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At least 19 recordsLinked to original sources

PubMed2000

[Diagnosis and treatment of gastroesophageal reflux disease in the mentally retarded: guidelines of a multidisciplinary consensus work group. Dutch Association of Physicians in Care of Mentally Handicapped].

Gastroesophageal reflux disease (GORD) is more frequent among people with intellectual disability than among the intellectually normal population. Also GORD is more serious in this population. The diagnosis is often missed, because most intellectually disabled cannot express their complaints of GORD. For that reason a multidisciplinary working group of the Dutch Association of physicians active in the care of persons with a mental handicap has developed guidelines. The working group recommends endoscopy in case of a (alarm) symptoms: haematemesis, prolonged vomiting, irondeficiency anaemia e.c.i., and a 24 hour oesophageal pH test in case of b (aspecific) symptoms: recurrent pneumonia, refusal of food, regurgitation, rumination, dental erosions. In general most patients are cured with drug treatment (omeprazol or another proton pump inhibitor). If symptoms are not improved after 6 months of optimal treatment, surgical treatment may be considered.

Adult↗

PubMed1999

['There is a need for women doctors to join forces': Dutch Association of Women Physicians, 1933-1998].

After a history of some years, the Dutch Association of Medical Women (VNVA) was founded in 1933. The aim of the Association was to promote the interests of women doctors. At that time about 5% of the physicians were women. Their position on the labour market was not at all equal to that of their male colleagues. In 1949 some VNVA members played an important part in stimulating the recognition of women's interests by publishing on anticonception in this journal. It is still necessary to pay attention to equal opportunities for women doctors. Besides, promotion of a sex-sensitive health care was added to the mission statement. The Association nowadays has more than 2600 members.

History, 20th Century↗

PubMed2006

Adherence to mental health guidelines by Dutch occupational physicians.

BACKGROUND: In 2000, the Dutch Association of Occupational Physicians published a national guideline for the management of employees with mental health problems. OBJECTIVES: To examine predictors of adherence to this guideline by Dutch occupational physicians (OPs). METHODS: Using the Theory of Planned Behaviour, a questionnaire was developed about self-reported guideline adherence of OPs and possible predictors of this behaviour. A total of 165 OPs were approached to complete the questionnaire and registration forms of first consultations of workers with mental health problems. Performance indicators based on the guideline were developed to calculate performance rates of guideline adherence by OPs. RESULTS: Eighty of 165 (48%) OPs approached completed the questionnaire. Fifty-six OPs returned one or more registration forms, totalling 344 consultations. On a five-point Likert scale, ranging from never (1) to always (5), the mean score on self-reported guideline adherence was 2.35, compared to a mean score of 4.06 on the intention to comply with the guideline. The mean performance rate of OPs ranging from 0 to 2 was 1.27 on diagnosis and 0.60 on guidance. No relation was found between self-reported guideline adherence and performance rates. Self-reported guideline adherence correlated significantly with perceived behaviour control (r = 0.48, P < 0.05), subjective norms (r = 0.33, P < 0.05) and positive job stress (r = 0.35, P < 0.05). CONCLUSIONS: Guideline adherence by Dutch OPs lags behind its acceptance. Further implementation efforts need to focus on diminishing barriers and enhancing social norms of OPs to work according to the guideline.

Adult↗

PubMed1999

[Female circumcision; histories of 3 patients].

Three Somali women presented with problems of the infibulation they had undergone when they were girls. The first one was 22 years old and had problems with coition, the second one was 21 years old and had problems with parturition, the third one was 28 years old and had an epidermal cyst near the ventral commissure of the vulva. Infibulation is a form of female circumcision, in which the clitoris, labia minora and labia majora are removed and the ostium vaginae is reduced to less than a centimeter. In the Netherlands the Ministry of Health, Wellbeing and Sport and the Association of Obstetricians and Gynaecologists have declared themselves opponents to female genital mutilation carried out by Dutch physicians. The association decided also to not carry out reinfibulation, e.g. after parturition.

