A comparative study of the financing, provision and quality of care in nursing homes. The approach of four European countries: Belgium, Denmark, Germany and the Netherlands.

A comparative study of the financing, provision and quality of care in nursing homes. The approach of four European countries: Belgium, Denmark, Germany and the Netherlands As result of an increase in the numbers of frail elderly people, most European countries are facing problems with the financing and provision of services by nursing homes. At the same time, the expectations of quality of these services continue to rise.

Rehabilitation of stroke patients with apraxia: the role of additional cognitive and motor impairments.

Purpose: The present study investigated which additional cognitive and motor impairments were present in stroke patients with apraxia and which of these factors influenced the effects of treatment.

Method: A group of 33 patients with apraxia were treated according to the guidelines of a therapy programme based on teaching patients strategies to compensate for the presence of apraxia. Patients were treated at occupational therapy departments in general hospitals, rehabilitation centres and nursing homes.

Range of joint motion and disability in patients with osteoarthritis of the knee or hip.

Objective: To establish the relationships between the range of joint motion (ROM) and disability in patients with osteoarthritis (OA) of the knee or hip. Two related issues were addressed: (1) the inter-relationships between ROMs of joint actions, and (2) the relationship between ROM and disability.

Methods: Data on 198 patients with OA of the knee or hip were used.

The number of therapeutic sessions in logopedic care: a description and analysis.

The aim of this study was (i) to describe the number of therapeutic sessions in logopedic care in the Netherlands and (ii) to analyse which factors determine the number of sessions. An analysis was performed on a data set of 517 patients who received logopedic treatment. Data concerning patient characteristics, medical diagnosis, logopedic diagnosis (in terms of impairments, disabilities and handicaps) and the number of sessions were available.

Liaison nursing for stroke patients: results of a Dutch evaluation study.

Liaison nurses, employed by a home care organization, were introduced into two Dutch hospitals to improve discharge planning for stroke patients. The main aim of the study presented was to gain insight into the effects of liaison nursing on the quality of the discharge process and related outcomes. After the introduction of liaison nursing, hospital nurses completed a questionnaire on satisfaction with the liaison nurse.

Science in practice: can health care reform projects in central and eastern Europe be evaluated systematically?

Since the beginning of the 1990s, health care reform projects have taken place in many of the former Communist countries, but these projects are rarely evaluated systematically. Evaluation, however, is an important tool for increasing their rationality and continuity. The aim of this paper is to identify the difficulties in the efforts towards systematic evaluation and draw lessons for the future.

A diagnostic test for apraxia in stroke patients: internal consistency and diagnostic value.

The internal consistency and the diagnostic value of a test for apraxia in patients having had a stroke are presented. Results indicate that the items of the test form a strong and consistent scale: Cronbach's alpha as well as the results of a Mokken scale analysis present good reliability and good scalability. The diagnostic value of the test was determined by comparison of test results in three groups of patients: 44 stroke patients with apraxia (patients), 35 stroke patients without apraxia (patient controls), and 50 healthy nursing home residents with no history of stroke (normal controls).

Gender differences in gynecologist communication.

The intimate nature of gynecological health problems requires the physician's specific attention. On the basis of previous findings in primary care, female gynecologists are expected to communicate more affectively than men. This study addressed gender differences in gynecologist communication behavior by comparing videotapes of real-life outpatient encounters with female (N = 107) and male (N = 196) gynecologists by means of bivariate and multilevel analysis.

Effects of continuing paediatric education in interpersonal communication skills.

Unlabelled: Paediatric care places great demands on interpersonal communication skills, especially as regards the handling of psychosocial issues. Recent shifts in paediatric morbidity and increases in patient empowerment furthermore emphasize the need for continuing paediatric education in communication skills. It is, however, debatable, whether after residency paediatric education can influence paediatrician performance.

All rights reserved, or can we just copy? Cost sharing arrangements and characteristics of health care systems.

In most European countries cost sharing has been introduced in order to reduce the demand for care. Different forms of cost sharing are available, but because of historically grown system characteristics and prevailing values countries differ in the application of specific forms. This review focuses on eighteen European countries, and on the combinations of health system characteristics and present forms of cost sharing.

GPs' referral to mental health care during the past 25 years.

Previous research has shown that mental disorder in the community has remained fairly constant over the past 30 years. As a result there has been a shift in mental health care from primary care to specialised mental health care. This shift should be visible in higher referral figures from general practice.

Innovations in the nursing care of the chronically ill: a literature review from an international perspective.

This literature review focuses on substitution-related innovations in the nursing care of chronic patients in six western industrialized countries. Differences between primary and secondary care-orientated countries in the kind of innovations implemented are discussed. Health care systems are increasingly being confronted with chronic patients who need complex interventions tailored to their individual needs.

Podiatric care for diabetic patients with foot problems: an observational study.

The aims of this study were to describe podiatric care for diabetic patients with foot problems and to explore the changes in knowledge, self-care behaviour and physical functioning after podiatric care. The treatment characteristics of 26 diabetic patients referred to podiatry were assessed. Prior to the first podiatric visit (T1) and 20 weeks later (T2) these patients filled in a structured questionnaire and performed a six-minute walking test.

