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Biomedical subjects

G van der Wal

Publications and source records attributed to G van der Wal.

At least 19 recordsLinked to original sources
PubMed2006

[Trends in the agents used for euthanasia and the relationship with the number of notifications].

OBJECTIVE: To provide insight into the relationship between the drugs used for euthanasia and its notification. DESIGN: Retrospective and descriptive. METHODS: By comparing the drugs used for euthanasia according to different components of studies carried out in 1990, 1995 and 2000, insight was obtained into the drugs used in all cases of euthanasia satisfying the definition thereof (death-certificate studies), those cases of euthanasia that, in addition, were defined as such by the physician (physician interviews), and the cases of euthanasia that, in addition, had been reported (reported case studies). RESULTS: In 2001, standard drugs for euthanasia were used in 76% of cases and opioids in 23%. Euthanasia with standard drugs was reported in 73% of cases in 1995, and in 71% of cases in 2000, while euthanasia with opioids was reported in 2% and 1% of cases, respectively. The total percentage of euthanasia reported was higher in 2001 than in 1995 (54% versus 44%), since in 2001 euthanasia was apparently performed more often with standard drugs and less with opioids. CONCLUSION: An increasing proportion of cases of euthanasia is being carried out with the drugs recommended for this purpose. Euthanasia with opioids was rarely reported. Possibly, physicians did not always consider these cases to be euthanasia.

Barbiturates↗
PubMed2006

Patient work in end-stage heart failure: a prospective longitudinal multiple case study.

OBJECTIVE: The most recent WHO definition of palliative care regards living as actively as possible as an important aim. We explored, over a 1-year period, the work this involves for patients with end-stage heart failure. DESIGN: Prospective longitudinal multiple case study using qualitative interview techniques. PARTICIPANTS: Thirty-one respondents from two hospitals who fulfilled one or more of the following criteria: NYHA III or IV, ejection fraction <25%, at least one hospitalization for heart failure. MAIN OUTCOMES: Types and content of patient work involved in living with end-stage heart failure. RESULTS: For patients with advanced heart failure, work consisted mainly of four types of tasks, as identified by Glaser and Strauss: 'managing illness', 'everyday work to keep life going', 'biographical work' and 'arrangement work'. CONCLUSIONS: Systematic attention to patient work, for example using these four categories, could improve the quality of care from the patient's perspective.

Aged↗
PubMed2006

[Experience of family members with the decision concerning artificial nutrition and hydration in people with dementia in nursing homes].

The purpose of this study is to investigate how relatives of nursing home patients with dementia, for whom the decision whether to start or forgo artificial nutrition and hydration (ANH) was made, assess the decision-making process. Furthermore we evaluated the information given by the nursing home staff to the relatives and the care provided by them to the patient. The study was an observational study based on written questionnaires. Relatives of 99 nursing home patients with dementia filled in a questionnaire at the time of the decision-making and 6 weeks after the decision was made or 6 weeks after the patient had died. Almost all relatives assessed the 4 aspects of the decision-making process (number of consults, content of the consults, carefulness of the decision-making and there own part in the decision-making process) at both times as 'good' or 'satisfactory'. Furthermore it appeared that they judged the carefulness of the decision-making process significantly more often as 'good' when they also assessed the other three aspects as 'good'. Especially their own influence on the decision-making process appeared to play a part in this matter. Information about the possible consequences of starting ANH as well as about the condition of the patient were experienced sufficient by almost all relatives. This was also the case for the care offered to the patient. In general almost all relatives reported satisfaction with the decision and with the carefulness of the decision-making process. This satisfaction did not differ between the moment of the decision and afterwards. For this it did not make any difference whether the patient had or had not died.

Adult↗
PubMed2005

[Patient safety in hospitals].

In various studies outside the Netherlands, it has been shown that a substantial number of patients suffer some kind of damage during their treatment in a hospital. The incidence of these so-called adverse events varies between 2.9% and 16.6%; of these, estimates between more than a quarter and up to half are considered to have been avoidable. Preventable adverse events can offer a starting point for interventions to increase patient safety. Therefore, a study has been initiated in Dutch hospitals investigating the nature and extent of adverse events and their causes. Important goals of the study are to reach a consensus on basic concepts and to improve the research methodology.

Hospitalization↗
PubMed2005

[Fourth evaluation of the law on the review of termination of life on request and assisted suicide (Euthanasia Act)].

