A methodology to systematically analyze the hospital discharge of terminally ill patients

To provide an appropriate method to systematically analyze the hospital discharge of terminally ill patients especially the cooperation between hospital and community nurses and the quality of the discharge handovers. To evaluate the hospital discharge process of terminally ill patients in an academic hospital in the Netherlands using the proposed method. Data were collected from a prospective cohort of all terminally ill patients discharged from the University Medical Center Groningen, the Netherlands, between June and November 2014. The hospital discharges were assessed using 2 questionnaires: an inventory questionnaire, to determine the required care, and an evaluation questionnaire, to evaluate the care actually organized and the discharge handovers. The inventory questionnaire was completed prior to discharge and the evaluation questionnaire between 3 to 7 days after discharge. Around 130 consecutive patients were included. The discharge took place on the desired date in 86% of cases and the average overall discharge grade on a 10-point scale was 7.4 (range: 3-9.5). In 23% of cases discrepancies between required and provided care were identified and medication queries existed in 29%. This study provides a methodology to analyze the hospital discharge procedure of terminally ill patients that can be utlized in any hospital. Structured analysis of the discharge process is valuable and identifies where improvements can be made. Within the study cohort the home care could be arranged at short notice and was considered sufficient. However, in a significant proportion of patients a discrepancy between required and arranged care and queries about medication were identified

Cardiovascular autonomic tests: Methodological considerations and clinical application

The autonomic nervous system plays a minor role in maintaining homeostasis. Short-term blood pressure and heart rate control are mainly modulated by the autonomic nervous system. Therefore, autonomic function can be assesed by cardiovascular autonomic tests. As mentioned in the introduction, a battery of tests is usually performed to determine autonomic function. Some of the tests, or parameters derived from a test or measurement, provide insight in sympathetic funtion, others in parasympathetic en some in symphatetic as well parasympathetic function. ... Zie: Summary