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Biomedical subjects

G van der Wal

Publications and source records attributed to G van der Wal.

At least 37 records · Page 2Linked to original sources
PubMed2003

Possibilities and barriers in the implementation of a preconceptional screening programme for cystic fibrosis carriers: a focus group study.

OBJECTIVE: This qualitative study aimed to explore possibilities and barriers in the implementation of a nationwide preconceptional cystic fibrosis (CF) carrier screening programme. METHODS: Sessions were held with two focus groups of CF patients and CF relatives, one focus group of people from the target population (couples planning a pregnancy), and two focus groups of potential providers (general practitioners (GPs) and municipal health service workers). RESULTS: Important barriers in the implementation of a preconceptional CF carrier screening programme included the problem of reaching the target population, the heavy workload of GPs, the limited public knowledge about CF in general, and the absence of a preconceptional consultation setting. In general, there was a positive attitude among the participants towards CF carrier screening. CONCLUSION: This study revealed some important barriers in the implementation of CF carrier screening programmes. More research is needed to specify and quantify the importance of the various barriers. Eventually, different intervention strategies should be included in an implementation plan to overcome the most important barriers in the organization and execution of screening.

Adult↗
PubMed2003

Quality of care for patients with Type 2 diabetes mellitus--a long-term comparison of two quality improvement programmes in the Netherlands.

AIM: To compare two intervention programmes, aimed at improving the quality of care provided for patients with Type 2 diabetes in the longer term. METHODS: A retrospective comparison of data derived from two non-randomized trials with 3.5 years of follow-up. In the first intervention group 401 patients were included, 413 in the second intervention group and 105 in the reference group. The first programme focused on improving the skills and knowledge of general practitioners (GPs) with regard to Type 2 diabetes, and supported them in making organizational changes in their practice (GP care only). Centralized shared diabetes care was implemented in the second programme in which the GPs received therapy advice according to a protocol for each individual patient. The patients were also encouraged in self-management, and received structured diabetes education (Diabetes Service). The main patient outcomes were HbA1c, blood pressure and serum lipid levels. Multilevel analysis was applied to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices. RESULTS: The HbA1c levels of patients of GPs who were supported by the Diabetes Service improved significantly more than the HbA1c levels of patients receiving GP care only (-0.28% [95% confidence interval (CI) -0.45; -0.11]). In contrast, the systolic blood pressure of patients receiving GP care only decreased more than that of patients of GPs supported by the Diabetes Service [4.14 mmHg (95% CI 1.77, 6.51)]. CONCLUSION: A Diabetes Service, providing GPs with individual therapy advice and patient education, resulted in better glycaemic control over 3.5 years than an intervention aimed at improving the skills of GPs in combination with organizational changes in the general practice.

Aged↗
PubMed2003

Proxy reporting in after-death interviews: the use of proxy respondents in retrospective assessment of chronic diseases and symptom burden in the terminal phase of life.

This study evaluates the quality of data obtained from after-death interviews with significant others of deceased older persons regarding the prevalence of chronic diseases and symptoms in the terminal phase of life. These data are compared with reports from physicians and earlier self-reports from the deceased person. There were significant increases in nonresponse and nonavailability of significant others for decedents who had been divorced or had never been married, thus introducing some selection bias. At the level of the total sample, significant others seem to give accurate information about the prevalence of chronic diseases when compared with self-reports and reports from physicians. At the level of the individual sample member, after-death interviews with significant others provide valid information for the assessment of the prevalence of malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease and cerebrovascular disease, but not for osteo- and rheumatoid arthritis and artherosclerotic disease. At the level of the total sample, the prevalence of symptoms assessed by significant others did not differ greatly from the assessment made by physicians. However, at the level of the individual sample member, the validity of symptom assessment by significant others could not be supported by data obtained from the physicians. With regard to the type of significant others interviewed, children reported more symptoms than partners. The use of significant others in after-death interviews can be a valid method with regard to the assessment of chronic diseases and symptoms on a group level. On an individual level this can be concluded only for chronic diseases with clearly observable consequences.

Aged↗
PubMed2002

[The term 'cause of death': an international comparison].

'Cause of death' is an ambiguous concept. Terms such as 'immediate', 'underlying' or 'primary' cause of death are used, along with indications such as 'associated conditions' and 'contributing factors'. Furthermore, the terms 'mechanism', 'manner' and 'method' of death are used internationally. The Dutch classification of the manner of death with just two categories (natural and unnatural death) is not used in other countries. Belgium, Germany, England and the USA use more or other categories. It is recommended that the Netherlands consistently use these terms in accordance with the international codes for both the death certificate as well as the registration form for the cause of death statistics. The circumstances of death of which the medical examiner needs to be notified should be explicitly stated on the death certificate.

