    NARCIS (Netherlands)

    T. Schils

    2007-01-01

    The Dutch system of employment protection is often perceived as too strict for workers on permanent contracts, because of the large procedural inconveniences, difficulty of dismissal and high severance pay. It is suggested that the system of employment protection lowers labour market flexibility by

  10. Economic assessment of Dutch agricultural research

    NARCIS (Netherlands)

    Poppe, K.J.

    2008-01-01

    To cope with globalisation and other changes in the industry, in the last 20 years the Dutch Ministry of Agriculture has reorganised its system for education, extension and research considerably. It moved away from the concept of a linear process of innovation to that of an agro-innovation system.

  11. The transition in Dutch water management

    NARCIS (Netherlands)

    R. van der Brugge (Rutger); J. Rotmans (Jan); D.A. Loorbach (Derk)

    2006-01-01

    textabstractOver the past decades the Dutch people have been confronted with severe waterrelated problems, which are the result of an unsustainable water system, arising from human interventions in the physical infrastructure of the water system and the water management style. The claims of housing,

  12. Question Answering for Dutch: Simple does it

    NARCIS (Netherlands)

    Hoekstra, A.H.; Hiemstra, Djoerd; van der Vet, P.E.; Huibers, Theo W.C.

    2006-01-01

    When people pose questions in natural language to search for information on the web, the role of question answering (QA) systems becomes important. In this paper the QAsystem simpleQA, capable of answering Dutch questions on which the answer is a person or a location, is described. The system's

  13. Economic assessment of Dutch agricultural research

    NARCIS (Netherlands)

    Poppe, K.J.

    2008-01-01

    To cope with globalisation and other changes in the industry, in the last 20 years the Dutch Ministry of Agriculture has reorganised its system for education, extension and research considerably. It moved away from the concept of a linear process of innovation to that of an agro-innovation system. T

  14. Continuum of Medical Education in Obstetrics and Gynecology.

    Science.gov (United States)

    Dohner, Charles W.; Hunter, Charles A., Jr.

    1980-01-01

    Over the past eight years the obstetric and gynecology specialty has applied a system model of instructional planning to the continuum of medical education. The systems model of needs identification, preassessment, instructional objectives, instructional materials, learning experiences; and evaluation techniques directly related to objectives was…

  15. Ambulance referral for emergency obstetric care in remote settings.

    Science.gov (United States)

    Tsegaye, Ademe; Somigliana, Edgardo; Alemayehu, Tadesse; Calia, Federico; Maroli, Massimo; Barban, Paola; Manenti, Fabio; Putoto, Giovanni; Accorsi, Sandro

    2016-06-01

    To evaluate the functionality of an ambulance service dedicated to emergency obstetric care (EmOC) that referred pregnant women to health centers for delivery assistance or to a hospital for the management of obstetric complications. A retrospective study investigated an ambulance referral system for EmOC in a rural area of Ethiopia between July 1 and December 31, 2013. The service was available 24h a day and was free of charge. Women requesting referral were transported to nearby health centers. Assistance was provided locally for uncomplicated deliveries. Women with obstetric complications were referred from health centers to a hospital. A total of 528 ambulance referrals were recorded. The majority of patients (314 [59.5%]) were transported from villages to health centers. The remaining individuals were brought to a hospital, having been referred from health centers (179 [33.9%]) or were referred directly from villages owing to hospital proximity (35 [6.6%]). Of the 179 patients referred to the hospital from health centers, 84 (46.9%) were diagnosed with major direct obstetric complications. No maternal deaths were recorded among patients using the ambulance service. The cost of the ambulance service was US$ 18.47 per referred patient. An ambulance service dedicated to EmOC that interconnected health centers and a hospital facilitated referrals and better utilized local resources. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Bases moleculares do sistema Rh e suas aplicações em obstetrícia e medicina transfusional The molecular basis of RH system and its applications in obstetrics and transfusion medicine

    Directory of Open Access Journals (Sweden)

    Luciano Marcondes Machado Nardozza

    2010-01-01

    Full Text Available O sistema Rh é o mais polimórfico e imunogênico de todos os sistemas de grupos sanguíneos. Atualmente mais de 49 antígenos foram identificados sendo cinco principais os antígenos D, C, c, E, e. O conhecimento das bases moleculares do sistema Rh desde a sua primeira clonagem há 17 anos possibilitou o entendimento tanto do mecanismo do fenótipo Rh negativo quanto das variantes dos antígenos RHD e RHCE. As deleções, rearranjos gênicos e as inserções são as principais mutações encontradas. Nos caucasianos, o mecanismo principal do fenótipo Rh negativo é a completa deleção do gene RHD, enquanto nos afrodescendentes é a presença do pseudogene RHDψ e do gene híbrido RHD-CE (4-7-D. Os autores analisam a estrutura do complexo Rh nas hemácias, as bases moleculares do Sistema Rh, os mecanismos de negatividade RHD, além da Expressão fraca e parcial de D.The Rh system is the most polymorphic and immunogenic for all blood group systems. Currently more than 49 antigens were identified with five major antigens D, C, c, E, e. Knowledge of the Rh system's molecular basis, since its first cloning 17 years ago, allowed to understand the mechanism of Rh-negative phenotype and the variants of antigens as RHD and RHCE. Deletions, gene rearrangements and insertions are the main mutations. In Caucasians the primary mechanism of Rh-negative phenotype is the complete RHD gene deletion, while in African descendants it is the presence of pseudogene and gene RHDψ hybrid RHD-CE (4-7-D. The authors analyze the structure of the Rh complex in red cells, molecular basis of the Rh system, mechanisms of Negativity RHD and weak and incomplete expression of RHD.

  17. A New Dutch Spelling Guide.

    Science.gov (United States)

    Kruyt, J. G.; van Sterkenburg, P. G. J.

    This paper describes the development of two new corpus-based Dutch spelling guides using language data gathered by the Institute for Dutch Lexicology, a research institute subsidized by the Dutch and Belgian governments. The guides were produced in 1990 and 1995. The guides are based on two earlier ones, published in 1866 and 1954, but attempt to…

  18. Utilization of obstetric services in Ghana between 1999 and 2003.

    Science.gov (United States)

    Adanu, Richard M K

    2010-09-01

    Analysis of the 2003 Ghana Demographic and Health Survey shows that even though over 90% of pregnant women attend antenatal care in health institutions, only 43% deliver in the health institutions. The quality of antenatal care received is also lower than is expected for standard obstetric care. The national caesarean section rate of 3.7% reflects inadequate obstetric coverage. There is a need for continued education of health workers to improve the quality of antenatal care. The Ghanaian health system needs to consider how to improve obstetric coverage by skilled attendants and to study the reasons for inadequate use of delivery services in order to be able to achieve the target for maternal health set in the Millennium Development Goals.

  19. Teamwork in obstetric critical care.

    Science.gov (United States)

    Guise, Jeanne-Marie; Segel, Sally

    2008-10-01

    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well trained and competent medically, they have not traditionally been trained in how to work well as part of a team. Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams.

  20. Ranking Dutch Economists

    NARCIS (Netherlands)

    van Ours, J.C.; Vermeulen, F.M.P.

    2007-01-01

    This paper ranks Dutch economists using information about publications and citations. Rankings involve the aggregation of several performance dimensions. Instead of using a cardinal approach, where each dimension is weighted based on impact factors of journals for example, we use an ordinal approach

  1. Revisiting the Dutch hypothesis

    NARCIS (Netherlands)

    Postma, Dirkje S.; Weiss, Scott T.; van den Berge, Maarten; Kerstjens, Huib A. M.; Koppelman, Gerard H.

    The Dutch hypothesis was first articulated in 1961, when many novel and advanced scientific techniques were not available, such as genomics techniques for pinpointing genes, gene expression, lipid and protein profiles, and the microbiome. In addition, computed tomographic scans and advanced analysis

  2. Survival of Dutch heathlands.

    NARCIS (Netherlands)

    Diemont, W.H.

    1996-01-01

    OBJECTIVES OF THE THESISHeathlands in The Netherlands are vanishing due to the invasion of trees. The transition from heathland to woodland in Dutch heathlands may either proceed directly or is preceded by the development of an intermediate grass heath. These changes are due to natural succession in

  3. Dutch Vegetation Database (LVD)

    NARCIS (Netherlands)

    Hennekens, S.M.

    2011-01-01

    The Dutch Vegetation Database (LVD) hosts information on all plant communities in the Netherlands. This substantial archive consists of over 600.000 recent and historic vegetation descriptions. The data provide information on more than 85 years of vegetation recording in various habitats covering te

  4. The New Dutch Waterline

    NARCIS (Netherlands)

    Verschuure, G.A.

    2015-01-01

    Nowadays, heritage is shifting towards a more structural approach, focusing on the urban landscape in which the intangible or the narrative of the place is used more often. The New Dutch Waterline is an example of this changing focus. This national transformation process (1999-now) led to high profi

  5. Dutch Culture Overseas

    NARCIS (Netherlands)

    Gouda, Frances

    1995-01-01

    Why were citizens of a small and politically insignificant European nation like the Netherlands able to represent as natural and normal their paternalistic dominance over ancient civilizations in places such as Java and Bali? How did 'ethical' twentieth century residents of the Dutch East Indies see

  6. Dutch house price fundamentals

    NARCIS (Netherlands)

    Haffner, M.E.A.; de Vries, P.

    2009-01-01

    This paper discusses house price developments in the Netherlands, specifically focussing on the question whether current house prices in the Dutch owner-occupied market are likely to decrease. We analyse three aspects of the question based on a literature review: (1) whether there is a house price b

  7. Dutch house price fundamentals

    NARCIS (Netherlands)

    Haffner, M.E.A.; de Vries, P.

    2009-01-01

    This paper discusses house price developments in the Netherlands, specifically focussing on the question whether current house prices in the Dutch owner-occupied market are likely to decrease. We analyse three aspects of the question based on a literature review: (1) whether there is a house price

  8. The New Dutch Waterline

    NARCIS (Netherlands)

    Verschuure, G.A.

    2015-01-01

    Nowadays, heritage is shifting towards a more structural approach, focusing on the urban landscape in which the intangible or the narrative of the place is used more often. The New Dutch Waterline is an example of this changing focus. This national transformation process (1999-now) led to high

  9. Dutch Arthurian literature

    NARCIS (Netherlands)

    Besamusca, A.A.M.

    2006-01-01

    Ironically, the currently flourishing study of Arthurian literature in the Low Countries had a false start, as L.G. Visscher’s 1838 publication of Ferguut, the thirteenth-century Middle Dutch rendition of Guillaume le Clerc’s Fergus, was full of flaws.1 The many inaccuracies in this first complete e

  10. Rostering at a Dutch Security Firm

    NARCIS (Netherlands)

    R. Freling (Richard); N. Piersma (Nanda); A.P.M. Wagelmans (Albert); A. van de Wetering

    2001-01-01

    textabstractThe roster planning process at the Dutch security firm NVD was traditionally carried out by hand. A few years ago, because of changing labor laws in The Netherlands, this became practically impossible. We developed a decision support system which has four main modules. The first one chec

  11. Ethical motivation of Dutch egg consumers

    NARCIS (Netherlands)

    Burrell, A.M.; Vrieze, G.

    2003-01-01

    This paper analyses a representative sample of 356 Dutch egg consumers in order to measure the extent to which ethical principles concerning the welfare of hens in different rearing systems are translated into egg purchasing intentions, and the extent to which declared intentions are expressed in ac

  12. Obstetric medical emergency teams are a step forward in maternal safety!

    Directory of Open Access Journals (Sweden)

    Al Kadri Hanan

    2010-01-01

    Full Text Available Background and Aim : The medical emergency team (MET system was introduced successfully worldwide. With the exception of a few research publications, most of the described teams are based on patients′ medical rather than obstetric management. The objective of this study was to review literature on the outcome of obstetric MET implementation. Materials and Methods : Systematic review has been done through searching MEDLINE, the Cochrane Library, relevant articles references, and contact with experts. The author and one other researcher independently selected literature on the establishment or implementation of obstetric MET. There were no restrictions on language, sample size, type of publication, or duration of follow up. Results : Three publications were identified: Catanzarite et al., Gosman et al., and Skupski et al. They were heterogeneous in terms of the method of implementation and the outcomes discussed. None of them discussed obstetric MET implementation in developing countries. Conclusion: In the literature, there is a lack of reporting and probably of implementation of Obstetrics METs. Therefore, there is a need for more standardized experiences and reports on the implementation of various types of Obstetrics METs. We propose here a design for Obstetrics METs to be implemented in developing countries, aiming to reduce maternal mortality and morbidity resulting from obstetric hemorrhage.

  13. Objectivating nasality in healthy and velopharyngeal insufficient children with the Nasalance Acquisition System (NasalView). Defining minimal required speech tasks assessing normative values for Dutch language.

    Science.gov (United States)

    Hogen Esch, Thijs T; Dejonckere, Philippe H

    2004-08-01

    (1) To define normative nasalance data for Dutch language with "the NasalView System", and obtain a reference for normality when nasality is evaluated in children. (2) To investigate the minimal number of required speech tasks for a reliable nasalance measurement. 55 children (30 normal and 25 velopharyngeal insufficient), aged between 4 and 11 were included. All children had to read or repeat two Dutch passages ((one with a normal amount of nasal consonants (normal passage) and one with none (nonnasal passage)). Further, one normal and one velopharyngeal insufficient subject read a passage in repetition to test the NasalViews reproducibility: (1) For both passages, group means (GM) and standard deviations (S.D.) were used to compute "pathological nasalance boundaries" [GM +/- (2 x S.D.)], in combination with the coefficient of variation (CV), sensitivity, specificity and positive predictive values. (2) With ANOVA all sentences within each passage were tested for significant differences in nasalance. (1) The pathological boundaries were 28.6-41.4% (GM: 35.0) and 21.4-34.7% (GM: 28.1), for the normal and nonnasal passage, respectively. For the normal passage a sensitivity of 96%, a specificity of 93% and a positive predictive value of 92% was computed. For the nonnasal passage these parameters were 96, 95 and 96%, respectively. Intra subject CVs of 3.6% (normal subject) and 1.5% (VI subject) showed good reproducibility of measurements. (2) Within the normal passage only the third sentence was significantly different in nasalance, compared to the entire passage (31.2% versus 35.0%). Within the nonnasal passage the second and fifth sentences were significantly different (23.8 and 24.8% versus 28.1%). However, the individual nonsignificantly different sentences showed a higher variation in nasalance compared to the entire passages. The NasalView System seems to be reliable and quantifies valid nasalance values when nasality is evaluated. Within both passages high

  14. Natural and built environmental exposures on children's active school travel: A Dutch global positioning system-based cross-sectional study.

    Science.gov (United States)

    Helbich, Marco; Emmichoven, Maarten J Zeylmans van; Dijst, Martin J; Kwan, Mei-Po; Pierik, Frank H; Vries, Sanne I de

    2016-05-01

    Physical inactivity among children is on the rise. Active transport to school (ATS), namely walking and cycling there, adds to children's activity level. Little is known about how exposures along actual routes influence children's transport behavior. This study examined how natural and built environments influence mode choice among Dutch children aged 6-11 years. 623 school trips were tracked with global positioning system. Natural and built environmental exposures were determined by means of a geographic information system and their associations with children's active/passive mode choice were analyzed using mixed models. The actual commuted distance is inversely associated with ATS when only personal, traffic safety, and weather features are considered. When the model is adjusted for urban environments, the results are reversed and distance is no longer significant, whereas well-connected streets and cycling lanes are positively associated with ATS. Neither green space nor weather is significant. As distance is not apparent as a constraining travel determinant when moving through urban landscapes, planning authorities should support children's ATS by providing well-designed cities.

  15. Do Dutch doctors communicate differently with immigrant patients than with Dutch patients?

    Science.gov (United States)

    Meeuwesen, Ludwien; Harmsen, Johannes A M; Bernsen, Roos M D; Bruijnzeels, Marc A

    2006-11-01

    The aim of this study was to gain deeper insight into relational aspects of the medical communication pattern in intercultural consultations at GP practices in the Netherlands. We ask whether there are differences in the verbal interaction of Dutch GPs with immigrant and Dutch patients. Data were drawn from 144 adult patient interviews and video observations of consultations between the patients and 31 Dutch GPs. The patient group consisted of 61 non-Western immigrants (Turkish, Moroccan, Surinamese, Antillean, Cape Verdian) and 83 Dutch participants. Affective and instrumental aspects of verbal communication were assessed using Roter's Interaction Analysis System (RIAS). Patients' cultural background was assessed by ethnicity, language proficiency, level of education, religiosity and cultural views (in terms of being more traditional or more modern). Consultations with the non-Western immigrant patients (especially those from Turkey and Morocco) were well over 2 min shorter, and the power distance between GPs and these patients was greater when compared to the Dutch patients. Major differences in verbal interaction were observed on the affective behavior dimensions, but not on the instrumental dimensions. Doctors invested more in trying to understand the immigrant patients, while in the case of Dutch patients they showed more involvement and empathy. Dutch patients seemed to be more assertive in the medical conversation. The differences are discussed in terms of patients' ethnic background, cultural views (e.g. practicing a religion) and linguistic barriers. It is concluded that attention to cultural diversity does matter, as this leads to different medical communication patterns. A two-way strategy is recommended for improving medical communication, with implications for both doctor and patient behavior.

  16. The role of obstetric complications in schizophrenia.

    Science.gov (United States)

    Heun, R; Maier, W

    1993-04-01

    The importance of obstetric complications in sporadic and familial psychoses was analyzed in 43 schizophrenic and 28 chronic schizoaffective patients. Patients and first-degree relatives were diagnosed using Research Diagnostic Criteria and the best-estimate procedure. Mothers of patients were interviewed for histories of pregnancy and obstetric complications in their offspring. Patients had more often suffered perinatal complications (42%) than their siblings (29%). The risk for obstetric complications and secondary cases of psychosis was enhanced in relatives of patients with a history of obstetric complications. Siblings with obstetric complications had a low incidence of psychoses; therefore, obstetric complications could not explain the occurrence of secondary cases of psychosis in siblings. Patients with familial psychoses had a higher incidence of obstetric complications than did sporadic cases (without reaching statistical significance). There was no inverse relationship between the history of obstetric complications in patients and the morbid risk of first-degree relatives for psychoses. The familial versus sporadic distinction revealed no subgroups where obstetric complications were of special relevance.

  17. Evaluation of transition in Dutch senior secondary vocational education

    NARCIS (Netherlands)

    Lazonder, A.W.; Jong, F.P.C.M. de

    1999-01-01

    Survey responses from 55 Dutch agricultural vocational schools show that administrators believe that transition, the ability of students to change between training modes or qualification levels easily, has enhanced the flexibility of the qualification system developed under recent national reforms.

  18. The effect of concentrating obstetrics services in fewer hospitals on patient access: a simulation.

    Science.gov (United States)

    Koike, Soichi; Matsumoto, Masatoshi; Ide, Hiroo; Kashima, Saori; Atarashi, Hidenao; Yasunaga, Hideo

    2016-01-22

    In Japan, the number of obstetrics facilities has steadily decreased and the selection and concentration of obstetrics facilities is progressing rapidly. Obstetrics services should be concentrated in fewer hospitals to improve quality of care and reduce the workload of obstetricians. However, the impact of this intensification of services on access to obstetrics hospitals is not known. We undertook a simulation to examine how the intensification of obstetrics services would affect access to hospitals based on a variety of scenarios, and the implications for health policy. The female population aged between 15 and 49 living within a 30-min drive of an obstetrics hospital was calculated using a Geographic Information System for three possible intensification scenarios: Scenario 1 retained facilities with a higher volume of deliveries without considering the geographic boundaries of Medical Service Areas (MSAs, zones of healthcare administration and management); Scenario 2 prioritized retaining at least one hospital in each MSA and then retained higher delivery volume institutions, while Scenario 3 retained facilities to maximize population coverage using location-allocation modeling. We also assessed the impact of concentrating services in academic hospitals and specialist perinatal medical centers (PMCs) alone. In 2011, 95.0% of women aged 15-49 years lived within a 30-min drive of one of 1075 obstetrics hospitals. This would fall to 82.7% if obstetrics services were intensified into academic hospitals and general and regional PMCs. If 55.0% of institutions provided obstetrics services, the coverage would be 87.6% in Scenario 1, whereas intensification based on access would achieve over 90.5% coverage in Scenario 2 and 93.9% in Scenario 3. Intensification of obstetrics facilities impairs access, but a greater caseload and better staffing have the potential advantages of better clinical outcomes and reduced costs. It is essential to consult residents of hospital

  19. Survival of Dutch heathlands.

    OpenAIRE

    Diemont, W.H.

    1996-01-01

    OBJECTIVES OF THE THESISHeathlands in The Netherlands are vanishing due to the invasion of trees. The transition from heathland to woodland in Dutch heathlands may either proceed directly or is preceded by the development of an intermediate grass heath. These changes are due to natural succession in the absence of management. In addition to the absence of management atmospheric pollution i.e. increased inputs of nitrogen has accelerated the replacement of heather heath by grass heath.The main...

  20. DUTCH R&B

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    <正>I have forgotten who had said: "Music has no boundary." In the Netherlands, we met with the four boys of the bandRe-Play by accident. As we talked about the "Tornado," they,who were grown up in the Netherlands, sang it in the Dutchlanguage. We felt very surprised.It was the year of 1994 when four guys from Rotterdam,the Netherlands, decided to take part in a Dutch singing contest,

  1. Obstetrics and Gynecology Hospitalist Fellowships.

    Science.gov (United States)

    Vintzileos, Anthony M

    2015-09-01

    This article establishes the rationale and development of an obstetrics and gynecology (OB/GYN) hospitalist fellowship program. The pool of OB/GYN hospitalists needs to be drastically expanded to accommodate the country's needs. Fellowship programs should provide extra training and confidence for recent resident graduates who want to pursue a hospitalist career. Fellowships should train physicians in a way that aligns their interests with those of the hospital with respect to patient care, teaching, and research. Research in the core measures should be a necessary component of the fellowship so as to provide long-term benefits for all stakeholders, including hospitals and patients.

  2. Obstetrics Hospitalists: Risk Management Implications.

    Science.gov (United States)

    Veltman, Larry

    2015-09-01

    The concept of having an in-house obstetrician (serving as an obstetrics [OB] hospitalist) available 24 hours a day, 7 days a week provides a safety net for OB events that many need immediate intervention for a successful outcome. A key precept of risk management, that of loss prevention, fits perfectly with the addition of an OB hospitalist role in the perinatal department. Inherent in the role of OB hospitalists are the patient safety and risk management principles of improved communication, enhanced readiness, and immediate availability.

  3. Proteomics in obstetrics and gynecology

    Directory of Open Access Journals (Sweden)

    Seema Lekhwani

    2011-01-01

    Full Text Available Proteomics helps to understand the basic biological processes critical to normal cellular functions as well as the development of diseases. It identifies the essential components of these processes and exploits these components as targets in the development of new methods to prevent or treat diseases. Proteomics, although in an infancy stage in India, has the potential to complement and further enlarge the wealth of information in medicine, especially in the field of cancer. This article reviews the recent progress in proteomic techniques and their applications in the field of obstetrics and gynecology.

  4. Perceptual assimilation of Dutch vowels by Peruvian Spanish listeners.

    Science.gov (United States)

    Escudero, Paola; Williams, Daniel

    2011-01-01

    Many cross-language and L2 speech perception studies have been conducted on English sounds and a limited number of speakers or synthetic tokens have been used for auditory stimuli. The Spanish listeners of the present study were presented with natural tokens of Dutch vowels produced by males and females selected from the corpus reported in Adank et al. [(2004) J. Acoust. Soc. Am. 116, 1729-1738]. The results show that single category assimilations are common and that certain Dutch vowels frequently assimilate to Spanish diphthongs. Predictions are made for Spanish learners' initial stage in the acquisition of the Dutch vowel system.

  5. Evaluation of the Efficiency of Treatment for Massive Obstetric Hemorrhage

    Directory of Open Access Journals (Sweden)

    S. V. Barinov

    2014-01-01

    Full Text Available Objective: to evaluate the efficiency of therapy for massive obstetric hemorrhage, by applying thromboelastography (TEG. Subjects and methods. Sixty six patients with massive obstetric hemorrhage who were divided into two groups: a study (A; n=37 and comparison (B; n=29 groups were examined. A control group (C; n=30 comprised women with physiological blood loss during labor. The efficiency of TEG was evaluated from the volume of blood loss and the frequency of hysterectomy.Results. Fibrin clot density, MA have the highest prognostic capacity to identify the risk of massive obstetric hemorrhage [AUC=0.83 (95% CI 0.79—0.87; р=0.001]. A therapeutic and diagnostic set for massive obstetric hemorrhage, by applying TEG, can reduce the number of hysterectomies by 3. 1 times (p=0.02, the volume of blood loss by 1.3 times (p=0.03, and the use of fresh frozen plasma by 2.0 times (p=0.01. Conclusion. Rapid evaluation of the blood coagulation system, by using a TEG® 5000 device (Haemoscope Corp., USA makes it possible to perform timely pathogenetic sound therapy, to prevent a critical condition, and to implement organ-sparing tactics.  

