[Working methods of ambulatory psychiatric emergency services in the Netherlands]. / Werkwijze van ambulante psychiatrische crisisdiensten in Nederland.

BACKGROUND: No recent information is available concerning the working methods of the ambulatory psychiatric emergency services in The Netherlands.
AIM: To obtain insight into the working methods of the ambulatory psychiatric emergency services.
METHOD: We performed a descriptive research.
RESULTS: Twenty of the 28 ambulatory psychiatric emergency services participated in our study (more than 71 %). The study revealed that some of the ambulatory psychiatric emergency services used differing procedures. However, all the services had a common target: they dealt with young people, adults and the elderly. In half of the organisations it was the community mental health nurse who initially went alone to visit a prospective patient. There are large differences in the number of face-to-face contacts made by emergency services and in the type of medication provided before the patient was taken by ambulance to a psychiatric hospital.
CONCLUSION: In our study we describe the working methods used by several of the ambulatory psychiatric emergency services in the Netherlands. However, our investigation produced only limited information because participating institutions were often unable to provide the information we requested and/or they did not record the methods they had used. More attention needs to be given to the best way of dealing with patients who already have an official 'emergency card'; in addition, more information is required about whether the medication used by the emergency services influenced the subsequent course of the treatment that a patient received. In view of the current situation certain important features of the emergency services such as the quality of care they provided remains underexposed.

[Drop-out from after-care following compulsory hospitalisation--how serious is the problem?]. / Drop-out na gedwongen opname--hoe groot is het probleem?

BACKGROUND: Little is known about the amount and quality of after-care provided for patients hospitalised as a result of a court authorisation. AIM: To obtain insight into the rate of drop-out from after-care and the quality of after-care. METHOD: In our study we included all patients in Rotterdam Rijnmond who, in the last 3 months of 2004, had been compulsorily hospitalised for at least one day by reason of a court authorisation. A retrospective study of patients' records let us ascertain whether drop-out from after-care occurred and let us check on the quality of the after-care provided. RESULTS: 214 patients were included. Of these, 33 (15.4%) dropped out of after-care. Prior to discharge, the drop-out group received an outpatient appointment at a local clinic less often and waited longer for their first appointment at that clinic than did the 'non-drop-out' group. The medical records of the drop-out group were less accurate and there was less cooperation between community care and clinical mental health care professionals. CONCLUSION: The quality of after-care can be improved if community care and clinical health care professionals cooperate more intensively in drawing up conditions for discharge and in arranging the transfer of patients from clinical care to community care. Further investigations are needed to find out whether these steps will have a beneficial effect on the drop-out percentage.

[References for evaluation instruments in quality assurance in rehabilitation--3. The EAM profile system--capacity and requirement profile as a decision aid in the tension field between (medical) rehabilitation and vocational integration]. / Hinweise auf Bewertungsinstrumente zur Qualitätssicherung in der Rehabilitation - Blatt 3. Das EAM-Profilsystem - Fähigkeits- und Anforderungsprofile als Entscheidungshilfe im Spannungsfeld zwischen (medizinischer) Rehabilitation und beruflicher Integration.

The EAM profile system is characterized by enabling comparison of a subject's abilities with the requirements present on the job. The article initially outlines the structure of the necessary abilities and/or requirements profiles, describes the assessment criteria used, and concludes by presenting a case example, showing that the question of individual employability and placement can be answered by acting upon profile comparison findings.

Estimated workplace protection factors for positive-pressure self-contained breathing apparatus.

An analytical model is presented that estimates the distribution of workplace protection factor (WPF) values for positive-pressure respirators. Input for the model is (1) the instantaneous facepiece pressure measured as a function of time and (2) the distribution of WPF values for a negative-pressure version of the respirator. As an example application, the model was applied to 57 measurements of facepiece pressure made in a previous National Institute for Occupational Safety and Health study called "Firesmoke." That study involved professional firefighters wearing positive-pressure self-contained breathing apparatus (SCBA). During Firesmoke, there were four donnings in which facepiece pressure momentarily went negative one or more times during use. The purpose of the effort described here was to assess the significance of these momentary, negative excursions in facepiece pressure. To that end, an analytical model was developed that estimates the ratio of the mass of contaminant that enters the facepiece during these negative excursions to that which would be expected to enter a negative-pressure respirator utilizing the same facepiece. Thus, the performance of a positive-pressure SCBA can be determined relative to the performance of a negative-pressure respirator with the same facepiece--either a negative-pressure SCBA or a negative pressure air-purifying respirator. The NIOSH-assigned protection factor (APF) for a negative-pressure full facepiece is 50; the APF for a positive-pressure SCBA is 10,000. The results of the application of this analytical model are consistent with the current NIOSH APF for a positive-pressure SCBA.

Antibodies formed against fibrin glue components and their circulatory relevance.

To elucidate the safety of fibrin glue application, antibody formation against fibrinogen and thrombin was studied in rabbits. The pathophysiology of developed antibodies was tested by an intravenous challenge with both components and by related blood pressure measurements. All fibrin glue-treated animals developed antibodies against both components. The quantity of antibodies against thrombin (20.4 mg/mL) was higher than the quantity against fibrinogen (0.38 mg/mL). The intravenous challenge with both components resulted in a significant and long-lasting blood pressure decrease to about 50% of the control values, indicating that these antibodies can induce circulatory disorders by antigen-antibody reaction, activation of the complement cascade, and liberation of histamine. Since rabbits promptly produce antibodies against antigenic material and humans do not, the results of this investigation suggest that fibrin glue should be used with caution in humans.