A. Lagro-Janssen - Academia.edu (original) (raw)
Papers by A. Lagro-Janssen
Family Practice, 2016
Background. Some gynaecological and pregnancy-associated conditions are more common in abused wom... more Background. Some gynaecological and pregnancy-associated conditions are more common in abused women than in non-abused women, but this has not been examined in family practice. Objective. We aimed to investigate intimate partner violence (IPV) prevalence in family practice and to investigate whether gynaecological and pregnancy-associated conditions are more common in abused women than in non-abused women. Methods. We conducted a cross-sectional waiting room survey in 12 family practices in the Netherlands in 2012. Women were eligible if they were of 18 years or older. Questionnaires measured IPV and gynaecological and pregnancy-associated conditions. Chi-square tests were used to assess the differences in gynaecological and pregnancy-associated conditions between abused women and non-abused women. Results. The response rate was 86% (262 of 306 women). The past-year prevalence of IPV in women who had had an intimate relationship in the past year and were not accompanied by their partner was 8.7% (n = 195). Lifetime prevalence of women who had ever had an intimate relationship, but not in the past year, was 17.6% (n = 51). Sexually transmitted infections (STIs) [odds ratio (OR) = 4.6, 95% confidence interval [CI] = 1.7-12.5, n = 240], menstrual disorders (OR = 3.7, 95% CI = 1.2-11.2, n = 143), sexual problems (OR = 3.3, 95% CI = 1.2-9.3, n = 229), miscarriages (OR = 2.5, 95% CI = 1.062-5.8, n = 202) and induced abortions (OR = 2.7, 95% CI = 1.028-7.3, n = 202) were significantly more common in abused women than in non-abused women. Conclusion. Family physicians should ask about IPV when women present with STIs, menstrual disorders, sexual problems, miscarriages or induced abortions. To improve the recognition of IPV, future research needs to investigate whether a combination of symptoms offers improved prediction of IPV.
Family Practice, 2016
Background. Accurate health information exchange (HIE) is pivotal for good quality of care. Howev... more Background. Accurate health information exchange (HIE) is pivotal for good quality of care. However, patients with intellectual disabilities (ID) face challenges in processing and exchanging health information around GP consultations. Knowledge of HIE barriers and facilitators, including the roles of carers, may help to improve GP care for people with ID. Objective. To gain more insight into HIE barriers and facilitators for ID patients in GP care. Methods. A qualitative study exploring GP consultation experiences of people with ID (n = 35), professional carers (n = 20) and relatives (n = 15). Transcripts from interviews and focus groups were analyzed using a framework analysis approach. Results. Analyses resulted in four themes: (i) Recognizing patient health needs; (ii) Impaired doctor-patient communication; (iii) Carers' mediating roles during consultations; and (iv) Patients' autonomy and self-determination. Barriers related to communication skills, lack of time, continuity of carers and physicians, information alignment between relative or professional carer and the GP, and information transfer and recording within the patient network. Facilitating factors related mainly to carer interventions, personal connections with patients and GP communication with patients and carers outside the consultation. Conclusion. There is considerable HIE potential in patients themselves, as well as in their network, although many barriers have to be overcome to profit from this. GP practices are recommended to adjust consultations and communication practices and to facilitate deployment of the patient's network, while still considering patient autonomy.
Gerontology & Geriatrics Education, 2016
Geriatrics continues to draw insufficient numbers of medical students today. Currently, little is... more Geriatrics continues to draw insufficient numbers of medical students today. Currently, little is known regarding how education can motivate students to choose geriatrics. The authors' aim was to examine geriatrics from the students' perspective to identify elements that can be useful in education and improving attitudes toward, interest in, and knowledge about geriatrics. The authors analyzed narrative reflection essays of 36 students and clarified the themes from the essays during focus group sessions. Four overarching themes that influenced students' perspective on geriatrics were identified: professional identity, perception of geriatrics, geriatric-specific problems, and learning environment. Students have an inaccurate image of clinical practice and the medical professional identity, which has a negative impact on their attitude toward, interest in, and knowledge of geriatrics. Furthermore, this study yielded the important role of the hidden curriculum on professional identity, the novelty of geriatric-specific problems to students, and the importance of educational approach and good role models.