  6. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identied by the introduction of experience-rated malpractice liability insurance. Our identication...... by a reduction in the discretion of obstetric decision making rather than by patient cream skimming....

  7. Obstetric Provider Maldistribution: Georgia, USA, 2011.

    Science.gov (United States)

    Spelke, Bridget; Zertuche, Adrienne D; Rochat, Roger

    2016-07-01

    Objectives In 2010, Georgia had the nation's highest maternal mortality rate, sixteenth highest infant mortality rate, and a waning obstetrician/gynecologist (ob/gyn) workforce. Statewide ob/gyn workforce data, however, masked obstetric-specific care shortages and regional variation in obstetric services. The Georgia Maternal and Infant Health Research Group thereby assessed each Georgia region's obstetric provider workforce to identify service-deficient areas. Methods We identified 63 birthing facilities in the 82 Primary Care Service Areas (PCSAs) outside metropolitan Atlanta and interviewed nurse managers and others to assess the age, sex, and expected departure year of each delivering professional. Using accepted annual delivery rates of 155 per obstetrician (OB), 100 per certified nurse midwife (CNM), and 70 per family medicine physician (FP) we converted obstetric providers into "OB equivalents" to standardize obstetric services available in any given area. Using facility births and computed OB equivalents (contemporary and 2020 estimates), we calculated current and projected average annual births per provider (AABP) for each PCSA, categorizing its obstetric provider workforce as "adequate" (AABP  166). We mapped results using ArcGIS. Results Of 82 surveyed PCSAs, 52 % (43) were deficient in obstetric care; 16 % (13) had a shortage and 37 % (30) lacked obstetric providers entirely. There were no delivering FPs in 89 % (73) of PCSAs and no CNMs in 70 % (56). If Georgia fails to recruit delivering providers, 72 % (58/77) of PCSAs will have deficient or no obstetric care by 2020. Conclusions Obstetric provider shortages in Georgia hinder access to prenatal and delivery services. Care-deficient areas will expand if recruitment and retention of delivering professionals does not improve.

  8. Dutch house price fundamentals

    OpenAIRE

    Haffner, M.E.A.; De Vries, P.

    2009-01-01

    This paper discusses house price developments in the Netherlands, specifically focussing on the question whether current house prices in the Dutch owner-occupied market are likely to decrease. We analyse three aspects of the question based on a literature review: (1) whether there is a house price bubble ready to burst; (2) whether house prices will decline in response to the credit crisis that started in 2007; and (3) whether it is likely that house prices will decrease as a result of reform...

  9. Towards Evidence-Based, Quality-Controlled Health Promotion: The Dutch Recognition System for Health Promotion Interventions

    Science.gov (United States)

    Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo

    2010-01-01

    Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and…

  10. [HYPNOSIS IN OBSTETRICS AND GYNECOLOGY].

    Science.gov (United States)

    Rabinerson, David; Yeoshua, Effi; Gabbay-Ben-Ziv, Rinat

    2015-05-01

    Hypnosis is an ancient method of treatment, in which an enhanced state of mind and elevated susceptibility for suggestion of the patient, are increased. Hypnosis is executed, either by a caregiver or by the person himself (after brief training). The use of hypnosis in alleviating labor pain has been studied as of the second half of the 20th century. In early studies, the use of hypnosis for this purpose has been proven quite effective. However, later studies, performed in randomized controlled trial terms, have shown controversial results. Other studies, in which the effect of hypnosis was tested in various aspects of both obstetrics and gynecology and with different levels of success, are elaborated on in this review.

  11. Haemostatic management of obstetric haemorrhage.

    Science.gov (United States)

    Collis, R E; Collins, P W

    2015-01-01

    The haemostatic management of major obstetric haemorrhage remains challenging, and current published guidance relies heavily on experience from the non-pregnant population and expert opinion. In recent years, an interest in the implications of relative hypofibrinogenaemia, point-of-care monitoring of coagulation abnormalities, and the potential to give goal-directed therapy to correct coagulopathies, have created the possibility of significantly challenging and changing guidance. There is evidence that the haemostatic impairment in the pregnant population is different from trauma-induced bleeding, and the type and rate of onset of coagulopathies differ depending on the underlying cause. This review examines areas such as possible intervention points, describes evidence for over-transfusion of fresh frozen plasma in some situations and challenges conventional thinking on formulaic management. It also examines the rationale for other therapeutic options, including fibrinogen concentrate and tranexamic acid.

  12. The "group" in obstetric psychoprophylaxis.

    Science.gov (United States)

    Volpe, B; Tenaglia, F; Fede, T; Cerutti, R

    1983-01-01

    In the practice of obstetric psychoprophylaxis every method employed considered always the group both from a psychological and a pedagogic point of view. Today the group of pregnant women (or couples) is considered under various aspects: - psychological: the group as a support for members with regard to maternal and parental emotional feelings; - anthropological: the group fills up an empty vital space and becomes a "rite de passage" from a state of social identity to another one; - social: the group is a significative cultural intermediary between health services and the women-patient. The knowledge of these aspects becomes an important methodological support for group conductors. We present an analysis of our experience with groups and how this has affected the Psychoprophylaxis in the last years.

  13. The soil-water system as basis for a climate proof and healthy urban environment: opportunities identified in a Dutch case-study.

    Science.gov (United States)

    Claessens, Jacqueline; Schram-Bijkerk, Dieneke; Dirven-van Breemen, Liesbet; Otte, Piet; van Wijnen, Harm

    2014-07-01

    One of the effects of climate change expected to take place in urban areas in the Netherlands is an increase in periods of extreme heat and drought. How the soil can contribute to making cities more climate proof is often neglected. Unsealed soil and green spaces increase water storage capacity and can consequently prevent flooding. The planning of public or private green spaces can have a cooling effect and, in general, have a positive effect on how people perceive their health. This paper reviews existing guidelines from Dutch policy documents regarding unsealed soil and green spaces in the Netherlands; do they support climate adaptation policies? Scientific literature was used to quantify the positive effects of green spaces on water storage capacity, cooling and public health. Finally we present a case study of a model town where different policy areas are linked together. Maps were made to provide insight into the ratio of unsealed soil and the number of green spaces in relation to existing guidelines using Geographical Information Systems (GIS). Maps marking the age and social-economic status of the population were also made. The benefits of green spaces are difficult to express in averages because they depend on many different factors such as soil properties, type of green spaces, population characteristics and spatial planning. Moreover, it is not possible to provide quantifications of the benefits of green spaces because of a lack of scientific evidence at the moment. Based on the maps, however, policy assessments can be made, for example, in which site a neighborhood will most benefit from investment in parks and public gardens. Neighborhoods where people have a low social-economic status have for example fewer green spaces than others. This offers opportunities for efficient adaptation policies linking goals of several policy fields. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Heavy and light money in the Netherlands Indies and the Dutch Republic: dilemmas of monetary management with unit of account systems

    NARCIS (Netherlands)

    Wolters, W.G.

    2008-01-01

    In its Asian operations the Dutch United East Indies Company (VOC) (1602–1798) acted both as a territorial ruler and as a trading company. The company shipped large amounts of precious metals to Asia, both in the form of bullion and as coins, to pay for its trade and to provide currency for the area

  15. Heavy and light money in the Netherlands Indies and the Dutch Republic: dilemmas of monetary management with unit of account systems

    NARCIS (Netherlands)

    Wolters, W.G.

    2008-01-01

    In its Asian operations the Dutch United East Indies Company (VOC) (1602–1798) acted both as a territorial ruler and as a trading company. The company shipped large amounts of precious metals to Asia, both in the form of bullion and as coins, to pay for its trade and to provide currency for the area

  16. Frequency and impact of obstetric complications prior and subsequent to unexplained secondary recurrent miscarriage

    DEFF Research Database (Denmark)

    Nielsen, H S; Steffensen, R; Lund, M

    2010-01-01

    The chance of a live birth after a diagnosis of secondary recurrent miscarriage (SRM) is reduced in patients who, prior to the miscarriages, gave birth to a boy and carry HLA class II alleles that efficiently present male-specific (H-Y) antigens to the immune system. Information about obstetric...... complications in births prior and subsequent to the SRM diagnosis is limited. The relations between maternal carriage of H-Y-restricting HLA, fetal sex, obstetric complications and prognosis are unknown....

  17. Barriers to emergency obstetric care services

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique

    2014-01-01

    barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. Methods: A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced...... obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district. Elizabeth Echoka1,&, Anselimo Makokha2, Dominique Dubourg3, Yeri Kombe1, Lillian Nyandieka1, Jens Byskov4 Results: Findings indicate that pregnant women experienced delays in making...

  18. [Recent standards in management of obstetric anesthesia].

    Science.gov (United States)

    van Erp, Maximiliaan; Ortner, Clemens; Jochberger, Stefan; Klein, Klaus Ulrich

    2017-07-25

    The following article contains information not only for the clinical working anaesthesiologist, but also for other specialists involved in obstetric affairs. Besides a synopsis of a German translation of the current "Practice Guidelines for Obstetric Anaesthesia 2016" [1], written by the American Society of Anesthesiologists, the authors provide personal information regarding major topics of obstetric anaesthesia including pre-anaesthesia patient evaluation, equipment and staff at the delivery room, use of general anaesthesia, peridural analgesia, spinal anaesthesia, combined spinal-epidural anaesthesia, single shot spinal anaesthesia, and programmed intermittent epidural bolus.

  19. A multi disciplinary obstetric emergency training programme.

    LENUS (Irish Health Repository)

    Whelan, Mary

    2012-09-01

    The Rotunda Hospital (Dublin) obstetric emergency training programme (RHOET) was designed, in 2008, to meet the ongoing education and training needs of the local multidisciplinary team. Prior to its implementation, senior midwives attended the advanced life support in obstetrics (ALSO) course, and many of the obstetricians attended the Management of obstetric emergencies and trauma (MOET) and\\/or ALSO courses. Attendance at these off site courses meant that the only opportunity for team training was the informal and ad hoc \\'drills and skills\\' that took place in the birthing suite. This paper documents our journey since RHOET was implemented.

  20. Reflexive choice in Dutch and German

    NARCIS (Netherlands)

    Hendriks, Petra; Hoeks, John C. J.; Spenader, Jennifer

    2014-01-01

    Standard Dutch and German have two reflexive forms: a weak form ('zich' in Dutch and 'sich' in German) and a strong form ('zichzelf' in Dutch and 'sich selbst' in German). The choice between the two reflexive forms in Dutch has been explained by the selectional restrictions of the verb, distinguishi

  1. Chain digitisation support by point-of-sale systems: an analysis of the Dutch product software market.

    NARCIS (Netherlands)

    Plomp, M.G.A.; Rijn, G. van; Batenburg, R.S.

    2012-01-01

    Point-of-sale (POS) systems increasingly support more retail processes than just the basic cash functionality. But to what extent do they support chain digitisation, i.e., interorganisational processes as the exchange of order and sales information? We develop a two-dimensional maturity model for ca

  2. Industrial Relations Systems, Innovation and Economic Performance: Uncovering Myth and Reality from a Dutch Point of View.

    NARCIS (Netherlands)

    Looise, Jan C.; Torka, Nicole; Zagelmeyer, S.J.

    2012-01-01

    In the last two decades there has been a considerable amount of rhetoric about an alleged need to subvert established industrial relations systems for the sake of economic performance. Western Europe's Coordinated Market Economies (CMEs) have been the main target of debates centred on the question

  3. Establishment and embedding of innovation brokers at different innovation system levels: Insights from the Dutch agricultural sector

    NARCIS (Netherlands)

    Klerkx, L.W.A.; Leeuwis, C.

    2009-01-01

    In the systems perspective on innovation, co-operation between several different types of actors is seen as key to successful innovation. Due to the existence of several gaps that hinder such effective co-operation, the scientific and policy literature persistently points at the need for

  4. Establishment and embedding of innovation brokers at different innovation system levels: Insights from the Dutch agricultural sector

    NARCIS (Netherlands)

    Klerkx, L.W.A.; Leeuwis, C.

    2009-01-01

    In the systems perspective on innovation, co-operation between several different types of actors is seen as key to successful innovation. Due to the existence of several gaps that hinder such effective co-operation, the scientific and policy literature persistently points at the need for intermediar

  5. Designing a decision support system for marine reserves management: an economic analysis for the Dutch North Sea

    NARCIS (Netherlands)

    Ding, Hongyu; Ruijs, A.J.W.; Ierland, van E.C.

    2007-01-01

    The authors explore how a Decision Support System (DSS) for managing the marine environment can be set up. They use the Driving force-Pressure-State- Impact-Respond (DPSIR) framework to analyze which are the major driving forces impacting upon the marine environment in the North Sea. Moreover, a num

  6. Understanding implementation: the case of a computerized physician order entry system in a large Dutch university medical center.

    NARCIS (Netherlands)

    J.E.C.M. Aarts (Jos); H. Doorewaard (Hans); M. Berg (Marc)

    2004-01-01

    textabstractMost studies of the impact of information systems in organizations tend to see the implementation process as a "rollout" of technology, as a technical matter removed from organizational dynamics. There is substantial agreement that the success of implementing informatio

  7. Obstetric Fistula "Disease" and Ensuing Care: Patients' Views in West-Africa.

    Science.gov (United States)

    Maulet, Nathalie; Berthé, Abdramane; Traoré, Salamatou; Macq, Jean

    2015-03-01

    We explored obstetric fistula patients' real-life experience of care in modern Health System. Our aim was to analyze how these women's views impacted their care uptake and coping. We conducted 67 in-depth interviews with 35 fistula patients or former patients in 5 fistula repair centers within referral hospitals in Mali and Niger. Perceptions of obstetric fistula influenced the care experience and vice versa. Obstetric fistula was viewed as a severe chronic disease due to length of care process, limitation of surgery and persisting physical and moral suffering. We highlight the opportunity to build on patients' views on obstetric fistula trauma and care in order to implement an effective holistic care process.

  8. Is personalized medicine achievable in obstetrics?

    Science.gov (United States)

    Quinney, Sara K; Patil, Avinash S; Flockhart, David A

    2014-12-01

    Personalized medicine seeks to identify the right dose of the right drug for the right patient at the right time. Typically, individualization of therapy is based on the pharmacogenomic makeup of the individual and environmental factors that alter drug disposition and response. In addition to these factors, during pregnancy, a woman's body undergoes many changes that can impact the therapeutic efficacy of medications. Yet, there is minimal research regarding personalized medicine in obstetrics. Adoption of pharmacogenetic testing into the obstetrical care is dependent on evidence of analytical validity, clinical validity, and clinical utility. Here, we briefly present information regarding the potential utility of personalized medicine for treating the obstetric patient for pain with narcotics, hypertension, and preterm labor, and discuss the impediments of bringing personalized medicine to the obstetrical clinic.

  9. The critically ill obstetric patient - Recent concepts

    Directory of Open Access Journals (Sweden)

    Anjan Trikha

    2010-01-01

    Full Text Available Obstetric patients admitted to an Intensive Care Unit (ICU present a challenge to an intensivist because of normal physiological changes associated with pregnancy and puerperium, the specific medical diseases peculiar to pregnancy and the need to take care of both the mother and the foetus. Most common causes of admission to an ICU for obstetric patients are eclampsia, severe preeclampsia, haemorrhage, congenital and valvular heart disease, septic abortions, severe anemia, cardiomyopathy and non-obstetric sepsis. The purpose of this review is to present the recent concepts in critical care management of obstetric patients with special focus mainly on ventilatory strategies, treatment of shock and nutrition. The details regarding management of individual diseases would not be discussed as these would be beyond the purview of this article. In addition, some specific issues of importance while managing such patients would also be highlighted.

  10. Botulinum A toxin utilizations in obstetric palsy

    Directory of Open Access Journals (Sweden)

    Atakan Aydin

    2012-12-01

    Conclusion: We conclude that with the help of botulinum A toxin and physyotherapy, obstetrical palsy patient with cocontractions can significantly improve movements and may have less surgery. [Hand Microsurg 2012; 1(3.000: 89-94

  11. Is Personalized Medicine Achievable in Obstetrics?

    Science.gov (United States)

    Quinney, Sara K; Flockhart, David A; Patil, Avinash S

    2014-01-01

    Personalized medicine seeks to identify the right dose of the right drug for the right patient at the right time. Typically, individualization of therapy is based on the pharmacogenomic make-up of the individual and environmental factors that alter drug disposition and response. In addition to these factors, during pregnancy a woman’s body undergoes many changes that can impact the therapeutic efficacy of medications. Yet, there is minimal research regarding personalized medicine in obstetrics. Adoption of pharmacogenetic testing into the obstetrical care is dependent on evidence of analytical validity, clinical validity, and clinical utility. Here, we briefly present information regarding the potential utility of personalized medicine for treating the obstetric patient for pain with narcotics, hypertension, and preterm labor and discuss the impediments of bringing personalized medicine to the obstetrical clinic. PMID:25282474

  12. common laboratory investigations in obstetrics and gynaecology

    African Journals Online (AJOL)

    Enrique

    tice have much in common with those in other medical disci- ... Vitamin B12 and folate ... hypertensive disorders of ... antenatal full blood count screening ... and Low Platelets). ... be of value in detecting obstetrically .... The cut-off at 2 hours.

  13. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. Our identification...... by a reduction in the discretion of obstetric decision making rather than by patient cream skimming.Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified...... that these results are robust to the different methodologies and can be explained by a reduction in the discretion of obstetric decision making rather than by patient cream skimming....

  14. Evaluating the UK and Dutch defined benefit policies using the holistic balance sheet framework

    NARCIS (Netherlands)

    Chen, Z.; Pelsser, A.; Ponds, E.H.M.

    2014-01-01

    This paper compares the UK and Dutch occupational defined-benefit pension policies using the holistic balance sheet (HBS) framework. The UK DB pension system differs from the Dutch one in terms of the steering tools and adjustment mechanisms. In addition to the sponsor guarantee, the UK system has t

  15. Non-physician providers of obstetric care in Mexico: Perspectives of physicians, obstetric nurses and professional midwives

    Science.gov (United States)

    2012-01-01

    Background In Mexico 87% of births are attended by physicians. However, the decline in the national maternal mortality rate has been slower than expected. The Mexican Ministry of Health’s 2009 strategy to reduce maternal mortality gives a role to two non-physician models that meet criteria for skilled attendants: obstetric nurses and professional midwives. This study compares and contrasts these two provider types with the medical model, analyzing perspectives on their respective training, scope of practice, and also their perception and/or experiences with integration into the public system as skilled birth attendants. Methodology This paper synthesizes qualitative research that was obtained as a component of the quantitative and qualitative study that evaluated three models of obstetric care: professional midwives (PM), obstetric nurses (ON) and general physicians (GP). A total of 27 individual interviews using a semi-structured guide were carried out with PMs, ONs, GPs and specialists. Interviews were transcribed following the principles of grounded theory, codes and categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results All provider types interviewed expressed confidence in their professional training and acknowledge that both professional midwives and obstetric nurses have the necessary skills and knowledge to care for women during normal pregnancy and childbirth. The three types of providers recognize limits to their practice, namely in the area of managing complications. We found differences in how each type of practitioner perceived the concept and process of birth and their role in this process. The barriers to incorporation as a model to attend birth faced by PMs and ONs are at the individual, hospital and system level. GPs question their ability and training to handle deliveries, in particular those that become complicated, and the professional midwifery model particularly as it relates to a clinical setting, is

  16. Tocolytic Drugs for Use in Veterinary Obstetrics

    OpenAIRE

    Ménard, L

    1984-01-01

    The author presents a literature review of two tocolytic agents used in veterinary obstetrics: isoxsuprine and clenbuterol. The medical background from which these drugs emerged for human use and to which is linked their application in animal medicine is described. Each drug is reviewed according to its pharmacology, basic considerations for its clinical use and the reports on its application in the treatment and management of obstetrical disorders in veterinary medicine.

  17. Assessing the repeatability and reproducibility of the Leg Score: a Dutch Claw Health Scoring System for dairy cattle.

    Science.gov (United States)

    Holzhauer, M; Middelesch, H; Bartels, C J M; Frankena, K; Verhoeff, J; Noordhuizen-Stassen, E N; Noordhuizen, J P T M

    The optimal moment for trimming the claws of all dairy cows in a herd was investigated by assessing the external rotation of the hind claws of individual cows relative to the spinal column. This leg score consisted of three independent descriptors: 1 (good/normal), 2 (moderately deviant), and 3 (severely deviant). This study assessed the repeatability and the reproducibility of the leg score system, and the consistency of the advice given subsequently about trimming of the hind claws of all cows in the herd. Repeatability was assessed for 52 cows that were scored twice on the same day by 11 observers; the kappa value ranged from 0.17 to 0.66 (mean: 0.36). The probability of the same result for both assessments ranged from 0.49 to 0.80 (mean: 0.61). Claw trimming was advised if at least 20% of the cows had a leg score of 3. On the basis of the scores, 3 observers consistently advised trimming of the hind claws of all the cows in the herd, and 6 observers consistently advised against the need for trimming in the short term; 2 observers had an inconsistent advice. The reproducibility of the scoring system was assessed in two dairy herds (62 and 50 cows). Eight observers evaluated the leg score of the cows of both herds on the same day. The mean kappa value of the leg score for all pairs of different observers (A-B, A-C etcetera) was 0.24 [-0.08-0.49]. In conclusion, the leg score is not a reliable method for determining the optimal moment for claw trimming in dairy cattle. The reasons for the inconsistent observations require further investigation.

  18. Disseminated intravascular coagulation in obstetric and gynecologic disorders.

    Science.gov (United States)

    Montagnana, Martina; Franchi, Massimo; Danese, Elisa; Gotsch, Francesca; Guidi, Gian Cesare

    2010-06-01

    Disseminated intravascular coagulation (DIC) is a syndrome characterized by a massive, widespread, and ongoing activation of the coagulation system, secondary to a variety of clinical conditions. Many obstetric complications, such as abruptio placentae, amniotic fluid embolism, endotoxin sepsis, retained dead fetus, post-hemorrhagic shock, hydatidiform mole, and gynecologic malignancies, might trigger DIC. In these gynecologic and obstetric settings, DIC is usually associated with high mortality and morbidity rates. No single laboratory test is sensitive or specific enough to diagnose DIC definitively, but it can be diagnosed by using a combination of multiple clinical and laboratory tests that reflect the pathophysiology of the syndrome. At present, the therapeutical approach to pregnancy- and gynecologic-related DIC comprises the specific and aggressive treatment of the underlying disease, eventually followed by a supportive blood product replacement therapy and restoration of physiological anticoagulant pathways. This article reviews the etiopathogenesis, clinical manifestations, laboratory diagnosis, and therapy of pregnancy- and gynecologic-related DIC.

  19. Opinion mining in Dutch Hansards

    NARCIS (Netherlands)

    Grijzenhout, S.; Jijkoun, V.; Marx, M.

    2010-01-01

    The question is addressed if opinion mining techniques can be successfully used to automatically retrieve political viewpoints in Dutch parliamentary publications. Two specific tasks are identified: automatically determining subjectivity in the publications and automatically determining the semantic

  20. Identifying Obstetrical Emergencies at Kintampo Municipal Hospital: a perspective from Pregnant Women and Nursing Midwives

    National Research Council Canada - National Science Library

    Oiyemhonlan, Brenda; Udofia, Emilia; Punguyire, Damien

    2013-01-01

    .... The most common obstetric emergencies were hemorrhage, eclampsia and anemia. Potential obstetric complications were poorly understood by antenatal women and known barriers limited access to emergency obstetric care...

  1. Availability and quality of emergency obstetric care in Gambia's main referral hospital: women-users' testimonies

    Directory of Open Access Journals (Sweden)

    Sundby Johanne

    2009-04-01

    Full Text Available Abstract Background Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital. Methods From weekend admissions a group of 30 women treated for different acute obstetric conditions including five main diagnostic groups: hemorrhage, hypertensive disorders, dystocia, sepsis and anemia were purposively selected. In-depth interviews with the women were carried out at their homes within two weeks of discharge. Results Substantial difficulties in obtaining emergency obstetric care were uncovered. Health system inadequacies including lack of blood for transfusion, shortage of essential medicines especially antihypertensive drugs considerably hindered timely and adequate treatment for obstetric emergencies. Such inadequacies also inflated the treatment costs to between 5 and 18 times more than standard fees. Blood transfusion and hypertensive treatment were associated with the largest costs. Conclusion The deficiencies in the availability of life-saving interventions identified are manifestations of inadequate funding for maternal health services. Substantial increase in funding for maternal health services is therefore warranted towards effective implementation of emergency obstetric care package in The Gambia.

