One-year mortality after a first visit to a cardiology outpatient clinic: a useful performance indicator?

Purpose In 2003 the Dutch Health Care Inspectorate introduced performance indicators to monitor and compare quality of care in Dutch hospitals. In 2007, the new performance indicator ‘one-year mortality after a first visit to a cardiology outpatient clinic’ was introduced. We set out to evaluate this new indicator in three Dutch teaching hospitals. Methods Using electronic medical records, information was collected retrospectively of patients aged ≥70 years who visited the cardiology outpatient clinic of Medical Centre Alkmaar, Meander Medical Centre Amersfoort and Deventer Hospital between 1 January 2006 and 31 January 2006. Diagnoses were based on the diagnosis treatment combination (DBC) coding system. Results 547 patients (mean age 78.0 years, 53% men) were included, 35 (6.4%) of whom had died after one year. Cardiovascular disease was the most frequent cause of death (22/35, 62.9%). The oneyear mortality among the three hospitals varied from 5.0 to 7.3% (NS). Conclusion One-year mortality after the first visit to a cardiology outpatient clinic amounted to 6.4% in patients aged ≥70 years and did not differ significantly between the three Dutch teaching hospitals. The administrative load to obtain the necessary information was considerable. One-year mortality should be regarded as an ‘outcome’ parameter rather than a ‘performance’ indicator. (Neth Heart J 2009;17:52-5.)     

From heroes to vulnerable victims: labelling Christian Turks as genuine refugees in the 1970s

Abstract

In 1975, the first Christian Turks applied for asylum in the Netherlands. They were at first denied, and only in the early 1980s did they finally begin to win refugee status from the Dutch government. In the meantime, they faced years of uncertainty. Campaigns of lobbyists in the years between 1977 and 1983 contributed to end their waiting. Their campaigns caused a drastic change of the image of the ‘deserving refugee’ in the Netherlands. This article explores the arguments that lobbyists used to influence decision-makers. It shows how and why the public and political image of the ‘deserving refugee’ had to change in order to successfully claim refugee status.     

Clinical implementation of guidelines for cardioverter defibrillator implantation: lost in translation?

Purpose: Guidelines for implantation of cardioverter defibrillators (ICD) are increasingly including indications for primary prevention of sudden cardiac death in high-risk groups, where ICDs were traditionally implanted for secondary prevention. We performed a single-centre audit to evaluate adherence to the recent Dutch guidelines. Methods: All 1886 patients visiting a large regional Dutch teaching hospital (attending 1.8 to 2.0% of the Dutch population) in November 2005 were screened using the recently updated Dutch guidelines. Patients fulfilling these criteria were categorised as having an ICD indication for primary or secondary prevention. Results: 135 patients had an indication for ICD, 19 of whom had one or received one. Of the remaining 116 patients, 14 were ‘new’ to the department of cardiology. The 102 ‘known’ patients had 466 doctor-patient contacts in the previous year, which averages 4.57 cardiology contacts per patient per year. Patients were more likely to receive an ICD for the secondary prevention of SCD (10/11, 91%) than for primary prevention (9/124, 7%). Conclusion: In a large regional teaching hospital in the Netherlands, only a small proportion of patients eligible for ICD implantation actually receive one. Cardiologists tend to implant ICDs for secondary prevention of SCD. The low ICD implantation rate for primary prevention of SCD may relate to logistics (e.g. permission to implant ICDs, the presence of an electrophysiology lab) or the perceived low cost-benefit ratio. Our results indicate that once the substantial backlog (13,500 ICDs) has been addressed, the annual implantation of new ICDs should rise from the current 125 to at least 510 per million inhabitants per year in the Netherlands. (Neth Heart J 2007;15:129-32.)     

Benefits of an open access echocardiography service: a Dutch prospective cohort study

Background

Open access echocardiography has been evaluated in the United Kingdom, but hardly in the Netherlands. The echocardiography service of the SHL-Groep in Etten-Leur was set up independently from the regional hospitals. Cardiologists not involved in the direct care of the participating patients evaluated the echocardiograms taken by ultrasound technicians.

