A patient-centred instrument for assessment of quality of breast cancer care: results of a pilot questionnaire.

BACKGROUND: In several breast cancer research environments, there was a need to develop a questionnaire that would (1) provide data on how breast cancer patients experience healthcare services, (2) address issues corresponding with patients' needs and expectations and (3) produce useful data for quality assessment and improvement projects aimed at breast cancer care. This article describes the first part of the quantitative process of item selection, instrument construction and optimisation based on the results of a pilot questionnaire. METHODS: Based on qualitative research, a pilot questionnaire with items formulated as "performance" and "importance" statements was developed and sent to all breast cancer patients operated on in the previous 3-15 months in five participating hospitals. Reduction criteria, exploratory factor analysis and reliability analysis were used as part of the process of instrument optimisation. RESULTS: Of the 637 questionnaires sent out, 299 (47%) were returned and 276 (43%) were used for analyses. Out of the 72 quality items included in the pilot questionnaire, 42 items did not meet the inclusion criteria for the revised version. The remaining items refer to the factors patient education regarding aspects related to postoperative treatment, services by the breast nurse, services by the surgeon, patient education regarding activities at home and patient education regarding aspects related to preoperative treatment (Cronbach α = 0.70-0.89). CONCLUSIONS: In this study, the number of items to be included in the self-administered questionnaire was reduced. The resulting set of items that determines patients' perceptions on quality of breast cancer care is easy to complete and enables anonymous responses. Further research can be aimed at establishing the reliability of the current questionnaire.

Patients' opinions on quality of care before and after implementation of a short stay programme following breast cancer surgery.

PURPOSE: To assess breast cancer patients' opinions on quality of care during an implementation study on short hospital stay, and to formulate patient inspired targets for further quality improvement based on results of the QUOTE (Quality of Care Through the Patients' Eyes) breast cancer instrument. RESULTS: Quality of patient education regarding activities at home was in need of improvement in both measurements. Quality of services delivered by the surgeon improved somewhat after implementation. Although quality of waiting and process times improved after implementation, there was still room for further improvement on these aspects. CONCLUSION: A breast cancer care programme in short stay was introduced while, on average, preserving quality of care as perceived by the patient. However, aspects regarding education on drains, prosthesis, exercises after surgery, survival rates, and waiting and process times require continuing attention to enhance patients' assessment of quality of care.

Implementation of a short-stay programme after breast cancer surgery.

BACKGROUND: : Short-stay breast cancer surgery (24 h or day case) is not common practice in Europe. This before-after comparative study was carried out to test the feasibility of systematically implementing a care programme incorporating short-stay admission using strategies tailored to individual hospital needs, and to assess safety and facilitating factors. METHODS: : Patients with breast cancer from four Dutch hospitals participated. The intervention concerned the programme developed by the Maastricht University Medical Centre. This was implemented through local multidisciplinary meetings and educational outreach visits. RESULTS: : Of 421 eligible patients, 324 (77.0 per cent) gave consent to participate. The proportion of patients who had short-stay treatment increased from 45.3 per cent before to 82.2 per cent after implementation of the programme (P < 0.001). No increase was observed in the rate of complications, readmissions, reoperations or number of visits to the emergency department. Factors associated with an increased chance of short-stay treatment were: breast-conserving surgery, having children and being employed. Being aged over 64 years showed a trend towards a decreased chance. CONCLUSION: : Introducing a care programme incorporating short stay following breast cancer surgery in four hospitals was feasible and safe.

Prevalence of acquired undescended testis in 6-year, 9-year and 13-year-old Dutch schoolboys.

OBJECTIVE: To investigate the prevalence of acquired undescended testis (UDT) in Dutch schoolboys. DESIGN AND PARTICIPANTS: As a part of routine school medical examinations, during a 2-year period (2001-3), testis position was determined in 6-year, 9-year and 13-year-old schoolboys. Before the examination, a parent questionnaire was sent inquiring both about the position of the testes and whether the child had been admitted earlier to hospital for orchidopexy. In 6-year and 13-year olds, a physical examination was performed by the school medical officer; in 9-year olds, a school nurse interview was held. Each boy for whom there was any doubt of the scrotal position was referred to the hospital for examination of both testes. SETTING: Institution for Youth Health Care "Noordkennemerland" and Medical Centre Alkmaar, Alkmaar, the Netherlands. RESULTS: Testis position was determined in 2042 boys aged 6, 1038 aged 9 and 353 aged 13. Of these, 47, 53 and 8 boys, respectively, were referred to the hospital and seen for further evaluation. The diagnosis of acquired UDT was made in 25 boys aged 6, 23 aged 9 and four aged 13. In 33 boys, a congenital UDT was diagnosed; 32 (97%) had already been diagnosed and treated at an early age. CONCLUSIONS: The prevalence of acquired UDT for 6-year, 9-year and 13-year olds was, respectively, 1.2% (25/2042), 2.2% (23/1038) and 1.1% (4/353). In addition, congenital UDT is treated during the early years of life and, in contrast with popular belief, screening programmes for detecting UDT in the early years are successful.