Cause of Death↗
PubMed2002

[The role of physicians in the case of death, and professional secrecy in the Netherlands, Belgium, Germany, England and the US].

The role of physicians in issuing a death certificate in the Netherlands differs from that in neighbouring countries and the US; there is also a difference in the degree to which professional secrecy plays a role in this respect. In the Netherlands, England and the US the external examination of the dead body is performed primarily by the attending physician, whereas in Belgium and Germany this may be performed by any physician. Competences and tasks of government-appointed officials such as the medical examiner, forensic pathologist and coroner differ widely. In some countries many data concerning the deceased, the findings of the post-mortem examination, the post-mortal symptoms, the cause of death and the manner of death must be recorded on the death certificate, whilst in other countries, including the Netherlands, hardly any data are recorded. It is recommended that Dutch death certificates should state the points to be covered during a post-mortem as well as explicitly stating the circumstances in which the medical examiner should be called in.

Belgium↗
PubMed2001

The emotional impact on physicians of hastening the death of a patient.

OBJECTIVE: To investigate the emotional feelings reported by physicians in The Netherlands after having performed euthanasia or other medical end-of-life decisions. DESIGN: Nationwide interview study in The Netherlands, November 1995 through February 1996. PARTICIPANTS AND SETTING: A random sample of 405 physicians (general practitioners, nursing home physicians, and clinical specialists). MAIN OUTCOME MEASURES: Subsequent feelings of physicians about their most recent cases (if any) of euthanasia, assisted suicide, life-ending without an explicit request from the patient, and alleviation of pain and other symptoms with high doses of opioids. RESULTS: The response rate was 89%. In 52% of all cases of hastening death, physicians had feelings of comfort afterwards, which included feelings of satisfaction in 44% and of relief in 13%. Feelings of discomfort were reported in 42%, most frequently referred to as emotional (28%) or burdensome (25%). Feelings of discomfort were highest for euthanasia (75%; P<0.000). 95% of physicians were willing to perform euthanasia or assisted suicide again in similar situations. Afterwards, 5% had doubts, but none had regrets, about performing euthanasia. CONCLUSIONS: Hastening the death of a patient evokes different feelings among physicians. Although performing euthanasia is often experienced as burdensome and emotional, granting the ultimate wish of a competent patient may also give physicians a feeling of having contributed to the quality of the dying process.

Adaptation, Psychological↗
PubMed2001

[New research on the practice, reporting and reviewing of euthanasia and other medical end-of-life decisions, 2001/2002].

In the second half of 2001, an extensive study will start which will evaluate the review procedure for euthanasia in the Netherlands. Since the end of 1998, euthanasia has to be reviewed by regional review committees, which include a physician and an ethicist, in addition to a legal expert. The aim of this study is to examine whether the reporting procedure meets the aim and whether there are any points which require improvement. This study follows on from those carried out in 1990/1991 and 1995/1996, which investigated euthanasia and other medical end-of-life decisions (assisted suicide, termination of life without the patient's explicit request, treatment of pain and symptoms with a possible life-shortening effect, and forgoing potentially life-prolonging treatment). The study consists of an analysis of cases of death (in which the numbers and nature of various medical end-of-life decisions will be established), physician interviews (to gain insight into the context in which medical end-of-life decisions are made), a study of reported cases (to give an overview of doctors' experiences with the review committees), and a study carried out amongst the general public (around 1,500 Dutch adults will be given a written questionnaire about their opinions concerning medical end-of-life decisions and the reporting procedure). In addition to this Dutch study, a European study subsidized by the European Commission is being carried out which will examine attitudes and experiences regarding medical end-of-life decisions in six European countries (Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland). This will, for the first time, enable a true comparison to be made between the Netherlands and other countries in terms of euthanasia and other medical end-of-life decisions.

Adult↗
PubMed2001

[Unclear roles of district medical examiner and the attending physician in cases of natural and unnatural deaths in the Netherlands].

The role of the attending physician and the district medical examiner in the case of a natural or unnatural death is subject to a number of legal regulations. The different parts of a postmortem examination, the conditions for the issue of a death certificate, the term 'attending physician', and the position and duties of the district medical examiner are not, however, unequivocally specified in Dutch law. This gives rise to frequent misunderstandings.

Autopsy↗
PubMed2001

[State of the Dutch health care: need for more refined and specific indicators].

