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The Hague, Netherlands

De Groot I.B.,Leiden University | Otten W.,TNO | Smeets H.J.,Bronovo Hospital | Marang-Van De Mheen P.J.,Leiden University
BMC Health Services Research | Year: 2011

Background: Public information on average has limited impact on patients' hospital choice. However, the impact may be greater in consumers who have compared hospitals prior to their hospital choice. We therefore assessed whether patients who have compared hospitals based their hospital choice mainly on public information, rather than e.g. advice of their general practitioner and consider other information important than patients who have not compared hospitals. Methods. 337 new surgical patients completed an internet-based questionnaire. They were asked whether they had compared hospitals prior to their hospital choice and which factors influenced their choice. They were also asked to select between four and ten items of hospital information (total: 41 items) relevant for their future hospital choice. These were subsequently used in a hospital choice experiment in which participants were asked to compare hospitals in an Adaptive Choice-Based Conjoint analysis to estimate which of the hospital characteristics had the highest Relative Importance (RI). Results: Patients who have compared hospitals more often used public information for their hospital choice than patients who have not compared hospitals (12.7% vs. 1.5%, p < 0.001). However, they still mostly relied on their own (47.9%) and other people's experiences (31%) rather than to base their decision on public information. Both groups valued physician's expertise (RI 20.2 [16.6-24.8] in patients comparing hospitals vs. 16.5 [14.2-18.8] in patients not comparing hospitals) and waiting time (RI 15.1 [10.7-19.6] vs. 15.6 [13.2-17.9] respectively) as most important public information. Patients who have compared hospitals assigned greater importance to information on wound infections (p = 0.010) and respect for patients (p = 0.022), but lower importance to hospital distance (p = 0.041). Conclusion: Public information has limited impact on patient's hospital choice, even in patients who have actually compared hospitals prior to hospital choice. © 2011 de Groot et al; licensee BioMed Central Ltd. Source


Vos M.S.,Bronovo Hospital | Putter H.,Leiden University | van Houwelingen H.C.,Leiden University
Lung Cancer | Year: 2011

Denial is a well-known phenomenon in clinical oncology practice. Yet whether the impact of denial on patient well-being is beneficial or harmful remains unknown. The purpose of the current study is to investigate the relationship between denial and social and emotional outcomes in a large sample of lung cancer patients over an extended time period.Denial and social and emotional outcomes were measured in 195 newly diagnosed lung cancer patients. Four assessments were conducted over 8 months. The level of denial was measured using the Denial of Cancer Interview. Patient-reported social and emotional outcomes were measured using the EORTC-QLQ-30 and the HADS.Patients with a moderate or increasing level of denial over time reported better social outcomes (role functioning: p=0.0036, social functioning: p=0.027) and less anxiety (p=0.0001) and depression (p=0.0019) than patients with a low level of denial. The overall quality of life was better among lung cancer patients who displayed either moderate or increasing levels of denial compared with those who displayed low levels of denial (p<0.0001).A certain level of denial in lung cancer patients can have a protective effect on social and emotional outcomes. Clinicians should take this into account when providing information about the illness and its prognosis. © 2010 Elsevier Ireland Ltd. Source


Small for gestational age (SGA) is associated with increased neonatal morbidity and mortality. At present, evidence on whether these pregnancies should be managed expectantly or by induction is lacking. To get insight in current policy we analysed data of the National Dutch Perinatal Registry (PRN). We used data of all nulliparae between 2000 and 2005 with a singleton in cephalic presentation beyond 36+0 weeks, with a birth weight below the 10th percentile. We analysed two groups of pregnancies: (I) with isolated SGA and (II) with both SGA and hypertensive disorders. Onset of labour was related to route of delivery and neonatal outcome. Induction was associated with a higher risk of emergency caesarean section (CS), without improvement in neonatal outcome. For women with isolated SGA the relative risk of emergency CS after induction was 2.3 (95% Confidence Interval [CI] 2.1 to 2.5) and for women with both SGA and hypertensive disorders the relative risk was 2.7 (95% CI 2.3 to 3.1). Induction in pregnancies complicated by SGA at term is associated with a higher risk of instrumental deliveries without improvement of neonatal outcome. Prospective studies are needed to determine the best strategy in suspected IUGR at term. Source


Tuijl J.P.,Bronovo Hospital | Scholte E.M.,Leiden University | De Craen A.J.M.,Leiden University | Van Der Mast R.C.,Leiden University
International Journal of Geriatric Psychiatry | Year: 2012

Objective To investigate the performance and usability of the Six-Item Cognitive Impairment Test (6CIT) as a screening instrument for cognitive impairment in older, general hospital inpatients/outpatients. Method In 253 general hospital patients aged ≥ 70 years, diagnostic accuracy of the 6CIT and time required to administer it were assessed using the Mini-Mental State Examination (MMSE) as the criterion standard. Results The (negative) correlation between the 6CIT and the MMSE was very high (r = -0.82). Optimal comparability was found using a MMSE cutoff of ≤19 for lower and a;circ23 for higher educated patients, at a cutoff of ≥11 on the 6CIT that was not sensitive to educational level. The sensitivity of the 6CIT was 0.90 and the specificity was 0.96, whereas the positive predictive value was 0.83 and the negative predictive value was 0.98. The area under the curve was 0.95. The mean administration time was 5.8 min for the MMSE and 2.5 min for the 6CIT (p ≤0.01). Conclusions Diagnostic accuracy of the 6CIT was high. As the 6CIT is not sensitive to educational level, does not require advanced language skills, only takes a few minutes to administer and is very easy to use, it appears to be a suitable screening instrument for cognitive impairment in older patients in the general hospital. Copyright © 2011 John Wiley & Sons, Ltd. Source


Kornaat P.R.,Bronovo Hospital | Van De Velde S.K.,Leiden University
American Journal of Sports Medicine | Year: 2014

Background: The clinical significance of an incidental finding of bone marrow edema (BME) on MRI in professional runners is poorly understood. Purpose: To investigate the prevalence and clinical and radiological progression of BME lesions in professional runners who consider themselves to be asymptomatic. Study Design: Case series; Level of evidence, 4. Methods: Sixteen athletes (13 men and 3 women; mean age, 22.9 ± 2.7 years) were recruited from the Dutch National Committee middle-distance and long-distance running selection. All athletes had been injury free for the year before the study. Magnetic resonance imaging scans were obtained before the start of the season and at the end of the season. Both pubic bones, hips, knees, and ankles were scanned in a single session. Preseason and postseason Lysholm scores were obtained. Results: Fourteen of the 16 athletes had BME lesions before the start of the season (45 BME lesions in total). Most BME lesions (69%; 31/45) were located in the ankle joint and foot. More than half of the lesions (58%; 26/45) fluctuated during the season, with new lesions occurring (20%; 9/45) and old lesions disappearing (22%; 10/45). The few clinical complaints that occurred throughout the season were not related to the presence of BME lesions. Conclusion: Almost all asymptomatic athletes showed BME lesions, with more than half of the lesions fluctuating during the season. These data suggest that the incidental finding of a BME lesion on MRI of professional runners should not immediately be related to clinical complaints or lead to an altered training program. © 2014 The Author(s). Source

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