Aims

We estimated the reduction in the number of referrals to regional cardiologists, the adherence of the general practitioners (GPs) to the advice of the evaluating cardiologist, GPs’ opinion on the benefit of the echocardiography service and GPs’ adherence to the diagnostic protocol advocated in the Dutch clinical guideline for heart failure.

Methods

A prospective cohort study was performed. Patients were included from April 2011 to April 2012 (N = 155). Data from application forms (N = 155), echocardiography results (N = 155) and telephone interviews with GPs (N = 138) were analysed.

Results

GPs referred less patients to the cardiologist than they would have done without echocardiography available (92 % vs. 34 %, p < 0.001). They treated more patients by themselves (62 % vs. 10 %, p < 0.001). Most GPs (81 %) followed the advice presented on the echocardiogram result. Most GPs (82 %) found the service had clinical benefit for the patient. Sixty two percent of echocardiography requests met the criteria of the Dutch clinical guideline for heart failure.

Conclusion

Open access echocardiography saved referrals to the cardiology department, saved time, and enabled GPs to treat more patients by themselves. Adherence to diagnostic guidelines for heart failure was suboptimal.     

The first 20 years of bradypacing in the Netherlands - with special reference to organisational structures

In 1958, Arne Larson was the first patient to undergo an implantation of a completely internal pacemaker. Four years after this successful implantation by Senning and Elmquist in Sweden, Brom implanted the first internal system in a Dutch patient in Leiden. The pioneering work and the early history of bradypacing in the Netherlands until 1982 are described. This article covers the involvement of different specialists, organisations and some of the technical problems encountered during the rapid increase in the number of implantations and the establishment of specialist centres. The important role of Thalen and Rodrigo, as founding fathers of cardiac pacing in the Netherlands, is also highlighted. (Neth Heart J 2008;16(Suppl 1):S5-S8).     

Using a phenological network to assess weather influences on first appearance of butterflies in the Netherlands

Phenological responses of butterflies to temperature have been demonstrated in several European countries by using data from standardized butterfly monitoring schemes. Recently, phenological networks have enabled volunteers to record phenological observations at project websites. In this study, the quality of the first appearance data of butterflies from the Dutch phenological network ‘De Natuurkalender’ was examined and these data were then used to analyze trends in butterfly appearance between 2001 and 2013, the effects of climatic factors on appearance of butterflies as well as the phenological interaction of one butterfly species, Anthocharis cardamines, and its two major host plants. Although phenological networks are relatively unstructured, this study shows that data from De Natuurkalender were highly comparable to more standardized data collected by the Dutch Butterfly Monitoring Scheme. No trend in first appearance of any butterfly species was found during the time period 2001–2013. The first appearance dates of most butterflies showed, however, a clear relationship with spring temperature. Higher temperatures, especially in March and April, advanced the first appearance of butterflies. Therefore, with climatic warming in the future, earlier appearance of butterflies is expected. Although climate warming is a potential threat for phenological mismatches between different trophic levels, this study shows a similar temperature response of A. cardamines and its main host plants in the Netherlands. However, as only few phenological interactions between species are examined, further research including rarer monophagous butterfly species and their host plants is needed.     

Family metaphor in political and public debates in the Netherlands on migrants from the (former) Dutch East Indies 1949–66

Abstract

In 1949, the Dutch East Indies became independent Indonesia. In the aftermath of decolonization more than 300,000 people migrated from this former colony to the Netherlands. This article focuses on political and public debates in the Netherlands in which the boundaries between former colonizer and colonized were redrawn as a consequence of decolonization and migration. Migrants from former colonies claimed and were attributed a different position in the societies of their former colonizer than other migrants, based on their juridical citizenship, perceived shared history, Dutchness, loyalty and debt. Not all migrants for the former Dutch East Indies could be recipients of the same label. Dutchness could be stretched, but at one point the rhetoric changed from ‘family’ to ‘guests’.     

