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PubMed2006

Determinants of potential drug-drug interaction associated dispensing in community pharmacies in the Netherlands.

OBJECTIVE: There are many drug-drug interactions (D-DI) of which some may cause severe adverse patient outcomes. Dispensing interacting drug combinations should be avoided when the risks are higher than the benefits. The objective of this study was to identify determinants of dispensing undesirable interacting drug combinations by community pharmacies in the Netherlands. METHODS: A total of 256 Dutch community pharmacies were selected, based on the dispensing of 11 undesirable interacting drug combinations between January 1st, 2001 and October 31st, 2002. These pharmacies were sent a questionnaire by the Inspectorate for Health Care (IHC) concerning their process and structure characteristics. MAIN OUTCOME MEASURE: The number of times the 11 undesirable interacting drug combinations were dispensed. RESULTS: Two hundred and forty-six questionnaires (response rate 96.1%) were completed. Dispensing determinants were only found for the D-DI between macrolide antibiotics and digoxin but not for the other 10 D-DIs. Pharmacies using different medication surveillance systems differed in the dispensing of this interacting drug combination, and pharmacies, which were part of a health care centre dispensed this interacting drug combination more often. CONCLUSION: Medication surveillance in Dutch community pharmacies seems to be effective. Although for most D-DIs no determinants were found, process and structure characteristics may have consequences for the dispensing of undesirable interacting drug combinations.

Adverse Drug Reaction Reporting Systems↗
PubMed1993

Excimer laser coronary angioplasty in The Netherlands: preamble for a randomized study.

The immediate outcome of ELCA by XeCl excimer laser radiation is described in 53 patients who were selected to undergo ELCA from December 1990 to September 1991 in two centers that are currently performing ELCA in the Netherlands. Immediate success rates on the basis of visual assessment of the angiogram were as follows. Laser success (> 20% reduction of diameter stenosis after ELCA alone) was observed in 77% of patients, procedural success (< 50% residual stenosis after ELCA with or without adjunctive balloon dilatation [PTCA]) in 91%, and clinical success (procedural success without clinical complications) in 83% of patients. Quantitative coronary angiography by automated contour detection was performed in 31 patients who underwent ELCA in the Thoraxcenter. The minimal luminal diameter (mean +/- SD) of the treated coronary segments increased from 0.77 +/- 0.41 mm to 1.24 +/- 0.25 mm after ELCA and further to 1.67 +/- 0.29 mm after adjunctive PTCA in 25 patients. The present experience is put in perspective of results initially reported by other centers and compared with data from multicenter registries of ELCA. Finally, a short description is given of the design of a prospective, randomized trial of ELCA versus conventional PTCA (AMRO trial).

Angioplasty, Balloon, Coronary↗
PubMed1990

Clinical benefits and cost-effectiveness of lowering serum cholesterol levels: the case of simvastatin and cholestyramine in The Netherlands.

To assess the cost-effectiveness of cholesterol-reducing therapy with cholestyramine and simvastatin in the primary prevention of coronary artery disease in The Netherlands, a model of coronary artery disease incidence was used based on multivariate logistic risk functions from the Framingham study. For men with initial cholesterol levels of 8 mmol/liter, the cost per year of life saved of cholestyramine, expressed in Dutch guilders (NLG; 1 NLG = $0.50), ranges from approximately NLG 208,000 to NLG 483,000, depending on the patient's age at initiation of therapy. For simvastatin, cost-effectiveness ranges from NLG 46,000 to NLG 98,000 per year of life saved among this group of men. Similar differences between simvastatin and cholestyramine therapy prevail among women, although the costs per year of life saved for both agents are considerably higher. These results suggest that (1) simvastatin is substantially more cost effective than is cholestyramine; (2) simvastatin therapy compares favorably with other generally accepted medical practices, especially if treatment is initiated at an early age; and (3) as its long-term safety record becomes more established, simvastatin may become accepted as a drug of first choice in the treatment of persons with elevated serum cholesterol levels.