  2. Challenges to the provision of emergency obstetric care in Iraq.

    Science.gov (United States)

    Ameh, Charles A; Bishop, Sophie; Kongnyuy, Eugene; Grady, Kate; Van den Broek, Nynke

    2011-01-01

    To assess the availability of, and challenges to the provision of emergency obstetric care in order to raise awareness and assist policy-makers and development partners in making appropriate decisions to help pregnant women in Iraq. Descriptive and exploratory study based on self-administered questionnaires, an in-depth interview and a Focus Group Discussion. The setting was 19 major hospitals in 8 out of the 18 Governorates and the participants were 31 Iraqi doctors and 1 midwife. The outcome measures were availability of emergency obstetric care (EOC) in hospitals and challenges to the provision of EOC. Only 26.3% (5/19) of hospitals had been able to provide all the 8 signal functions of comprehensive emergency obstetric care in the previous 3 months. All the 19 hospitals provided parenteral antibiotics and uterine evacuation, 94.7% (18/19) were able to provide parenteral oxytocics and perform manual removal of retained placenta, magnesium sulphate for eclampsia was available in 47.4% (9/19) of hospitals, 42.1% (8/19) provided assisted vaginal delivery, 26.5% (5/19) provided blood transfusion and 89.5% (17/19) offered Caesarean section. The identified challenges for health care providers include difficulties travelling to work due to frequent checkpoints and insecurity, high level of insecurity for patients referred or admitted to hospitals, inadequate staffing due mainly to external migration and premature deaths as a result of the war, lack of drugs, supplies and equipment (including blood for transfusion), and falling standards of training and regulation. Most women and their families do not currently have access to comprehensive emergency obstetric care. Health care providers recommend reconstruction and strengthening of all components of the Iraqi health system which may only be achieved if security returns to the country.

  3. A trend analysis in referrals during pregnancy and labour in Dutch midwifery care 1988-2004

    NARCIS (Netherlands)

    Amelink-Verburg, M.P.; Rijnders, M.E.B.; Buitendijk, S.E.

    2009-01-01

    Objective To assess the trends and patterns of referral from midwives to obstetricians within the Dutch maternity care system from 1988 to 2004, and the differences in referral patterns between nulliparous and parous women. Design A descriptive study. Setting The Dutch midwifery database (LVR1), whi

  4. Zertifikat Niederlaendisch: Examen en getuigschrift Nederlands als vreemde taal (Certificate in Dutch)

    Science.gov (United States)

    Beersmans, Frans; Sudhoelter, Juergen

    1976-01-01

    An interim report on preparations for designing an examination in Dutch. The "unit-credit system" proposed by the Council of Europe is being used. The Dutch certificate will be comparable to the certificates given by the British Council and by the People's Universities. Sample portions are given. (Text is in German.) (IFS/WGA)

  5. The use of therapeutic ultrasound by physical therapists in Dutch primary health care.

    NARCIS (Netherlands)

    Roebroeck, M.E.; Dekker, J.; Oostendorp, R.A.B.

    1998-01-01

    Background and purpose: the purpose of this study were to describe the use of ultrasound by Dutch physical therapists and to address the question of whether this use is what would be considered correct. Subjects and methods: physical therapists in the Dutch primary health care system gathered data

  6. Creating a Dutch testbed to evaluate the retrieval from textual databases

    NARCIS (Netherlands)

    Hiemstra, Djoerd; Leeuwen, van David A.

    2002-01-01

    This paper describes the first large-scale evaluation of information retrieval systems using Dutch documents and queries. We describe in detail the characteristics of the Dutch test data, which is part of the official CLEF multilingual texttual database, and give an overview of the experimental resu

  7. A trend analysis in referrals during pregnancy and labour in Dutch midwifery care 1988-2004

    NARCIS (Netherlands)

    Amelink-Verburg, M.P.; Rijnders, M.E.B.; Buitendijk, S.E.

    2009-01-01

    Objective To assess the trends and patterns of referral from midwives to obstetricians within the Dutch maternity care system from 1988 to 2004, and the differences in referral patterns between nulliparous and parous women. Design A descriptive study. Setting The Dutch midwifery database (LVR1),

  8. New pedestrian facilities : technique, observations and opinions : the Dutch experiment. DRIVE project V1061 : pussycats.

    NARCIS (Netherlands)

    Levelt, P.M.B.

    1993-01-01

    This report is the Dutch part of an international (French-British-Dutch) evaluation study of new pedestrian crossing facilities, summarized under the name 'PUSSYCATS' (See also IRRD 859331). 'PUSSYCATS' is a new system, characterized by technical improvements better adapted to the behaviour and need

  9. The use of therapeutic ultrasound by physical therapists in Dutch primary health care.

    NARCIS (Netherlands)

    Roebroeck, M.E.; Dekker, J.; Oostendorp, R.A.B.

    1998-01-01

    Background and purpose: the purpose of this study were to describe the use of ultrasound by Dutch physical therapists and to address the question of whether this use is what would be considered correct. Subjects and methods: physical therapists in the Dutch primary health care system gathered data o

  10. Sustainable Entrepreneurship in the Dutch Construction Industry

    Directory of Open Access Journals (Sweden)

    Rosalinde J.A. Klein Woolthuis

    2010-02-01

    Full Text Available This article discusses the strategies that sustainable entrepreneurs use to interact with their environment in the Dutch construction industry. The Dutch construction industry is under great pressure to move towards sustainability, and entrepreneurs are believed to be able to play a large role in this transition by introducing new products and new business practices. But how can entrepreneurs prosper in an environment that is not geared up towards such a change? And which strategies do they use to bend conditions in their favor? In this article we make use of the Market and System Failure Framework to analyze the pressures that entrepreneurs are confronted with when introducing sustainable innovations. We recognize that these pressures can be seen as bottlenecks, but that market and system failures can also create entrepreneurial opportunities. We interviewed 16 entrepreneurs in the Dutch construction industry to determine the influences they experienced from their environment and the strategies they use to deal with these. We conclude that we can distinguish between system building and following entrepreneurs, where the former aims to build a new system to challenge the old one, whereas the latter rather makes use of existing structures to build a business. We find that both strategies can be successful and that overall, the entrepreneurs confirm the belief that sustainability on people, planet and transparency aspects, can contribute very well to the long term profitability of the businesses the entrepreneurs are running. These in-depth insights into the influences from the context on the one hand, and the entrepreneurs’ strategic reactions on the other hand, contribute to our understanding of the interactions between entrepreneurs and the system context. This can help us to more effectively stimulate and support innovating entrepreneurs to contribute to the transition towards sustainability.

  11. Sisters in Dutch hospitals.

    Science.gov (United States)

    van den Bergh-Braam, A H

    1985-11-01

    This study focuses on hospital sisters in 30 Dutch hospitals. The so-called role-set approach has been adopted. In this approach the sisters are the focal persons. Direct superiors, specialists, registered nurses and student nurses acted as role-senders. The possible number of respondents is 600 (120 of each group). The response of hospital sisters is 100%, that of role-senders 88%. The study started out as an attempt to collect background information on the causes of wastage of sisters. High wastage rates are generally regarded as an indication of an unfavourable working environment. Since hospital sisters occupy a key position in hospitals, the ward problems will be studied from their angle. Although wastage rates have dropped recently, it does not necessarily follow that the working environment has improved. Wastage is known to act as a safety valve, thus allowing tensions to resolve. The threat of unemployment clogs this outlet, which increases the tensions on the hospital ward. Data from the study show that work overload is one of the major stress factors for sisters. Analyses demonstrated that there exists a relationship between work overload and tensions with the management and direct superiors, tensions in job execution, irritableness on the ward, low self-esteem, health complaints and psychological condition. Sisters with an excessive job involvement refer to work overload more often than their moderate colleagues. There is a relationship between an unfavourable working environment and irritableness of sisters.

  12. Acute myocardial infarction in the obstetric patient.

    Science.gov (United States)

    Firoz, Tabassum; Magee, Laura A

    2012-06-01

    Acute myocardial infraction (AMI) in the obstetric patient is a rare event, although the incidence is rising due to advancing maternal age and pre-existing cardiac risk factors and medical co-morbidities. While atherosclerotic disease is the leading cause of AMI, coronary artery dissection is an important consideration in pregnancy and in the postpartum period. The physiological changes of pregnancy as well as pregnancy-specific risk factors can predispose the obstetric patient to AMI. Diagnosis of AMI can be challenging as symptoms may be atypical. Furthermore, diagnostic tests must be interpreted in the context of pregnancy. While the overall management of the obstetric patient with AMI is similar to that outside of pregnancy, drug therapy requires modification as some medications may be contraindicated in pregnancy and breastfeeding. There is limited information about prognosis and risk stratification but it is anticipated that future studies will address this issue.

  13. Obstetrics and Gynecology: Considerations in Career Selection

    Science.gov (United States)

    Stephen Petrilli, Edmund

    1981-01-01

    Current training programs in obstetrics and gynecology are not producing an excess of specialists in view of future manpower needs. In addition to being specialists and consultants, obstetrician-gynecologists also function as providers of primary care for women. During the last decade, three formal sub-specialties of obstetrics and gynecology have evolved: gynecologic oncology, maternal-fetal medicine and reproductive endocrinology. These have improved patient care and have altered the structure of resident education. With more American medical school graduates entering this specialty, the quality of resident applicants has improved, creating intense competition for desirable training positions. Those inclined toward a career in obstetrics and gynecology can be assured that it will provide an increasingly favorable and challenging environment for professional activity in the future. PMID:7210670

  14. Controversies concerning the antiphospholipid syndrome in obstetrics.

    Science.gov (United States)

    Camarena Cabrera, Dulce María Albertina; Rodriguez-Jaimes, Claudia; Acevedo-Gallegos, Sandra; Gallardo-Gaona, Juan Manuel; Velazquez-Torres, Berenice; Ramírez-Calvo, José Antonio

    Antiphospholipid antibody syndrome is a non-inflammatory autoimmune disease characterized by recurrent thrombotic events and/or obstetric complications associated with the presence of circulating antiphospholipid antibodies (anticardiolipin antibodies, anti-β2 glycoprotein-i antibodies, and/or lupus anticoagulant. Antiphospholipid antibodies are a heterogeneous group of autoantibodies associated with recurrent miscarriage, stillbirth, fetal growth restriction and premature birth. The diversity of the features of the proposed placental antiphospholipid antibodies fingerprint suggests that several disease processes may occur in the placentae of women with antiphospholipid antibody syndrome in the form of immune responses: inflammatory events, complement activation, angiogenic imbalance and, less commonly, thrombosis and infarction. Because of the disparity between clinical and laboratory criteria, and the impact on perinatal outcome in patients starting treatment, we reviewed the aspects of antiphospholipid antibody syndrome related to obstetric complications and seronegative antiphospholipid antibody syndrome, and their treatment in obstetrics.

  15. Obstetrical violence: activism on social networkin

    Directory of Open Access Journals (Sweden)

    Lia Hecker Luz

    2015-12-01

    Full Text Available Normal birth in contemporaneity is discussed and the three models of birth care are presented, accordingly to categorization proposed by the north-American anthropologist Davis-Floyd, pointing out the consequences of the technocratic model, which has become hegemonic in contemporary societies, naturalizing obstetrical violence. The problematic is contextualized to Brazilian reality, with the analyses of the blog Cientista que virou mãe making it evident that Brazilian women on social media are articulating themselves in order to defend and give visibility to initiatives of natural and humanized birth, acting against obstetrical violence. It is concluded that Internet tools have allowed a pioneer mobilization in respecting women’s reproductive rights in Brazil, turning blogs into a potential hegemonic alternative way to reach more democratic forms of social organization. In addition to denaturalize the obstetrical violence, the bloggers also act aiming to pave the way for the humanistic approach and to motivate planned home birth initiatives.

  16. Considerations about our approach to obstetric psychoprophylaxis.

    Science.gov (United States)

    Cerutti, R; Volpe, B; Sichel, M P; Sandri, M; Sbrignadello, C; Fede, T

    1983-01-01

    Usually the term "obstetric psychoprophylaxis" refers to a specific method or technique. We prefer to consider it as a procedure that involves on one side the woman, the child and its family, and on the other the services entitled to give pre- and post-natal assistance. In order to realize this, a reformation of our methodological parameters and a critical analysis of the results obtained are required. In the courses of obstetric psychoprophylaxis that are held in the Department of Obstetrics and Gynaecology of the University of Padua we take into consideration the following themes: - Methodological approach - Professional training of the staff - Significance of psychosocial culture in the management of the pregnancy by the health services.

  17. Accounting for hybridity: Accrual budgeting in the Dutch central government

    NARCIS (Netherlands)

    Mol, Nico P.; de Kruijf, J.A.M.

    2003-01-01

    In the Dutch central government (following countries like New Zealand, Australia and the UK) a system of resource budgeting is being developed as a substitute for its present dual system of cash/commitment budgeting for core departments and accrual accounting for executive agencies. Advocates of

  18. What is an Obstetrics/Gynecology Hospitalist?

    Science.gov (United States)

    McCue, Brigid

    2015-09-01

    The obstetrics/gynecology (OB/GYN) hospitalist is the latest subspecialist to evolve from obstetrics and gynecology. Starting in 2002, academic leaders recognized the impact of such coalescing forces as the pressure to reduce maternal morbidity and mortality, stagnant reimbursements and the increasing cost of private practice, the decrease in applications for OB/GYN residencies, and the demand among practicing OB/GYNs for work/life balance. Initially coined laborist, the concept of the OB/GYN hospitalist emerged. Thinking of becoming an OB/GYN hospitalist? Here is what you need to know.

  19. Freestanding midwifery units versus obstetric units

    DEFF Research Database (Denmark)

    Overgaard, Charlotte; Fenger-Grøn, Morten; Sandall, Jane

    2012-01-01

    women intending to give birth in two freestanding midwifery units (FMU) versus two obstetric units in Denmark differed by level of social disadvantage Methods The study was designed as a cohort study with a matched control group. It included 839 lowrisk women intending to give birth in an FMU, who were...... prospectively and individually matched on nine selected obstetric/socio-economic factors to 839 low-risk women intending OU birth. Educational level was chosen as a proxy for social position. Analysis was by intention-to-treat. Results Women intending to give birth in an FMU had a significantly higher...

  20. low birthweight babies: socio-demographic and obstetric ...

    African Journals Online (AJOL)

    2002-10-01

    Oct 1, 2002 ... mothers (aged below 20 years) and older mothers of low birthweight ( ... have unfavourable socio-demographic and obstetric factors like ... having less formal education, being unemployed and having obstetric risks for poor.

  1. What Role Does Obstetrical Care Play in Childbirth?

    Science.gov (United States)

    ... Research Planning Scientific Resources Research A-Z Topics Obstetrics Overview Condition Information What medical care is provided? ... during labor and delivery. 4 American Board of Obstetrics and Gynecology. (n.d.). Frequently asked questions . Retrieved ...

  2. Society for Maternal-Fetal Medicine (SMFM) Special Report: Current approaches to measuring quality of care in obstetrics.

    Science.gov (United States)

    Bailit, Jennifer L; Gregory, Kimberly D; Srinivas, Sindhu; Westover, Thomas; Grobman, William A; Saade, George R

    2016-09-01

    Heath care measurement and evaluation is an integral piece of the health care system. The creation and assessment of care performance metrics are important and relevant for the obstetric community including both clinicians and patients. Careful deliberation is required to create a measurement system that results in optimal care for women and families. This article reviews the current approaches to measuring quality in obstetrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. The Current Status and Future of Academic Obstetrics.

    Science.gov (United States)

    Bowers, John Z., Ed.; Purcell, Elizabeth F., Ed.

    The state of research in academic obstetrics and its relationship to research in other academic disciplines was addressed in a 1979 conference. Participants included representatives of academic obstetrics, academic pediatrics, and public health. After an introductory discussion by Howard C. Taylor, Jr. on changes in obstetrics in the last 25…

  4. The Current Status and Future of Academic Obstetrics.

    Science.gov (United States)

    Bowers, John Z., Ed.; Purcell, Elizabeth F., Ed.

    The state of research in academic obstetrics and its relationship to research in other academic disciplines was addressed in a 1979 conference. Participants included representatives of academic obstetrics, academic pediatrics, and public health. After an introductory discussion by Howard C. Taylor, Jr. on changes in obstetrics in the last 25…

  5. A qualitative study of the experience of obstetric fistula survivors in Addis Ababa, Ethiopia.

    Science.gov (United States)

    Gebresilase, Yenenesh Tadesse

    2014-01-01

    Research on obstetric fistula has paid limited attention to the lived experiences of survivors. This qualitative study explored the evolution of survivors' perceptions of their social relationships and health since developing this obstetric complication. In-depth interviews were conducted with eight survivors who were selected based on purposive and snowball sampling techniques. Thematic categorization and content analysis was used to analyze the data. The resultant themes included participants' understanding of factors predisposing to fistula, challenges they encounter, their coping responses, and the meaning of their experiences. First, the participants had a common understanding of the factors that predisposed them to obstetric fistula. They mentioned poor knowledge about pregnancy, early marriage, cultural practices, and a delay in or lack of access to emergency obstetric care. Second, the participants suffered from powerlessness experienced during their childhood and married lives. They also faced prolonged obstructed labor, physical injury, emotional breakdown, depression, erosion of social capital, and loss of healthy years. Third, to control their negative emotions, participants reported isolating themselves, having suicidal thoughts, positive interpretation about the future, and avoidance. To obtain relief from their disease, the women used their family support, sold their properties, and oriented to reality. Fourth, the participants were struggling to keep going, to accept their changed reality, and to change their perspectives on life. In conclusion, obstetric fistula has significant physical, psychosocial, and emotional consequences. The study participants were not passive victims but rather active survivors of these challenges. Adequate support was not provided by their formal or informal support systems. To prevent and manage obstetric fistula successfully, there should be family-based interventions that improve access to and provision of emergency

  6. Vaginal versus Obstetric Infection Escherichia coli Isolates among Pregnant Women: Antimicrobial Resistance and Genetic Virulence Profile.

    Science.gov (United States)

    Sáez-López, Emma; Guiral, Elisabet; Fernández-Orth, Dietmar; Villanueva, Sonia; Goncé, Anna; López, Marta; Teixidó, Irene; Pericot, Anna; Figueras, Francesc; Palacio, Montse; Cobo, Teresa; Bosch, Jordi; Soto, Sara M

    2016-01-01

    Vaginal Escherichia coli colonization is related to obstetric infections and the consequent development of infections in newborns. Ampicillin resistance among E. coli strains is increasing, which is the main choice for treating empirically many obstetric and neonatal infections. Vaginal E. coli strains are very similar to extraintestinal pathogenic E. coli with regards to the virulence factors and the belonging to phylogroup B2. We studied the antimicrobial resistance and the genetic virulence profile of 82 E. coli isolates from 638 vaginal samples and 63 isolated from endometrial aspirate, placental and amniotic fluid samples from pregnant women with obstetric infections. The prevalence of E. coli in the vaginal samples was 13%, which was significant among women with associated risk factors during pregnancy, especially premature preterm rupture of membranes (pcoli isolates causing obstetric infections showed higher resistance levels than vaginal isolates, particularly for gentamicin (p = 0.001). The most prevalent virulence factor genes were those related to the iron uptake systems revealing clear targets for interventions. More than 50% of the isolates belonged to the virulent B2 group possessing the highest number of virulence factor genes. The ampicillin-resistant isolates had high number of virulence factors primarily related to pathogenicity islands, and the remarkable gentamicin resistance in E. coli isolates from women presenting obstetric infections, the choice of the most appropriate empiric treatment and clinical management of pregnant women and neonates should be carefully made. Taking into account host-susceptibility, the heterogeneity of E. coli due to evolution over time and the geographical area, characterization of E. coli isolates colonizing the vagina and causing obstetric infections in different regions may help to develop interventions and avoid the aetiological link between maternal carriage and obstetric and subsequent puerperal infections.

  7. Vaginal versus Obstetric Infection Escherichia coli Isolates among Pregnant Women: Antimicrobial Resistance and Genetic Virulence Profile.

    Directory of Open Access Journals (Sweden)

    Emma Sáez-López

    Full Text Available Vaginal Escherichia coli colonization is related to obstetric infections and the consequent development of infections in newborns. Ampicillin resistance among E. coli strains is increasing, which is the main choice for treating empirically many obstetric and neonatal infections. Vaginal E. coli strains are very similar to extraintestinal pathogenic E. coli with regards to the virulence factors and the belonging to phylogroup B2. We studied the antimicrobial resistance and the genetic virulence profile of 82 E. coli isolates from 638 vaginal samples and 63 isolated from endometrial aspirate, placental and amniotic fluid samples from pregnant women with obstetric infections. The prevalence of E. coli in the vaginal samples was 13%, which was significant among women with associated risk factors during pregnancy, especially premature preterm rupture of membranes (p<0.0001. Sixty-five percent of the strains were ampicillin-resistant. The E. coli isolates causing obstetric infections showed higher resistance levels than vaginal isolates, particularly for gentamicin (p = 0.001. The most prevalent virulence factor genes were those related to the iron uptake systems revealing clear targets for interventions. More than 50% of the isolates belonged to the virulent B2 group possessing the highest number of virulence factor genes. The ampicillin-resistant isolates had high number of virulence factors primarily related to pathogenicity islands, and the remarkable gentamicin resistance in E. coli isolates from women presenting obstetric infections, the choice of the most appropriate empiric treatment and clinical management of pregnant women and neonates should be carefully made. Taking into account host-susceptibility, the heterogeneity of E. coli due to evolution over time and the geographical area, characterization of E. coli isolates colonizing the vagina and causing obstetric infections in different regions may help to develop interventions and avoid the

  8. A qualitative study of the experience of obstetric fistula survivors in Addis Ababa, Ethiopia

    Directory of Open Access Journals (Sweden)

    Gebresilase YT

    2014-12-01

    Full Text Available Yenenesh Tadesse Gebresilase Programme Quality Department, Vita, Addis Ababa, Ethiopia Abstract: Research on obstetric fistula has paid limited attention to the lived experiences of survivors. This qualitative study explored the evolution of survivors' perceptions of their social relationships and health since developing this obstetric complication. In-depth interviews were conducted with eight survivors who were selected based on purposive and snowball sampling techniques. Thematic categorization and content analysis was used to analyze the data. The resultant themes included participants' understanding of factors predisposing to fistula, challenges they encounter, their coping responses, and the meaning of their experiences. First, the participants had a common understanding of the factors that predisposed them to obstetric fistula. They mentioned poor knowledge about pregnancy, early marriage, cultural practices, and a delay in or lack of access to emergency obstetric care. Second, the participants suffered from powerlessness experienced during their childhood and married lives. They also faced prolonged obstructed labor, physical injury, emotional breakdown, depression, erosion of social capital, and loss of healthy years. Third, to control their negative emotions, participants reported isolating themselves, having suicidal thoughts, positive interpretation about the future, and avoidance. To obtain relief from their disease, the women used their family support, sold their properties, and oriented to reality. Fourth, the participants were struggling to keep going, to accept their changed reality, and to change their perspectives on life. In conclusion, obstetric fistula has significant physical, psychosocial, and emotional consequences. The study participants were not passive victims but rather active survivors of these challenges. Adequate support was not provided by their formal or informal support systems. To prevent and manage obstetric

  9. Obstetric patients in a surgical intensive care unit: prognostic factors and outcome.

    Science.gov (United States)

    Mjahed, K; Hamoudi, D; Salmi, S; Barrou, L

    2006-07-01

    The objective of this study was to assess the incidence, prognostic factors and the outcome of obstetric patients admitted in a surgical intensive care unit (SICU) during the ante-partum or postpartum period (within 6 weeks of delivery). Between 1995 and 2002, the patients transferred from the department of obstetrics were retrospectively included into the study. Demographics included: obstetric data, medical and surgical histories, diagnosis, simplified acute physiology score (SAPS II), acute physiology and chronic health evaluation system APACHE II score; and the occurrence of organ failure, therapeutic interventions, length of stay in the SICU and outcome were recorded. During the study period, 364 obstetric patients were admitted to the SICU. Obstetric admissions to the SICU represented 0.6% of all deliveries and the SICU utilisation rate was 14.96%. The main indications for admission were eclampsia (70.6%) and postpartum haemorrhage (16.2%). The overall mortality rate was 16.7% (n = 61). In a logistic regression model, risk factors for death included organ system failure (odds ratio (OR) = 3.95 confidence interval (CI) [1.84 - 8.48], bilirubin >12 mg/l (OR = 1.017 CI [1.00 - 1.03]), and prolonged prothrombin time (OR = 0.97 CI [0.95 - 0.99]). Median length of stay was longer in non- survivors (6.5 +/- 7.3 vs 5.5 +/- 4.6 days). Maternal condition on admission and associated complications are the major determinant of maternal outcome.

  10. [Propanidid-ketamine combination in obstetrical anesthesia].

    Science.gov (United States)

    Purita, N; Lisardi, S; Bilotta, F; Accorinti, L

    1979-09-01

    The A. have introduced a new technique in obstetrical, anaesthesia for short and long term intervention, included caesarean section, inducing anaesthesia with a mixture in the same syringe of propanidid and ketamin. The A. exhibit the results they have got treating the first 100 patients in this way and conclude with an extremely positive judgement.

