A literature review of the Dutch debate on the nurse practitioner role: efficiency vs. professional development.

AIM: To explore the debate on the development of the nurse practitioner profession in the Netherlands. BACKGROUND: In the Netherlands, the positives and negatives of nurse practitioners working in the medical domain have been debated since the role was introduced in 1997. The outcome of the debate is crucial for nurse practitioners' professional development and society's justification of their tasks. METHOD: Review of 14 policy documents, 35 opinion papers from nurses, 363 opinion articles from physicians and 24 Dutch research papers concerning nurse practitioners from 1995 to 2012. RESULTS: Two discourses were revealed: one related to efficiency and one to the development of the profession. In both, the nurse practitioner role was presented as a solution for healthcare and workforce problems, while arguments differed. The efficiency discourse seemed most influential. Opinions of nurse practitioners were underrepresented; taking up new responsibilities was driven by the wish to improve patient care. While most physicians were willing to delegate tasks to nurse practitioners, they wished to retain final responsibility for medical care. LIMITATIONS: All available publications were extensively studied, which could not include unpublished policy documents from the government or influential parties. This may have led to some selectivity. CONCLUSION: The case of the Netherlands shows that nurses in developing their advanced role are facing barriers, similar to those in other countries. The dominance of efficiency arguments combined with protection of medical autonomy undermines the development towards nursing care that really benefits patients. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse practitioners should strive to obtain positions in which they are allowed to make their own decisions and wise use of healthcare resources for the good of patients and society. Nurse practitioners should aim to become members of influential healthcare Boards in their countries, in which they can raise their voices and be involved in policy making.

Thermal Brownian motor.

Recently, a thermal Brownian motor was introduced (Van den Broeck et al 2004 Phys. Rev. Lett. 93 090601), for which an exact microscopic analysis is possible. The purpose of this paper is to review some further properties of this construction, and to discuss in particular specific issues including the relation with macroscopic response and the efficiency at maximum power.

Child coping strategies, dental anxiety and dental treatment: the influence of age, gender and childhood caries prevalence.

AIM: This was to investigate what coping strategies are used by children, the efficacy of these strategies and the influences of age, gender, dental anxiety, pain experience and childhood caries prevalence (place of residence) upon the efficacy of the coping strategies used by Dutch (NL) children in The Netherlands and Northern Ireland (NI). METHODS: Convenience samples of Dutch and NI children were taken and asked to fill out a coping questionnaire (Dental Cope Questionnaire) and an anxiety schedule (CFSS-DS). Data were entered onto a SPSS database and subjected to frequency distributions, Chi-square analysis, t-tests and analysis of variance. RESULTS: The children used a wide variety of coping strategies in dealing with pain in dentistry. The most frequently used and those reported to have the greatest efficacy by the children in this investigation were cognitively based strategies. Different strategies were used in relation to place of residence, age and level of dental anxiety. The variance in the number of strategies used was significantly explained by the experienced pain during dental treatment. The efficacy of the coping strategies used was significantly explained by level of dental anxiety. CONCLUSIONS: Dental coping strategies used by children seem to vary with age, dental anxiety and pain experience. This information can help dental practitioners to adjust his or her treatment to the child's emotional needs.

Rectification of thermal fluctuations in ideal gases.

We calculate the systematic average speed of the adiabatic piston and a thermal Brownian motor, introduced by C. Van den Broeck, R, Kawai and P. Meurs [Phys. Rev. Lett. 93, 090601 (2004)], by an expansion of the Boltzmann equation and compare with the exact numerical solution.

Microscopic analysis of a thermal brownian motor.

We study a genuine Brownian motor by hard disk molecular dynamics and calculate analytically its properties, including its drift speed and thermal conductivity, from microscopic theory.

Holmium laser thermal keratoplasty for hyperopia and astigmatism after photorefractive keratectomy.

PURPOSE: To report results of holmium laser thermal keratoplasty used to treat induced hyperopia and induced, as well as pre-existing astigmatism after photorefractive keratectomy. METHODS: Sixteen eyes of 16 patients were included in this study. Contact holmium laser (Technomed Holmium 25) was used in 7 patients to correct hyperopia (8 spots at 8 or 9 mm) and in 9 patients to correct astigmatism (4 spots at 7, 8, or 9 mm). Follow-up evaluation was done after at least 6 months. The effectiveness, stability, and safety of the procedure were investigated. RESULTS: Spherical correction was ineffective (1.00 D or less) when applied at the 9-mm diameter treatment zone. Spherical correction applied at the 8-mm diameter treatment zone was ineffective in 1 eye. Three eyes achieved 1.00 to 2.00 D change, but 2 of these eyes showed an induced astigmatic change as well. Correction of astigmatism at the 7-mm diameter treatment zone resulted in a 0 to 4.00 D cylinder component change. Treatment at the 8-mm diameter treatment zone showed a 0 to 1.50 D effect and at the 9-mm treatment zone, 0.25 to 1.50 D. All eyes that achieved significant improvement (1.00 D or more change in cylinder component) showed significant overcorrection in the first postoperative phase. There were no sight threatening complications. CONCLUSION: Holmium laser thermal keratoplasty can be useful for the treatment of overcorrection and induced as well as pre-existing astigmatism after photorefractive keratectomy. However, predictability is low and astigmatism can be induced with the attempted spherical correction.