Previous testicular position in boys referred for an undescended testis: further explanation of the late orchidopexy enigma?

OBJECTIVE: To investigate the significance of the acquired undescended testis (UDT), which is differentiated into congenital and acquired forms, by assessing the previous testicular position in affected boys. PATIENTS AND METHODS: The study comprised 261 boys who had been referred for a non-scrotal testis to the outpatient clinic during an 8-year period (1993-2000). There was a bimodal distribution of age, with peaks at 2.0 and 10.0 years. In each boy with UDT the previous testicular position was ascertained. RESULTS: On referral, 340 testes were not in the scrotum (182 uni- and 79 bilateral). Of the 340 testes, 82 (24%) in 61 boys were diagnosed as retractile, whereas the remaining 258 in 221 boys were undescended. The previous testicular position was known in 208 of 221 boys (94%), with 244 UDTs. In 65 of these 244 (26.6%) the testis had never been scrotal (congenital UDT); in 179 (73.4%) a previous intrascrotal position was recorded in early childhood (acquired UDT) at least once, in 149 (61%) at least twice and in 117 (48%) at least three times. The mean age at referral for congenital UDT was 2.1 years and for acquired UDT was 8.4 years. CONCLUSIONS: These results show that acquired UDT is frequent, and occurs at about three times the rate of congenital UDT. Because these boys are referred for treatment later in childhood, the acquired UDT probably accounts for the high rate of (late) orchidopexy.

[Previous testicular position in boys who underwent orchidopexy due to undescended testis at the Alkmaar Medical Center, the Netherlands, during the period 1986-1999]. / De vroegere testisligging van jongens bij wie orchidopexie was verricht wegens niet-ingedaalde testis in het Medisch Centrum Alkmaar (1986-1999).

OBJECTIVE: To determine the previous testicular position in boys, in whom orchidopexy was performed for undescended testis. DESIGN: Retrospective, descriptive. METHOD: All boys, aged 0-18 years, who underwent orchidopexy in the Alkmaar Medical Centre, the Netherlands, during the period 1986-1999, were studied. The following information was obtained from the hospital medical records: indication for operation, date of the operation, laterality (unilateral or bilateral), the surgical findings and whether previous testicular position played a role in the decision to perform orchidopexy. For each boy who underwent orchidopexy for undescended testis, previous testicular positions up until the date of the operation were obtained from the appropriate youth health care institutions. RESULTS: Hospital records were available for 851 boys who had undergone orchidopexy. The operation for undescended testis was performed in 717 boys and previous testicular positions were obtained for 565 boys. On a per testicle basis, 707 operations were carried out (142 bilaterally, 205 left-sided, 218 right-sided). From these 707 testes, a previous intrascrotal position was found at least once in 572 (80.9%), at least twice in 493 (69.7%) and at least three times in 419 (59.3%); 135 (19.1%) testes had never been intrascrotal. The majority of previously undescended testes were operated on at 3 years of age; most operations on previously descended testes were performed at 10.5 years of age. For 344 (48.7%) out of 707 testes, previous testis localisation was known in the hospital's medical records, for 96 (13.6%) testes registration was unclear and in 267 (37.8%) testes it was not reported. In 8 (1.4%) boys, testis registration after the birth was used on referral to document previous testicular position. CONCLUSION: In total 80.9% of all orchidopexy operations were performed on testes that had previously been diagnosed as having descended normally. These probably included retractile testes as well as acquired forms. In 51.3% of the cases, previous testicular position was not known in the hospital's medical records at the time of operation.

Low diagnostic value of respiratory impedance measurements in children.

