The windsor definition for hyperemesis gravidarum: A multistakeholder international consensus definition.

OBJECTIVE: To develop an international definition for hyperemesis gravidarum to assist in clinical diagnosis and harmonize hyperemesis gravidarum definition for study populations. STUDY DESIGN: A mixed-methods approach was used to identify potential hyperemesis gravidarum definition criteria (i.e. systematic review, semi-structured interviews and closed group sessions with patients and Project Steering Committee input). To reach consensus on the definition we used a web-based Delphi survey with two rounds, followed by a face-to-face consensus development meeting, held in Windsor UK, and a web-based consultation round, in which the provisional hyperemesis gravidarum definition was fed back to the stakeholders. Four stakeholder groups were identified 1) researchers; 2) women with lived experience of hyperemesis gravidarum and their families; 3) obstetric health professionals (obstetricians, gynecologists, midwives); and 4) other health professionals involved in care for women with hyperemesis gravidarum (general practitioners, dieticians, nurses). To reflect the opinions of the international community, stakeholders from countries in all global regions were invited to participate. RESULTS: Twenty-one identified potential criteria entered the Delphi survey. Of the 277 stakeholders invited, 178 completed round one, and 125 (70%) also completed round two. Twenty stakeholders attended the consensus development meeting, representing all stakeholder groups. The consultation round was completed by 96 (54%) stakeholders, of which 92% agreed with the definition as presented. The consensus definition for hyperemesis gravidarum consisted of: start of symptoms in early pregnancy (before 16 weeks gestational age); nausea and vomiting, at least one of which severe; inability to eat and/or drink normally; strongly limits daily living activities. Signs of dehydration were deemed contributory for the definition for hyperemesis gravidarum. CONCLUSIONS: The proposed definition for hyperemesis gravidarum will help clinical studies to achieve more uniformity, and ultimately increasing the value of evidence to inform patient care.

[Medical Psychiatric Units in the Netherlands: an investigation into distribution and quality]. / Medisch-psychiatrische units in Nederland.

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.

Estimated hospital health costs of chronic abdominal pain in the Netherlands.

UNLABELLED: aim: Calculation of the hospital costs of chronic abdominal pain in the Netherlands. DESIGN: Cross-sectional study. METHODS: We selected 'Diagnosis-Related Groups' (DRG) of disorders that are associated with chronic abdominal pain from a large teaching hospital and a tertiary referral centre. For each DRG we determined the percentage of patients that can present with abdominal pain. The total costs for both hospitals were calculated using the registered quantity of the DRGs. Each DRG was categorised by somatic and functional origin. The results were subsequently extrapolated to the entire Dutch population demanding hospital care for chronic abdominal pain. Finally, the percentage and associated costs were calculated for patients who had two or more separate diagnoses for chronic abdominal pain in the field of gastroenterology, gynaecology, internal medicine and urology. RESULTS: The yearly outpatient and (day) clinical health costs for patients with chronic abdominal pain in the Netherlands were approximately €623 million (gastroenterology €226 million; gynaecology €303 million; internal medicine €63 million; and urology €31 million). Of these diagnoses, 53.6% were related to functional disorders, which accounts for approximately €220 million per year. The yearly costs of patients who had at least two separate diagnoses within one year for chronic abdominal pain were estimated at €23.5 million per year. CONCLUSION: Chronic abdominal pain is a common problem that entails significant healthcare costs in the Netherlands of which functional diagnoses compromise a significant amount.