International Journal of Medical Education, 2011
Objectives: To investigate future life expectations among male and female medical students in the... more Objectives: To investigate future life expectations among male and female medical students in their first and final year. Methods: The study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create statistically comparable themes and categories. Results: Students' written answers were coded, categorized and clustered into four themes: "Work", "Family", "Leisure" and "Quality of personal life". Almost all students included aspects of work in their answers. Female students were more detailed than male ones in their family concerns. Almost a third of all students reflected on a future work-life balance, but considerations regarding quality of personal life and leisure were more common among last-year students. Conclusions: Today's medical students expect more of life than work, especially those standing on the doorstep of working life. They intend to balance work not only with a family but also with leisure activities. Our results reflect work attitudes that challenge the health care system for more adaptive working conditions. We suggest that discussions about work-life balance should be included in medical curricula.
Bijblijven, 2012
ABSTRACT Onderbuikspijn bij een adolescent is een veelvoorkomende klacht. In dit artikel wordt aa... more ABSTRACT Onderbuikspijn bij een adolescent is een veelvoorkomende klacht. In dit artikel wordt aan de hand van een casus beschreven wat de belangrijkste differentiaaldiagnoses zijn. Met eenvoudige middelen, zoals anamnese, lichamelijk onderzoek en beperkt aanvullend onderzoek, is het meestal mogelijk een diagnose te stellen in de huisartsenpraktijk en een goede behandeling in te stellen. Als de behandeling niet het gewenste resultaat heeft, worden er adviezen gegeven over het verdere beleid. Tot slot volgen enige kernboodschappen.
Frontiers in medicine, 2015
In most countries, maternal and newborn care is fragmented and focused on identification and trea... more In most countries, maternal and newborn care is fragmented and focused on identification and treatment of pathology that affects only the minority of women and babies. Recently, a framework for quality maternal and newborn care was developed, which encourages a system-level shift to provide skilled care for all. This care includes preventive and supportive care that works to strengthen women's capabilities and focuses on promotion of normal reproductive processes while ensuring access to emergency treatment when needed. Midwifery care is pivotal in this framework, which contains several elements that resonate with the main dimensions of primary care. Primary health care is the first level of contact with the health system where most of the population's curative and preventive health needs can be fulfilled as close as possible to where people live and work. In this paper, we argue that midwifery as described in the framework requires the application of a primary care philosop...
BMC pregnancy and childbirth, Jan 9, 2014
For most women, participation in decision-making during maternity care has a positive impact on t... more For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women. An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive c...
International Journal of Medical Education, 2013
Objectives: We determine how gender or culture influence new medical students' specialty preferen... more Objectives: We determine how gender or culture influence new medical students' specialty preferences and work-life issues and explore the relation between work-life issues and each specialty preference. Methods: In a cross-sectional study, we surveyed first year Dutch and Swedish medical students (N=1173, cohorts from 2006-2009) on their preferences for specialties, fulltime or part-time work, and agreement to eleven work-life issues. We tested differences by gender or culture using chi square and logistic regression. Results: Over 93% of all students responded (N=1095). Almost no male first year student preferred gynecology as a specialty. Dutch male students were more often interested in surgery, Dutch female students in paediatrics. In the Netherlands, male students in particular preferred full-time work. In Sweden gender did not influence working hour preferences. Women in both countries expected equality in career-opportunities and care-tasks more than men, and agreed more often that their career would influence their family life. Women with a preference for surgery most often emphasized equality in career opportunities and care tasks. In most preferred specialties female gender related to a lower degree to full-time work. A gender gap in preferred working hours was larger for Dutch students preferring surgery or paediatrics than for Swedish students. For most of the specialty preferences studied, Swedish students anticipated childcare by day cares and Dutch students' informal day care. Conclusions: Early in training, medical students have gendered specialty preferences and work-life preferences which relate to each other. Gender differences are significantly more pronounced in the Netherlands than in Sweden.