Quality and continuity of care in Dutch nurse clinics for people with rheumatic diseases.

Objective: Recently a new form of nurse clinic for people with rheumatic diseases has been introduced into Dutch health care. This study gives insight into: (i) patients' perceptions about the quality and continuity of care given at these (transmural) nurse clinics; and (ii) specialized rheumatology nurses' and rheumatologists' perceptions about the quality and continuity of care in the clinics.

Design: Validated measurement tools (QUOTE and QCC) were used, before and after patients visited a clinic, to determine patient perceptions about the quality and continuity of care.

Dynamic exercise therapy for rheumatoid arthritis.

Objectives: To assess the effects of dynamic exercise therapy in improving joint mobility, muscle strength, aerobic capacity and daily functioning in patients with rheumatoid arthritis (RA). In addition, possible unwanted effects such as an increase in pain, disease activity and radiological progression were studied.

Search Strategy: We searched the Cochrane Musculoskeletal trials register, the Cochrane Controlled trials Register, Medline, Embase and SCISEARCH databases up to may 1997 in order to controlled trials on the effect of exercise therapy.

Quality of care from the perspective of elderly people: the QUOTE-elderly instrument.

Background: patient views on the quality of care are usually assessed by means of patient satisfaction questionnaires.

Aim: to develop an instrument that would: (i) produce data related to the expectations and experiences of noninstitutionalized elderly people, (ii) contain items that had been formulated in collaboration with elderly people, (iii) measure quality from the perspective of the users of health care services and (iv) produce data on generic quality aspects and quality aspects specifically related to the needs of elderly people.

Methods: we developed the instrument for measuring quality of care from the perspective of non-institutionalized elderly people (QUOTE-Elderly) by using a combination of qualitative and quantitative methods.

Prevalence of apraxia among patients with a first left hemisphere stroke in rehabilitation centres and nursing homes.

Objective: To investigate the prevalence of apraxia in patients with a first left hemisphere stroke.

Subjects: Left hemisphere stroke patients staying at an inpatient care unit of a rehabilitation centre or nursing home and receiving occupational therapy (n = 600).

Measures: A short questionnaire on general patient characteristics and stroke-related aspects was completed by occupational therapists for every left hemisphere stroke patient they treated.

Career preferences and the work-family balance in medicine: gender differences among medical specialists.

In this article career preferences of medical specialists in the Netherlands are analysed, based on a survey among the members of medical associations of five specialties. Four different career preferences were offered, each of which implied a possible variation in working hours. A questionnaire was sent to a random selected group of working specialists in general practice, internal medicine, anaesthesiology, ophthalmology and psychiatry.

Nurse-patient communication in cancer care. A review of the literature.

Patients with cancer seem to experience distress particularly in the first period after diagnosis, and are likely to develop an affective disorder in the first 2 to 3 months. Communicative behaviors of nurses seem to play an important role in meeting the cognitive and affective needs of patients with cancer. This review of the literature examines the communicative behaviors of nurses during care activities with patients who have cancer.

Is there a geography of alternative medical treatment in The Netherlands?

An increasing number of people are using alternative medical care. The literature suggests that there are important between place variations, however. This paper tries to assess the extent of these variations and mechanisms behind them for the utilization of homeopathy, paranormal healing and manual therapy.

Dutch nurse clinics for children with asthma: views of professionals and parents.

In the Netherlands, there are two kinds of nurse clinics for asthmatics. Extramural nurse clinics are run under the sole responsibility of a home care organization while transmural nurse clinics are run under the joint responsibility of a home care organization and a hospital. This article gives insight into the opinions of professionals and parents of asthmatic children about the care given at these clinics.

Factors related to nurse communication with elderly people.

This study explores variables that might influence nurses' communication with elderly patients. Three groups of variables arise from the literature that seem to affect the quality or quantity of nurse-patient communication: variables related to nurses, to patients, and to the setting in which nursing care takes place. The study was conducted in two different care settings: a home for elderly people and a home care organization.

Gender differences in fatigue: biopsychosocial factors relating to fatigue in men and women.

Background: Fatigue is a common problem, which is found more frequently among women than men. To date, neither the etiology of fatigue nor the factors that explain the gender difference in its incidence are still fully understood.

Methods: In a sample of men (n = 4,681) and women (n = 4,698) (age range, 15-64 years) in the Dutch National Survey of Morbidity and Interventions in General Practice, the gender differences in the underlying biological, psychological, and social factors of fatigue were analyzed.

Internal consistency and validity of an observational method for assessing disability in mobility in patients with osteoarthritis.

Objective: To establish the internal consistency and validity of an observational method for assessing disability in mobility in patients with osteoarthritis (OA).

Methods: Data were obtained from 198 patients with OA of the hip or knee. Results of the observational method were compared with results of self-report methods (questionnaires) on disability in mobility.

Diffusion of a quality improvement programme among allied health professionals.

Objective: To assess the diffusion of a quality improvement (QI) programme among allied health professions in The Netherlands.

Design: Descriptive study, based on a questionnaire distributed to allied health professionals; response rate, 63%.

Settings And Participants: All subsectors in health care were covered, including primary care and institutional care.