scholarly journals Does High and Intensive Care Reduce Coercion? Association of Hic Model Fidelity to Seclusion Use in the Netherlands

2020 ◽  
Author(s):  
A.L. van Melle ◽  
E.O. Noorthoorn ◽  
G.A.M. Widdershoven ◽  
C.L Mulder ◽  
Y. Voskes
Keyword(s):  
Intensive Care ◽  
The Netherlands ◽  
Rating Scale ◽  
Patient Characteristics ◽  
Team Processes ◽  
Model Fidelity ◽  
Fidelity Scale ◽  
Explained Variance ◽  
High Level

Abstract BackgroundA new inpatient care model has been developed in the Netherlands: High and Intensive Care (HIC). The purpose of HIC is to improve quality of inpatient mental healthcareand to reduce coercion.MethodsIn 2014, audits were held at 32 closed acute admission wards for adult patients throughout the Netherlands. The audits were done by trained auditors, who were professionals of the participating institutes, using the HIC monitor, a model fidelity scale to assess implementation of the HIC model. The HIC model fidelity scale (67 items) encompasses 11 domains including for example team structure, team processes, diagnostics and treatment, and building environment. Data on seclusion and forced medication was collected using the Argus rating scale. The association between HIC monitor scores and the use of seclusion and forced medication was analyzed, corrected for patient characteristics.ResultsResults showed that wards having a relatively high HIC monitor total score, indicating a high level of implementation of the model as compared to wards scoring lower on the monitor, had lower seclusion hours per admission hours (2.58 versus 4.20) and less forced medication events per admission days (0.0162 versus 0.0207).The HIC model fidelity scores explained 27% of the variance in seclusion rates (p< 0.001). Adding patient characteristics to HIC items in the regression model showed an increase of the explained variance to 40%. ConclusionsThis study showed that higher HIC modelfidelity was associated with less seclusion and less forced medication at acute closed psychiatric wards in the Netherlands.

scholarly journals Does high and intensive care reduce coercion? Association of HIC model fidelity to seclusion use in the Netherlands

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
A. L. Van Melle ◽  
E. O. Noorthoorn ◽  
G. A. M. Widdershoven ◽  
C. L. Mulder ◽  
Y. Voskes
Keyword(s):  
Intensive Care ◽  
The Netherlands ◽  
Rating Scale ◽  
Mental Healthcare ◽  
Patient Characteristics ◽  
Team Processes ◽  
Model Fidelity ◽  
Fidelity Scale ◽  
High Level

Abstract Background A new inpatient care model has been developed in the Netherlands: High and Intensive Care (HIC). The purpose of HIC is to improve quality of inpatient mental healthcare and to reduce coercion. Methods In 2014, audits were held at 32 closed acute admission wards for adult patients throughout the Netherlands. The audits were done by trained auditors, who were professionals of the participating institutes, using the HIC monitor, a model fidelity scale to assess implementation of the HIC model. The HIC model fidelity scale (67 items) encompasses 11 domains including for example team structure, team processes, diagnostics and treatment, and building environment. Data on seclusion and forced medication was collected using the Argus rating scale. The association between HIC monitor scores and the use of seclusion and forced medication was analyzed, corrected for patient characteristics. Results Results showed that wards having a relatively high HIC monitor total score, indicating a high level of implementation of the model as compared to wards scoring lower on the monitor, had lower seclusion hours per admission hours (2.58 versus 4.20) and less forced medication events per admission days (0.0162 versus 0.0207). The HIC model fidelity scores explained 27% of the variance in seclusion rates (p < 0.001). Adding patient characteristics to HIC items in the regression model showed an increase of the explained variance to 40%. Conclusions This study showed that higher HIC model fidelity was associated with less seclusion and less forced medication at acute closed psychiatric wards in the Netherlands.

Ethical Decisions in Neonatal Intensive Care Units: The Dutch Experience

PEDIATRICS ◽  
1992 ◽  
Vol 90 (5) ◽  
pp. 729-732
Author(s):  
Pieter J. J. Sauer
Keyword(s):  
Quality Of Life ◽  
Intensive Care ◽  
The Netherlands ◽  
Neonatal Intensive Care ◽  
Fatal Outcome ◽  
Modern Technology ◽  
Withholding Treatment ◽  
Intensive Care Treatment ◽  
Best Interest

