Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Nov 2008
[Ethnic differences in preference for home delivery and in pregnancy care received by pregnant women].
To investigate differences among pregnant women from various ethnic groups in terms of pregnancy care and the place of delivery. ⋯ Large ethnic differences exist in both pregnancy care and preference for place of delivery and, ultimately, place of birth. This should be taken into account in policy-making and in the provision of information regarding the Dutch midwifery system.
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Ned Tijdschr Geneeskd · Nov 2008
[A safer surgical pathway: monitoring in the operation room alone is insufficient].
Surgical adverse events remain a considerable problem: over 50% of in-hospital adverse events are related to a surgical procedure. The WHO, in its 'Safe surgery saves lives' campaign, propose what is essentially an expanded time-out procedure, including a debriefing. In recent years, this type of procedure has been widely advocated and implemented. ⋯ We therefore developed and validated a multidisciplinary checklist that covers the entire surgical patient pathway, instead of just the operative phase. The implementation of the so-called 'Surgical patient safety system' (SURPASS) checklist is currently underway. The effectiveness of the checklist in reducing adverse events and improving patient safety is being studied.
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The proportion of pregnant women from ethnic minorities is increasing in the Netherlands. A recent study revealed ethnic differences between pregnant women of various ethnic origins in the trajectories of pregnancy care and their preferences for the place of delivery. ⋯ Although most women are satisfied with the care provided, the data indicate that steps have to be taken in the Dutch obstetric care system to anticipate the new challenges. The focus should be on early counselling, greater transparency in the quality of pregnancy care, and continuity between primary and secondary care initiatives for relevant research.
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Ned Tijdschr Geneeskd · Nov 2008
[The role of diet in the development of type 2 diabetes mellitus: calories play the leading role].
Diets high in saturated fat, trans fat and glycaemic load and low in fibre and polyunsaturated fat are associated with a 25 to 50% increase in the risk of type 2 diabetes. However, obesity increases this risk by 500 to 1000%. Effects ascribed to dietary composition might therefore be due to unmeasured effects of body size. ⋯ The size of this effect is remarkable. It points to the solution to the diabetes epidemic, which is to reconstruct cities so as to make people eat less and move more. There is an analogy here with the cholera epidemics, which also could be solved only by changing the urban environment.
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Ned Tijdschr Geneeskd · Oct 2008
[The role of consultation in palliative sedation in the central region of the Netherlands].
To gain insight into the role of consultation in palliative sedation. ⋯ Palliative sedation was an important reason for consulting the PTMN. The high percentage of negative advice indicates that consultation about palliative sedation has an added value. It gives the questioner the opportunity to check whether all options for treatment have been tried. The question as to whether existential problems are an indication for palliative sedation should be discussed between medical professionals as well as publicly. Palliative sedation rarely is an alternative for euthanasia.