Disciplinary complaints concerning transgressive behaviour by healthcare professionals:an analysis of 5 years jurisprudence in the Netherlands

OBJECTIVES: To study the frequency of observed cases of disciplinary law complaints concerning transgressive behaviour in Dutch healthcare by analysing disciplinary cases handled in Dutch disciplinary law. DESIGN: Retrospective review of complaints in the Dutch disciplinary law tribunals from the period 1 January 2015 to 1 January 2020. SETTING: Dutch healthcare. METHOD: Descriptive retrospective study. All judgements at regional disciplinary tribunals in the first instance from the period 1 January 2015 to 1 January 2020 concerning transgressive behaviour were investigated. The following was studied: year of judgement, number and nature of complaints, type of complainants, profession of defendant. RESULTS: Over the study period, 139 complaints about transgressive behaviour were handled, 90 of which involved sexual behaviour. 66/139 complaints were submitted by patients themselves (47.5%). Most complaints were directed against physicians (44.6%; n=62), followed by nurses (30.2%; n=42), psychologists (11.5%; n=16) and physiotherapists (7.9%; n=11). 80.6% of the complaints were directed against a male healthcare professional (OR 4.25; 95% CI 1.7590 to 10.2685; p=0.0013). 104/139 of the complaints originated from an outpatient work setting and about half of the complaints originated from mental healthcare. Of the 90 disciplinary cases in which the complaint was related to sexually transgressive behaviour, 83.3% (n=75) were ruled to be substantiated (5 of which partially) with a measure imposed in all cases: 6 formal warnings (8%), 11 reprimands (14.7%), 10 denials (partial suspension) (13.3%), 26 temporary suspensions (34.7%) and 22 cancellations of the licence to practice (29.3%). CONCLUSION: This study describes jurisprudence of disciplinary cases about transgressive behaviour of healthcare professionals in the Netherlands. The results of this study can be used to monitor trends in observed cases of transgressive behaviour

CD40-CD40 Ligand Interactions in Experimental Allergic Encephalomyelitis and Multiple Sclerosis.

We investigated the role of CD40-CD40 ligand (CD40L) interactions in multiple sclerosis (MS) and experimental allergic encephalomyelitis (EAE). Activated helper T cells expressing CD40L (gp39) surface protein were found in MS patient brain sections, but not in brain tissue sections of normal controls or patients with other neurological disease. CD40L-positive cells were co-localized with CD40-bearing cells in active lesions (perivascular infiltrates). Most of these CD40-bearing cells proved to be of the monocytic lineage (macrophages or microglial cells), and relatively few were B cells. To functionally evaluate CD40-CD40L interactions, EAE was elicited in mice by means of proteolipid-peptide immunization. Treatment with anti-CD40L monoclonal antibody completely prevented the development of disease. Furthermore, administration of anti-CD40L monoclonal antibody, even after disease onset, shortly before maximum disability score was reached led to dramatic disease reduction. The presence of helper T cells expressing CD40L in brain tissue of MS patients and EAE animals, together with the functional evidence provided by successful experimental prevention and therapy in an animal model, indicates that blockade of CD40-CD40L-mediated cellular interactions may be a method for interference in active MS

Isolation and characterization of Alicycliphilus denitrificans strain BC, which grows on benzene with chlorate as the electron acceptor

A bacterium, strain BC, was isolated from a benzene-degrading chlorate-reducing enrichment culture. Strain BC degrades benzene in conjunction with chlorate reduction. Cells of strain BC are short rods that are 0.6 microm wide and 1 to 2 microm long, are motile, and stain gram negative. Strain BC grows on benzene and some other aromatic compounds with oxygen or in the absence of oxygen with chlorate as the electron acceptor. Strain BC is a denitrifying bacterium, but it is not able to grow on benzene with nitrate. The closest cultured relative is Alicycliphilus denitrificans type strain K601, a cyclohexanol-degrading nitrate-reducing betaproteobacterium. Chlorate reductase (0.4 U/mg protein) and chlorite dismutase (5.7 U/mg protein) activities in cell extracts of strain BC were determined. Gene sequences encoding a known chlorite dismutase (cld) were not detected in strain BC by using the PCR primers described in previous studies. As physiological and biochemical data indicated that there was oxygenation of benzene during growth with chlorate, a strategy was developed to detect genes encoding monooxygenase and dioxygenase enzymes potentially involved in benzene degradation in strain BC. Using primer sets designed to amplify members of distinct evolutionary branches in the catabolic families involved in benzene biodegradation, two oxygenase genes putatively encoding the enzymes performing the initial successive monooxygenations (BC-BMOa) and the cleavage of catechol (BC-C23O) were detected. Our findings suggest that oxygen formed by dismutation of chlorite can be used to attack organic molecules by means of oxygenases, as exemplified with benzene. Thus, aerobic pathways can be employed under conditions in which no external oxygen is supplie