Modern technology makes it possible to keep more sick, extremely small, and vulnerable neonates alive. Many neonatologists in the Netherlands believe they should be concerned not only about the rate of survival of their patients, but also about the way the graduates of their care do, in fact, survive beyond the neonatal period. In most cases, we use all available methods to keep newborns alive. However, in some instances there is great concern about the quality of life, if the newborn should survive; here questions do arise about continuing or withholding treatment. In this commentary, I present my impression of the opinions held by a majority of practicing neonatologists in the Netherlands, as well as some personal thoughts and ideas. Recently, a committee convened by the Ministers of Justice and Health in the Netherlands issued an official report regarding the practice of euthanasia and the rules of medical practice when treatment is withheld.1 In this report of more than 250 pages, only 2 pages focus on the newborn. The following conclusions were made in this small section of the report. In almost one half of the instances of a fatal outcome in a neonatal intensive care unit in the Netherlands, discussions about sustaining or withholding treatment did take place at some stage of the hospital stay. A consideration of the future quality of life was always included in the discussion. The committee agreed with doctors interviewed for the report that there are circumstances in which continuation of intensive care treatment is not necessarily in the best interest of a neonate.

scholarly journals “Assessing Today for a Better Tomorrow”: An observational cohort study about quality of care, mortality and morbidity among newborn infants admitted to neonatal intensive care in Guinea

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254938
Author(s):  
Maria Bea Merscher Alves ◽  
N’Fanly Conté ◽  
Boubacar Diallo ◽  
Moustapha Mamadou ◽  
Albert Delamou ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Mortality ◽  
General Condition ◽  
Hospital Care ◽  
Neonatal Intensive Care ◽  
Birth Asphyxia ◽  
Patient Characteristics ◽  
Observational Cohort Study ◽  
Observational Cohort

Background Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed. Objective To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality. Methods Prospective observational cohort study of newborns admitted to the hospital between mid-February and mid-March 2019 after birth in other institutions. Data were collected on maternal/prenatal history, delivery, and in-hospital care via convenience sampling. Associations of patient characteristics with in-hospital death were assessed using cause-specific Cox proportional-hazards models. Results Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42–11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10–3.65, p = 0.023). Conclusion Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.

scholarly journals Caregiving Burden And Depression Among Caregivers Of Patient With Epilepsy

2019 ◽  
Vol 8 (2) ◽  
pp. 40-44
Author(s):  
S. Shah ◽  
C. Sah ◽  
A. Shahi ◽  
R. KC
Keyword(s):  
Rating Scale ◽  
Structured Interview ◽  
Caregiving Burden ◽  
Significant Burden ◽  
Significant Area ◽  
Collection Data ◽  
High Level ◽  
Patients With Epilepsy ◽  
The Impact

Introduction: The impact of caregiving on caregivers is a significant area to be studied which will directly affect the quality of care given by them to patients with epilepsy. Family caregivers have been described as forgotten patients. The aim of the study was to assess the caregiving burden and depression among caregivers of patient with epilepsy. Material and Method: Descriptive study was conducted among 100 caregivers of adult patients with epilepsy. Samples were selected using purposive sampling. Semi-structured interview schedule, Zarit Burden Interview (ZBI) and Hamilton depression rating scale (HAM-D) were used for data collection. Data was analyzed by descriptive and inferential statistics with SPSS version 20. Results: Among 100 caregivers, 42% reported high mean burden scores on the ZBI and overall 50% of caregivers reported moderate depression on the HAM-D. High level of burden was significantly associated with age of caregivers (p= 0.018) and caregivers’ relationship with patients (p= 0.023). The result suggests that there was statistically significant positive relationship on ZBI vs HAM-D (p≤ 0.01). Conclusion: Caregivers of patients with epilepsy experience significant burden while caring for their relatives and level of burden is positively correlated with depression. The study highlights the need for comprehensive care system recognizing caregivers as “co-client”.

scholarly journals Characteristics and outcome of COVID-19 patients admitted to the ICU: a nationwide cohort study on the comparison between the first and the consecutive upsurges of the second wave of the COVID-19 pandemic in the Netherlands

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Dave A. Dongelmans ◽  
Fabian Termorshuizen ◽  
Sylvia Brinkman ◽  
Ferishta Bakhshi-Raiez ◽  
M. Sesmu Arbous ◽  
...  
Keyword(s):  
Quality Of Care ◽  
The Netherlands ◽  
Patient Characteristics ◽  
Third Wave ◽  
The Third ◽  
Icu Discharge ◽  
Occupancy Rates ◽  
Second Wave ◽  
Care Evaluation

