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At least 19 recordsLinked to original sources
PubMed1992

Experience with an operational nuclear medicine PACS in the Utrecht University Hospital.

At the department of nuclear medicine of the University Hospital Utrecht a single modality PACS has been operational since mid 1990. After 1 year of operation the functionality, the organizational and economical consequences and the acceptability of the PACS are evaluated. The functional aspects reviewed are: viewing facilities, patient data management, connectivity, reporting facilities, archiving, privacy and security. It is concluded that the improved quality of diagnostic viewing and the potential integration with diagnosis, reporting and archiving are highly appreciated. The many problems that have occurred during the transition period, however, greatly influence the appreciation and acceptability of the PACS. Overall, we feel that on the long term there will be a positive effect on the quality and efficiency of the work done in our department.

Computer Communication Networks↗
PubMed1999

Occupationally related exposures and reduced semen quality: a case-control study.

OBJECTIVE: To determine whether there is an association between abnormal semen parameters and occupational exposures to organic solvents, metals, and pesticides. DESIGN: Case-control study using three case groups based on different cutoff values for semen parameters and one standard reference group. SETTING: University Hospital Utrecht and University Hospital Rotterdam, the Netherlands. PATIENT(S): Male partners of couples having their first consultation at the two infertility clinics (n = 899). INTERVENTION(S): Men provided at least one semen sample. Occupational exposure was assessed with use of job-specific questionnaires, a job exposure matrix, and measurements of metals and metabolites of solvents in urine. MAIN OUTCOME MEASURE(S): Standard clinical semen analyses were used to define case groups and controls. RESULT(S): An association between aromatic solvents and reduced semen quality was demonstrated, irrespective of the exposure assessment method used. The associations were stronger if the case definition was based on stricter cutoff values for semen parameters. Risk estimates were higher if the analysis was restricted to primary infertile men. Exposure to other pollutants at the workplace was not associated with impaired semen quality. CONCLUSION(S): The findings indicated an association between aromatic solvent exposure and impaired semen parameters.

Adult↗
PubMed1996

[Outpatient sports clinic, first impressions].

OBJECTIVE: To review the first year of the outpatient sports clinic in Utrecht University Hospital (AZU), and to demonstrate the feasibility of such a sports clinic. DESIGN: Retrospective study (period: April 1993-March 1994). SETTING: University Hospital Utrecht, the Netherlands. METHODS: The patients attended the sports clinic either on referral or on their own initiative. The specialist directly entered the patients' data onto a registration form. RESULTS: Over a period of one year 461 consultations where given to 271 patients. The patients' average age was 31 years. The commonest sports were soccer, running and tennis. The lower limb was the commonest site of injury (79%) and overuse injuries predominated. For 57% of the patients therapy was instituted, which consisted in 67% of the cases of physiotherapy and in 13% of operative intervention. CONCLUSION: The outpatient sports clinic appears to be visited in particular by senior athletes with chronic complaints caused by surmenage injuries or with residual complaints following acute injuries. Future intramural sports medicine will have to deal not only with treatment of injuries as presented at the sports clinic, but also with prevention of chronic complaints resulting from acute injuries in this group of athletes.

Adult↗
PubMed1992

[How much information is retained by participants in clinical trials?].

OBJECTIVE: To assess which information participants of the Dutch TIA trial could remember from the informed consent procedure. DESIGN: Descriptive investigation. SETTING: The University Hospital Utrecht and the University Medical Centre Amsterdam. METHODS: One hundred of the 308 patients from 2 of the 63 participating clinical centres (the University Hospital Utrecht and the University Medical Centre Amsterdam), were selected at random for telephone interviews. Nineteen were not interviewed, most of them because they did not have access to a telephone. By a weighted score based on the replies the influence of some baseline variables was explored. The information sheet that patients had received was analysed with the readability tests of Flesh and Fry. RESULTS: Eighty-six percent of all patients were aware of the correct diagnosis. The name and action of the trial drug Ascal (a brand of acetylsalicylic acid) were retained better than those of atenolol. The nature of the disease and therapy were better known than the design of the trial. Of the baseline variables explored only the level of education was significantly related to what patients remembered about the trial. The readability of the information sheet required more education than was intended. CONCLUSION: Although we did not study a random sample the conclusion seems warranted that the level of information was not optimal in this trial.

Adult↗
PubMedDate not supplied

An analysis of the costs of a hospital-wide Picture Archiving and Communication System with the software package CAPACITY.

Within the scope of the Dutch PACS project, the costs of a hospital wide PACS in the Utrecht University Hospital were estimated, with the help of the software package CAPACITY. The cost analysis was based on the most recent specifications of the costs of the equipment, on extrapolations, and on the experience acquired with a PACS prototype in the Utrecht University Hospital. Savings due to a possible reduction in the length of stay, or due to logistic improvements were not taken into account. The results indicate that the extra costs of a hospital wide PACS would amount to 3.2% of the total hospital budget. By taking into account the expected price movements, it is predicted that a hospital wide PACS may allow enough savings to pay itself back, when installed near the turn of the century. The result of this cost analysis depends on a large number of assumptions. Therefore two sensitivity analyses are carried out, i.e., concerning the number of workstations required and concerning the organizational impact of PACS.