BMJ Open, 2015
Objectives: To explore and describe the value general practitioner (GPs) attribute to medical gui... more Objectives: To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherence in patients with multimorbidity, as perceived by GPs, and to describe their empirical solutions to manage these obstacles. Design: Focus group study with purposive sampling of participants. Focus groups were guided by an experienced moderator who used an interview guide. Interviews were transcribed verbatim. Data analysis was performed by two researchers using the constant comparison analysis technique and field notes were used in the analysis. Data collection proceeded until saturation was reached. Setting: Primary care, eastern part of The Netherlands. Participants: Dutch GPs, heterogeneous in age, sex and academic involvement. Results: 25 GPs participated in five focus groups. GPs valued the guidance that guidelines provide, but experienced shortcomings when they were applied to patients with multimorbidity. Taking these patients' personal circumstances into account was regarded as important, but it was impeded by a consistent focus on guideline adherence. Preventative measures were considered less appropriate in (elderly) patients with multimorbidity. Moreover, the applicability of guidelines in patients with multimorbidity was questioned. GPs' extensive practical experience with managing multimorbidity resulted in several empirical solutions, for example, using their 'common sense' to respond to the perceived shortcomings. Conclusions: GPs applying guidelines for patients with multimorbidity integrate patient-specific factors in their medical decisions, aiming for patient-centred solutions. Such integration of clinical experience and best evidence is required to practise evidence-based medicine. More flexibility in pay-for-performance systems is needed to facilitate this integration. Several improvements in guideline reporting are necessary to enhance the applicability of guidelines in patients with multimorbidity.
Nederlands tijdschrift voor geneeskunde, 2000
OBJECTIVE To determine whether women with anamnestic suspicion of angina pectoris more often than... more OBJECTIVE To determine whether women with anamnestic suspicion of angina pectoris more often than men with suspicion of angina pectoris have normal coronary arteries on coronary arteriograms. Second, to compare the prognosis of these patients with that of the mean population. DESIGN Literature study. METHOD Articles were selected from Medline over the period 1966 to May 1998 with the use of search terms, and in De geïnformeerde huisarts (The informed GP) over 1992 to November 1998 following which the relevance of the articles was assessed on the basis of title and abstract. Data on the prognosis of the general population were obtained from a WHO project. RESULTS Three articles were selected about sex differences in the presence of angiographically normal coronary arteries in patients with suspected angina pectoris. In 2 articles normal coronary arteries were found more often in women (40-41%) than in men (8-12%). In 1 article women were found to have less severe and extensive corona...
BMC Pregnancy and Childbirth
Background: The caregiver has an important influence on women's birth experiences. When transfer ... more Background: The caregiver has an important influence on women's birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care. It is speculated that satisfaction with care is affected in particular for women who need to be transferred from home to hospital. We examined the level of satisfaction with the caregiver among women with planned home versus planned hospital birth in midwife-led care. Methods: We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Women filled in a postpartum questionnaire which contained elements of the Consumer Quality index. This instrument measures 'general rate of satisfaction with the caregiver' (scale from 1 to 10, with cutoff of below 9) and 'quality of treatment by the caregiver' (containing 7 items on a 4 point Likert scale, with cutoff of mean of 4 or lower). Results: Women who planned a home birth (n = 1372) significantly more often rated 'quality of treatment by caregiver' high than women who planned a hospital birth (n = 829). Primiparous women who planned a home birth significantly more often had a high rate (9 or 10) for 'general satisfaction with caregiver' (adj.OR 1.48; 95% CI 1.1, 2.0). Also, primiparous women who planned a home birth and had care transferred during labour (331/553; 60%) significantly more often had a high rate (9 or 10) for 'general satisfaction' compared to those who planned a hospital birth and who had care transferred (1.44; 1.0-2.1). Furthermore, they significantly more often rated 'quality of treatment by caregiver' high, than 276/414 (67%) primiparous women who planned a hospital birth and who had care transferred (1.65; 1.2-2.3). No differences were observed for multiparous women who had planned home or hospital birth and who had care transferred. Conclusions: Planning home birth is associated to a good experience of quality of care by the caregiver. Transferred planned home birth compared to a transferred planned hospital birth does not lead to a more negative experience of care received from the caregiver.
Nederlands tijdschrift voor geneeskunde, 2019
The concepts of individualised care and continuity are used in many ways in healthcare. However, ... more The concepts of individualised care and continuity are used in many ways in healthcare. However, these concepts are in conflict with actual choices in healthcare which focus mainly on efficiency, standardization and productivity. In this perspective paper, we analyse the thoughts of three philosophers - Levinas, Baart and Nussbaum - on the important starting points of the doctor-patient consultation. These philosophers talk about concepts such as meeting, attention and equivalence. Based on these considerations, we recommend some additions to a number of vocational training programmes.
