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Background: The Netherlands Triage Standard (NTS) is a triage system that can be used by different types of emergency care organisations. Our objective was to determine the interrater reliability and construct validity of the NTS when applied to self-presenting patients., Methods: We performed a cross-sectional case scenario study consisting of two parts: (1) paediatric triage in January-February 2019 and (2) adult triage in October-November 2020. In each part, we invited nurse triagists from three general practitioner cooperatives, three ambulance dispatching centres and three hospital emergency departments in the Netherlands to participate. We used 40 case scenarios involving paediatric patients and 41 involving adult patients who could self-present to any emergency care organisation. In advance, an expert panel determined the urgency (six levels) of the case scenarios (reference standard). The main outcome for reliability was the intraclass correlation coefficient (ICC) for urgency level. The main outcomes for validity were degree of agreement with the reference standard, for urgency level, and sensitivity and specificity for high versus low urgency. We used descriptive statistics and logistic multilevel modelling with both case and triagist as random effects., Results: 218 out of 240 invited triagists participated. The ICC among all triagists was 0.73 for paediatric cases and 0.88 for adult cases and was highest in general practitioner cooperatives. For paediatric cases, there was 62.3% agreement with the reference standard about urgency, 17.4% underestimation and 20.2% overestimation. The sensitivity of the NTS for identifying highly urgent paediatric cases was 85.2%; the specificity was 89.7%. For adult cases, there was 68.3% agreement, 13.7% underestimation and 18.0% overestimation. The sensitivity of triage for high urgency in adults was 94.5% and the specificity 83.3%., Conclusion: NTS appears to have good reliability and construct validity for estimating the urgency of health complaints of non-referred patients presenting themselves in emergency care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Various models exist to organize out-of-hours primary care (OOH-PC). We aimed to provide an up-to-date overview of prevailing organizational models in the European Union (EU), implemented changes over the last decade and future plans. This baseline overview may provide information for countries considering remodelling their OOH-PC system., Methods: A cross-sectional web-based questionnaire among 93 key informants from EU countries, Norway and Switzerland. Key informants with expertise in the field of primary health care were invited to participate. Themes in the questionnaire were the existing organizational models for OOH-PC, model characteristics, major organizational changes implemented in the past decade and future plans., Results: All 26 included countries had different coexisting OOH-PC models, varying from 3 to 10 models per country. 'GP cooperative was the dominant model in most countries followed by primary care centre and rota group'. There was a large variation in characteristics between the models, but also within the models, caused by differences between countries and regions. Almost all countries had implemented changes over the past 10 years, mostly concerning the implementation of telephone triage and a change of organizational model by means of upscaling and centralization of OOH-PC. Planned changes varied from fine-tuning the prevailing OOH-PC system to radical nationwide organizational transitions in OOH-PC., Conclusions: Different organizational models for OOH-PC exist on international and national level. Compared with a decade ago, more primary care-oriented organizational models are now dominant. There is a trend towards upscaling and centralization; it should be evaluated whether this improves the quality of health care., (© The Author(s) 2020. Published by Oxford University Press.)

