Legislation in the Netherlands requires routine analysis of drinking water samples for cultivable Legionella species from high-priority installations. A field study was conducted to investigate the presence of Legionella species in thermostatic shower mixer taps. Water samples and the interior of ten thermostatic shower mixer taps were investigated for cultivable Legionella species. In seven cases, Legionella species was found in at least one of the samples. In four cases, Legionella species was detected in the biofilm on the thermostatic shower mixer taps interior, with the highest values on rubber parts, and in five cases in the cold supply water. These results show that thermostatic shower mixer taps can play a role in exceeding the threshold limit for cultivable Legionella species, but the cold supply water can also be responsible. Practical implications: This study showed that contamination of thermostatic shower mixer taps (TSMTs) with Legionella spp. was frequently observed in combination with contamination of the water system. Consequently, a combined focus is necessary to prevent the proliferation of cultivable Legionella spp. in TSMTs. In addition, the results also demonstrated that biofilms on rubbers inside the TSMT had high numbers of Legionella spp., probably because rubber contains relatively high concentrations of biodegradable substrates. Therefore, improvement of the rubber materials is necessary to reduce the proliferation of cultivable Legionella spp. in TSMTs.
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Psychiatrisch verpleegkundigen hebben in hun werk regelmatig te maken met mensen die ernstig lijden. Voor een aantal van deze mensen is dit lijden dusdanig ondraaglijk dat zij overwegen om hun leven te beëindigen, een aantal mensen doet dit ook daadwerkelijk. Gemiddeld plegen in Nederland 1600 mensen per jaar suïcide (CBS). Het aantal mensen dat een suïcidepoging doet is rond 94.000 per jaar en 410.000 mensen in de Nederlandse bevolking hebben weleens suïcidegedachten (Ten Have et al. 2006). Hoewel suïcide niet voorbehouden is aan mensen met een psychiatrische diagnose, blijkt uit onderzoek dat bij 47% tot 74% van alle mensen de suïcide is toe te schrijven aan psychiatrische problematiek (Cavanagh et al. 2003). Het uitvragen en bespreken van suïcidaal gedrag is een belangrijk aandachtspunt in elke psychiatrische behandeling. In aansluiting op de internationale term 'suicidal behavior' wordt suïcidaal gedrag gedefinieerd als het geheel aan gedachten, voorbereidingshandelingen en pogingen die een zekere intentie uitdrukken om zichzelf te doden (Hemert et al. 2012). Verpleegkundigen hebben een belangrijke functie in het signaleren, monitoren en behandelen van suïcidaal gedrag.
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To identify ethical issues that interns encounter in their clinical education and thus build a more empirical basis for the required contents of the clinical ethics curriculum. The authors analyzed a total of 522 required case reports on ethical dilemmas experienced by interns from September 1995 to May 1999 at the medical school of Vrije Universiteit in Amsterdam. They identified four regularly described and numerous less frequently described topics. The interns addressed a wide range of ethical themes. In 45% of the cases, they mentioned disclosure or non-disclosure of information and informed consent; in 37%, medical decisions at the end of life; in 16%, medical failures; and in 9%, problems transferring patients from one caregiver to another. The interns also identified 27 themes linked to their unique position as interns and 19 themes related to specific types of patients. Based on self-reported experiences, the authors conclude that clinical ethics teachers should reflect on a multitude of dilemmas. Special expertise is required with respect to end-of-life decisions, truth telling, medical failures, and transferring patients from one caregiver to another. The clinical ethics curriculum should encourage students to voice their opinions and deal with values, responsibilities, and the uncertainty and failings of medical interventions.
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