Nederlands tijdschrift voor geneeskunde, 1998
A woman aged 23 visited the GP because of nagging back pain at the level of L.2-L.3. In spite of ... more A woman aged 23 visited the GP because of nagging back pain at the level of L.2-L.3. In spite of the atypical symptom, the GP made the diagnosis of 'back pain of myogenic origin', possibly the result of camping in inclement weather. When the pain was still present after one week, the patient coughed, produced greyish-green mucus, was dyspnoeic, had 38.5 degrees C fever, while crepitations and reduced breathing sounds were heard in the right lower lung fields, the working diagnosis of 'pneumonia' was made. No laboratory studies were done; X-ray diagnostics and a good response to antibiotic treatment confirmed the diagnosis. After the symptoms recurred and patient's use of an oral contraceptive was established, she was examined for 'pulmonary embolism'. After this condition was shown to be likely, anticoagulant treatment was instituted, which led to rapid recovery.
Birth, 2013
To examine the episiotomy incidence and determinants and outcomes associated with its use in prim... more To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices. Secondary analysis of two prospective cohort studies (n = 3,404). The episiotomy incidence was 10.8 percent (20.9% for nulliparous and 6.3% for parous women). Episiotomy was associated with prolonged second stage of labor (adj. OR 12.09 [95% CI 6.0-24.2] for nulliparous and adj. OR 2.79 [1.7-4.6] for parous women) and hospital birth (adj. OR 1.75 [1.2-2.5] for parous women). Compared with episiotomy, perineal tears were associated with a lower rate of postpartum hemorrhage in parous women (adj. OR 0.58 [0.4-0.9]). Fewer women with perineal tears reported perineal discomfort (adj. OR 0.35 [0.2-0.6] for nulliparous and adj. OR 0.22 [0.1-0.3] for parous women). Among nulliparous women episiotomy was performed most frequently for prolonged second stage of labor (38.8%) and among parous women for history of episiotomy or prevention of major perineal trauma (21.1%). The incidence of episiotomy is high compared with some low-risk settings in other Western countries. Episiotomy was associated with higher rates of adverse maternal outcomes. Restricted use of episiotomy is likely to be beneficial for women.
OBJECTIVE To obtain insight regarding the prevalence of faecal incontinence according to age and ... more OBJECTIVE To obtain insight regarding the prevalence of faecal incontinence according to age and sex and the influence of an anal sphincter rupture during vaginal delivery on its development. METHOD Literature search in Medline (1966-May 1998), Huisarts en Wetenschap (1972-1997) and Nederlands Tijdschrift voor Geneeskunde (1986-1997). RESULTS The prevalence of faecal incontinence was 0.75-2.2% of the adult population, increasing to 2.8-9% at the age of 65 years and older. Among people aged 85 years and older and those living in homes for the aged, the prevalence was much higher (up to 16.7%). There was no clear difference between the sexes, but dependable research on sex differences at a younger age did not exist. There was a significantly higher risk of developing faecal incontinence after an intrapartum anal sphincter rupture, compared to women without an anal sphincter rupture. This difference persisted until 30 years postpartum, but disappeared afterwards. A possible explanation...
BMJ Open
Introduction: Worldwide, sexual and family violence are highly prevalent problems. Victims of sex... more Introduction: Worldwide, sexual and family violence are highly prevalent problems. Victims of sexual and family violence often do not seek formal help in the acute phase. When they do seek help, they encounter a system of scattered care. For this reason, a centre for sexual and family violence was launched in Nijmegen, the Netherlands. The centre provides multidisciplinary care for victims of acute sexual and/or family violence. With the study described in this study protocol, we want to evaluate the implementation process and the reach of the Center for Sexual and Family Violence Nijmegen (CSFVN). Methods and analysis: We will conduct a mixedmethods study including quantitative and qualitative methods of data collection and analysis. Data about the implementation process will be obtained via semistructured interviews and focus group discussions. Content analysis will be done in software program Atlas.ti. Analysis of file data will be undertaken to assess the reach of the CSFVN (patient characteristics and characteristics of the care they received). The data will be analysed in SPSS. Ethics and dissemination: The Medical Ethics Committee of the Radboud University Nijmegen Medical Center approved the study protocol under file number 2012-1218. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant international, national and local conferences and meetings. We will send press releases to relevant media. We will share the results with the network of assault centres in the Netherlands.