The aim of this study was to determine whether impedance values in children with various chronic respiratory complaints differed from those observed in symptom-free children. Respiratory impedance was measured using the forced oscillation technique in 1,776 Dutch children aged 6-12 yrs. In addition to the commonly used parameters of resistance and reactance, further impedance parameters were obtained by using linear and quadratic regression to describe individual resistance and reactance curves as a function of frequency. Furthermore, the diagnostic value of the individual impedance parameters was evaluated by means of receiver operator characteristic (ROC) curves. Statistically significant differences in impedance values were found in girls with symptoms suggesting asthma compared to symptom-free girls, but not in boys. In children with chronic cough, impedance was not significantly different from the values of symptom-free children. The results obtained by the additional impedance parameters were comparable to those of the commonly used measures. We conclude that the diagnostic values of the impedance parameters appeared to be low, as no cut-off points were found to discriminate clearly between symptomatic and symptom-free children. These findings may reflect absence of functional abnormalities in symptomatic children at this age.

The rate of respiratory symptoms among primary school children in two Dutch regions.

UNLABELLED: A cross-sectional study was conducted to evaluate possible interregional differences in respiratory health in primary school children living in two different towns of the Netherlands, Melick/Herkenbosch Asenray (MHA) (n = 511) and Leek (LK) (n = 612). The prevalence of respiratory symptoms was determined by means of a questionnaire and respiratory impedance was measures using the forced oscillation technique (FOT). Respiratory symptoms were reported consistently more often in MHA than in LK; chronic cough (17% MHA vs 5% LK), shortness of breath (15% vs 8%), wheeze (16% vs 13%) and attacks of shortness of breath with wheeze (10% vs 7%). However, doctor-diagnosed asthma was reported as 7% in MHA and 6% in LK. The prevalence rates expressed as odds ratios of MHA versus LK were all > 1 even when adjusted for known indoor environmental factors. Living in MHA appeared to be a statistically significant determinant of the reported symptom prevalence. Furthermore, the child's age, maternal smoking (> 10 cigarettes/day), and having had domestic animals were positively associated with one or more respiratory symptoms. Calculating adjusted differences in respiratory impedance between the regions resulted in a small but statistically significant difference in resonant frequency, LK being slightly at a disadvantage. Measured outdoor air pollution levels of SO2, NO2, O3 and PM10 were in general higher in MHA. In both regions however, the average levels remained below the present WHO guidelines, except for NO2 in MHA where the guideline was slightly exceeded. CONCLUSION: In this study prevalence rates of key symptoms of asthma were found to be significantly higher in children living in one region of the Netherlands (MHA) compared to another (LK). Known (indoor) risk factors for respiratory disease could not explain the observed differences in symptom prevalence between the regions. However, statistically but not clinically significant interregional differences in respiratory impedance values were found between children living in MHA and children living in LK. Further research will have to incorporate techniques to evaluate the potential influence of information bias.

Electrotransfection of protoplasts from tomato, wild tomato, barley and chrysanthemum with tobacco mosaic virus RNA.

Protoplasts isolated from tomato, wild tomato, barley and chrysanthemum were electrotransfected with tobacco mosaic virus (TMV) RNA under almost the same optimum electric conditions: five square DC pulses of 50 microseconds duration at 500 to 800 V/cm, with the protoplasts suspended at 2 x 10(5)/ml in 0.5 M-mannitol containing 100 microM-MgCl2 and 10 to 20 micrograms/ml TMV RNA. ELISAs of these transfected protoplasts showed that the yields and the growth curves of the virus were quite similar, indicating a lack of host specificity in the initially infected cells of these plants.

Clinical study of the modified Equipoise clasp.

The modified Equipoise clasp has been developed to overcome the negative aesthetics of anterior clasping. Fifteen patients involving twenty-two Equipoise clasps were followed up for retention, aesthetics and oral health. Examiners found that 36.4% of the clasps gave poor retention, 18.1% were reasonable and 45.5% were good. Aesthetics were 23.6% poor, 36.4% reasonable and 50% good. Oral health was 9.1% poor, 50% reasonable and 40.9% good. The patients reported that retention was 13.3% reasonable and 86.7% good. Twenty percent of the patients felt aesthetics were reasonable and 80% felt it was good. The clasps were reasonably comfortable in 13.3% and most comfortable in 86.7%. The Equipoise clasp can be used with success for, among others, the Kennedy Class IV case if the correct clinical and laboratory procedures are followed. However, it is unsuitable in, for example, a Class I dentition where posterior stability is poor. Its lingual window can adversely affect oral hygiene and careful patient selection is necessary.