The normal and abnormal owl monkey (Aotus sp.) heart: looking at cardiomyopathy changes with echocardiography and electrocardiography

Background Cardiovascular disease, especially cardiomyopathy, was the major cause of death among owl monkeys (Aotus sp.) at a major colony and threatened colony sustainability. For this study, echocardiography (echo) and electrocardiography (ECG) normal values were established, and cardiomyopathy animals identified. Methods Forty‐eight owl monkeys were studied, 30 older than 10 years of age (‘aged’) and 8 of age 5 years (‘young’). Eight aged owl monkeys had cardiomyopathy. Results and Conclusions Aged Aotus had increased left ventricular posterior wall thickness over young animals. Left ventricular diameter and ejection fraction appeared to be the best identifying measurements for cardiomyopathy. There were no differences in the ECG.     

Implementation of the 2015 European Society of Cardiology guidelines for the management of infective endocarditis in the Netherlands

Because the occurrence of infective endocarditis (IE) continues to be associated with high mortality, a working group was created by the Dutch Society of Cardiology to examine how the most recent European Society of Cardiology (ESC) guidelines for IE management could be implemented most effectively in the Netherlands. In order to investigate current Dutch IE practices, the working group conducted a country-wide survey. Based on the results obtained, it was concluded that most ESC recommendations could be endorsed, albeit with some adjustments. For instance, the suggested pre-operative screening and treatment of nasal carriers of Staphylococcus aureus as formulated in the ESC guideline was found to be dissimilar to current Dutch practice, and was therefore made less restrictive. The recently adapted ESC diagnostic criteria for IE were endorsed, while the practical employment of the relevant diagnostic techniques was simplified in an adapted flowchart. In addition, the presence of a multidisciplinary, so-called ‘endocarditis team’ in tertiary centres was proposed as a quality indicator. An adapted flowchart specifically tailored to Dutch practice for microbiological diagnostic purposes was constructed. Lastly, the working group recommended the Stichting Werkgroep Antibioticabeleid (SWAB; Dutch Working Party on Antibiotic Policy) guidelines for IE treatment instead of the antibiotic regimens proposed by the ESC.

     

The imagination of ‘society’ in measurements of immigrant integration

Abstract

My aim in this contribution is to clarify in which way social scientific measurements of immigrant integration operate as a form of ‘social imagination’, that is, of the routinized and professionalized visualization of social life. Through such measurements, images of ‘society’ are produced that feed into larger social imaginaries. My discussion takes as an example Dutch discourse and research on integration. Crucial to the constitution of society in the Netherlands and many other Western European countries is what I call a culturist discourse that has many similarities to racism. This discourse demarcates the boundaries of society by rendering objectively observable the non-integrated who are considered to reside ‘outside society’. The image of society thereby produced is that of a morally cleansed realm: social problems are relegated to the domain ‘outside society’, consisting of persons in need of integration.     

Life cycles of nemerteans that are symbiotic egg predators of decapod Crustacea: adaptations to host life histories

The Netherlands occupy 41,864 km² of which about 6,600 km² (16%) have been classified as internationally important wetlands. About 3000 km² (7%) have been included in the Ramsar Convention list of internationally important wetlands. The situation of the wetlands in The Netherlands has seen large changes during the last 2000 years. Thousands of km² of peatlands have disappeared; thousands of km² of coastal salt marshes and a similar area of shallow lakes have been reclaimed for agriculture. The Dutch wetlands occupy a key position in the bird migration of the West-Palaearctic flyway. The hydrology of The Netherlands and of Dutch wetlands is dominated by the river Rhine. Hence, nutrients and contaminants imported by the Rhine and from other sources have a major impact on Dutch wetlands. Reduction of pollution and eutrophication is a major requirement for conservation of Dutch wetlands. Dutch politics appears to be moving in this direction.     