This fall, an extensive study will start to evaluate the Dutch Euthanasia Act. This law was enacted in 2002. According to this law, physicians must report cases of euthanasia and physician-assisted suicide. The cases are then judged by regional euthanasia review committees consisting of a lawyer, a physician and an ethicist. Only if they conclude that the case does not meet the requirements for prudent practice, it will be sent to the public prosecutor. The study will be focused on the practice of medical end-of-life decision-making, the functioning and effects of the Euthanasia Act, and opinions of physicians about the scope of the law and the demarcation between different end-of-life decisions. The study will comprise 4 sub-studies: a judicial evaluation, a death certificate study, a survey among physicians and a panel study among physicians, nurses, members of euthanasia review committees, lawyers and ethicists. This study is the fourth in a row of nationwide studies into end-of-life practices that have been performed since 1990. The previous studies contributed to the public debate about medical care at the end of life and to the development of policy in this field. It is expected that this study, by providing up-to-date information on and insight into end-of-life care in the Netherlands, will do the same.

Attitude to Health↗
PubMed2005

[No conspicuous changes in the practice of medical end-of-life decision-making for neonates and infants in the Netherlands in 2001 as compared to 1995].

OBJECTIVE: To establish whether the practice of end-of-life decision-making for neonates and infants under the age of 1 in the Netherlands in 2000 was different from that in 1995. DESIGN: Retrospective descriptive and comparative study. METHODS: In both years, all deaths of children under the age of one year that took place in August-November (1995: n = 338; 2001: n = 347) were studied. The response rate was 96% in 1995 and 84% in 2001. The questionnaires which were sent to the physicians who reported the deaths, included structured questions about whether or not death had been preceded by end-of-life decisions, i.e. decisions to withhold or withdraw potentially life-prolonging treatment or to administer (potentially) life-shortening drugs, and questions about the decision-making process. RESULTS: The proportion of end-of-life decisions increased slightly from 62% to 68% of all deaths in the first year of life, but the difference was not statistically significant. The large majority of these decisions involved withholding or withdrawing life-sustaining treatment. The frequency of decisions to actively terminate the life of an infant who was not dependent on life-sustaining treatment remained stable at 1%. The proportion of decisions that had been discussed with the parents increased slightly, from 91% in 1995 to 97% in 2001; similar percentages of the decisions had been discussed with other physicians. The percentage of decisions that had been discussed with the nursing staff decreased from 40 in 1995 to 28 in 2001. CONCLUSION: The findings suggest that the practice of end-of-life decision-making in neonatology was rather stable between 1995 and 2001. The frequency of the active termination of life had not increased, despite the new euthanasia regulation in the Netherlands.

Attitude of Health Personnel↗
PubMed2005

[Publication practice and policy for disciplinary proceedings regarding health care in the Netherlands].

OBJECTIVE: To provide insight into practice and policy regarding the publication of disciplinary verdicts in Dutch health care. DESIGN: Descriptive. METHOD: The study covered all of the verdicts issued by disciplinary boards and courts of justice that were published in the Dutch the Staats-courant (Government Gazette) during the period 1995-2002. The following attributes were recorded for each verdict: year of publication and verdict, the disciplinary board concerned, the accused professional, the type of complainant, the nature of the complaint and verdict, and the journals that were offered the decision. The published verdicts were related to the total number of verdicts and cases during the study period. Questionnaires were used to investigate the publication policy of the disciplinary boards. RESULTS: A total of 4% of all verdicts were published in the Dutch Government Gazette (323/8902). The central disciplinary board decided to publish more often than the regional disciplinary boards (8% and 2%, respectively). There were considerable differences between the various regional disciplinary boards (range: 1-5%). Per professional group the percentage of verdicts in cases that were published ranged from 2% to 23%. The decisions were offered to over 20 journals, but mainly to the Tijdschrift voor Gezondheidsrecht [Dutch Journal of Health Law] (TvGR; 92%) and Medisch Contact [Medical Contact] (MC; 88%). The TvGR published almost two-thirds of the verdicts offered (63%), and the MC published almost three-quarters (74%). In the decision to publish, the disciplinary boards differed in their interpretation of the concept of 'general importance'. CONCLUSION: If disciplinary proceedings are to achieve the desired quality-promoting effect on professional practice, then more attention will need to be paid to the publication policy, and the disciplinary boards will have to develop a joint code of practice. More verdicts could be published, also in professional journals.

Humans↗
PubMed2005

Risky procedures by nurses in hospitals: problems and (contemplated) refusals of orders by physicians, and views of physicians and nurses.

Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60-71%). Of the respondents, 11-30% experienced problems with and (contemplated) refusals of orders for risky procedures in the previous 12 months. Gynaecologists and internists most frequently mentioned problems concerning the practical performance of the procedure (44% and 30%, respectively). The reason for a problem or a contemplated refusal most frequently given by nurses was that they disagreed with the medication policy (34% and 35%, respectively). The reason for a refusal most frequently given by the gynaecologists, internists and nurses was that the nurses themselves were of the opinion that they did not have the necessary authorisation (95%, 67%, and 62%, respectively). With regard to certain procedures, the views of professionals are more strict than the current legal regulations.

Attitude of Health Personnel↗
PubMed2005

Risky procedures by nurses in hospitals: problems and (contemplated) refusals of orders by physicians, and views of physicians and nurses: a questionnaire survey.

Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60--71%). Of the respondents, 11--30% experienced problems with and (contemplated) refusals of orders for risky procedures in the previous 12 months. Gynaecologists and internists most frequently mentioned problems concerning the practical performance of the procedure (44% and 30%, respectively). The reason for a problem or a contemplated refusal most frequently given by nurses was that they disagreed with the medication policy (34% and 35%, respectively). The reason for a refusal most frequently given by the gynaecologists, internists, and nurses was that the nurses themselves were of the opinion that they did not have the necessary authorisation (95%, 67%, and 62%, respectively). With regard to certain procedures, the views of professionals are more strict than the current legal regulations.

Attitude of Health Personnel↗
PubMed2005

The disciplinary code for nurses and its contribution to the quality of nursing care in the Netherlands.

AIM: To obtain insight into the contribution of the disciplinary code for nurses to monitoring the quality of nursing care in the Netherlands. METHODS: Complaints dealt with in the period 1998-2001 were studied. Questionnaires were sent to 3200 nurses (71%), all 388 members of the disciplinary boards (89%) and 43 lawyers (65%). RESULTS: There was an increase in the number of nurses who were accused (20 in 1998, 12 in 1999, 54 in 2000, and 56 in 2001) and also in the annual percentages of sanctions imposed (0% in 1998, 8% in 1999, 13% in 2000 and 16% in 2001). The disciplinary code appears to be an important corrective instrument for serious professional misconduct.

Attitude of Health Personnel↗
PubMed2005

Neurological complications following Plasmodium falciparum infection.

Several neurological complications are associated with severe falciparum malaria. Cerebral malaria is one of the most life-threatening complications. A few patients may experience a neurological syndrome after complete recovery from Plasmodium falciparum infection. In the literature especially the postmalaria neurological syndrome (PMNS), acute disseminated encephalomyelitis (ADEM) and delayed cerebellar ataxia have been reported. We describe a case of a 53-year-old woman who was readmitted after an adequately treated P. falciparum infection with word-finding difficulties, confusion and tremor. Peripheral blood smears were repeatedly negative for malarial parasites. The clinical features best fitted a PMNS. Because of the severity of the syndrome she was treated with high-dose prednisone. She recovered completely. The possibility of ADEM is also discussed. Aetiology of these syndromes is still unknown, but it could be mediated by an immunological mechanism. PMNS or ADEM must be considered when neurological signs and symptoms occur after recovery from a P. falciparum infection.

Animals↗
PubMed2004

[Prevention demands a more ambitious approach. Response to the cabinet policy document 'Live healthier for longer 2004-2007; also a matter of healthy behavior'].

In the cabinet policy document 'Live healthily for longer 2004-2007; also a matter of healthy behaviour' the Dutch Secretary of State for Health, Welfare and Sport assumes that many health problems are linked to behaviours such as smoking and lack of physical activity. He places the prime responsibility for that with the citizens and also with local councils, trade and industry, care providers and schools. However conscious behavioural choices by individual citizens form only a small part of the cause-effect chain that leads to ill health. It is incorrect to ascribe the differences in unhealthy behaviour to freely made behavioural choices. Moreover it begs the question as to whether the proposed measures will be effective. Over and above all this, the finances that are available to strengthen preventative measures are completely inadequate. The central government should be encouraging the health care sector to devise a more central position for prevention and ensuring that effective opportunities for prevention are used as much as possible. After all, it is expected of the central government that it will look after the collective interests and protect and promote the health of the population. The necessary improvements can only be achieved through a much more ambitious approach than that presented by the cabinet.

Exercise↗
PubMed2004

[No improvement of disciplinary jurisprudence since the implementation of the Individual Health Care Professions Act (IHCP Act)].