Adult↗
PubMed1987

Multiple endocrine neoplasia syndrome type 2: the value of screening and central registration. A study of 15 kindreds in The Netherlands.

Since 1975, 10 families with the multiple endocrine neoplasia (MEN)-2A syndrome and five with the MEN-2B syndrome, making a total of 101 patients, have been identified in The Netherlands. Twenty-three of the MEN-2A patients died before the start of the screening program. The average age of the patients whose death was due to pheochromocytoma (n = 11) or medullary thyroid carcinoma (n = 12) was 34.9 and 49.2 years, respectively. Eighty-seven patients with the MEN-2A syndrome and eight with the MEN-2B syndrome underwent thyroidectomy for C-cell hyperplasia and/or medullary thyroid carcinoma. Eighteen patients had signs or symptoms caused by MEN-2A (group A), 60 were relatives of these patients who had been found to be affected at the first screening of the family (group B), and nine relatives had had negative screening results that later became positive (group C). Five patients had signs or symptoms due to MEN-2B (group A) and three were relatives of these patients who had been found to be affected at the initial screening (group B). To assess the effect of screening, we compared these groups with respect to the occurrence of metastatic medullary thyroid carcinoma at thyroidectomy and the results of the postoperative calcitonin tests. Among the MEN-2A families, 72 percent of group A, 33 percent of group B, and none of group C were found to have metastatic medullary thyroid carcinoma at surgery. In the MEN-2B families, all five patients in group A and one of the three patients in group B had metastatic disease. The "cure rates" in these three groups with MEN-2A, as determined by stimulated calcitonin assessment, were 11, 57, and 100 percent, respectively. One of the five patients with MEN-2B in group A and two of the three patients in group B showed normalization of the stimulated calcitonin value after surgery. From these results, it may be concluded that screening can lead to the detection of medullary thyroid carcinoma in an earlier stage, which in turn may permit curative treatment and improvement of both prognosis and life expectancy. The need for supervision of affected families by central registration to promote periodic examination and to guarantee the continuity of such screening is discussed.

Adrenal Gland Neoplasms↗
PubMed1987

The reliability of perinatal mortality statistics in The Netherlands.

All 13 hospitals in the municipality of Amsterdam cooperated in this study; labor ward records for the years 1981 and 1982 were personally searched for cases of perinatal death that corresponded with the World Health Organization definitions of perinatal mortality, presently applied in The Netherlands. The 360 cases that had apparently occurred in the Amsterdam hospitals were individually linked to the cases that had been entered into the national records at the Central Bureau of Statistics. The study established that the magnitude of underregistration of perinatal mortality is considerable (14.3%). Underregistration at the national level is due to underreporting by physicians and not due to errors in statistical bookkeeping. Underreporting is related to birth weight, that is, viability of the infant, and immigrant status of the mother. Recommendations are made to improve uniformity of notification criteria and reliability of perinatal mortality statistics.

Female↗
PubMed1993

Routine testing for Chlamydia trachomatis on Curaçao, Netherlands Antilles.

OBJECTIVE: Although genital Chlamydia trachomatis infection is most often asymptomatic, early treatment may prevent serious complications. For screening or routine testing to be cost effective, the prevalence of the infection must not be too low. STUDY DESIGN: On Curaçao, Netherlands Antilles, the prevalence of chlamydial infection in 205 asymptomatic women of reproductive age, who were seen by a general practitioner or gynecologist for a gynecologic examination was measured. RESULTS: The overall prevalence was found to be 5.4% (95% confidence interval 2.7% to 9.4%) with the enzyme-linked immunosorbent assay method. Of all possible predictors of a chlamydial infection, only young age (< 25 years, prevalence 10.3%) seemed to be indicative of such an infection. CONCLUSION: Routine testing for Chlamydia trachomatis in sexually active women on Curaçao and on other Caribbean islands is indicated for women < 25 years old.