Background: General practitioners experience a high workload during out-of-hours care. A possible solution is the shifting of care to nurse practitioners., Objectives: To provide insight into patient- and care characteristics, safety, efficiency, and patient satisfaction of substituting general practitioners with nurse practitioners for home visits by out-of-hours primary care services., Design: Quasi-experimental non-randomised study comparing home visits by nurse practitioners (intervention group; one out-of-hours care service) with home visits by general practitioners (control group; two out-of-hours care services) for 24 protocolised health problems., Setting: Three out-of-hours primary care services in the East of the Netherlands., Participants: 1601 patients who received a home visit by a nurse practitioner (N = 386) or a general practitioner (N = 1215). Of these patients, 639 gave informed consent to be included in the protocol adherence assessment and follow-up record review (nurse practitioner: N = 358; general practitioner: N = 281)., Methods: Five nurse practitioners with experience in ambulance care were recruited and trained. From September 2016 to March 2017 the nurse practitioners took over home visits under supervision of a general practitioners. This was evaluated using: (1) data-extraction from the patient registration system, (2) follow-up record review in the patients' general practices, and (3) patient satisfaction survey. Two general practitioners independently assessed protocol adherence based on the extracted registration data., Results: Nurse practitioners prescribed medication significantly less often than general practitioners (19.9% versus 30.6%), and referred patients significantly more often to the hospital (24.1% versus 15.9%). The mean length of the home visit was significantly longer for nurse practitioners (34.1 versus 21.1 min). Nurse practitioners adhered to the protocol significantly more often than general practitioners (84.9% versus 76.2%) and their medication prescribing was significantly more often appropriate (93.7% versus 79.5%). There were no differences in the number of missed diagnoses and complications. The number of follow-up contacts was also similar in both groups. Patient satisfaction was generally high and significantly higher for nurse practitioners on several items., Conclusions: Nurse practitioners with experience in ambulance care can safely, efficiently, and satisfactorily perform low complex out-of-hours primary care home visits. It is recommended to study the safety and efficiency of nurse practitioners' home visits in other regions and with nurse practitioners with different educational levels and different specialisations. In addition, we recommend to evaluate the cost-effectiveness and if it leads increased quality of care., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Thenar hammer syndrome is a very rare condition that mimics rheumatic diseases such as carpal syndrome tunnel, Raynaud's phenomenon, and hand synovitis., Objective: To describe the sonographic presentation of thenar hammer syndrome in a typical patient., Methods: Grey-scale sonography and colour Doppler imaging of the hands with an iU22 scanner (Philips) were performed., Results: In B mode, the lesion was seen as a large, rounded, heterogeneous area combining hypoechoic and echogenic components. Pseudoaneurysm was diagnosed based on presence of a cystic saccular formation arising directly from the adjacent artery and exhibiting an irregular thick wall with turbulent blood flow in the lumen. Colour Doppler showed blood flow in part of the lumen, the rest of which was filled with a thrombus seen as echogenic tissue., Conclusion: Sonography can help to diagnose thenar hammer syndrome. Angiography may be unnecessary in patients with normal colour Doppler findings., (Copyright © 2010 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.)

Cannabis is the most widely consumed drug in the world, particularly among young subjects. Cocaine is the third leading illicit drug. Cases of renal infarction associated with combined consumption of cannabis and cocaine have been reported in the literature. We describe the case of a 24-year-old man who presented renal and spleen infarction after massive consumption of cannabis and cocaine. Both vascular events arose on healthy arteries. Etiological tests were negative leading to the conclusion that the events resulted from a toxic cause related to cannabis and cocaine consumption. Different mechanisms, potentially including thrombosis, might explain the association of cannabis and cocaine with vascular events. We suggest that a systematic search for cannabis and cocaine consumption among young victims of vascular disease might be useful., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Unlike in other countries, postgraduate training in Germany is not attached to academic centres. Content and duration of postgraduate training are stipulated by the federal medical boards, with the process being unstructured and solely at the responsibility of the trainee. As a model for a structured postgraduate training programme, the Dutch training system for general practitioners is described in detail. The most important difference is the funding of trainees and training facilities within the frame of structured training programmes by the Dutch Ministry of Health. Acquisition of qualifications thus becomes more important than the work performance of the trainee. After reforming graduate medical training, it is now time to rethink postgraduate training in Germany.

Several lines of evidence indicate that people with Parkinson's disease are impaired at detecting their own motor errors. In the present study, we use a component of the event-related brain potential called the error-related negativity (ERN) to ask whether a high-level, generic error-processing system is compromised in Parkinson's disease. We recorded the electroencephalogram (EEG) from nine patients with mild to moderate Parkinson's disease and from nine normal control subjects while they performed a choice reaction time task. We found that the amplitude of the ERN was the same for both populations, indicating that the error-processing system associated with the ERN is not severely compromised in this Parkinson's disease population. These results are discussed in terms of disease progression.