ABSTRACT
OBJECTIVE: One of the spearheads of psychiatric healthcare in the Netherlands is hospital care for patients with a psychiatric comorbidity. In 2014, the Netherlands Psychiatric Association published ten field standards for Medical Psychiatric Units (MPUs). We catalogued healthcare in the Netherlands on the basis of these field standards. DESIGN: Telephone screening, followed by a questionnaire investigation. METHOD: In the period May-August 2015, psychiatrists in 90 hospitals in the Netherlands were approached by telephone with 4 screening questions. If the department complied with the screening criteria for an MPU, a structured interview comprising 51 questions followed. The interview script was tested against the field standards using the Delphi method. RESULTS: The screening identified 40 potential MPUs; 37 (92.5%) wards participated in the complete interview. CONCLUSION: MPUs are unevenly distributed across the country; care content is adequate, but education, tighter multidisciplinary cooperation and availability of somatic nursing expertise on every shift could improve care on MPUs. The departments should also pay more attention to care chain arrangements. The field standards are too stringent; these could be improved by defining 'essential care' and application of differentiated assessment of subcriteria.
Subject(s)
Delivery of Health Care , Health Services Accessibility , Mental Disorders/diagnosis , Psychiatry , Comorbidity , Humans , Netherlands , Psychiatry/standards , Surveys and QuestionnairesABSTRACT
To examine the effectiveness of liver transplantation (LTx) for the treatment of primary biliary cirrhosis (PBC) the actual survival of 30 PBC patients who received liver grafts was compared with predictions of what survival would have been without transplantation. Three models, based on Cox' regression analysis, were used. Two models were derived from survival of PBC patients in drug trials and the third from cirrhotic patients who did not receive transplants. Observed and expected survival were compared for a follow-up time of 7 years. After 1 year the difference in favour of LTx was small, but after 5 years survival with LTx exceeded all predicted survival probabilities without LTx. After 3 years every year of follow-up added about 0.3 years to expected survival gain per transplanted patient, resulting in 1.5 to 2.3 life-years gained at 7 years' follow-up, depending on the model used. The benefit was greatest for patients in Child-Pugh classes B and C. The consistency between the three models in their predictions supports the validity of the use of predictive models in the indirect assessment of LTx.
Subject(s)
Liver Cirrhosis, Biliary/mortality , Liver Transplantation/mortality , Models, Statistical , Actuarial Analysis , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Liver Cirrhosis, Biliary/surgery , Male , Middle Aged , Prognosis , Regression Analysis , Severity of Illness IndexABSTRACT
The liver transplantation programme of the University Hospital of Groningen, the Netherlands, was evaluated on behalf of the Dutch Sick Fund Council. From 1978 to 1987 561 patients were put forward for liver transplantation (LTX). During this period, 76 orthotopic liver transplants were carried out, 8 of which were retransplantations. Survival proved to depend on, among other things, diagnosis and age. One-year survival was 100% in children with biliary atresia and 60% in other diagnosis and age groups. The number of life-years gained by LTX depends on the stage of disease. After LTX the quality of life improves quickly. One year after LTX most survivors experience a virtually normal quality of life. The need of LTX in the Netherlands was estimated to be in the range of 25 to 69 transplantations on an annual basis. The annual supply of donor livers is expected to be about adequate. Costs amount to approx. Hfl 250,000.--per transplanted patient including costs of follow-up for up to five years. The cost-effectiveness ratio for all forms of cirrhosis was estimated at Hfl 47,000.--to 133,000.--per life year gained. The results of this first technology assessment on liver transplantation proved relevant for clinicians as well as health politicians.
Subject(s)
Liver Transplantation , Program Evaluation , Adolescent , Adult , Biliary Atresia/surgery , Child , Female , Humans , Liver Cirrhosis, Biliary/surgery , Male , Netherlands , Prognosis , Quality of Life , Reoperation , Tissue and Organ ProcurementABSTRACT
The net passive influx of Na+ and efflux of K+ (orthodirection) through the red blood cell membranes from spontaneously hypertensive rats (SHR) were observed to be significantly higher (p less than 0.05) than those of three strains of normotensive rats when the measurements were made at 4 degrees C. Similar comparative studies, carried out at 37 degrees C, in the absence or presence of ouabain, showed no difference in these fluxes through this membrane from SHR compared to those from Wistar-Kyoto (WKY) rats, one of the normotensive strains. A study was undertaken to determine the temperature at which the greater cation fluxes in SHR red blood cells occurred. The net fluxes of Na+ and K+ decreased as the temperature was reduced from 37 degrees to 15 degrees C, but a paradoxical increase in the fluxes was observed as the temperature was decreased from 15 degrees to 4 degrees C. Only with this temperature shift (15 degrees to 4 degrees C) was the increase in flux significantly greater in SHR than in WKY cells. Subsequent studies were designed to determine whether the difference in the transport systems of red blood cells of SHR and WKY could be observed in fluxes of these cations in either direction across the membrane. For "reverse direction" flux studies, red blood cells were loaded with Na+ (to 130 mEq/liter cell water) and depleted of K+ (to 30 mEq/liter cell water) by incubation with the ionophore monensin.(ABSTRACT TRUNCATED AT 250 WORDS)
