Registration of catheter-related complications in adverse events reporting systems: a major underestimation of the real complication practice.

Reporting and learning from preventable adverse events is crucial to improve patient safety. Although physicians should file and analyse adverse events by law in The Netherlands, it is unknown if these reporting systems are sufficiently used in clinical practice. This study is a substudy of the multicenter RICAT trial, a successful quality improvement project to reduce inappropriate use of intravenous and urinary catheters in medical wards in seven hospitals, in which we screened 5696 patients and documented 803 catheter-related complications.

Preconception use of cART by HIV-positive pregnant women increases the risk of infants being born small for gestational age.

Background: The benefits of combination anti-retroviral therapy (cART) in HIV-positive pregnant women (improved maternal health and prevention of mother to child transmission [pMTCT]) currently outweigh the adverse effects due to cART. As the variety of cART increases, however, the question arises as to which type of cART is safest for pregnant women and women of childbearing age. We studied the effect of timing and exposure to different classes of cART on adverse birth outcomes in a large HIV cohort in the Netherlands.

De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study.

Background: Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy.

HIV infection is independently associated with frailty in middle-aged HIV type 1-infected individuals compared with similar but uninfected controls.

Background: Frailty is an age-related syndrome of decreased physiological reserve and resistance to stressors, associated with increased morbidity and mortality in the general elderly population. An increased prevalence of frailty has been reported amongst HIV-infected individuals.

Methods: Fried frailty phenotype was systematically assessed in predominantly virologically suppressed HIV type 1 (HIV-1)-infected and otherwise comparable HIV-uninfected participants aged at least 45 at enrollment into the AGEhIV Cohort Study.

Hcv coinfection, an important risk factor for hepatotoxicity in pregnant women starting antiretroviral therapy.

Objectives: This retrospective cohort study evaluated the risk of hepatotoxicity in HIV-1 positive pregnant and non-pregnant women starting combined ART.

Methods: Data were used from the ATHENA observational cohort. The study population consisted of HIV-1 infected, therapy naïve, pregnant and non-pregnant women, followed between January 1997 and February 2008.

[Treatment of HIV-infected pregnant women: prevention of virus transmission and adverse effects in mother and child].

Without intervention, the probability of HIV transmission from mother to child varies from less than 10% to over 60%, dependent on the quantity of freely circulating HIV in the plasma. The prevention of HIV transmission from mother to child is based on the perinatal administration of a combination of antiretroviral drugs (highly active antiretroviral therapy; HAART) to both mother and child. The value of elective caesarean section along with an effective treatment with HAART during the pregnancy is very limited.

Medical specialists' patient-centered communication and patient-reported outcomes.

Background: Physicians' patient-centered communication in the medical consultation is generally expected to improve patient outcomes. However, empirical evidence is contradictory so far, and most studies were done in primary care.

Objective: We sought to determine the association of specialists' patient-centered communication with patient satisfaction, adherence, and health status.

Patient participation in the medical specialist encounter: does physicians' patient-centred communication matter?

Objective: Physicians' patient-centred communication is assumed to stimulate patients' active participation, thus leading to more effective and humane exchange in the medical consultation. We investigated the relationship between physicians' patient-centred communication and patient participation in a medical specialist setting.

Methods: Participants were 30 residents and specialists in internal medicine, and 323 of their patients.

Determinants of physicians' patient-centred behaviour in the medical specialist encounter.

It has been suggested that patient-centred communication does not necessarily translate into a 'one-size fits all' approach, but rather that physicians should use a flexible style and adapt to the particular needs of their patients. This paper examines variability in physicians' patient-centred behaviour in medical specialist encounters, and determines whether patient, visit, and physician characteristics influence this variability. Participants were 30 residents and specialists in internal medicine at an academic teaching hospital in The Netherlands, and 323 patients having a (videotaped) outpatient follow-up appointment.

Nelfinavir and nevirapine side effects during pregnancy.

Background: The risk of vertical transmission of HIV has been substantially reduced since the introduction of highly active antiretroviral therapy (HAART); however, the impact of taking HAART during pregnancy on the woman, the fetus and the infant is not yet understood.

Objective: To assess and compare tolerability, safety and efficacy of nelfinavir- or nevirapine-containing HAART in a cohort of pregnant and non-pregnant HIV-infected women in The Netherlands.

Design: Retrospective comparative study.

Satisfaction with the outpatient encounter: a comparison of patients' and physicians' views.

Objective: To compare patients' and physicians' visit-specific satisfaction in an internal medicine outpatient setting, and to explain their respective views.

Design: Patients' and physicians' background characteristics were assessed prior to outpatient encounters. Immediately after the encounter, both patients and physicians completed a questionnaire assessing satisfaction with the visit.

Nelfinavir plasma concentrations are low during pregnancy.

Plasma nelfinavir concentration ratios (CRs) were calculated for all pregnant (n=27) and nonpregnant (n=48) human immunodeficiency virus type 1-infected women receiving the drug who visited our outpatient clinic. In pregnant women, mean and median nelfinavir CRs were significantly lower (P=.02 and P=.

Frequency of spontaneous fist clenching during routine blood pressure measurements and its effect on measurement accuracy.

Background: Guidelines for office blood pressure reading techniques do not warn us about the possibility that patients may clench their fist during cuff-inflation. It is unknown how often patients do this, and what effect it has on measured blood pressure readings.

Design And Methods: We registered double blood pressure readings in 150 outpatient clinic subjects, who were not given specific instructions as to how to hold their hand during the procedure.