  11. Cultural Competence of Obstetric and Neonatal Nurses.

    Science.gov (United States)

    Heitzler, Ella T

    To measure the cultural competence level of obstetric and neonatal nurses, explore relationships among cultural competence and selected sociodemographic variables, and identify factors related to cultural competence. Descriptive correlational study. Online survey. A convenience sample of 132 obstetric and neonatal registered nurses practicing in the United States. Nurse participants completed the Cultural Competence Assessment (CCA) instrument, which included Cultural Awareness and Sensitivity (CAS) and Cultural Competence Behaviors (CCB) subscales, and a sociodemographic questionnaire. Correlation and regression analyses were conducted. The average CCA score was 5.38 (possible range = 1.00-7.00). CCA scores were negatively correlated with age and positively correlated with self-ranked cultural competence, years of nursing experience, years of experience within the specialty area, and number of types of previous cultural diversity training. CCB subscale scores were correlated positively with age, years of nursing experience, years of experience within the specialty area, and number of types of previous diversity training. CAS subscale scores were positively correlated with number of types of previous diversity training. Standard multiple linear regression explained approximately 10%, 12%, and 11% of the variance in CCA, CAS, and CCB scores, respectively. Obstetric and neonatal registered nurses should continue to work toward greater cultural competence. Exposing nurses to more types of cultural diversity training may help achieve greater cultural competence. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  12. Integrating Prevention into Obstetrics/Gynecology.

    Science.gov (United States)

    Carey, J. Christopher

    2000-01-01

    Discusses formats to teach preventive medicine in obstetrics and gynecology (including learning objectives, lectures/seminars, and rounds/office practice) and evaluation methods (oral examinations, computerized question banks, objective structured clinical examinations). Offers examples from specific programs at American medical schools, including…

  13. Integrating Prevention into Obstetrics/Gynecology.

    Science.gov (United States)

    Carey, J. Christopher

    2000-01-01

    Discusses formats to teach preventive medicine in obstetrics and gynecology (including learning objectives, lectures/seminars, and rounds/office practice) and evaluation methods (oral examinations, computerized question banks, objective structured clinical examinations). Offers examples from specific programs at American medical schools, including…

  14. knowledge about obstetric danger signs among preg

    African Journals Online (AJOL)

    user

    about knowledge level of pregnant women on obstetric danger signs. The objective of this ... deficiencies in awareness should be addressed through maternal and child health services by designing an appro- ..... demographic, cultural, and health interventions as well as ... Baby Package: Implementing Safe Motherhood.

  15. Beta-adrenoceptors in obstetrics and gynecology.

    Science.gov (United States)

    Modzelewska, Beata

    2016-01-01

    One hundred and twenty years after the description of extracts from the adrenal medulla, the use of beta-blockers and beta-agonists evolved from antianginal drugs and tocolytics to ligand-directed signaling. Beta-blockers in the fields of obstetrics and gynecology have so far been limited to the consideration of continuing treatment of disorders of the cardiovascular system and other dysfunctions that started before pregnancy. Studies in recent years have shown that beta-adrenoceptor signaling might be crucial in carcinogenesis and metastasis, apoptosis and anoikis. On the other hand, the use of beta-adrenoceptor agonists in tocolysis is, as yet, the primary method for inhibiting premature uterine contractions. Unfortunately, the efficacy of current pharmacological treatment for the management of preterm labor is regularly questioned. Moreover, studies related to non-pregnant myometrium performed to date indicate that the rhythmic contractions of the uterus are required for menstruation and have an important role in human reproduction. In turn, abnormal uterine contractility has been linked to dysmenorrhea, a condition associated with painful uterine cramping. The benefits of the use of beta2-adrenoceptor agonists in dysmenorrhea are still unclear and should be balanced against a wide range of adverse effects recognized with this class of medication. The ideal tocolytic agent is one which is effective for the pregnant or non-pregnant woman but has no side effects on either the woman or the baby. Looking to the future with both caution and hope, the potential metamorphosis of beta3-adrenoceptor agonists from experimental tools into therapeutic drugs for tocolysis warrants attention.

  16. Is obstetrics and gynaecology going the distance?

    Science.gov (United States)

    Gallagher, Joe; Kenwright, Diane; Abels, Peter; Gallagher, Peter

    2012-08-01

    To determine how distance learning should be delivered to trainee interns in New Zealand, and compare these methods with the views of teachers. Many sixth-year medical students (trainee interns) in Obstetrics and Gynaecology (O&G) are placed in provincial centres. Feedback surveys suggested that these students felt disadvantaged using distance education compared with students at the main base. Currently distance education is delivered using traditional methods (textbooks and DVDs) and 'Web 1.0' software (e-mails and static material on blackboard™). Using a mix of structured interviews and a survey we asked how staff and students would prefer to access distance education, how familiar they were with 'Web 2.0' software (wikis, podcasts, blogs and social networking) and what is required to make distance education work well. 'Web 2.0' technologies were used by students socially but not academically, except for Wikipedia. Both staff and students felt competent using 'Web 1.0' (the internet), but many students did not access blackboard™ (a course management and content system) for information, citing the limited material there as a reason. Both groups highly valued face-to-face contact, and distant students were frustrated by the inability to attend tutorials given at the base medical school. A blended learning delivery comprising videoconferencing combined with a better use of blackboard™ would meet the learning preferences of the students. Universities should consider investing in and encouraging videoconferencing and a better use of current technology, rather than implementing 'Web 2.0' technology. © Blackwell Publishing Ltd 2012.

  17. Developing obstetric medicine training in Latin America.

    Science.gov (United States)

    Rojas-Suarez, José; Suarez, Niza; Ateka-Barrutia, Oier

    2017-03-01

    Maternal mortality is an important indicator of health in populations around the world. The distribution of maternal mortality ratio globally shows that middle- and low-income countries have ∼99% of the mortality burden. Most countries of Latin America are considered to be middle- or low-income countries, as well as areas of major inequities among the different social classes. Medical problems in pregnancy remain an important cause of morbidity and mortality in this region. Previous data indicate the need for a call to action for adequate diagnosis and care of medical diseases in obstetric care. The impact of nonobstetric and medical pathologies on maternal mortality in Latin America is largely unknown. In Latin America, two educational initiatives have been proposed to improve skills in maternity care. The Advanced Life Support in Obstetrics (ALSO®) was first started to address obstetric emergencies, and subsequently adapted for low-middle-income country settings as the Global ALSO®. In parallel, the Latin American obstetric anesthesia community has progressively focused on improvement of several intrapartum/intraoperative issues, which has secondarily taken them to embrace the obstetric medicine area on interest and join the former initiatives. In the present review, we summarize the available data regarding medical morbidity and mortality in pregnancy in Latin America, as well as the challenges, achievements, issues, initiatives, and future directions encouraging maternal health educators, health care trainers, and physicians in middle- and low-income countries, such as many Latin American ones, to improve and/or change attitudes, if needed, on current clinical practice.

  18. Acute Respiratory Distress Syndrome in Obstetric Patients

    Directory of Open Access Journals (Sweden)

    S. V. Galushka

    2007-01-01

    Full Text Available Objective: to define the specific features of the course of acute respiratory distress syndrome (ARDS in puer-peras with a complicated postpartum period. Subjects and methods. Sixty-seven puerperas with ARDS were examined. Group 1 included 27 puerperas with postpartum ARDS; Group 2 comprised 10 puerperas who had been treated in an intensive care and died; Group 3 consisted of nonobstetric patients with ARDS of various genesis (a control group. Results. In obstetric patients, the baseline oxygenation index was significantly lower than that in the control group. However, Group 1 patients showed a rapid increase in PaO2/FiO2 on days 3—4 of treatment. In the control group, the changes occurred later — on days 5—6. The baseline alveolar-arterial oxygen difference was significantly higher in the obstetric patients than that in the controls. In Group 1, AaDpO2 drastically decreased on days 3—4, which took place in parallel with an increase in the oxygenation index. At the beginning of the study, pulmonary shunting was high in the group of survivors, deceased, and controls. In Group 1, the shunting decreased on days 3—4 whereas in the control group this index normalized later — only by days 6—7. In Group 1, compliance remained lower throughout the observation, but on day 7 there was a significant difference in this index between the deceased, survivors, and controls. Conclusion. Thus, more severe baseline pulmonary gas exchange abnormalities are observed in obstetric patients than in general surgical and traumatological patients; the oxygenation index, alveolar-arterial oxygen difference, and pulmonary shunting index more rapidly change in patients with severe obstetric disease in its favorable course than in general surgical and traumatological patients; throughout the observation, thoracopulmonary compliance was less in obstetric patients than in the controls. Key words: acute respiratory distress syndrome, puerperium.

  19. Afrikaans and Dutch as closely-related languages: A comparison to West Germanic languages and Dutch dialects

    CSIR Research Space (South Africa)

    Heeringa, W

    2015-07-01

    Full Text Available ). In the summary of his book, Kloeke (1950: 262-263) writes: The two chief sources of Afrikaans, the old dialects of South Holland on the one hand and the “High” Dutch on the other, are reflected in the vowel system. In some respect Afrikaans is of a... (1950: 262-263) writes in his Herkomst en Groei van het Afrikaans (“Origin and Growth of Afrikaans”) that the old dialects of South-Holland on the one hand and “High” Dutch on the other are the chief sources of Afrikaans. In contrast, Scholtz (1963...

  20. Midwifery and obstetrics: twenty years of collaborative academic practice.

    Science.gov (United States)

    Angelini, Diane J; O'Brien, Barbara; Singer, Janet; Coustan, Donald R

    2012-09-01

    This review describes a collaborative educational practice model partnering midwifery and obstetrics within a department of obstetrics and gynecology. For more than 20 years, the authors' model has demonstrated sustainability and influence on medical education. The focus is on resident education in obstetrics, using midwifery faculty as teachers in the obstetric and obstetric triage settings. This noncompetitive and integrated educational practice model has achieved sustainability and success using midwives in a collaborative approach to medical education. The continuing collaboration and innovation within medical and resident education are important elements for the future of collaborative practice.

  1. 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.

  2. Nitrification in Dutch heathland soils.

    NARCIS (Netherlands)

    Boer, de W.

    1989-01-01

    This thesis is the result of a study on the production of nitrate in Dutch heathland soils. Most of the heathlands are located on acid, sandy soils. Therefore , it has dealt mainly with the occurrence, nature and mechanisms of nitrification in acid soils. In the Netherlands, the production of nitrat

  3. The Dutch interbank computer network

    NARCIS (Netherlands)

    Michiels, Eddie

    1988-01-01

    At the end of 1980, a strategic decision was made by the Dutch banks and savings banks to commence the development of a Data Communications Infrastructure (DCI), to be used for a number of forthcoming interbank applications. It was agreed that this new data communications infrastructure should be ba

  4. Dutch Architecture with Landscape Methods

    NARCIS (Netherlands)

    Jauslin, D.

    2009-01-01

    14 Project Documentations and Analysis of Dutch Architecture with Landscape Methods. MVRDV Villa VPRO, Powerhouse Company Villa 1, Herman Herzberger Coda Museum, NL Architects Basket Ba, SeARCH Posbank Pavillion, Wiel Arets Hedge House, OMA Kunsthal and Educatorium, Maaskant Johnson Wax, Diller & Sc

  5. Problem behavior in Dutch preschoolers

    NARCIS (Netherlands)

    J.M. Koot (Hans)

    1993-01-01

    textabstractThe present study was an attempt to contribute to the standardized assessment and the study of prevalence of problem behavior in children 2- to 3-years old by means of empirically derived rating scales. The basic questions were: 1. What are the psychometric characteristics of the Dutch v

  6. The Dutch Interbank Computer Network

    NARCIS (Netherlands)

    Michiels, E.F.

    1988-01-01

    At the end of 1980, a strategic decision was made by the Dutch banks and savings banks to commence the development of a Data Communications Infrastructure (DCI), to be used for a number of forthcoming interbank applications. It was agreed that this new data communications infrastructure should be

  7. Reforming Dutch Occupational Pension Schemes

    NARCIS (Netherlands)

    Bovenberg, A.L.; Gradus, R.H.J.M.

    2014-01-01

    Dutch occupational defined-benefit plans suffer from a number of serious weaknesses, including ambiguous ownership of the surplus, back-loading of benefits, and lack of tailor-made risk management. To address these weaknesses, we propose collective individual defined-contribution plans that are actu

  8. Reforming Dutch Occupational Pension Schemes

    NARCIS (Netherlands)

    Bovenberg, A.L.; Gradus, R.H.J.M.

    2014-01-01

    Dutch occupational defined-benefit plans suffer from a number of serious weaknesses, including ambiguous ownership of the surplus, back-loading of benefits, and lack of tailor-made risk management. To address these weaknesses, we propose collective individual defined-contribution plans that are actu

  9. Children of Dutch Nazi collaborators

    NARCIS (Netherlands)

    Tames, I.

    2015-01-01

    This article looks into what happened to the children of Dutch Nazi collaborators after the liberation of the Netherlands in May 1945. The author first outlines the historical context in which these children lived and the manner in which they recounted and recorded their memories much later. In comb

  10. 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

  11. Translating Dutch: challenges and opportunities in reforming health financing in Ireland.

    Science.gov (United States)

    Ryan, P; Thomas, S; Normand, C

    2009-09-01

    In 2006, Dutch authorities introduced a new health financing system of compulsory private for-profit insurance with strong government regulation. This system has recently attracted attention in Ireland. This paper assesses the theoretical arguments and evidence for applying the Dutch ideas to Ireland. In particular, the authors address how it would help the stated health system policy objectives of improving value for money, fairness and capacity. While the current Dutch reform is still a work in progress, it offers the headline attraction of a single tier system with few waiting lists. Nevertheless, the Dutch system of managed competition may entail risks for Ireland relating to ensuring sufficient system capacity, protecting those on low-incomes and ensuring cost control.

  12. Development of a test of spoken Dutch for prospective immigrants

    NARCIS (Netherlands)

    de Jong, J.H.A.L.; Lennig, M.; Kerkhoff, A.; Poelmans, P.

    2009-01-01

    Based on a parliamentary vote with broad support, the Ministry of Justice of the Netherlands in December 2003 commissioned the development of an examination system to test the Dutch oral language skills of foreigners who want to immigrate permanently to the Netherlands for economic or family

  13. Lexicon Optimization for Dutch Speech Recognition in Spoken Document Retrieval

    NARCIS (Netherlands)

    Ordelman, Roeland; Hessen, van Arjan; Jong, de Franciska

    2001-01-01

    In this paper, ongoing work concerning the language modelling and lexicon optimization of a Dutch speech recognition system for Spoken Document Retrieval is described: the collection and normalization of a training data set and the optimization of our recognition lexicon. Effects on lexical coverage

  14. Lexicon optimization for Dutch speech recognition in spoken document retrieval

    NARCIS (Netherlands)

    Ordelman, Roeland; Hessen, van Arjan; Jong, de Franciska

    2001-01-01

    In this paper, ongoing work concerning the language modelling and lexicon optimization of a Dutch speech recognition system for Spoken Document Retrieval is described: the collection and normalization of a training data set and the optimization of our recognition lexicon. Effects on lexical coverage

  15. Exit and voice in dutch social health insurance.

    NARCIS (Netherlands)

    Gress, S.; Delnoij, D.; Groenewegen, P.P.

    2003-01-01

    According to Hirschmann's concept of exit and voice, people have two options to make sure that firms or organisations realise what they (their consumers or members) are interested in (Hirschmann 1970). In the Dutch public health insurance system voice existed for a long time, but exit was only intro

  16. Dutch health insurance reform: the new role of collectives.

    NARCIS (Netherlands)

    Groenewegen, P.P.; Jong, J.D. de

    2007-01-01

    In the new Dutch health insurance system individuals have the option of joining a collective insurance contract. Insurers are allowed to offer premium reductions of up to 10% to members of collectives, based on the number of insurees. Collectives might exert more influence on insurers than individua

  17. Equality on different terms: the case of Dutch Hindu schools

    NARCIS (Netherlands)

    Merry, M.S.; Driessen, G.

    2012-01-01

    n this article the authors examine the reasons for the establishment of Hindu schools in the Netherlands and how the Dutch system of education facilitates these and other voluntarily separate schools. In particular, the authors explore the manner in which Hindu schools aim to cultivate and sustain a

  18. Dutch health insurance reform: the new role of collectives.

    NARCIS (Netherlands)

    Groenewegen, P.P.; Jong, J.D. de

    2007-01-01

    In the new Dutch health insurance system individuals have the option of joining a collective insurance contract. Insurers are allowed to offer premium reductions of up to 10% to members of collectives, based on the number of insurees. Collectives might exert more influence on insurers than

  19. Placental vascular pathology and increased thrombin generation as mechanisms of disease in obstetrical syndromes

    Directory of Open Access Journals (Sweden)

    Salvatore Andrea Mastrolia

    2014-11-01

    Full Text Available Obstetrical complications including preeclampsia, fetal growth restriction, preterm labor, preterm prelabor rupture of membranes and fetal demise are all the clinical endpoint of several underlying mechanisms (i.e., infection, inflammation, thrombosis, endocrine disorder, immunologic rejection, genetic, and environmental, therefore, they may be regarded as syndromes. Placental vascular pathology and increased thrombin generation were reported in all of these obstetrical syndromes. Moreover, elevated concentrations of thrombin-anti thrombin III complexes and changes in the coagulation as well as anticoagulation factors can be detected in the maternal circulation prior to the clinical development of the disease in some of these syndromes. In this review, we will assess the changes in the hemostatic system during normal and complicated pregnancy in maternal blood, maternal–fetal interface and amniotic fluid, and describe the contribution of thrombosis and vascular pathology to the development of the great obstetrical syndromes.

  20. Local health workers’ perceptions of substandard care in the management of obstetric hemorrhage in rural Malawi

    Directory of Open Access Journals (Sweden)

    Beltman Jogchum Jan

    2013-02-01

    Full Text Available Abstract Background To identify factors contributing to the high incidence of facility-based obstetric hemorrhage in Thyolo District, Malawi, according to local health workers. Methods Three focus group discussions among 29 health workers, including nurse-midwives and non-physician clinicians (‘medical assistants’ and ‘clinical officers’. Results Factors contributing to facility-based obstetric hemorrhage mentioned by participants were categorized into four major areas: (1 limited availability of basic supplies, (2 lack of human resources, (3 inadequate clinical skills of available health workers and (4 substandard referrals by traditional birth attendants and lack of timely self-referrals of patients. Conclusion Health workers in this district mentioned important community, system and provider related factors that need to be addressed in order to reduce the impact of obstetric hemorrhage.

  1. Obstetric near miss morbidity and maternal mortality in a Tertiary Care Centre in Western Rajasthan

    Directory of Open Access Journals (Sweden)

    Priyanka Kalra

    2014-01-01

    Full Text Available Obstetric near-miss (ONM describes a situation of lethal complication during pregnancy, labor or puerperium in which the woman survives either because of medical care or just by chance. In a cross-sectional observational study, five factor scoring system was used to identify the near-miss cases from all the cases of severe obstetric morbidity. Assessment of the causes of maternal mortality and near-miss obstetric cases was done. The ONM rate in this study was 4.18/1000 live births. Totally 54 maternal deaths occurred during this period, resulting in a ratio of 202 maternal deaths per 100,000 live births. Hemorrhage, hypertension and sepsis were major causes of near-miss maternal morbidity and mortality, respectively in descending order.

  2. Obstetric near miss morbidity and maternal mortality in a Tertiary Care Centre in Western Rajasthan.

    Science.gov (United States)

    Kalra, Priyanka; Kachhwaha, Chetan Prakash

    2014-01-01

    Obstetric near-miss (ONM) describes a situation of lethal complication during pregnancy, labor or puerperium in which the woman survives either because of medical care or just by chance. In a cross-sectional observational study, five factor scoring system was used to identify the near-miss cases from all the cases of severe obstetric morbidity. Assessment of the causes of maternal mortality and near-miss obstetric cases was done. The ONM rate in this study was 4.18/1000 live births. Totally 54 maternal deaths occurred during this period, resulting in a ratio of 202 maternal deaths per 100,000 live births. Hemorrhage, hypertension and sepsis were major causes of near-miss maternal morbidity and mortality, respectively in descending order.

  3. Risk for obstetric complications and schizophrenia.

    Science.gov (United States)

    Preti, A; Cardascia, L; Zen, T; Marchetti, M; Favaretto, G; Miotto, P

    2000-10-30

    The goal of this study was to determine whether cases with schizophrenia or related disorders show a history of obstetric complications significantly more often than control subjects and, if so, whether the enhanced risk of a negative pregnancy outcome also extends to the non-schizophrenic offspring of cases. Data based on the obstetric birth case-notes of patients with diagnosed schizophrenia or related disorders were compared to those of normal 'healthy' control subjects; each case/control pair was individually matched by gender, time and parity of birth, maternal age and marital status. Forty-four case/control pairs born in Padova (Italy) between 1964 and 1978 were assessed for prenatal and perinatal complications, including abnormal gestational age or birthweight. No significant differences were observed between cases and control subjects in the general characteristics of birth; gestational age and birthweight in particular were strictly comparable between cases and control subjects. The schizophrenia spectrum patients (75%) were more likely than control subjects (59%) to have experienced at least one definite obstetric complication: odds ratio=2.07 (95% CI: 0.83-5. 15). Cases also suffered more complications per birth than control subjects (average 2:1). In particular, obstetric complications involving a clear damaging potential were seen significantly more often among cases than control subjects: 34% vs. 9%, Fisher's exact test, P=0.008 (odds ratio=5.17, 95% CI: 1.55-17.21). Moreover, severe obstetric complications were noted more often among males (n=13, 41%) than females (n=2, 15%). When any previous pregnancies of the mothers of patients were compared with those of the mothers of control subjects, mothers of cases were seen to have suffered unfavorable pregnancy outcomes significantly more often. In particular mothers of cases were seen to have had more miscarriages (OR=4.66), and pre-term births (OR=2.58) than control subects' mothers. Severe, brain

  4. Obstetric Brachial Plexus Palsy in the Context of Early Physical Rehabilitation

    Directory of Open Access Journals (Sweden)

    Vivian Lucía Yanes Sierra

    2014-08-01

    Full Text Available Cuban health system currently promotes prenatal testing and monitoring of pregnancy; nevertheless obstetric brachial plexus palsy remains an unfortunate consequence of a difficult delivery and is one of the most common birth trauma. Traditionally, its treatment has been conservative, based on multidisciplinary monitoring and consultations with various specialists to deal with the consequences. After conducting an extensive literature review, we discussed in this paper the etiology, anatomy, pathophysiology, types of injuries, prognosis and outcome, consequences, assessment tools, existing treatments and series of exercises for obstetric brachial plexus palsy.

  5. Corporate control mechanisms, voting and cash flow rights, and the performance of Dutch firms

    NARCIS (Netherlands)

    Chirinko, Robert; Garretsen, Harry; Sterken, Elmer

    2003-01-01

    This paper exploits several unique institutional features in the Dutch system of corporate control to examine the relations among investor protections, concentrated ownership, and firm performance. Four conclusions emerge. First, controlling shareholders do not appear to ameliorate corporate

  6. Obstetric performance following an induced abortion.

    Science.gov (United States)

    Lowit, Alison; Bhattacharya, Sohinee; Bhattacharya, Siladitya

    2010-10-01

    Abortion has been legalised in most of the Western world for the past four decades. In areas where abortion practices are legal and easy to access, the risk of short-term complications is very low. As most women requesting induced abortion (IA) are young, potential adverse effects on subsequent reproductive function are important to them. This review investigates obstetric performance following IA and highlights methodological problems associated with research in this area. Some data suggest that IA may be linked with an increased risk of low birth weight, miscarriage and placenta previa but could be protective for pre-eclampsia. Current evidence also suggests an association between IA and pre-term birth. Large prospective cohort studies, which permit meaningful subgroup analyses, are needed to provide definitive answers on outcomes following alternative methods of IA and the impact of gestational age at abortion on future obstetric outcomes. Copyright 2010 Elsevier Ltd. All rights reserved.

  7. Myokymia in obstetrically related brachial plexopathy.

    Science.gov (United States)

    Sclar, Gary; Maniker, Allen; Danto, Joseph

    2004-06-01

    Myokymic discharges are spontaneous bursts of semirhythmic potentials that are sometimes correlated with rippling movements of skin and muscle. They have been reported in limb muscles in patients with Guillain-Barré syndrome, spinal stenosis, nerve root and nerve compression, and envenomations. They commonly occur with radiation induced plexopathies (approximately 60% of patients), but have not been reported in obstetrically related brachial plexopathies. We report 2 instances of myokymia in children with obstetric brachial plexus palsies. Each child was studied twice, and it was only at the later study, when the child was 10 or 11 months of age, that these potentials were noted. This could represent ongoing recovery from lesions incurred at birth or developmental changes. The final common pathway of all causes of myokymia could be to generate axonal membrane hyperexcitability.