Gene therapy in The Netherlands: highlights from the Low Countries

Gene therapy is an active research area in The Netherlands and Dutch scientists involved in fundamental and clinical gene therapy research significantly contribute to the progresses made in this field. This ranges from the establishment of the 293, 911 and PER.C6 cell lines, which are used worldwide for the production of replication-defective adenoviral vectors, to the development of targeted viral vectors and T lymphocytes as well as of non-viral vectors. Several milestones have been achieved in Dutch clinical gene therapy trials, including the first treatment worldwide of patients with adenosine deaminase deficiency with genetically corrected hematopoietic stem cells in collaboration with French and British scientists. Until now, about 230 patients with various diseases have been treated with viral and non-viral gene therapy in this country. Ongoing and upcoming Dutch clinical trials focus on the translation of new developments in gene therapy research, including the restoration of genetic defects other than SCID, and the use of oncolytic adenoviruses and targeted T cells for the treatment of cancer. The growing commercial interest in Dutch clinical gene therapy is reflected by the involvement of two Dutch companies in ongoing trials as well as the participation of Dutch clinical centres in large phase III international multicenter immuno-gene therapy trials on prostate cancer sponsored by an American company. Translational gene therapy research in The Netherlands is boosted at a governmental level by the Dutch Ministry of Health via a dedicated funding programme. This paper presents an overview on milestones in Dutch basic gene therapy research as well as on past, present and future clinical gene therapy trials in The Netherlands.     

Diagnostic and therapeutic approach of congenital solitary coronary artery fistulas in adults: Dutch case series and review of literature

Background

Coronary artery fistulas (CAFs) are infrequent anomalies, coincidentally detected during coronary angiography (CAG).

Aim

To elucidate the currently used diagnostic imaging modalities and applied therapeutic approaches.

Materials and Methods

Five Dutch patients were found to have CAFs. A total of 170 reviewed subjects were subdivided into two comparable groups of 85 each, treated with either percutaneous ‘therapeutic’ embolisation (PTE group) or surgical ligation (SL group).

Results

In our series, the fistulas were visualised with several diagnostic imaging tests using echocardiography, multidetector computed tomography, and CAG. Four fistulas were unilateral and one was bilateral; five originated from the left and one originated from the right coronary artery. Among the reviewed subjects, high success rates were found in both treatment groups (SL: 97% and PTE: 93%). Associated congenital or acquired cardiovascular disorders were frequently present in the SL group (23%). Bilateral fistulas were present in 11% of the SL group versus 1% of the PTE group. The fistula was ligated surgically in one and abolished percutaneously in another. Medical treatment including metoprolol was conducted in two, and watchful waiting follow-up was performed in one.

Conclusions

Several diagnostic imaging techniques are available for assessment of the anatomical and functional characteristics of CAFs.     

Dispersal and development ofMarenzelleria spp. (Polychaeta, Spionidae) populations in NW Europe and The Netherlands

The North American spionid polychaeteMarenzelleria cf.wireni was first recorded in the North Sea by Scotland in 1982.Marenzelleria cf.viridis was first found in the Baltic Sea in 1985. Tentative routes of dispersal since then are presented in this paper. In the Netherlands, a biological monitoring programme has revealed populations ofM. cf.wireni in the Ems estuary, Wadden Sea, and in the SW Netherlands. In the Dollard (Ems estuary) a large population has developed (2000–3000 individuals m^?2; 8–16 g ash-free dry weight m^?2). Since the introduction, the macrozoobenthic community has changed from being dominated (by biomass) by bivalves, to domination by polychaetes. Recently, a similar population started to develop at Balgzand (western Dutch Wadden Sea).     

Cardiomyopathies: a revolution in molecular medicine and cardiac imaging

The cardiomyopathies are defined as: ‘a myocardial disorder in which the heart is structurally and functionally abnormal, in the absence of coronary artery disease, hypertension and congenital heart disease sufficient to cause the myocardial abnormality.’1 With the advent of molecular cardiology and cardiovascular imaging (including MRI and echocardiography) in the last decade, much insight has been gained into the different clinical presentations, its familial and genetic causes and pathophysiology in explaining left ventricular function and prognosis. This has been especially true for hypertrophic cardiomyopathy, but also for dilated cardiomyopathy (DCM) and RV cardiomyopathy.     

