Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
Comparative Study[Hospital standardised mortality ratio (HSMR): adjustment for severity of primary diagnosis can be improved].
To study the impact of casemix variations within primary diagnostic groups on hospital standardised mortality ratios and to improve the current HSMR model. ⋯ The HSMR model currently used in the Netherlands does not adequately adjust for casemix differences at the level of ICD-9 primary diagnoses. A model using a severity classification of ICD-9 codes based on actual Dutch hospital mortality allows for a better, albeit not perfect, adjustment. We recommend implementation of the 'Dutch' severity classification in order to improve the HSMR model.
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Ned Tijdschr Geneeskd · Jan 2011
[Palliative sedation largely in accordance with Dutch national guideline].
To evaluate the practice of continuous palliative sedation after the introduction of a national guideline. ⋯ Continuous sedation practice in the Netherlands largely reflects the recommendations of the national guideline. Issues needing further attention are the pressure felt by physicians to start continuous sedation, as well as the possible life-shortening effect of continuous sedation as perceived by some of the physicians.
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Ned Tijdschr Geneeskd · Jan 2011
[Scan for residency programmes is a useful instrument for modernising residency training].
The modernisation of residency training programmes entails the implementation of many modifications. Revised residency training programmes, quality criteria and renewed legislation all have major consequences for residents, faculty and residency groups. Leiden University Medical Centre has developed a residency training programme evaluation tool that compares each training programme's activities with its relevant stakeholders, for example, the resident, the instructors and the central residency training committee. The outcome of this scan provides residents, instructors and central residency training committees with an overview of the current state of progression of modernisation activities, in addition to providing guidance as to the improvement of both individual training programmes and the programmes offered by institutions.
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The publication of inadequately adjusted mortality rates has led to incorrect and unfair comparison of outcomes in quality of care between hospitals. In order to ensure adequate risk-adjustment of such outcomes, care providers should maintain their own registries. Such databases enable the monitoring and benchmarking of outcomes adjusted for case mix. ⋯ The goal of the database is to control and to improve the quality of care by providing frequent feedback to the participating hospitals about their risk-adjusted mortality rates. Other care providers should follow this example and register their own risk-adjusted outcomes. Such registries will function as a quality instrument and will provide an in-depth explanation of the oversimplified results that are often published.
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[Imminent respiratory insufficiency in children resulting from Guillain-Barré syndrome].
Early recognition of Guillain-Barré syndrome (GBS) is crucial to anticipate and adequately respond to possible respiratory insufficiency. Young children with GBS frequently have non-specific complaints and are more difficult to examine, which may cause a significant delay in diagnosing GBS. ⋯ Young children with GBS often present with pain and refusal to walk, or with difficulty swallowing, and are often initially misdiagnosed with e.g. tonsillitis or coxitis. These nonspecific symptoms can be a first sign of a progressive polyradiculoneuropathy and should prompt a full neurological examination and timely referral to a paediatric neurological centre with Intensive Care facilities.