[Relationship between volume and quality of care for surgical interventions; results of a literature review]. / Verband tussen volume en kwaliteit van zorg bij heelkundige ingrepen; resultaten van een literatuuronderzoek.

OBJECTIVE: To examine the relationship between the number of procedures performed per hospital or per surgeon and health care outcomes. DESIGN: Literature review. METHOD: Relevant literature was identified using recent systematic reviews from Germany, England, France and the United States. The Cochrane Library, Medline and Embase were also searched for recent studies (2000-2005) published in German, English, French, or Dutch using the combined search terms 'surgery' and 'volume'; included studies reported mortality or morbidity as measures of health care quality. RESULTS: 5 systematic reviews were found, which described the results of a total of 41 relevant articles. 8 original articles of sufficient quality published since 2000 were also identified. Most of these articles were also included in the reviews. Relationships between volume per hospital and per surgeon and case fatality (or survival) and morbidity were found for a number of surgical procedures. The strongest associations between volume and case fatality were found for pancreatic and oesophageal resection and, to a lesser degree, elective repair ofabdominal aortic aneurysm. For other procedures the relationship was relatively weak, absent, or not studied. CONCLUSION: Volume appears to be related to quality for some surgical procedures. The magnitude of the relationship differs depending on the procedure. For technically less complex procedures, organisation within the hospital appears to have a greater influence on the differences between hospitals than the performing surgeon.

[Guideline "Dyspepsia"]. / Richtlijn 'Maagklachten'.

For the management of patients with dyspepsia a multidisciplinary working party has made recommendations, i.e. about indications for prompt endoscopy, the management of dyspeptic complaints of recent onset, the application of diagnostic tests and treatment of recurrent dyspepsia and the indications for long term use of acid suppressants. Endoscopy is indicated in every patient with alarm symptoms, i.e. blood loss, dysphagia, weight loss or anemia in combination with dyspepsia. Age alone is not a decisive factor in this. Given the good prognosis of recent onset dyspepsia, the application of diagnostic tests is generally not required. Treatment should be restricted to antacids or H2 receptor antagonists. Only in case of persistent or recurring complaints, diagnostic tests or another treatment (Helitobacter pylori diagnostic tests, empirical treatment or endoscopy) should be considered. Testing for H. pylori is especially effective in patients at risk for peptic ulcer disease: those with recurrent complaints, and those with a history of peptic ulcer, without typical reflux symptoms or those with a history ofpeptic ulcer. Short term empirical treatment with a proton pump inhibitor is especially effective in patients with typical reflux symptoms. Endoscopy is the only way to rule out malignancy, and should be used to solve serious diagnostic uncertainty in patient or physician. The only indication for continuous proton pump inhibitor treatment is severe oesophagitis. All other patients with less severe reflux disease should preferably be treated on either on demand or intermittent basis. Long term proton pump inhibitor treatment is not indicated for patients with peptic ulcer disease or functional dyspepsia.

[Passive smoking and lung cancer: a new report in perspective]. / Passief roken en longkanker: een nieuw rapport in perspectief.

Recently, a working group of six European scientists published a report on exposure to environmental tobacco smoke and the risk of lung cancer. The report concludes that environmental tobacco smoke is not a primary lung carcinogen. Critical evaluation of the report, however, shows that this conclusion is not justified. Results of recent epidemiologic studies support the earlier conclusion of the American Environmental Protection Agency (EPA) that environmental tobacco smoke does cause lung cancer. Furthermore, the working group fails to present compelling evidence that the results of the epidemiological studies in this field can be explained by bias or confounding, or that the association between environmental tobacco smoke and lung cancer is biologically implausible. Therefore, we see no reason to modify the conclusion of the EPA that passive smoking causes lung cancer.