Assessing quality of life in respiratory disorders: chronic nonspecific lung disease.
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Asthma↗
Biomedical subjects
A A Kaptein
Publications and source records attributed to A A Kaptein.
[Psychological and psychiatric problems in chronic somatic patients; recommendations for future studies and implications for care].
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Chronic Disease↗
Assessing quality of life in chronic non-specific lung disease--a review of empirical studies published between 1980 and 1994.
Chronic non-specific lung disease (CNSLD), a chronic disease with considerable prevalence and mortality rates, is not only a medical problem, it also has significant psychological and social consequences for the patients concerned. Quality of life research on CNSLD has been rather underdeveloped for quite a long period of time, but has recently become an important topic in research as well as in patient care. In order to get insight into the state of the art of empirical research on quality of life (QOL) in CNSLD, a review of the literature between 1980-1994 on this topic is presented. Special attention is paid to definitions and operationalizations of the QOL concept as well as on questionnaires used to assess QOL and the aims of QOL research. Analysis reveals that QOL is seldom defined clearly and is operationalized in a variety of ways. Most studies have a descriptive nature or pertain to clinical trials. The negative impact of CNSLD on QOL is well-documented and shows the importance of incorporating assessment of QOL in research as well as in patient care. Future research is called for, which should be theory-driven, taking into account recent developments concerning disease-specific measures of QOL.
Humans↗
Health-related quality of life assessments in osteoarthritis during NSAID treatment.
There is some evidence that nabumetone (1000 mg once daily) in comparison with piroxicam (20 mg once daily) in patients with OA in general practice is associated with a lower incidence and less severe occurrence of stomach pain but with more withdrawals due to lack of efficacy. The aim of this analysis was to investigate whether these differences are reflected in health-related quality of life assessments. Patients (n = 198) included in this study were selected in general practice according to a protocol. The patients were randomized and treated for a period of six weeks. Clinical assessments were performed by the general practitioner (CP) during treatment. The Sickness Impact Profile (SIP), the Activities of Daily Living (ADL), and a pain questionnaire were filled out by the patients before and after treatment. As measured with the SIP, the ADL and the pain questionnaire, there were no significant differences between nabumetone and piroxicam. The correlations between (changes in) patient assessments and (changes in) clinical assessments were low. The differences between the two drugs regarding withdrawals and adverse events were not reflected by patient health-related quality of life assessments. There was a low correlation between patient health-related quality of life assessment and clinical assessments. To get a complete picture of the efficacy and safety of a drug, patient health-related quality of life assessments should be a part of a clinical trial.
Adult↗
Health-related quality of life in patients with osteoarthritis in a family practice setting.
OBJECTIVE: To study the impact of osteoarthritis (OA) on all areas of a patient's health-related quality of life. METHODS: The Sickness Impact Profile (SIP) was administered to a group of patients with OA selected from a family medicine setting. The results were compared to a reference population, stratified by age, and adjusted for sex. RESULTS: OA was associated with significant impairment, and had an important impact on, health-related quality of life in the areas of ambulation, body care and movement, emotional behavior, sleep and rest, home management, and work, especially in patients ages 41-60. The older patients differed less from the controls than did the younger ones. Items that contributed to the differences between OA patients and controls were mainly related to physical limitations. CONCLUSION: Most dysfunctions related to OA are physical.
Adult↗
Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale.
BACKGROUND: Many scales have been developed to assess depression, but they are often too lengthy to be of practical use in general practice consultations. AIM: A study was undertaken to investigate the feasibility, reliability and diagnostic value of the geriatric depression scale and its shorter versions for screening in general practice. METHOD: A total of 586 consecutive consulting patients aged 65 years and over were studied in nine general practices in the west of the Netherlands (13 doctors). The 30-item version of the geriatric depression value was compared with the diagnostic interview schedule as a reference test. RESULTS: The reference test indicated a major depression in six patients while 27 patients had a dysthymic disorder (that is, a chronic mild depression). Five per cent of patients required help for 50% of the questions on the geriatric depression scale. The diagnostic value of the 30-item, 15-item, 10-item and four-item versions did not differ significantly, but the one-item version performed no better than chance. Two items discriminated best between patients who were and who were not depressed (P < 0.05), only one of which was included in a previously proposed four-item version of the scale. The reliability of the proposed four-item version was 0.64, the reliability of the other versions ranging from 0.70 to 0.87. CONCLUSION: The results for the different versions of the geriatric depression scale suggest the use of a 10-item or a four-item version. For practical purposes, the smallest subset would be the most desirable: the four-item version. These scales may be better suited for exclusion rather than inclusion purposes. The feasibility of screening for depression in elderly people in a general practice setting is discussed in the light of the results of the study.