Family Practice, 2016
Background. Some gynaecological and pregnancy-associated conditions are more common in abused wom... more Background. Some gynaecological and pregnancy-associated conditions are more common in abused women than in non-abused women, but this has not been examined in family practice. Objective. We aimed to investigate intimate partner violence (IPV) prevalence in family practice and to investigate whether gynaecological and pregnancy-associated conditions are more common in abused women than in non-abused women. Methods. We conducted a cross-sectional waiting room survey in 12 family practices in the Netherlands in 2012. Women were eligible if they were of 18 years or older. Questionnaires measured IPV and gynaecological and pregnancy-associated conditions. Chi-square tests were used to assess the differences in gynaecological and pregnancy-associated conditions between abused women and non-abused women. Results. The response rate was 86% (262 of 306 women). The past-year prevalence of IPV in women who had had an intimate relationship in the past year and were not accompanied by their partner was 8.7% (n = 195). Lifetime prevalence of women who had ever had an intimate relationship, but not in the past year, was 17.6% (n = 51). Sexually transmitted infections (STIs) [odds ratio (OR) = 4.6, 95% confidence interval [CI] = 1.7-12.5, n = 240], menstrual disorders (OR = 3.7, 95% CI = 1.2-11.2, n = 143), sexual problems (OR = 3.3, 95% CI = 1.2-9.3, n = 229), miscarriages (OR = 2.5, 95% CI = 1.062-5.8, n = 202) and induced abortions (OR = 2.7, 95% CI = 1.028-7.3, n = 202) were significantly more common in abused women than in non-abused women. Conclusion. Family physicians should ask about IPV when women present with STIs, menstrual disorders, sexual problems, miscarriages or induced abortions. To improve the recognition of IPV, future research needs to investigate whether a combination of symptoms offers improved prediction of IPV.
Family Practice, 2016
Background. Accurate health information exchange (HIE) is pivotal for good quality of care. Howev... more Background. Accurate health information exchange (HIE) is pivotal for good quality of care. However, patients with intellectual disabilities (ID) face challenges in processing and exchanging health information around GP consultations. Knowledge of HIE barriers and facilitators, including the roles of carers, may help to improve GP care for people with ID. Objective. To gain more insight into HIE barriers and facilitators for ID patients in GP care. Methods. A qualitative study exploring GP consultation experiences of people with ID (n = 35), professional carers (n = 20) and relatives (n = 15). Transcripts from interviews and focus groups were analyzed using a framework analysis approach. Results. Analyses resulted in four themes: (i) Recognizing patient health needs; (ii) Impaired doctor-patient communication; (iii) Carers' mediating roles during consultations; and (iv) Patients' autonomy and self-determination. Barriers related to communication skills, lack of time, continuity of carers and physicians, information alignment between relative or professional carer and the GP, and information transfer and recording within the patient network. Facilitating factors related mainly to carer interventions, personal connections with patients and GP communication with patients and carers outside the consultation. Conclusion. There is considerable HIE potential in patients themselves, as well as in their network, although many barriers have to be overcome to profit from this. GP practices are recommended to adjust consultations and communication practices and to facilitate deployment of the patient's network, while still considering patient autonomy.
Gerontology & Geriatrics Education, 2016
Geriatrics continues to draw insufficient numbers of medical students today. Currently, little is... more Geriatrics continues to draw insufficient numbers of medical students today. Currently, little is known regarding how education can motivate students to choose geriatrics. The authors' aim was to examine geriatrics from the students' perspective to identify elements that can be useful in education and improving attitudes toward, interest in, and knowledge about geriatrics. The authors analyzed narrative reflection essays of 36 students and clarified the themes from the essays during focus group sessions. Four overarching themes that influenced students' perspective on geriatrics were identified: professional identity, perception of geriatrics, geriatric-specific problems, and learning environment. Students have an inaccurate image of clinical practice and the medical professional identity, which has a negative impact on their attitude toward, interest in, and knowledge of geriatrics. Furthermore, this study yielded the important role of the hidden curriculum on professional identity, the novelty of geriatric-specific problems to students, and the importance of educational approach and good role models.
