ABSTRACT
This article describes the history, development, and current position of Dutch foundations. In the past, the philanthropy sector and foundations initiated many nonprofit services in the Netherlands. Along with the growth of the welfare state, philanthropy was sidelined. Due to public funding, the pillarized Dutch nonprofit sector extended strongly. However, despite its large scale it shows a special feature. Most nonprofits are still privately governed institutions although publicly funded. In the 1980s, governmental budget cuts forced the nonprofits to embrace the market as income source. A dualistic model got dominancy or state or market. At the end of the 20th century, however, philanthropy revived and a new philanthropy sector emerged. The article addresses the issue of the role of philanthropy in changing (European) welfare states. Are we experiencing further marketization and privatization-toward a so-called Anglo-Saxon shareholder model-or are we seeing a continuation of the so-called Rhineland, multistakeholder model of government, market, and philanthropy?
ABSTRACT
AIM: Transumbilical Laparo-Endoscopic Single Site (LESS) surgery promises improved cosmesis, quick recovery, reduced postoperative pain and shorter length of hospital stay. Since only a simple umbilical incision is used, LESS surgery can be completed with segmental epidural anesthesia. This study describes the evolution of our technique of LESS cholecystectomy from a combination of spinal and epidural anesthesia to thoracic epidural alone and presents our experience with its safety, the observed morbidity, and the reported patient satisfaction. METHODS: In August 2009, a prospective evaluation of LESS cholecystectomy with regional anesthesia was undertaken. We recruited patients with chronic cholecystitis or symptomatic cholelithasis. Blood loss, operative time, complications, and length of hospital stay were measured. Preoperatively and 14 days postoperatively, outcome and symptom resolution were scored. RESULTS: Fifteen consecutive patients underwent LESS cholecystectomy; first with combined spinal-epidural (CSE), and then with thoracic epidural anesthesia alone. Immediate postoperative pain and discomfort were well tolerated. VAS scores upon admission to PACU were 0.4 (1.7±2.2). At postoperative day 14, the patients scored high values for "Satisfaction", 10 (10±1.0) and "Cosmesis", 10 (9.3±1.5). CONCLUSION: LESS cholecystectomy with epidural anesthesia can be undertaken safely. Patient satisfaction and cosmesis are particularly prominent amongst our patients. Our experience supports further utilization of epidural anesthesia for selected patients undergoing LESS cholecystectomy.