Adult↗

PubMed1994

[Life-terminating actions by family practitioners and nursing home physicians without the patient's request].

OBJECTIVE: To describe deliberate and active termination of life without the patient's request by general practitioners and Dutch 'nursing home' physicians. DESIGN: Descriptive, retrospective investigation. METHOD: Data were collected through anonymous postal questionnaires sent to a random sample of 521 general practitioners in North Holland and 521 general practitioners in the rest of the Netherlands regarding 1986-1989 and to all 713 Dutch 'nursing home' physicians affiliated to the Dutch Association of Nursing Home Physicians regarding 1986-June 1990. RESULTS: 65 General practitioners (10%) and 28 nursing home physicians (5%) had at any time deliberately terminated the life of a patient without explicit request by the patient, 94 and 70 times, respectively. In almost all cases the general practitioners indicated that the patients were suffering intensely; the nursing home physicians indicated this in 65% of the cases; with 66% and 57% of the patients contact was not possible; in 50% and in 65% of the cases, respectively, the family was involved in the decision to terminate the patient's life. CONCLUSION: Termination of life without request by the patient occurs in the practices of Dutch general practitioners and Dutch 'nursing home' physicians, but is rare.

Advance Directives↗

PubMed1999

[Practice guidelines for diagnosis of vision disorders in mentally handicapped persons. National Organization for Quality Assurance in Hospitals].

Visual impairment is more frequent among people with intellectual disability than among the general population. Because the diagnosis often fails to be made in this group screening is justified. Timely recognition may have consequences for prevention and treatment. Therefore, a consensus statement has been developed by the Dutch associations of physicians for intellectual disability, general practitioners, ophthalmologists, paediatricians, youth health physicians and orthoptists. Specialized ophthalmological assessment of all young children with retarded development is recommended, as well as assessment of visual function at the ages of 3, 6, 12 and 18 years and every 5 years from the age of 45. In adults with Down's syndrome, an additional assessment at the age of 30 is recommended for detection of age-related cataract and (increased) refractive errors. Most people can be assessed by the general practitioner, using normal methods. Diagnostic methods applicable in insufficiently co-operative people have been recommended. Low-threshold regional expert centres for diagnosis in children and adults who are difficult to assess and for specialized guidance would be advisable.

Adolescent↗

PubMed1994

Voluntary active euthanasia and physician-assisted suicide in Dutch nursing homes: requests and administration.

OBJECTIVE: To learn how many requests for voluntary active euthanasia and/or physician-assisted suicide (EAS) are made to Dutch nursing home physicians (NHPs) and how often these requests are honored. DESIGN: Retrospective survey. SETTING: The Netherlands. PARTICIPANTS: All Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713). MEASUREMENTS: An anonymous postal questionnaire was sent to all Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713). Respondents were asked how often they had received an explicit request for EAS and whether they had complied with that request. Those who had complied were asked questions about the last occasion on which they had administered either voluntary active euthanasia or physician-assisted suicide. RESULTS: The response rate was 86% (n = 582). Of the respondents, 88% had never administered EAS in nursing homes. The remaining 12% (n = 69) had received 164 requests for voluntary active euthanasia and 53 requests for physician-assisted suicide in the period 1986 through mid-1990. Of these requests, 74 were granted (51 voluntary active euthanasia and 23 physician-assisted suicide). Dutch NHPs together receive an average of 300 requests for EAS a year. They comply with 25 of such requests annually. CONCLUSION: Not many requests for EAS are made in Dutch nursing homes. Of these requests, fewer than 1 in 10 result in the actual administration of EAS. The data presented are relatively constant for the 4.5-year period studied.

Adult↗

PubMed2005

[The role of the physician in requests for physician-assisted suicide in patients who are 'suffering from life': the Dijkhuis Report commissioned by the Royal Dutch Medical Association].