Computer Systems↗
PubMed1991

Control of epidemic methicillin-resistant Staphylococcus aureus in a Dutch university hospital.

Between 1986 and 1989 a single strain of a methicillin- and multiply-resistant Staphylococcus aureus caused three distinct outbreaks at Utrecht University Hospital, involving 11, 19 and 32 patients, respectively. In all three episodes, members of staff were screened for MRSA carriage, and 58 persons were found to have positive nose cultures. In each outbreak it became necessary to isolate colonized and infected patients on a separate isolation ward. Staff carriers were also treated. Over the 18 months since the last outbreak, no new acquisitions of this epidemic MRSA strain have occurred. Between 1986 and 1989, the strain which caused the three outbreaks was not the only MRSA strain which was introduced into the hospital. Six other strains, which differed from the epidemic strain as shown by phage typing and antimicrobial susceptibility pattern, were found in single patients. The experience at Utrecht University Hospital illustrates the need for strict measures to eradicate epidemic strains of MRSA as well as the differences in "epidemicity" among various strains of MRSA.

Bacteriophage Typing↗
PubMed1995

[Acute appendicitis: a serious disease in the elderly].

OBJECTIVE: To determine the differences between acute appendicitis in younger and in older patients. DESIGN: Retrospective study. SETTING: Utrecht University Hospital and Diakonessen Hospital Utrecht, the Netherlands. METHOD: All patients operated in the period 1989-1991 because acute appendicitis was suspected were included in this study. The patients were divided into two groups, one fifty years of age or older, one younger. Duration of symptoms, histology, closure or non-closure of the incision, complications and hospital stay were examined. RESULTS: About ten percent of the patients were over fifty years of age (35/366). The duration of symptoms in this group was significantly longer. Appendix sana occurred less often in the elderly, perforated appendix more often. The wound was left open more often in the elderly, but they did not have more complications. Their hospital stay, however, was significantly longer. CONCLUSION: The longer duration of symptoms and the higher rate of perforation justify a higher place of acute appendicitis in the differential diagnosis of acute abdomen in the elderly. The more serious course of the disease appears from the longer hospital stay.

Acute Disease↗
PubMed1996

Early experience with transfemoral endovascular aneurysm management (TEAM) in the treatment of aortic aneurysms.

OBJECTIVES: To evaluate the early experience with transfemoral endovascular aortic aneurysm management using the Endovascular Grafting System. DESIGN: Multi-centre prospective evaluation of the implantation procedure and early results (median follow-up 153 days). SETTING: Department of Surgery, University Hospital Utrecht, The Netherlands; Department of Surgery, University of Sydney, Australia; University of Leicester School of Medicine, Leicester, U.K., Department of Surgery, Karolinska Hospital, Stockholm, Sweden and Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital; Oxford, U.K. MATERIALS: 31 consecutive patients treated in 13 months. CHIEF OUTCOME MEASUREMENTS: Peri and postoperative morbidity and mortality in accordance with the recommendations of the Ad Hoc Committee on Reporting Standards. MAIN RESULTS: Graft placement was initially successful in all 31 patients. In one patient the endograft had to be replaced by a standard aortic tube graft because of extra graft flow in the aneurysm sac, and complaints of back pain. One patient died from multiple organ failure, 11 days after the operation. In three patients five severe adverse events were recorded. Breaks of the attachment system were encountered in two patients. These failures did not have severe clinical consequences for individual patients. CONCLUSIONS: Transfemoral Endovascular Aneurysm Management is a technically demanding procedure that requires special training in both catheter and surgical techniques. The potential for less operative morbidity when compared to conventional surgery and the prospect of technical improvements in graft and introduction system design will make TEAM an important tool in aneurysm management in the near future.

Aged↗
PubMed1993

[Selection of medical residents for medical specialist education: experiences with a structured procedure].

OBJECTIVE: Evaluation of an objective, standardised method for selection of residents for medical specialty training. DESIGN: Retrospective. SETTING: University Hospital Utrecht, department of diagnostic radiology. Utrecht University, Department of Clinical Psychology and Health Psychology. METHODS: All applicants for residency positions in 1990-1991 were requested to complete a standard application form. The applications were judged by seven staff members on six criteria. Using statistical tests the relative contribution of each criterium was calculated. A similar procedure was followed for those who were invited for an interview. RESULTS: Most of the criteria applied for the written and oral applications contributed significantly to the rank order achieved. The written and oral criteria showed some degree of overlap, whilst the criteria used for the written application were relatively independent from those used for the interview. For a balanced evaluation of the written information a selection committee of four staff members was sufficient. CONCLUSION: Structuring the selection process as described gives both staff and applicants more insight in the criteria applied, and thus allows a more objective and valid evaluation. To medical students it is beneficial to become acquainted with criteria that may be used in selection procedures for medical specialty training, so they can prepare themselves adequately.

Education, Medical↗
PubMed1994

Euthanasia: the Dutch experience.