Aged↗
Osteoarthritis pain assessment in family practice.
PURPOSE: The objective is to study the assessment of pain severity, following the conventional family physician routines, in patients with peripheral osteoarthritis. METHODS: The patient's perception of pain and the physician's assessment of the pain were measured by means of questionnaires and were compared in a study population of 198 patients with osteoarthritis. RESULTS: A rather low association was found between a patient's perception of pain and the physician's assessment of pain. CONCLUSIONS: It is an accepted fact that too much treatment can have undesirable effects, and that inadequate management of symptoms seems to be associated with a reduced quality of life in osteoarthritic patients. In the absence of a high correlation between patient's perception and physician's assessment of pain severity, it is concluded that a patients' pain questionnaire could be a very useful instrument for improving the care given to patients with osteoarthritis in family practice.
Adult↗
Prevalence of depressive symptoms and depressive disorder in primary care patients over 65 years of age.
The aim of this study was to estimate the prevalence of depressive symptoms and depressive disorder (ICHPPC-2-defined) in patients over 65 years of age. A cross-sectional, partly two-phased, study was performed in general practices in The Netherlands. A total of 384 consecutive patients aged 65 and above, 116 men and 268 women were included, both during practice visits and home visits. Depressive symptoms were recorded with the Zung Self-rating Depression Scale, the Geriatric Depression Scale, and with physician ratings. Assessments of depressive disorder were based on an adaptation of interview ratings with the Montgomery Asberg Depression Rating Scale. The proportion of patients considered to have depressive symptoms ranged from 11 to 29% of patients, depending on the self-report instrument and the cut-off point. According to interviews a depressive disorder was estimated to be present in 17%. The high prevalence of depressive symptoms and depressive disorder suggest a higher index of suspicion of depression in elderly general practice patients.
Aged↗
The Phadiatop test compared with RAST, with the CAP system; proposal for a third Phadiatop outcome: "inconclusive".
In 19 general practices, blood samples were obtained from 361 patients aged 12 years or older with chronic nasal symptoms. The Phadiatop test and a panel of RASTs to common inhalant allergens were performed on all sera with the recently introduced Pharmacia CAP system. The RAST panel was accepted as the standard. The sensitivity of the Phadiatop was 94% (95% confidence interval (CI): 89-97%), the specificity 98% (95% CI: 95-99%), the positive predictive value 97% (95% CI: 94-99%), and the negative predictive value 95% (95% CI: 91-98%). It is noteworthy that these values are very similar to those found in hospital outpatient departments. It was possible to reduce further the small percentage of false outcomes by replacing the cutoff point of the Phadiatop ratio of 1.00 by the two cutoff points 0.75 and 1.15. This resulted in three possible outcomes: a highly predictive positive outcome, a highly predictive negative outcome, and an "inconclusive" outcome. Alternatively, the cutoff point of 1.00 may be maintained while attaching the annotation "borderline" to all positive or negative Phadiatop outcomes where the Phadiatop ratio is between 0.75 and 1.15. By this simple method, physicians are alerted to the possibility of a false outcome; on the basis of the case history and other clinical findings, they can then decide whether further testing should be done.
Administration, Inhalation↗
Effect of a home exercise training program in patients with cystic fibrosis.
Physical training in patients with pulmonary diseases, including cystic fibrosis (CF), may improve exercise tolerance in these patients. Most training programs are performed in a clinical setting. Little information is available concerning the effect of home exercise training programs in CF patients. The purpose of this study was to investigate the effect of a home exercise training program in CF patients. Ten adolescent patients (seven male and three female) with CF, mean (SD) age 20.6 (6.5) years, participated in a home exercise training program for 3 months. Pretraining condition was assessed during a control period of 2 months in which patients were asked to continue their normal daily activities. Home exercise training consisted of cycle training of 15 min at a submaximal workload once a day and was supervised by a physiotherapist two times a week. A follow-up period of 1 month, in which the patients were advised to continue cycling at home without supervision, was included after the training program. Pulmonary function, bicycle exercise test performance, and the degree of limitation in activities of daily living (ADL) were measured. No significant differences were found between the two pretraining assessments. After the training period we found significant improvement in maximal exercise capacity (Wmax) (mean [SEM]: 126 [10] W before and 146 [11] W after; p = 0.004), maximal oxygen uptake (VO2max) (mean [SEM]: 31.4 [2.1] ml.kg-1.min-1 before and 36.5 [2.5] ml.kg-1.min-1 after; p = 0.008), oxygen pulse (VO2/HR) (mean [SEM]: 10.9 [0.66] ml before and 11.9 [0.74] ml after; p = 0.047), and degree of limitation in ADL (mean [SEM]: 2.4 [0.43] before and 1.5 [0.48] after; p = 0.019) as compared with the initial values. Since no significant differences were found between the posttraining values and the results at the end of the follow-up period, the patients were apparently able to maintain the training effects during the follow-up period. We conclude that in CF patients, a home exercise training program, after clinical assessment of exercise tolerance, is an effective and relatively simple treatment to improve physical performance and decrease limitation in ADL and should be included in the maintenance treatment in these patients.