International Journal of Medical Education, 2011
Objectives: To investigate future life expectations among male and female medical students in the... more Objectives: To investigate future life expectations among male and female medical students in their first and final year. Methods: The study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create statistically comparable themes and categories. Results: Students' written answers were coded, categorized and clustered into four themes: "Work", "Family", "Leisure" and "Quality of personal life". Almost all students included aspects of work in their answers. Female students were more detailed than male ones in their family concerns. Almost a third of all students reflected on a future work-life balance, but considerations regarding quality of personal life and leisure were more common among last-year students. Conclusions: Today's medical students expect more of life than work, especially those standing on the doorstep of working life. They intend to balance work not only with a family but also with leisure activities. Our results reflect work attitudes that challenge the health care system for more adaptive working conditions. We suggest that discussions about work-life balance should be included in medical curricula.
Bijblijven, 2012
ABSTRACT Onderbuikspijn bij een adolescent is een veelvoorkomende klacht. In dit artikel wordt aa... more ABSTRACT Onderbuikspijn bij een adolescent is een veelvoorkomende klacht. In dit artikel wordt aan de hand van een casus beschreven wat de belangrijkste differentiaaldiagnoses zijn. Met eenvoudige middelen, zoals anamnese, lichamelijk onderzoek en beperkt aanvullend onderzoek, is het meestal mogelijk een diagnose te stellen in de huisartsenpraktijk en een goede behandeling in te stellen. Als de behandeling niet het gewenste resultaat heeft, worden er adviezen gegeven over het verdere beleid. Tot slot volgen enige kernboodschappen.
Frontiers in medicine, 2015
In most countries, maternal and newborn care is fragmented and focused on identification and trea... more In most countries, maternal and newborn care is fragmented and focused on identification and treatment of pathology that affects only the minority of women and babies. Recently, a framework for quality maternal and newborn care was developed, which encourages a system-level shift to provide skilled care for all. This care includes preventive and supportive care that works to strengthen women's capabilities and focuses on promotion of normal reproductive processes while ensuring access to emergency treatment when needed. Midwifery care is pivotal in this framework, which contains several elements that resonate with the main dimensions of primary care. Primary health care is the first level of contact with the health system where most of the population's curative and preventive health needs can be fulfilled as close as possible to where people live and work. In this paper, we argue that midwifery as described in the framework requires the application of a primary care philosop...
BMC pregnancy and childbirth, Jan 9, 2014
For most women, participation in decision-making during maternity care has a positive impact on t... more For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women. An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive c...
International Journal of Medical Education, 2013
Objectives: We determine how gender or culture influence new medical students' specialty preferen... more Objectives: We determine how gender or culture influence new medical students' specialty preferences and work-life issues and explore the relation between work-life issues and each specialty preference. Methods: In a cross-sectional study, we surveyed first year Dutch and Swedish medical students (N=1173, cohorts from 2006-2009) on their preferences for specialties, fulltime or part-time work, and agreement to eleven work-life issues. We tested differences by gender or culture using chi square and logistic regression. Results: Over 93% of all students responded (N=1095). Almost no male first year student preferred gynecology as a specialty. Dutch male students were more often interested in surgery, Dutch female students in paediatrics. In the Netherlands, male students in particular preferred full-time work. In Sweden gender did not influence working hour preferences. Women in both countries expected equality in career-opportunities and care-tasks more than men, and agreed more often that their career would influence their family life. Women with a preference for surgery most often emphasized equality in career opportunities and care tasks. In most preferred specialties female gender related to a lower degree to full-time work. A gender gap in preferred working hours was larger for Dutch students preferring surgery or paediatrics than for Swedish students. For most of the specialty preferences studied, Swedish students anticipated childcare by day cares and Dutch students' informal day care. Conclusions: Early in training, medical students have gendered specialty preferences and work-life preferences which relate to each other. Gender differences are significantly more pronounced in the Netherlands than in Sweden.
