Relationship between location and activity in injurious falls: an exploratory study.

Background: Knowledge about the circumstances under which injurious falls occur could provide healthcare workers with better tools to prevent falls and fall-related injuries. Therefore, we assessed whether older persons who sustain an injurious fall can be classified into specific fall types, based on a combination of fall location and activity up to the moment of the fall. In addition, we assessed whether specific injurious fall types are related to causes of the fall, consequences of the fall, socio-demographic characteristics, and health-related characteristics.

A gender-specific evaluation of a care-oriented curricular change in a Dutch medical school.

Background: Patients with chronic diseases need doctors who have the appropriate skills to maintain a long-term doctor-patient relationship with an orientation towards care rather than cure and focused on the patient's role in managing their condition. As the number of chronically ill patients is rising, medical education has to develop and evaluate instructional formats to prepare future doctors to provide care tailored to these patients.

Aim: To examine the possibly gender-specific effects on students' orientations of a patient-oriented programme.

Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: a process evaluation.

Background: Falls are a major health threat to older community-living people, and initiatives to prevent falls should be a public health priority. We evaluated a Dutch version of a successful British fall prevention programme. Results of this Dutch study showed no effects on falls or daily functioning.

Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized, controlled trial.

Objectives: To assess whether a pragmatic multidisciplinary fall-prevention program was more effective than usual care in preventing new falls and functional decline in elderly people.

Design: A two-group, randomized, controlled trial with 12 months of follow-up.

Setting: University hospital and home-based intervention, the Netherlands.

A multidisciplinary fall prevention program for elderly persons: a feasibility study.

Falling is a common problem among elderly people and has many negative consequences. In the Netherlands, there is a need for effective fall prevention interventions aimed at elderly persons with an increased risk of falling. For this reason, we adapted a successful British fall prevention program comprising a medical occupational therapy assessment to the Dutch health care setting.

Transfer of care for outpatients with stable chronic obstructive pulmonary disease from respiratory care physician to respiratory nurse--a randomized controlled study.

Objectives: To assess effects on patient outcomes when care for patients with stable chronic obstructive pulmonary disease (COPD) is transferred from respiratory care physician to respiratory nurse.

Methods: A randomized controlled trial was used with a follow-up period of 9 months. Of 720 patients from the respiratory outpatient clinic of the general and teaching hospital in Alkmaar (The Netherlands), 187 were eligible for randomization and gave informed consent.

Exclusive, idiosyncratic and collective expertise in the interprofessional arena: the case of optometry and eye care in The Netherlands.

This paper addresses expertise as the foundation of professional boundaries and domains through a comparative study of four eye care occupations in the Netherlands. Claims of expertise are explored with an analysis of whether practitioners believe that expertise is exclusive to their profession. Results show that (a) established professions display a stronger sense of the 'exclusiveness' of expertise; (b) idiosyncratic expertise is more common among encroaching professions than among established ones.

Chronic patients in undergraduate education: didactic value as perceived by students.

Objectives: Medical education should prepare students for future clinical practice. However, this preparation is inadequate for the most prevalent problem in health care: chronic disease. This applies to the continuous aspect of chronic disease.

Effectiveness and cost-effectiveness of a minimal psychological intervention to reduce non-severe depression in chronically ill elderly patients: the design of a randomised controlled trial [ISRCTN92331982].

Background: Depression is a prevalent disorder in chronically ill elderly persons. It may decrease quality of life, and increase functional disability, medical costs, and healthcare utilisation. Because patients may slip into a downward spiral, early recognition and treatment of depression is important.

[More social exclusion of chronically ill patients with lower incomes].

Objective: To determine whether income is connected with the variation in the social exclusion of chronically ill patients.

Design: Descriptive.

Method: In 223 chronically ill patients that had been detected via patients' associations, general practitioners and outpatient clinics, a structured interview was administered during a home visit 4 times during a period of 7 months (October 2003-April 2004).

Effectiveness and cost-effectiveness of a multidisciplinary intervention programme to prevent new falls and functional decline among elderly persons at risk: design of a replicated randomised controlled trial [ISRCTN64716113].

Background: Falls are common among community-dwelling elderly people and can have a considerable impact on quality of life and healthcare costs. People who have sustained a fall are at greater risk of falling again.We replicated a British randomised controlled trial which demonstrated the effectiveness of a multidisciplinary intervention programme to prevent falls.

Development and feasibility of a nurse administered strategy on depression in community-dwelling patients with a chronic physical disease.

This contribution reports on the acceptability and feasibility to nurses and patients of an intervention to ameliorate minor depression among patients with chronic physical diseases. Elderly patients with chronic obstructive pulmonary disease (COPD) and type II Diabetes Mellitus were recruited from 10 general practices. All eligible patients were screened.

Scaling the sickness impact profile using item response theory: an exploration of linearity, adaptive use, and patient driven item weights.

Background And Objective: The objective of the study was to enhance the clinical interpretation and practicality of the widely used comprehensive Sickness Impact Profile.

Method: Item Response Theory (extension of the Rasch model) was used to calibrate the severity of the SIP items, to assess item bias and to construct equally severe short forms of the SIP that can be used interchangeably. The scores of 1507 subjects were analyzed.

