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Human immunodeficiency virus (HIV)-infected individuals may be at increased risk of age-associated noncommunicable comorbidities (AANCCs). Cross-sectional analyses of AANCC prevalence (including cardiovascular, metabolic, pulmonary, renal, bone, and malignant disease) and risk factors in a prospective cohort study of HIV type 1-infected individuals and HIV-uninfected controls, who were aged ≥45 years and comparable regarding most lifestyle and demographic factors. HIV-infected participants (n = 540) had a significantly higher mean number of AANCCs than controls (n = 524) (1.3 [SD, 1.14] vs 1.0 [SD, 0.95]; P < .001), with significantly more HIV-infected participants having ≥1 AANCC (69.4% vs 61.8%; P = .009). Hypertension, myocardial infarction, peripheral arterial disease, and impaired renal function were significantly more prevalent among HIV-infected participants. Risk of AANCC by ordinal logistic regression was independently associated with age, smoking, positive family history for cardiovascular/metabolic disease, and higher waist-to-hip ratio, but also with HIV infection (odds ratio, 1.58 [95% confidence interval, 1.23-2.03]; P < .001). In those with HIV, longer exposure to CD4 counts

Patient handover is of major importance for continuity of care and contributes to patient safety. According to Joint Commission International (JCI), an American quality institute, 67% of medical errors result from miscommunication. More than half of these errors appear to be attributable to poor medical handover. JCI and the World Health Organisation recommend standardising handover and training doctors in order to improve the quality of medical handover. Little attention is paid to handover as an essential medical competence during training to become a doctor or medical specialist. Many hospitals lack either training or a standardised format for handover. In this paper we discuss 10 tips for improving the quality of intradisciplinary handover.

Antimicrobial resistance is an increasing health care problem, both abroad and in the Netherlands, and its main driving force is antibiotic use. In patients with pneumonia or sepsis, appropriate antibiotic use has been associated with improved clinical outcome, shorter length of hospital stay, decreased bacterial resistance and reduced costs. In a recent study in 19 hospitals in the Netherlands, we found that appropriate antibiotic use in patients with another common type of infection, i.e. urinary tract infection, was also associated with a reduction in length of hospital stay, thus improving patient outcome and healthcare costs. A social and behavioural scientific approach with different intervention strategies - restrictive and persuasive - is required if antibiotic prescription in hospitals is to be improved. As a part of this antimicrobial stewardship programme, antibiotic teams (A-teams) must be introduced in all hospitals in 2014

The Dutch College of General Practitioners (NHG) practice guideline 'Urinary tract infections' intended for primary health care and the Dutch Working Party on Antibiotic Policy (SWAB) practice guideline 'Antimicrobial therapy in complicated urinary tract infections' intended for specialists in secondary care, were reviewed together. - In the NHG guideline the differentiation between 'complicated' and 'uncomplicated' urinary tract infections has been replaced by categorisation into age, sex, risk group and the presence of fever, or invasion of tissues.- If urinary tract infection has been diagnosed, a dip slide test can be used to determine resistance.- The guidelines recommend the most narrow-spectrum antibiotic to reduce further increase in antimicrobial resistance.- A chapter about women with recurrent urinary tract infections has been added to the SWAB guideline. Amongst other things, the chapter provides information on the prescription of prophylactic lactobacillus in secondary care

Many hospitalized patients receive a urinary catheter during their stay. In 21-54% of patients, however, there is no appropriate indication for this. The most significant complication caused by the use of urinary catheters is the development of a urinary tract infection (UTI), one of the most common nosocomial infections. In 71-80% of hospital acquired UTIs a urinary catheter is present. The duration of the presence of a catheter is the major risk factor for catheter-associated UTI. Reducing the number of inappropriate catheterisations is an effective way of preventing catheter-related UTIs. Inappropriate use of indwelling urinary catheters can be reduced by maintaining strict guidelines on justifiable indications for inserting a urinary catheter, verifying daily whether the indication still applies, and by timely removal of the catheter when it is not or no longer needed

As in other countries, the growing resistance to antimicrobial drugs is also taking place in the Netherlands; the primary cause being the total consumption of antibiotics. Given the steady decline in the discovery of new antimicrobials, better use of agents currently available is warranted. Guidelines describing appropriate antimicrobial therapy play an important role; however, such guidelines are not optimally used in daily practice. Quality indicators can be used to assess the quality of antibiotic treatment and evaluate the impact of interventions aimed at improving care. Quality indicators used for evaluating treatment of infections of the respiratory and urinary tracts are developed previously. A comprehensive set of indicators that could be used to assess the quality of hospital antibiotic use for all bacterial infections has not yet been developed. A new project has recently been started in the Netherlands called 'The development of Reliable generic quality Indicators for the optimalisation of ANTibiotic use in the hospital' (RIANT study) for developing such a set of comprehensive indicators

In-hospital adult cardiopulmonary resuscitation is successful in only approximately 20% of cases and may result in permanent neurological damage. Two reasons justify not commencing resuscitation: either the patient does not want to be resuscitated, or resuscitation is considered medically futile by the doctor. This subject should be discussed timely with all chronically ill patients who are likely to be admitted to hospital, preferably in the outpatient clinic setting, and results must be communicated with all doctors involved (e.g. general practitioners). Here we describe 3 cases that demonstrate the need to discuss possible restrictions on cardiopulmonary resuscitation with all chronically ill patients, regardless of their age. The first was a 45-year-old HIV-positive male with chronic clinical depression who refused ICU care, the second a 75-year-old patient whose initial 'do no resuscitate' order was reversed based on the wishes of her daughter and the third a 45-year-old female with sickle cell disease who expressed a sustained wish not to be treated in the ICU or to be resuscitated