Adolescent↗
PubMed1977

Experience in the Netherlands with an external quality control and scoring system for clinical chemistry laboratories.

A procedure is described to judge the quality of clinical chemistry hospital laboratories in The Netherlands. In 1974, 45% of the laboratories took part in the national control scheme. A score system of the results, independent of the standard deviation, opens a provisional possibility to strive for (dynamic) reference laboratories. The Youden plots possibly will unveil systematic method-differences. Discrepancies in results seem to be caused as much by methods/instruments applied, as by unknown factors which are under investigation now.

Chemistry, Clinical↗
PubMed1987

Epidemiology of Crohn's disease in Regio Leiden, The Netherlands. A population study from 1979 to 1983.

An epidemiologic study of inflammatory bowel disease was conducted in Regio Leiden, the Netherlands, between 1979 and 1983. Archives of endoscopy, radiology, pathology, and specialist letters were reviewed for suspected patients with inflammatory bowel disease, together with a survey of all general practitioners to verify completeness of data. One thousand forty patients were identified and each diagnosis was reviewed. Two hundred ten patients had Crohn's disease and 257 had ulcerative colitis. Of the other 573 patients, the largest proportion (21%) had incomplete data for disease classification. Others had irritable bowel syndrome, diverticulitis, or ischemic or irradiation colitis; some were nonresident patients with inflammatory bowel disease treated within the region and others were out of the period for inclusion in this investigation. The incidence of Crohn's disease was 3.9 per 10(5) per year and the period prevalence was 48 per 10(5). The sex-specific incidence was similar, although the disease was significantly more common in women aged 20-29 yr. The prevalence in the city municipalities of Leiden and Alphen on the Rijn (63 per 10(5)) was similar but significantly greater than in suburban (39 per 10(5)) or agarian areas (40 per 10(5)). This may be partially due to urban density but not to differences in water supply. The lack of cases in the migrant population almost reaches significant levels, but studies in locations with a higher migrant population may clarify the issue.

Colitis, Ulcerative↗
PubMed1992

Home deliveries in The Netherlands--perinatal mortality and morbidity.

The obstetrical organizational system in the Netherlands is based on the selection for risk factors. We conclude that: (i) The reporting of perinatal death is not complete. (ii) Perinatal mortality can be reduced. (iii) More iatrogenic interventions are present in low-risk deliveries in hospitals. (iv) Neurological behavior of low-risk babies born at home is equal to those born at the hospital, despite the worse maternal profile of the latter and the level of acidemia at birth in the first. Good data especially in referred cases are necessary before adopting a similar system.

Female↗
PubMed1992

The need for graduate nursing education and nursing research in The Netherlands: an exploratory study.

In 1989 research was performed aimed at discovering the views of Dutch administrators of intramural health care institutions on the need for graduate nursing education and nursing research in The Netherlands. The study was completed in 1990. Because the research aim was to learn the informants' point of view, a grounded theory method was applied. The sample size was 13. The subjects were selected by using two separate sampling procedures, so as to minimize bias. Data were collected by means of semi-structured interviews of 1 hour, which were tape recorded and transcribed verbatim. Analysis of the data was done by using the constant comparative method, involving concurrent collection, collation and analysis. The three major themes that finally emerged from the data analysis were named Change, Problems and Solutions. In order to keep as open a mind as possible the systematic review of the literature was done after the field work and analysis of the data. This article presents the findings and the implications of the study.

Data Interpretation, Statistical↗
PubMed1995

The tasks of psychiatric nurses in long-term residential settings in The Netherlands.