  8. Clinical proteomics in obstetrics and neonatology.

    Science.gov (United States)

    Klein, Julie; Buffin-Meyer, Benedicte; Mullen, William; Carty, David M; Delles, Christian; Vlahou, Antonia; Mischak, Harald; Decramer, Stéphane; Bascands, Jean-Loup; Schanstra, Joost P

    2014-02-01

    Clinical proteomics has been applied to the identification of biomarkers of obstetric and neonatal disease. We will discuss a number of encouraging studies that have led to potentially valid biomarkers in the context of Down's syndrome, preterm birth, amniotic infections, preeclampsia, intrauterine growth restriction and obstructive uropathies. Obtaining noninvasive biomarkers (e.g., from the maternal circulation, urine or cervicovaginal fluid) may be more feasible for obstetric diseases than for diseases of the fetus, for which invasive methods are required (e.g., amniotic fluid, fetal urine). However, studies providing validated proteomics-identified biomarkers are limited. Efforts should be made to save well-characterized samples of these invasive body fluids so that many valid biomarkers of pregnancy-related diseases will be identified in the coming years using proteomics based analysis upon adoption of 'clinical proteomics guidelines'.

  9. Blood transfusion practices in obstetric anaesthesia

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2014-01-01

    Full Text Available Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Obstetric haemorrhage, especially postpartum haemorrhage, remains one of the major causes of massive haemorrhage and a prime cause of maternal mortality. Blood loss and assessment of its correct requirement are difficult in pregnancy due to physiological changes and comorbid conditions. Many guidelines have been used to assess the requirement and transfusion of blood and its components. Infrastructural, economic, social and religious constraints in blood banking and donation are key issues to formulate practice guidelines. Available current guidelines for transfusion are mostly from the developed world; however, they can be used by developing countries keeping available resources in perspective.

  10. Obstetric care for women with thalassemia.

    Science.gov (United States)

    Lao, Terence T

    2017-02-01

    Thalassemia is the commonest monogenic disease and manifests as severe anemia. It is increasingly encountered outside the Mediterranean region, Africa, Middle East, and Southeast Asia because of immigration. Pregnancy, previously uncommon in patients with homozygous β-thalassemia, is encountered increasingly because of improved management and assisted reproduction technology; however, preconceptional problems that include anemia, iron overload, cardiac dysfunction, thromboembolism, alloimmunization, infections, and endocrine and bone disorders, could influence maternal and obstetric outcome. Although, successful pregnancy in thalassemia trait carriers and women with hemoglobin H disease is more common, there is still increased risk of obstetric and perinatal complications. Prenatal diagnosis to exclude fetal homozygous thalassemia and other congenital anomalies, together with close monitoring of the pregnancy, would optimize outcome. Further research is warranted to elucidate the fetal safety of iron chelation therapy and potential effect of pregnancy on long-term maternal health outcome, especially following occurrence of maternal complications. Copyright © 2016. Published by Elsevier Ltd.

  11. Magnesium in obstetric anesthesia and intensive care.

    Science.gov (United States)

    Kutlesic, Marija S; Kutlesic, Ranko M; Mostic-Ilic, Tatjana

    2017-02-01

    Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic and postoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects. In obstetric intensive care, magnesium represents a first-choice medication in the treatment and prevention of eclamptic seizures. If used in recommended doses with close monitoring, magnesium is a safe and effective medication.

  12. Barriers to emergency obstetric care services

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique

    2014-01-01

    Introduction: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore...... decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay...... was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Conclusion: Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching...

  13. Gerontology and geriatrics in Dutch medical education.

    Science.gov (United States)

    Tersmette, W; van Bodegom, D; van Heemst, D; Stott, D; Westendorp, R

    2013-01-01

    The world population is ageing and healthcare services require trained staff who can address the needs of older patients. In this study we determined how current medical education prepares Dutch students of medicine in the field of Gerontology and Geriatrics (G&G). Using a checklist of the essentials of G&G, we assessed Dutch medical education on three levels. On the national level we analysed the latest National Blueprint for higher medical education (Raamplan artsopleiding 2009). On the faculty level we reviewed medical curricula on the basis of interviews with program directors and inspection of course materials. On the student level we assessed the topics addressed in the questions of the cross-institutional progress test (CIPT). The National Bluepr int contains few specific G&G objectives. Obligatory G&G courses in medical schools on average amount to 2.2% of the total curriculum measured as European Credit Transfer System units (ECTS). Only two out of eight medical schools have practical training during the Master phase in the form of a clerkship in G&G. In the CIPT, on average 1.5% of questions cover G&G. Geriatric education in the Netherlands does not seem to be in line with current demographic trends. The National Blueprint falls short of providing sufficiently detailed objectives for education on the care of older people. The geriatric content offered by medical schools is varied and incomplete, and students are only marginally tested on their knowledge of G&G in the CIPT.

  14. Obstetrical and perinatal outcomes in patients with or without obstetric analgesia during labor

    Directory of Open Access Journals (Sweden)

    Piedrahíta-Gutiérrez, Dany Leandro

    2016-07-01

    Full Text Available Objective: To describe and compare the obstetric and perinatal outcomes in patients with or without obstetric analgesia during labor, and to determine whether such analgesia is associated with adverse maternal or perinatal outcomes. Methodology: Comparative, retrospective, descriptive study, between January and November 2014, that included 502 healthy patients with normal pregnancies, out of which 250 received obstetric analgesia. The groups were compared as to maternal and perinatal outcomes. Results: Young, single and nulliparous mothers predominated; delivery was vaginal in 86 % of the cases, and by caesarean section in 14 %. Obstetric analgesia was associated with longer duration of the second stage of labor, instrumental delivery and cesarean section due to arrest of dilatation or fetal bradycardia; however, it was not related with higher incidence of postpartum hemorrhage or adverse perinatal outcomes such as meconium-stained amniotic fluid, Apgar under 5 at one minute or under 7 at 5 minutes, the need for neonatal resuscitation or for admission to NICU. Conclusion: Obstetric analgesia increases the duration of the second stage of labor and can increase the rate of caesarean sections and instrumental delivery, but it is not associated with adverse maternal or perinatal outcomes. Therefore, its use in labor is justified.

  15. Cutaneous pseudovasculitis, antiphospholipid syndrome and obstetric misadventure.

    Science.gov (United States)

    Thayaparan, A S; Lowe, S A

    2015-09-01

    We present two women with severe obstetric complications from antiphospholipid (aPL) syndrome associated with a rare dermatological manifestation, cutaneous pseudovasculitis. Both of these women developed a rash on the palmar aspect of the hands during the post partum period, with histology consistent with microthrombotic disease, despite anticoagulation. Cutaneous pseudovasculitis appears to be a maternal manifestation of aPL coagulopathy, possibly reflecting the severity of the underlying pregnancy pathology.

  16. Concepts of humanistic theory in obstetric care

    OpenAIRE

    Isolda Pereira da Silveira; Ana Fátima Carvalho Fernandes

    2012-01-01

    This study reflects the concepts of Paterson’s and Zderad’s humanistic theory, applied to daily nursing care during labor and childbirth. The objective of the study is to understand the importance of their application to attendant care. We take into account that the application of such concepts in obstetric nursing provides to the nurse and the expectant mother interaction and also a sense of being properly cared on behalf of the patient.

  17. [Validity of psychoprophylaxis in obstetrics. Authors' experience].

    Science.gov (United States)

    D'Alfonso, A; Zaurito, V; Facchini, D; Di Stefano, L; Patacchiola, F; Cappa, F

    1990-12-01

    The Authors report the results based on 20 years of practice on obstetric psycho-prophylaxis (PPO). Data on presence at course, on frequency, on primipares/pluripares ratio, on labour, on timing and mode of delivery, are assembled. Moreover, neonatal status at birth and at 10th day of life, are investigated. The data obtained were compared with a control group, constituted by women without any treatment before delivery. The acquired experience confirm the utility of PPO in the ordinary clinical practice.

  18. Maternal morbid obesity and obstetric outcomes.

    LENUS (Irish Health Repository)

    Farah, Nadine

    2012-02-01

    OBJECTIVE: The purpose of this retrospective cohort study was to review pregnancy outcomes in morbidly obese women who delivered a baby weighing 500 g or more in a large tertiary referral university hospital in Europe. METHODS: Morbid obesity was defined as a BMI > or =40.0 kg\\/m2 (WHO). Only women whose BMI was calculated at their first antenatal visit were included. The obstetric out-comes were obtained from the hospital\\'s computerised database. RESULTS: The incidence of morbid obesity was 0.6% in 5,824 women. Morbidly obese women were older and were more likely to be multigravidas than women with a normal BMI. The pregnancy was complicated by hypertension in 35.8% and diabetes mellitus in 20.0% of women. Obstetric interventions were high, with an induction rate of 42.1% and a caesarean section rate of 45.3%. CONCLUSIONS: Our findings show that maternal morbid obesity is associated with an alarmingly high incidence of medical complications and an increased level of obstetric interventions. Consideration should be given to developing specialised antenatal services for morbidly obese women. The results also highlight the need to evaluate the effectiveness of prepregnancy interventions in morbidly obese women.

  19. [Selective embolization to treat obstetric hemorrhage].

    Science.gov (United States)

    Ferrer Puchol, M D; Lanciego, C; Esteban, E; Ciampi, J J; Edo, M A; Ferragud, S

    2014-01-01

    To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. Hemorrhage was classified as primary (25/27) or secondary (2/27). The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1). The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients). Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  20. Existence and functionality of emergency obstetric care services at district level in Kenya

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Kombe, Yeri; Dubourg, Dominique

    2013-01-01

    The knowledge on emergency obstetric care (EmOC) is limited in Kenya, where only partial data from sub-national studies exist. The EmOC process indicators have also not been integrated into routine health management information system to monitor progress in safe motherhood interventions both...... and functionality of EmOC services at district level....

  1. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module XI. Obstetric/Gynecologic Emergencies.

    Science.gov (United States)

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This instructor's lesson plan guide on obstetric/gynecologic emergencies is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Six units of study are presented: (1) anatomy and physiology of the female reproductive system; (2) patient assessment; (3) pathophysiology and management of gynecologic…

  2. Design methodology of Dutch banknotes

    Science.gov (United States)

    de Heij, Hans A. M.

    2000-04-01

    Since the introduction of a design methodology for Dutch banknotes, the quality of Dutch paper currency has improved in more than one way. The methodology is question provides for (i) a design policy, which helps fix clear objectives; (ii) design management, to ensure a smooth cooperation between the graphic designer, printer, papermaker an central bank, (iii) a program of requirements, a banknote development guideline for all parties involved. This systematic approach enables an objective selection of design proposals, including security features. Furthermore, the project manager obtains regular feedback from the public by conducting market surveys. Each new design of a Netherlands Guilder banknote issued by the Nederlandsche Bank of the past 50 years has been an improvement on its predecessor in terms of value recognition, security and durability.

  3. Catastrophic antiphospholipid syndrome in obstetric practice

    Directory of Open Access Journals (Sweden)

    Валерий Николаевич Запорожан

    2015-05-01

    Full Text Available Thus, the Catastrophic antiphospholipid syndrome (CAPS is much more common than has been assumed until now, in all patients the authors strongly recommend screening for AFA. Furthermore, eclampsia, HELLP-syndrome premature detachment of normally located placentae (PDNSP can develop in the presence of other defects of hemostasis, in particular in mutation FV Leiden, MTHFR C677T, deficiency of protein C (PC, protein S (PS. The combination of acquired thrombophilia due to APS, with genetic defects worsen hemostasis during the pathological process leading to the development of thrombotic complications. Perhaps a combination of hereditary thrombophilia and APS creates a favorable environment in which, under certain conditions, possible decompensation of the hemostatic system and the development of CAPS. Patients with APS constitute a group of very high risk of thromboembolic complications in the perioperative period. Even a minimally invasive intervention (biopsy, curettage, tooth extraction may trigger the development of CAPS. Thus, according to Erkan et al. (2003, 40% of patients develop CAPS was provoked by surgery. The main reasons for the development of thrombotic complications in connection with surgical intervention is the damage to the vessel wall, blood stasis and the abolition of indirect anticoagulants. In the study on the presence of genetic thrombophilia was found heterozygous form of FV Leiden mutation and homozygous mutation of MTHFR C677T. He was diagnosed with pregnancy 14 weeks, APS, mixed form of thrombophilia (a combination of acquisitions and multigenic thrombophilia, hyperhomocysteinemia, weighed down by obstetric and somatic history.It is very urgent and important problem remains diagnosis CAPS, which is inconceivable without the determination of AFA. The latter should be mandatory for all pregnant women with preeclampsia habitual miscarriage, Premature detachment of normally situated placenta (PDNSP, genital herpes history

  4. Intelligent navigation to improve obstetrical sonography.

    Science.gov (United States)

    Yeo, Lami; Romero, Roberto

    2016-04-01

    'Manual navigation' by the operator is the standard method used to obtain information from two-dimensional and volumetric sonography. Two-dimensional sonography is highly operator dependent and requires extensive training and expertise to assess fetal anatomy properly. Most of the sonographic examination time is devoted to acquisition of images, while 'retrieval' and display of diagnostic planes occurs rapidly (essentially instantaneously). In contrast, volumetric sonography has a rapid acquisition phase, but the retrieval and display of relevant diagnostic planes is often time-consuming, tedious and challenging. We propose the term 'intelligent navigation' to refer to a new method of interrogation of a volume dataset whereby identification and selection of key anatomical landmarks allow the system to: 1) generate a geometrical reconstruction of the organ of interest; and 2) automatically navigate, find, extract and display specific diagnostic planes. This is accomplished using operator-independent algorithms that are both predictable and adaptive. Virtual Intelligent Sonographer Assistance (VIS-Assistance®) is a tool that allows operator-independent sonographic navigation and exploration of the surrounding structures in previously identified diagnostic planes. The advantage of intelligent (over manual) navigation in volumetric sonography is the short time required for both acquisition and retrieval and display of diagnostic planes. Intelligent navigation technology automatically realigns the volume, and reorients and standardizes the anatomical position, so that the fetus and the diagnostic planes are consistently displayed in the same manner each time, regardless of the fetal position or the initial orientation. Automatic labeling of anatomical structures, subject orientation and each of the diagnostic planes is also possible. Intelligent navigation technology can operate on conventional computers, and is not dependent on specific ultrasound platforms or on the

  5. Modern Marriage and Dutch Treatment

    Institute of Scientific and Technical Information of China (English)

    王雪芹

    2008-01-01

    In shanghai ,Beijing, Guangdong and other big cities, the invesligation in 2003 indicated that 25% couples had no children;38% couples agreed that married couples who did not give birth to child were acceptable;22% keep silent and only 15% people excepted to have children (Yu, 2003). The DINK phenomenon, nowadays, is being more and more fashionable. Under the effect of modern market, many new marital phenomena like Dutch Treatment are coming into be-ing in china.

  6. Availability, utilization, and quality of emergency obstetric care services in Bauchi State, Nigeria.

    Science.gov (United States)

    Abegunde, Dele; Kabo, Ibrahim A; Sambisa, William; Akomolafe, Toyin; Orobaton, Nosa; Abdulkarim, Masduk; Sadauki, Habib

    2015-03-01

    To report the availability, utilization, and quality of emergency obstetric care (EmOC) services in Bauchi State, Nigeria. Between June and July 2012, a cross-sectional survey of health facilities was conducted. Data on the performance of EmOC services between June 2011 and May 2012 were obtained from records of 20 general hospitals and 39 primary healthcare centers providing delivery services. Additionally, structured interviews with facility managers were conducted. Only 6 (10.2%) of the 59 facilities met the UN requirements for EmOC centers. None of the three senatorial zones in Bauchi State had the minimum acceptable number of five EmOC facilities per 500 000 population. Overall, 10 517 (4.4%) of the estimated 239 930 annual births took place in EmOC facilities. Cesarean delivery accounted for 3.6% (n=380) of the 10 517 births occurring in EmOC facilities and 0.2% of the 239 930 expected live births. Only 1416 (3.9%) of the expected 35 990 obstetric complications were managed in EmOC facilities. Overall, 45 (3.2%) of 1416 women with major direct obstetric complications treated at EmOC facilities died. Among 379 maternal deaths, 317 (83.6%) were attributable to major direct obstetric complications. Availability, utilization, and quality of EmOC services in Bauchi State, Nigeria, are suboptimal. The health system's capacity to manage emergency obstetric complications needs to be strengthened. Copyright © 2014 International Federation of Gynecology and Obstetrics. All rights reserved.

  7. [Neurologic vigor of term newborns according to the type of delivery and obstetric maneuvers].

    Science.gov (United States)

    Riesgo, Rudimar dos Santos; Ohlweiler, Lygia; Winckler, Maria Isabel Bragatti; Ranzan, Josiane; Riesgo, Itamar Dos Santos; Rotta, Newra Tellechea

    2009-06-01

    to evaluate the effect of delivery type and usual obstetric procedures on the neurologic condition of a sample of consecutive term and healthy neonates, in the first 48 hours of life, using the Neurologic Adaptative Capacity Score (NACS) system. cohort prospective study with 313 neonates, from a neonatology unit: Unidade de Neonatologia e Alojamento Conjunto. The variables analyzed were obstetric variables; clinical outcome: low neurologic vigor phase, evaluated by NACS, at 4, 24 and 48 hours of life. The data have been assessed twice: once with the whole sample and the other comparing the Vigorous Group, whose neonates kept a score of 35 or more during the three evaluations, and the Low Vigor Group, with less than 35 scores during the three consecutive evaluations. Bivariate and multivariate analyses have been done. Possible associations between low neurologic vigor phase and the type of delivery, as well between the low neurologic vigor phase and obstetric variables have been searched. in the bivariate analysis, the delivery type and the obstetric variables were not associated with the low neurologic vigor phase. Nevertheless, the association between the amniotic fluid and the low neurologic vigor phase reached values very close to significance and, then, it was included in the multivariate analysis. In the multivariate analysis, the only variable associated with low neurologic vigor was the presence of meconium stained amniotic fluid, which has shown to be 8.1 times more risky for the neurologic scoring, when Vigorous Group and Low Vigor Group were compared. In the analysis of the whole sample, the same risk was 1.7. neither the delivery type, nor the usual obstetric procedures were associated with low neurologic vigor phase. This is useful information, clinically or legally speaking, mainly for obstetricians. According to this sample data, when the term neonate is healthy, the delivery type and the usual obstetric procedures have no impact in the neurologic

  8. Public private partnerships for emergency obstetric care: Lessons from Maharashtra

    Directory of Open Access Journals (Sweden)

    Sarika Chaturvedi

    2011-01-01

    Full Text Available Background: The National Rural Health Mission of India advocates public private partnerships (PPPs to meet its "service guarantee" of Emergency obstetric care (EmOC provision. The Janani Suraksha Yojana (JSY has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Methods: A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. Results: The PPP scheme for EmOC is restricted to deliveries by Caesarean section. The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. Conclusion: The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs.

  9. Public private partnerships for emergency obstetric care: lessons from maharashtra.

    Science.gov (United States)

    Chaturvedi, Sarika; Randive, Bharat

    2011-01-01

    The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its "service guarantee" of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. The PPP scheme for EmOC is restricted to deliveries by Caesarean section.The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs.

  10. An obstetrics and gynaecology graduate residency programme in Venezuela.

    Science.gov (United States)

    Faneite, P.

    1998-01-01

    We present our experience on the design and development of a gynaecology and obstetrics graduate residency programme, developed in the Department of Obstetrics and Gynecology at the Dr Adolfo Prince Lara Hospital, Puerto Cabello, Venezuela, in which medical specialists and residents participate synergistically. From January to September 1993, curricular activities were planned and students selected. The programme started in October 1993, with six residents for a three-year programme. Courses were given by medical specialists from the Department. In addition to a Programme Coordinator, there is also a Residents' Coordinator, appointed for a two-month term of office; specific functions were assigned for residents occupying this position. All the programmed activities for three years were accomplished, including lectures and rotations, with an important record of surgical interventions. In our grade system, residents got an average of 18 over a maximum of 20 points. Residents also participated as speakers in workshops, special courses and national medicinal meetings, in which they presented a total of nine papers. Activities were evaluated bimonthly in meetings with students and each semester by the Graduate Committee. The first class graduated in September 1996. Results suggest that resident participation in graduate programmes is an important part of their education. PMID:9538482

  11. Dutch novelists beyond ‘postmodern’ relativism

    OpenAIRE

    Vaessens, T.

    2011-01-01

    In this article I will show how Dutch authors reoriented themselves from the late 1980s onwards in relation to the postmodern tradition they inherited. I will discuss the critique of postmodernism formulated by Dutch writers in the light of the following hypothesis. A new, late postmodern position has gradually emerged from the Dutch debate about literature and its function. The authors in question consider (literary) postmodernism as a necessary but insufficient counter-reaction against libe...

  12. Increasing information accessibility for patients in obstetrics-gynecology domain.

    Science.gov (United States)

    Crişan-Vida, Mihaela; Stoicu-Tivadar, Lăcrămioara

    2014-01-01

    It is important for the patient to have access to personal medical information in order to manage information for increased quality of medical care and life. The paper presents a module added to an Obstetrics-Gynaecology Department information system (OGD IS) supporting patient empowerment. The patient is accessing the system easily using laptops or mobile devices. The application accessed by the patient is web-based, implemented in Visual Studio. NET, using ASP.NET pages and C# language, and the application is published in the Windows Azure cloud. The solution is user friendly using familiar devices and is ubiquitous using the cloud solution. A module for translating medical terms in colloquial ones is integrated in the system. For certain situations the patient will get information related to life style influencing health status as how and what to eat or what type of exercise it is recommended.

  13. [Centralization in obstetrics: pros and cons].

    Science.gov (United States)

    Roemer, V M; Ramb, S

    1996-01-01

    Possible advantages and disadvantages of a general centralization of German obstetric facilities are analysed in the study. The need for centralization of risk cases, especially premature births (regionalization) is pointed out. Centralization appears appropriate, since every fifth maternity unit in Germany (19.78%) has 300 or fewer deliveries per year. This one fifth of perinatal clinics accounts for 6.3% of all deliveries (N = 49450). There are appreciable differences between the old and new federal states (Bundesländer): in the recently acceded federal states, 48.7% of all perinatal clinics have deliveries of 300 and less per year. This group of perinatal clinics accounts for 29% of all deliveries in the new federal states. We have carried out a survey of the mother's attitude to centralization: out of 416 patients in the Detmold women's hospital whose mean age was 29.0 +/- 4.2 years, 90.4% were not in favor of general centralization of obstetrics. 43% were also against a centralization of risk cases (regionalization). 75% of the women surveyed objected to centralized obstetrics because of the 'possible absence of the family', the 'possible absence of students and trainees' (44.9%), the 'unfamiliarity with staff and premises' (41.8%) and 'fear of anonymity' (44.5%). The majority of all women (84.1%) did not want to have a drive more than 20 km to an obstetrics center. Fear of 'delivery in a taxi'(78.6%), the 'fear that the husband will come too late to the delivery' (65.4%) and that the 'overall course of the delivery might not be adequate for reasons of time'. The presence of a pediatrics department in conjunction with the perinatal clinic was rated very positively (93%). It is concluded from the data and further juridical considerations that centralization of risk cases (regionalization) is indispensable in the near future and that somewhat more further into the future decentralization should be carried out by closing obstetrics departments with substantially

  14. Deconstructing the Dutch multicultural model: a frame perspective on Dutch immigrant integration policymaking

    NARCIS (Netherlands)

    Duyvendak, J.W.; Scholten, P.

    2012-01-01

    Dutch immigrant integration policies have often been labelled ‘multiculturalist’. This article empirically and conceptually challenges the idea of a Dutch multicultural model. First, it deconstructs the image that Dutch policies would have been driven by a single, coherent and consistent model, by

  15. The art of governance of Dutch hospitals.

    Science.gov (United States)

    Hoek, H

    1999-01-01

    Hospitals in The Netherlands are governed by two boards: The Board of Directors, the legal representative of the hospital, responsible for strategic and operational business activities; and the Supervisory Board, made up of co-opted volunteers and responsible for checking and approving of the major decisions of the Board of Directors. The question which arises is whether the system of governance is able to function appropriately and guarantee enough concern about general health problems, moral and ethical questions and the interest of the patients. This paper investigate the successes and shortfalls of such a system of governance in Dutch hospitals. The results and conclusions determine that although copied from the corporate governance model, it does not function well in an environment where the influence of patients and the inhabitants of the region are of great importance and shareholders do not exist.

  16. Obstetric Provider Trainees in Georgia: Characteristics and Attitudes About Practice in Obstetric Provider Shortage Areas.

