['Wrong beds', a continuous misunderstanding?]. / 'Verkeerde bedden', een blijvende misstand?

The run-off of hospital patients to nursing homes is insufficient. In the hospital that was examined 10% of the available beds were occupied by patients who belonged in nursing homes. In the region concerned 3% of the available nursing home beds would be sufficient to solve this problem. For human and financial considerations reservation of nursing beds for this purpose is to be preferred to the current temporary provision that labels the hospital bed financially as a nursing home bed.

Cholangiography during cholecystectomy: a plea for selective use.

Routine peroperative cholangiography was retrospectively studied in 376 patients who underwent elective cholecystectomy. Adequate cholangiograms were obtained in 325 patients using a C-arm image intensifier. Pre- and peroperative indications for common bile duct stones were correlated to the outcome of peroperative cholangiography. The sensitivity and specificity of the cholangiographic technique were 96 and 95 per cent respectively. A false-positive rate of 4.6% and a false-negative rate of 0.6% were found. No serious complications due to the method were observed. Peroperative cholangiography prevented unnecessary exploration of the common bile duct in 70 per cent of the patients with clinical indications for exploration. Abnormal cholangiograms were rare (0.8%) in the absence of clinical signs of stones in the bile ducts. These results demonstrate that selective rather than routine peroperative cholangiography should be performed.

[Visit to the emergency department: primary or secondary character?]. / EHBO-bezoek: eerste- of tweedelijnskarakter?

In a prospective study, 961 patients who came to the Emergency Department were registered and their cases were analysed on the basis of criteria drawn up in consultation with a group of general practitioners. Of this number 74% had presented themselves on their own initiative; 40% had been suffering from the complaint for some time. 66% of the patients who had not been referred and 60% of the total number could have been treated by their GP, at less expense for the National Health Service. It is worth considering for GPs on duty to make use of the facilities provided by the Emergency Departments of hospitals. This would increase patients' understanding of the function and the accessibility of Emergency Departments, enable GPs to work more efficiently and be cost effective.