BMJ Open, 2015
Objectives: To explore and describe the value general practitioner (GPs) attribute to medical gui... more Objectives: To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherence in patients with multimorbidity, as perceived by GPs, and to describe their empirical solutions to manage these obstacles. Design: Focus group study with purposive sampling of participants. Focus groups were guided by an experienced moderator who used an interview guide. Interviews were transcribed verbatim. Data analysis was performed by two researchers using the constant comparison analysis technique and field notes were used in the analysis. Data collection proceeded until saturation was reached. Setting: Primary care, eastern part of The Netherlands. Participants: Dutch GPs, heterogeneous in age, sex and academic involvement. Results: 25 GPs participated in five focus groups. GPs valued the guidance that guidelines provide, but experienced shortcomings when they were applied to patients with multimorbidity. Taking these patients' personal circumstances into account was regarded as important, but it was impeded by a consistent focus on guideline adherence. Preventative measures were considered less appropriate in (elderly) patients with multimorbidity. Moreover, the applicability of guidelines in patients with multimorbidity was questioned. GPs' extensive practical experience with managing multimorbidity resulted in several empirical solutions, for example, using their 'common sense' to respond to the perceived shortcomings. Conclusions: GPs applying guidelines for patients with multimorbidity integrate patient-specific factors in their medical decisions, aiming for patient-centred solutions. Such integration of clinical experience and best evidence is required to practise evidence-based medicine. More flexibility in pay-for-performance systems is needed to facilitate this integration. Several improvements in guideline reporting are necessary to enhance the applicability of guidelines in patients with multimorbidity.
Nederlands tijdschrift voor geneeskunde, 2000
OBJECTIVE To determine whether women with anamnestic suspicion of angina pectoris more often than... more OBJECTIVE To determine whether women with anamnestic suspicion of angina pectoris more often than men with suspicion of angina pectoris have normal coronary arteries on coronary arteriograms. Second, to compare the prognosis of these patients with that of the mean population. DESIGN Literature study. METHOD Articles were selected from Medline over the period 1966 to May 1998 with the use of search terms, and in De geïnformeerde huisarts (The informed GP) over 1992 to November 1998 following which the relevance of the articles was assessed on the basis of title and abstract. Data on the prognosis of the general population were obtained from a WHO project. RESULTS Three articles were selected about sex differences in the presence of angiographically normal coronary arteries in patients with suspected angina pectoris. In 2 articles normal coronary arteries were found more often in women (40-41%) than in men (8-12%). In 1 article women were found to have less severe and extensive corona...
BMC Pregnancy and Childbirth
Background: The caregiver has an important influence on women's birth experiences. When transfer ... more Background: The caregiver has an important influence on women's birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care. It is speculated that satisfaction with care is affected in particular for women who need to be transferred from home to hospital. We examined the level of satisfaction with the caregiver among women with planned home versus planned hospital birth in midwife-led care. Methods: We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Women filled in a postpartum questionnaire which contained elements of the Consumer Quality index. This instrument measures 'general rate of satisfaction with the caregiver' (scale from 1 to 10, with cutoff of below 9) and 'quality of treatment by the caregiver' (containing 7 items on a 4 point Likert scale, with cutoff of mean of 4 or lower). Results: Women who planned a home birth (n = 1372) significantly more often rated 'quality of treatment by caregiver' high than women who planned a hospital birth (n = 829). Primiparous women who planned a home birth significantly more often had a high rate (9 or 10) for 'general satisfaction with caregiver' (adj.OR 1.48; 95% CI 1.1, 2.0). Also, primiparous women who planned a home birth and had care transferred during labour (331/553; 60%) significantly more often had a high rate (9 or 10) for 'general satisfaction' compared to those who planned a hospital birth and who had care transferred (1.44; 1.0-2.1). Furthermore, they significantly more often rated 'quality of treatment by caregiver' high, than 276/414 (67%) primiparous women who planned a hospital birth and who had care transferred (1.65; 1.2-2.3). No differences were observed for multiparous women who had planned home or hospital birth and who had care transferred. Conclusions: Planning home birth is associated to a good experience of quality of care by the caregiver. Transferred planned home birth compared to a transferred planned hospital birth does not lead to a more negative experience of care received from the caregiver.
Nederlands tijdschrift voor geneeskunde, 2019
The concepts of individualised care and continuity are used in many ways in healthcare. However, ... more The concepts of individualised care and continuity are used in many ways in healthcare. However, these concepts are in conflict with actual choices in healthcare which focus mainly on efficiency, standardization and productivity. In this perspective paper, we analyse the thoughts of three philosophers - Levinas, Baart and Nussbaum - on the important starting points of the doctor-patient consultation. These philosophers talk about concepts such as meeting, attention and equivalence. Based on these considerations, we recommend some additions to a number of vocational training programmes.