    Science.gov (United States)

    Smulian, Elizabeth A; Zahedi, Leilah; Hurvitz, Julie; Talbot, Abigail; Williams, Audra; Julian, Zoë; Zertuche, Adrienne D; Rochat, Roger

    2016-07-01

    Objectives In Georgia, 52 % of the primary care service areas outside metropolitan Atlanta have a deficit of obstetric providers. This study was designed to identify factors associated with the likelihood of Georgia's obstetric trainees (obstetrics and gynecology (OB/GYN) residents and certified nurse midwifery (CNM) students) to practice in areas of Georgia that lack obstetric providers and services, i.e. rural Georgia. Methods Pilot-tested electronic and paper surveys were distributed to all of Georgia's OB/GYN residents (N = 95) and CNM students (N = 28). Mixed-methods survey questions assessed characteristics, attitudes, and incentives that might be associated with trainee desire to practice in areas of Georgia that lack obstetric providers and services. Surveys also gathered information about concerns that may prevent trainees from practicing in shortage areas. Univariate and bivariate analyses were performed, and qualitative themes were abstracted from open-ended questions. Results The survey response rate was 87.8 % (108/123). Overall, 24.4 % (19/78) of residents and 53.6 % (15/28) of CNM students expressed interest in practicing in rural Georgia, and both residents and CNM students were more likely to desire to practice in rural Georgia with the offer of any of six financial incentives (P < 0.001). Qualitative themes highlighted trainees' strong concerns about Georgia's political environment as it relates to reproductive healthcare. Conclusions Increasing state-level, rurally-focused financial incentive programs and emphasizing the role of CNMs may alleviate obstetric provider shortages in Georgia.

  17. A hospital-centered approach to improve emergency obstetric care in South Sudan.

    Science.gov (United States)

    Groppi, Lavinia; Somigliana, Edgardo; Pisani, Vincenzo; Ika, Michelina; Mabor, Joseph L; Akec, Henry N; Nhial, John A; Mading, Michel S; Scanagatta, Chiara; Manenti, Fabio; Putoto, Giovanni

    2015-01-01

    To assess provision of emergency obstetric care (EmOC) in Greater Yirol, South Sudan, after implementation of a hospital-centered intervention with an ambulance referral system. In a descriptive study, data were prospectively recorded for all women referred to Yirol County Hospital for delivery in 2012. An ambulance referral system had been implemented in October 2011. Access to the hospital and ambulance use were free of charge. The number of deliveries at Yirol County Hospital increased in 2012 to 1089, corresponding to 13.3% of the 8213 deliveries expected to have occurred in the catchment area. Cesareans were performed for 53 (4.9%) deliveries, corresponding to 0.6% of the expected number of deliveries in the catchment area. Among 950 women who delivered a newborn weighing at least 2500 g at the hospital, 6 (0.6%) intrapartum or very early neonatal deaths occurred. Of 1232 women expected to have major obstetric complications in 2012 in the catchment area, 472 (38.3%) received EmOC at the hospital. Of 115 expected absolute obstetric indications, 114 (99.1%) were treated in the hospital. A hospital-centered approach with an ambulance referral system effectively improves the availability of EmOC in underprivileged remote settings. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  18. The Dutch Works Council from an Institutional Economics Point of View: An Efficient Solution to the Governance Structure Problem?

    NARCIS (Netherlands)

    van den Berg, J.E.

    2003-01-01

    The aim of this paper is to explain, with the aid of institutional economic theories, why Dutch works councils may contribute to an efficient governance structure. To this end, in this study a sketch will be given of the existing structure, in which the particular Dutch two-tier system plays an impo

  19. Greenhouse gas reporting of the LULUCF sector for the UNFCCC and Kyoto Protocol : background to the Dutch NIR 2013

    NARCIS (Netherlands)

    Arets, E.J.M.M.; Hoek, van der K.W.; Kramer, H.; Kuikman, P.J.; Lesschen, J.P.

    2013-01-01

    This report provides a complete description and background information of the Dutch National System for Greenhouse gas Reporting of the LULUCF sector and the Dutch LULUCF submission under the Kyoto Protocol for the 2013 submission of The Netherlands. The 2013 submission reports greenhouse gas emissi

  20. The embedding of reported speech in a rhetorical structure by prosecutors and defense lawyers in Dutch trials

    NARCIS (Netherlands)

    Sneijder, P.W.J.

    2014-01-01

    Closing arguments in Dutch trials are representative of the adversarial part of the Dutch criminal justice system. The prosecutor and the defense lawyer design these arguments to persuade the judges of their opposing versions of the criminal events. Both parties draw on written documents such as the

  1. Potential Impact of Obstetrics and Gynecology Hospitalists on Safety of Obstetric Care.

    Science.gov (United States)

    Srinivas, Sindhu K

    2015-09-01

    Staffing models are critical aspects of care delivery. Provider staffing on the labor and delivery unit has recently received heightened attention. Based on the general medicine hospitalist model, the obstetrics and gynecology hospitalist or laborist model of obstetric care was introduced more than a decade ago as a plausible model-of-care delivery to improve provider satisfaction, with the goal of also improving safety and outcomes through continuous coverage by providers whose sole focus was on the labor and delivery unit without other competing clinical duties. It is plausible that this model of provider staffing and care delivery will increase safety.

  2. Availability and access in modern obstetric care: a retrospective population-based study.

    Science.gov (United States)

    Engjom, H M; Morken, N-H; Norheim, O F; Klungsøyr, K

    2014-02-01

    To assess the availability of obstetric institutions, the risk of unplanned delivery outside an institution and maternal morbidity in a national setting in which the number of institutions declined from 95 to 51 during 30 years. Retrospective population-based, three cohorts and two cross-sectional analyses. Census data, Statistics Norway. The Medical Birth Registry of Norway from 1979 to 2009. Women (15-49 years), 2000 (n = 1,050,269) and 2010 (n = 1,127,665). Women who delivered during the period 1979-2009 (n = 1,807,714). Geographic Information Systems software for travel zone calculations. Cross-table and multiple logistic regression analysis of change over time and regional differences. World Health Organization Emergency Obstetric and Newborn Care (EmOC) indicators. Proportion of women living outside the 1-hour travel zone to obstetric institutions. Risk of unplanned delivery outside obstetric institutions. Maternal morbidity. The proportion of women living outside the 1-hour zone for all obstetric institutions increased from 7.9% to 8.8% from 2000 to 2010 (relative risk, 1.1; 95% confidence interval, 1.11-1.12), and for emergency obstetric care from 11.0% to 12.1% (relative risk, 1.1; 95% confidence interval, 1.09-1.11). The risk of unplanned delivery outside institutions increased from 0.4% in 1979-83 to 0.7% in 2004-09 (adjusted odds ratio, 2.0; 95% confidence interval, 1.9-2.2). Maternal morbidity increased from 1.7% in 2000 to 2.2% in 2009 (adjusted odds ratio, 1.4; 95% confidence interval, 1.2-1.5) and the regional differences increased. The availability of and access to obstetric institutions was reduced and we did not observe the expected decrease in maternal morbidity following the centralisation. © 2013 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  3. Auditing the standard of anaesthesia care in obstetric units.

    Science.gov (United States)

    Mörch-Siddall, J; Corbitt, N; Bryson, M R

    2001-04-01

    We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area.

  4. Association study of obstetrical complication and depressive disorder

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:To investigate the correlation between obstetrical complications and depressive disorder.Methods:Depressive disorder probands and their adult sibling were diagnosed using CCMD-3 criteria.Obstetrical data from maternal reports were scored,applying published scales that take into account number and severity of complication.Results:The scores of obstetric complication and prenatal complications and low birth weight were significantly worse in probands than siblings without depressive disorders.Conclusion:Results suggest obstetric complications are etiologically significant in depressive disorder.

  5. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

    Directory of Open Access Journals (Sweden)

    Saliku Teresa

    2009-03-01

    Full Text Available Abstract Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1 delay in making the decision to seek care; 2 delay in reaching an appropriate obstetric facility; and 3 delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden

  6. ‘Essential but not always available when needed’ – an interview study of physicians’ experiences and views regarding use of obstetric ultrasound in Tanzania

    Directory of Open Access Journals (Sweden)

    Annika Åhman

    2016-07-01

    Full Text Available Background: The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries. Objective: We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management. Design: A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis. Results: Use of obstetric ultrasound in the management of complicated pregnancy was much appreciated by participating physicians, although they expressed considerable concern about the lack of ultrasound equipment and staff able to conduct the examinations. These limitations were recognized as restricting physicians’ ability to manage complications adequately during pregnancy and birth. Better availability of ultrasound was requested to improve obstetric management. Concerns were also raised regarding pregnant women's lack of knowledge and understanding of medical issues which could make counseling in relation to obstetric ultrasound difficult. Although the physicians perceived a positive attitude toward ultrasound among most pregnant women, occasionally they came across women who feared that ultrasound might harm the fetus. Conclusions: There seems to be a need to provide more physicians in antenatal care in Tanzania with ultrasound training to enable them to conduct obstetric ultrasound examinations and interpret the results themselves. Physicians also need to acquire adequate counseling skills as counseling can be especially challenging in this setting where many expectant parents have low levels of education. Providers of obstetric care and policy makers in Tanzania will need to take measures to ensure appropriate

  7. Dutch Energy Investment Allowance (EIA). Energy List for 2013; Energie-investeringsaftrek (EIA). Energielijst 2013

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-01-15

    The Energy Investment Allowance (EIA) is a tax system by means of which the Dutch government supports companies with investments in energy-saving equipment and renewable energy. This brochure explains the assets eligible for EIA and how the scheme works [Dutch] De Energie-investeringsaftrek (EIA) is een fiscale regeling waarmee de overheid ondersteuning biedt voor bedrijven bij investeringen in energiebesparende bedrijfsmiddelen en duurzame energie. In deze brochure wordt uitgelegd welke bedrijfsmiddelen in aanmerking komen voor EIA en hoe de regeling werkt.

  8. Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: A Study of Obstetric Providers in Michigan

    Science.gov (United States)

    Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Gueorguieva, Iana; Ransom, Scott B.

    2009-01-01

    Context: It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. Purpose: This study examined whether higher malpractice…

  9. Training in motivational interviewing in obstetrics

    DEFF Research Database (Denmark)

    Lindhardt, Christina L; Rubak, Sune Leisgaard Mørck; Mogensen, Ole

    2014-01-01

    : The Region of Southern Denmark. METHODS: Eleven obstetric healthcare professionals working with obese pregnant women underwent a three day course in motivational interviewing techniques and were assessed before- and after training to measure the impact on their overall performance as well as the effect......-adherent interventions). Furthermore, the participants asked fewer closed and more open questions before training in motivational interview. In the assessment of proficiency and competency, most of the participants scored higher after the training in motivational interviewing. CONCLUSIONS: Training in motivational...

  10. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    2015-01-01

    Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court...... districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure...

  11. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identied by the introduction of experience-rated malpractice liability insurance. Our identication...... in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained...

  12. An obstetric emergency called peripartum cardiomyopathy!

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2010-01-01

    Full Text Available Peripartum cardiomyopathy (PPCM is a rare obstetric emergency affecting women in late pregnancy or up to five months of postpartum period. The etiology of PPCM is still not known. It has potentially devastating effects on mother and fetus if not treated early. The signs, symptoms and treatment of PPCM are similar to that of heart failure. Early diagnosis and proper management is the corner stone for better outcome of these patients. The only way to prevent PPCM is to avoid further pregnancies.

  13. Fistulas secondary to gynecological and obstetrical operations

    Directory of Open Access Journals (Sweden)

    Jakovljević Branislava N.

    2003-01-01

    Full Text Available The authors present urogenital and rectogenital fistulas treated at the Department of Obstetrics and Gynecology in Novi Sad in the period from 1976 to 1999. The study comprised 28 cases of fistula out of which 17 were vesicovaginal, 3 ureterovaginal, 1 vesicorecto vaginal and 7 recto vaginal. During the investigated period there were 182 Wertheim operations, 3864 total abdominal hysterectomies, 1160 vaginal hysterectomies and 7111 cesarean sections. The vesicovaginal fistulas were most frequent with the incidence of 0.33%, whereas the tocogenic fistulas did not occur. Urogenital fistulas secondary to radical hysterectomy are extremely rare thanks to the administered measures of prevention during the surgical procedure.

  14. Seed bank characteristics of Dutch plant communities

    NARCIS (Netherlands)

    Bekker, RM; Schaminee, JHJ; Bakker, JP; Thompson, K

    With the recent appearances of a new and well-documented classification of the Dutch plant communities (Schaminee et al 1995a,b; 1996) and a database on the seed longevity of plant species of North West Europe (Thompson ct al. 1997a) it was possible to investigate patterns of seed longevity in Dutch

  15. Nutrient cycling and foodwebs in Dutch estuaries

    NARCIS (Netherlands)

    Nienhuis, P.H.

    1993-01-01

    In this review several aspects of the functioning of the Dutch estuaries (Ems-Dollard, Wadden Sea, Oosterschelde, Westerschelde, Grevelingen and Veerse Meer) have been compared. A number of large European rivers (especially Rhine) have a prevailing influence on the nutrient cycling of most Dutch est

  16. Management of the Dutch development cooperation

    NARCIS (Netherlands)

    Janssen, Lodevicus Johannes Henricus

    2009-01-01

    There is reason for concern about the Dutch development cooperation. A survey of some aid evaluations of the Dutch Ministry of Foreign Affairs (MFA) showed that the aid results are limited and that the goals of the programs are not achieved. Management concerns using an organisation's resources to a

  17. Morphological Atlas of the Dutch Dialects

    NARCIS (Netherlands)

    Schutter, de Georges; Berg, van den Boudewijn; Goeman, Ton; Jong, de Thera

    2005-01-01

    For the first time in the history of Dutch dialectology, a detailed overview of the variation in the formation of words has become available in the Morphological Atlas of the Dutch Dialects (MAND). MAND presents the state of the art in dialect morphology at the end of the twentieth century in two vo

  18. Management of the Dutch development cooperation

    NARCIS (Netherlands)

    Janssen, Lodevicus Johannes Henricus

    2009-01-01

    There is reason for concern about the Dutch development cooperation. A survey of some aid evaluations of the Dutch Ministry of Foreign Affairs (MFA) showed that the aid results are limited and that the goals of the programs are not achieved. Management concerns using an organisation's resources to

  19. Accurate stemming of Dutch for text classification

    NARCIS (Netherlands)

    Gaustad, T; Bouma, G; Theune, M; Nijholt, A; Hondorp, H

    2002-01-01

    This paper investigates the use of stemming for classification of Dutch (email) texts. We introduce a stemmer, which combines dictionary lookup (implemented efficiently as a finite state automaton) with a rule-based backup strategy and,how, that it outperforms the Dutch Porter stemmer in terms of ac

  20. Responses to Dutch-accented English

    NARCIS (Netherlands)

    Nejjari, W.; Gerritsen, M.; Haagen, M.J. van der; Korzilius, H.P.L.M.

    2012-01-01

    This paper reports on a study into the reactions of ‘native’ speakers of British English to Dutch-English pronunciations in the onset of a telephone sales talk. In an experiment 144 highly educated British professionals who were either familiar or not familiar with Dutch-accented English responded t

  1. Seed bank characteristics of Dutch plant communities

    NARCIS (Netherlands)

    Bekker, RM; Schaminee, JHJ; Bakker, JP; Thompson, K

    1998-01-01

    With the recent appearances of a new and well-documented classification of the Dutch plant communities (Schaminee et al 1995a,b; 1996) and a database on the seed longevity of plant species of North West Europe (Thompson ct al. 1997a) it was possible to investigate patterns of seed longevity in Dutch

  2. Sports participation of Dutch lower limb amputees

    NARCIS (Netherlands)

    Bragaru, Mihail; Meulenbelt, Hendrik; Dijkstra, Pieter U.; Geertzen, Jan H.B.; Dekker, Rienk

    2013-01-01

    Objective: To analyze sports participation of Dutch lower limb amputees and factors influencing sports participation. Study design: A cross-sectional survey was performed. Dutch lower limb amputees (N = 2039) were invited to participate in a postal survey addressing personal and amputation character

  3. Dutch novelists beyond ‘postmodern’ relativism

    NARCIS (Netherlands)

    Vaessens, T.

    2011-01-01

    In this article I will show how Dutch authors reoriented themselves from the late 1980s onwards in relation to the postmodern tradition they inherited. I will discuss the critique of postmodernism formulated by Dutch writers in the light of the following hypothesis. A new, late postmodern position h

  4. The Dutch private company: successfully relaunched?

    NARCIS (Netherlands)

    van der Elst, C.F.; Vermeulen, E.P.M.; De Cordt, Y.; Navez, E.J.

    2014-01-01

    This Chapter in a comparative book on private limited liability companies starts with an illustration of the former success of the Dutch limited liability company (BV). Next it addresses the competitive European legal environment within which the Dutch BV has to operate. The study shows how the

  5. Rewarding peak avoidance: the Dutch 'Spitsmijden' projects

    NARCIS (Netherlands)

    Knockaert, J.; Bakens, J.; Ettema, D.F.; Verhoef, E.

    2011-01-01

    The Dutch road network is becoming increasingly congested. In late 2006, a group of companies, universities and government institutions established the Spitsmijden project. ‘Spitsmijden’ is the Dutch term for ‘avoiding the peak’. This joint initiative aimed to identify and assess a short-term

  6. Dutch VULA consumer market services over Cable

    NARCIS (Netherlands)

    Anoniem

    2015-01-01

    KPN offers a virtual unbundled local access wholesale service over its DSL infrastructure. This offer has been accepted by the Dutch Authority Consumer Market. In the report, it is argued that for consumer market services, the Dutch cable providers can develop an equivalent wholesale service from th

  7. Environmental Voluntary Agreements in the Dutch Context

    NARCIS (Netherlands)

    Bressers, Johannes T.A.; de Bruijn, Theo; Croci, Edoardo

    2005-01-01

    This paper describes and analyses the use of environmental voluntary agreements, or covenants, in Dutch environmental policy. Covenants have become a widely used policy instrument in the Netherlands. This trend reinforces the strong neo-corporatist traits of Dutch society with its tendency towards

  8. Ethnic disparities in Dutch juvenile justice

    NARCIS (Netherlands)

    Komen, M.; van Schooten, E.

    2009-01-01

    In the Netherlands, ethnic minority boys are heavily overrepresented in prisons and secure judicial institutions for juveniles. In a sample of 324 juveniles of both native Dutch and ethnic minority origin who have come into contact with the Dutch criminal justice authorities, we compared the number

  9. Dutch Corporate Finance, 1602-1850

    NARCIS (Netherlands)

    A. de Jong (Abe); J. Jonker (Joost); A. Roëll (Ailsa)

    2013-01-01

    textabstractEarly Modern Dutch corporate finance had two notable features, a remarkable ease of raising large amounts of capital and a flexible legal framework. Having pioneered new corporate forms with two intercontinental trading companies, Dutch business adopted such forms on a wider scale only

  10. The Dutch surgical colorectal audit.

    Science.gov (United States)

    Van Leersum, N J; Snijders, H S; Henneman, D; Kolfschoten, N E; Gooiker, G A; ten Berge, M G; Eddes, E H; Wouters, M W J M; Tollenaar, R A E M; Bemelman, W A; van Dam, R M; Elferink, M A; Karsten, Th M; van Krieken, J H J M; Lemmens, V E P P; Rutten, H J T; Manusama, E R; van de Velde, C J H; Meijerink, W J H J; Wiggers, Th; van der Harst, E; Dekker, J W T; Boerma, D

    2013-10-01

    In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch Institute for Clinical Auditing (DICA). This article illustrates key elements of the DSCA and results of three years of auditing. Key elements include: a leading role of the professional association with integration of the audit in the national quality assurance policy; web-based registration by medical specialists; weekly updated online feedback to participants; annual external data verification with other data sources; improvement projects. In two years, all Dutch hospitals participated in the audit. Case-ascertainment was 92% in 2010 and 95% in 2011. External data verification by comparison with the Netherlands Cancer Registry (NCR) showed high concordance of data items. Within three years, guideline compliance for diagnostics, preoperative multidisciplinary meetings and standardised reporting increased; complication-, re-intervention and postoperative mortality rates decreased significantly. The success of the DSCA is the result of effective surgical collaboration. The leading role of the ASN in conducting the audit resulted in full participation of all colorectal surgeons in the Netherlands. By integrating the audit into the ASNs' quality assurance policy, it could be used to set national quality standards. Future challenges include reduction of administrative burden; expansion to a multidisciplinary registration; and addition of financial information and patient reported outcomes to the audit data. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Remembering Dutch-Moluccan radicalism

    DEFF Research Database (Denmark)

    Marselis, Randi Lorenz

    2016-01-01

    This article examines memory politics in relation to radical actions of young Dutch-Moluccans, more specifically a train hijacking in 1977 at the village of De Punt in the Netherlands. The article examines how these historical events were remembered in the drama-documentary television film, De Punt......, as well as in user-generated comments in an online discussion. The television film represented an inclusive memory culture that made room for the difficult memories of all parties involved, including the radicalised, young hijackers. Based on a multidimensional model of mass media reception, the analysis...

  12. [Dutch parliament legitimizes harmful quackery].

    Science.gov (United States)

    van Dam, Frits S A M; Renckens, Cees N M

    2010-01-01

    The Dutch parliament has recently accepted a tax law in which certain groups of alternative therapists can be exempt from VAT. To be eligible for this VAT exemption, the disciplines to which the therapists belong have to meet certain training requirements. In this article it is contended, in agreement with the Royal College of Physicians in the UK, that statutory regulation is inappropriate for disciplines whose therapies are neither of proved benefit nor appropriately tested. It legitimizes harmful therapies. This is illustrated by two serious accidents, previously described in this journal, caused by a chiropractor and a craniosacral therapist.

  13. Impact of the Great East Japan Earthquake on Regional Obstetrical Care in Miyagi Prefecture.

    Science.gov (United States)

    Sugawara, Junichi; Hoshiai, Tetsuro; Sato, Kazuyo; Tokunaga, Hideki; Nishigori, Hidekazu; Arai, Takanari; Okamura, Kunihiro; Yaegashi, Nobuo

    2016-06-01

    The authors report the results of surveys on the emergency transport or evacuation status of obstetric patients conducted in Miyagi prefecture, one of the major disaster areas of the Great East Japan Earthquake and tsunami. The surveys examined the damages to maternity institutions, evacuation status and transport of pregnant women, and prehospital childbirths and were conducted in 50 maternity institutions and 12 fire departments in Miyagi. Two coastal institutions were destroyed completely, and four institutions were destroyed partially by the tsunami, forcing them to stop medical services. In the two-month period after the disaster, 217 pregnant women received hospital transport or gave birth after evacuation. Satisfactory perinatal outcomes were maintained. Emergency obstetric transport increased to approximately 1.4 fold the number before the disaster. Twenty-three women had prehospital childbirths, indicating a marked increase to approximately three times the number of the previous year. In the acute phase of the tsunami disaster, maternity institutions were damaged severely and perinatal transport was not possible; as a result, pregnant women inevitably gave birth in unplanned institutions, and the number of prehospital births was increased extremely. To obtain satisfactory obstetric outcomes, it is necessary to construct a future disaster management system and to re-recognize pregnant women as people with special needs in disaster situations. Sugawara J , Hoshiai T , Sato K , Tokunaga H , Nishigori H , Arai T , Okamura K , Yaegashi N . Impact of the Great East Japan Earthquake on regional obstetrical care in Miyagi Prefecture. Prehosp Disaster Med. 2016;31(3):255- 258.

  14. ‘A Newspaper War’?: Dutch Information Networks during the South African War (1899-1902

    Directory of Open Access Journals (Sweden)

    Vincent Kuitenbrouwer

    2013-03-01

    Full Text Available The South African War (1899-1902 caused a stir in the Netherlands. The Dutch public overwhelmingly supported the Boers in their struggle against the British. To support the ‘kinsmen’ in South Africa several organisations in the Netherlands embarked on an international propaganda campaign. This article considers the involvement of Dutch journalists in the pro-Boer agitation. They were confronted with a dilemma because as a small country the Netherlands officially was neutral and did not possess strong international lines of communications, which made it difficult to distribute information in other countries. This problem raised moral and practical questions about the Dutch press and its position in the world. Using concepts from the historiography on the media of the British Empire, Kuitenbrouwer analyses the Dutch press system around 1900.

  15. Medication error report: Intrathecal administration of labetalol during obstetric anesthesia

    Directory of Open Access Journals (Sweden)

    Baisakhi Laha

    2015-01-01

    Full Text Available Labetalol, a combined alfa and beta-adrenergic receptor antagonist, is used as an antihypertensive drug. We report a case of an acute rise in blood pressure and lower limb pain due to the inadvertent intrathecal administration of labetalol, mistaking it for bupivacaine, during obstetric anesthesia. The situation was rescued by converting to general anesthesia. The cesarean delivery was uneventful, and mother as well as newborn child showed no ill-effect. This particular medication error was attributable to a failure on the part of the doctors administering the injection to read and cross-check medication labels and the practice of keeping multiple injections together. In the absence of an organized medication error reporting system and action on that basis, such events may recur in future.