OBJECTIVE: To compare the number and nature of the complaints, the complainants, the accused health professionals and the sanctions imposed by the disciplinary boards before and after the Individual Health Care Professions Act (IHCP Act) came into effect at the end of 1997. DESIGN: Descriptive, retrospective. METHOD: The authors examined all 4980 verdicts pronounced by the disciplinary boards in the first instance during the period 1995-1997 (before the IHCP Act) and then during the period 1999-2001 (after the IHCP Act), together with the resulting appeal procedures involving physicians, dentists, pharmacists and midwives. The following were noted: the year of the verdict, the number and nature of the complaints, the types of complainants, the categories of professionals accused, the nature of the verdicts, and the number of appeal procedures. RESULTS: During the first period, 2453 complaints were brought before the disciplinary board, compared to 2527 during the second period. Most of the complaints were made against physicians (92% in both periods). The number of complaints that were declared to be justified fell from 19% to 15% (p < 0.001). In both periods, approximately half of the complaints concerned 'lack of care or inadequate care' or 'incorrect treatment', the most frequent verdict was a warning (67% and 72%, respectively), and appeals were lodged against almost one-third of the verdicts. The number of complaints submitted by the Inspectorate for Health Care decreased from 47 to 19. CONCLUSION: In any important aspects, the IHCP Act did not lead to improvement in the disciplinary jurisprudence. The decrease in the number of complaints that were declared to be justified could be explained by the change in composition of the disciplinary boards prescribed by the IHCP Act (more lawyers and less fellow professionals). Informing citizens about disciplinary jurisprudence and other procedures for lodging complaints may increase the number of justified complaints and hence the number of 'justified' verdicts. There is a need for further clarification of the tasks and responsibility of the Inspectorate for Health Care in case of complaints to the disciplinary boards.

Humans↗
PubMed2004

Reserved procedures in Dutch hospitals: knowledge, experiences and views of physicians and nurses.

The Individual Health Care Professions Act came into force in The Netherlands in 1997, introducing a mixed system for the regulation of the practice of medicine. One of its components, the reserved procedures regulations, was studied in hospitals to gain insight into the knowledge, experiences and views of physicians and nurses with regard to these regulations. Questionnaires were sent to representative samples of 250 gynaecologists, 350 internists, and 3200 nurses, response rates were 65, 60 and 71%, respectively. Almost all respondents were aware that physicians are authorised to perform reserved procedures on their own initiative (93-99%), and 48-63% knew that nurses are not authorised to do this. A substantial percentage of the nurses performed reserved procedures on their own initiative (17-53%). A majority of gynaecologists and internists presumed that the hospital had ensured the proficiency of the nurses to perform reserved procedures (58% resp. 65%), while 82% of the nurses determined their own proficiency for each procedure. Most respondents felt that the reserved procedures regulations offer adequate protection for patients (58-72%). Although recommendations are made for improvement, the functioning of the reserved procedures regulations in hospitals is considered to be moderately positive.

Attitude of Health Personnel↗
PubMed2003

[Professional confidentiality and forensic medicine].

Medical confidentiality is a complex subject. The legal position of a physician depends on his or her role (medical advisor, attending physician, official, or medical examiner) as well as the physician's task and commission. In common with all physicians, the forensic physician has a duty to provide confidentiality. As a medical examiner, he or she has a limited professional confidentiality: there is an oath of secrecy, but not a right of refusal to testify with respect to the information obtained in carrying out the commission. When the forensic physician assumes the role of the attending physician, the professional confidentiality applies in full.

Confidentiality↗
PubMed2003

[Similarities and differences between the euthanasia laws in Belgium and the Netherlands].

Recently, a law on euthanasia has been adopted in both the Netherlands and Belgium. In both countries euthanasia has been legalized under strict conditions and after confirmation with a notification procedure. Although both laws are similar, the Belgian law is more extensive on the requirements of prudent practice. On the other hand, in Dutch society the norm-setting on euthanasia has been more widely developed through jurisprudence. Nevertheless, we expect that the implementation of the new law and the notification procedure in Belgium will be more difficult than in the Netherlands. In order to promote, safeguard and guarantee the quality of the euthanasia practice, the present euthanasia notification procedure in the Netherlands is supplemented with feedback to the physicians. The strict anonymous procedure in the Belgian notification procedure prevents this possibility. Therefore, Belgian physicians will not be supported by the notification procedure to improve their knowledge and skills in euthanasia.

Belgium↗