Abstract Background To assess trends in the quality of care for COVID-19 patients at the ICU over the course of time in the Netherlands. Methods Data from the National Intensive Care Evaluation (NICE)-registry of all COVID-19 patients admitted to an ICU in the Netherlands were used. Patient characteristics and indicators of quality of care during the first two upsurges (N = 4215: October 5, 2020–January 31, 2021) and the final upsurge of the second wave, called the ‘third wave’ (N = 4602: February 1, 2021–June 30, 2021) were compared with those during the first wave (N = 2733, February–May 24, 2020). Results During the second and third wave, there were less patients treated with mechanical ventilation (58.1 and 58.2%) and vasoactive drugs (48.0 and 44.7%) compared to the first wave (79.1% and 67.2%, respectively). The occupancy rates as fraction of occupancy in 2019 (1.68 and 1.55 vs. 1.83), the numbers of ICU relocations (23.8 and 27.6 vs. 32.3%) and the mean length of stay at the ICU (HRs of ICU discharge = 1.26 and 1.42) were lower during the second and third wave. No difference in adjusted hospital mortality between the second wave and the first wave was found, whereas the mortality during the third wave was considerably lower (OR = 0.80, 95% CI [0.71–0.90]). Conclusions These data show favorable shifts in the treatment of COVID-19 patients at the ICU over time. The adjusted mortality decreased in the third wave. The high ICU occupancy rate early in the pandemic does probably not explain the high mortality associated with COVID-19.

scholarly journals A Prospective Audit of Patient Experiences in Colonoscopy Using the Global Rating Scale: A Cohort of 1187 Patients

2010 ◽  
Vol 24 (10) ◽  
pp. 607-613 ◽  
Author(s):  
Vincent de Jonge ◽  
Jerome Sint Nicolaas ◽  
Eoin A Lalor ◽  
Clarence K Wong ◽  
Brennan Walters ◽  
...  
Keyword(s):  
Literature Review ◽  
Rating Scale ◽  
Information Provision ◽  
Patient Characteristics ◽  
Patient Experiences ◽  
Global Rating Scale ◽  
Service Improvement ◽  
Global Rating ◽  
Prospective Audit

BACKGROUND: The Global Rating Scale (GRS) comprehensively evaluates the quality of an endoscopy department, providing a patient-centred framework for service improvement.OBJECTIVE: To assess patient experiences during colonoscopy and identify areas that need service improvement using the GRS.METHODS: Consecutive outpatients undergoing colonoscopy were asked to complete a pre- and postprocedure questionnaire. Questions were based on GRS items and a literature review. The preprocedure questionnaire addressed items such as patient characteristics and information provision. The postprocedure questionnaire contained questions regarding comfort, sedation, the attitude of endoscopy staff and aftercare.RESULTS: The preprocedure questionnaire was completed by 1187 patients, whereas the postprocedure part of the questionnaire was completed by 851 patients (71.9%). Fifty-four per cent of patients were first seen in the outpatient clinic. The indication for colonoscopy was explained to 85% of the patients. Sixty-five per cent of the patients stated that information about the risks of colonoscopy was provided. Sedation was used in 94% of the patients; however, 23% judged the colonoscopy to be more uncomfortable than expected. Ten per cent of patients rated the colonoscopy as (very) uncomfortable. Preliminary results of the colonoscopy were discussed with 87% of patients after the procedure. Twenty-one per cent of the patients left the hospital without knowing how to obtain their final results. Being comfortable while waiting for the procedure (OR 9.93) and a less uncomfortable procedure than expected (OR 2.99) were important determinants of the willingness to return for colonoscopy.CONCLUSIONS: The present study provided evidence supporting the GRS in identifyng service gaps in the quality of patient experiences for colonoscopy in a North American setting. Assessing experiences is useful in identifying areas that need improvement such as the provision of pre- and postprocedure information.

scholarly journals Disparity between High Satisfaction and Severe Pain in Patients after Caesarean Section: A Prospective Observational-Controlled Investigation

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Thomas Hesse ◽  
Andreas Julich ◽  
James Paul ◽  
Klaus Hahnenkamp ◽  
Taras I. Usichenko
Keyword(s):  
Quality Of Life ◽  
Rating Scale ◽  
Pharmacological Therapy ◽  
University Hospital ◽  
Surgical Patients ◽  
Patients Satisfaction ◽  
High Satisfaction ◽  
High Level ◽  
The University

Objectives. Recent advances in the treatment of postoperative pain (POP) have increased the quality of life in surgical patients. The aim of this study was to examine the quality of POP management in patients after CS in comparison with patients after comparable surgical procedures. Methods. This was a prospective observational analysis in patients after CS in comparison with the patients of the same age, who underwent comparable abdominal gynaecological surgeries (GS group) at the university hospital. A standardised questionnaire including pain intensity on the Verbal Rating Scale (VRS-11), incidence of analgesia-related side effects, and incidence of pain interference with the items of quality of life and patients’ satisfaction with the treatment of POP was used. Results. Sixty-four patients after CS reported more pain on movement than the patients after GS (N=63): mean 6.1 versus 3.6 (VRS-11; P<0.001). The patients after CS reported less nausea (8 versus 41%) and vomiting (3 versus 21%; P<0.001) and demonstrated better satisfaction with POP treatment than the patients after GS: 1.4 (0.7) versus 1.7 (0.7) (mean (SD); VRS-5; P=0.02). Conclusion. The disparity between the high level of pain and excellent satisfaction with POP treatment raises the ethical and biomedical considerations of restrictive pharmacological therapy of post-CS pain.