Activities of Daily Living↗
Management of depression in elderly general practice patients.
OBJECTIVE: To describe general practitioners' (GP) management (i.e., recognition and treatment) of depression in elderly patients. DESIGN: Two separate studies were performed: (a) to study recognition of depression, a postal survey was sent to GPs; (b) to evaluate the consistency of treatment, patients considered depressed by GPs were described. SETTING: general practices in the West of The Netherlands. SUBJECTS: 65 GPs, and 44 patients of 7 GPs. MAIN OUTCOME MEASURES: (a) degree of recognition of depression as described in major depression case-vignettes (b) consistency of treatment. RESULTS: (a) On average 65% of the GPs recognized every depressive symptom in case-vignette one, while 52% of GPs recognized each symptom in case two. Most (39) doctors used a time criterion of less than 5 weeks for depressive disorder. (b) Depressed patients with at least three depressive symptoms all received treatment. Chronically depressed patients appeared to be treated somewhat inadequately. CONCLUSION: The results suggest some inadequate knowledge of criteria for major depression and some inconsistency in treatment. The management of depression in elderly GP patients appears to need improvement.
Aged↗
Developing a quality-of-life questionnaire for patients with respiratory illness.
In this short report, the construction of a disease-specific quality-of-life questionnaire for patients with asthma and chronic obstructive pulmonary disease (COPD) is described. Some psychometric aspects are also discussed. We listed 221 items relating to several domains of quality-of-life, and asked 204 patients to indicate, on a seven-point Likert-scale, how much of a problem each item had been during the last year. After item selection, a quality-of-life scale was constructed, consisting of 55 items divided into 7 subscales. The reliability estimates vary from 0.68 to 0.89, and can be considered as quite satisfactory. Results concerning construct validity are promising; there is a strong relationship between the Quality-of-life subscales and several indicators of illness severity. Further research is called for to validate the questionnaire.
Adolescent↗
Fosfomycin trometamol in a single dose versus seven days nitrofurantoin in the treatment of acute uncomplicated urinary tract infections in women.
In general practice acute uncomplicated urinary tract infections in women are treated with different courses of antibiotics. In this study the efficacy and tolerability of a single dose of 3 g fosfomycin trometamol and the conventional treatment with nitrofurantoin 50 mg four times daily for seven days were compared. In a randomized, double-blind, double-dummy trial in 31 general practices in the Netherlands 231 patients with symptoms of acute dysuria, stranguria and/or urinary frequency received treatment. Evaluation was based on resolution of symptoms, dipslide results and side-effects at 4, 9 and 42 days after starting the treatment. The clinical cure rates and bacteriological cure rates were not significantly different between the treatment groups. Side-effects were reported at day 4 by 43% of the women receiving single-dose treatment, compared with 25% of the women in the seven-day treatment group, a significant difference. At day 9 the groups did not significantly differ in the number of patients with side-effects. Almost all side-effects were mild and gastro-intestinal complaints were reported most. Taking into account the convenience of taking a single dose we conclude that fosfomycin trometamol is a reasonable alternative to 7 days nitrofurantoin 50 mg four times a day in the treatment of women with symptoms of acute uncomplicated urinary tract infections in general practice.
Acute Disease↗
[Favorable effects of a stay in the Dutch Asthma Center Davos on medical consumption and quality of life in COPD patients].