Dutch medical disciplinary law cases concerning psychiatry, 2015-2019

Achtergrond De kwaliteit van medische beroepsbeoefening wordt bewaakt via het tuchtrecht. Kwantitatieve gegevens over Nederlandse tuchtrechtspraak zijn beperkt beschikbaar: weinig is bekend over aard, aantal en uitkomst van klachten tegen psychiaters(-psychotherapeuten) of artsen in opleiding tot psychiater (aiossen).Doel Inzicht krijgen in de Nederlandse tuchtrechtspraak, met name aantal en soort tuchtzaken tegen psychiaters(-psychotherapeuten) en a(n)iossen.Methode Descriptief retrospectief onderzoek. Alle uitspraken in eerste aanleg van regionale tuchtcolleges uit de periode 2015-2019 betreffende psychiaters(-psychotherapeuten) en aiossen werden onderzocht. Bestudeerd werden: jaar van uitspraak, aantal en aard van de klachten, soort klagers, categorieën van de aangeklaagde beroepsbeoefenaar (psychiater(-psychotherapeut), a(n)ios).Resultaten De regionale tuchtcolleges behandelden in de onderzoeksperiode 353 unieke tuchtklachten; 70,6 gemiddeld per jaar. 321 waren gericht tegen psychiaters(-psychotherapeuten), 32 tegen aiossen. De klachtendichtheid was 1,74 per 100 psychiaters en 0,37 per 100 aiossen. De meeste klachten betroffen ‘onjuiste diagnose’, ‘onjuist beleid’ en ‘onjuiste communicatie’. Gemiddeld 31% resulteerde in een maatregel: het merendeel betrof een waarschuwing (49%), berisping (30%) of voorwaardelijke schorsing (5%). In totaal werd in 17 (15%) zaken besloten tot gedeeltelijke ontzegging of doorhaling in het BIG-register.Conclusie Binnen de psychiatrie is weinig aandacht voor tuchtrecht, ondanks dat psychiaters regelmatig geconfronteerd worden met tuchtklachten. Deze exploratieve analyse van tuchtklachten geeft aanleiding voor vervolgonderzoek, met name om de gevonden verschillen te verklaren tussen mannelijke-vrouwelijke beklaagden, en internationale vergelijking in de gegrondverklaring van klachten over (seksueel) grensoverschrijdend gedrag.BACKGROUND: The aim of medical disciplinary law (as part of the Dutch law 'Wet BIG') is to safeguard the quality of professional practice in the health services. Quantitative data about Dutch medical disciplinary law is sparse: little is known about the nature, quantity and the verdicts of disciplinary law complaints against psychiatrists and residents.AIM: Gaining insight in Dutch medical disciplinary law, in particular with regard to number and nature of disciplinary law complaints against psychiatrists(-psychotherapist) and psychiatry residents.METHOD: Descriptive retrospective study. We examined all medical disciplinary law cases against psychiatrists(-psychotherapist) and psychiatry residents in the period 2015-2019.RESULTS: In the study period the regional medical disciplinary courts handled 353 cases against psychiatrists(-psychotherapist) and residents psychiatry, on average 70.6 per year. 321 of these cases were against psychiatrists and 32 against residents. Complaint density was 1.74 for psychiatrists and 0.37 for residents. Subject of most cases was 'wrong diagnosis', followed by 'wrong therapeutic plan' and 'incorrect communication'. The number of cases resulting in a disciplinary measure was on average 31%: warning (49%), reprimand (30%), (conditional) suspension (15%). In 17 cases the professional was (partially) denied to practice. CONCLUSIONS Within Dutch psychiatry little attention is paid to disciplinary law, despite the fact that psychiatrists are relatively often confronted with disciplinary law complaints. The current explorative analysis underlines the need for further research, especially on the difference between male/female psychiatrists and an international comparison with respect to complaints about (sexual) misconduct.</p