[Dealing with treatment limitations during anaesthesia].

Treatment limitations may create a clinical dilemma during anaesthesia. Because mostly, pre-existing treatment limitations have been decided upon without considering the occurrence of a future medical intervention with its unique circumstances. In case treatment limitations are not reassessed prior to an intervention and a life threatening situation occurs during the intervention, a dilemma may arise between the patient's wishes and physician's actions.

What makes a good home-based nocturnal seizure detector? A value sensitive design.

A device for the in-home detection of nocturnal seizures is currently being developed in the Netherlands, to improve care for patients with severe epilepsy. It is recognized that the design of medical technology is not value neutral: perspectives of users and developers are influential in design, and design choices influence these perspectives. However, during development processes, these influences are generally ignored and value-related choices remain implicit and poorly argued for.

[Timing of Advance Care Planning in frail elderly patients: when to start?].

Advance Care Planning (ACP) is the process of discussing and recording patient preferences concerning goals for end-of-life care and to facilitate decision-making. ACP is an essential element of care for frail elderly patients because frailty increases the risks of negative health outcomes and loss of function. In this article, we present three patient cases to illustrate how general practitioners (GPs) can perform ACP and to demonstrate the importance of early and iterative end-of-life discussions with frail elderly patients.

Absence of influenza A(H1N1) during seasonal and pandemic seasons in a sentinel nursing home surveillance network in the Netherlands.

Objectives: To describe the epidemiological, virological, and institutional characteristics of influenza-like illness (ILI) in nursing homes (NHs).

Design: Continuous clinical surveillance of ILI and virological surveillance of ILI and other acute respiratory infections (ARIs) during four influenza seasons.

Setting: National sentinel NH surveillance network.

Medical and nonmedical determinants of decision making about potentially life-prolonging interventions.

Patient characteristics may influence medical decision making in various ways. The contribution of several patient characteristics to medical decision making was studied. Thirty oncologists, 29 nursing home physicians, and 22 cardiologists were interviewed (overall response = 60%).