Nederlands tijdschrift voor geneeskunde, 1998
A woman aged 23 visited the GP because of nagging back pain at the level of L.2-L.3. In spite of ... more A woman aged 23 visited the GP because of nagging back pain at the level of L.2-L.3. In spite of the atypical symptom, the GP made the diagnosis of 'back pain of myogenic origin', possibly the result of camping in inclement weather. When the pain was still present after one week, the patient coughed, produced greyish-green mucus, was dyspnoeic, had 38.5 degrees C fever, while crepitations and reduced breathing sounds were heard in the right lower lung fields, the working diagnosis of 'pneumonia' was made. No laboratory studies were done; X-ray diagnostics and a good response to antibiotic treatment confirmed the diagnosis. After the symptoms recurred and patient's use of an oral contraceptive was established, she was examined for 'pulmonary embolism'. After this condition was shown to be likely, anticoagulant treatment was instituted, which led to rapid recovery.
Birth, 2013
To examine the episiotomy incidence and determinants and outcomes associated with its use in prim... more To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices. Secondary analysis of two prospective cohort studies (n = 3,404). The episiotomy incidence was 10.8 percent (20.9% for nulliparous and 6.3% for parous women). Episiotomy was associated with prolonged second stage of labor (adj. OR 12.09 [95% CI 6.0-24.2] for nulliparous and adj. OR 2.79 [1.7-4.6] for parous women) and hospital birth (adj. OR 1.75 [1.2-2.5] for parous women). Compared with episiotomy, perineal tears were associated with a lower rate of postpartum hemorrhage in parous women (adj. OR 0.58 [0.4-0.9]). Fewer women with perineal tears reported perineal discomfort (adj. OR 0.35 [0.2-0.6] for nulliparous and adj. OR 0.22 [0.1-0.3] for parous women). Among nulliparous women episiotomy was performed most frequently for prolonged second stage of labor (38.8%) and among parous women for history of episiotomy or prevention of major perineal trauma (21.1%). The incidence of episiotomy is high compared with some low-risk settings in other Western countries. Episiotomy was associated with higher rates of adverse maternal outcomes. Restricted use of episiotomy is likely to be beneficial for women.
OBJECTIVE To obtain insight regarding the prevalence of faecal incontinence according to age and ... more OBJECTIVE To obtain insight regarding the prevalence of faecal incontinence according to age and sex and the influence of an anal sphincter rupture during vaginal delivery on its development. METHOD Literature search in Medline (1966-May 1998), Huisarts en Wetenschap (1972-1997) and Nederlands Tijdschrift voor Geneeskunde (1986-1997). RESULTS The prevalence of faecal incontinence was 0.75-2.2% of the adult population, increasing to 2.8-9% at the age of 65 years and older. Among people aged 85 years and older and those living in homes for the aged, the prevalence was much higher (up to 16.7%). There was no clear difference between the sexes, but dependable research on sex differences at a younger age did not exist. There was a significantly higher risk of developing faecal incontinence after an intrapartum anal sphincter rupture, compared to women without an anal sphincter rupture. This difference persisted until 30 years postpartum, but disappeared afterwards. A possible explanation...
BMJ Open
Introduction: Worldwide, sexual and family violence are highly prevalent problems. Victims of sex... more Introduction: Worldwide, sexual and family violence are highly prevalent problems. Victims of sexual and family violence often do not seek formal help in the acute phase. When they do seek help, they encounter a system of scattered care. For this reason, a centre for sexual and family violence was launched in Nijmegen, the Netherlands. The centre provides multidisciplinary care for victims of acute sexual and/or family violence. With the study described in this study protocol, we want to evaluate the implementation process and the reach of the Center for Sexual and Family Violence Nijmegen (CSFVN). Methods and analysis: We will conduct a mixedmethods study including quantitative and qualitative methods of data collection and analysis. Data about the implementation process will be obtained via semistructured interviews and focus group discussions. Content analysis will be done in software program Atlas.ti. Analysis of file data will be undertaken to assess the reach of the CSFVN (patient characteristics and characteristics of the care they received). The data will be analysed in SPSS. Ethics and dissemination: The Medical Ethics Committee of the Radboud University Nijmegen Medical Center approved the study protocol under file number 2012-1218. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant international, national and local conferences and meetings. We will send press releases to relevant media. We will share the results with the network of assault centres in the Netherlands.