[The desire for attachment with the culture of origin--migrant families in psychodynamic therapy]. / Das Verlangen nach Verflochtenheit mit der Herkunftskultur--Migrantenfamilien in psychodynamischer Therapie.

The way migration is worked through will be largely influenced by two aspects: the wish for continuity in the personal identity one had build up before migrating, as well as the longing for staying interwoven with the social group and the cultural life world one had left. Only when these wishes for continuity and interwovenness are safeguarded, the loss that migration also has become, can be experienced and mourned. The element of discontinuity inherent in the migration process, then becomes less threatening. Thereby, aspects of "new encountered culture" will become woven into "brought with culture". To describe this process of intercultural encounter in a migrant family, Winnicott's concept of "potential space" or "transitional space" proves to be very apt. We illustrate this with a clinical vignette of a Moroccan family wherein adolescence brings about intergenerational conflicts, shaped by as well as influencing cultural identities. This article references to some earlier work of Lanfranchi (1988, 1993) and of Lanfranchi and Molinari (1995) in this journal.

[Results of photorefractive keratectomy using the excimer laser in the treatment of myopia; 1-year follow-up]. / Resultaten van fotorefractieve keratectomie met de excimer-laser ter behandeling van myopie; 1 jaar follow-up.

OBJECTIVE: Evaluation of the first excimer laser treatments of myopia. DESIGN: Descriptive. SETTING: Excimer Laser Centrum, Department of Ophthalmology, University of Nijmegen, Nijmegen, the Netherlands. METHOD: 312 patients underwent spherical excimer laser treatment to correct myopia of 1.2 up to 10 diopters between February 1992 and October 1993. 245 patients completed a follow-up of one year or more; 36 retreatments were carried out. Group I (treatment 1.2 to 6 D) numbered 174 patients, group II (6.1-10 D) 71 patients. RESULTS: After a follow-up period of one year or just before retreatment 79% of group I and 48% of group II achieved a refractive correction within 1 D of the attempted correction. Visual acuity without correction was 0.5 or more in 94% of group I and in 76% of group II. Less than one percent (n = 1) of group I and 6% (n = 4) of group II lost more than one line of best corrected visual acuity. Retreatment could correct 50% of those eyes that did not achieve a refraction within 1 D of attempted correction. Loss of visual acuity was corrected by retreatment in 5 of 6 cases of group I and in 7 of 11 cases of group II. CONCLUSION: Based on a one-year follow-up, refractive surgery with the excimer laser appears to correct myopia between 1 and 10 D effectively. Predictability is diminishing on correcting higher amounts of refractive error. Thorough information of the patients regarding the results to be expected will prevent disappointment.

Impairment scores of type III open tibial fractures.

The results of 17 patients with type III open tibial fractures were judged retrospectively by using the Guides to the Evaluation of Permanent Impairment. The fractures were divided into types IIIA (N = 7), IIIB (N = 5) and IIIC (N = 5) according to Gustilo et al. (1984). The impairment scores of these patients were compared with those after a through-knee amputation (36 per cent impairment) or a below-knee amputation (28 per cent impairment). The average impairment scores of the three groups were: IIIA 7.1 per cent, IIIB 19 per cent, IIIC 18.4 per cent. The impairment score of salvaged type III open tibial fractures, for each group, IIIA, IIIB and IIIC, was lower than that after a below-knee or through-knee amputation.

Serum interleukin-6 and C reactive protein responses in patients after laparoscopic or conventional cholecystectomy.

