BACKGROUND Blood loss in hip and knee arthroplasties may necessitate allogeneic blood transfusions. Different blood-saving measures (BSMs) were introduced to reduce these transfusions. Purpose of... Show moreBACKGROUND Blood loss in hip and knee arthroplasties may necessitate allogeneic blood transfusions. Different blood-saving measures (BSMs) were introduced to reduce these transfusions. Purpose of the present study was to assess the frequency of BSM use, stratified by type and hospital setting of orthopaedic departments in the Netherlands. METHODS An internet-based questionnaire was sent to all heads of orthopaedic departments of Dutch hospitals and private clinics (n = 99). Questions were asked on how often BSMs were used, reported on a 5-point Likert scale (never, almost never, regularly, almost always, always). In addition there were questions about discontinuation of anticoagulants preoperatively, the number of annually performed arthroplasties (size) and hospital setting. RESULTS The survey was completed by 81 (82%) departments. BSMs used frequently (regularly, almost always, always) were erythropoietine (EPO), with 55 (68%) departments being frequent users; acute normovolemic hemodilution, used frequently in 26 (32%) departments; cell saver in 25 (31%) and postoperative drainage and re-infusion in 56 (69%) departments. When compared by size, frequent EPO use was more common in large departments (with 22 (88%) large departments being frequent users versus 13 (63%) small departments and 16 (55%) intermediate departments, p = 0.03). No differences by size or type were observed for other BSMs. CONCLUSIONS Compared with previous survey's there is a tremendous increase in use of BSMs. EPO and autologous blood salvage techniques are the most often used modalities. Costs might be saved if use of non-cost-effective BSMs is stopped. Show less
Kok, L.M.; Vlieland, T.P.M.V.; Fiocco, M.; Nelissen, R.G.H.H. 2013
UNLABELLED ABSTRACT: BACKGROUND Research comparing the frequency of musculoskeletal complaints between musicians and non-musicians is scarce. The aim of this study was to compare the prevalence of... Show moreUNLABELLED ABSTRACT: BACKGROUND Research comparing the frequency of musculoskeletal complaints between musicians and non-musicians is scarce. The aim of this study was to compare the prevalence of musculoskeletal complaints between musicians and non-musicians. METHODS A cross-sectional study in 3215 students from three music academies (n = 345) and one medical school (n = 2870) in The Netherlands was performed, using an electronic questionnaire. The questionnaire included socio-demographic characteristics, use of music instruments and the occurrence of musculoskeletal complaints in six body regions. Questions were related to musculoskeletal complaints over the last twelve months and at the time of the questionnaire. Chi-square, t-tests and Kruskal-Wallis tests were used for comparison between the two groups. The association between musculoskeletal complaints and possible predictors was analyzed using a logistic and Poisson regression. RESULTS Eighty-seven music academy students and 503 medical students returned the questionnaire, of which respectively eighty-three and 494 were included in the study. Seventy-four music academy students (89.2%) reported one or more musculoskeletal complaints during the last twelve months, compared to 384 (77.9%) medical students (p = 0.019). Moreover 52 music academy students (62.7%) and 211 medical students (42.7%) reported current musculoskeletal complaints (p = 0.001). The Odds ratio (OR) for the development of musculoskeletal complaints during the last twelve months in music academy students versus medical students is 2.33 (95% CI 1.61-3.05, p = 0.022). The OR at the time of the questionnaire is 2.25 (95% CI 1.77-2.73, p = 0.001). The total number of complaints have been modeled by employing a Poisson regression; the results show that non-musicians have on average less complaints than musicians (p = 0.01). The adjusted means are 2.90 (95% CI 2.18-3.63) and 1.83 (95% CI 1.63-2.04) respectively for musicians and non-musicians. Regarding the localization of complaints, music academy students reported more complaints concerning the right hand, wrists, left elbow, shoulders, neck, jaw and mouth in contrast to medical students. CONCLUSIONS Musculoskeletal complaints are significantly more common among musicians compared to non-musicians, mainly due to a higher number of upper extremity complaints. Show less
This study aims to examine healthcare utilization and its determinants among patients with systemic sclerosis (SSc). A cross-sectional survey among all patients with SSc visiting an outpatient... Show moreThis study aims to examine healthcare utilization and its determinants among patients with systemic sclerosis (SSc). A cross-sectional survey among all patients with SSc visiting an outpatient clinic of an academic hospital in the Netherlands was done. Assessments included sociodemographic characteristics and a survey on healthcare utilization including a registration of contacts with healthcare services since onset of disease, contacts, and number of visits with healthcare services over the last 12 months. A total healthcare utilization score of all visits over the last 12 months was computed and classified as high and low care utilization according to the median. In addition, the Short Form-36 and the Scleroderma Health Assessment Questionnaire (SHAQ) were administered. Logistic regression analysis was used to determine the relationship between high and low healthcare utilization as dependent variable and sociodemographic and disease characteristics as independent variables. Sixty-four patients returned the questionnaires. Over the last 12 months, 83 % of the patients had had contact with one or more physicians. On average, patients reported 3.9 visits (SD, 2.9) to a rheumatologist and 6.9 visits (SD, 9.3) to other medical specialists over the last 12 months. The median total health-care utilization was six visits over the last 12 months. Multivariate regression showed that a higher SHAQ score was significantly associated with higher health-care utilization. Patients with SSc visited a considerable number of various health-care providers. Patients with more functional disability were using more healthcare. Show less
Hofstede, S.N.; Marang-van de Mheen, P.J.; Wentink, M.M.; Stiggelbout, A.M.; Vleggeert-Lankamp, C.L.A.; Vlieland, T.P.M.V.; ... ; DISC Study Grp 2013
Objective. To make an inventory of quality and content of currently available and published sets of health care quality indicators (HCQIs) for RA and OA. Methods. A systematic review was performed... Show moreObjective. To make an inventory of quality and content of currently available and published sets of health care quality indicators (HCQIs) for RA and OA. Methods. A systematic review was performed for documents on the development and/or a description of HCQIs for the management of patients with RA and/or OA, using the PubMed, EMBASE, Web of Science, Cochrane and CINAHL databases up to 1 December 2010 and official websites of arthritis organizations. The following data were extracted: general characteristics, contents and quality of developmental process (six aspects related to the definition of target, target group and stakeholders, patient involvement, description of development and test of validity). Results. The search yielded 498 potentially eligible references and two websites, with ultimately six original HCQI sets for RA and/or OA being identified (one for RA and OA, two for OA and three for RA). The number of HCQI ranged from 7 to 27, with the majority being process indicators. No conflicting indicators between the HCQI sets for one condition were seen. Concerning the quality of the developmental process, all six sets lacked patient involvement. Conclusion. Only a limited number of HCQI sets for the management of OA and RA are available, mainly including process indicators. The developmental process was methodologically suboptimal in all cases. As improvement of health care quality is an ongoing process, there is a need for development of HCQIs covering different aspects of health care quality (structure, process and outcome) and using appropriate methodology. Show less