  16. What's new in obstetric anesthesia? Focus on preeclampsia.

    Science.gov (United States)

    Leffert, L R

    2015-08-01

    Recent advances in the diagnosis, pathogenesis, and understanding of preeclampsia-related morbidity provide opportunities to optimize clinical management of the mother and fetus. These discoveries are timely, as contemporary data suggest that the prevalence of preeclampsia, affecting 7.5% of pregnancies globally and 2-5% in the USA, has increased by up to 30% over the last decade. Managing pregnant patients with preeclampsia can be challenging for all members of the obstetric care team due to the disease's multi-organ system maternal and fetal effects. This review presents recent updates in the definition of preeclampsia, etiology, comorbidities and therapeutic interventions and discusses how they impact the care of these high-risk patients.

  17. Reducing maternal mortality on a countrywide scale: The role of emergency obstetric training.

    Science.gov (United States)

    Moran, Neil F; Naidoo, Mergan; Moodley, Jagidesa

    2015-11-01

    Training programmes to improve health worker skills in managing obstetric emergencies have been introduced in various countries with the aim of reducing maternal mortality through these interventions. In South Africa, based on an ongoing confidential enquiry system started in 1997, detailed information about maternal deaths is published in the form of regular 'Saving Mothers' reports. This article tracks the recommendations made in successive Saving Mothers reports with regard to emergency obstetric training, and it assesses the impact of these recommendations on reducing maternal mortality. Since 2009, South Africa has had its own training package, Essential Steps in the Management of Obstetric Emergencies (ESMOE), which the last three Saving Mothers reports have specifically recommended for all doctors and midwives working in maternity units. A special emphasis has been placed on the need for the simulation training component of ESMOE, also called obstetric 'fire drills', to be integrated into the clinical routines of all maternity units. The latest Saving Mothers report (2011-2013) suggests there has been little progress so far in improving emergency obstetric skills, indicating a need for further scale-up of ESMOE training in the country. The example of the KwaZulu-Natal province of South Africa is used to illustrate the process of scale-up and factors likely to facilitate that scale-up, including the introduction of ESMOE into the undergraduate medical training curriculum. Additional factors in the health system that are required to convert improved skills levels into improved quality of care and a reduction in maternal mortality are discussed. These include intelligent government health policies, formulated with input from clinical experts; strong clinical leadership to ensure that doctors and nurses apply the skills they have learnt appropriately, and work professionally and ethically; and a culture of clinical governance.

  18. Dying in the arms of Dutch governmental authorities.

    Science.gov (United States)

    Kubat, B; Duijst, W; van de Langkruis, R; Thoonen, E

    2013-05-01

    Thorough investigation of deaths related to police actions or of persons placed under the 'care' of governmental authorities is anchored in the legal systems of every democratic system. The quality of this investigation should be guarded by an adequate set of control measures. Recently the Dutch Ombudsman published a report about this issue In the Netherlands no central registry of these deaths exists. The estimates based on the available data number some 400-500 deaths in custody in the past 10 years in the Netherlands of which only in 193 cases a legal postmortem was performed. We present an overview of these cases and discuss the present Dutch practice in the perspective of national and international legislation.

  19. Diagnosis and management of non-criteria obstetric antiphospholipid syndrome.

    Science.gov (United States)

    Arachchillage, Deepa R Jayakody; Machin, Samuel J; Mackie, Ian J; Cohen, Hannah

    2015-01-01

    Accurate diagnosis of obstetric antiphospholipid syndrome (APS) is a prerequisite for optimal clinical management. The international consensus (revised Sapporo) criteria for obstetric APS do not include low positive anticardiolipin (aCL) and anti β2 glycoprotein I (aβ2GPI) antibodies (pregnancy morbidity, particularly recurrent pregnancy loss, suggest that elimination of aCL and/or IgM aβ2GPI, or low positive positive aCL or aβ2GPI from APS laboratory diagnostic criteria may result in missing the diagnosis in a sizeable number of women who could be regarded to have obstetric APS. Such prospective and retrospective studies also suggest that women with non-criteria obstetric APS may benefit from standard treatment for obstetric APS with low-molecular-weight heparin plus low-dose aspirin, with good pregnancy outcomes. Thus, non-criteria manifestations of obstetric APS may be clinically relevant, and merit investigation of therapeutic approaches. Women with obstetric APS appear to be at a higher risk than other women of pre-eclampsia, placenta-mediated complications and neonatal mortality, and also at increased long-term risk of thrombotic events. The applicability of these observations to outcomes in women with non-criteria obstetric APS remains to be determined.

  20. 21st European Congress of Obstetrics and Gynaecology

    DEFF Research Database (Denmark)

    Hornnes, Peter

    2010-01-01

    The 21st European Congress of Obstetrics and Gynaecology took place in Antwerp 5-8 May 2010. The congress provided the participants with an overview of recent scientific and clinical developments throughout the field of obstetrics and gynaecology, and these are summarized in this article....

  1. Experiences of family medicine residents in primary care obstetrics training.

    Science.gov (United States)

    Koppula, Sudha; Brown, Judith Belle; Jordan, John M

    2012-03-01

    Obstetrical practice by family physicians has been declining rapidly for many reasons over the past number of decades. One reason for this trend is family medicine residents not considering intrapartum care as part of their future careers. Decisions such as this may be related to experiences during obstetrical training. This study explored the experiences of family medicine residents in core primary care obstetrics training. Using qualitative approaches, focus groups of family medicine residents were conducted. The resulting data were audiotaped and transcribed verbatim. Independent and team analysis was both iterative and interpretive. Data obtained from the focus groups revealed findings relating to the following categories: (1) perceived facilitators to practicing primary care obstetrics, (2) perceived barriers to practicing primary care obstetrics, and (3) learner experiences at the fulcrum of career decision making. Family medicine residents were encouraged by favorable learning experiences and group shared-call arrangements by their primary care obstetrics preceptors. Some concerns about a career including obstetrics persisted; however, positive experiences, including influential fulcrum points, may inspire family medicine residents to pursue a career involving primary care obstetrics.

  2. Obstetrical Complications and Violent Delinquency: Testing Two Developmental Pathways.

    Science.gov (United States)

    Arseneault, Louise; Tremblay, Richard E.; Boulerice, Bernard; Saucier, Jean-Francois

    2002-01-01

    Assessed interaction between obstetrical complications and early family adversity in predicting violent behavior during childhood and adolescence among 849 boys from low SES areas. Found that elevated scores on scale of obstetrical complications (preeclampsia, umbilical cord prolapse, induced labor) increased risk of being violent at 6 and 17…

  3. Determining Optimal Allocation of Naval Obstetric Resources with Linear Programming

    Science.gov (United States)

    2013-12-01

    NHCP Naval Hospital Camp Pendleton NICU neonatal intensive care unit NMCP Naval Medical Center Portsmouth NMCSD Naval Medical Center San Diego... obstetric care that meets the delivery volume of specific facilities as well as the standards and vision of BUMED. Furthermore, optimum staffing... obstetric care to include, but not limited to, the following services: hospitalization for labor, delivery, and postpartum care ; anesthesia; cesarean

  4. 21st European Congress of Obstetrics and Gynaecology

    DEFF Research Database (Denmark)

    Hornnes, Peter

    2010-01-01

    The 21st European Congress of Obstetrics and Gynaecology took place in Antwerp 5-8 May 2010. The congress provided the participants with an overview of recent scientific and clinical developments throughout the field of obstetrics and gynaecology, and these are summarized in this article....

  5. Obstetric emergencies in primary midwifery care In The Netherlands

    NARCIS (Netherlands)

    Smit, Marrit

    2014-01-01

    In this thesis, the primary aim was to gain insight into management of obstetric emergencies occurring in primary midwifery care in the Netherlands. Secondly, we aimed to develop preventative strategies and tools to optimise care in case of an obstetric emergency. From 2008-2010, a unique dataset of

  6. The Changing Scenario of Obstetrics and Gynecology Residency Training

    Science.gov (United States)

    Gupta, Natasha; Dragovic, Kristina; Trester, Richard; Blankstein, Josef

    2015-01-01

    Background Significant changes have been noted in aspects of obstetrics-gynecology (ob-gyn) training over the last decade, which is reflected in Accreditation Council for Graduate Medical Education (ACGME) operative case logs for graduating ob-gyn residents. Objective We sought to understand the changing trends of ob-gyn residents' experience in obstetric procedures over the past 11 years. Methods We analyzed national ACGME procedure logs for all obstetric procedures recorded by 12 728 ob-gyn residents who graduated between academic years 2002–2003 and 2012–2013. Results The average number of cesarean sections per resident increased from 191.8 in 2002–2003 to 233.4 in 2012–2013 (17%; P obstetric logs demonstrated decreases in volume of vaginal, forceps, and vacuum deliveries, and increases in cesarean and multifetal deliveries. Change in experience may require use of innovative strategies to help improve residents' basic obstetric skills. PMID:26457146

  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. The economic impact of rural family physicians practicing obstetrics.

    Science.gov (United States)

    Avery, Daniel M; Hooper, Dwight E; McDonald, John T; Love, Michael W; Tucker, Melanie T; Parton, Jason M

    2014-01-01

    The economic impact of a family physician practicing family medicine in rural Alabama is $1,000,000 a year in economic benefit to the community. The economic benefit of those rural family physicians practicing obstetrics has not been studied. This study was designed to determine whether there was any added economic benefit of rural family physicians practicing obstetrics in rural, underserved Alabama. The Alabama Family Practice Rural Health Board has funded the University of Alabama Family Medicine Obstetrics Fellowship since its beginning in 1986. Family medicine obstetrics fellowship graduates who practice obstetrics in rural, underserved areas were sent questionnaires and asked to participate in the study. The questions included the most common types and average annual numbers of obstetrics/gynecological procedures they performed. Ten physicians, or 77% of the graduates asked to participate in the study, returned the questionnaire. Fourteen common obstetrics/gynecological procedures performed by the graduates were identified. A mean of 115 deliveries were performed. The full-time equivalent reduction in family medicine time to practice obstetrics was 20%. A family physician practicing obstetrics in a rural area adds an additional $488,560 in economic benefit to the community in addition to the $1,000,000 from practicing family medicine, producing a total annual benefit of $1,488,560. The investment of $616,385 from the Alabama Family Practice Rural Health Board resulted in a $399 benefit to the community for every dollar invested. The cumulative effect of fellowship graduates practicing both family medicine and obstetrics in rural, underserved areas over the 26 years studied was $246,047,120. © Copyright 2014 by the American Board of Family Medicine.

  10. Availability and access in modern obstetric care: a retrospective population-based study

    Science.gov (United States)

    Engjom, HM; Morken, N-H; Norheim, OF; Klungsøyr, K

    2014-01-01

    Objective To assess the availability of obstetric institutions, the risk of unplanned delivery outside an institution and maternal morbidity in a national setting in which the number of institutions declined from 95 to 51 during 30 years. Design Retrospective population-based, three cohorts and two cross-sectional analyses. Setting Census data, Statistics Norway. The Medical Birth Registry of Norway from 1979 to 2009. Population Women (15–49 years), 2000 (n = 1 050 269) and 2010 (n = 1 127 665). Women who delivered during the period 1979–2009 (n = 1 807 714). Methods Geographic Information Systems software for travel zone calculations. Cross-table and multiple logistic regression analysis of change over time and regional differences. World Health Organization Emergency Obstetric and Newborn Care (EmOC) indicators. Main outcome measures Proportion of women living outside the 1-hour travel zone to obstetric institutions. Risk of unplanned delivery outside obstetric institutions. Maternal morbidity. Results The proportion of women living outside the 1-hour zone for all obstetric institutions increased from 7.9% to 8.8% from 2000 to 2010 (relative risk, 1.1; 95% confidence interval, 1.11–1.12), and for emergency obstetric care from 11.0% to 12.1% (relative risk, 1.1; 95% confidence interval, 1.09–1.11). The risk of unplanned delivery outside institutions increased from 0.4% in 1979–83 to 0.7% in 2004–09 (adjusted odds ratio, 2.0; 95% confidence interval, 1.9–2.2). Maternal morbidity increased from 1.7% in 2000 to 2.2% in 2009 (adjusted odds ratio, 1.4; 95% confidence interval, 1.2–1.5) and the regional differences increased. Conclusions The availability of and access to obstetric institutions was reduced and we did not observe the expected decrease in maternal morbidity following the centralisation. PMID:24283373

  11. Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations

    Science.gov (United States)

    Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

    2009-01-01

    Introduction: We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and…

  12. Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations

    Science.gov (United States)

    Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

    2009-01-01

    Introduction: We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and…

  13. Complicated deliveries, critical care and quality in emergency obstetric care in Northern Tanzania.

    Science.gov (United States)

    Olsen, Ø E; Ndeki, S; Norheim, O F

    2004-10-01

    Our objective was to determine the availability and quality of obstetric care to improve resource allocation in northern Tanzania. We surveyed all facilities providing delivery services (n=129) in six districts in northern Tanzania using the UN Guidelines for monitoring emergency obstetric care (EmOC). The three last questions in this audit outline are examined: Are the right women (those with obstetric complications) using emergency obstetric care facilities (Met Need)? Are sufficient quantities of critical services being provided (cesarean section rate (CSR))? Is the quality of the services adequate (case fatality rate (CFR))? Complications are calculated using Plan 3 of the UN Guidelines to assess the value of routine data for EmOC indicator monitoring. Nearly 60% of the expected complicated deliveries in the study population were conducted at EmOC qualified health facilities. 81.2% of the expected complicated deliveries are conducted in any facility (including facilities not qualifying as EmOC facilities). There is an inadequate level of critical services provided (CSR 4.6). Voluntary agencies provide most of these services in rural settings. All indicators show large variations with the setting (urban/rural location, level and ownership of facilities). Finally, there is large variation in the CFR with only one facility meeting the minimum accepted level. Utilization and quality of critical obstetric services at lower levels and in rural districts must be improved. The potential for improving the resource allocation within lower levels of the health care system is discussed. Given the small number of qualified facilities yet relatively high Met Need, we argue that it is neither the mothers' ignorance nor their lack of ability to get to a facility that is the main barrier to receiving quality care when needed, but rather the lack of quality care at the facility. Little can be concluded using the CFR to describe the quality of services provided.

  14. Summary of the Dutch S3-guidelines on the treatment of psoriasis 2011. Dutch Society of Dermatology and Venereology.

    Science.gov (United States)

    Zweegers, J; de Jong, E M G J; Nijsten, T E C; de Bes, J; te Booij, M; Borgonjen, R J; van Cranenburgh, O D; van Deutekom, H; van Everdingen, J J E; de Groot, M; Van Hees, C L M; Hulshuizen, H; Koek, M B G; de Korte, W J A; de Korte, J; Lecluse, L L A; Pasch, M C; Poblete-Gutiérrez, P A; Prens, E P; Seyger, M M B; Thio, H B; Torcque, L A; de Vries, A C Q; van de Kerkhof, P C M; Spuls, Ph I

    2014-03-17

    This document provides a summary of the Dutch S3-guidelines on the treatment of psoriasis. These guidelines were finalized in December 2011 and contain unique chapters on the treatment of psoriasis of the face and flexures, childhood psoriasis as well as the patient's perspective on treatment. They also cover the topical treatment of psoriasis, photo(chemo)therapy, conventional systemic therapy and biological therapy.

  15. OBSTETRICAL MORBIDITIES IN GENITAL TRACT INFECTION S

    Directory of Open Access Journals (Sweden)

    Sapna

    2013-05-01

    Full Text Available ABSTRACT: INTRODUCTION- Sub clinical ascending infections through the lower female genital tract are predominant worldwide. Important morbidit ies related to poor perinatal outcome both for the mother and for the fetus and new born compr ise preterm birth, prelabor rupture of membranes, post partum sepsis and maternal anaemia. In the fetus, sepsis and intrauterine growth retardation are suspected to be the consequences of ascending maternal infection. Both the direct effect of the infection and the maternal immune r esponse contribute to these eventualities. This study was done to identify antenatal women with va rious genital infections and to know the outcome of pregnancy in presence of these infection s. OBJECTIVES- Diagnosis treatment and preventive measures in genital infections in Antena tal period to improve the pregnancy out come . MATERIAL AND METHODS- One thousand women were studied for lower genital tract infection by ELISA KITS for chlamydia trachomatis, hanging dr op preparation of vaginal discharge for trichomoniasis and mycelia of candida albicans can be seen by wet mount of vaginal dischage in 10% KOH. Gardnerella vaginal infection was diagnose d by Amsel's criteria . RESULT- out of thousand women 53% were positive for single or mult iple infections (gp-1, 47% women had no infection (gp-11 . Labour outcome was studied in 4 15 antenatal women of gp -1 &395 antenatal women of gp -11 . In gp-1 51.80% had no effect ,7.7 1% had abortions and 40.48% had pre term labour and/or PROM .Which was significantly higher than in non infected group . IN INFECTED GROUP- 41.92% neonates had no effect others had some effec t in terms of LBW, birth asphyxia, neonatal death & IUD. Which was significantly highe r than in non infected group. P=0.00 CONCLUSION- The study showed significantly higher incidence of obstetrical morbidities in women with lower genital tract infection,since geni tal infections are the root cause of these obstetrical

  16. Globalisation of the National Judiciary and the Dutch Constitution

    Directory of Open Access Journals (Sweden)

    Elaine Mak

    2013-03-01

    Full Text Available This article examines the changing practices of the Dutch highest courts, the Hoge Raad and the Afdeling bestuursrechtspraak van de Raad van State, under the influence of globalisation, and the constitutional implications of this development. The increasing intertwinement of legal systems and the increasing possibilities for judges to interact with courts in foreign jurisdictions have stimulated the consideration of foreign legislation and case law in judicial decision-making in individual cases. An empirical study clarifies how the Dutch judges perceive the usefulness of legal comparisons in this context and how foreign law is used in deliberations and judgments. The constitutional implications of the changing practices of the courts are analysed in light of three aspects of the constitutional normative framework for judicial decision-making: the democratic justification of judicial decisions; legal tradition and the nature of cases; and the effectiveness and efficiency of judicial decision-making.

  17. In How Far is Elckerlijc Dutch? References to the Dutch Origin in the Polish Reception of the Middle Dutch Text

    Directory of Open Access Journals (Sweden)

    Dowlaszewicz Małgorzata

    2016-11-01

    Full Text Available The sixteenth-century morality play Elckerlijc is one of the few texts mentioned in almost all Dutch canon lists. It is no surprise that this is one of the few medieval Dutch texts transferred into different languages and cultures. There are two Polish texts based on it, the first from 1921 by Jarosław Iwaszkiewicz (Kwidam, the second from 1933 by Stanisław Helsztyński (Każdy (Everyman: średniowieczny moralitet angielski. The text was though never directly translated into Polish from Dutch. The main issue is whether these translations have influenced the image of Dutch literature in Poland. It appears that secondary literature has seen the plays of Iwaszkiewicz and Helsztyński only as transfer of German or English literature and ideas and that it is rarely known that the original story originates from the Netherlands.

  18. Obstetric use of nitroglycerin: Anesthetic implications

    Science.gov (United States)

    Saroa, Richa; Sachan, Shikha; Palta, Sanjeev; Gombar, Satinder; Sahai, Nitika

    2013-01-01

    Nitroglycerin has been used in anesthetic practice for induced hypotension and managing perioperative hypertension and myocardial ischemia. Contrary to the continuous low dose infusions (5-20 mcg/min) used for the same, intravenous bolus dosages are sometimes administered at the behest of obstetricians for removal of retained placenta. Use of nitroglycerine in managing retained placenta is undertaken as a last resort when other measures fail to relax the uterine smooth muscles. Intravenous nitroglycerine relaxes smooth muscle cells by releasing nitric oxide thus causing prompt cervico-uterine relaxation. However, administration of nitroglycerine in this manner is not without risks which should be kept in mind while using it for obstetric purposes. We hereby report a case of 22-year-old female scheduled for manual removal of placenta where unpredictable and unexpected hypoxemia was observed following nitroglycerine administration. PMID:24015145

  19. Obstetric use of nitroglycerin: Anesthetic implications

    Directory of Open Access Journals (Sweden)

    Richa Saroa

    2013-01-01

    Full Text Available Nitroglycerin has been used in anesthetic practice for induced hypotension and managing perioperative hypertension and myocardial ischemia. Contrary to the continuous low dose infusions (5-20 mcg/min used for the same, intravenous bolus dosages are sometimes administered at the behest of obstetricians for removal of retained placenta. Use of nitroglycerine in managing retained placenta is undertaken as a last resort when other measures fail to relax the uterine smooth muscles. Intravenous nitroglycerine relaxes smooth muscle cells by releasing nitric oxide thus causing prompt cervico-uterine relaxation. However, administration of nitroglycerine in this manner is not without risks which should be kept in mind while using it for obstetric purposes. We hereby report a case of 22-year-old female scheduled for manual removal of placenta where unpredictable and unexpected hypoxemia was observed following nitroglycerine administration.

  20. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. Our identification...... in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained...... by the introduction of experience-rated malpractice liability insurance. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences and difference-in-discontinuities analyses. We find...

  1. [Obstetrical handbook in comic strip form].

    Science.gov (United States)

    1998-04-01

    An obstetric handbook was created in comic strip form in cooperation with the Ministry of Health in the region of Segou, Mali, for training of traditional midwives living far from community health centers. The drawings illustrate pregnancies at risk that the midwife should be able to identify in order to advise women to stay near the health facility before onset of labor. Drawings indicate pregnancies that are at risk because of the following: small stature, limping as a result of polio or sciatic paralysis, high parity, prior cesarean delivery, heart disease, overly large uterus, or prior stillbirth. Serious complications requiring referral to a health service are also illustrated and include severe anemia, genital bleeding, and signs of toxemia and edema. The midwife should accompany the woman during transport.

  2. Obstetric hysterectomy, still a life saving tool in modern day obstetrics: a five year study

    Directory of Open Access Journals (Sweden)

    Neetu Singh

    2014-06-01

    Results: During the study period, 105 emergency obstetric hysterectomies were performed giving an incidence of 0.54% .The incidence of hysterectomy following vaginal delivery was 0.54% and that of caesarean hysterectomy was 2.08%. It was most common in the age group 26-35 years (66.66% and in women of parity 3-4 (71.42%.Rupture uterus was the most common indication accounting for 59.04% cases followed by Atonic PPH (18.09%. Febrile illness and wound infection were the two most common co-morbidities. Maternal mortality was 5.71%. Conclusions: Emergency obstetric hysterectomy is potentially a life saving procedure which every obstetrician must be familiar with in cases of catastrophic rupture uterus and intractable haemorrhage. With the help of prostaglandins, modern policies of active management of labor, timely performance of caesarean section, internal iliac artery ligation, compression sutures etc. obstetric hysterectomy should be made a more rare procedure. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 540-543

  3. OBSTETRICS AND PSYCHOSOCIAL OUTCOME OF TEENAGE PREGNANCY

    Directory of Open Access Journals (Sweden)

    Seetesh

    2013-11-01

    Full Text Available Teenage pregnancy is defined as pregnancies which occur in a female below the age of 20 i.e. when the pregnancy ends. A female can become pregnant as early as two weeks before menarche, although rare, but usually occurs after menarche. In healthy, well - nourished girls, menarche normally takes place around the ages 12 or 13. A number of personal and social factors are responsible for the onset of biological fertility in a teenage. Teenage pregnanc y rates vary between countries because of differences in socio - economic status, traditional culture of early marriage, besides levels of sexual activity, general sex education provided and access to affordable contraceptive options. Worldwide, teenage preg nancy rates range from 143 per 1000 in some sub - Saharan African countries to 2.9 per 1000 in South Korea. ( 1(2 The World Health Organization estimates that the risk of death following pregnancy is twice as great for women between 15 and 19 years than for those between the ages of 20 and 24. The maternal mortality rate can be up to five times higher for girls aged between 10 and 14 than for women of about twenty years of age. Illegal abortion also holds many risks for teenage girls in areas such as sub - Saha ran Africa (3 In our country teenage marriages does take place and pregnancy usually occur after marriage, despite a law against early marriage. Teenage pregnancy is considered to be high - risk due to many reasons because during this period a woman is physio logically and psychologically as well not mature. Their body itself is in growing stage. So to support the growth of the foetus exposes them to additional challenges. Complications of pregnancy result in the deaths of an estimated 70,000 teen girls in deve loping countries each year. Complications they develop can be grouped into medical, obstetrical, psychological and social. This chapter will highlight obstetrical, psychological and social impact of the teenage pregnancy

  4. Patient Satisfaction with Virtual Obstetric Care.

    Science.gov (United States)

    Pflugeisen, Bethann Mangel; Mou, Jin

    2017-02-07

    Introduction The importance of patient satisfaction in US healthcare is increasing, in tandem with the advent of new patient care modalities, including virtual care. The purpose of this study was to compare the satisfaction of obstetric patients who received one-third of their antenatal visits in videoconference ("Virtual-care") compared to those who received 12-14 face-to-face visits in-clinic with their physician/midwife ("Traditional-care"). Methods We developed a four-domain satisfaction questionnaire; Virtual-care patients were asked additional questions about technology. Using a modified Dillman method, satisfaction surveys were sent to Virtual-care (N = 378) and Traditional-care (N = 795) patients who received obstetric services at our institution between January 2013 and June 2015. Chi-squared tests of association, t-tests, logistic regression, and ANOVA models were used to evaluate differences in satisfaction and self-reported demographics between respondents. Results Overall satisfaction was significantly higher in the Virtual-care cohort (4.76 ± 0.44 vs. 4.47 ± 0.59; p Virtual-care selection (OR = 2.4, 95% CI: 1.5-3.8; p Virtual-care respondents was not significantly impacted by the incorporation of videoconferencing, Doppler, and blood pressure monitoring technology into their care. The questionnaire demonstrated high internal consistency as measured by domain-based correlations and Cronbach's alpha. Discussion Respondents from both models were highly satisfied with care, but those who had selected the Virtual-care model reported significantly higher mean satisfaction scores. The Virtual-care model was selected by significantly more women who already have children than those experiencing pregnancy for the first time. This model of care may be a reasonable alternative to traditional care.

