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In 1972 the psychiatric hospital 'Vijverdal' opened its doors in Maastricht. The building of this Community Mental Hospital was reported to be 'revolutionary'. Inspired by American architectural concepts about the construction of hospitals, Vijverdal arose as a huge complex with a nine storey radial block of flats: a unique building in Dutch psychiatry. The first reactions were very positive. The imposing flat expressed psychiatric optimism and therapeutic promises. However, confronted by the dynamic developments in psychiatry at the end of the seventies, the hospital more and more appeared to be a therapeutic monstrum: the flat became a symbol of alienation and medical detachment. Adapting it to the new ideas about differentiation and de-concentration appeared difficult, however. Only in 2000 Vijverdal started a fundamental renovation. The flat will be torn down in 2006. This changing evaluation of Vijverdal makes us wonder about the biography of this psychiatric hospital. Which intentions and which psychiatric concepts inspired Vijverdal to be built? How functioned the building environment of Vijverdal in practice? Could the hospital be accommodated to the new notions and wishes about psychiatric care? Moreover, in what way did the architecture determine the history of Vijverdal? And eventually, how are new conceptions about psychiatric care translated in the present renovation and reconstruction of Vijverdal? Do therapeutic promises play a role again? The adventures of Vijverdal tell us about the risks of visionary architecture, but also that a building matters: the psychiatric patients appreciate the new houses and the privacy of a room for their own.

To determine the quality of care in an intensive care unit.Prospective investigation for one year. Comparison with results from the literature.Surgical intensive care unit of a community hospital.Measurement of the APACHE-II-score was performed on days 1, 3 and 7 in all surgical intensive care unit patients admitted during a one-year period. The predicted mortality from the literature was compared with the actual mortality in our hospital.A total of 301 patients were admitted to the intensive care unit. Overall mortality was 9%. All the patients with an APACHE II score above 25 on admission died. The actual mortality was comparable with the predicted mortality from the literature.The APACHE II score can be used to determine the quality of care in an intensive care unit. Early prediction of a bad prognosis makes transportation to a more specialized hospital possible, before irreversible organ damage develops.

In 285 patients intracoronary fibrinolytic agents were administered 300 times during the acute phase of a myocardial infarction. The results and the complications of this therapy, as administered in a community hospital, did not differ from those obtained in a big randomized study performed by the Interuniversity Cardiological Institute of The Netherlands. Recanalization of a completely occluded coronary artery was obtained in 79% of the cases. Only 8.3% of the patients needed blood transfusion because of blood loss via the puncture in the femoral artery. No intracranial bleeding occurred. Actuarial total survival after 12 months was 90.5%. The incidence of recurrent myocardial infarction after successful intracoronary fibrinolytic therapy appears rather high; therefore, in some patient categories further therapy may be considered such as percutaneous transluminal coronary angioplasty or aortocoronary bypass surgery.

Thyroïd-surgery is possible in the smaller hospital, meeting the up to date standards. It means a thorough biochemical and functional exploration, scintigraphy (as an outpatient), radiography of neck and its soft tissues, eventually tomography and more seldom are required: the echography, scan (as an out-door patient), punction. The strict preoperative preparation and postoperative follow-up are required. Considerations referring to the interventions between 1984 to 1987 (28 cases).