In the Brongersma case, physician-assisted suicide was carried out in an 86-year-old man who was tired of life. The Dutch Supreme Court ruled that physician-assisted suicide may not be carried out if the suffering of the patient is not mainly determined by a medically classifiable disease. The Royal Dutch Medical Association set up a commission headed by J.Dijkhuis to advise them on determining their position in similar cases. This commission proposed a broader medical domain than had been determined by the Supreme Court. The commission was of the opinion that each physician should be able to manage requests for physician-assisted suicide from patients who are 'suffering from life' in terms of treatment that could influence the situation of the patient or his or her experience of it. If the patient continues to request physician-assisted suicide in spite of this, physicians are free to set their own individual limits which may be stricter than those set by the medical profession nationally. It is necessary to acquire scientifically underpinned knowledge of how to manage requests from patients who are 'suffering from life'.

Aged↗

PubMed1995

Attitudes of Dutch general practitioners and nursing home physicians to active voluntary euthanasia and physician-assisted suicide.

OBJECTIVE: To gain insight into the attitudes of Dutch general practitioners and nursing home physicians to voluntary active euthanasia and physician-assisted suicide. DESIGN: Descriptive study. METHOD: Data were collected by means of anonymous postal questionnaires to be completed by a random sample of 521 general practitioners from the province of North Holland, 521 general practitioners from the rest of the Netherlands, and 713 Dutch nursing home physicians who were members of the Dutch Association of Nursing Home Physicians. RESULTS: The written responses of general practitioners and nursing home physicians to six statements about voluntary active euthanasia and physician-assisted suicide showed that a large majority had a fairly positive attitude to euthanasia and suicide. This finding also emerged from the scores obtained on a scale compiled on the basis of the statements. General practitioners and nursing home physicians were more opposed to euthanasia and physician-assisted suicide if they had never performed it, if they belonged to a religious group, or if they were older. CONCLUSION: Dutch general practitioners and nursing home physicians have a fairly positive attitude toward euthanasia and physician-assisted suicide. However, the majority of these physicians favor a policy of voluntary active euthanasia and physician-assisted suicide under strict conditions.

Age Factors↗

PubMed1995

The Dutch experience with euthanasia: lessons for Canada?

Anne Mullens used a recent fellowship provided by the Atkinson Foundation to take an in-depth look at euthanasia in the Netherlands. During her time in Holland, she discussed the issue with doctors who support and oppose euthanasia. She accompanied a doctor as he visited a patient who was dying of cancer and was beginning to consider the possibility of euthanasia. She talked to a nonphysician who is adamantly opposed to euthanasia and carries a card stating that. She visited a hospital in Amsterdam that has received requests from foreigners seeking euthansia. Mullens offers a comprehensive look at an issue that continues to provoke strong feelings among Canadian physicians and patients.

Aged↗

PubMed1995

Active euthanasia and physician-assisted suicide in Dutch nursing homes: patients' characteristics.

We wished to obtain information about the principal and subsidiary diagnoses, sex, age, marital status, religion and background characteristics of Dutch nursing home patients to whom euthanasia/assisted suicide (EAS) was administered. We performed an exploratory, descriptive, retrospective study involving all Dutch nursing home physicians (NHPs) who in September 1990 were members of the Dutch Association of Nursing Home Physicians (NVVA; n = 713). An anonymous printed questionnaire in two parts was used. Part 1 was intended for all respondents and was expected to give insight into the nature and extent of EAS in Dutch nursing homes. Part 2 was intended only for respondents who had indicated in part 1 that they had administered EAS. They were asked to describe their last case of EAS. The study covered the period from 1986 to mid-1990. There was an 86% response. The respondents described 86 cases of EAS. Sixty-nine of these took place in a nursing home. The majority of patients to whom EAS was administered were suffering from a malignant neoplasm (53%). EAS was administered more often to men than to women. The average age of the patients was 70.9 years. When EAS was administered, the patients on average had been in the nursing home for 13.1 months. Dutch nursing home patients who were given EAS differed in various respects from 'the average nursing home patient'. The principal diagnosis for patients who were given EAS was a malignancy, whereas relatively few physically ill nursing home patients die as a result of a malignancy. The patients to whom EAS was administered were younger and more often male. EAS patients had been in the nursing home for a shorter time than the other somatic (physically disabled) patients who died during the study period.