Although rules about euthanasia have been developed in the Netherlands, euthanasia has not been legalized. We review the historical aspects of euthanasia, its definition and why no distinction is now made between active and passive euthanasia in the Netherlands. The guidelines for euthanasia, in use in the Utrecht University Hospital, are presented and the result of some studies on euthanasia is discussed. Non-treatment decisions were taken in 17.5% of all deaths in 1990 but only 1.8% of all deaths were the result of euthanasia. Life-terminating acts without explicit and persistent request of the patients occurred in 0.8% of all deaths. The most common reasons for requests for euthanasia were loss of dignity in 57%, pain in 46%, distressing mode of dying in 46% and being dependent on others in 33%. Of all medical decisions concerning the end of life 79% related to patients older than 65 years. The guidelines for euthanasia developed in the Netherlands support both patient and physician in the request for euthanasia.

Aged↗
PubMed1990

[Spread and control of a methicillin-resistant Staphylococcus aureus in an academic hospital].

Between December 1988 and March 1989 twelve patients in the Utrecht University Hospital developed an infection with a methicillin-resistant Staphylococcus aureus (MRSA). Twenty other patients and 39 personnel members became colonized with the same MRSA strain. In spite of early isolation measures, progression of this epidemic was probably caused by the extreme degree of contagiousness of the first patient, who had a drug-induced allergic skin eruption. It seems likely that spread occurred via personnel and via a computer tomographic scanner. To contain the epidemic it was necessary to institute a special isolation ward with dedicated personnel. Although several MRSA strains have been introduced in the University Hospital since 1986, the strain we describe here is the only one which spread epidemically.

Academic Medical Centers↗
PubMed2000

[Fewer x-rays while maintaining quality of clinical care using clinical protocols for physical diagnosis of ankle injuries].

OBJECTIVE: To determine whether it is possible to decrease the number of X-rays in acute ankle injury while keeping the health care constant, using a scoring system. DESIGN: Prospective. METHOD: Patients presenting in the emergency department of the University Hospital Utrecht (AZU), the Netherlands, over a one-year period of time with acute ankle injuries were subjected to a thorough physical examination based on a scoring system developed at Leiden University Hospital. The score was calculated and X-ray examination was indicated when this score was > or = 8 points. Radiological investigation or telephone interviews six weeks after injury achieved verification of the clinically relevant ankle fractures. Specificity and sensitivity were calculated from every possible cut-off point and drawn in a 'receiver operating characteristics' (ROC) curve. RESULTS: Of the 514 patients included 81 patients had a score of 8 or higher and 24 of them had a clinically relevant fracture. In 34 patients an ankle X-ray was made although their score was < 8 points. The positive and negative predictive values of the system were 30% (95% confidence interval (95% CI): 20-41) and 99% (95% CI: 97-100) respectively. The score yielded an area under the ROC curve of 91% (95% CI: 84-98). A cut-off point of 8 led to a reduction of X-rays by 60% (using the 'Ottawa ankle rules' the decrease in this population would have been 28%). On the other hand, 5 clinically relevant fractures were missed. CONCLUSION: Radiological examination in patients wit acute ankle complaints was reduced while health care remained almost constant. In the AZU, a decision was made for a major reduction in X-rays while accepting that some fractures would be missed.

Adult↗
PubMed1996

The clinical nurse specialist in geriatrics in Utrecht, The Netherlands.

The Clinical Nurse Specialist (CNS) position is relatively new in The Netherlands; of all the hospitals, only 25% have active CNSs. In University Hospital Utrecht, there are five CNSs, with one in geriatrics. The goal of the author is to further develop nursing knowledge in geriatrics. Emphasis is given to patient care, education, innovation, and research. Since the beginning the CNS history in 1992, much has been achieved.

Aged↗
PubMed1999

[Heart transplantation in the Netherlands, an option to be considered for 5 children per year on the average].

OBJECTIVE: To assess the number of possible candidates for paediatric cardiac transplantation and the number of available donors. DESIGN: Retrospective. PATIENTS AND METHODS: The population (date of birth 1 January 1980-31 March 1998) of the Department of Paediatric Cardiology of the Wilhelmina Children's Hospital, Utrecht, the Netherlands, was reviewed for possible candidates for cardiac transplantation and the resulting number of candidates was extrapolated to the entire country. Figures of the transplant co-ordination unit of the University Hospital Utrecht over 1993-1997 were obtained, to estimate the number of available donors. Furthermore, an overview was made of the results of paediatric cardiac transplantations reported in centres around the world. RESULTS: A total number of 15 possible candidates could be selected over the studied period. Extrapolated to the entire country, about 5 candidates each year could be expected. Per year 5 donor hearts of children (< 12 yr) and 11 hearts of adult donors with a low body weight (40-65 kg) have been available for paediatric cardiac transplantation. Worldwide 5- and 10-year survival rates reach 60% and 50%, respectively, morbidity seems low and the quality of life can be considered reasonably good. CONCLUSION: The number of expected recipients corresponds with the number of available donors. Together with the promising results reported in transplant centres around the world, this seems to justify the option of paediatric cardiac transplantation for children with end-stage cardiac disease.

Adolescent↗