The Dutch Asthma Centre Davos in Switzerland is a clinic where patients with chronic nonspecific lung disease (CNSLD) are given multidisciplinary treatment. In a prospective study in the clinic, data on quality of life (functional, psychological and social characteristics) and medical consumption (use of oral corticosteroids and use of health services) were collected in a group of 147 patients with CNSLD. 18 patients were lost due to non-medical reasons. Quality of life and the use of oral corticosteroids were registered on admission, at discharge and 4 weeks, 6 and 12 months after discharge. Data on use of health services were gathered over the period between one year before admission and one year after discharge from the asthma centre. The results of this study show a decrease in the use of oral corticosteroids, in the number of visits to the family physician and outpatient department and the number and duration of hospital admissions. Favourable changes occurred in psychological functioning, (including anxiety and depression) and positive changes were observed in the degree of limitation the patients experienced in their activities of daily living. No convincing changes were found in social functioning, including social support. It can be concluded, on the basis of these results, that a stay in the Dutch Asthma Centre Davos has favourable effects on medical consumption and on some aspects of quality of life.
Administration, Oral↗
Quality-of-life in a long-term multicentre trial in chronic nonspecific lung disease: assessment at baseline. The Dutch CNSLD Study Group.
Quality-of-life (QOL) in patients with respiratory illness is a topic of increasing interest to clinicians and researchers. In a multicentre trial, which studies the long-term effects of three medication regimens (beta-agonist plus either placebo, anticholinergic agent or corticosteroid, all by inhalation) in patients with chronic nonspecific lung disease ((CNSLD): asthma and chronic obstructive pulmonary disease (COPD)), quality-of-life was included as an additional outcome measure. We wanted to provide a baseline assessment of quality-of-life in 274 adult patients with a mild to moderate degree of CNSLD. Quality-of-life was measured using a set of six standardized tests: Anxiety, Depression and Sleep Disorders, Optimism and Stigma, and Activities of Daily Living were assessed via scales with adequate validity and reliability, as established in previous work in Dutch patients with CNSLD. We found that quality-of-life was mildly impaired in these patients. Although differences with a reference group were present throughout, these were not significant, probably due to selection of relatively young, clinically stable, and highly motivated patients for our study. Quality-of-life scores showed higher correlation coefficients (0.20 < r < 0.38) to symptom scores than did results of pulmonary function tests (r < 0.015). In logistic regression models, absence from work and hospitalizations due to CNSLD were partly determined by quality-of-life scores.(ABSTRACT TRUNCATED AT 250 WORDS)
Activities of Daily Living↗
Compliance with pulmonary medication in general practice.
We wanted to assess compliance with regular pulmonary medication, in 156 patients in a general practice setting. Patients completed a questionnaire on their reported daily intake, the perceived prescription, and their self-assessed perceived compliance with pulmonary medication. Compliance was defined as a reported daily intake > or = 50% of the prescribed amount. Using this definition, 30% of patients were considered to be compliant. Compliant patients had daily symptoms more often, were more often prescribed two or more different medications, and a greater proportion of them had at some time consulted a chest physician. When patients correctly perceived the prescription to refer to medication which had to be taken on a regular basis, they were more likely to be compliant. We conclude that, since less than one third of patients was compliant with medication, more efforts are needed to improve compliance in general practice. Non-compliance with medication may well provide an alternative explanation for the discrepancy between prescribed medication and medical outcome, which has been labelled in the literature as "undertreatment".
Adolescent↗
[A research program for behavioral studies in COPD research].
The demands for medical care of patients with chronic non-specific lung disease (CNSLD) and the prevalence of CNSLD will increase. The need, therefore, for behavioural research on CNSLD will also grow. In order to steer behavioural research in CNSLD, research programming is of great importance. Forty-seven Dutch and 13 foreign expert medical and behavioural scientists were asked via an interview about the most prominent topics and conditions for future research in this field. In addition a literature survey with the same aim was carried out. Important topics for future research include: quality of life of CNSLD patients, patient needs, psychophysiological investigation, social and psychosocial aspects of CNSLD, compliance, problems at work and school, and the education of those involved in patient care.
Behavior↗
Quality of self-care of patients with asthma.
In order to assess the quality of self-care of asthmatic patients in family practice, 150 patients were asked what they did when they felt an attack of asthma coming on. Twenty-four percent said they took no medication. Of the remaining 114 patients, only 49 took appropriate medication. Of these, however, most were not able to demonstrate correct use of their inhaler. This poor quality of self-care may contribute to the undertreatment of asthma in family practice. To improve the quality of care of asthmatic patients, comprehensive treatment is recommended, with the emphasis on improving self-care skills.
Adult↗