The 'World health report 2000' follows a trend towards the use of performance indicators in public services. The indicators used by WHO are in need of conceptual refinement and valid measurement, especially the more subjective ones. The use of indicators for final goals of health (care) systems makes it difficult to translate lack of performance into policy. Instrumental goals are also needed for the latter. It is concluded that the overall performance of the Dutch health care system is built up of the performance of its individual sections. The concrete areas for improvement within these sections need to be identified, while at the same time a performance paradox should be avoided.

Delivery of Health Care↗
PubMed2001

High quantitative job demands and low coworker support as risk factors for neck pain: results of a prospective cohort study.

STUDY DESIGN: A 3-year prospective cohort study among 1334 workers was conducted. OBJECTIVE: To determine whether the work-related psychosocial factors of quantitative job demands, conflicting job demands, skill discretion, decision authority, supervisor support, coworker support, and job security are risk factors for neck pain. SUMMARY OF BACKGROUND DATA: Among the various risk factors for neck pain, work-related psychosocial factors play a major role. Previous studies on risk factors for neck pain often had a cross-sectional design, and did not take both physical and psychosocial factors into account. METHODS: At baseline, data on work-related psychosocial factors were collected by means of a questionnaire. During the 3-year follow-up period, data on the occurrence of neck pain were collected by means of postal questionnaires. Individuals without neck pain at baseline were selected for the analyses. Cox regression analysis was applied to examine the relation between the work-related psychosocial factors and the cumulative incidence of neck pain. Adjustments were made for various physical factors and individual characteristics. RESULTS: The analysis included 977 patients. Altogether, 141 workers (14.4%) reported that they had experienced neck pain at least once during the 3-year follow-up period. The relation of neck pain to high quantitative job demands (relative risk [RR], 2.14; 95% confidence interval [CI], 1.28-3.58) and low coworker support (RR, 2.43; 95% CI, 1.11-5.29) was statistically significant. An increased risk was found for low decision authority in relation to neck pain (RR, 1.60; 95% CI, 0.74-3.45), but this relation was not statistically significant. CONCLUSIONS: High quantitative job demands and low coworker support are independent risk factors for neck pain. There are indications that another risk factor for neck pain is low decision authority.

Adult↗
PubMed2001

Psychosocial risk factors for neck pain: a systematic review.

BACKGROUND: Neck pain, which is assumed to be a multifactorial disease, is a major problem in modern society. METHODS: To identify the most important psychosocial risk factors for neck pain, a systematic review of the literature was carried out. The methodological quality of all studies in the review was assessed. Four levels of evidence were defined to assess the strength of evidence for potential risk factors for neck pain (strong, moderate, some or inconclusive evidence). RESULTS: Some evidence was found for a positive relationship between neck pain and high quantitative job demands, low social (coworker) support, low job control, high and low skill discretion and low job satisfaction. Inconclusive evidence was found for high job strain, low supervisor support, conflicts at work, low job security, and limited rest break opportunities. CONCLUSIONS: The procedure of the assessment of the methodological quality and the rating system applied to distinguish between high- and low-score studies, had a considerable influence on the level of evidence, indicating that changes in this procedure may have a major impact on the overall conclusions of this review.

Humans↗
PubMed2001

Support and consultation for general practitioners concerning euthanasia: the SCEA project. Support and Consultation in Euthanasia in Amsterdam.

UNLABELLED: In the project 'Support and consultation in Euthanasia in Amsterdam' (SCEA) general practitioners can turn to 20 especially trained physicians for advice or consultation concerning euthanasia or physician-assisted suicide. In this study the implementation was evaluated and it was investigated whether the goals of SCEA, supporting physicians and improving the quality of consultation, the quality of decision-making and the willingness to report, were met. Methods used were a questionnaire send to all general practitioners registered in Amsterdam (n=398), registration forms SCEA physicians filled in for every time SCEA was contacted and records of the public prosecutor. After the study period of 14 months, of the general practitioners who had performed euthanasia during this period, 53% had contacted SCEA at least once. The vast majority of general practitioners felt supported by SCEA. The quality of consultation was (even) higher in cases of euthanasia in which a SCEA physician acted as consultant than in cases with another consultant. We found no relation between use of SCEA and the last two goals of SCEA. CONCLUSIONS: Whether the lack of relation found between SCEA and it's last two goals is real or due to the studies limitations remains unclear. The results of this study do suggest that SCEA, by further improving the quality of consultation, has contributed to the safeguarding of euthanasia and assisted suicide. Therefore, similar networks are being developed throughout the Netherlands.

Attitude of Health Personnel↗
PubMed2001

Withholding or withdrawing artificial administration of food and fluids in nursing-home patients.

