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The differential diagnosis of chest pain in a patient with sickle cell disease is difficult and may encompass several serious conditions, including chest syndrome, pulmonary embolism and infectious complications. In this manuscript we provide an overview on the various underlying diseases that may cause chest pain in patients with sickle cell disease and provide clues for a proper diagnostic workup

The treatment of type 2 diabetes patients with insulin requires active dose titration to obtain optimal glycemic control. We developed a web-based decision support system to guide patients in performing the titration task autonomously, at their homes. The system is based on a clinically validated algorithm. The aim of this study was to test the safety of the system in a pilot implementation in clinical practice. Patients were blinded from the advice given by the system and instead received insulin dosing advice given by caregivers. At the end of the pilot, advice of the system were evaluated on safety by an expert panel. In this pilot study six patients used the web-based system at their home. In total, 48 advice were logged in the system resulting in eighteen deviating systems dosing advice as compared to the advice of the caregiver. Evaluation of the eighteen deviating systems advice lead to the detection of one unsafe advice indicating a need to extend the algorithm with an additional safety decision rule

Background: The release of the report 'To err is human' put medical safety and the disclosure of errors to the forefront of the health care agenda. Disclosure of medical errors by physicians is vital in this process. We studied the role of background and social psychological factors in internists' willingness to report medical errors. Methods: Survey among a random sample of internists from five teaching hospitals in the Netherlands, all internists and internists in training at the Departments of Internal Medicine of the participating hospitals. Results: Questionnaires were received from 115 participants (response 51%). The willingness to disclose was related to the severity of the error, with the majority of near misses not reported to the head of department or the hospital error committees. Errors were more often reported to colleagues. Positive factors in favour of disclosing were reported more often than negative ones prohibiting disclosure. Motivation, behavioural control and social barriers were related to the disclosure of errors. Conclusion: Personal and social issues contributing to the willingness to report medical errors should be identified and addressed properly to stimulate disclosure. The creation of an atmosphere where disclosing errors is routine seems vital. In addition, it is essential to create a departmental culture where medical errors are discussed in a non-judgmental, safe environment. In order to improve reporting of medical errors, more emphasis should be placed on the individual barriers that preclude adequate reporting

Currently there are over 740,000 patients with diabetes mellitus in the Netherlands, and this number will increase further in the coming years. Approximately 90% of patients has type 2 diabetes, a metabolic disorder that is often associated with obesity, hypertension and increased cholesterol levels. Treatment of diabetes mellitus is essential to reduce the risk of severe complications with irreversible organ damage in the long-term. Gingivitis and periodontitis are more common in patients with diabetes mellitus and are now also considered as complications of diabetes. Collaboration among healthcare professionals is important for effective diabetes care

Insulin is the most potent agent for the treatment of diabetes mellitus. However insulin treatment requires frequent evaluation of blood glucose levels and adjustment of the insulin dose. This process is called titration. To guide patients with type 2 diabetes using once-daily long-acting insulin, we have developed a web-based decision support system for insulin self-titration. The purpose of this paper is to provide an overview of the phases of development and the final design of the system. We reviewed the literature, consulted an expert panel, and conducted interviews with patients to elicit system requirements. This revealed four important aspects: the insulin titration algorithm, the handling of hypoglycemic events, telemedicine functionalities, and visiting frequency monitoring. We used these requirements to develop a fully functional system

No abstract available

The treatment of diabetes mellitus is focused on the prevention of micro- and macrovascular complications. The target HbA(1c) should therefore be 7% or lower. However, a recent study advised a HbA(1c) of 7.5%, since it was found that mortality increased with an HbA(1c) below 7.5%. This was probably caused by hypoglycaemia. A higher mortality in patients with a low HbA(1c) has been described before, but the causes were never understood. It is true that a lower HbA(1c) leads to more hypoglycaemia, but there are no indications that this is the cause of the increased mortality. Changing the target HbA(1c) based on one epidemiological retrospective study is unwise. Taking into account historic prospective studies such as the United Kingdom Prospective Diabetes Study, we think the target HbA(1c) should remain 7% or lower in the treatment of diabetes mellitus

No abstract available