Adult↗

PubMed2002

Improving homeopathic prescribing by applying epidemiological techniques: the role of likelihood ratio.

A committee of the Dutch Association of Homeopathic Physicians is trying to validate materia medica by evaluating successful cases. These cases are presented and assessed by a group of experienced homeopathic physicians to provide indications about the prevalence of symptoms related to particular homeopathic medicines. The next logical question is whether epidemiological techniques can be applied to them. We have some ideas concerning the information these data can provide, based on epidemiological theory and limited experimental data. Theoretical investigation suggests that the epidemiological concept of likelihood ratio is well adapted to homeopathy. Researching and applying likelihood ratio will lead to more accurate materia medica and repertory. These considerations already indicate some shortcomings in the representation of rare remedies and the use of grading in the current repertories.

Drug Prescriptions↗

PubMed1993

Prevalence of smoking in physicians and medical students, and the generation effect in The Netherlands.

This study investigates smoking habits and attitudes towards smoking in general practitioners, consultants at a university hospital, medical students and students of health policy and management (H.P.M.). An anonymous, self-administered postal survey was used. Thirty-eight percent of the general practitioners, 27% of the consultants, 18% of the medical students and 31% of the H.P.M. students are current smokers. The prevalence of smoking was found to be higher in the male general practitioners and the male H.P.M. students than in the general male population. The prevalence of smoking was lower in female physicians and students than in their male counterparts and also lower than in the general female population. Medical students are not inclined to start smoking: a strong generation effect can be observed. This will reinforce the current downward trend in the prevalence of smoking in Dutch physicians. The doctors were found to have a suboptimal level of knowledge about methods of smoking cessation and about the association between smoking and health disorders. Most Dutch physicians, especially those who smoke, fail to perceive their role as an example to the general population concerning smoking behaviour. Medical students were found to have even less recognition of their future exemplary role.

Adolescent↗

PubMed1999

[Physician-assisted suicide for a patient with a psychiatric disorder: guidelines for psychiatrists. Dutch Association of Psychiatry].

In September 1998, the Dutch Association of Psychiatry published guidelines for the psychiatrist concerning cases of psychiatric patients requesting assistance with suicide. Assistance with suicide is restricted to a psychiatrist in his role as a treating physician of a patient with a psychiatric disorder. Requests for assisted suicide should primarily be considered as requests for help with life. Individual psychiatrists have no moral or legal obligation to assist in suicide. The guidelines require that the request is voluntary, explicit and well considered, the desire for death long-lasting and the suffering unbearable and hopeless. In addition an independent psychiatrist should be consulted as well as former treating physicians, general practitioner, family members and other people involved. If a somatic specialist or a general practitioner is asked to assist in suicide consultation of two psychiatrists is required. The guidelines offer psychiatrists a framework for taking great care when their patients request assisted suicide and will certainly play a part in the legal control of assisted suicide.

Aged↗

PubMed2003

[Medical-scientific societies, quality control and disfunctional physicians].

One doctor denied an existing fatal malignancy and diagnosed cancer in patients who did not have it. He and two other doctors gave the impression that they could cure patients by methods of which the efficacy has not been demonstrated. All three were members of a society for alternative medicine; two of them no longer are. The third, an internist, is still a member of his alternative scientific medical society, but of the Netherlands Association of Internal Medicine as well. A clinical chemist with a private laboratory that continually diagnoses nutritional deficiencies in a disputable way, and a neurologist who cooperates with a highly controversial American back physician were not expelled from their associations nor corrected by them. The Dutch Health Inspectorate is investigating dysfunctioning physicians and may well take action against them. The medical-scientific societies could well pay closer attention to their task of promoting the quality of the professional activities of their members.

Clinical Competence↗

PubMed1994

Report of the Board of Trustees of the American Medical Association. Euthanasia/physician-assisted suicide: lessons in the Dutch experience.