  5. Continuous Renal Replacement Therapy for Severe Obstetric Sepsis

    Directory of Open Access Journals (Sweden)

    D. L. Shukevich

    2010-01-01

    Full Text Available Objective: to improve the results of treatment for severe obstetric sepsis by pathogenetically founded continuous renal replacement therapies as extracorporeal homeostatic correction. Subjects and methods. Forty-two women with severe abdominal sepsis were divided into 3 groups: 1 14 women with severe extragenital abdominal sepsis who received standard intensive care (a control group; 2 12 women with severe obstetric sepsis who had standard intensive care (a study group; 3 16 with severe obstetric sepsis who had the standard intensive care supplemented with continuous renal replacement therapy (an intervention group. Results. In Group 2, endogenous intoxication and multiple organ dysfunction were controlled later than in Group 1, mortality rates being 41.7 and 7.1%, respectively. Clinical laboratory differences were due to gestosis recorded in 100% of the patients with severe obstetric sepsis. When continuous renal replacement therapy was incorporated into the complex therapy of severe obstetric sepsis, there was a prompter regression of endogenous intoxication and multiple organ dysfunction, mortality was decreased by an average of 35% as compared with that during standard therapy. Conclusion. The inclusion of continuous renal replacement therapy into the complex treatment program for severe obstetric sepsis made it possible to reduce control time _ for endogenous intoxication and multiple organ dysfunction and to decrease mortality by an average of 35% as compared with that during standard intensive care. Key words: obstetric sepsis, abdominal sepsis, gestosis, endogenous intoxication, multiple organ dysfunction, renal replacement therapy.

  6. Using Web-Based Questionnaires and Obstetric Records to Assess General Health Characteristics Among Pregnant Women: A Validation Study.

    Science.gov (United States)

    van Gelder, Marleen M H J; Schouten, Naomi P E; Merkus, Peter J F M; Verhaak, Chris M; Roeleveld, Nel; Roukema, Jolt

    2015-06-16

    Self-reported medical history information is included in many studies. However, data on the validity of Web-based questionnaires assessing medical history are scarce. If proven to be valid, Web-based questionnaires may provide researchers with an efficient means to collect data on this parameter in large populations. The aim of this study was to assess the validity of a Web-based questionnaire on chronic medical conditions, allergies, and blood pressure readings against obstetric records and data from general practitioners. Self-reported questionnaire data were compared with obstetric records for 519 pregnant women participating in the Dutch PRegnancy and Infant DEvelopment (PRIDE) Study from July 2011 through November 2012. These women completed Web-based questionnaires around their first prenatal care visit and in gestational weeks 17 and 34. We calculated kappa statistics (κ) and the observed proportions of positive and negative agreement between the baseline questionnaire and obstetric records for chronic conditions and allergies. In case of inconsistencies between these 2 data sources, medical records from the woman's general practitioner were consulted as the reference standard. For systolic and diastolic blood pressure, intraclass correlation coefficients (ICCs) were calculated for multiple data points. Agreement between the baseline questionnaire and the obstetric record was substantial (κ=.61) for any chronic condition and moderate for any allergy (κ=.51). For specific conditions, we found high observed proportions of negative agreement (range 0.88-1.00) and on average moderate observed proportions of positive agreement with a wide range (range 0.19-0.90). Using the reference standard, the sensitivity of the Web-based questionnaire for chronic conditions and allergies was comparable to or even better than the sensitivity of the obstetric records, in particular for migraine (0.90 vs 0.40, P=.02), asthma (0.86 vs 0.61, P=.04), inhalation allergies (0

  7. Persistent Identifiers for Dutch cultural heritage institutions

    Science.gov (United States)

    Ras, Marcel; Kruithof, Gijsbert

    2016-04-01

    subject of persistent identifiers, (2) develop a business model for a persistent identifier service especially for smaller CH organisations, and (3) set up some show cases. Some of the products delivered by the project in 2016 will be: (1) a business model for a persistent identifier service based on an affordable co-financing model (2) a technical implementation of a persistent identifier service based on one of the existing PI models (3) a general agreement with suppliers of collection management systems and record management systems used by cultural heritage institutions in The Netherlands (4) a decision tree for cultural heritage organisations which can guide them through the process of selecting a particular type of Persistent Identifier (Handle, DOI, ARK or NBN:URN) (5) a technical implementation help function In the presentation we will explain the collaborative work carried out in The Netherlands within the framework of the NDE Network, focusing on the Persistent Identifiers project. We will present our preliminary results on communication strategy, business model and decision tree. And we will speak about the discussions we have with the commercial vendors of record management systems in order to built-in facilities for persistent identifiers in the systems used by the Dutch cultural heritage organisations.

  8. Teaching maternity care in family medicine residencies: what factors predict graduate continuation of obstetrics? A 2013 CERA program directors study.

    Science.gov (United States)

    Sutter, Mary Beth; Prasad, Ramakrishna; Roberts, Mary B; Magee, Susanna R

    2015-06-01

    Maternity care is an essential component of family medicine, yet the number of residency graduates providing this care continues to decline. Residency programs have struggled to identify strategies to increase continuation of obstetric practice among graduates. Leaders in family medicine obstetrics previously proposed a tiered model of training to ensure adequate volume for those desiring to continue maternity care upon graduation. However, whether this approach will be successful is unknown. This study aimed to identify program characteristics and teaching methods that may influence residents to continue obstetrics practice upon graduation. A nationwide survey of family medicine residency program directors (PDs) was conducted as part of the 2013 CERA survey to characterize teaching in maternity care and identify program-level predictors of graduate continuation of obstetrics (OB). Family medicine programs, which were community-based, university-affiliated programs in the Midwest and West, contributed more trainees who continued to provide OB care upon graduation. Trainees at these programs received greater supervision by family medicine faculty preceptors on labor and delivery, reported at least 80 deliveries by graduates during residency, and experienced greater autonomy in decision-making during OB rotations. This study supports a targeted approach to teaching maternity care in family medicine residency programs. Prioritizing continuity delivery experiences and fostering resident independence are strategies toward promoting increased provision of obstetric care by family medicine graduates. Further research is needed to evaluate the impact of tiered or track systems in practice.

  9. Present readiness of and white spots in the Dutch National System for greenhouse gas reporting of the Land Use, Land-Use Change and Forestry sector (LULUCF)

    Energy Technology Data Exchange (ETDEWEB)

    Nabuurs, G.J.; Dirkse, G.M.; Kuikman, P.J. [Alterra, Green World Research, Wageningen (Netherlands); Daamen, W. [Bureau Daamen, Kesteren (Netherlands); Paasman, J. [Institute for Forests and Forest Products, Wageningen (Netherlands); Verhagen, A. [Plant Research International, Wageningen (Netherlands)

    2003-07-01

    Current LULUCF greenhouse gas reporting by the Netherlands is incomplete. The few sections that are included in the current reporting are done at lower Tiers. Thirty nine existing monitoring systems or databases were identified as possibly relevant for setting up a national system. The systems are grouped as follows : (1) systems for land use and area (mapping), including soil maps:13; (2) data on agricultural and forestry practices that may serve to derive emission factors: 16; (3) data on emission factors including weather and groundwater data: 8; (4) modelling systems: 2. Based on the identified existing systems, the report concludes on the main discrepancies between the ongoing reporting/current monitoring systems and the requirements as set out by the Marrakesh Accords and the 1st draft of the Good Practice Guidance.

  10. Ultrasound in obstetric anaesthesia: a review of current applications.

    LENUS (Irish Health Repository)

    Ecimovic, P

    2010-07-01

    Ultrasound equipment is increasingly used by non-radiologists to perform interventional techniques and for diagnostic evaluation. Equipment is becoming more portable and durable, with easier user-interface and software enhancement to improve image quality. While obstetric utilisation of ultrasound for fetal assessment has developed over more than 40years, the same technology has not found a widespread role in obstetric anaesthesia. Within the broader specialty of anaesthesia; vascular access, cardiac imaging and regional anaesthesia are the areas in which ultrasound is becoming increasingly established. In addition to ultrasound for neuraxial blocks, these other clinical applications may be of value in obstetric anaesthesia practice.

  11. Subjective Oral Health in Dutch Adults

    Directory of Open Access Journals (Sweden)

    Gijsbert H.W. Verrips

    2013-05-01

    Full Text Available Aim: To determine whether the subjective oral health (SOH of the Dutch adult population was associated with clinical and demographic variables. Methods: A clinical examination was conducted in a sample of 1,018 people from the Dutch city of ‘s-Hertogenbosch. SOH was measured using the Dutch translation of the short form of the Oral Health Impact Profile (OHIP-NL14. Results: The average score on the OHIP-NL14 was 2.8 ± 5.9 and 51% of the respondents had a score of 0. Dental status was the most important predictor of SOH. Conclusions:  The SOH in the Dutch adult population was much better than in groups of adults in Australia, the United Kingdom and New Zealand. Nevertheless, there were important variations in SOH related to dental and socio-economic status.

  12. Development concept for Dutch user support

    Science.gov (United States)

    Pronk, C. N. A.; Koopman, N.; Dehoop, D.

    1992-06-01

    The main development approaches and some technologies developed in support of the different objectives of the Dutch Utilization Center (DUC) are reported. The DUC acts as a point of coordination of Dutch user support activities. The support needs of the user are analyzed and from there the required support efforts of the entities in the Dutch User Support Organization (DUSO) are activated. The main objectives of the DUSO are to promote the availability of the Columbus Space Station infrastructure among potential Dutch users, and to assist the users during the process of experiment definition, development, execution, and results evaluation. The DUSO support activities cover promotion and familiarization, and administrative, scientific, technical, and operational support to microgravity and space experimentation. The DUC developmental approaches consist of two approaches: a top down or formal approach; and a bottom up approach.

  13. Obstetric Brachial Plexus Palsy in the Context of Early Physical Rehabilitation

    OpenAIRE

    2014-01-01

    Cuban health system currently promotes prenatal testing and monitoring of pregnancy; nevertheless obstetric brachial plexus palsy remains an unfortunate consequence of a difficult delivery and is one of the most common birth trauma. Traditionally, its treatment has been conservative, based on multidisciplinary monitoring and consultations with various specialists to deal with the consequences. After conducting an extensive literature review, we discussed in this paper the etiology, anatomy, p...

  14. Shaping Collective Functions in Privatized Agricultural Knowledge and Information Systems: The Positioning and Embedding of a Network Broker in the Dutch Dairy Sector

    NARCIS (Netherlands)

    Klerkx, L.W.A.; Leeuwis, C.

    2009-01-01

    This paper examines new organizational arrangements that have emerged in the context of a privatized extension system. It investigates the positioning and embedding of a network broker aimed at enhancing interaction in the privatized agricultural knowledge and information system (AKIS), to assess wh

  15. Diagnosis summary and coding of obstetric conditions in the government hospitals in Pattalung Province, the effects of audit and feedback.

    Science.gov (United States)

    Wittayawarawat, Worapin; Liabsuetrakul, Tippawan; Tassee, Sathana

    2007-02-01

    Assess the effects of audit and feedback through a seminar on the obstetric summary and coding system with respect to the International Classification of Diseases, Tenth Revision (ICD-10) and to determine factors associated with the error of summary and coding audit. The medical records of 1,629 and 1,337 women with obstetric conditions admitted to one provincial and nine district hospitals in Pattalung Province, Southern Thailand, were evaluated before and after a seminar, respectively. The error of coding audit among cases with normal conditions and those with abnormal conditions after the seminar was reduced significantly from 40.7 to 13.0% and from 81.8% to 61.2%, respectively (p audit and feedback was moderately effective on summary and coding audit but the clinical significance of error reduction in abnormal obstetric conditions was marginal, thus intensive intervention, evaluation, and monitoring are necessary.

  16. Ethnic identity, externalizing problem behaviour and the mediating role of self-esteem among Dutch, Turkish-Dutch and Moroccan-Dutch adolescents

    NARCIS (Netherlands)

    Wissink, I.B.; Deković, M.; Yağmur, S.; Stams, G.J.; de Haan, M.

    2008-01-01

    The present study examined whether self-esteem mediates the relationship between two aspects of ethnic identity (i.e. ethnic identity exploration and ethnic identity commitment-affirmation) and externalizing problem behaviour in Dutch, Turkish-Dutch and Moroccan-Dutch adolescents living in the

  17. Ethnic identity, externalizing problem behaviour and the mediating role of self-esteem among Dutch, Turkish-Dutch and Moroccan-Dutch adolescents

    NARCIS (Netherlands)

    Wissink, I.B.; Deković, M.; Yağmur, S.; Stams, G.J.; de Haan, M.

    2008-01-01

    The present study examined whether self-esteem mediates the relationship between two aspects of ethnic identity (i.e. ethnic identity exploration and ethnic identity commitment-affirmation) and externalizing problem behaviour in Dutch, Turkish-Dutch and Moroccan-Dutch adolescents living in the Nethe

  18. Dutch social housing sector reforms: Exploring the effects on low income households

    NARCIS (Netherlands)

    De Groen, A.; Pruyt, E.; Boumeester, H.J.F.M.

    2012-01-01

    Social rental housing ought to function as safety net for the lower income groups in the housing system. However, the Dutch housing system has a relatively large social housing stock in relation to other housing systems in Europe – larger than would be required for a safety net for lower income grou

  19. [At the limits of viability: Dutch referral policy for premature birth too reserved].

    Science.gov (United States)

    Gerrits-Kuiper, J A; de Heus, R; Bouwers, H A A; Visser, G H A; den Ouden, A L; Kolleé, L A A

    2008-02-16

    Evaluation of policy and treatment of deliveries at the limits of viability in the Netherlands and resulting survival figures. Cohort study. Within the framework of the European 'Models of organising access to intensive care for very preterm births in Europe' (MOSAIC) study, data was collected on all 512 births in 2003 (terminations excluded) following 22-31 weeks gestation in the catchment areas of the perinatal centres in Nijmegen and Utrecht, the Netherlands. Gynaecologists and neonatologists practised a reserved policy for the active treatment of pregnancies under 25 weeks (5/77; 6%); all infants died. At 25 weeks, an active obstetric policy was used in one quarter of pregnancies, but none of the infants survived. Even at 26 weeks pregnancy, the obstetric policy was reserved and the mortality relatively high (9/31; 29%). From the neonatal deaths, 86 out of 92 (93%) were preceded by a decision either not to start or to discontinue treatment. Dutch obstetricians and neonatologists practised a reserved policy at the limits of neonatal viability. There is more need for active antenatal transfer to perinatal centres for those at the lower limit of neonatal viability to enable well-balanced decisions to take place. The parents' wishes should always be taken into account.

  20. Obstetric Complications Tied to Slightly Upped Risk for Autism

    Science.gov (United States)

    ... Obstetric Complications Tied to Slightly Upped Risk for Autism Study suggests link, but one expert stressed that most complicated pregnancies result in babies without autism To use the sharing features on this page, ...

  1. Obstetric hysterectomy: a retrospective study at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Anjali Kanhere

    2013-08-01

    Conclusions: Obstetric hysterectomy is a lifesaving procedure. The outcome depends on timely decision, good clinical judgement and professional surgical technique. It reduces maternal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 562-565

  2. Knowledge and Utilization of the Partograph among obstetric care ...

    African Journals Online (AJOL)

    elearning

    This cross-sectional study assessed knowledge and utilization of the ... Correspondence: Dr. Fawole AO Department of Obstetrics & Gynaecology, University College Hospital, Ibadan,. Nigeria. .... was 0% while modal score for Physicians was.

  3. Old primips and big babies; Changing the art of obstetrics

    LENUS (Irish Health Repository)

    Flood, K

    2011-02-01

    Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting Junior Obstetrics & Gynecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Matenity Hospitals Report Meeting Friday 26th Nov 2010

  4. Obstetric outcome with low molecular weight heparin therapy during pregnancy.

    LENUS (Irish Health Repository)

    Donnelly, J

    2012-01-01

    This was a prospective study of women attending a combined haematology\\/obstetric antenatal clinic in the National Maternity Hospital (2002-2008). Obstetric outcome in mothers treated with low molecular weight heparin (LMWH) was compared to the general obstetric population of 2006. There were 133 pregnancies in 105 women. 85 (63.9%) received prophylactic LMWH and 38 (28.6%) received therapeutic LMWH in pregnancy. 10 (7.5%) received postpartum prophylaxis only. The perinatal mortality rate was 7.6\\/1000 births. 14 (11.3%) women delivered preterm which is significantly higher than the hospital population rate (5.7%, p<0.05). Despite significantly higher labour induction rates (50% vs 29.2% p<0.01), there was no difference in CS rates compared to the general hospital population (15.4% vs 18.9%, NS). If carefully managed, these high-risk women can achieve similar vaginal delivery rates as the general obstetric population.

  5. [110 years--University Obstetrics and Gynecology Hospital "Maichin dom"].

    Science.gov (United States)

    Zlatkov, V

    2014-01-01

    The first specialized Obstetrics and Gynecology Hospital in Bulgaria was founded based on the idea of Queen Maria Luisa (1883). Construction began in 1896 and the official opening of the hospital took place on November 19, 1903. What is unique about the University Obstetrics and Gynecology Hospital "Maichin dom" is above all the fact that the Bulgarian school of obstetrics and gynecology was founded within its institution. Currently, the hospital has nearly 400 beds and 600 employees who work at nine clinics and six laboratories, covering the entire spectrum of obstetric and gynecological activities. Its leading specialists still continue to embody the highest level of professionalism and dedication. The future development of the hospital is chiefly associated with the renovation of facilities, resources and equipment and with the enhancement of the professional competence of the staff and of the quality of hospital products to improve the health and satisfaction of the patients.

  6. Inconsistencies in clinical guidelines for obstetric anaesthesia for Caesarean section

    DEFF Research Database (Denmark)

    Winther, Lars; Mitchell, A U; Møller, Ann

    2013-01-01

    Anaesthetists need evidence-based clinical guidelines, also in obstetric anaesthesia. We compared the Danish, English, American, and German national guidelines for anaesthesia for Caesarean section. We focused on assessing the quality of guideline development and evaluation of the guidelines...

  7. Uterine rupture an obstetrics catastrophy; incidence, risk factors ...

    African Journals Online (AJOL)

    Uterine rupture an obstetrics catastrophy; incidence, risk factors, management ... at Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria. ... is 0.35% and the common risk factors include high parity, exposure to oxytocin in ...

  8. Screening for Chlamydia trachomatis in Low-Risk Obstetric Patients

    Directory of Open Access Journals (Sweden)

    Robert K. Gribble

    1994-01-01

    Full Text Available Objective: The purpose of this study was to evaluate the prevalence of Chlamydia trachomatis in our rural obstetric population and assess the appropriateness of selective vs. universal prenatal screening.

  9. male knowledge of danger signs of obstetric complications

    African Journals Online (AJOL)

    and cultural status in society. In addition to ... Keywords: Danger Signs in Pregnancy, Obstetric Complications, Male Knowledge ... documentation of this would be useful in designing ... Package for the Social Sciences version 16 with analysis.

  10. Guest Editorial The Obstetric Anaesthesia Special Interest Society ...

    African Journals Online (AJOL)

    , Z Farina, ... courses, educating the public on epidurals and pain relief in 30 languages ... The organisation will address interventions to improve outcomes, based primarily ... obstetric haemorrhage, and epidural and postoperative analgesia.

  11. Social implications of obstetric fistula: an integrative review.

    Science.gov (United States)

    Roush, Karen M

    2009-01-01

    Obstetric fistula is a devastating complication of obstructed labor that affects more than two million women in developing countries, with at least 75,000 new cases every year. Prolonged pressure of the infant's skull against the tissues of the birth canal leads to ischemia and tissue death. The woman is left with a hole between her vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal) or both, and has uncontrollable leakage of urine or feces or both. It is widely reported in scientific publications and the media that women with obstetric fistula suffer devastating social consequences, but these claims are rarely supported with evidence. Therefore, the true prevalence and nature of the social implications of obstetric fistula are unknown. An integrative review was undertaken to determine the current state of the science on social implications of obstetric fistula in sub-Saharan Africa.

  12. Obstetrical brachial plexus palsy (OBPP) outcome with conservative management

    NARCIS (Netherlands)

    Eng, GD; Binder, H; Getson, P; ODonnell, R

    1996-01-01

    Resurgence of neurosurgical intervention oi obstetrical brachial plexus palsy prompted our review of 186 patients evaluated between 1981 and 1993, correlating clinical examination, electrodiagnosis, and functional outcome with conservative management. Eighty-eight percent had upper brachial plexus p

  13. How do Turkish-Dutch Bilingual Children Interpret Pronouns and Reflexives in Dutch?

    NARCIS (Netherlands)

    van Koert, M.; Hulk, A.; Koeneman, O.; Weerman, F.; Cabrelli Amaro, J.; Judy, T.; Pascual y Cabo, D.

    2013-01-01

    This study compared the comprehension of Dutch reflexives (zichzelf 'SE-self') and pronouns (hem 'him') by Turkish-Dutch bilingual children (n=33) to the comprehension of English reflexives (himself) and pronouns (him) by Turkish-English bilingual children (n=39) documented by Marinis and Chondrogia

  14. Marxism and the 'Dutch miracle': the Dutch Republic and the transition-debate

    NARCIS (Netherlands)

    Brandon, P.

    2011-01-01

    The Dutch Republic holds a marginal position in the debate on the transition from feudalism to capitalism, despite its significance in the early stage of the development of global capitalism. While the positions of those Marxists who did consider the Dutch case range from seeing it as the first capi

  15. Marxism and the Dutch Miracle : The Dutch Republic and the transition debate

    NARCIS (Netherlands)

    Brandon, Pepijn

    2011-01-01

    The Dutch Republic holds a marginal position in the debate on the transition from feudalism to capitalism, despite its significance in the early stage of the development of global capitalism. While the positions of those Marxists who did consider the Dutch case range from seeing it as the first capi

  16. Dutch voices: exploring the role of oral history in Dutch secondary history teaching

    NARCIS (Netherlands)

    Huijgen, Tim; Holthuis, Paul; Trškan, Danijela

    2016-01-01

    Oral history may enhance students’ historical content knowledge, historical reasoning competencies, and motivation to learn history. However, little is known regarding the role of oral history in Dutch history education. This study therefore explores the role of oral history in Dutch history

  17. Dutch voices: exploring the role of oral history in Dutch secondary history teaching

    NARCIS (Netherlands)

    Huijgen, Tim; Holthuis, Paul; Trškan, Danijela

    2016-01-01

    Oral history may enhance students’ historical content knowledge, historical reasoning competencies, and motivation to learn history. However, little is known regarding the role of oral history in Dutch history education. This study therefore explores the role of oral history in Dutch history educati

  18. Mutual learning in Dutch-Moroccan and Dutch-Turkish municipal partnerships: window on the Netherlands

    NARCIS (Netherlands)

    van Ewijk, E.

    2012-01-01

    This paper focuses on mutual learning (learning by both involved parties) in Dutch-Moroccan and Dutch-Turkish municipal partnerships. This is particularly relevant as strengthening local governance is high on the agenda of both migrant source and destination countries and the body of knowledge on mu

  19. Obstetric risk indicators for labour dystocia in nulliparous women

    DEFF Research Database (Denmark)

    Kjaergaard, Hanne; Olsen, Jørn; Ottesen, Bent

    2008-01-01

    In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often...... do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria....

  20. [Husband's presence at childbirth in light of obstetric psychoprophylaxis].

    Science.gov (United States)

    Sioma-Markowska, Urszula; Sipiński, Adam; Majerczyk, Iwona; Selwet, Monika; Kuna, Anna; Machura, Mariola

    2004-01-01

    Contemporary obstetric psychoprophylaxis gives prospective parents wide opportunities to prepare to the pregnancy period and delivery. It is educationally-minded and points the importance to modify the life style, introduces exercises accompanied by the relative during the pregnancy and delivery. The survey portrays husband's--child father's role in obstetric psychoprophylaxis. The importance to continue the psychoprophylaxis in the delivery room was spotted in the survey, too. The continuation might be reached by close relative's presence.