Impact of Discontinuing Contact Precautions for MRSA and ESBLE in an Intensive Care Unit: A Prospective Noninferiority Before and After Study

2017 ◽  
Vol 38 (11) ◽  
pp. 1342-1350 ◽  
Author(s):  
Laurie Renaudin ◽  
Mathieu Llorens ◽  
Christophe Goetz ◽  
Sébastien Gette ◽  
Vincente Citro ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Patient Characteristics ◽  
Antibiotic Consumption ◽  
Standard Precautions ◽  
Contact Precautions ◽  
Before And After ◽  
High Level ◽  
Before And After Study

OBJECTIVETo compare incidence densities of methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBLE) acquisition in the intensive care unit (ICU) before and after discontinuation of contact precautions (CP) and application of standard precautions (SP).DESIGNProspective noninferiority before-and-after study comparing 2 periods: January 1, 2012, to January 31, 2014 (the CP period) and February 1, 2014, to February 29, 2016 (the SP period).SETTINGA 16-bed polyvalent ICU in France with only single-bed rooms with dedicated equipment and reusable medical devices.PATIENTSAll patients admitted to the ICU during the CP and SP periods were included: 1,547 and 1,577 patients, respectively.METHODSIncidence densities of ICU-acquired MRSA or ESBLE were determined per 1,000 patient days. Other studied factors included (1) patient characteristics, (2) incidence densities of MRSA or ESBLE carried at admission, (3) compliance with hand hygiene protocols, and (4) antibiotic consumption.RESULTSIncidence densities of ICU-acquired MRSA were 0.82 (95% confidence interval [CI], 0.31–1.33) and 0.79 (95% CI, 0.30–1.29) per 1,000 patient days during the CP and SP periods, respectively. For ESBLE, values were 2.7 (95% CI, 1.78–3.62) and 2.06 (95% CI, 1.27–2.86) per 1,000 patient days. These rates were significantly nonsuperior during the SP period compared to CP period, with a margin of 1 per 1,000 patient days for both MRSA (P=.002) and ESBLE (P=.004). Other factors were comparable during the 2 periods. Only ESBLE carried at admission was inferior during the SP period. We observed a high level of compliance to hand hygiene protocols.CONCLUSIONSDiscontinuing CP did not increase acquired MRSA and ESBLE in our ICU with single rooms with dedicated equipment, strict application of hand hygiene, medical and paramedical leadership, and good antibiotic stewardship.Infect Control Hosp Epidemiol 2017;38:1342–1350

scholarly journals O21 EVALUATION OF THE TREATMENT OF PARASTOMAL HERNIA IN THE NETHERLANDS: A NATIONAL SURVEY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Sarah van Egmond ◽  
Marijn Poelman ◽  
Johannes Wegdam ◽  
Bob Bloemendaal
Keyword(s):  
The Netherlands ◽  
Parastomal Hernia ◽  
Daily Practice ◽  
Prophylactic Mesh ◽  
Level Of Evidence ◽  
Mesh Placement ◽  
Surgical Department ◽  
European Hernia Society ◽  
High Level

Abstract Aim The incidence of a parastomal hernia (PSH) is approximately 40% two years after stoma construction and can even increase to 50% after a longer period. The European Hernia Society (EHS) published a guideline showing that the evidence for treatment of a PSH is of low quality. Due to the lack of evidence, a survey was conducted to provide insight into the Dutch approach. Material and Methods A survey was sent to 104 surgeons in the Netherlands representing their surgical department. The survey was developed by three hernia surgeons and a physiotherapist specialized in abdominal wall pathology. Results The survey was completed by 103 surgeons (99%) from 75 hospitals. 75% of the respondents perform a laparoscopic Sugarbaker for the treatment of PSH after colostomy, ileostomy or Bricker deviation. Most respondents (75%) replied that they never use a prophylactic mesh to prevent for the occurrence of PSH, although more than half of them do wish to introduce this. Conclusions Authors believe that the implementation of minimally invasive surgery and the systematic review performed by Hansson et al. in 2012, shifted the treatment strategy for PSH towards the use of a laparoscopic Sugarbaker. Nevertheless, little is known about the results of this treatment. Although there is a high level of evidence for the use of prophylactic mesh placement in reducing the incidence of PSH development, this has not been implemented in daily practice for colorectal and/or hernia surgeons. Authors aim for registration of PSH repair to evaluate the outcomes in terms of recurrence, pain and quality of life.

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