BACKGROUND: withholding or withdrawing artificial administration of food and fluids, especially in incompetent patients, has been the subject of turbulent discussions. Insight into this practice may be useful in the debate, and also in the development of guidelines. OBJECTIVES: to gain insight into the frequency and circumstances of forgoing artificial administration of food and fluids in nursing homes. DESIGN: we sent a written questionnaire to the nursing-home physicians of a stratified sample of 6060 people who died in the Netherlands in 1995, and interviewed a random sample of 74 nursing-home physicians. SETTING: Dutch nursing homes. MAIN OUTCOME MEASURES: incidence of withholding or withdrawing artificial administration of food, patient characteristics and features of the decision-making process. RESULTS: in 23% of deaths in nursing homes, artificial administration of food and fluids were foregone. In two-thirds of cases, life was shortened by 1 week at most. The decision was almost always discussed with competent patients. In the case of incompetent patients, the decision was almost always discussed with the patient's relatives. Frequently mentioned considerations in the decision were: the patient's (presumed) wish, low quality of life, no prospect of improvement and the desire not unnecessarily to prolong life. CONCLUSIONS: artificial administration of food and fluids is one of the most frequently forgone treatments in nursing homes. In general, the physician involves the patient or the patient's relatives and the nursing staff in the decision-making. In most cases, the nursing-home physicians thought that the decision to forgo artificial administration of food and fluids improved the patient's quality of dying.

Adolescent↗
PubMed2001

Environmental and organizational determinants of quality management.

The aim of the study was to obtain more insight into the organizational and environmental determinants of the implementation of quality management in health care organizations. Primary survey data were collected in 1995 in a large nationwide study within 15 fields of health care and health care-related social services in The Netherlands. In general, there are more differences between health care organizations than between fields of health care. Environmental influence was found to be less important than was expected. Care-oriented organizations have a greater opportunity to involve their patients. It seems that apart from patients, the perceived pressure from other third parties has little influence on the implementation of quality management in health care organizations.

Cross-Sectional Studies↗
PubMed2001

3-M syndrome: description of six new patients with review of the literature.

3-M syndrome combines pre- and postnatal growth retardation and dysmorphic facial features with autosomal recessive inheritance. Six new patients with 3-M syndrome are described and compared with 28 cases from the literature. Our six patients have a growth pattern, which parallels that of Silver-Russell syndrome (SRS). Final height is ISD less in 3-M syndrome than in SRS. Growth hormone treatment significantly increased final height in two of our patients. 3-M syndrome can be differentiated from other types of dwarfism by clinical criteria and by the demonstration of characteristically slender long bones and foreshortened vertebral bodies. We propose that calculating the metacarpal and vertebral indices can be used to measure and document this important diagnostic feature. While the gonadal status of female patients with 3-M syndrome is completely normal, male patients have a gonadal dysfunction and sub- or infertility.

Abnormalities, Multiple↗
PubMed2001

Collusion in doctor-patient communication about imminent death: an ethnographic study.

OBJECTIVE: To discover and explore the factors that result in the "false optimism about recovery" observed in patients with small cell lung cancer. DESIGN: A qualitative observational (ethnographic) study in 2 stages over 4 years. SETTING: Lung diseases ward and outpatient clinic in a university hospital in the Netherlands. PARTICIPANTS: 35 patients with small cell lung cancer. RESULTS: False optimism about recovery usually developed during the first course of chemotherapy and was most prevalent when the cancer could no longer be seen on x-ray films. This optimism tended to vanish when the tumor recurred, but it could develop again, though to a lesser extent, during further courses of chemotherapy. Patients gradually found out the facts about their poor prognosis, partly by their physical deterioration and partly through contact with fellow patients in a more advanced stage of the illness who were dying. False optimism about recovery was the result of an association between physicians' activism and patients' adherence to the treatment calendar and to the "recovery plot," which allowed them to avoid acknowledging explicitly what they should and could know. The physician did and did not want to pronounce a "death sentence," and the patient did and did not want to hear it. CONCLUSION: Solutions to the problem of collusion between physician and patient require an active, patient-oriented approach by the physician. Perhaps solutions have to be found outside the physician-patient relationship itself--for example, by involving "treatment brokers."

Aged↗
PubMed2001

A protocol for consultation of another physician in cases of euthanasia and assisted suicide.

OBJECTIVE: Consultation of another physician is an important method of review of the practice of euthanasia. For the project "support and consultation in euthanasia in Amsterdam" which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. PARTICIPANTS: Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the general practitioners who were going to use the protocol. EVIDENCE: There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. CONSENSUS: An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. CONCLUSIONS: The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere.

Clinical Protocols↗