The tasks of the psychiatric nurse, working in long-term psychiatric settings, are described and analysed in this study. A questionnaire was completed by 361 nurses in five different psychiatric hospitals in the Netherlands. Nurses appear to concentrate upon personal care tasks in and around their ward. This does not fit adequately the changes in psychiatric practice. By means of an externally oriented hospital policy, cooperation with other care agencies and a realization of a more patient-orientated and rehabilitation model of care, the nurse is better prepared for helping patients make their move to the community.

Adult↗
PubMed1984

The DOM project for the early detection of breast cancer, Utrecht, The Netherlands.

This report describes the short-term results of a population-based screening programme--the DOM project--during the years 1975-1980. Screening was offered to all women in the city of Utrecht (The Netherlands) and 11 neighbouring areas who were born between 1911 and 1925. Further evaluation will be reported in future publications. The programme was organised by the Department of Epidemiology, Institute of Social Medicine (now renamed The Institute of Public Health and Epidemiology), University of Utrecht, which established a screening centre--The Preventicon--in a new commercial and shopping centre with good public transport facilities. The study population was between 50 and 65 years old at intake, a decision based on results obtained in the H.I.P. study in New York. Women resident in the city of Utrecht (n = 14,697 at intake) were screened four times, with intervals of 12, 18 and 24 months respectively between the first and fourth examinations. Women resident in the other areas (n = 8814) were screened twice with an interval of 18 months. Screening consisted of a clinical examination (inspection, palpation) and xero-mammography. An important role was played by paramedical personnel, who performed the examination and had a degree of responsibility in reading the mammograms. Initially the radiation dose per breast was about 1 rad, but from 1977 onwards this was reduced to 0.4 rad per exposure; for women living in Utrecht (4 screenings) the total dose was less than 5 rad over the 5-year period. Referral policy was based on a set of three types of "signal" to general practitioners (who coordinated specialist services): 1. Recommendation for biopsy; 2. Suggested repeat examination after 6 months; 3. Brief note on palpable abnormalities, considered likely to be benign. In Section II the response of the invited population is analysed. The response rate for the first screening was 72% in the city of Utrecht and 68% in the other areas. Variation in response rates can only be explained to a minor degree by measured demographic and sociological variables, age being the most important determinant. Women were asked to contribute D.fl. 12.50 (approx. US $5) per screening cycle to meet part of the expenses, the rest being paid by public health research funds. A total number of 61,649 examinations was performed in 23,511 women. In Section III the immediate results of screening are presented. An analysis is made of the cancer yield of the 3 signals mentioned above.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1994

How to compare and report department specific mortality rates for peer review using the Perinatal Database of The Netherlands.

Since characteristics of patient populations of obstetric departments vary substantially with respect to the pathology presented, (perinatal) mortality rates as such can not be used for a fair peer review without adjustment for those differences. Using the Perinatal Database of The Netherlands (LVR), data on approximately 80,000 newborns annually from 1985 to 1991 inclusive were used in statistical models to predict the perinatal mortality risks of four subpopulations of different gestational age in about 125 obstetric departments. As predictors for perinatal mortality we used only those risk factors which were judged to reflect the 'pathology' of the patient; risk factors associated with or resulting from hospital care and/or policy are (by definition) excluded. The statistical technique of logistic regression was used. The expected and observed mortality within each of these four subpopulations (for 1985-1991) was sent anonymously to each department as a specially designed graphical overview. This method of (anonymous) peer review was met favourably. In peer review the difference between observed and expected mortality should be used, rather than mortality per se, to adjust for differences in basic risk in the intake populations on which the departmental policy has no influence.

Gestational Age↗
PubMed1994

Routine clinical policy and application of Doppler measurements in suspected intrauterine growth retardation in university hospitals in The Netherlands.