This Board of Trustees Reports urges physicians to be aware of continuing efforts by some in society to end suffering by speeding deaths through medical interventions. The experience in Holland with euthanasia and physician-assisted suicide is outlined in this report, as are the differing interpretations of the Dutch data by voices in Holland. The Dutch guidelines intended to protect patients have not been consistently respected. The sum of the experience suggests that implementation of their controls on euthanasia and physician-assisted suicide has not been effective. Recognizing that there are differences between withholding or withdrawing life-sustaining treatment and euthanasia and physician-assisted suicide, the availability of mechanisms for end of life medical decision-making by patients, such as powers of attorney, etc., should be more widely promoted. The Board of Trustees recommends that the American Medical Association reject euthanasia and physician-assisted suicide as being incompatible with the nature and purposes of the healing arts.

American Medical Association↗

PubMed2005

[Thromboprophylaxis in general surgical practices in the year 2004: perioperative use during hospitalisation, during out-patient care and following plaster cast immobilisation].

OBJECTIVE: To determine which thromboprophylactic modalities were used by general surgeons in the Netherlands; to check current clinical practice against national and international guidelines. DESIGN: Descriptive. METHOD: In April 2004 a questionnaire was sent to all 106 surgical practices in the Netherlands with questions regarding the use of thromboprophylaxis before, during and after various surgical interventions. Practice was compared with guidelines from the Dutch Institute for Healthcare Improvement CBO, the Dutch Surgical Association and the American College of Chest Physicians. RESULTS: We obtained data from 92 (87%) surgical practices. Low molecular weight heparin was initiated before surgery by 92% of respondents. Risk factors such as age (72%) and prior venous thromboembolism (76%) played an important role in determining the thromboprophylactic protocol used. During hospitalisation, variations were seen primarily for operations performed on an out-patient basis: 61% of surgeons gave thromboprophylaxis in this setting. Prolonged thromboprophylaxis after hospital discharge was seldom administered. 54% of surgeons used prolonged thromboprophylaxis after surgery for hip or femur fractures. During cast immobilisation of the upper leg, 79% of all surgeons prescribed thromboprophylaxis. CONCLUSION: Current practice regarding thromboprophylaxis during hospitalisation conformed consistently to the guidelines. The guidelines were followed moderately with regard to the use of prolonged thromboprophylaxis following hip fractures. In the absence of clear guidelines, there were striking differences among surgical practices regarding thromboprophylaxis during out-patient care and plaster cast immobilisation.

Age Factors↗

PubMed2004

Satisfaction with the outpatient encounter: a comparison of patients' and physicians' views.

OBJECTIVE: To compare patients' and physicians' visit-specific satisfaction in an internal medicine outpatient setting, and to explain their respective views. DESIGN: Patients' and physicians' background characteristics were assessed prior to outpatient encounters. Immediately after the encounter, both patients and physicians completed a questionnaire assessing satisfaction with the visit. SETTING: The outpatient division of an academic teaching hospital. PARTICIPANTS: Thirty residents and specialists in general internal medicine, rheumatology, and gastroenterology, and 330 patients having a follow-up appointment with one of these physicians. MEASUREMENTS AND MAIN RESULTS: Patients' and physicians' visit-specific satisfaction was assessed using 5 Visual Analogue Scales (0 to 100). Patients' overall satisfaction was higher than physicians' satisfaction (mean 81 vs. 66), and correlation of patients' and physicians' overall satisfaction with the specific visit was medium sized (r= .28, P < .001). Patients' satisfaction ratings were associated with their previsit self-efficacy in communicating with their physician (P < .001) and with visiting a female physician (P < .01). Physicians' satisfaction was associated with patients' higher educational level (P < .05), primary language being Dutch (P < .001), better mental health (P < .05), and preference for receiving less than full information (P < .05). CONCLUSIONS: In an outpatient setting, patients' visit-specific satisfaction ratings were substantially higher than, and only moderately associated with, physicians' ratings of the same visit. The dissimilar predictors explaining patients' and physicians' satisfaction suggest that patients and physicians form their opinion about a consultation in different ways. Hence, when evaluating outpatient encounters, physicians' satisfaction has additional value to patients' satisfaction in establishing quality of care.

Adult↗