Undiagnosed patients and patients at risk for COPD in primary health care: early detection with the support of non-physicians.

Given the increasingly heavy workload in the primary health care sector, the option of allocating activities involving the management of chronic diseases to non-physicians has recently come under scrutiny. The purpose of this study was to assess the feasibility of the support provided by non-physicians to general practitioners (GPs) in the early detection of chronic obstructive pulmonary disease (COPD). A convenience sample consisting of 231 patients [40-70 years; >10 pack years (number of packs of cigarettes smoked per day multiplied by the number of years the individual has smoked)] from eight general practices in the Maastricht region in the southern Netherlands, who consulted their GP for reasons unrelated to respiratory diseases, were assessed for their respiratory function.

Applying low disease activity criteria using the DAS28 to assess stability in patients with rheumatoid arthritis.

Objectives: To examine whether low disease activity criteria using the disease activity score (DAS28) can be applied to identify a reasonably large number of patients with stable low disease activity of rheumatoid arthritis (RA) over a six month period, with the ultimate intention of including these patients in a substitution based, shared care model. Additionally, to assess the reliability of the DAS28 for selecting patients with stable disease from an outpatient population.

Methods: Patients regularly seen at the rheumatology outpatient department of the university hospital Maastricht, were invited for assessment of the stability of their RA.

A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study.

The object of this article was to determine the predictive value of risk factors for recurrent falls and the construction of a fall risk model as a contribution to a mobility assessment for the identification of community-dwelling elderly at risk for recurrent falling in general practice. The design was a prospective cohort study (n = 311). There were four primary health care centers.

Process-evaluation of a home visit programme to prevent falls and mobility impairments among elderly people at risk.

This paper describes the results of a detailed evaluation of the intervention process of a multifactorial home visit programme aimed at preventing falls and mobility impairments among elderly persons living in the community. The aim of the study is to provide insight in factors related to the intervention process that may have influenced the effectiveness of this home visit programme. The programme consisted of five home visits performed by a community nurse over a period of 1 year.

The nurse specialist as main care-provider for patients with type 2 diabetes in a primary care setting: effects on patient outcomes.

A solution to safeguard high quality diabetes care may be to allocate care to the nurse specialist. By using a one group pretest-posttest design with additional comparisons, this study evaluated effects on patient outcomes of a shared care model with the diabetes nurse as main care-provider for patients with type 2 diabetes in a primary care setting. The shared care model resulted in an improved glycaemic control, additional consultations and other outcomes being equivalent to diabetes care before introduction, with the general practitioner as main care-provider.

Substitution model with central role for nurse specialist is justified in the care for stable type 2 diabetic outpatients.

Aim Of The Study: Assessment of effects on quality of care, in terms of patient outcomes, when tasks in the care for outpatients with stable type 2 diabetes are transferred from internist to nurse specialist and from outpatient clinic to general practice.

Background: For the management of chronic diseases with a high prevalence and requiring current monitoring, it is suggested that substitution of care may be an appropriate solution to safeguard high quality care.

Design And Methods: A 12-month nonequivalent control group design was used.

Preventing falls and mobility problems in community-dwelling elders: the process of creating a new intervention.

Mobility impairments and the consequences of falls can have a considerable impact on community-dwelling elders' autonomy and quality of life. This article describes the development and implementation of a falls and mobility intervention that features preventive home visits by public health nurses; the study accompanying the intervention also is presented. This article offers practical guidelines to health professionals who are considering, developing, implementing, and testing new interventions aimed at the prevention of falls and mobility problems in this population.

The construction of a patient record-based risk model for recurrent falls among elderly people living in the community.

Background: Predictive models of fall risk in the elderly living in the community may contribute to the identification of elderly at risk for recurrent falling.

Objectives: Our aim was to investigate occurrence, determinants and health consequences of falls in a community-dwelling elderly population and the contribution of data from patient records to a risk model of recurrent falls.

Methods: A population survey was carried out using a postal questionnaire.

Effects on quality of care for patients with NIDDM or COPD when the specialised nurse has a central role: a literature review.

Chronic care has to be organised in a way that care from any one caregiver is linked up to that provided by others so that disturbing gaps, contradictions and overlaps are avoided. In the search for the most effective and efficient combination of health professionals to deliver care to chronic patients, the role of the specialised nurse has become important. This article reviews a Medline search for publications about the effects of models of care for patients with NIDDM or COPD in which the specialised nurse has a central role.

Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial.

Objective: To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community.

Design: Randomised controlled trial with 18 months of follow up.

Setting: Six general practices in Hoensbroek, the Netherlands.

Self-care and quality of life in patients with advanced heart failure: the effect of a supportive educational intervention.

Objective: The goal of this study was to determine the effects of a supportive educational nursing intervention on self-care abilities, self-care behavior, and quality of life of patients with advanced heart failure.

Design: The study design was an experimental, random assignment.

Setting: The study was located at the University Hospital in Maastricht, The Netherlands.

Effects of preventive home visits to elderly people living in the community: systematic review.

Objective: To assess the effects of preventive home visits to elderly people living in the community.

Design: Systematic review.

Setting: 15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register.