Development and measurement of guidelines-based quality indicators of caesarean section care in the Netherlands: A RAND-modified delphi procedure and retrospective medical chart review

Background There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates. Method Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery. Results The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adh

The incorporation of different demand concepts in the job demand-control model: effects on health care professionals

This paper reports a study of 212 health care professionals that focuses on job characteristics as predictors of employee health. By means of covariance structure modelling (LISREL 8) we tested the interactive assumptions of the Karasek (1979) Job Demand-Control (JD-C) Model [Karasek, R.A., Jr., 1979. Job demands, job decision latitude, and mental strain: implications for job redesign. Administrative Science Quarterly, 24, 285-307.] using three different concepts of job demands (i.e. psychological job demands, physical demands and emotional demands) in combination with a more focused measure of decision latitude (i.e. job autonomy) to predict employee health (i.e. job satisfaction, job involvement, emotional exhaustion and psychosomatic health complaints). Controlling for gender and age, the results partly support the JD-C hypotheses by finding three out of twelve assumed interaction effects. More specifically, different outcome variables are predicted by different combinations of job autonomy with the three kinds of job demands, respectively. In conclusion, although we refute the central hypotheses of the JD-C model to a large extent, the current (interactive) findings are quite illuminating and will be discussed in the context of their theoretical and practical implications. Researchers as well as practitioners have to broaden their perspective on 'job demands' in health care work and need to focus on different kinds of job demands to capture the complexity of this work setting.Job demand-control model Health care professionals Burnout Covariance structure modelling

Rotating reactors : a review

This review-perspective paper describes the current state-of-the-art in the field of rotating reactors. The paper has a focus on rotating reactor technology with applications at lab scale, pilot scale and industrial scale. Rotating reactors are classified and discussed according to their geometry: stirred tanks, tubes, discs and miscellaneous reactors. Their operating characteristics, industrial applications, and their main advantages and disadvantages are discussed including power requirements, residence time distribution, reactor volume, gas–liquid mass transfer rate, and the micromixing time. Finally, the barriers for further industrial implementations are discussed

Vaginale baring veilig voor tweeling vanaf 32 weken?

Compared with other countries, the elective caesarean section rate for twins is relatively low in the Netherlands. Worldwide, there is an increasing trend toward performing more elective caesarean sections for women with a twin pregnancy at term, be it for twins with the first child in breech or in cephalic presentation. The results of the 'Twin Birth Study' indicate that a planned caesarean section does not improve outcome as compared with planned vaginal birth for twins with the first child in cephalic position beyond 32 weeks gestation. During the study, an experienced obstetrician was present during planned vaginal delivery and there was a possibility of performing a secondary caesarean section within 30 minutes. This study provides an additional argument to guarantee the aforementioned conditions in all hospitals where women plan to deliver their twins vaginally. However, the definition of an experienced obstetrician is subject to debat