OBJECTIVE: To investigate the acute phase inflammatory response to surgical trauma after laparoscopic and conventional cholecystectomy. DESIGN: Prospective open study. SETTING: University Hospital in The Netherlands. SUBJECTS: 21 patients with symptomatic cholelithiasis admitted for elective cholecystectomy who had had no previous upper abdominal operations. INTERVENTIONS: 12 patients underwent conventional, and 9 patients laparoscopic, cholecystectomy. Circulating interleukin-6 (IL-6) and C reactive protein concentrations were measured 6, 12, 24 and 48 hours after operation. MAIN OUTCOME MEASURE: Changes in IL-6 and C reactive protein concentrations, and comparison of operative blood loss and length of stay in hospital. RESULTS: Those treated by laparoscopic cholecystectomy lost significantly less blood (median 60 compared to 100 ml) and spent significantly fewer days in hospital (median 2 compared with 7 days), (p < 0.01 in each case). The only changes in circulating IL-6 concentrations were seen in patients over the age of 60 years who underwent conventional cholecystectomy. There were significant differences in C reactive protein concentrations between the two operations at both 24 and 48 hours after the operation (p < 0.01 in each case). CONCLUSION: We conclude that laparoscopic cholecystectomy reduces the acute phase inflammatory response compared with the conventional operation; there seems to be no relevant correlation between plasma concentrations of IL-6 and C reactive protein; the presence of IL-6 does not affect the response of C reactive protein to trauma; and the response of IL-6 to trauma is age dependent.

Bromovinyldeoxyuridine and interferon treatment in ulcerative herpetic keratitis: a double masked study.

Bromovinyldeoxyuridine is a potent and safe antiherpes compound that in combination with a placebo treatment promoted the partial and complete healing of herpetic epithelial disease in 22 patients in average times of 4-6 days and 8.5 days respectively. However, when BVDU was combined with 1.5 X 10(6) IU of recombinant a 2C interferon, partial and complete healing times for keratitis in 19 patients were reduced to 2-6 days and 4-6 days respectively. No toxic effects of the medications were observed in any patient.

REM sleep deprivation (REMSD) antagonizes naloxone-precipitated withdrawal in acute morphine-dependent rats.

In rats allowed undisturbed sleep (control and stress) the administration of naloxone (10 mg/kg, s.c.) to morphine (7.5 mg/kg, s.c. 90 min prior) pretreated animals precipitated a jumping behaviour. REM sleep deprivation (REMSD 96 h, prior) significantly decreased the frequency of the naloxone-precipitated jumping behaviour compared with control and stressed animals. In second animal model for morphine withdrawal, naloxone (10 mg/kg, s.c.) provoked myoclonic twitch activity (MTA) in rats previously exposed to morphine (7.5 mg/kg, s.c., 90 min prior). The intensity of naloxone-induced MTA in REM sleep deprived rats was significantly lower compared to stressed animals, but it is not different from the control group. It is suggested that REMSD interferes with a neural mechanism involved in the development of acute dependence. Results are discussed in light of a possible functional insufficiency of a mu-opioid system during REMSD.

[Berofor alpha 2 (r-HUIFN-alpha 2 arg) and acyclovir in the treatment of dendritic keratitis]. / Berofor Alpha 2 (r-Hu IFN-alpha 2 arg) und Aciclovir in der Behandlung der Herpes-Keratitis-dendritica.

In a double-masked clinical trial a total of 24 patients have so far been treated with recombinant human alpha 2-interferon in combination with Acyclovir (ACV), and 21 patients with a placebo-Acyclovir combination. Both partial and complete healing times were statistically significantly shortened in the r-Hu IFN-alpha 2-AVC group, by 35 and 32 percent respectively. No difference could be demonstrated between the combination of r-Hu IFN-alpha 2 arg and ACV and that of BCL IFN and ACV as far as the therapeutic effect was concerned. R-Hu IFN-alpha 2 drops in combination with Acyclovir ointment were excellently tolerated.

Combination therapy of recombinant human alpha 2 interferon and acyclovir in the treatment of herpes simplex keratitis.

No statistical difference was found in both partial and complete healing time in acute epithelial herpetic keratitis between the ACV-recombinant human alpha 2 IFN (both "eyedrops" and "eyerods") and Buffy coat human leucocyte alpha IFN. A highly significant difference was found in both partial and complete healing time between the ACV-IFN combination versus the ACV-Placebo combination. The combination of ACV and recombinant human alpha 2 arg IFN is a potent anti-herpetic treatment.

Nocardia gypsoides corneal ulcer.

Nocardia gypsoides, a species characterised by its ability to produce calcium sulphate granules, has been isolated for the first time from a corneal ulcer. In vivo this pseudomycete also forms gypsum. Every effort should be made to identify Actinomycetales to species level. The names Leptothrix and Streptothrix should be abandoned.

Limit aesthesiometry.

An aesthesiometer with disposable monofilaments is designed for measuring very small pressures on the corneal surface. This was achieved by using various lengths of a nylon monofilament with diameters of 0.08, 0.10, and 0.12 mm. With these lengths and diameters pressures between 0.1 and 1.0 g/mm2 can be exerted on the corneal surface.