Using patient experiences on Dutch social media to supervise health care services: exploratory study.

BACKGROUND: Social media has become mainstream and a growing number of people use it to share health care-related experiences, for example on health care rating sites. These users' experiences and ratings on social media seem to be associated with quality of care. Therefore, information shared by citizens on social media could be of additional value for supervising the quality and safety of health care services by regulatory bodies, thereby stimulating participation by consumers. OBJECTIVE: The objective of the study was to identify the added value of social media for two types of supervision by the Dutch Healthcare Inspectorate (DHI), which is the regulatory body charged with supervising the quality and safety of health care services in the Netherlands. These were (1) supervision in response to incidents reported by individuals, and (2) risk-based supervision. METHODS: We performed an exploratory study in cooperation with the DHI and searched different social media sources such as Twitter, Facebook, and healthcare rating sites to find additional information for these incidents and topics, from five different sectors. Supervision experts determined the added value for each individual result found, making use of pre-developed scales. RESULTS: Searches in social media resulted in relevant information for six of 40 incidents studied and provided relevant additional information in 72 of 116 cases in risk-based supervision of long-term elderly care. CONCLUSIONS: The results showed that social media could be used to include the patient's perspective in supervision. However, it appeared that the rating site ZorgkaartNederland was the only source that provided information that was of additional value for the DHI, while other sources such as forums and social networks like Twitter and Facebook did not result in additional information. This information could be of importance for health care inspectorates, particularly for its enforcement by risk-based supervision in care of the elderly. Further research is needed to determine the added value for other health care sectors.

Causes of frequency and nocturia after renal transplantation.

OBJECTIVE: To explore the role of bladder capacity, bladder pain, dysfunctional voiding, urgency, urinary tract infections (UTIs), and urinary output as potential causes of frequency and nocturia after renal transplantation. PATIENTS AND METHODS: Data were gathered from 52 adult renal transplant patients (35 men and 17 women, mean age 49 years), using a written questionnaire, medical records, frequency/volume charts, and urinary cultures. The mean time between transplantation and data collection was 5 months. Structural equation modelling (SEM) was used for the simultaneous assessment of direct and indirect relationships between explanatory variables and voiding frequency. RESULTS: Frequency and nocturia were found in 54% and 60% of the study population, respectively. Frequency was directly associated with a small bladder capacity, bladder pain, urgency, and a high daytime urine volume, and indirectly by UTIs (via urgency and bladder pain). Nocturia was associated with high nocturnal urine volume, small bladder capacity and dysfunctional voiding. A quarter of the patients had small bladders and another quarter had large bladders, the latter being associated with nocturnal polyuria. CONCLUSIONS: The presence of frequency, especially when accompanied by bladder pain, might aid the physician to identify patients with small bladders. The presence of nocturia can be the result of a high nocturnal urine volume, which increases the risk of bladder enlargement. Because both abnormal bladder conditions can contribute to graft dysfunction, we recommend a urological follow-up after renal transplantation, using frequency/volume charts.

Dysfunction of lower urinary tract in renal transplant children with nephrologic disease.

OBJECTIVES: To investigate the relationship between dysfunction of the lower urinary tract after renal transplantation and renal transplant function in children with an underlying nephrologic disease. METHODS: The research group consisted of 21 renal transplant children (12 girls and 9 boys, mean age 13.5 years, range 6 to 18) with an underlying nephrologic disease. To indicate renal transplant function, the calculated creatinine clearance rate (Ccr) according to Schwartz was used. The Ccr was measured at two points, 2 months after transplantation and at the moment of study. The average graft age was 34 months (range 5 to 85). The data on dysfunction of the lower urinary tract were gathered using a written questionnaire, frequency volume chart, free uroflowmetry, transabdominal ultrasonography, and medical records. To determine the relationship between the symptoms of dysfunction of the lower urinary tract and Ccr at the moment of study, we computed bivariate correlations and performed multivariate regression analyses in which the associations were studied while controlling for the Ccr 2 months after transplantation and graft age. RESULTS: A sensation of incomplete emptying (P = 0.03), postvoid residual urine volume (P = 0.06), and urinary tract infection (P = 0.004) correlated negatively with the Ccr at the moment of study. These effects remained present (P = 0.07, P = 0.03, and P = 0.003, respectively) while controlling for graft age and the Ccr at 2 months after transplantation in the regression analysis. CONCLUSIONS: The results of our study have shown that a postvoid residual urine volume and urinary tract infections after renal transplantation may result in renal transplant deterioration in children with an underlying nephrologic disease.

Lower urinary tract symptoms after renal transplantation in children.

PURPOSE: We investigated the prevalence and nature of LUTS after renal Tx in children. The focus of the study was the presence of LUTS in children without a history of urological symptoms. We also studied the relationship between the characteristics of these patients and the occurrence of LUTS. MATERIALS AND METHODS: Data were gathered using a written questionnaire, frequency volume chart, free uroflowmetry, transabdominal ultrasonography and medical records. The study group (30 patients) consisted of 9 children (30%) undergoing renal transplantation with an underlying urological disease and 21 (70%) with an underlying nephrological disease. RESULTS: In the nephrological group the incidence of high capacity bladder was 75%, residual urine 50%, UTI 43%, hesitancy 38%, intermittent flow 33%, bladder pain 33%, nighttime incontinence 29%, nocturia 24%, feeling of incomplete emptying 15%, daytime incontinence 14%, straining 14%, urgency 10%, burning sensation 10% and intermittency 5%. No substantial difference in the occurrence of LUTS, UTI or high bladder capacity after Tx was found between children with an underlying urological disease and those with an underlying nephrological disease. On average, patients in both groups suffered from 3 different LUTS. CONCLUSIONS: After renal Tx children with a nephrological disease demonstrated a high incidence of LUTS. The occurrence of LUTS combined with UTI and increased bladder capacity indicates that these children are at risk for development of myogenic failure. This finding emphasizes the importance of close urological followup after Tx in children with urological and nephrological disease.

Lower urinary tract symptoms after renal transplantation: are there changes over time?

OBJECTIVES: To examine the changes in bladder function after renal transplantation by comparing lower urinary tract symptoms in the first and third years after transplantation in a group of renal transplant recipients. METHODS: The long-term changes in bladder function after transplantation were studied using a longitudinal study design. The study group consisted of 53 patients who underwent renal transplantation in 1998 at the University Medical Centre Nijmegen and who returned a completed questionnaire about their micturition pattern in the first and third year after transplantation. The data on symptoms of lower urinary tract dysfunction were collected using the International Continence Society (male) and Bristol Female Lower Urinary Tract Symptoms questionnaires. The control group consisted of 74 patients who visited the Outpatient Clinic of Otorhinolaryngology at year 1. In our analyses, we compared the micturition behavior of the transplant group at year 3 with the control group and with their own micturition behavior at year 1. RESULTS: The results of our study showed that 3 to 4 years after transplantation, the renal transplant group still urinated significantly more often during the day and during the night than did the control patients. Furthermore, among most (63% to 68%) of the patients who showed these symptoms in the first year after transplantation, the symptoms were still present 2 to 3 years later. CONCLUSIONS: The frequency and incidence of nocturia among renal transplant patients are fairly persistent phenomena.