Benefits of an open access echocardiography service: a Dutch prospective cohort study

BACKGROUND: Open access echocardiography has been evaluated in the United Kingdom, but hardly in the Netherlands. The echocardiography service of the SHL-Groep in Etten-Leur was set up independently from the regional hospitals. Cardiologists not involved in the direct care of the participating patients evaluated the echocardiograms taken by ultrasound technicians. AIMS: We estimated the reduction in the number of referrals to regional cardiologists, the adherence of the general practitioners (GPs) to the advice of the evaluating cardiologist, GPs’ opinion on the benefit of the echocardiography service and GPs’ adherence to the diagnostic protocol advocated in the Dutch clinical guideline for heart failure. METHODS: A prospective cohort study was performed. Patients were included from April 2011 to April 2012 (N = 155). Data from application forms (N = 155), echocardiography results (N = 155) and telephone interviews with GPs (N = 138) were analysed. RESULTS: GPs referred less patients to the cardiologist than they would have done without echocardiography available (92 % vs. 34 %, p < 0.001). They treated more patients by themselves (62 % vs. 10 %, p < 0.001). Most GPs (81 %) followed the advice presented on the echocardiogram result. Most GPs (82 %) found the service had clinical benefit for the patient. Sixty two percent of echocardiography requests met the criteria of the Dutch clinical guideline for heart failure. CONCLUSION: Open access echocardiography saved referrals to the cardiology department, saved time, and enabled GPs to treat more patients by themselves. Adherence to diagnostic guidelines for heart failure was suboptimal

Evaluation of an open access echocardiography service in the Netherlands: a mixed methods study of indications, outcomes, patient management and trends

Background: In our region (Eastern South Limburg, The Netherlands) an open access echocardiography service started in 2002. It was the first service of this kind in The Netherlands. Our study aims were: (1) to evaluate demand for the service, participation, indications, echocardiography outcomes, and management by the general practitioner (GP); (2) to analyse changes in indications and outcomes over the years. Methods: (1) Data from GP request forms, echocardiography reports and a retrospective GP questionnaire on management (response rate 83%) of 625 consecutive patients (Dec. 2002-March 2007) were analysed cross-sectionally. (2) For the analysis of changes over the years, data from GP request forms and echocardiography reports of the first and last 250 patients that visited the service between Dec. 2002 and Feb. 2008 (n = 1001) were compared. Results: The echocardiography service was used by 81% of the regional GPs. On average, a GP referred one patient per year to the service. Intended indications for the service were dyspnoea (32%), cardiac murmur (59%), and peripheral oedema (17%). Of the other indications (22%), one-third was for evaluation of suspected left ventricular hypertrophy (LVH). Expected outcomes were left ventricular dysfunction (LVD) (43%, predominantly diastolic) and valve disease (25%). We also found a high proportion of LVH (50%). Only 24% of all echocardiograms showed no relevant disease. The GP followed the cardiologist's advice to refer the patient for further evaluation in 71%. In recent patients, more echocardiography requests were done for 'cardiac murmur' and 'other' indications, but less for 'dyspnoea'. The proportions of patients with LVD, LVH and valve disease decreased and the proportion of patients with no relevant disease increased. The number of advices by the cardiologists increased. Conclusion: Overall, GPs used the open access echocardiography service efficiently (i. e. with a high chance of finding relevant pathology), but efficiency decreased slightly over the years. To meet the needs of the GPs, indications might be widened with 'suspicion LVH'. Further specification of the indications for open access echocardiography-by defining a stepwise diagnostic approach including ECG and (NT-pro)BNP-might improve the service

Berlin: Stadt in Planung und im Wandel

Berlin has always been a city in a process of change. Since the reunification, however, the transition has gained pace. Berlin has reclaimed the status of the German capital city and become a target of international direct investment. Despite prestigous developments such as the Potsdamer Platz or the new central station brought forth in the earlier years after re-unification, the economics recovery has not gained strength until recently. The historic center has re-established itself as the center of the unified city while at the same time, the City West, despite several ups and downs, is thriving. The new international major airport is finally close to completion. Not least, the city has become a research lab for e-mobility and a center of IT and creative industries. At the same time the economic recovery has started to eliminate excess supply of space, which was characteristic for the city over the recent decades, giving rise to affordability concerns and social conflicts. This city tour introduces into the tensions between ambitions and anxieties of planners and residents that are associated with the ongoing transition

Burgeronderzoek Heerlen 1998 - VSO

Survey among inhabitants of Heerlen Satisfaction with neighbourhood / housing / public order and safety/ victimisation / satisfaction with police / management and control of neighbourhood / environmental issues Background variables: basic characteristics/ place of birth/ housing situation/ household characteristics/ place of work/ occupation/employment/ income/capital assets/ educatio

The City as a Creative Hub: The Case of the Fashion Industry in Milan, Italy

The chapter explores the extents to which the concept of “hub” is suitable to represent the role performed by the city of Milan in the spatial, social and economic organisation of the fashion industry. The system is territorially organised according to two main, complementary, forces: a strong local embeddedness and an equally strong internationalisation process. Through these analyses, the authors draw some reflections on the importance of the notion of hub for the urban and development policie

The Clustering of Creative Networks: Between Myth and Reality

and even deepening that which it claims to transcend—namely, socio-spatial inequalities (Oakley, 2006). On the other hand, clustering really does take place and it can be argued that networks of aesthetic production have an inherent tendency to converge together into spatial agglomerations (Scott, 2000). In this paper, I discuss the structuring function of urban location by analysing the tensions between networks of aesthetic pro-duction and the various ‘creative clusters ’ that emerge from these networks. My argument in a nutshell is that the clustering of networked aesthetic production is structured by the con-temporary accumulation regime and mod

Anti-Space : the political complexion of an inner city art gallery

The subject of this paper is an inner city artist-run gallery called Eastside Projects. As part of an historical trend in artistrun spaces, Eastside Projects have innovated a strategic approach to post-industrial space, their location and role within the city of Birmingham, UK. This paper outlines their approach in the context of the recent cultural policy frameworks impressed on publicly funded city-based art organisations. It attempts to extend the conceptualisation of contemporary art in the city within urban studies generally, specifically investigating the theoretical potential of Eastside Project's curatorial strategy. How can we define public agency for art in the neoliberal city? For Eastside Projects, agency is defined principally through space and the aesthetics of space. This paper proposes a theoretical framework for articulating the political aesthetics of new public spaces for art