Live-cell imaging in the era of too many microscopes

At the time of this writing, searching Google Scholar for ‘light-sheet microscopy’ returns almost 8500 results; over three-quarters of which were published in the last 5 years alone. Searching for other advanced imaging methods in the last 5 years yields similar results: ‘super-resolution microscopy’ (>16 000), ‘single-molecule imaging’ (almost 10 000), SPIM (Single Plane Illumination Microscopy, 5000), and ‘lattice light-sheet’ (1300). The explosion of new imaging methods has also produced a dizzying menagerie of acronyms, with over 100 different species of ‘light-sheet’ alone, from SPIM to UM (Ultra microscopy) to SiMView (Simultaneous MultiView) to iSPIM (inclined SPIM, not to be confused with iSPIM, inverted SPIM). How then is the average biologist, without an advanced degree in physics, optics, or computer science supposed to make heads or tails of which method is best suited for their needs? Let us also not forget the plight of the optical physicist, who at best might need help with obtaining healthy samples and keeping them that way, or at worst may not realize the impact their newest technique could have for biologists. This review will not attempt to solve all these problems, but instead highlight some of the most recent, successful mergers between biology and advanced imaging technologies, as well as hopefully provide some guidance for anyone interested in journeying into the world of live-cell imaging.     

Approaching MALDI molecular imaging for clinical proteomic research: current state and fields of application

MALDI imaging mass spectrometry (‘MALDI imaging’) is an increasingly recognized technique for biomarker research. After years of method development in the scientific community, the technique is now increasingly applied in clinical research. In this article, we discuss the use of MALDI imaging in clinical proteomics and put it in context with classical proteomics techniques. We also highlight a number of upcoming challenges for personalized medicine, development of targeted therapies and diagnostic molecular pathology where MALDI imaging could help.     

Genetic diagnostics and genetic counselling in Hypertrophic Cardiomyopathy (HCM)

Dutch professional groups involved in drawing up this guideline: cardiologists, paediatric cardiologists, clinical geneticists, clinical molecular geneticists, genetic counsellors, psychosocial workers, associated with or cooperating with the university hospitals’ outpatient clinics for cardiogenetics. Approved by the NVVC, VKGN and NVK (paediatric cardiology section). NVVC - Nederlandse Vereniging voor Cardiologie – Dutch Society for Cardiology; VKGN - Vereniging Klinische Genetica Nederland – the Netherlands Society for Clinical Genetics; NVK - Nederlandse Vereniging Kindergeneeskunde – Dutch Society for Paediatrics. First published in Dutch in June 2009.     

Does natural selection favour taller stature among the tallest people on earth?

The Dutch are the tallest people on earth. Over the last 200 years, they have grown 20 cm in height: a rapid rate of increase that points to environmental causes. This secular trend in height is echoed across all Western populations, but came to an end, or at least levelled off, much earlier than in The Netherlands. One possibility, then, is that natural selection acted congruently with these environmentally induced changes to further promote tall stature among the people of the lowlands. Using data from the LifeLines study, which follows a large sample of the population of the north of The Netherlands (n = 94 516), we examined how height was related to measures of reproductive success (as a proxy for fitness). Across three decades (1935–1967), height was consistently related to reproductive output (number of children born and number of surviving children), favouring taller men and average height women. This was despite a later age at first birth for taller individuals. Furthermore, even in this low-mortality population, taller women experienced higher child survival, which contributed positively to their increased reproductive success. Thus, natural selection in addition to good environmental conditions may help explain why the Dutch are so tall.     

Clinical application of three-dimensional echocardiography: past, present and future

Significant advances in three-dimensional echocardiography have made this modality a powerful diagnostic tool in the cardiology clinic. It can provide accurate and reliable measurements of chamber size and function, including the quantification of left ventricular mechanical dyssynchrony to guide patient selection for cardiac resynchron-isation therapy. Furthermore, three-dimensional echocardiography offers novel views and comprehensive anatomic definition of valvular and congenital abnormalities, improving diagnosis and preoperative planning. In addition, it is extremely useful in monitoring the effectiveness of surgical or percutaneous transcatheter interventions. As its efficacy for more and more clinical applications is demonstrated, it is clear that three-dimensional echocardiography has become part of the routine clinical diagnostic armamentarium. In this article, we describe the development of three-dimensional echocardiography over the last decades, review the scientific evidence for its current clinical use and discuss potential future applications. (Neth Heart J 2009;17:18-24.)