Suspected intrauterine growth retardation is a clinical problem with financial consequences, as it can lead to costly, in-hospital fetal monitoring. At present, no prospective 'gold standard' for growth retardation exists. Hence, a proportion of the fetuses suspected are likely to be genetically small, in which case hospitalization is superfluous. Doppler ultrasound measurements might be applied to differentiate between growth retardation and genetically based smallness. Before the diagnostic effectiveness of Doppler ultrasound can be evaluated, however, the magnitude of the problem of suspected intrauterine growth retardation, or what it is experienced to be, must be known. The occurrence of suspected intrauterine growth retardation, routine clinical policy, and use of Doppler ultrasound techniques were assessed by a questionnaire among obstetricians in the university hospitals in The Netherlands. Of the obstetricians approached, 81% responded (59/73). Intrauterine growth retardation was defined mainly by a lag in fundal height of at least 3 weeks. It is suspected in about 11% of singleton pregnancies. An estimated 70% of those suspected of growth retardation are hospitalised. Fewer than half of the respondents thought Doppler ultrasound measurements an asset to antenatal diagnosis. Five of the eight university hospital clinics used Doppler measurements in clinical decision making. Sixty percent of responding obstetricians were of the opinion that there was a 'routine clinical policy' in suspected intrauterine growth retardation.

Cardiotocography↗
PubMed1994

Social class, ethnicity and other risk factors for small for gestational age and preterm delivery in The Netherlands.

Social class and ethnicity are important risk factors for small-for-gestational-age and preterm delivery in many countries. This study was performed to assess whether this is also the case in the Netherlands, a country with a high level of social security, relatively small income differences and easy access to medical care for all its inhabitants. Other risk factors that were taken into account were smoking, drinking, occupation, age and height. Information was collected by interview in the first 3 weeks of life of the mothers of 2027 (response 97%) live-born singletons born in the period from April 1988 to October 1989 in the study area. After adjustment for possible confounding factors very low social class, compared with high social class, was significantly associated with reduced birthweight (-4.0%; 95% CI, -7.4% to -0.7%), but not with preterm delivery (OR, 2.09; 95% CI, 0.67-6.48). The adjusted birthweight of Turkish infants (2.7%; 95% CI, -1.1% to 6.5%) and the adjusted birthweight of infants from Suriname or the Antilles (-1.6%; 95% CI, -5.5% to 2.1%) were not significantly different compared with infants of Dutch mothers. After adjustment, the frequency of preterm birth was lower in Turkish infants, but not significantly (OR, 0.22; 95% CI, 0.04-1.10), whereas the frequency of preterm birth in infants from Suriname or the Antilles was significantly higher (OR, 2.51; 95% CI, 1.04-6.08) compared with Dutch infants. Of the other factors the main risk factors were smoking (negatively related with birth-weight) and maternal age(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Villus height and crypt depth in weaned and unweaned pigs, reared under various circumstances in The Netherlands.

The height of the villi and depth of the crypts in the small intestine were studied after weaning in pigs reared under various circumstances in the Netherlands. Pigs taken from herds with a long history of postweaning diarrhoea had in general significantly shorter villi and deeper crypts than their counterparts from a specific pathogen-free herd. Weaning was associated with villus shortening, crypt deepening and subsequent villus lengthening in pigs from the specific pathogen-free herd. Giving supplementary feed during the sucking period was beneficial in preventing shortening of the villi and this villus shortening was less severe when the crypts were deep at weaning, a condition that perhaps lessens the severity of postweaning diarrhoea.

Animal Feed↗
PubMed1981

A case of Acanthamoeba keratitis in The Netherlands.

A severe kerato-iritis of the right eye of a 36-year-old healthy man constituted a diagnostic and therapeutic problem. More than seven months after the onset of his complaints a cornea transplantation was carried out because a large abscess had developed in the stroma of the cornea and perforation was feared. Amoebae, belonging to the free-living genus Acanthamoeba, were found in the excised corneal disc. Similar infections have been described earlier in the USA, in England and in Germany. The case described here is the first well documented one in the Netherlands. The case history and identification of the amoeba are described. Data from the literature on epidemiology, pathogenicity and treatment are discussed.

Adult↗