Physicians Report Barriers to Deliver Best Practice Care for Asplenic Patients: A Cross-Sectional Survey

Background: Current management of asplenic patients is not in compliance with best practice standards, such as defined by the British Committee for Standards in Haematology. To improve quality of care, factors inhibiting best practice care delivery need to be identified first. With this study, we aimed to identify and quantify physicians' barriers to adhere to best practice management of asplenic patients in the Netherlands. Methods and Principal Findings: A cross-sectional survey, preceded by multiple focus group discussions, was performed among Dutch physicians responsible for prevention of infections in asplenic patients, including specialists ( of Internal medicine and Surgery) and general practitioners (GPs). Forty seven GPs and seventy three hospital specialists returned the questionnaire, yielding response rates of 47% and 36,5% respectively. Physicians reported several barriers to deliver best practice. For both GPs and specialists, the most frequently listed barriers were: poor patient knowledge (> 80% of hospital specialists and GPs) and lack of clarity about which physician is responsible for the management of asplenic patients (50% of Internists, 46% of Surgeons, 55% of GPs). Both GPs and hospital specialists expressed to experience a lack of mutual trust: specialists were uncertain whether the GP would follow their advice given on patient discharge (33-59%), whereas half of GPs was not convinced that specialists' discharge letters contained the correct recommendations. Almost all physicians (> 90%) indicated that availability of a national guideline would improve adherence to best practice, especially if accessible online. Conclusion: This study showed that, in accordance with reports on international performance, care delivery for asplenic patients in the Netherlands is suboptimal. We identified and quantified perceived barriers by physicians that prevent adherence to post-splenectomy guidelines for the first time. Better transmural collaboration and better informed patients are likely to improve the quality of care of the asplenic patient population. A national, online-available guideline is urgently require

Stockbåtar i Sverige:Typologi och datering

This article is based on a master's thesis in maritime archaeology and aims to establish a typology for logboats found in Sweden. The 52 studied logboats are from all over the country, most however from southern Sweden. A structural analysis classifies the boats according to the shape of their cross-sections and their sterns. An attempt is made to connect the natural environment at the find spots to the shape and structural features of the logboats. One aim is to point out the main differences between logboats left in or near lakes with those left in or at the sea. Correspondence analysis of data on the logboats makes it possible to place 40% of the samples in six defined groups. The analysis also suggests that it may be possible to date logboats typologically. 3D digital models were made of three logboats in order to calculate their original displacement.</p

Stockbåtar i Sverige:Typologi och datering

This article is based on a master's thesis in maritime archaeology and aims to establish a typology for logboats found in Sweden. The 52 studied logboats are from all over the country, most however from southern Sweden. A structural analysis classifies the boats according to the shape of their cross-sections and their sterns. An attempt is made to connect the natural environment at the find spots to the shape and structural features of the logboats. One aim is to point out the main differences between logboats left in or near lakes with those left in or at the sea. Correspondence analysis of data on the logboats makes it possible to place 40% of the samples in six defined groups. The analysis also suggests that it may be possible to date logboats typologically. 3D digital models were made of three logboats in order to calculate their original displacement.</p

Antibody levels against <i>Streptococcus pneumoniae</i> and <i>Haemophilus influenzae</i> type b in a population of splenectomized individuals with varying vaccination status

In order to determine antibody levels against Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) in a population of splenectomized subjects, 561 persons in a Danish county, splenectomized between 1984 and 1993 were identified. Two hundred and thirty-five were alive and 149 participated in the study. Each person donated a blood sample for antibody determination by ELISA. Though vaccine coverage among the 149 persons was 91% only 52% had ‘protective’ levels of pneumococcal antibodies. Despite recommendations for regular follow-up on pneumococcal antibody levels this had only been carried out in 4% of the subjects. Splenectomized subjects who needed pneumococcal revaccination were significantly more likely to have received their initial vaccination less than 14 days before or after splenectomy, as recommended, than those not requiring revaccination. Therefore, the timing of initial pneumococcal vaccination in relation to splenectomy seems to be important. All persons had Hib antibody levels higher than 0·15 μg/ml and 60% had levels higher than 1 μg/ml, which are the levels thought to provide short term and long term protection, respectively. In total, 37% of the 149 persons tested had pneumococcal and Hib antibody levels thought to correlate with protection from serious infections.</jats:p